Creatine supplements – do they do anything?

22nd August 2025, A/Prof Chee L Khoo

Creatine

We always worry when athlete patients take supplements to improve their workout and performance. We don’t really know what these “supplements” are. We don’t really know whether they work or whether they are safe. One of the most commonly used supplements is creatine. Does it help muscle building and performance? Does it help to lose fat? Does it cause increase in fat mass? Is it ok for older patients? Is it ok for females?  What about children? If it is helpful, how much should they take? As doctors, we need to know the answers to many of those questions as patients look to us for answers.

Creatine was first identified in 1832 when Michel Eugène Chevreul isolated it from the basified water-extract of skeletal muscle. He later named the crystallized precipitate after the Greek word for meat, κρέας (kreas) (1). Studies in the 1920s showed that consumption of large amounts of creatine did not result in its excretion.

Creatine is involved in the regeneration of ATP (from ADP) for use as an energy source. During times of increased energy demands, phosphocreatine (PCr) is involved in the rapid conversion of ADP to ATP through a reversible reaction catalysed by the enzyme creatine kinase. 95% of creatine in the body is found in skeletal muscles. Approximately 1–2% of intramuscular creatine is degraded per day and an individual would need about 1–3 grams of creatine per day to maintain average (unsupplemented) creatine storage. An omnivorous diet provides roughly half of this value, with the remainder synthesized in the liver and kidneys.

Because of the widespread use of creatine supplements, the International Society of Sports Nutrition (ISSN) published an updated position stand in 2017 on the safety and efficacy of creatine supplementation in exercise, sport, and medicine [2].

Creatine supplementation and muscle benefits

Creatine supplementation increases muscle availability of creatine and PCr and can enhance acute exercise capacity and training adaptations in adolescents [3-7], younger adults [8,9] and older individuals [10-12]. This allows an athlete to do more work over a series of sets or sprints leading to greater gains in strength, muscle mass, and/or performance due to an improvement in the quality of training.

Creatine supplementation has primarily been recommended as an ergogenic aid for power/strength athletes to help them optimise training adaptations or athletes who need to sprint intermittently and recover during competition. After creatine loading, performance of high intensity and/or repetitive exercise is generally increased by 10–20% depending on the magnitude of increase in muscle PCr [13].

Does it help to lose fat? Does it cause increase in fat mass?

There has been many studies looking into the benefit of creatine supplements but most of the studies were small studies with limited power because of small numbers of participants. A recent meta-analysis, in adults < 50 years of age, the combination of resistance exercise and creatine supplementation had no effect on absolute fat mass compared to resistance exercise alone but resulted in a minimal reduction in body fat percentage (1.19%) (14).This suggests that creatine supplement in combination with resistance exercise increase muscle mass which results in a better fat:muscle ratio. Creatine supplementation combined with resistance exercise does not increase fat mass in adults < 50 years of age.

Is creatine beneficial for older adults?

Creatine supplements increase functionality (e.g., strength, activities of daily living, delay fatigue) and muscle mass in older adults [15-17]. But creatine supplement has to be combined with resistance training program. The fact that creatine is more effective when combined with a training stimulus suggests that the main mechanistic action of creatine is its ability to enhance training volume and/or intensity, which may influence muscle protein kinetics, growth factors, satellite cells, inflammation and/or oxidative stress [15-17], ultimately resulting in greater skeletal muscle adaptations.

Does creatine supplement benefit women?

Creatine kinase levels are significantly elevated during menstruation [18], with CK levels decreasing throughout the menstrual cycle, pregnancy, and with age. The lowest range of CK values have been reported during early pregnancy (20 weeks or less), equating to about half the concentration found at peak levels (teenage girls) [18-19].

In postmenopausal females, creatine supplementation during a resistance training program can improve muscle mass, upper- and lower-body strength, and tasks of functionality [15]). Vandenberghe et al. [20] showed that creatine during 10 weeks of resistance training significantly increased intramuscular concentrations, muscle mass and strength compared to placebo in females (19-22 yrs). In elite female soccer players (22 ± 5 yrs), creatine supplementation (20 g/day for 6 days) improved sprint and agility performance compared to placebo [21].

Is it just strength and performance?

Creatine supplementation with carbohydrate or carbohydrate and protein has been reported to promote greater muscle glycogen storage than carbohydrate supplementation alone. Since glycogen replenishment is important for promoting recovery and preventing overtraining during intensified training periods [2, 22], creatine supplementation may help athletes who deplete large amounts of glycogen during training and/or performance (i.e., sporting events) to maintain optimal glycogen levels.

Creatine supplementation may reduce muscle damage and/or enhance recovery from intense exercise. Cooke et al [23] reported that creatine supplementation during recovery from exercise-induced muscle damage promoted less muscle enzyme efflux and better maintenance of isokinetic muscle performance. Moreover, there is evidence that individuals supplementing their diet with creatine experienced less muscle damage, inflammation, and muscle soreness in response to running 30-km [24] as well as during 4-weeks of intensified training. Athletes who supplement with creatine during training experience had fewer musculoskeletal injuries, accelerated recovery time from injury and less muscle atrophy after immobilization.

Creatine supplementation may reduce the risk of heat-related illness when athletes train and/or compete in hot and humid environments. There is evidence from animal models that creatine supplementation is neuroprotective and can reduce the severity of spinal cord injury, cerebral ischemia and concussion/traumatic brain injury.

In summary, creatine supplement (in combination with resistance exercises) is beneficial for muscle strength, performance, recovery and tolerance. It is not just beneficial in athletes or body builders, it is also beneficial in women and older patients. Creatine supplementation appears to be generally safe and potentially beneficial for children and adolescents (2). It is recommended that daily dosages of creatine supplementation (3-5 g or 0.1 g/kg of body mass) are effective.

References:.

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