Creatine: Good for All of Us?

Creatine is a supplement that is gaining popularity. And not just among the gym bros. I’m reading more and more about it in longevity literature, on menopause blogs and various traditional medical sites. 

In last week’s blog, I delved into all the potential health benefits of creatine supplementation. This week, I look at the potential downsides. As well as some of the myths.

 

The side effects (real and myth):

Water retention: real. Your muscles will hold more water when creatine levels are high. Expect 2–6 pounds of water weight in the first week or two. It's not fat, it stabilizes, and for most people it's a non-issue.

GI upset: possible at high doses. The loading phase (20 grams/day) that some protocols recommend isn't really necessary and is where most stomach issues come from. 3 to 5 grams a day (the maintenance dose that loads up over time) taken with food minimizes this side effect. 

Kidney damage: largely a myth. Creatine supplementation will raise circulating creatinine levels. Creatinine is a byproduct of us living, has no real physiologic function, and is harmless in and of itself.  We measure it because the only organ that can remove creatinine from our bloodstream is the kidney. As kidney function deteriorates, creatinine levels go up.  

Given that creatinine can go up in creatine supplementers, worries around kidney health are understandable. However, to date, multiple large reviews have found no impairment of actual kidney function in healthy adults who add creatine to their intakes.

That said, if you have existing kidney issues, you might want to talk to your doctor before starting this supplement. And if you don’t have kidney issues, make sure you let your doctor know you’re taking the supplement in case they notice your creatinine levels changing. This may save you from additional, sometimes expensive, medical testing. 

Hair loss: not supported. The concern comes from one small study in 2009 that has never been replicated. No other research has directly linked creatine to hair loss, and mechanistically, the association does not make sense.

Bone density: no direct benefit. Early studies were promising, but a rigorous 2-year trial in postmenopausal women found creatine didn't improve bone mineral density — even when combined with exercise.

 

How to take creatine:

Creatine monohydrate is the form with all the research behind it. It's also the cheapest. Fancier versions may cost more, but you’re not likely to see enough additional impact to offset the higher cost.   

One thing you want to make sure of is purity.  In terms of the ingredient itself, Creapure® is a highly purified (99.9% pure) form of creatine made by a German company, AlzChem.  Look for Creapure® as being called out by the supplement supplier as its creatine source. 

But even beyond the core ingredient, supplements are notorious for being poorly regulated.  So, you’re really relying upon the promises the supplement company makes in terms of what's in there and how much.  I would favor looking for a creatine monohydrate supplement that is also “NSF Certified for Sport”.  The logo looks something like this:

 

Athletes are under the microscope in terms of what shows up in their blood.  NSF Certified for Sport means that the supplement has undergone a different level of scrutiny in terms of what’s in – and what isn’t in – the product.

In terms of dosing, three to five grams a day is what you need, typically mixed into a glass of water or other beverage. Creatine will not dissolve in a cold beverage. You will need to stir it into something warm if you want to avoid the gritty texture.

No loading phase is needed — you'll reach the same place in 3–4 weeks, just without the bloating. Timing doesn't matter much; consistency does. Take it with a meal, so you don't forget.

And there’s no need to over-do it. More is not necessarily better.  Going over the 5 g/day threshold is unlikely to yield massive additional health improvements over lower doses, but could lead to significant digestive upset.

 

Two MAJOR Caveats:

First, muscle doesn’t bulk up simply because you take creatine. All the strength and muscle building benefits happen ONLY IF you engage in regular physical activity, especially resistance training. Otherwise, as with all extraneous supplements, you will only be creating expensive urine.

Second, taking a creatine supplement can never replace the fundamentals of a healthful diet. Remember, this is a SUPPLEMENT. It's NOT a core nutrient. No amount of ATP can drive a cell that's poorly nourished.   

 

Bottom line:

Creatine isn't magic. But it is one of the most thoroughly studied, safe supplements available with benefits that appear to go well beyond the gym. For women, especially those navigating midlife changes, for older adults trying to hold onto muscle and mental sharpness, and for anyone eating a plant-based diet, the case for considering taking it is genuinely strong. As I fit into all 3 of those categories, I'm getting on board.