Creatine Explained

Podcast 167: Creatine Explained

You’ve probably heard the basics — it can help you lift heavier and get stronger. But creatine isn’t just a gym supplement. It’s also being studied for brain health, recovery after stroke, and even certain muscle disorders.

In this episode, we’ll break down what creatine actually is, where it comes from — in food and in supplements — how it works in your body, the real benefits, the real risks, and how to dose it safely and effectively.

What is creatine?

Creatine is a type of amino acid made by the liver and kidneys and stored mostly in skeletal muscle in the form of creatine phosphate. It’s also stored in the brain tissue and found in certain foods and in many dietary supplements. 

What does creatine do?

Creatine helps give your body’s muscles energy and strength. When your body needs a sudden burst of energy, your muscles convert creatine phosphate into energy-carrying molecules which help improve athletic perfomance and enhance muscle mass.

Food sources vs. supplements — what’s the difference? 

When it comes to getting creatine from your diet, the best sources are animal-based foods — basically anything high in protein. Think of things like red meat, chicken, turkey, and even dairy. Fish like salmon and tuna are especially rich sources.

On the flip side, plant-based foods don’t contain any creatine at all. So if you follow a vegetarian or vegan diet, your body relies completely on what it makes on its own, which is one reason why creatine supplements often have an even bigger impact in those groups.

Most creatine supplements you’ll see on the shelf are creatine monohydrate, and for good reason — it’s the most studied, effective, and affordable form out there. When you take it, your body naturally converts a portion into phosphocreatine, which is the stored form your muscles use for quick bursts of energy. That’s what really powers short, intense movements like sprints, jumps, or heavy lifts.

You might see some niche products marketed as “creatine phosphate,” but these are rare and there’s little evidence that they work any better than regular monohydrate. The bottom line is that monohydrate reliably boosts your muscle creatine and phosphocreatine stores, so you don’t need a fancy version — your body does the rest naturally.

The key difference between food sources of creatine and creatine monohydrate supplements is amount and consistency. You can get creatine from foods that we mentioned earlier, but the amounts are relatively small. To match the levels used in research for performance benefits, you’d have to eat an unrealistic amount of meat or fish every day.

Creatine monohydrate, on the other hand, delivers a precise, reliable dose that quickly raises your muscle creatine stores. It’s not necessarily “better” biologically — your body ultimately stores it the same way — but supplements are far more efficient, convenient, and consistent, especially for athletes, vegetarians, or anyone who wants the performance and recovery benefits without having to consume copious amounts of animal-based protein.

And before we move on, I want to talk about the three big forms of creatine you’ll see on the shelves/online: powders, gummies, and liquids. 

Creatine powder is  the most studied, the most stable, and definitely the most cost-effective. The only catch is you have to mix it, and some people aren’t fans of the texture because the powder form doesn’t dissolve in liquid very well.

Gummies are used by some people because they taste good and they’re super convenient, but they usually pack less creatine per serving and cost more, so you often need several gummies to reach an effective dose. 

And then there are liquid creatine drinks, which are the easiest to grab and go, but creatine doesn’t stay as stable once it’s dissolved, so you may not get the full potency from the product.

Bottom line: powder is best for value and results. It’s also been studied the most extensively. 

Creatine Benefits

How creatine helps during exercise 

Creatine increases the capacity for short, high-intensity work. If your sport or training includes sprints, jumps, or heavy lifts — things that last seconds — creatine helps you produce more power and repeat those efforts more times. That extra work capacity translates into better training sessions, and over weeks and months, more muscle and greater strength. And we have large position statements and decades of trials back this up. In fact, creatine is one of the best-supported performance enhancing supplements we have. 

Now let’s talk about muscle mass, strength, recovery, and injury prevention. 

There are really two mechanisms that explain the gains people notice:

1. Cell volume effect: creatine draws water into muscle cells. That immediate water increase explains the quick 1–3 kg weight rise many users see during loading. But it’s important to mention here that weight gain is due to intracellular water, not fat.
   
2. Training effect: by improving short-term power and reducing fatigue between sets, you can train harder and more often, which leads to real increases in lean mass and strength over time. In fact, a meta-analysis showed that creatine can help increase muscle size, but there’s a catch — it only works if you’re also doing effective exercise training. Also, interestingly, the boost in muscle size tends to be much stronger in younger adults compared to older adults, so age can play a role in how dramatic the results are. There’s also evidence for faster recovery between repeated high-intensity efforts and for lower markers of muscle damage after some workouts — which may help reduce injury risk.

Brain health and cognition 

Your brain is an energy-hungry organ. Because creatine helps buffer and recycle cellular energy, scientists have tested whether raising brain creatine could help cognitive function, especially under stress (like sleep deprivation) or when baseline stores are low (vegetarians, older adults). 

A recent double-blind crossover study found that a single high dose of creatine (0.35 g/kg) of creatine monohydrate taken during a 21‑hour sleep‑deprivation period significantly improved cognitive performance and altered brain energy‑metabolism markers. This suggests that even an acute dose (rather than only long‑term use) can produce measurable brain‑benefits in the right context.

There’s also some exciting research on head injury recovery. In one randomized trial, children who received creatine after a traumatic brain injury had fewer headaches, less dizziness, and lower fatigue compared to those who didn’t take it. They also spent less time in the ICU and had fewer memory problems. 

Further studies are being conducted to understand creatine’s potential role in preventing symptoms after concussions and traumatic brain injuries, so we’re just starting to understand how it might help the brain recover.

Creatine and neurological diseases — what the trials show 

Creatine is also being studied for neurological health. Animal studies suggest it might help with conditions like Huntington’s disease, Parkinson’s disease, and stroke. The catch? So far, we don’t have strong evidence in humans to show that it is actually effective for these conditions.

Where creatine does show promise is in supporting muscle strength and daily function for people with muscular dystrophies. 

Safety & side effects 

As we mentioned earlier, creatine monohydrate is one of the most well-studied supplements available and is generally very safe for healthy adults when taken at standard doses. A few things to be aware of:

• Initial weight gain — you might notice 1–3 kg on the scale during the loading phase, mostly from water in your muscles. Over time, especially if you’re doing resistance training, some of that weight can turn into actual muscle gain.
  
• Digestive issues — taking a big dose at once can sometimes cause nausea, stomach upset, or diarrhea. Splitting your dose throughout the day or taking it with food usually helps.
  
• Muscle cramps or stiffness — a few people notice tightness or cramping, particularly in the legs. Staying hydrated can help reduce this risk.
  
• Trouble with heat — some individuals may feel more sensitive to hotter temperatures when supplementing with creatine, so extra hydration and caution during intense heat is wise.

Does creatine damage kidneys? This is the big myth vs. reality question. Creatine supplementation raises serum creatinine (the lab value commonly used to estimate kidney function), because you’re creating and breaking down more creatine. But multiple systematic reviews and clinical studies have not demonstrated that typical creatine dosing causes renal damage in healthy people. 

That said, because creatine affects creatinine lab values, it can confound kidney tests — and anyone with preexisting kidney disease should consult their clinician before starting creatine. Recent meta-analyses show small rises in serum creatinine but no clinical renal harm in healthy adults during studied durations. 

What about drug interactions with creatine?

Creatine doesn’t interact with other medications the way a prescription drug might, but there are a few things to keep in mind. If you’re taking NSAIDs (e.g., ibuprofen or naproxen) or certain blood pressure medications (e.g., ACE inhibitors or ARBs), these medications can sometimes increase the risk of kidney issues. Both ACE inhibitors and ARBs widen the blood vessels leading out of the kidneys, which can temporarily lower filtration pressure and mildly increase creatinine—especially when you first start them or if you’re dehydrated. When combined with creatine (which can also slightly raise serum creatinine), it can look like your kidney function has worsened even though the change is often harmless and reversible.

The same goes for diuretics (e.g., hydrochlorothiazide or furosemide). Diuretics change your fluid balance, and creatine pulls water into your muscles, so you want to make sure you’re staying hydrated and keeping an eye on kidney labs. 

Creatine itself doesn’t cause kidney damage, but because it can raise your creatinine levels in lab tests, it’s a good idea to check with your doctor if you take these regularly.

Dosage

Lastly, I want to talk about creatine doses. There are two common, evidence-backed approaches:

1. Loading + maintenance: 0.3 grams per kilogram of body weight per day (split into 4 doses) for 5–7 days, then 3–5 g/day maintenance. This saturates muscle stores faster.
   
2. No-load (daily): 3–5 g/day continuously — reaches saturation over 3–4 weeks and avoids the higher short-term dose that can cause GI issues.

The main difference between the two schedules is that a loading dose gets you results faster. But since the end effect is the same, many experts actually suggest skipping the loading phase altogether.

Use creatine monohydrate — it’s cheap, stable, and the most studied form. Look for third-party tested products to ensure purity and potency.

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