Is creatine safe, and who benefits from it?

Creatine is a compound the body makes and also gets from food. The liver and kidneys make about 1 g a day from three amino acids, and animal foods such as beef, pork, and salmon supply more. It helps muscles regenerate energy for short, hard efforts.^[1] About 95% of the body's creatine is stored in skeletal muscle.^[2]

On a typical mixed diet, about half the creatine the body needs comes from food, and muscle stores sit at roughly 60 to 80% of their maximum.^[2] Supplements raise those stores further: in one early study, muscle creatine rose about 20%.^[5] Vegetarians tend to start with lower stores and may respond more.^[1]

The findings below run from best supported to least. Many creatine researchers disclose ties to creatine makers, so we lean on independent reviews where they exist and note the ties where they don't.

Short, hard efforts

NIH says creatine improves performance in repeated short bursts of high-intensity activity, such as sprinting and weight lifting, and is of little value for endurance sports.^[1]

Strength with training

In adults 60 and older, a 2026 meta-analysis of 11 trials, by authors with no declared conflicts, found that creatine plus resistance training improved strength more than training alone. The effect was small, and the authors rated the certainty moderate.^[3]

Muscle, with and without exercise

A 2022 meta-analysis of 35 trials found about 1.1 kg more lean mass when creatine was combined with resistance training, and essentially none without exercise (0.03 kg).^[4] Lean mass includes water, so these gains may overstate new muscle.^[3]

Muscle mass after 60

The 2026 analysis did not find a statistically significant effect on muscle mass or physical function in people 60 and older, with low and very low certainty.^[3]

Women

A 2026 review of postmenopausal women found small gains in lean mass (0.37 kg) and leg-press strength (7.5 kg) when at least 5 g a day was paired with resistance training; its authors disclose ties to a creatine maker.^[8] Earlier pooled data found smaller lean-mass gains in women than in men.^[4]

Memory and thinking

The European Food Safety Authority reviewed the evidence in 2024, at a creatine maker's request, and concluded that a cause-and-effect link to better cognitive function has not been established.^[9]

Mood

A 2025 meta-analysis of 11 trials in depression found an average effect below the threshold considered clinically important, with very low certainty.^[10] Creatine is not a substitute for depression treatment.

Bone

In a 2-year trial of 237 postmenopausal women, creatine with exercise did not change bone mineral density.^[7]

Studies use two patterns. One loads 20 g a day, split into four 5 g doses, for 5 to 7 days, then continues at 3 to 5 g a day.^[1] The other skips loading: 3 g a day raised muscle creatine by about as much over 28 days as loading did in 6 days, and stores returned to normal about a month after stopping.^[5] Creatine monohydrate is the most studied form, and NIH says other, usually more expensive forms have not been shown to work better.^[1] Large single doses can upset the stomach; one review suggests single doses of 5 g or less.^[6]

1. Find the form.

   Look for creatine monohydrate by name.^[1]

2. Find the amount per serving.

   A Supplement Facts panel lists creatine with an amount. A product sold as a food carries a Nutrition Facts panel instead, which may name creatine only in the ingredient list.

3. Check what else the serving carries.

   Protein, electrolytes, caffeine, and sweeteners change what a product is for. The electrolyte drinks guide walks through that comparison.

4. Look for testing of that exact product.

   NIH notes that independent certification gives some assurance that a product contains its labeled amounts, and that products sold for bodybuilding are among those most often adulterated.^[1]

Kidneys

In healthy people, studies consistently show no harm to kidney function.^[6] One catch matters for blood tests: the body turns creatine into creatinine, so supplements can raise blood creatinine and make kidney function look worse on the usual test without any injury.^[1][6] In the 2-year trial, a few high-creatinine and low-eGFR results appeared only in the creatine group, yet total kidney-related adverse events were similar to placebo.^[7] If you take creatine, tell whoever orders your blood work; markers such as cystatin C do not depend on creatinine.^[6]

Weight

Expect about 1 to 2 kg of weight gain in the first month, largely from water retention.^[1]

Stomach, cramps, dehydration

Stomach upset is uncommon and tied to large single doses. Controlled studies do not support claims that creatine causes dehydration or muscle cramps.^[6]

Hair loss

The worry traces to one small 2009 study of rugby players that found a rise in the hormone DHT; it did not measure hair.^[11] A 12-week trial in 38 men that did measure hair found no change, though it was short and its authors have supplement-industry ties.^[12]

Who should check first

Evidence is lacking for people with kidney disease and during pregnancy. A 2025 safety review advises close monitoring for anyone with reduced kidney function and says creatine should not be recommended in pregnancy outside research.^[6] Cleveland Clinic adds breastfeeding, diabetes, and liver disease to the groups where evidence is insufficient, and says creatine may raise the risk of mania in bipolar disorder.^[15] FDA advises talking with a health care professional before taking any supplement, especially alongside medicines.^[14]

Regulation

FDA does not approve supplements for safety or effectiveness before they are sold.^[14] Its 2020 letter on creatine monohydrate answered one manufacturer's notice about using 1 g per serving in foods and drinks, and states that it is not an affirmation that creatine is generally recognized as safe.^[13]

• The longest controlled trials in healthy adults run about two years, so rare or longer-term harms are harder to rule out.^[7]
• This guide does not set a dose for you or say whether you should take creatine.
• It does not cover people under 18, athletes under drug-testing rules, or medical uses of creatine.
• It reports conflicts of interest but cannot correct for them.

All sources were read on September 23, 2026; several are abstracts only, as marked. Many creatine researchers disclose ties to creatine manufacturers, including AlzChem, or to the International Society of Sports Nutrition, which accepts industry sponsorship. We note those ties on each source.

1. Dietary Supplements for Exercise and Athletic Performance: Fact Sheet for Health Professionals

   NIH Office of Dietary Supplements, updated April 1, 2024. Full creatine section read. Used for how the body makes creatine, food sources, study doses, forms, weight gain, performance, and third-party certification. Limitation: its statement on several years of safe use rests partly on older and retrospective studies.

2. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine

   Kreider RB et al., Journal of the International Society of Sports Nutrition, 2017. Full text read. Used for how much creatine comes from diet and where the body stores it. Conflicts: prepared with support from the Council for Responsible Nutrition, a supplement-industry trade association, and several authors disclose ties to companies that sell creatine. A narrative review, not a systematic one.

3. Effects of resistance training combined with creatine supplementation on muscle strength, physical function, and muscle mass in older adults: a systematic review and three-level meta-analysis

   Yao L, Yang D, Gao J. Frontiers in Nutrition, 2026. Full text read. Used for strength, muscle mass, and physical function in adults 60 and older. The authors declare no conflicts. Limitations: 11 trials, six at high risk of bias, all in healthy older adults.

4. Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: a systematic review and meta-analysis of randomized clinical trials

   Delpino FM et al., Nutrition, 2022. Abstract only. Used for lean mass with and without exercise, and by sex. Two co-authors disclose creatine-industry ties elsewhere. Lean mass includes body water.

5. Muscle creatine loading in men

   Hultman E et al., Journal of Applied Physiology, 1996. Abstract only. Used for loading compared with 3 g a day, and for how stores fall after stopping. Limitation: 31 men.

6. A short review of the most common safety concerns regarding creatine ingestion

   Longobardi I, Solis MY, Roschel H, Gualano B. Frontiers in Nutrition, 2025. Full text read. Used for kidney function and the creatinine test caveat, stomach upset, cramps and dehydration, and the evidence gaps in kidney disease and pregnancy. Conflicts: creatine maker AlzChem paid the publication fee, and two authors disclose AlzChem grants or advisory roles. A narrative review.

7. A 2-yr Randomized Controlled Trial on Creatine Supplementation during Exercise for Postmenopausal Bone Health

   Chilibeck PD et al., Medicine & Science in Sports & Exercise, 2023. Full text read. Used for bone density and kidney-related adverse events over two years. Publicly funded; one author discloses an AlzChem advisory role. The authors report low compliance and high attrition.

8. Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis

   Naddafha S, Antonio J, Kreider RB, Stout JR. Journal of the International Society of Sports Nutrition, 2026. Full text read. Used for lean mass and strength in postmenopausal women. Conflicts: one author chairs an AlzChem-supported advisory board, and AlzChem paid part of the publication fee. Seven trials; the review was not prospectively registered.

9. Creatine and improvement in cognitive function: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006

   EFSA Panel on Nutrition, Novel Foods and Food Allergens, EFSA Journal, 2024. Full text read. Used for the regulator's conclusion on memory and thinking. The claim under review was submitted by AlzChem.

10. Creatine supplementation for treating symptoms of depression: a systematic review and meta-analysis

    Eckert I, Lima J, Dariva AA. British Journal of Nutrition, 2025. Abstract only. Used for the size and certainty of effects on depression symptoms. Conflict statements were not visible to us.

11. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players

    van der Merwe J, Brooks NE, Myburgh KH. Clinical Journal of Sport Medicine, 2009. Abstract only. The study behind the hair-loss concern: 20 men enrolled, and hair was not measured.

12. Does creatine cause hair loss? A 12-week randomized controlled trial

    Lak M et al., Journal of the International Society of Sports Nutrition, 2025. Full text read. Used for hair outcomes: 38 men completed 12 weeks. Several authors disclose advisory or consulting roles with supplement companies.

13. Agency Response Letter, GRAS Notice No. GRN 000931 (creatine monohydrate)

    U.S. Food and Drug Administration, 2020. Full text read. Used for the scope of FDA's response to AlzChem's notice about one company's ingredient in foods at 1 g of creatine per serving.

14. FDA 101: Dietary Supplements

    U.S. Food and Drug Administration. Used for premarket approval and the advice to talk with a health care professional before taking a supplement.

15. Creatine: What It Does, Benefits, Supplements & Safety

    Cleveland Clinic, last updated April 26, 2023. Used only for the groups in which it says evidence of safety is insufficient. Some of its other statements conflict with trial evidence, so we did not rely on them.

16. USANA Introduces 3-in-1 Protein, Creatine, and Electrolyte Drink Mix

    USANA Health Sciences, August 17, 2026. Launch announcement used for the creatine amount, which the label does not state, and for flavors, formats, and mixing directions. A company statement, not independent testing. Read September 23, 2026.