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From the National Institutes of HealthNational Institutes of Health

Creatine


What is it?

Creatine is a chemical that is normally found in the body, mostly in muscles. It is made by the body and can also be obtained from certain foods. Fish and meats are good sources of creatine. Creatine can also be made in the laboratory.

Creatine is most commonly used for improving exercise performance and increasing muscle mass in athletes and older adults. There is some science supporting the use of creatine in improving the athletic performance of young, healthy people during brief high-intensity activity such as sprinting. But older adults don’t seem to benefit. Creatine doesn’t seem to improve strength or body composition in people over 60.

Creatine use is widespread among professional and amateur athletes and has been acknowledged by well-known athletes such as Mark McGuire, Sammy Sosa, and John Elway. Following the finding that carbohydrate solution further increases muscle creatine levels more than creatine alone, creatine sports drinks have become popular.

Creatine is allowed by the International Olympic Committee, National Collegiate Athletic Association (NCAA), and professional sports. However, the NCAA no longer allows colleges and universities to supply creatine to their students with school funds. Students are permitted to buy creatine on their own and the NCAA has no plans to ban creatine unless medical evidence indicates that it is harmful. With current testing methods, detection of supplemental creatine use would not be possible.

In addition to improving athletic performance, creatine is used for congestive heart failure (CHF), depression, bipolar disorder, Parkinson’s disease, diseases of the muscles and nerves, an eye disease called gyrate atrophy, and high cholesterol. It is also used to slow the worsening of amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease), rheumatoid arthritis, McArdle’s disease, and for various muscular dystrophies.

Americans use more than 4 million kilograms of creatine each year.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CREATINE are as follows:

Possibly effective for...

  • Improving the athletic performance of young, healthy people during brief, high-intensity exercise such as sprinting. Many factors seem to influence the effectiveness of creatine, including the fitness level and age of the person using it, the type of sport, and the dose. Creatine does not seem to improve performance in aerobic exercises, or benefit older people. Also, creatine does not seem to increase endurance or improve performance in highly trained athletes. There is some evidence that creatine “loading,” using 20 grams daily for 5 days, may be more effective than continuous use. But remember, there is still some uncertainty about exactly who can benefit from creatine and at what dose. Studies to date have included small numbers of people (all have involved fewer than 40 participants), and it is not possible to draw firm conclusions from such small numbers.
  • Parkinson’s disease. Creatine might slow the worsening of some symptoms in people with early Parkinson’s disease.
  • Increasing strength and endurance in people with heart failure.
  • Increasing strength in people with muscle diseases such as muscular dystrophy.
  • Slowing loss of sight in an eye disease called gyrate atrophy.
  • Improving symptoms of a muscle disease called McArdle's disease. There is some evidence that taking high-dose creatine daily can increase exercise capacity and decrease exercise-induced muscle pain in some patients with McArdle's disease.

Possibly ineffective for...

  • Rheumatoid arthritis (RA). Taking creatine can increase muscle strength in people with RA, but it doesn’t seem to help them function better physically.
  • Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease). Taking creatine orally doesn’t seem to slow disease progression or improve survival in people with ALS.

Insufficient evidence to rate effectiveness for...

  • Muscle diseases such as polymyositis and dermatomyositis. Early studies suggest taking creatine might produce small improvements in muscle strength in people with these conditions.
  • High cholesterol.
  • Huntington's disease.
  • Depression.
  • Bipolar disorder.
  • Other conditions.
More evidence is needed to rate the effectiveness of creatine for these uses.

How does it work?

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Creatine is involved in making the energy muscles need to work.

Vegetarians and other people who have lower total creatine levels when they start taking creatine supplements seem to get more benefit than people who start with a higher level of creatine. Skeletal muscle will only hold a certain amount of creatine; adding more won’t raise levels any more. This “saturation point” is usually reached within the first few days of taking a “loading dose.”

Are there safety concerns?

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Creatine is LIKELY SAFE for most people when used at recommended doses. Creatine can cause stomach pain, nausea, diarrhea, and muscle cramping.

When taken by mouth in high doses, creatine is POSSIBLY UNSAFE. There is some concern that it could harm the kidney, liver, or heart function. However, a connection between high doses and these negative effects has not been proven.

Creatine causes muscles to draw water from the rest of your body. Be sure to drink extra water to make up for this. Also, if you are taking creatine, don't exercise in the heat. It might cause you to become dehydrated.

Many people who use creatine gain weight. This is because creatine causes the muscles to hold water, not because it actually builds muscle.

There is some concern that combining creatine with caffeine and the herb ephedra (also called Ma Huang) might increase the chance of having serious side effects such as stroke.

There is concern that creatine might cause irregular heartbeat in some people. But more information is needed to know if creatine can cause this problem.

There is concern that creatine might cause a skin condition called pigmented purpuric dermatosis in some people. But more information is needed to know if creatine can cause this problem.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of creatine during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Kidney disease or diabetes: Don’t use creatine if you have kidney disease or a disease such as diabetes that increases your chance of developing kidney disease. There is some concern that creatine might make kidney disease worse.

Are there interactions with medications?

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Moderate

Be cautious with this combination.

Medications that can harm the kidneys (Nephrotoxic Drugs)
Taking high doses of creatine might harm the kidneys. Some medications can also harm the kidneys. Taking creatine with other medications that can harm the kidneys might increase the chance of kidney damage.

Some of these medications that can harm the kidneys include cyclosporine (Neoral, Sandimmune); aminoglycosides including amikacin (Amikin), gentamicin (Garamycin, Gentak, others), and tobramycin (Nebcin, others); nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin, Nuprin, others), indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprelan, Naprosyn), piroxicam (Feldene); and numerous others.

Are there interactions with herbs and supplements?

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Caffeine
There is some concern that combining caffeine, ephedra, and creatine might increase the risk of serious adverse effects. There is a report of stroke in an athlete who consumed creatine monohydrate 6 grams, caffeine 400-600 mg, ephedra 40-60 mg, and a variety of other supplements daily for 6 weeks. Caffeine might also decrease creatine's beneficial effects on athletic performance.

Ephedra
There is some concern that combining ephedra, caffeine, and creatine might increase the risk of serious adverse effects. There is a report of stroke in an athlete who consumed creatine monohydrate 6 grams, caffeine 400-600 mg, ephedra 40-60 mg, and a variety of other supplements daily for 6 weeks.

Are there interactions with foods?

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Carbohydrates
Combining carbohydrates with creatine can increase muscle creatine levels more than creatine alone. Supplementing 5 grams of creatine with 93 grams of simple carbohydrates 4 times daily for 5 days can increase muscle creatine levels as much as 60% more than creatine alone.

What dose is used?

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The following doses have been studied in scientific research:

BY MOUTH:
  • For improving physical performance, several dosing regimens have been tried:
    • Creatine is typically loaded with 20 grams per day (or 0.3 grams per kg) for 5 days followed by a maintenance dose of 2 or more grams (0.03 grams per kg) daily, Although 5 day loading is typical, 2 days of loading has also been used.
    • A loading dose of 9 grams per day for 6 days has also been used. Some sources suggest that, instead of acutely loading, similar results can be obtained with 3 grams per day for 28 days.
During creatine supplementation, the water intake should be 64 ounces per day.
  • For heart failure: 20 grams per day for 5-10 days.
  • For Parkinson's disease:
    • 10 grams/day.
    • A loading dose of creatine 20 grams/day for 6 days followed by 2 grams/day for 6 months, and then 4 grams daily for 18 months has also been used.
  • For improving resistance training in people with Parkinson's disease: a loading dose of 20 grams/day for 5 days, followed by 5 grams/day.
  • For gyrate atrophy: 1.5 grams per day.
  • For muscular dystrophies: 10 grams per day has been used by adults and 5 grams per day has been used by children.
  • For McArdle’s disease: 150 mg / kg daily for 5 days and then continue with 60 mg / kg / day.

Other names

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Cr, Creatina, Créatine, Créatine Anhydre, Creatine Anhydrous, Creatine Citrate, Créatine Citrate, Creatine Ethyl Ester, Créatine Ethyl Ester, Creatine Ethyl Ester HCl, Créatine Ethyl Ester HCl, Créatine Kré Alkaline, Creatine Malate, Créatine Malate, Creatine Monohydrate, Créatine Monohydrate, Créatine Monohydratée, Creatine Pyroglutamate, Créatine Pyroglutamate, Creatine Pyruvate, Créatine Pyruvate, Dicreatine Malate, Dicréatine Malate, Di-Creatine Malate, Éthyle Ester de Créatine, Glycine, N-(aminoiminométhyl)-N-Méthyl, Kre-Alkalyn Pyruvate, Malate de Tricréatine, N-amidinosarcosine, N-(aminoiminomethyl)-N Methyl Glycine, Phosphocreatine, Phosphocréatine, Tricreatine HCA, Tricréatine HCA, Tricreatine Malate, Tricréatine Malate.

Methodology

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To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).

References

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To see all references for the Creatine page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html.

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Last reviewed - 01/10/2011

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