Thinking about creatine supplements for your workout? Here's what you need to know
Creatine provides notable boosts for muscle and skeletal strength, with some mental benefits
Darren Candow has taken creatine almost every day for over two decades.
He says the supplement helps during intense workouts and helps him combat grogginess while travelling, especially after long international flights.
Candow is a kinesiology professor and director of the University of Regina's Aging Muscle and Bone Health Laboratory, and is an adviser for two supplement companies that produce creatine.
He's part of a large group of health experts who say that decades of research supports taking between two to five grams of creatine per day to increase musculoskeletal strength and performance.
More recent research suggests these supplements might have cognitive benefits, too.
"Creatine is probably one of the most effective supplements to consume from a muscle performance perspective," Candow told Dr. Brian Goldman, host of CBC's The Dose.
Taking too much, though, could lead to gastrointestinal distress, including nausea, vomiting and diarrhea. And it may be linked to body dysmorphia in boys and men.
Here's what you need to know about the benefits and risks of creatine and how to use it safely.
What is creatine?
Discovered in the 1830s, creatine is a naturally occurring compound produced in the liver, pancreas, and kidneys that helps provide energy to the muscles and brain. We can get additional creatine by eating protein-rich foods like red meat and seafood, says registered dietitian Katie Jessop, who works with the Toronto FC. We can also get the compound through supplements.
Roughly half of what we need comes from dietary sources, Jessop says.
Red meat is the best source, but fatty, cold-water fish including mackerel, herring and sardines are good sources, as well. Poultry provides some, but cheese has the least among animal proteins, Candow says.
Research shows that vegans get very little dietary creatine, drawing instead on their body's natural supply.
Candow says roughly 15 to 30 per cent of people are creatine non-responders, who won't see any of the usual benefits of creatine supplementation. That could be because they already have high creatine levels, or lower stores due to age. Women also may have less overall creatine than men, which might "blunt their response" to supplementation.
Taking too much creatine — which can vary from person to person — can sometimes lead to gastrointestinal distress, including nausea, vomiting and diarrhea.
Candow says he takes roughly 10 grams per day but that most people don't need to take that much, recommending people start with about two to three grams per day and work their way up.
How does creatine improve musculoskeletal performance?
"One of the things that creatine does is it helps our muscles run more efficiently by changing or reducing the acidic environment in our muscles," Jessop said.
Research suggests that taking the supplement can provide a boost during high-intensity tasks like weight training.
"On average, if you just perform weight training and you do it for maybe four to six weeks, you probably get about an eight to 10 per cent improvement in muscle mass," Candow said.
Jessop says creatine supplements work best combined with exercise and a healthy diet. However, she says they can also help athlete recovering from injuries, by helping maintain muscle during a break from exercise.
Creatine supplements can also help older adults avoid conditions like sarcopenia, which can lead to losses in muscle strength, mass and performance, Candow says.
A 2022 review found that combining the supplements with resistance training increased lean body mass by roughly 1.1 kilograms in adults, regardless of age.
Research also suggests taking creatine might slow bone mineral density loss and reduce the amount of bone tissue that's broken down and absorbed by the body. However, more research needs to be done to verify these results.
Are there brain benefits?
Though its effects require further study, some research suggests creatine could improve cognition, specifically short-term memory and reasoning.
A 2024 study found that creatine supplements "may confer beneficial effects on cognitive function in adults, particularly in the domains of memory, attention time, and information processing speed," though further validation trials are needed.
Candow says they seem to be particularly beneficial for individuals whose brains are under stress.
"For example, sleep deprivation, hypoxia [a form of oxygen deficiency], getting individuals to do a really mentally fatiguing task, that's where creatine seems to come to the rescue."
How much creatine should I take per day?
Creatine supplements come in various forms, but a 2021 study is one of many that suggests a kind called creatine monohydrate is best.
Candow, who co-authored that study, says this is simply a water molecule linked to creatine. Once consumed, the water molecule dissolves and the creatine left most closely resembles the kind that we produce naturally.
Experts recommend that people who want to take creatine supplements should consume two to five grams a day, roughly equal to the creatine in 1.1 kilograms of uncooked beef.
Candow adds that some athletes may take roughly 20 grams of the supplement a day for five to seven days, to saturate their muscles with it. However, this can lead to grastrointestinal issues.
He recommends starting with two to three grams a day and slowly increasing the dosage.
"From a clinical pathology perspective, we've looked at kidney and liver enzymes, blood cell count, heart [health] and we don't see any adverse effects even at higher dosages up to about 11 grams of [creatine] monohydrate a day for two years," said Candow.
He says people should consult with a physician if they have concerns. Candow also noted that there are few studies that assess its long-term effects beyond four to six months.
Links between creatine use and muscle dysmorphia
While creatine supplements are considered safe by many health experts, a growing body of evidence links muscle and body dysmorphia in boys and men with the use of performance-enhancing substances, including the relatively benign creatine.
Kyle Ganson, an assistant social work professor at the University of Toronto, says his research shows that young people who consume creatine supplements showed higher levels of muscle dysmorphia symptoms compared to those who don't take it.
"I would never say that creatine is the cause [of body dysmorphia]," he said. "But what we do know is that there is something about the use of creatine that contributes to some degree to muscle dysmorphia symptoms."
That includes the belief that one's muscles aren't big enough or strong enough, despite outward appearances to the contrary, as well as an intense desire for bigger muscles, leading to distress.
People considering creatine or any other dietary supplement should focus on a healthy diet and exercise first, Ganson says.
He adds that supplements aren't well regulated in Canada, with bodies like Health Canada relying on industry to "prove efficacy and safety."
Ganson says people should still exercise caution.
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