Misunderstood

For decades, creatine has occupied a strange position in the world of health and fitness. Despite being one of the most extensively studied sports supplements available, it continues to be associated with myths about kidney damage, dehydration and even confusion with anabolic steroids. Yet scientific evidence accumulated over more than 30 years paints a very different picture. Today, researchers generally regard creatine monohydrate as safe and effective for most healthy adults when taken at recommended doses.

What is creatine?

Creatine is a naturally occurring compound produced by the liver, kidneys and pancreas. It is also found in foods such as red meat, fish and dairy products. Around 95% of the body's creatine is stored in skeletal muscles, where it is converted into phosphocreatine. This compound helps produce adenosine triphosphate (ATP), the body's primary source of quick energy. This is particularly important during short bursts of high-intensity activity such as sprinting, jumping or lifting weights.

What does creatine do?

Creatine's primary role is to help muscles produce energy more rapidly during intense exercise. Research suggests supplementation may improve strength, power output and exercise performance, particularly during repeated bouts of short-duration, high-intensity activity. It may also help muscles recover following strenuous exercise by supporting energy replenishment within muscle tissue.

Although creatine does not directly build muscle, it can help people train harder and recover more effectively. When combined with resistance training and adequate nutrition, this may contribute to increases in muscle size and strength over time. Researchers have also explored its potential role in reducing age-related muscle loss, known as sarcopenia, and supporting healthy ageing.

What about brain health?

While creatine is best known for its role in sports performance, emerging research suggests it may also support cognitive function. Some studies have found potential benefits during periods of sleep deprivation, intense mental effort and ageing, although researchers say more evidence is needed before firm conclusions can be drawn.

Why do doctors not routinely recommend it?

One reason is simple: most healthy people do not require supplements to maintain good health. Doctors generally prioritise balanced nutrition, regular physical activity, adequate sleep and hydration before recommending supplements. Creatine is also considered an elective supplement rather than a medical necessity for most individuals. In addition, dietary supplements are regulated differently from prescription medicines, meaning product quality can vary between manufacturers.

The myths that refuse to disappear

Myth 1: Creatine damages the kidneys

This is perhaps the most persistent misconception. Research has consistently found that creatine does not harm kidney function in healthy individuals when taken at recommended doses. The confusion arises because creatine breaks down into creatinine, a substance commonly measured during kidney function tests. Supplementation can increase creatinine levels without indicating kidney damage. People with existing kidney disease should consult a healthcare professional before using creatine.

Myth 2: Creatine is a steroid

Creatine and anabolic steroids are entirely different substances. Steroids are synthetic hormones that alter the body's hormonal environment. Creatine is a naturally occurring compound involved in energy production and is found in everyday foods.

Myth 3: Creatine causes dehydration and cramping

Early concerns suggested creatine increased the risk of dehydration and muscle cramps. Current evidence does not support these claims. Creatine draws water into muscle cells, which is part of how it works, but research has not shown it increases dehydration risk in healthy users.

Myth 4: Creatine causes unhealthy weight gain

Many users experience a small increase in body weight during the first few weeks of supplementation. This is typically due to increased water being stored within muscle tissue rather than an increase in body fat.

How much should you take?

Creatine monohydrate remains the most studied and widely recommended form. For most healthy adults, a daily dose of three to five grams is considered sufficient. While some people use a short-term "loading phase" involving larger doses, research suggests this is unnecessary for most users and may increase the likelihood of stomach discomfort.

Who should avoid creatine?

Although creatine is considered safe for most healthy adults, people with pre-existing kidney disease, liver disease or other significant medical conditions should seek medical advice before using it. Pregnant or breastfeeding women should also consult a healthcare professional before taking creatine supplements.

For healthy adults, evidence suggests it can safely improve performance during high-intensity exercise and support gains in strength when combined with regular training. While it is not a miracle supplement, and certainly not a substitute for good nutrition and exercise, much of the fear surrounding creatine stems from myths that scientific research has repeatedly failed to support.