Creatine benefits

Does creatine work for muscle and strength?

Performance in short-duration high-intensity exercise

EFSA concluded that a cause-and-effect relationship was established between creatine consumption and increased performance in short-duration, high-intensity, repeated exercise; it stated that 3 g per day needs to be consumed for the effect to be seen and that the target population is adults performing high-intensity exercise. ^[1] In the EU health claims register, the claim “creatine increases physical performance in successive bursts of short-term, high intensity exercise” is listed as authorised; the claim can be used only for foods providing 3 g of creatine per day and for products aimed at adults performing high-intensity exercise. ^[2]

The mechanism of the effect is an increase in phosphocreatine stores in muscle; according to EFSA, the greatest improvements are seen in repeated sets of very high-power efforts that can last a few seconds, separated by 20–60 seconds of rest, in the later repetitions of the set (for example, the third, fourth and fifth), where performance may rise by 5–20%. ^[1]

Lean mass and strength with training

The meta-analysis by Branch (2003) covered 96 peer-reviewed articles (100 studies) meeting the conditions of random allocation, placebo control and blinding. The effect of creatine was small but significant; the effect size was larger for lean mass change with short-term use, for laboratory-based repeated efforts of 30 seconds and under, and for upper-body exercises. The meta-analysis found no evidence of an effect of sex or training status on effect size. ^[3] The Branch analysis does not examine resistance training programs separately; the Nissen and Sharp (2003) meta-analysis relayed by EFSA reports an effect in favor of lean mass (effect size 0.26; 95% CI 0.17–0.34) and strength (0.36; 0.28–0.43) during repeated resistance training with 3–13 weeks of use. ^[1]

The limit of these results: the meta-analysis was published in 2003; it does not cover later studies. Part of the weight gain may be due to an increase in body water; EFSA relays that a 1–3 kg increase is often reported with 5–7 days of use. ^[1]

Does creatine improve endurance performance?

No benefit shown. EFSA stated that no difference was found in any of the three human intervention studies examined for endurance capacity and that there is no consensus among experts in this area; it concluded that a cause-and-effect relationship could not be established for either endurance capacity or endurance performance. ^[1] The Branch meta-analysis likewise reported that creatine did not appear effective in improving running and swimming performance. ^[3]

Does creatine work in older adults?

The 2017 meta-analysis by Chilibeck and colleagues pooled 22 randomized studies (721 participants; men and women; mean age across studies 57–70; resistance training 2–3 days per week, 7–52 weeks) comparing creatine with placebo during resistance training in older adults. In the creatine group, lean mass increased by an average of 1.37 kg (95% CI 0.97–1.76) more than with placebo; the standardized mean difference in leg press strength was 0.24 (0.05–0.43). ^[4]

This result applies to use together with resistance training. The ISSN 2021 paper states that it is unlikely that creatine alone (without resistance training) provides marked strength and function gains in older adults; in most studies, use alone for more than a month did not increase lean mass. The same paper relays that in a two-year study of 3 g per day in postmenopausal women, lean mass did not increase, and says that part of the mass gains seen in short studies may be due to water retention. ^[10] The EFSA 2018 guidance also relays that a favorable assessment on this subject was made in 2016: in adults aged 55 and over performing regular resistance training, an effect of at least 3 g/day of creatine on muscle strength together with training three times per week was supported by ten human studies; when the same weekly amount was taken only on training days, no such effect was seen. ^[11] This is a health claim assessment; it is not a personal dose recommendation.

Does creatine work in women and vegetarians?

In the randomized, double-blind study by Burke and colleagues, 18 vegetarian and 24 non-vegetarian adults (aged 19–55) performed resistance training for eight weeks and received placebo or creatine. At baseline, total muscle creatine was lower in vegetarians (117 mmol/kg vs 130 mmol/kg). In vegetarians receiving creatine, total creatine, phosphocreatine, lean tissue and total work performance rose more than in non-vegetarians receiving creatine. The authors suggested that people with low baseline creatine levels are more responsive to supplementation. ^[9] The groups are small (8–12 people per group).

For women, the ISSN 2021 paper relays that creatine kinetics may differ between men and women and that in some studies responsiveness or the performance effect may be smaller in women; it adds that hormone-related differences in creatine kinetics have been largely ignored in performance studies. ^[10]

Does creatine affect memory and cognitive function?

In the 2023 systematic review by Prokopidis and colleagues, 10 RCTs on memory in healthy individuals were examined; 8 were included in the meta-analysis. Overall, creatine increased memory measures compared with placebo (standardized mean difference 0.29; 95% CI 0.04–0.53; I² 66%). In the subgroup analysis by age, the effect was larger in the 66–76 age group (0.88; 0.22–1.55; I² 83%) and absent in the 11–31 age group (0.03; −0.14 to 0.20). Dose (about 2.2–20 g/day), duration (5 days–24 weeks), sex or geography did not change the result. ^[5]

This finding has two important limits. First, in the same journal, Eckert and Pascher published a letter to the editor arguing that “double-counting due to inadequate statistics” occurred in the analysis and that this may have led to false-positive findings; the authors responded with a reply letter. ^[6] Second, the 2024 systematic review by McMorris and colleagues reported that creatine increases brain creatine content but that findings for cognitive outcomes are “somewhat equivocal.” ^[7] For this reason, the memory area is a hypothesis still under investigation rather than a strong result.

Does creatine help with depression?

In the double-blind, placebo-controlled study by Lyoo and colleagues, 52 women with major depressive disorder received either 5 g of creatine per day (n=25) or placebo (n=27) together with escitalopram for eight weeks. In the creatine group, greater improvement in the Hamilton Depression Rating Scale score compared with placebo was seen from the second week, and this difference persisted at the fourth and eighth weeks. Those who left treatment early were 8 (32%) in the creatine group and 5 (18.5%) in the placebo group; there was no difference between groups in the frequency of all reported side effects (creatine 36, placebo 45 events). ^[8]

This study is a single trial conducted only in women and only as an add-on to an SSRI; the authors stated that the result is “promising.” Creatine does not replace depression treatment, and the treatment decision for depressive symptoms is made by a physician.

In what other areas has it been investigated?

The ISSN 2021 paper states that evidence is accumulating that creatine may have various beneficial effects in older and patient groups, that age-related sarcopenia is “perhaps the most promising” of the conditions in this area; the same paper stresses that the evidence in this area applies to creatine added to resistance training. ^[10] This guide does not evaluate other clinical areas separately; each disease requires its own level of evidence.

Summary of the evidence

This guide does not recommend a personal dose.