Disclaimer: This post is not meant to replace medical advice. Consult with your healthcare provider before starting any supplement regimen. 


There has been a new trend in the use of the supplement creatine. I have been asked my opinion about this supplement by fellow gym friends and by patients. The first time I was asked my opinion on creatine, I was taken aback. I had no opinion because I hadn’t done any research on it. I have since read a lot about creatine and have summarized the evidence based information on the use of this supplement.

Majority of this information comes from an article in the Journal of International Society of Sports Nutrition, which is free and you can read it in full HERE.


Creatine is an amino acid derivative that is normally ingested by eating meat, fish, and animal products. It is also synthesized in non-meat products from arginine, glycine,
and methionine by our livers where it is ultimately turned into creatine. Once creatine is in the blood, it is taken up by muscle and nervous tissues. Healthy individuals who also eat animal products intake about 1g from food and 1g from liver synthesis; even less is ingested in vegetarians/vegans. About 2g of creatine is excreted daily through urine as a byproduct, meaning we are taking it in as fast as we are putting it out. So, generally speaking, in healthy individuals creatine is not fully saturated in the bodies.


Creatine supplementation use has lead to recorded improved single and repetitive sprint performance, improved maximal effort muscle contractions, enhanced recovery, increased work capacity, and greater training tolerance. Benefits that come from these improvements include gains in muscle mass and greater strength adaptions during training due to the ability to perform higher level contractions with quicker recovery. Research has recorded a 10-20% improvement in performance of high intensity and repetitive exercise.


During exercises, creatine levels are depleted. By ingesting creatine, especially with carbohydrates (with or without protein), our bodies are able to maintain creatine stores which will enhance overall muscle recovery. By maintaining stores, the muscle damage done during exercises can be reduced, which can decrease risk for injury and promote faster recovery. Use of creatine has been shown in literature to decrease inflammatory markers during various forms of exercise, including long distance running and sprinting.


Literature has noted that use of creatine has allowed for continued maintenance of muscle performance even in cases of high volume weight training that may lead to overtraining which would normally result in performance declines. With improved recovery comes inherent improved performance due to ability to return to high level activities at a quicker pace while preventing injuries that would normally negatively impact performance.


In research, it has been noted that athletes who supplement with creatine have shown decreased incidence of cramping, dehydration, over heating, non-contact injuries, and muscle strains than those that did not use creatine. The studies that demonstrate these benefits are measured in football, basketball, and soccer participants during training seasons and may or may not be able to be generalized to the general population. Creatine is an osmotic supplement that leads to small amounts of water retention. This water retention can help improve tolerance to exercise in the heat which can decrease risk for heat related illness.


There has been mention of measured improved recovery from muscle injuries, spinal cord injuries, brain injuries, and forms of neurodegenerative diseases. There are also now various literature cited on creatine and how it may positively impact fetal growth during pregnancy, the aging process, and ischemic heart disease. To read further about these things go to the article linked above.


Currently there are no adverse effects reported for short term or long term use of creatine in literature. One side effect most commonly noted is a small amount of weight gain which is most likely due to the water retention associated with creatine intake. Special considerations would be populations of pediatric and adolescent individuals as well as those with renal dysfunction as creatine may have a negative impact on these individuals.


As stated above, daily intake of creatine is 1-2g per day. At a given time, our bodies are 60-80% saturated in creatine since we are excreting it as fast as we are intaking it. To achieve full muscle stores, an individual would have to intake 20-40% extra creatine per day. To fully saturate the body, studies have suggested supplementing with 5g of creatine for 5-7 days and then entering a maintenance phase of ingesting 3-5g per day. Although some athletes have been suggested to use up to 10g per day since they are competing at a higher level. An alternate way to supplement that involves a much slower increase in stores over time would be to supplement 3g per day for 28 days.  When supplementation is ceased, it can take 4-6 weeks for stores to return to their baseline saturation of 60-80%. It has been suggested that ingesting creatine with carbohydrates or carbohydrates with protein can improve creatine retention as opposed to creatine alone.

Before starting any creatine supplementation protocol, it is important that you discuss it with your healthcare provider.


When I am asked of my opinion on creatine I do not provide an opinion, but resources so that others can develop their own opinions on its use. I do not like to sway people to or from a decision based solely on my opinion. And as a physical therapist, advice on supplementation is outside my scope of practice in my state. I find providing evidence based literature for individuals to make their own educated decision is the best approach. As always, DO YOUR RESEARCH! Before you buy any creatine products, make sure it is a brand that has good reviews, is trusted and reliable, and lists ingredients on their nutrition label.

Let me know if you use creatine and if you have noticed any changes in your performance or recovery- anecdotal stories are always appreciated!


-Katie PT, DPT

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