Creatine is a compound naturally produced in the body and found in foods like red meat and fish. It plays a crucial role in cellular energy production, particularly for short, high-intensity exercise. For decades, it has been a popular supplement among athletes and fitness enthusiasts for its proven benefits in increasing muscle mass, strength, and performance. However, myths about its potential negative health effects have persisted. By examining the scientific evidence, we can separate fact from fiction regarding the supposed harms of creatine.
The Myth of Creatine and Kidney or Liver Damage
One of the most persistent creatine myths is its alleged risk to kidney and liver function. This misconception often arises from a misunderstanding of how the body processes creatine.
Why creatinine levels rise without damage
Creatine is broken down into a waste product called creatinine, which is filtered by the kidneys and excreted in urine. When someone supplements with creatine, their overall creatine pool increases, leading to a slight, but benign, rise in blood creatinine levels. Standard kidney function tests measure creatinine, so this rise can be misinterpreted as organ damage. However, multiple controlled studies have shown no detrimental effect on kidney or liver function in healthy individuals, even with long-term supplementation.
Who should exercise caution?
While safe for healthy individuals, those with pre-existing kidney or liver conditions should consult a healthcare professional before taking creatine. A comprehensive review published in Nutrients concluded that while more research is needed for those with pre-existing kidney disease, available evidence shows no harm in healthy populations.
Dispelling Other Common Side Effect Concerns
Beyond organ damage, several other unfounded side effects are often attributed to creatine use.
Creatine and dehydration/cramping
The myth that creatine causes dehydration and muscle cramps is widely refuted by science. It's based on the fact that creatine pulls water into muscle cells. In reality, this effect is beneficial and can lead to a state of hyper-hydration, which may actually help prevent dehydration and cramping, particularly when exercising in heat. Proper overall hydration is still recommended for everyone, including those supplementing with creatine.
Creatine and hair loss
This myth stems from a single, small study from 2009 that suggested a potential link between creatine and an increase in the hormone DHT, which is linked to hair loss. However, larger, well-designed studies have not replicated this finding, and the evidence is not conclusive. Hair loss is predominantly a genetic issue, and there is no solid scientific backing to suggest creatine is a direct cause.
Creatine and digestive issues
Some individuals may experience mild gastrointestinal discomfort, such as stomach upset, bloating, or diarrhea. This is most often associated with high loading-phase doses (e.g., 20g/day) or taking creatine on an empty stomach. Reducing the dosage, splitting it throughout the day, and taking it with food can help alleviate these symptoms.
Creatine and water weight gain
Many people notice an increase in body weight shortly after starting creatine supplementation. This is not fat, but rather water weight as the supplement draws extra fluid into the muscles. This initial gain is temporary and can be minimized by skipping the loading phase and starting with a maintenance dose. Over the long term, any further weight gain is typically due to increased lean muscle mass.
Comparison of Creatine Forms
While various forms of creatine exist on the market, the scientific community recognizes creatine monohydrate as the gold standard. Here is a comparison of common creatine types:
| Feature | Creatine Monohydrate | Creatine HCl | Creatine Ethyl Ester (CEE) |
|---|---|---|---|
| Research Support | Most researched and evidence-backed. | Less studied than monohydrate. | Least effective; shown to be less effective than monohydrate. |
| Effectiveness | Highly effective for performance and muscle gain. | Some studies show comparable results, but less evidence exists. | Ineffective; converts to useless creatinine in the stomach. |
| Safety Profile | Extremely safe with decades of research. | Limited safety data available. | Limited safety data available. |
| Cost | Most affordable option. | Typically more expensive. | Often more expensive. |
Given the extensive research and cost-effectiveness of creatine monohydrate, there is no strong evidence to support paying more for alternative, less-studied forms.
Best Practices for Safe Creatine Use
To maximize the benefits and minimize any potential side effects, follow these simple guidelines:
- Choose a reputable brand: Look for products that are third-party tested (e.g., NSF Certified for Sport) to ensure purity and quality.
- Stay hydrated: Drink plenty of water throughout the day, especially during intense training periods or if starting with a loading dose.
- Stick to recommended doses: A maintenance dose of 3-5 grams per day is sufficient for most people. The loading phase (20g/day for 5-7 days) can be skipped to avoid potential stomach upset.
- Consult a professional: If you have any pre-existing health conditions, are pregnant or breastfeeding, or take other medications, talk to a doctor before starting creatine.
Conclusion
While many myths about its dangers persist, the overwhelming body of scientific evidence confirms that creatine monohydrate is a safe and effective supplement for healthy individuals when used correctly. Concerns regarding kidney and liver damage, dehydration, and cramping have been debunked by numerous well-controlled studies. Temporary water weight gain and mild digestive issues can occur, particularly with higher doses, but are manageable. As with any supplement, ensuring you purchase a high-quality product, staying well-hydrated, and consulting a healthcare provider if you have pre-existing conditions are the best steps to ensure safe usage. For the vast majority of users, the benefits of creatine for muscle growth, strength, and performance far outweigh the minimal risks.
For a deeper dive into creatine's effects, especially regarding renal function, consider reviewing recent scientific literature, such as this review on creatine supplementation and kidney health.
