Understanding Creatine: What Research Says About Strength and Performance

Creatine is one of the most widely studied ingredients in sports nutrition. This guide explains what creatine is, what can legally be said about it in the EU, how it has been researched, and what to look for on a label.

Key points

• Creatine is a compound the body makes itself and also obtains from foods such as meat and fish.
• In the EU, the authorised claim is that creatine increases physical performance in successive bursts of short-term, high intensity exercise. The beneficial effect is obtained with a daily intake of 3 g of creatine.
• A second claim is authorised for adults over 55 who do regular resistance training (details below).
• Creatine monohydrate is the form used in most published studies.
• Check the amount of creatine per serving on the label, and ask a doctor first if you have a medical condition.

What is creatine?

Creatine is a naturally occurring compound. Part of the body's creatine comes from the diet, mostly from red meat and seafood, and the rest is made by the body, primarily in the liver and kidneys, from the amino acids arginine and glycine with a methyl group supplied by methionine. Around 95% of the body's creatine is found in skeletal muscle, and about two thirds of it is stored there as phosphocreatine, a compound the body uses to regenerate ATP, the molecule that supplies energy to cells (Kreider et al., 2017).

Vegetarians have been reported to have lower muscle creatine stores than people who eat meat and fish (Kreider et al., 2017).

What can be said about creatine in the EU?

Health claims on foods and food supplements sold in the EU must be authorised in advance. For creatine, Commission Regulation (EU) No 432/2012 permits this claim:

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

The claim may only be used for a food that provides a daily intake of 3 g of creatine, and consumers must be told that the beneficial effect is obtained with a daily intake of 3 g of creatine. The European Food Safety Authority (EFSA) assessed the scientific evidence behind it in 2011 (EFSA NDA Panel, 2011). Claims about endurance were assessed at the same time and are not on the list of authorised claims.

In 2017 a second claim was authorised for older adults (Commission Implementing Regulation (EU) 2017/672):

Daily creatine consumption can enhance the effect of resistance training on muscle strength in adults over the age of 55.

This claim is aimed at adults over 55 who do regular resistance training. The effect is obtained with a daily intake of 3 g of creatine combined with resistance training that increases in workload over time and is performed at least three times a week for several weeks, at an intensity of at least 65–75% of one-repetition maximum.

How has creatine been studied?

Creatine has been researched for several decades in laboratory and training studies. The International Society of Sports Nutrition (ISSN) reviewed this work in a 2017 position stand, and a 2021 paper by researchers in the field addressed common questions and misconceptions (Kreider et al., 2017; Antonio et al., 2021). Systematic reviews have also pooled results on specific questions, such as upper-body strength outcomes (Lanhers et al., 2017) and creatine combined with resistance training in older adults (Devries & Phillips, 2014).

Two practical points stand out from this literature:

• Creatine monohydrate is the form studied most. Other forms are sold, but there is much less research on them.
• Study protocols differ. Some studies started with a short "loading" period at higher daily amounts followed by a lower maintenance amount; others used the same daily amount throughout. The EU-authorised claims refer to a daily intake of 3 g.

Common questions

Does creatine cause water retention?

Creatine is stored in muscle together with water. Short-term studies have reported increases in body water during the first days of use, and the 2021 review explains that the common belief that creatine causes lasting water retention is largely based on these short-term findings (Antonio et al., 2021).

Is creatine hard on the kidneys?

This is a frequent concern. In a 2019 systematic review and meta-analysis, the authors reported that creatine supplementation did not significantly alter serum creatinine or plasma urea, two common markers of kidney function, in the studies they analysed (de Souza e Silva et al., 2019). The 2021 review concluded that creatine taken at recommended amounts does not result in kidney damage or renal dysfunction in healthy individuals (Antonio et al., 2021). These conclusions concern healthy people: if you have a kidney condition, or any other medical condition, talk to a doctor before using creatine.

Does creatine cause hair loss?

Most of the speculation comes from a single study in which male rugby players taking creatine showed a rise in blood levels of the hormone DHT. The 2021 review concluded that the majority of available evidence does not support a link between creatine and hair loss (Antonio et al., 2021).

How to read a creatine label

• Amount per serving. Check how much creatine one serving provides and how many servings the pack contains. A product that uses the EU claim must state that the beneficial effect is obtained with a daily intake of 3 g of creatine.
• Form. The label names the form, for example creatine monohydrate. Blends and "stacks" combine creatine with other ingredients, so read the full ingredient list.
• Other active ingredients. Some creatine products also contain caffeine or other stimulants. Check the composition if you avoid them.
• Directions and warnings. Follow the recommended daily dose and do not exceed it. Food supplements should not be used as a substitute for a varied and balanced diet and a healthy lifestyle.

Who should take extra care?

Speak to a doctor or pharmacist before using creatine if you are pregnant or breastfeeding, under 18, have a kidney or other medical condition, or take medication. If you compete in tested sport, check every product against the anti-doping rules that apply to you.

Creatine at GIGACULT

Our Creatine collection lists creatine monohydrate and creatine blends, with the composition per serving on each product page. For example, Genetic Nutrition Nano Pure Creatine Monohydrate is a micronised creatine monohydrate powder; its product page shows the amount per serving, directions and safety information.

Training is only one part of the picture. Read our guides to electrolytes and hydration and recovery fundamentals.

References

1. Commission Regulation (EU) No 432/2012 establishing a list of permitted health claims made on foods (consolidated version). EUR-Lex
2. Commission Implementing Regulation (EU) 2017/672 authorising a health claim made on foods (creatine and muscle strength in adults over 55). EUR-Lex
3. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the substantiation of health claims related to creatine and increase in physical performance during short-term, high intensity, repeated exercise bouts. EFSA Journal. 2011;9(7):2303. doi:10.2903/j.efsa.2011.2303
4. Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18. doi:10.1186/s12970-017-0173-z
5. Antonio J, Candow DG, Forbes SC, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021;18:13. doi:10.1186/s12970-021-00412-w
6. Lanhers C, Pereira B, Naughton G, et al. Creatine supplementation and upper limb strength performance: a systematic review and meta-analysis. Sports Med. 2017;47:163–173. doi:10.1007/s40279-016-0571-4
7. Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults – a meta-analysis. Med Sci Sports Exerc. 2014;46(6):1194–1203. doi:10.1249/MSS.0000000000000220
8. de Souza e Silva A, Pertille A, Reis Barbosa CG, et al. Effects of creatine supplementation on renal function: a systematic review and meta-analysis. J Ren Nutr. 2019;29(6):480–489. doi:10.1053/j.jrn.2019.05.004

This article is general information and is not medical advice. If you have a medical condition, are pregnant or breastfeeding, or take medication, speak to a healthcare professional before using food supplements.