Creatine Monohydrate: Science, Uses and Benefits
Creatine monohydrate effectively enhances muscle performance by increasing phosphocreatine stores that help regenerate ATP during high-intensity exercise. Research shows cognitive improvements, particularly during stressful or sleep-deprived states.
What is Creatine?
Creatine is a naturally occurring compound found primarily in muscle cells. It’s composed of three amino acids: glycine, arginine, and methionine. Our bodies produce about 1-2 grams of creatine daily in the liver, kidneys, and pancreas, (1) while the average person consumes an additional 1-2 grams through dietary sources like meat and fish. (2) Due to its strong effects on exercise performance, athletes commonly take it as a supplement, in a capsule or powder form.
In the body, creatine is stored as phosphocreatine or CrP. These high-energy phosphate groups help recycle energy by donating one phosphate group to ADP or AMP, regenerating them to ATP, the primary site of energy in the cell. (3)
Creatine has substantial scientific backing for its performance-enhancing properties, particularly in high-intensity, short-duration activities. (2) (4)
Does creatine increase testosterone?
Tested at both low (maintenance) doses (3-5 grams) and high (loading phase) doses (up to 25 grams), the majority of the research shows weak link between creatine and increase in testosterone.
Some data shows a small increase in dihydrotestosterone (DHT), an active androgen, in athletes, (5) and testosterone in healthy active young men. (6) (7)
How much water to drink with creatine?
Since creatine increases water absorption into muscle tissue, it’s essential to increase water intake when supplementing with creatine. Hydration needs greatly vary and depend on activity level and sweat rate.
How much creatine should I take?
The standard recommended dosage for creatine is 3-5 grams. For maintenance, most studies use around 0.003 grams/kg/bw, which is around 2-3 grams. Another strategy is loading creatine by taking 20-25 grams of creatine daily (divided into 4-5 equal doses) for 5-7 days, known to effectively elevate creatine levels in the muscle fast.
How does creatine work in the body?
Creatine increases the pool of high-energy phosphate groups which help resynthesize energy (ATP) faster, leading to improvements in anaerobic metabolism and exercise performance.
What are the side effects of creatine?
The most common side effects of creatine include weight gain (primarily from water retention), bloating, and digestive discomfort, especially during the loading phase when higher doses are taken. (8)
Is creatine good or bad?
Creatine is generally considered good and safe for most healthy people when taken at recommended doses. It’s one of the most well-studied and effective supplements for enhancing exercise performance, increasing muscle mass and strength, and improving recovery.
Long-term studies (up to 21 months) have shown no adverse effects on markers of health status in athletes taking creatine regularly. (9) Beyond athletic benefits, creatine may also support brain health, bone health, and help prevent chronic diseases. (10) However, it’s not recommended for people with kidney disease, liver disease, diabetes, or for pregnant/nursing women and children under 18. (8)
How Does Creatine Work?
Adenosine triphosphate (ATP) is the primary site for energy, both for the muscles and brain. Particularly during short, high-intensity exercise, ATP availability decreases, as most of the available ATP is used quickly. The muscle stores ATP for only a few seconds of maximal effort.
In the muscle, creatine binds with phosphate to form creatine phosphate (phosphocreatine). When ATP is used, it’s degraded into ADP or AMP with two, or one phosphate groups carrying less energy. Creatine donates one phosphate group, allowing for faster recycling of energy, easing the body’s ability to convert ADP to ATP. (2) In a way, creatine increases the pool of available energy, providing the body with additional resources to create more energy, particularly during times of depletion. (14) (15)
The reason creatine increases strength, power output, and brain function is because it exerts such pro-energetic effects not just in the muscle, but nervous system as well. (16)
Should I take creatine every day?
Daily intake helps maintain high levels of creatine in your muscle stores, which is necessary for experiencing its full benefits. While supplementation can help, it is not a necessity, as creatine can be found in foods like meat, fish, and eggs, and obtained through diet. For people with insufficient levels, taking creatine daily may help optimize its stores in the muscle, enhancing anaerobic performance, energy, and cognition.
What is the best form of creatine?
Creatine monohydrate is considered the best form of creatine, backed by the most extensive scientific research. It has proven effectiveness for improving strength, muscle mass, and exercise performance.
Do I need to load creatine?
Loading creatine is not strictly necessary, but it does increase creatine levels in the body faster, thus accelerating results. The standard loading protocol involves taking 20-25g daily (divided into 4-5 doses) for 5-7 days, followed by a maintenance dose of 3-5g daily. This approach supersaturates muscle creatine stores quickly, allowing one to experience benefits within 1-2 weeks.
Does creatine improve athletic performance?
Yes, creatine significantly improves athletic performance across multiple domains. It can increase muscle mass, strength, power output, and anaerobic performance in high-intensity exercise by enhancing ATP availability during short bursts of intense activity.
Does creatine improve blood sugar control?
The possible mechanism behind creatine’s glucose-stabilizing effect is enhanced glucose transport into muscle cells by GLUT-4 translocation. However, evidence is lacking and for now, it’s mainly speculative, as meta-analysis did not find strong correlation. (11) (12) Some small trials in type 2 diabetic patients show efficacy, but it’s yet to be confirmed. (13)
Benefits of Creatine
In the area of exercise performance, creatine is one of the most extensively researched and effective nutritional supplements. Due to its ability to recycle energy fast, it is particularly useful in high-intensity, short bursts of activity that depend on anaerobic metabolism.
Beyond improvements in power output, anaerobic performance, and strength, creatine can also aid cognitive function. Numerous studies support creatine’s beneficial role in improving domains of cognition, particularly in highly stressful tasks or during sleep-deprived states.
Muscle Mass
Due to its water-pulling effect, creatine is one of the most effective aids to increase muscle mass. The increased osmotic pressure causes cell volumization or swelling. (17) (18) (19) This serves as an anabolic signal that stimulates protein synthesis (MPS), creating an optimal environment for muscle growth.
On a molecular level, creatine enhances muscle protein synthesis through multiple pathways, including (20)
- increased expression of insulin-like growth factor 1 (IGF-1)
- activation of the mammalian target of rapamycin (mTOR)
- impact on myogenic regulatory factors essential for muscle repair and growth following exercise-induced damage
These effects partly explain the mechanism behind creatine’s muscle-building effect.
Research shows that individuals supplementing with creatine during resistance training can gain ~1.5-2 kg more lean mass than those taking placebo over the same period, with significant hypertrophy occurring in both upper and lower body regions. (19)
Notably, creatine’s muscle-building effects extend beyond young athletes to older adults, where it effectively counters age-related sarcopenia when combined with resistance training, demonstrating its therapeutic potential for muscle wasting conditions throughout the lifespan. (21)
Strength Gain
Increasing strength primarily depends on neuromuscular adaptations, increasing the CNS ability to fire up larger motor units quicker. For such adaptation, one needs to train at higher loads, for maximal strength.
The ergogenic effect of creatine lies in its ability to resynthesize ATP faster. This helps maintain higher force production for extended periods by increasing intramuscular phosphocreatine stores. It works by increasing the pool of available energy, fueling muscle performance. (22) (23) (24)
Beyond its effect on the muscle, elevated creatine levels in the body strongly impact the nervous system, (16) supporting neuromuscular function, or muscle-activation on which strength gains depend.
Additionally, as shown in animal models, creatine may enhance strength via (25) (26)
- increased cross-sectional area of fast-twitch (Type II) muscle fibers
- increased muscle fiber recruitment through neural mechanisms
Quantitative research demonstrates significant strength gains, with meta-analyses showing that combining creatine with resistance training can increase maximum strength by approximately 8-14% more. (23). These improvements manifest particularly in high-activation states, occurring during compound movements involving large muscle mass, like the squats, deadlifts, and bench press.
Anaerobic Performance
Anaerobic exercise is characterized by high-intensity, short activity lasting <30 seconds. The phosphagen system plays a key role in anaerobic metabolism, providing energy for such activities.
Creatine increases intramuscular phosphocreatine stores, (27) (28) allowing individuals to maintain higher power output across repeated intense efforts with limited recovery periods.
Research shows substantial performance improvements across various anaerobic exercise modalities following creatine supplementation.
- 5-15% increases in maximal power and strength (29)
- 7.6% improvements in total power output during Wingate tests (30)
- improved repeated sprint performance, with notable improvements in power maintenance across multiple sprint bouts (22)
- increased anaerobic working capacity by 13-15% (31)
- 1-5% improvements in single-effort sprint performance (29)
- vertical jump and CMJ height improving by approximately 4-5% (32)
- cycling performance showing consistent improvements, particularly during repeated efforts. (22)
The magnitude of creatine’s performance benefits correlates directly with the anaerobic energy contribution of the activity, with the most pronounced improvements occurring in activities lasting under 30 seconds, where the phosphagen system contributes maximally. The longer the activity, the more the aerobic metabolism dominates, the effect of creatine diminishes.
Cognitive Performance
Emerging research reveals creatine’s potential for supporting cognitive function and brain health. The neurobiological basis for these cognitive benefits stems from the brain’s substantial energy requirements (33) consuming approximately 20% of the body’s energy despite representing only 2% of total body weight.
The brain requires constant energy, thus benefiting from creatine’s function as a temporal and spatial energy buffer in neural tissues, where it rapidly regenerates ATP during periods of high neuronal activity.
Studies show creatine’s potential across various domains of mental performance, including improvements in short-term memory and intelligence test performance. (34)
Creatine has been shown to attenuate mental fatigue and maintain cognitive performance during sleep deprivation, suggesting enhanced neural resilience to stressors. (35) (36) (37) (38)
The cognitive benefits of creatine appear most pronounced in populations with lower baseline creatine levels (vegans) or higher cerebral metabolic demands (stress, aging). (39) (40)
Beyond acute cognitive performance enhancement, emerging evidence suggests potential neuroprotective properties that could benefit brain health across the lifespan, though research on creatine’s cognitive effects remains less extensive than studies on its exercise performance.
Potential Drawbacks of Creatine
Weight Gain and Bloating
One of the most common side effects of creatine supplementation is weight gain. This occurs primarily due to water retention in muscles, as creatine draws water into muscle cells. While this isn’t fat gain, it can cause a bloated appearance and temporary weight increase which might be problematic for those competing in specific sports. (41)
Digestive Issues
Creatine supplementation can cause gastrointestinal distress in some individuals, including diarrhea, nausea, and stomach cramps. These symptoms are often dose-dependent and may improve when taking smaller amounts or with food. (42)
Muscle Cramps and Dehydration
Despite popular belief, research hasn’t consistently shown that creatine causes muscle cramps. However, since creatine pulls water into muscle cells, it’s theoretically possible that inadequate fluid intake while supplementing could contribute to dehydration and cramping. Staying properly hydrated is essential when taking creatine.
Liver and Kidney Concerns
There have been concerns about creatine’s effects on liver and kidney function, particularly with long-term use. While most research suggests creatine is safe for healthy individuals, those with pre-existing kidney or liver conditions should exercise caution. The body naturally processes creatine through these organs, and supplementation increases their workload. (43) (44) (45)
To minimize potential side effects:
- Start with a lower dose and gradually increase
- Stay well-hydrated throughout the day.
- Consider taking creatine with meals
- Cycle on and off creatine periodically
- Consult a healthcare provider before use, especially if you have pre-existing conditions
While creatine is generally considered safe for most healthy adults, individual responses vary. Understanding these potential side effects allows for informed decisions about supplementation and appropriate monitoring during use.
Creatine Dosage
The most commonly used and studied form is creatine monohydrate, which offers excellent stability, bioavailability, and cost-effectiveness compared to other forms.
Most common maintenance dosage ranges at ~3-5 grams of creatine daily. (49)
Loading Phase
Many users begin with a loading phase to rapidly saturate muscle creatine stores. This is proposed to raise creatine levels in the muscle slightly faster, providing additional benefits. Loading creatine typically involves consuming about 0.3 grams per kilogram of bodyweight daily, or around 20-25 grams (divided into 4-5 equal doses) for 5-7 days. (2) (50)
Maintenance Phase
After the loading phase, a maintenance dose of 3-5 grams daily, or close to 0.03 grams per kg of bodyweight is generally sufficient to maintain elevated muscle creatine stores. (51) Some users skip the loading phase entirely and simply take the maintenance dose, which will eventually achieve the same muscle saturation but over a longer period (approximately 3-4 weeks).
Timing considerations
While opinions vary on optimal timing, taking creatine close to workout times (either before or after) may provide slight advantages. Consuming creatine with carbohydrates may enhance uptake due to insulin’s effect on creatine transport into muscles.
Creatine Cycling
Some users cycle creatine (periods of use followed by periods of abstinence), though scientific evidence doesn’t necessarily support the need for cycling in healthy individuals. Continuous use appears safe and effective for maintaining elevated muscle creatine levels.
Individual response
Approximately 20-30% of people are classified as “non-responders” who experience minimal benefits from supplementation, often due to naturally higher baseline creatine levels or genetic factors affecting creatine transport. This aligns with research showcasing greater benefits in creatine deficient population, like vegans.
