How to use creatine

Which creatine protocols have been applied in studies?

Loading and maintenance

The ISSN’s 2017 position stand describes the most effective way to raise muscle creatine and phosphocreatine stores as 5 g of creatine monohydrate four times a day (about 0.3 g/kg body weight) for 5–7 days. It relays that after stores are full they can be maintained with 3–5 g/day, but that in some studies large athletes may take 5–10 g/day to maintain stores. ^[1] The IOC’s 2018 consensus statement describes a similar protocol: about 20 g/day (in four equal doses) for 5–7 days, then 3–5 g/day. ^[4]

The ISSN 2021 paper defines “loading” as 20–25 g per day for 5–7 days, an amount mostly split into 4–5 servings; it can also be given as 0.3 g/kg/day by body weight, followed by 3–5 g per day of maintenance. ^[2]

Low daily amount without loading

According to ISSN 2017, taking 3 g of creatine for 28 days raises muscle creatine only gradually, and performance effects are less supported until stores are full. The same paper states that initially with 3–5 g per day, stores rise over three to four weeks. ^[1]

As seen in the table, the sources give different values for the maintenance amount (2 g, 3 g, 3–5 g); these are the products of different approaches and this page does not choose among them.

Is creatine loading necessary?

The ISSN 2021 paper states that the belief that “loading” is necessary to see the effects of creatine is a common misconception; it reports that lower amounts such as 3–5 g per day increased muscle creatine, muscle gain and performance compared with placebo. Lower amounts delay maximal storage; the paper says that taking 3–5 g per day for at least four weeks provides similar saturation. According to the paper, for an athlete who wants to maximize the effect in under 30 days, loading “may be reasonable”; for a person planning to use it for longer than 30 days or who wants to avoid the weight gain that can be seen during loading, a maintenance strategy is a suitable option. ^[2]

The classic comparison on which this claim rests is the study by Hultman and colleagues in 31 men: total muscle creatine rose by about 20% with 20 g per day over 6 days; with 3 g per day over 28 days a similar, but slower, 20% rise was seen. The high level was maintained with 2 g per day over the following 30 days. ^[3] EFSA also relays that total muscle creatine rose by an average of 15–20%, that this could be achieved with 20 g per day in 4–5 days or with 3 g per day in a month, and that there is large variability between people. ^[5]

How much at one time? Digestive tolerance

The ISSN 2021 paper states that single servings above 10 g during loading may cause digestive distress (diarrhea) and that servings of 10 g and under are therefore emphasized. ^[2] In the study by Ostojic and Ahmetovic, 59 elite male soccer players were divided double-blind into three groups for 28 days: 5 g twice daily (C5), 10 g once daily (C10) or placebo. The most commonly reported complaints were diarrhea (39.0%), stomach discomfort (23.8%) and belching. There was no difference between C5 and placebo; diarrhea was 28.6% in C5, 55.6% in C10 and 35.0% in the placebo group, and C10 was significantly higher than both C5 and placebo. The authors concluded that the risk may be increased when 10 g is taken in a single serving. ^[8] The data rest on a complaint questionnaire and cover only elite male soccer players.

Should creatine be taken before or after training, and does it matter?

In the randomized, double-blind, placebo-controlled study by Dinan and colleagues, 34 male and female collegiate athletes performing resistance training received, for 8 weeks, placebo, 5 g of creatine monohydrate within one hour before training, or 5 g of creatine monohydrate within one hour after training; each dose was given with 25 g of whey protein isolate and 25 g of maltodextrin. Lean mass and strength increased to a similar extent in all groups; the authors concluded that creatine timing had no additional effect on the measured outcomes. ^[7] The number of participants is small; the ISSN and IOC papers define no specific time for timing. ^{[1] [4]}

Is creatine taken with carbohydrate or protein?

ISSN 2017 states that taking creatine with carbohydrate, or with carbohydrate and protein, has been reported to increase creatine retention more consistently, but that the effect on performance measures may not be greater than creatine alone. ^[1] The IOC paper says that taking it with a mixture of about 50 g of protein and carbohydrate may increase muscle creatine uptake through insulin stimulation. ^[4] These data rest on muscle content measurements; a difference in clinical outcome has not been proven.

Can creatine be taken with caffeine?

In the 1996 study by Vandenberghe and colleagues, 9 healthy men received for 6 days placebo, 0.5 g/kg of creatine per day, or the same creatine together with 5 mg/kg of caffeine per day. Muscle phosphocreatine rose by 4–6% in the creatine and creatine-plus-caffeine groups; dynamic torque production rose by 10–23% with creatine but did not change in the creatine-plus-caffeine group. The authors concluded that the ergogenic effect of creatine was abolished by caffeine. ^[6] This result rests on a single 9-person study, a high creatine loading amount and a short duration; it is not sufficient for generalization.

How long is creatine used, and is a break needed?

According to ISSN 2017, after muscle creatine stores are raised, when use is stopped it generally takes 4–6 weeks for stores to return to baseline. The paper states that there is no evidence that muscle creatine falls below baseline after stopping; therefore the possibility of long-term suppression of the body’s own creatine production has not been seen. ^[1] In the Hultman study as well, when no support was given after loading, total creatine fell to baseline within 30 days. ^[3]

On duration, studies show the following: the ISSN reports studies lasting up to 5 years at doses of 0.3–0.8 g/kg per day; the IOC states that long-term use (up to 4 years) showed no adverse health effect when appropriate loading protocols were followed. ^{[1] [4]} A mandatory break schedule for use within these ranges is not described in these sources.

Does creatine degrade in liquid?

Creatine, which is stable in solid form, may convert to creatinine in aqueous solution; conversion accelerates as pH falls and temperature rises. ISSN 2017 relays that in a solution stored at 25 °C for 3 days, creatine converts to creatinine at rates of 4% (pH 5.5), 12% (pH 4.5) and 21% (pH 3.5). The same paper states that this does not mean conversion also occurs during digestion: conversion in the digestive tract is minimal regardless of transit time, and absorption is about 100%. ^[1]

Who should consult a physician before use?

• People with pre-existing kidney disease: The ISSN relays the view that these people should consult a physician as a precaution (not as its own recommendation, but as the view of some authors); few studies have been done in this group (details on the harms page). ^[1]
• Pregnant and breastfeeding women: The ISSN 2021 paper states that no human study evaluating creatine supplementation in pregnancy exists. ^[2]
• Under 18: The ISSN states it finds this acceptable only under certain conditions (supervised competitive training, balanced diet, knowledge of use, not exceeding recommended amounts). ^[1]
• People using regular medication and those monitored with a creatinine test: Creatine can raise blood creatinine; test interpretation is done with this information. ^[2]

This guide does not recommend a personal dose; the amounts above are protocols described in studies and institutional papers.