Creatine may be the most misunderstood supplement in the entire world. You mention you’re taking it and the IQ in the room drops twenty points. The assumptions people make about creatine are almost entirely incorrect, and the questions they often ask are completely unfounded. Usually, the opposite is true.
“So you’re taking steroids then?”
“Oh, you just want the easy way out?”
“But isn’t it just for men?”
In reality, creatine and steroids couldn’t be further apart. Creatine is a naturally occurring nutrient that appears in most omnivorous diets, especially those containing red meat and fish. We make it in our own bodies; supplementary creatine just provides extra.
In reality, creatine isn’t a short cut at all. It allows you to work harder and longer. Creatine only helps if you’re willing to put in more work.
In reality, creatine has been shown to improve the health and performance in all populations, including men, women, and teens. I bet babies and toddlers would benefit, too, but that hasn’t been shown.
Allow me to explain.
What is Creatine?
Creatine is the precursor to phosphocreatine (PC), an energy source used to produce ATP (the primary energy currency of the body) to allow rapid generation of force in the muscles. This is the ATP-PC energy pathway, and when we’re putting up large amounts of weight or going for 1 rep maximums or lifting cars off of accident victims, we are engaging our ATP-PC energy. Although we make creatine in the liver, supplementary creatine allows us to store more creatine in the muscle for energy generation along the ATP-PC pathway. In other words, taking creatine can help us lift more weight, more times.
How does this translate into athletic performance?
Creatine Benefits for Physical Performance
By far the most powerful benefits of creatine lie in its effect on strength training, power output, and sprinting.
The biggest effects of creatine are seen in strength training. Whether you want to lift more weight or build more muscle, creatine can help.
Compared to placebo, creatine has been shown to improve performance in almost every lift you can think of, including bench press and back squat (and bench).12 The more compound the lift, the better it’ll probably help.
Creatine supplementation paired with resistance training enhances fat-free mass, increases strength adaptations, and has massive effects on muscle fiber growth—especially the all-important type 2 muscle fibers involved with strength and power generation.3
Creatine is a great way to enhance strength and muscle gains in elderly.4 You add creatine, and an already effective resistance training program gets even more effective. They gain more muscle and more strength.5 In other words, the people who need it more than anyone. The people for whom training gains and more muscle are a life and death situation!
You see similar boosts to strength training results in vegans and vegetarians who have lower baseline creatine than anyone.6
Creatine supplementation reduces protein oxidation, leaving more available for muscle protein synthesis. It also up regulates genes in the muscle cells involved with muscle hypertrophy—and it does so in the absence of strength training!7
The best way to describe “power” is “moving weight quickly” or “strength expressed through speed.” It’s clean and jerking a heavy barbell. It’s a running back powering through two defenders. It’s dunking a basketball or swinging a baseball bat. Power is moving weight really quickly for short bursts, and it turns out that creatine is really good at enhancing your ability to express it.
Creatine enhances performance in the Wingate test, one of the most brutal ways to measure muscle power output.8 It’s 30 seconds of all-out cycling against resistance, often repeated 4 times.
Creatine boosts power output in strength exercises, particularly those involving major muscle groups. For instance, while squat and bench press improved with creatine supplementation, bicep curls did not.9
As sprinting is heavily dependent on phosphocreatine levels in the muscles, and phosphocreatine replenishment in between sets is linked to repeated sprint performance, supplementing with creatine can help with sprint performance.
Youth sprinters who supplement with creatine enjoy improved power output and faster times, a performance improvement accompanied by a reduction in inflammatory markers.10
During sprint cycling, creatine supplementation for at least 6 days reduces lactate accumulation, raises lactate threshold, and even improves power output as the threshold approaches.11
It also helps sprinting in the pool, although not all kinds of sprint protocols.
Swimmers doing 50 meter repeat sprints (swim 50 m as fast as you can, rest 2 minutes, performed 6 times) saw improvements in sprint speed after taking creatine.12 A similar group doing 10 25 meter repeats saw no benefit.13
For a single 50 meter sprint, creatine supplementation improves speed by 4.6%. However for a 100 meter sprint, creatine has no effect in amateur swimmers.14 Elite college swimmers do seem to get an effect at both 50 meters and 100 meters, probably because the more advanced you are the more of a “sprint” 100 meters becomes.15
Creatine does not appear to directly help endurance training. Studies have found little no effects on a range of aerobic performance-related measures.
However, there are two exceptions. There are indirect benefits.
One is in heat tolerance. When people take creatine and then go train in the heat, they can handle higher temperatures without “feeling” overly hot. This is true for any training you do in the heat, whether it’s lifting, sprinting, or lower level endurance activity. One reason for the increased heat tolerance is the increased intracellular water storage—you have a higher sweat capacity, which helps maintain a lower internal body temperature even as ambient temperatures and exercise intensities rise.
A second lies in anti-catabolism. A major negative of excessive endurance training is that it’s catabolic. It breaks down muscle tissue without stimulating the growth of new tissue. Taking creatine appears to reduce the catabolic effect of endurance training by limiting the increase in lactate, maintaining the tryptophan/BCAA ratio, and inhibiting the rise in serum catabolites.
By increasing cellular water volume and uptake, creatine also increases glycogen loading. Creatine seems to increase the amount of glycogen you can “fit” into a muscle, and this pays off for anyone interested in performance.16
It may even help people deal with dietary glucose by increasing glucose disposal capacity. One study found that giving normal men creatine for several weeks reduced their blood glucose response to an oral glucose test, despite having no effect on insulin sensitivity.17
Other Creatine Benefits
Creatine has a host of other effects unrelated to muscle, strength, and speed. After all, creatine doesn’t just appear in muscle cells. Your brain also uses creatine to generate ATP for cognitive functions, particularly those involving the frontal cortex. Any “conscious” or “concerted” mental effort can theoretically benefit from creatine supplementation.
Creatine supplementation enhances memory and other cognitive functions in all groups, but especially in the elderly and in vegans and vegetarians who have lower baseline creatine intakes and levels.1819
Creatine enhances mental performance and mood after sleep deprivation, particularly on tasks involving the front cortex.20
Creatine may act as an important energy source for the heart during times of stress, such as after a cardiac event or during heart failure.21.
Who Should Take Creatine?
I think everyone should try creatine. Not everyone responds to it, but everyone who does gets some benefit. And the benefits are “free.” There are little to no side effects. Burt who should really consider creatine?
Vegans and vegetarians. People who aren’t getting much creatine from their diet and thus have lower levels to being with.
The elderly. People who need all the help they can get in putting on muscle and gaining strength.
Strength and power athletes. People who need to move really fast and express a lot of power.
Keto and low-carb people. People who have lower glycogen stores can benefit from the top-end power offered by increased creatine stores.
The sleep deprived. Creatine can take the edge off a bad night’s sleep.
How to Take Creatine
If you want to speed creatine uptake in the muscles, you can do a “loading phase” of 20 grams a day (split up into 4 doses) for a week before dropping down to 3 to 5 grams a day. If you don’t, you can just take 3 to 5 grams a day from the get-go. Both strategies work just fine, but what seems to be most important is consistency in the early weeks. Taking it every day works better than one day on, two days off, for saturating your stores.
If you have a lot of muscle mass—and thus higher creatine storage capacities—or if you burn through a lot of creatine with intense activity, you might benefit from larger daily doses in the 8 to 10 grams range. This is speculative, however, though I have heard from people for whom this strategy worked. It just hasn’t been studied.
Once you’ve been taking creatine consistently enough at high enough doses to saturate your muscle stores (20 grams a day for 5 to 7 days, or 3 to 5 grams a day for 28 days, to give two common examples), you can probably get away with “cycling” your creatine. Taking days off, doing lower doses here and there. Maybe even taking creatine “as needed” around resistance exercise, when you’re really going to use it. I’m just speculating here, but I think I’m right.
Whenever you take creatine, make sure you’re drinking plenty of water—more than normal. Otherwise it can cause stomach cramps or even dehydration. You have to “meet the demand” for water.
When to Take Creatine
Creatine is more of a long-term supplement. It’s something that you “load” into your muscles and once it’s there, it stays until you expend it with intense activity. This is why many people go through the “loading” phase with 20 grams per day for a week until tapering off with lower doses—they want to speed up the saturation of creatine storage. However, timing your creatine intake can affect how well it works in your body.
One study found that taking creatine immediately after a workout led to better strength gains in the bench press, more lean mass, and lower fat mass than taking creatine immediately before a workout.22 Another study using a creatine/carbohydrate/protein supplement found that it didn’t really matter whether you took it before or after a workout as long as you took it close to the workout. Both pre- and post-workout creatine were far more effective than taking it in the morning or night, well away from your workout.
The most important factor is proximity to the workout. Before or after, it doesn’t matter. Just keep it close.
Creatine and Hair Loss
This is a persistent concern, but there’s not much solid research lending credence to it. The majority of the “evidence” lies in an older study where college rugby players took creatine for a few weeks and saw their dihydrotestosterone, or DHT, rise over baseline. (The placebo control group saw no rise in DHT).23 DHT is a more active or potent form of testosterone that has powerful anabolic effects. It can also bind to hair follicles and cause them to shrink, reducing your ability to support a dense, healthy head of hair.
However, the creatine group had lower DHT levels at baseline, so it may be that the creatine was simply correcting lower starting levels. Other studies on creatine and testosterone have failed to find any consistent links between creatine and higher testosterone, free testosterone (from which DHT is produced), or DHT itself.
Finally, there are no studies showing that taking creatine causes hair loss. It’s not impossible or even improbable. It simply hasn’t been definitively shown.
Anecdotally, some people notice hair loss after starting creatine, but those are the toughest connections to draw without a control group and good methodology. Would they have lost the hair anyway? Were there other factors at play?
Creatine Weight Gain
In the first week or so of taking creatine, you will gain water weight as the body stores water along with creatine. This is completely normal and usually subsides after a few weeks, but it can be alarming if the scale suddenly shows 8 more pounds and you start looking more “puffy.”
Studies in both older men and older women have found that creatine use increases body mass.2425 In other words, their BMI would have “worsened.”
However, while creatine will increase body mass, creatine has never been shown to cause fat gain. Creatine will likely help you gain lean muscle mass by helping you lift more weight in the gym, maintain higher exercise intensities, and do higher-volume sets. It will even trigger the genes your muscles need to grow. The creatine isn’t directly causing the weight gain, but it is helping to enable it. This is “good weight.” This is the weight you want to gain. In all those “increased body mass” studies, the creatine also increased the amount of weight they were lifting and their performance in a broad range of physical activities. It was making them more robust.
Creatine may make you gain weight, but it’s the good kind of lean mass.
Creatine and Kidney Function
If you have healthy kidney function, creatine is proven to be safe. Creatine excretion in the urine will rise, but this is considered to be a normal response to increased creatine intake and the sign of a healthy kidney function (besides, it happens with strength training anyway). Creatine supplementation has never been shown to cause impaired kidney function in healthy people with healthy kidneys at baseline. While there are case studies of renal dysfunction “accompanying” creatine supplementation, these cases were all confounded by variables like preexisting kidney disease, excessive dosing (100x what’s normally recommended), steroid use, and other medicines they were taking.26
If you have poor kidney health or function, supplemental creatine may be contraindicated. However, there is a case report of a young adult male with one kidney who was able to take creatine while eating a high protein diet and suffered no health consequences.27 Whatever you do, if you’re worried about your kidneys or have impaired kidney function, check with your doctor before proceeding.
Overall, creatine is a bit of wonder supplement. It isn’t necessary to be strong, fast, powerful, and quick-thinking, but it doesn’t hurt—and there are almost no other popular supplements with a better safety track record. I suggest that everyone at least try it for a few weeks to see if they respond to it or not.
Let me know how creatine has helped you. Do you take creatine?
About the Author
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.