Increasingly, creatine is gaining recognition far beyond its roots in athletic performance. Once seen as a gym-only supplement, it's now understood to play a vital role in cellular energy, cognitive function and healthy ageing, say experts.
From boosting memory and reducing fatigue to preserving muscle mass over time, it is emerging as a powerful tool for everyday wellness, and despite persistent myths about bloating or safety risks, a vast body of research shows it’s both safe and effective for nearly everyone, especially those who don’t get enough from diet alone.
The compound’s usefulness extends well beyond the gym, said Dr Richard Kreider, Professor and director of the Exercise & Sport Nutrition Lab at Texas A&M University.
Kreider has spent more than 30 years investigating the effects of creatine, the naturally occurring compound stored in the muscle that combines with phosphate to form creatine phosphate, which is needed for cellular energy.
“When the body is stressed, for instance in exercise or under metabolic conditions like some diseases, creatine phosphate is needed to maintain energy in the cell, and therefore has a lot of protective and health benefits, in addition to the exercise performance effects that have been seen,” he said.
How much do we need?
Our bodies create about a gram per day, but it’s recommended to get two to four grams of creatine per day, depending on muscle mass and activity levels.
However, said Kreider, most people don’t get enough creatine from diet alone. The best sources in the diet are meat and fish.
“You only get about a gram of creatine per half kilo of red meat or fish, like salmon, so it’s expensive and takes a lot of calories to get a gram.”
This is why supplementation matters, especially for vegetarians or vegans who do not consume enough creatine in their diet.
For athletes with performance-related goals, Kreider said it’s recommended to supplement 5g four times a day for a week. “Supplementation helps load the muscle up with more energy, which makes for improved high-intensity exercise, recovery and even cognitive function.”
After that, consuming 5g to 10g per day will maintain creatine stores and provide enough creatine for the brain.
Beyond boosting athletic performance, creatine is important for everyone as they age, Kreider added. It can help older adults who lose muscle mass and cognitive function as they age, and in adolescents, low dietary creatine intake is associated with slower growth, less muscle mass and higher body fat.
Is creatine safe?
In a comprehensive review published in the Journal of the International Society of Sports Nutrition, Kreider and colleagues analysed 685 clinical trials on creatine supplementation to assess its safety and the frequency of reported side effects. The analysis showed there were no significant differences in the rate of side effects for participants taking a placebo and those taking creatine.
As for anecdotal concerns like bloating or cramping, Kreider said those claims don’t hold up under scrutiny, and studies have shown creatine can actually prevent cramping because it helps the body retain more fluid.
Despite the strong evidence base, he added, creatine has long been the subject of misconceptions and misinformation.
He’s among the members of the International Society of Sports Nutrition who recently issued a letter affirming the safety and efficacy of creatine, urging lobbyists and policymakers not to restrict access to it.
“There are absolutely no data supporting any negative side effect anecdotally reported about creatine on the internet and in the media,” he said. “It is safe, and it’s important for everybody, not just bodybuilders and athletes.”
Study details
Safety of creatine supplementation: analysis of the prevalence of reported side effects in clinical trials and adverse event reports
Richard Kreider, Drew Gonzalez, Kelly Hines, Adriana Gil, Diego Bonilla.
Published in the Journal of the International Society of Sport Nutrition on 8 April 2025
Abstract
Background
Individual studies have indicated that creatine supplementation is generally well tolerated and not associated with clinically significant side effects. Nevertheless, anecdotal reports about side effects persist primarily from popular and social media and on the internet.
Methods
This study evaluated side effects reported from 685 human clinical trials on creatine supplementation, worldwide adverse event report (AER) databases, and performed a social media sentiment analysis. The presence of side effects (No, Yes) in studies was evaluated using chi-squared analysis. The frequency of side effects among study participants was evaluated using a multivariate analysis of variance.
Results
A total of 13,452 participants in 652 studies ingested placebos (PLA), while 12,839 participants in 685 studies consumed creatine (Cr). Nearly all studies (95%) provided CrM at an average dose of 0.166 [0.159, 0.173] g/kg/d (about 12.5 g/d) for 64.7 [52.0, 77.3] days in studies lasting up to 14 yrs. Side effects were reported in 13.2% of studies in the PLA groups and 13.7% of studies in the Cr-supplemented groups, with no significant differences observed between the groups (p = 0.776). There was a slightly higher percentage of studies reporting gastrointestinal (GI) issues (PLA 4.3%, Cr 4.9%, p < 0.001) and muscle cramping/pain (PLA 0.9%, Cr 2.9%, p = 0.008) with Cr supplementation, but not when the total number of participants in these studies was evaluated (muscle cramping/pain: PLA 0.07%, Cr 0.52%, p = 0.085; GI issues: PLA 4.05%, Cr 5.51%, p = 0.820). Additionally, there was no significant multivariate difference among the 49 side effects evaluated (p = 0.340), no significant difference in the total frequency of side effects reported among participants (PLA 4.21%, Cr 4.60%, p = 0.828), and no significant differences in any of the other side effect evaluated that included markers of renal function and health. The percentage prevalence of side effects was small, with differences between groups generally within ± 0.5%. Analysis of 28.4 million AERs revealed that the mention of Cr was rare (0.00072%), 46.3% of CAERS had no Cr in the products listed, and 63% of AERs with Cr in the product involved the use of other types of Cr or ingestion with other supplements or drugs. The overall sentiment analysis was neutral about perceptions of Cr, although those with strong perceptions about Cr were slightly more negative.
Conclusion
Results demonstrate that Cr supplementation does not increase the prevalence or frequency of side effects when compared to participants ingesting PLA. Therefore, claims that Cr supplementation increases the risk of side effects are unfounded.
JISSN article – Safety of creatine supplementation (Open access)
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