What to Know Before You Try the Supplement

It’s easy to see why creatine is one of the most popular sports supplements on the market.

Creatine, a compound synthesized naturally in the body from amino acids, plays a key role in making adenosine triphosphate (ATP), which is the body’s main energy provider. (ATP captures chemical energy generated from the breakdown of food molecules and releases it as fuel for cells.)

Creatine supplements can help athletes eke out more reps, outlast an opponent, and move faster. In fact, research shows that increasing your creatine levels may boost your performance during high-intensity or repetitive exercise by 5 to 15 percent.

It’s not surprising, then, that many people turn to creatine supplements to gain an edge on their fitness goals.

But like any dietary supplement, creatine has potential risks and side effects. If you’re thinking about adding creatine — or any supplement — to your diet, talk to your doctor or sports dietitian and learn why it may or may not be right for you.

Here’s what to know about some of the potential pitfalls of creatine supplements, and how to take them safely and effectively.

What Research Shows About the Safety of Creatine Supplements

Creatine is generally considered safe when taken as a supplement, according to a review in the journal Current Sports Medicine Reports, which is published by the American College of Sports Medicine. The review notes that the safety of supplementing with creatine has been investigated thoroughly, and that research shows that when creatine is taken as directed for a short or long period of time (up to 30 grams [g] a day for five years or less), it has been found to be generally safe and without side effects in healthy people.

Case in point: One small study of 18 men found that seven days of creatine supplements had no effect on different organs or blood and urine health markers in a group of volunteers, notes Michael Roberts, PhD, a professor in the School of Kinesiology at Auburn University in Alabama.

What Are the Side Effects of Creatine Supplements?

While creatine supplements are considered generally safe, experts caution that they may cause side effects in some people. Side effects may include muscle cramping, dehydration, diarrhea, nausea, and seizures, according to the American Academy of Orthopaedic Surgeons (AAOS).

That said, there isn’t much evidence to support the suggestion that creatine causes dehydration and muscle cramping, according to the Current Sports Medicine Reports review. In fact, the authors pointed to several studies that found the opposite: that creatine supplementation reduced the frequency of muscle cramping.

The one side effect that has evidence to support it is weight gain. “It’s tough to generalize, but most people experience a five-pound gain while consuming [creatine] supplements,” Dr. Roberts says.

On the other hand, that gain comes in the form of water weight, and “there’s actually a benefit there because the water is in the muscle cells, so it helps to hydrate your muscles,” explains Kelly Jones, RD, a board-certified specialist in sports dietetics based in Philadelphia. “So any weight gain you might see from creatine is simply water and better hydration.”

Plus, muscle is denser than fat, which means if you’re using creatine supplements and building muscle, you may see an increase in body weight overall. That weight gain may be from added muscle, not fat.

Who Should Not Take Creatine?

While some small studies from decades ago linked creatine to kidney problems, recent research has found no such evidence. According to a review of common misconceptions about creatine, the notion of creatine causing kidney damage is a myth. The authors note that after more than 20 years of research, including multiple clinical trials, there has been no evidence of negative effects from recommended dosages of creatine supplements on kidney health.

But, since creatine supplements may increase blood levels of the (similarly named) compound creatinine, a waste product of muscle activity, AAOS recommends that anyone with kidney disease steer clear of creatine.

AAOS also notes that there isn’t enough information yet to indicate whether creatine supplements are safe for people who are pregnant or breastfeeding. In addition, people who are taking creatine supplements should exercise caution and check with their doctor before combining creatine supplements with over-the-counter medications, prescriptions, vitamins, and energy drinks.

At the end of the day, it’s important to discuss any supplement with a healthcare professional such as a dietitian or doctor before you take it. And while creatine is not considered a banned substance by the International Olympic Committee and National Collegiate Athletic Association (NCAA), professional or college athletes should still make sure they select a creatine supplement that’s been third-party certified by NSF International or Informed Sport. These agencies test dietary supplements for safety and screen for substances that are banned by sports organizations, though the risks aren’t completely eliminated, according to a review article in the journal Sports Medicine.

How Much Creatine Do You Need?

Your body already makes creatine naturally — about 1 g per day, according to Mayo Clinic. Additional amounts come from animal foods such as seafood and red meat, though at levels far below what you can get from supplements.

Dietary supplements — including creatine — may not be needed if you’re eating a healthy, balanced diet that includes red meat and seafood. According to a position paper by the International Society of Sports Nutrition (ISSN), a normal diet that contains 1 to 2 g of creatine per day will saturate muscle creatine stores by 60 to 80 percent.

If you’re looking to build muscle mass or strength, however, a daily creatine supplement to your diet may be a good move, Roberts says.

The standard daily dose is 3 to 5 g of creatine monohydrate.

 “That’s what is recommended by most research,” Jones says. There are other forms of creatine available on the market, but creatine monohydrate is the supplemental form that’s been backed by research, she notes.

Depending on your diet, it may take a few weeks to fully saturate your creatine stores and notice a difference. “If someone’s following a vegan diet, never eating meat or fish, then it might take them a bit longer than someone who’s regularly including those in their diet,” Jones explains.

Bottom line: Creatine supplements are generally safe and carry few side effects. You may notice slight weight gain, but that typically comes from water retention or increased muscle rather than fat. Despite creatine’s relative safety, it’s essential to check with a doctor or dietitian before taking any supplement — especially if you’re pregnant or breastfeeding.

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