Is Creatine Safe? Myths vs. Reality

You don’t want a simple and short answer in yes or no, right? The actual question should be is creatine safe for me, or how much creatine a day is safe?

What is Creatine

Creatine is actually a naturally occurring chemical in the human body. It supplies energy to your muscles and helps your skeleton muscles contract. This energy supply ensures that muscles keep working, especially when you exercise. The human body relies on diet for about 50% of the creatine supply. Foods, especially rich in protein, are common sources of creatine, including:

• Animal milk (cow, sheep and goat)

• Seafood

• Red meat (beef, veal and pork)
  
  

Athletes and fitness enthusiasts use creatine to improve exercise and muscle mass. Though no good scientific evidence is available, some people report other benefits including relief from fatigue, muscle cramps, depression, multiple sclerosis and several other conditions.

Now, this may eliminate some doubts about creatine use and safety. Still, some misconceptions linked with creatine use and safety raise some questions, such as

• Does creatine affect your kidneys?

• Can creatine damage the liver?

• Can creatine affect your heart?

• Is creatine safe for teens?

• Does creatine upset your stomach?

• Does creatine cause fat and weight gain?

• Does creatine cause excessive water retention?

You will get answers to all these questions.

Types of Creatine

There are different forms of creatine supplements, including:

• Creatine Monohydrate

• Creatine Ethyl Ester

• Creatine Hydrochloride

Creatine Safety Concerns: Debunking the Myths

Let’s debunk common creatine myths:

Creatine Kidney Damage

Normal Kidney Function: Creatine does not appear to cause any damage to your kidney if you are a healthy individual.

Effects on Kidney: Creatine metabolism produces a byproduct known as creatinine. So, creatine can increase the level of creatinine in your kidney which generally does not indicate kidney damage. It also does not affect Glomerular Filtration Rate which is used to measure kidney function.

Potential Risks: If you are at risk for kidney disease or you have a pre-existing kidney condition, avoid taking creatine without consulting with a healthcare provider. Dehydration or high doses of creatine can potentially stress the kidney by increasing creatinine levels. However, you can mitigate potential risks with proper hydration.

Research: No long-term or short-term study involving healthy individuals found evidence of damage to the kidney with recommended creatine dosage.

Recommendations

• Take the recommended dosage.

• Stay hydrated.

• Consult with a healthcare provider if you are at risk of kidney disease or if you have a pre-existing kidney condition.

Creatine Liver Damage

Normal Liver Function: Taking recommended doses does not cause any damage to the liver in healthy individuals.

Effects on Liver: The liver has a role to play in creatine synthesis. It helps in metabolising creatine and other substances. Liver processes and converts creatine into phosphocreatine. Muscles use phosphocreatine for energy. No study has found significant scientific evidence indicating damage to the liver due to creatine in healthy individuals.

Potential Risks: Liver function impacts the processing and metabolism of creatine. So, if you are at risk of liver disease or you are suffering from one, speak to a healthcare provider before taking creatine. Excessive dosage combined with other substances may increase the risk of liver damage.

Research: No long-term or short-term study involving healthy individuals reported significant evidence of damage to the liver with the recommended dosage.

 Recommendations

• Take recommended dosages.

• Stay hydrated

• Get medical advice if you are suffering from liver disease or some other disease.

Creatine Heart Problems:

Effects on Heart: Taking recommended doses of creatine does not appear to have any negative impact on heart health or cardiovascular function in healthy individuals. As creatine boosts adenosine triphosphate (ATP) levels in muscles, it improves overall fitness and cardiovascular health.

Potential Risks: Be cautious if you are at risk of cardiovascular disease or if you have some heart condition. The combination of dehydration and creatine can affect fluid balance.

Research: No long-term or short-term study involving healthy individuals reported significant evidence of damage to the heart with the recommended dosage.

Recommendations

• Take recommended dosages.

• Stay hydrated

• Get medical advice if you are suffering from heart disease or at risk of heart disease.

Creatine Upset Stomach

Can creatine cause an upset stomach?

Yes.

• Higher doses during the loading phase

• Individual digestive sensitivity

• Bloating

• Diarrhoea

• Cramping

• Nausea

Upset Stomach Management and Prevention

• Start with a lower dose to see if your stomach can handle it or not.

• Gradually increase the dose.

• Try different creatine forms.

• Stay hydrated.

• Take smaller amounts of creatine throughout the day.

• Take creatine with snacks or meals for better absorption.

• Seek medical advice.

Creatine Fat and Weight Gain

Weight Gain: Creatine can increase muscle water content which increases your weight during the early supplementation stages. Creatine also increases lean muscle mass by increasing muscle protein synthesis. It improves performance and strength making your workout more effective, which increases greater muscle growth.

Fat Gain: Creatine does not directly impact the storage and metabolism of fat. Increased training capacity may increase appetite in some individuals, leading to higher calorie intake, which can lead to fat gain.

Managing Fat and Weight Gain: Keep track of unwanted weight gain and adjust creatine dosage accordingly. Maximise muscle growth by incorporating resistance training. Add cardiovascular exercises. Stay well-hydrated and eat a balanced diet with adequate carbohydrates, healthy fats and protein.

Creatine Excessive Water Retention

Excessive water retention due to creatine is generally manageable. Creatine increases muscle weight and volume by drawing water into the muscles. This also increases your weight during the initial stages of supplementation. Higher intake during the loading phase can increase water retention.

To manage water retention, you can reduce dosage or skip the loading phase. Cardiovascular exercises and strength training help manage fluid balance. It is crucial to stay hydrated. Monitor your sodium intake and eat a balanced diet. Try some other form of creatine. Seek medical advice if you experience significant issues due to water retention.

Benefits of Creatine

Increased Muscle Mass and Strength

Increased Muscle Mass: Creatine increases water retention which increases muscle volume and size. It increases ATP (adenosine triphosphate) availability for effective muscle protein synthesis which supports muscle repair and growth. Increased ATP availability also allows more intense and prolonged workouts.

Increased Strength: The availability of ATP during sprinting, weightlifting and other high-intensity, short-duration exercises improves strength and power. ATP availability also reduces fatigue. Creatine also supports faster recovery. As a result, you gain greater strength over time.

Enhanced Athletic Performance

Enhanced athletic performance requires:

• Energy

• Endurance

• Flexibility

• Strength and power

• Agility and quickness

• A balanced diet

• Supplements

• Hydration

• Stress management

• Training consistency

• Rest

• Recovery

Exercising intensely depletes ATP quickly. Creatine helps replenish ATP for sustained high-intensity efforts for longer. Muscle growth increases strength and power. Muscle mass also improves overall athletic performance. Creatine reduces muscle damage and supports faster recovery. Taking creatine is beneficial when you are engaged in exercises that require bursts of strength and power, such as high-intensity interval training, plyometrics, sprinting, powerlifting, and weightlifting.

Improved Cognitive Function

Creatine can potentially support energy production in the brain. Cognitive processes such as learning and memory require significant energy. The neuroprotective properties of creatine are beneficial for Parkinson’s disease and Alzheimer’s disease as these properties protect brain cells from damage.

Creatine Dosage and Safety

Recommended Dosage: 5 grams per day is the recommended creatine dosage for healthy individuals. You should take smaller doses of creatine throughout the day. Individuals following the loading phase usually take 20 to 25 grams for 5 to 7 days. Remember, some pre-workout supplements already contain creatine, so it's important to check the labels carefully to avoid over consumption.

Individual Variations: The optimal creatine dosage and response to creatine depends on the weight, age and overall health. Speak to a registered dietitian to determine your individual dosage.

Cycling Creatine: It is a strategy in which an individual takes creatine for a certain period of time and then discontinues it for a certain period of time. Some people believe that alternating between these two phases enhances long-term effectiveness and prevents dependence. Individuals using this approach take 3 to 5 grams per day for a few weeks to months. This phase is followed by discontinuing for 2 to 4 weeks.

Side Effects of Creatine

Common Side Effects

Depending on your age and health, you may experience the following common side effects, mostly due to high dosage or pre-existing health conditions:

• Water retention which can further cause a bloated feeling and temporary weight gain.
• Dehydration
• Digestive issues such as cramping, discomfort, diarrhoea and bloating
• Muscle cramps due to water retention and electrolyte imbalance

Rare Side Effects

You may experience the following rare side effects, especially if you have pre-existing health issues:

• If you have an underlying kidney disease, creatine can worsen it.
• Creatine rarely causes liver damage or strain if you have a pre-existing liver condition.
• Though it is extremely rare, creatine can cause rhabdomyolysis, a severe condition in which the kidney can be damaged due to breakdown of muscle tissue.
• Creatine can rarely lead to electrolyte imbalance and cause nausea, dizziness or heart palpitations.

When to Consult a Doctor

Consult a doctor if:

• You have pre-existing liver or kidney conditions
• You experience persistent digestive issues such as bloating, cramping or diarrhoea even after lowering the dose
• You experience unusual or severe muscle cramps with dark urine, possibly a sign of rhabdomyolysis
• You have gained excessive or rapid weight
• You have swelling in the face, feet or hands
• You experience symptoms of kidney problems such as persistent fatigue, swelling or urine output

Creatine for Specific Populations

Creatine for Teens

Creatine use is not recommended in teens. If you are a teen considering creatine, make sure that you read product labels to check if it is safe for your age or not. You will get benefits like enhanced muscle growth and improved athletic performance. However, you cannot ignore concerns and risks like dehydration, overuse or improper dosage. Avoid creatine if you have some pre-existing condition.

Creatine for Older Adults

Benefits: Older adults in good health can get the following benefits of creatine with a safe dosage:

• Counteracts age-related declines  
• Improves exercise performance
• Helps fight diabetes
• Helps fight certain neurological diseases such as Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease, Parkinson's disease, Huntington's disease, and Alzheimer's disease
• Counteracts tiredness
• Reduces skin ageing

• 20 grams per day for a week, followed by 10 grams per week
• 20 grams per day for 10 days, followed by 4 grams per day for 20 days

Side Effects: You may experience the following side effects:

• Nausea or stomach pain 
• Diarrhoea 
• Weight gain
• Muscle cramps  

Speak to a healthcare professional if you are suffering from liver, kidney or some other health condition. 

Creatine for Vegetarians and Vegans

Following are the common creatine supplementation options for vegetarians and vegans:

Creatine Monohydrate 

Vegan-friendly creatine monohydrate is typically synthesised in labs. Creatine monohydrate is safe and effective. You can buy it in capsule or powder form.

Creatine HCl

As it is more soluble, it does not cause stomach issues. Creatine HCL for vegans is synthesised in labs. 

Buffered Creatine 

This vegan-friendly creatine is designed to reduce stomach discomfort with pH balance.

Creatine Ethyl Ester

It is a modified version of creatine that improves absorption rates. This synthetically made, vegan-friendly creatine is expensive with limited evidence supporting benefits.

Capsule or Powder

You can mix creatine supplement powder and capsule with plant-based protein shakes or water. However, capsules are typically more expensive.

You can buy vegan-certified creatine supplements for extra assurance.