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Creatine and its myths: what does science have to say?

by P. Debraux | 23 January 2024

Fitness, sport, science, creatine, supplement, strength, muscle, mass, hypertrophy, recovery, myth, water retention, baldness, doping, steroid

In the field of sports science and nutrition, creatine is a subject of great interest and debate. Widely recognized for its role in enhancing athletic performance, this natural, endogenous substance has found its way into the diets of many athletes and fitness enthusiasts. Creatine's ability to boost muscle mass and strength, improve recovery and overall performance (not to mention potential mental health benefits) makes it a cornerstone in the world of sports supplements.

However, this widespread popularity has also given rise to a host of myths and misconceptions that persist to this day. From unjustified fears about its safety to misunderstandings about its effects, creatine is often misinterpreted and misinformed. The result is a gap between perception and reality, where creatine's true potential and limitations are not fully understood by many of its users.

Understanding creatine's true impact is crucial not only for athletes and bodybuilders, but also for anyone wishing to improve their health and physical performance. From its impact on muscle and body composition to its safety for different demographics, this article aims to bridge that gap by shedding light on what the scientific evidence really shows about creatine supplementation.

Creatine and water retention

A common myth about creatine is its association with water retention, a misunderstanding that stems from early creatine research in the 90s. Creatine is an osmotically active substance. Consequently, an increase in the body's creatine content could theoretically lead to an increase in water retention. Creatine is absorbed into muscles from the circulation by a sodium-dependent creatine transporter. Since transport involves sodium, water will also be absorbed into the muscle to help maintain intracellular osmolality. However, given the activity of sodium-potassium pumps, it is unlikely that intracellular sodium concentration will be significantly affected by creatine supplementation.

Early studies suggested that high-dose creatine supplementation, around 20 g/day, could lead to an increase in body water. However, all these studies were carried out over very short periods, from 3 to 6 days. Conversely, most training studies over periods of 5 to 10 weeks incorporating creatine supplementation (generally 20 g/day for 5 days, then 5g/day) did not always observe an increase in total body water, intracellular water or extracellular water. The studies that did observe changes were carried out with beginners, and most of the time, the researchers did not observe any change in muscle mass/intracellular water ratios. Moreover, it's important to remember that intracellular water is an important cellular signal for protein synthesis and therefore helps build muscle mass over time.

In short, fears of excessive and harmful water retention due to creatine supplementation are largely unfounded. Modern research indicates that any minor and temporary increase in intracellular water is a positive aspect of creatine's role in muscle performance and recovery.

Does creatine cause dehydration and muscle cramps?

The belief that creatine supplementation causes dehydration and muscle cramps is widespread, but current research suggests otherwise. Initially, this misconception stemmed from the idea that creatine's osmotic properties could alter fluid distribution, potentially affecting muscle and whole-body hydration. And some American athletes taking creatine reported frequent cramps and hydration problems via questionnaires. However, their diet and supplementation were not monitored...

But scientific studies have consistently refuted this notion. A landmark study conducted by Greenwood et al. in 2003 among NCAA Division IA college soccer players, over the course of an entire season, revealed that creatine users experienced significantly fewer incidents of cramps, heat-related problems and muscle strain than those consuming a placebo. This result is particularly remarkable given the hot, humid conditions to which the athletes were exposed.

In clinical settings, creatine has also shown potential benefits in reducing muscle cramps. One study involving haemodialysis patients, who frequently suffer from muscle cramps, reported a 60% reduction in cramp frequency after supplementation with 12 grams of creatine 5 minutes before haemodialysis (Chang et al., 2002).

In short, rather than contributing to dehydration and cramps, creatine appears to offer protective effects against these problems. Athletes and people engaged in strenuous physical activity may consider creatine supplementation as a safe addition to their diet, likely to contribute to hydration, muscle cramp reduction and muscle function.

Creatine and kidney health: Understanding the origin of kidney problems

One of the most persistent concerns about creatine supplementation is its potential impact on kidney health, in particular the myth that it causes kidney damage or renal dysfunction. This apprehension stems largely from misunderstandings about how the body processes creatine and its by-product, creatinine.

The origin of this myth goes back to the way creatine influences creatinine levels in the body. Creatine, when metabolized, breaks down into creatinine, a waste product that is filtered by the kidneys. Elevated blood creatinine levels are often used as an indicator of renal dysfunction in clinical settings. However, in the context of creatine supplementation, elevated creatinine levels are not necessarily indicative of kidney damage, but rather the result of increased creatine consumption and metabolism. But the idea of making the kidneys work too hard germinated and spread. The same idea that continues to proliferate concerning protein consumption...

This concern was fuelled by a case study published in 1998 which reported on a person with pre-existing kidney problems whose kidney function deteriorated after taking creatine supplements. However, this case did not take into account the person's underlying health problems, nor the safe dosage of creatine. Other studies showed that this person's problem did not stem from creatine supplementation, but by then it was too late.

Since then, extensive research has been carried out to investigate this potential link. Studies such as those by Poortmans and Francaux (1998) and later by Gualano et al. (2011) have systematically evaluated the effects of creatine supplementation on renal function in healthy individuals. These studies have consistently shown that creatine, when used at recommended doses, does not adversely affect renal function.

It's important to note that in most case studies reporting kidney problems and implicating creatine supplementation, confounding factors were consistently found, such as drug treatment, pre-existing kidney problems, use of other supplements, inappropriate creatine dosages and use of anabolic steroids.

In short, if you suffer from kidney problems, it's mandatory to consult a doctor before starting creatine supplementation. However, for the general population, creatine remains a safe and effective supplement, with no risk of kidney damage or dysfunction, as some have suggested for many years.

Is a creatine "loading phase" necessary?

The concept of a "loading phase" in creatine supplementation is the subject of much debate. Originally, it was thought that it was necessary to rapidly increase muscle creatine stores through high doses over a short period of time (known as "loading") to reap the full benefits of supplementation. Early research, such as the study by Hultman et al (1996), demonstrated that a "loading" regimen (20 g/day of creatine for 6 days) significantly increased muscle creatine levels. This approach was thought to rapidly saturate muscles with creatine, resulting in rapid improvements in performance and strength.

However, more recent research suggests that such a loading phase may not be necessary for long-term creatine use. Numerous studies have shown that lower daily doses of creatine (e.g. 3-5 g/day), without an initial loading phase, can also lead to similar levels of muscle saturation, but over a longer period. At 3-5 grams/day, it will generally take at least 4 weeks of creatine supplementation to achieve muscle saturation. But the improvements induced will be similar, whether in terms of muscle mass, performance or recovery.

The choice between "loading" and constant low-dose supplementation often depends on personal preference and specific athletic goals. For those seeking immediate performance enhancement, a loading phase may be beneficial. However, for long-term supplementation, a regular low-dose approach is just as effective in increasing muscle creatine stores.

In conclusion, while the "loading" phase can accelerate muscle creatine saturation, it is not a mandatory approach. Both methods lead to similar benefits over time, allowing flexibility in creatine supplementation strategies. However, you should be aware that doses in excess of 10 grams a day expose you to the risk of intestinal disorders such as diarrhea.

Creatine's many applications

One of creatine's significant benefits is its role in improving muscle glycogen storage. This is particularly beneficial for endurance athletes who need to maintain optimal glycogen levels during prolonged training and competition. A study by Nelson et al (2001) demonstrated that creatine supplementation, combined with carbohydrate intake, effectively increased muscle glycogen storage compared to carbohydrate intake alone.

Furthermore, creatine has been shown to help reduce muscle damage and improve recovery after intense exercise. Cooke et al (2009) found that creatine supplementation during recovery from exercise-induced muscle damage promoted better maintenance of muscle performance.

Creatine also offers potential benefits in terms of hydration and exercise tolerance in the heat, as suggested by the research of Greenwood et al. (2003) and Easton et al. (2007). It is therefore of interest to athletes who train or compete in hot, humid environments.

In short, creatine's benefits are not limited to strength sports. Its positive impacts extend to all types of sporting disciplines, contributing to improved performance, better recovery and reduced risk of dehydration.

Is creatine doping?

Creatine's role in enhancing muscular performance is well documented in scientific literature. One of its key functions is to increase phosphocreatine reserves in the muscles, thereby improving the production of Adenosine TriPhosphate (ATP), the body's main energy molecule, particularly during high-intensity activities. This effect was highlighted in a study by Greenhaff et al. (1994), who observed an increase in phosphocreatine resynthesis in human skeletal muscle after creatine supplementation, resulting in improved performance during short, intense exercises.

As for the misconception that creatine is an anabolic steroid, it's essential to distinguish between the two. Creatine's mechanism is totally different, focusing on energy production rather than directly influencing muscle protein synthesis like steroids. Anabolic steroids are a synthetic version of testosterone, an androgenic hormone produced endogenously in both men and women. Used in conjunction with resistance training, steroids stimulate protein synthesis. Testosterone has the ability to penetrate the muscle cell, bind to the intracellular androgen receptor and increase the expression of various muscle-specific genes. The muscle mass gains achieved with anabolic steroids are far greater than what is naturally possible, even with years of serious practice. Creatine, on the other hand, aids hypertrophy, but the gains are only slightly greater than those achievable without supplementation (Burke et al., 2023). It's therefore an ergogenic aid, but without the negative health consequences of anabolic steroids.

In essence, creatine's contribution to muscular performance is manifold. It improves immediate energy production, aids faster recovery after exercise and contributes to increased muscle mass over time, all without the hormonal effects associated with anabolic steroids.

Creatine and hair loss: separating fact from fiction

A concern often raised in discussions about creatine is its potential link with hair loss or baldness. This concern stems mainly from a study that suggested an increase in levels of dihydrotestosterone (DHT), a hormone associated with hair loss, following creatine supplementation. DHT is a metabolite of testosterone, converted from free testosterone. In men, DHT can bind to androgen receptors in hair follicles, leading to hair loss.

The study in question, conducted by van der Merwe et al (2009), observed an increase in DHT levels in university rugby players following creatine supplementation. Although DHT is linked to hair loss, the study did not directly measure hair loss, and the increase in DHT was within normal clinical limits. It is important to note that the DHT levels of players taking creatine were significantly lower at the start of the study than those of players in the control group. Furthermore, no subsequent studies have replicated these results or demonstrated a direct link between creatine use and hair loss.

Other research has investigated the link between creatine and testosterone. In most cases, there was no increase in testosterone following creatine intake, and if there was, it was physiologically insignificant.

In conclusion, although the subject merits further research, the current body of evidence does not support the idea that creatine supplementation would lead to hair loss.

Is creatine harmful for children and adolescents?

The safety of creatine supplementation in children and adolescents is a topic of great interest, especially considering its popularity among young athletes. Contrary to common concerns, a growing body of evidence suggests that creatine is safe and potentially beneficial for this age group.

Research has shown that in adolescent athletes, creatine supplementation is unlikely to cause adverse effects. A literature review by Jagim et al (2018) analyzed several studies involving adolescent athletes and found no evidence of harmful impacts. These findings are crucial, given the increasing use of creatine among young athletes.

From a clinical point of view, studies have also indicated health benefits with minimal negative effects in younger populations. For example, research by Hayashi et al (2014) found improvements in young patients with systemic lupus erythematosus, an autoimmune disease, with no negative changes in laboratory results after creatine supplementation. In another study, in children with Duchenne muscular dystrophy, 4 months of creatine supplementation improved grip strength and lean body mass.

In summary, while young individuals are always advised to consult a healthcare professional before starting a supplement, current scientific evidence indicates that creatine is a safe and potentially beneficial option for children and adolescents involved in athletic activities.

Does creatine increase body fat?

A common misconception about creatine supplementation is that it increases body fat. This misconception generally stems from the fact that creatine induces an increase in body mass from the very first days of supplementation. However, scientific research consistently shows that this is not the case. On the contrary, creatine is more likely to promote an increase in lean muscle mass than fat mass.

Numerous studies have examined the effects of creatine on body composition. Acute creatine supplementation has been shown not to affect body fat in young adults and seniors. Similarly, short-term studies, such as those carried out by Becque et al (2000), reported no change in body fat after weeks of creatine supplementation combined with resistance training.

Longer-term studies have also shown that creatine does not increase body fat. A notable study by Candow et al (2015) examined seniors over a 32-week period and observed an increase in lean tissue and strength with a decrease in fat mass.

These results clearly suggest that creatine supplementation, rather than contributing to fat mass gain, may actually help reduce fat mass or maintain a healthier body composition, particularly when combined with strength training.

The benefits of creatine for the elderly

As we age, maintaining muscle mass and strength becomes increasingly important. Creatine supplementation has emerged as a promising strategy for combating age-related muscle loss, known as sarcopenia. This strategy is particularly relevant for older people seeking to preserve their muscle function and improve their quality of life.

Several studies have highlighted the benefits of creatine for seniors. Most results highlight that creatine supplementation, combined with resistance training, leads to significant improvements in muscle mass and strength in people over 50, far more than resistance training alone.

Creatine's role in sarcopenia is multifaceted. It not only increases muscle mass, but also improves muscle strength and function. This is crucial in reducing the risk of falls, fractures and physical disability associated with aging.

Creatine has also been shown to benefit cognitive function in the elderly. This aspect is particularly promising, given the growing concern about cognitive decline with aging.

In summary, combined with strength training, creatine supplementation represents a safe and effective approach to mitigating the effects of aging on muscular and cognitive health. It offers older people a viable means of improving their physical capabilities and maintaining a better quality of life as they age.

Creatine's effectiveness in women

Creatine supplementation is often associated with male athletes, but its benefits are just as important for women at all stages of life. In recent years, research has increasingly highlighted the multiple benefits of creatine for women, from athletic performance to general health and well-being.

One notable aspect of creatine's effectiveness in women is its role in improving muscle strength and performance. Studies have shown that creatine supplementation combined with resistance training significantly increases strength and muscle mass in women.

Beyond physical performance, creatine also has potential implications for women's reproductive health. Some studies have highlighted the importance of creatine during menstruation, pregnancy and menopause, suggesting that creatine supplementation could offer particular benefits during these stages.

With regard to aging, creatine appears promising for improving muscle quality and performance in post-menopausal women. Creatine supplementation, when combined with resistance training, has been shown to improve muscle strength and functionality in this population.

In addition, emerging research suggests that creatine may have neuroprotective effects, which could be particularly beneficial for women, who have higher rates of depression and cognitive decline, and lower levels of creatine in the brain. Studies have indicated that creatine supplementation can help alleviate symptoms of depression and support brain health.

In summary, the benefits of creatine supplementation are not gender-specific. For women, it offers a range of benefits from improving physical performance to supporting reproductive health and cognitive function, making it a valuable supplement for women at different stages of their lives.

Creatine forms: Monohydrate and other forms

Creatine supplementation comes in a variety of forms, with creatine monohydrate being the most widely studied and used. Although other forms of creatine, such as creatine salts and creatine ethyl ester, have been marketed as superior, the scientific evidences continue to support the efficacy of creatine monohydrate.

Studies consistently show that creatine monohydrate is highly effective in increasing muscle creatine stores, improving exercise performance and enhancing muscle growth. For example, a comprehensive study by Buford et al (2007) evaluated different forms of creatine and concluded that creatine monohydrate remains the most effective option for increasing muscle creatine levels and improving exercise performance.

Other forms of creatine, while potentially offering different absorption rates or solubility, have not demonstrated significant advantages over creatine monohydrate in terms of efficacy. A study by Jagim et al (2012) compared creatine monohydrate with a buffered creatine (Kre-Alkalyn), which, according to its producer, had the correct pH and better bioavailability... The researchers found no significant difference in their effects on muscle creatine saturation or exercise performance compared with creatine monohydrate.

So, while other forms of creatine may be marketed with various claims, creatine monohydrate stands out for its proven efficacy, safety and cost-effectiveness. Its extensive research and consistent results in athletic and clinical populations make it the preferred choice for creatine supplementation.


Creatine supplementation, the subject of many debates and misconceptions, is now a fairly well-documented supplement for athletes and fitness enthusiasts. Whether it's improving muscular performance, aiding recovery or making creatine safe for different demographics, creatine is proving to be a versatile and effective supplement. Its benefits are not limited by age, gender or type of athletic activity.

Scientific evidence overwhelmingly supports creatine monohydrate as a safe, effective and cost-efficient choice for those looking to improve physical performance, combat age-related muscle loss or simply maintain optimal muscle health. In the fitness industry, truly useful supplements are few, but creatine is one of them.

In conclusion, whether you're a high-level athlete, a fitness enthusiast or simply someone concerned about maintaining muscular health with age, creatine supplementation, backed by scientific evidence, offers a range of benefits that can help you achieve your health and fitness goals.


  1. Antonio J, Candow DG, Forbes SC, Gualano B, Jagim AR, Kreider RB, Rawson ES, Smith-Ryan AE, VanDusseldorp TA, Willoughby DS and Ziegenfuss TN. Common questions and misconceptions about creatine supplementation : what does the scientific evidence really show ?. J Int Soc Sports Nutr 18 (13), 2021.

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