As a doctor, here’s my advice on creatine supplements

If you’re already training, and are in those higher-risk categories or just want a small edge, then it’s reasonable to discuss creatine with your physician. Some people start at 3-5g a day, although for women, higher doses may be helpful. But remember: creatine isn’t a magic bullet. The magic is lifting consistently. Master that first.

What is creatine?

Creatine is considered a non-essential nutrient because it’s produced naturally by your body. It can help form a compound called adenosine triphosphate, also known as ATP, an important source of energy for your muscles and organs.

Creatine supplements are sold as a powder, gummies or pills, but you can also get creatine in your diet from animal-derived foods, like beef or seafood. Plant-based sources don’t contain significant amounts of creatine.

What the research says about creatine

Strength

Meta-analyses of dozens of clinical trials suggest that the clearest strength and power gains show up in men and among adults below age 50. For instance, younger adults taking creatine powder while resistance training improved their bench and chest press strength by roughly 4 pounds compared with training alone. Some might feel that 4 pounds isn’t life-changing, but especially for higher risk groups, a small edge may be worth it. (One caveat: As with most research on supplements, several scientists in these studies have industry ties.)

Bone mineral density

As a physician, I’d love to see a benefit for my patients in bone mineral density, especially for postmenopausal women, and ultimately a reduction in fractures. Unfortunately, there have been no real-world studies clearly showing this is the case.

A large randomised controlled trial of postmenopausal women doing regular resistance training found that creatine did not improve bone mineral density compared to placebo over two years. The same group had previously studied creatine supplementation for one year and saw some initial improvements in bone mineral density at the femoral neck (the most common site for hip fractures), so it was disappointing that this did not appear to hold in the long term. It’s harder to remain compliant with creatine supplementation long-term, which could account for this difference.

Phil Chilibeck, a professor of kinesiology at the University of Saskatchewan and the first author of both studies, noted that even if a clear improvement in bone mineral density didn’t pan out, the two-year study still demonstrated other small but statistically meaningful benefits from creatine.

Creatine helped increase walking speed and the geometric arrangement of bone – which, although not quite the same as bone mineral density, also “theoretically leads to higher bone strength,” Chilibeck said in an email.

“Is it worth it? I would say it is relatively inexpensive and better than most of the other supplements out there for increasing muscle mass and functional performance,” he said. But, Chilibeck cautioned, “most people can expect only relatively small improvements”.

Performance

Other studies have shown increased performance during short periods among female athletes taking creatine powder, which scientists believe is because creatine can add a burst of energy that helps people work a bit harder.

And creatine powder combined with resistance training may help older adults with functional ability, such as standing up from a chair as many times as possible in 30 seconds without using your arms.

Cognitive function

The data on cognitive function is still in its infancy, and it’s mixed. For instance, a 2013 randomised double-blind placebo controlled trial of older women did not find that creatine supplementation improved cognition or depression, while a small handful of observational studies have reported a positive association with memory testing and creatine intake among older adults (including from dietary sources – and not necessarily supplementation). More research on how creatine supplementation impacts the brain is still needed.

How much creatine should you take?

Start by discussing creatine with your physician, especially if you have kidney disease, as some case studies have found an increased risk of damage among those with baseline disease.

In terms of dosage, even 3g of creatine powder a day has been shown to be as effective in the long term, at least for healthy men. For women – particularly, postmenopausal women – higher doses may be helpful, and studies suggest that 5-10g per day is optimal.

One common approach for boosting muscle creatine stores quickly, which is used in several studies, is to take a “loading” dose of about 20g daily (broken up into smaller doses of 4-5g throughout the day) for about a week and then transition to a “maintenance” dose in the range of 3-5g. But in people who take 3-5g daily, studies have found muscle creatine stores reach similar levels after about a month.

Should I take creatine and protein powder?

Protein powders – like whey, pea or soy – are often taken to support muscle recovery after exercise, and it’s common for people to take both protein and creatine supplements. It’s worth keeping a few things in mind though:

Protein powders are composed of essential amino acids, meaning they are not made naturally by the body, and so we need to get them from our diets. Most people get enough protein from what they eat. But older adults, women and highly active people should pay closer attention.The US Food and Drug Administration does not approve or regulate dietary supplements in the same way as prescription medication, and a report from Consumer Reports released in October found that more than two-thirds of the 23 protein powders tested contained more lead in a single serving that they considered safe to ingest in a day, which they cite as no more than 0.5 micrograms. Formally, the FDA says there is no safe level of lead exposure – and of note, none of the powders tested were creatine powder specifically. But it’s worth considering whether bringing supplements into your body is truly necessary – and worth the potential risks – especially for people who are pregnant or are in other high-risk groups.

What I want my patients to know

Resistance training should be as important a part of your health routine as eating fruits and vegetables. Believe me, that’s not a message I heard growing up. I heard plenty about the importance of regular aerobic exercise (and yes, I still do my American Heart Association-approved 150 minutes of moderate intensity activity per week). Unfortunately, less than half of men of all ages and only about 27% of adult women met the recommended amount of resistance training in 2020.