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Nutrition

Creatine: Separating Fact from Fiction

By Dr. Mark Evans, PhD, Optimum Nutrition, EMEA Performance Nutritionist

Key Learnings

  • Why does creatine have so many misconceptions associated with it? Misinterpretations of scientific data, anecdotal evidence, and misunderstandings of how creatine works in the body.

  • Does creatine cause weight gain or fat gain? Maybe?! Body weight may increase 1-2kg in the initial days of supplementation, but this is water retention, not fat gain.

  • Is creatine a steroid? No. Creatine is a legal and safe way to build muscle and improve performance.

  • Does creatine supplementation damage the kidneys? In healthy adults using recommended dosages, there is currently very limited evidence showing creatine causes damage to the kidneys.

  • Does creatine cause hair loss or balding? No. Creatine does not cause hair loss or baldness.

  • Does creatine cause dehydration or muscle cramping? No. The evidence does not support the belief that creatine causes dehydration and muscle cramping.

  • Is creatine only for men? No. Alongside a appropriate training programme, women can experience the same benefits, increases in muscle mass and strength, as men, from creatine supplementation.

Contents

1. Why does creatine have so many misconceptions associated with it
2. Does creatine cause weight gain or fat gain?
3. Is creatine a steroid?
4. Does creatine supplementation damage the kidneys?
5. Does creatine cause hair loss or balding?
6. Does creatine cause dehydration or muscle cramping?
7. Is creatine only for men?

Creatine, a staple in the world of sports nutrition for a long time, often finds itself associated with several misconceptions. As a performance nutritionist, it’s essential to dispel these and ensure athletes can make informed decisions about the potential benefits of supplementation. This article aims to dissect the common misconceptions surrounding creatine, backed by scientific evidence, to reveal its true impact on health and performance.

Why does creatine have so many misconceptions associated with it?

Creatine, widely researched and used for its performance-enhancing benefits, with over 500 scientific papers published on its effectiveness is often misunderstood1. Its popularity in the fitness community, coupled with misinformation and a lack of understanding, has led to the spreading of various myths. These misconceptions come from misinterpretations of scientific data, anecdotal evidence, and misunderstandings of how creatine works in the body to improve physical performance. Common myths around creatine include causing dehydration, muscular injuries, cramps, and hair loss. We will introduce you to these topics and more and what the science really says.

Does creatine cause weight gain or fat gain?

Early research showed an increase in body water retention during the first week of creatine supplementation and an increase in bodyweight of 1-2kg. When creatine is taken up by the muscle, it may drag water with it to maintain water balance between the inside and outside of the muscle1. However, longer term supplementation studies (5-6 weeks) have shown no increase in total body water. This short-term increase in body mass has caused some people to think creatine may cause increase levels of fat mass in the body. Alongside appropriate resistance training, 5-6 weeks of creatine supplementation has been shown to have no effect on body fat levels.

In summary, you may experience a short term 1-2kg increase in body weight when starting to take creatine, but this is due to water retention in the body and not an increase in fat mass.

Is creatine a steroid?

No. The way creatine and anabolic steroids help to increase muscle mass and strength are completely different. Anabolic steroids, which mimic testosterone, work by enhancing muscle mass and strength through increasing muscle protein synthesis. They do this by interacting with receptors in the muscle to increase muscle growth. Creatine, on the other hand, plays a different role. It is transformed into phosphocreatine in our muscles, assisting in the production of ATP, our cells’ source of energy. This boost in ATP recycling can enhance muscle power and performance during high-intensity workouts, contributing to better muscle performance and growth over time. Anabolic steroids are also classified as drugs, due to their potential side effects, while creatine is classified as a dietary supplement and is legal to buy and widely available.

In summary, no creatine is not a steroid. Creatine offers a legal and safe way to build muscle and improve performance. ON creatine monohydrate – Elite Series is Informed Sport certified, meaning every batch produced is tested for the presence of ingredients and compounds that are banned in sport.

Does creatine supplementation damage the kidneys?

No. The cause of this misconception is unknown but may stem from a basic misunderstanding of how our body handles creatine and the product of its breakdown, creatinine. In our muscle, creatine is broken down to creatinine, which is transported to the blood and leaves the body in urine, after being filtered out by the kidneys10. Levels of creatinine in the blood increase through creatine supplementation or a high intake of creatine containing foods, such as meat. Some people fear that by increasing the levels of creatinine in the blood through creatine supplementation, you may ‘overload’ the kidney’s ability to remove creatinine and cause long term damage. However, most studies show that recommended doses of creatine supplementation do not lead to increases in serum creatinine, or that the increase is within normal clinical limits in healthy individuals11. However, it is important to note that creatine supplementation is not recommended for those with pre-existing kidney conditions.

In summary, in healthy adults using recommended dosages, there is no evidence showing creatine supplementation overloads the kidneys and causes long term damage. Those with existing kidney conditions should refrain from creatine supplementation.

Does creatine cause hair loss or balding?

No. The link between creatine supplementation and hair loss is primarily due to one study, which observed an increase in DHT (dihydrotestosterone) levels in male rugby players after taking creatine. DHT, a product of testosterone breakdown, can play a role in hair loss for some individuals. In this study, DHT levels rose significantly during and after a creatine loading phase compared to a placebo group. However, this study’s findings have not been replicated elsewhere, and no study has reported hair loss or baldness with creatine supplementation.

In summary, creatine does not cause hair loss or baldness.

Does creatine cause dehydration or muscle cramping?

No. The belief here is that when creatine is transported into the muscle, it can drag water with it, disrupting the body’s fluid balance, causing dehydration and potentially muscle cramping in athletes. In fact, this belief caused the American College of Sports Medicine to advise against creatine use in athletes competing in hot environments. Early observations seemed to support this view, as creatine users reported an increase in body mass due to water retention and some athletes, including NCAA Division 1 baseball and football players, self-reported negative effects like cramping and dehydration. However, self-reported measures may be unreliable the dose of creatine used by each player was not reported. More recent work showed that creatine users experienced significantly fewer incidences of cramping, heat illnesses, dehydration, muscle tightness, and muscle strains over the course of a full NCAA football season.

In summary, the evidence does not support the belief that creatine causes dehydration and muscle cramping.

Is creatine only for men?

The short answer is no, creatine is not just for men. It is believed women may experience reduced performance benefits compared to men with creatine supplementation because women have higher pre-supplementation levels of creatine in their muscle. This difference means that men typically have more room for improvement when they begin supplementation. Despite this, 3-4 weeks of creatine supplementation increases creatine levels in the muscle, cause muscle mass gains and improve strength in women.

In summary, women can benefit from creatine supplementation through increases in muscle mass and strength alongside a resistance training programme.

Conclusion

Creatine supplementation, when practiced correctly, can be impactful in enhancing your physical performance. By understanding the optimal ways to incorporate creatine into a training regimen, individuals can safely experience its benefits.

*Creatine increases physical performance in successive bursts of short-term high intensity exercise.

References

1. Antonio, J., et al. (2021) Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. J Int Soc Sports Nutr 18, 13.

2. Hultman, E., et al. (1996) Muscle creatine loading in men. J Appl Physiol (1985): 81(1):232–7.

3. Hall, M., & Trojian, T.H. (2013) Creatine supplementation. Curr. Sports Med. Rep; 12:240–4.

4. Andre T.L., Gann, J.L. et al., (2016) Effects of Five Weeks of Resistance Training and Relatively-Dosed Creatine Monohydrate Supplementation on Body Composition and Muscle Strength, and Whole-Body Creatine Metabolism in Resistance-Trained Males. Int J Kinesiol Sports Sci: 4, 28-35.

5. Rawson, E.S., Stec, M.J, et al. (2011) Low-dose creatine supplementation enhances fatigue resistance in the absence of weight gain. Nutrition:27:451–5.

6. Antonio, J., & Ciccone, V. (2013) The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. J. Int. Soc. Sports Nutr: 10:36–6.

7. Becque, M.D., Lochmann, J.D., & Melrose, D.R. (2000) Effects of oral creatine supplementation on muscular strength and body composition. Med. Sci. Sports Exerc: 32:654–8.

8. Kersey, R.D., et al. (2012) National Athletic Trainers’ Association National Athletic Trainers’ Association position statement: anabolic-androgenic steroids. J. Athl Train: 47:567–88.

9. Kreider, R. B., et al.(2017) International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14, 18.

10. Wyss, M., & Kaddurah-Daouk, R. (2000) Creatine and creatinine metabolism. Physiol. Rev: 80:1107–213.

11. Persky, A.M., & Rawson, E.S. (2007) Safety of creatine supplementation. Subcell. Biochem: 46:275–89.

12. Gualano, B., et al. (2012). In sickness and in health: the widespread application of creatine supplementation. Amino Acids: 43:519–29.

13. van der Merwe, J., Brooks, N. E., & Myburgh, K. H. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 19(5), 399–404.

14. Terjung R.L., et al. (2000) American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Med. Sci Sports Exerc. 2000;32:706–17.

15. Greenwood, M., et al. (2000) Creatine supplementation patterns and perceived effects in select division I collegiate athletes. Clin. J. Sport Med. 10:191–4.

16. Greenwood, M., et al (2003) Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol. Cell. Biochem. 2003;244:83–8.

17. Mihic, S., et al (2000). Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men and women. Med. Sci. Sports Exerc: 32:291–6.

18. Vandenberghe, K., et al. (1997) Long-term creatine intake is beneficial to muscle performance during resistance training. J. Appl. Physiol. (1985): 83:2055–63.

19. Hamilton, K.L., et al. (2000). Oral creatine supplementation and upper extremity anaerobic response in females. Int. J. Sport Nutr. Exerc: 2000;10:277–89.