Creatine
Creatine
Brief description
Creatine is a molecule produced from amino acids and it is involved with energy transport within the body. The most notable benefits of Creatine appear to be within the athletic world of strength and fitness, where it is commonly supplemented to improve strength and power during resistance exercise(1).
Mechanism of action(1):
Energy is normally released from the breakdown of a large molecule (Adenosine triphosphate/ ATP) into two smaller molecules (Adenosine diphosphate / ADP + Phosphate / Pi) using an enzyme (creatine kinase)
Creatine supplementation produces a molecule known as phosphocreatine (PCr).
When this molecule (PCr) is broken down by an enzyme (Creatine Kinase), it produces two smaller molecules (Creatine /Cr + Phosphate /Pi). This breakdown releases 10.3kcal of free energy.
This extra energy (+ Pi) is used to reproduce the larger molecule again (ATP) using the smaller molecules (ADP + Pi).
Hence providing PCr through creatine supplementation can replenish low levels of ATP during high-demand states e.g intense exercise or where energy production is impaired.
Evidence base
Sarcopenia: Multiple studies (men and women, aged 57-70 yrs) who took creatine supplementation during resistance training 2-3 days per week for up to 1 year, resulted in greater lean tissue mass, chest press strength and leg press strength(2, 3) (vs placebo).
Cognition: Some studies have demonstrated supplementation may improve short-term memory, intelligence and/or reasoning in healthy individuals, however, this has not been tested on individuals with dementia. May benefit ageing or stressed individuals(4).
Performance: When creatine is loaded (average of 20g/day for 5-7 days) followed by a maintenance dose, supplementation of creatine was able to improve upper and lower limb strength. Improvements were noted in resistance training, mixed training and aerobic training(5). Recommended serving & duration. - Loading protocols vary depending on goal e.g. 0.3g/kg of bodyweight for 5-7 days, followed by 0.03g/kg/day for a set period of time (if you wish to cycle creatine), or indefinitely (without further loading).
Another more recent (2024) systematic review and meta-analysis examined randomised controlled trials involving healthy adults under 50 years old, assessing the combined effects of creatine supplementation and resistance training on muscle strength. The findings indicated that this combination significantly enhances both upper-body (weighted mean difference [WMD] = 4.43 kg, p < 0.001) and lower-body strength (WMD = 11.35 kg, p < 0.001) compared to resistance training alone. Subgroup analyses revealed that males experienced significant strength gains, whereas females did not show significant improvements. However, limitations include the small number of studies involving female participants and variability in study designs, which may affect the generalizability of the results(6).
To address the effect on women further, a 2025 systematic review examined creatine supplementation specifically in female populations. Of 27 studies which examined outcomes such as strength, power, anaerobic and aerobic performance; findings were inconclusive as to its’ effectiveness. Again, there were many limitations comparing these studies – differences in athletic levels (from beginner to elite), dosages, intervention durations and variety in performance measures to name a few(7).
Recommended serving & duration.
Loading protocols vary depending on goal e.g. 0.3g/kg of bodyweight for 5-7 days, followed by 0.03g/kg/day for a set period of time (if you wish to cycle creatine), or indefinitely (without further loading).
Safety & tolerability
Multiple studies examining dosages between 4-20grams/day for up to a period of 112 weeks, found no association with kidney damage(7).
Stomach cramping when taking without sufficient water, nausea and diarrhoea if too much creatine is consumed quickly. You can spread the dose out over the day.
References:
Kreider RB, Stout JR. Creatine in Health and Disease. Nutrients. 2021;13(2).
Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access J Sports Med. 2017;8:213-26.
Stares A, Bains M. The Additive Effects of Creatine Supplementation and Exercise Training in an Aging Population: A Systematic Review of Randomized Controlled Trials. J Geriatr Phys Ther. 2020;43(2):99-112.
Avgerinos KI, Spyrou N, Bougioukas KI, Kapogiannis D. Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Exp Gerontol. 2018;108:166-73.
Lanhers C, Pereira B, Naughton G, Trousselard M, Lesage FX, Dutheil F. Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis. Sports Med. 2017;47(1):163-73.
Wang Z, Qiu B, Li R, Han Y, Petersen C, Liu S, et al. Effects of Creatine Supplementation and Resistance Training on Muscle Strength Gains in Adults <50 Years of Age: A Systematic Review and Meta-Analysis. Nutrients. 2024;16(21).
Tam R, Mitchell L, Forsyth A. Does Creatine Supplementation Enhance Performance in Active Females? A Systematic Review. Nutrients. 2025;17(2).
de Souza ESA, Pertille A, Reis Barbosa CG, Aparecida de Oliveira Silva J, de Jesus DV, Ribeiro A, et al. Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis. J Ren Nutr. 2019;29(6):480-9.
