Creatine is the one supplement that survived the evidence, and most of what is claimed for it still has not

Creatine monohydrate has strong and consistent evidence for improving performance in short, high-intensity, repeated efforts and for supporting lean mass gains alongside resistance training. Roughly 3 to 5 g per day is sufficient; loading is optional and only changes how fast saturation is reached. It does not damage the kidneys in healthy people, does not cause hair loss on current evidence, and the cognitive and mood claims are promising but far less settled than the performance ones.

By Better Baseline · Last updated 15 September 2026

There are a few hundred supplements on the shelf and one of them has several hundred human trials behind it. That asymmetry is the whole story, and it is routinely obscured by putting creatine in a blend with eleven other ingredients that have none.

What creatine actually does

Short, maximal efforts run on phosphocreatine. It donates a phosphate to regenerate ATP faster than any other pathway, and the store is small enough to be depleted within roughly ten seconds of all-out work. Supplementation raises intramuscular creatine and phosphocreatine stores by roughly 20 to 40 percent depending on starting levels, which shortens the time to resynthesise ATP between efforts.

That mechanism predicts exactly where the benefit shows up: the fifth set, not the first; the sixth sprint, not the opening one; the extra rep at a given load rather than a higher one-rep max. Over months, more accumulated work at a given intensity is the mechanism by which it contributes to lean mass.

Some of the early weight gain is intracellular water, because creatine is osmotically active. That is not a trick and it is not fat, but it is also not contractile tissue, and it is why the scale can move two or three pounds in the first fortnight.

Dosing, stripped of the marketing

3 to 5 g per day of creatine monohydrate. That is it. Muscle saturates at that intake within roughly three to four weeks.

Loading is optional. Around 20 g per day split into four doses for five to seven days reaches saturation faster, then drops to the maintenance dose. It changes the timeline, not the destination, and it is the phase where gastrointestinal complaints cluster.

Monohydrate, not the expensive forms. Hydrochloride, ethyl ester, buffered and liquid variants have been compared against monohydrate and none has demonstrated superiority. Monohydrate is the form used in the overwhelming majority of the research and it is the cheapest.

Timing does not matter much. Saturation is a function of total daily intake over weeks. Taking it with a meal is reasonable for adherence and for absorption, and that is about the extent of the timing question.

Consistency matters more than any of the above. Stores wash out over roughly four to six weeks off it.

What the evidence actually supports

• Improved performance in repeated high-intensity efforts, resistance training and sprint work. This is the strongest finding and it has held up across decades and hundreds of trials.
• Greater gains in lean mass when combined with resistance training, relative to training alone.
• Some benefit for muscle preservation in older adults training against resistance.
• An emerging and genuinely interesting literature on cognition under stress, sleep deprivation and in vegetarians, where baseline creatine stores are lower.

What it does not support

Kidney damage in healthy people. This one refuses to die. Creatine raises serum creatinine, which is a breakdown product of creatine and a marker used to estimate kidney function. Higher creatinine from supplementation is not higher creatinine from impaired filtration, but it can trigger a worried phone call after routine bloods. Tell whoever ordered the test that you supplement. Long term studies in healthy individuals have not shown renal harm. People with existing kidney disease are a separate conversation and should have it with a clinician.

Hair loss. This traces to a single 2009 study in twenty rugby players that reported an increase in dihydrotestosterone. It measured a hormone, not hair, and the finding has not been replicated in the years since. It is a hypothesis that got treated as a result.

Dehydration and cramping. Repeatedly examined, including in athletes training in heat, and not supported. If anything the intracellular water effect points the other way.

Any benefit in a proprietary blend that does not disclose the creatine dose. If the label does not tell you how many grams you are getting, assume it is under the effective dose, because disclosing 5 g is free marketing when you have it.

The part worth sitting with

Creatine is cheap, unglamorous, out of patent, and it works. That combination is commercially inconvenient, which is why it is so often buried as the fourth ingredient in a product whose marketing is about something else. When evaluating anything else on the shelf, the useful question is not whether it has studies. It is whether it has this many, in humans, at the dose on the label, with results that replicate.

Almost nothing does.

FAQ

How much creatine should I take per day?

3 to 5 g per day of creatine monohydrate is sufficient for most people. Muscle stores saturate at that intake within three to four weeks.

Do I need to load creatine?

No. Loading with roughly 20 g per day for five to seven days reaches saturation faster but produces the same end state as taking 3 to 5 g daily. It is also the phase most associated with gastrointestinal discomfort.

Is creatine bad for your kidneys?

There is no evidence of renal harm in healthy people. Creatine raises serum creatinine, which is a marker used to estimate kidney function, so bloods can look alarming without kidney function being affected. Mention supplementation when you have bloods drawn.

Does creatine cause hair loss?

Current evidence does not support it. The concern originates from one 2009 study in twenty rugby players that measured a rise in dihydrotestosterone, not hair loss, and it has not been replicated.

Which form of creatine is best?

Monohydrate. Hydrochloride, ethyl ester, buffered and liquid forms have not demonstrated superiority over monohydrate, which is also the form used in most of the research and the cheapest.

When should I take creatine?

Timing has little effect, because the benefit comes from saturated muscle stores built over weeks. Take it whenever you will consistently remember, ideally with a meal.

Does creatine help with cognition?

The evidence is early but real, with the clearest signals under sleep deprivation, under stress, and in vegetarians whose baseline stores are lower. It is considerably less settled than the performance evidence.

Sources

• Kreider RB et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport and medicine. Journal of the International Society of Sports Nutrition, 2017.
• Antonio J et al. Common questions and misconceptions about creatine supplementation. Journal of the International Society of Sports Nutrition, 2021.
• van der Merwe J et al. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical Journal of Sport Medicine, 2009.
• Candow DG et al. Effectiveness of creatine supplementation on aging muscle and bone. Journal of Clinical Medicine.

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