Creatine monohydrate is probably the best-studied supplement in sports nutrition: hundreds of randomized studies, dozens of meta-analyses and official positions of specialized organizations. The editors collected the main points from this evidence base and separately analyzed where the effect has been convincingly proven, and where the data are still preliminary.
Why creatine is considered the "gold standard"
Creatine is a natural compound that the body synthesizes from the amino acids arginine, glycine, and methionine, and also obtains from meat and fish. Approximately 95% of creatine stores are concentrated in skeletal muscle, where a significant portion exists in the form of phosphocreatine. It is phosphocreatine that provides instant ATP recovery in the first seconds of maximum effort.
Classic works by Swedish and British physiologists in the early 1990s showed that taking creatine increases its content in muscles, and the most in people with initially low levels. This became the physiological rationale for all subsequent performance studies: if the "fuel tank" for short efforts is larger, then repeated sprints or sets should be performed better.
Unlike many fashionable supplements, creatine has a clear biochemical model of action that can be measured: creatine content in muscle biopsies, magnetic resonance spectroscopy, dynamics of phosphocreatine resynthesis after exercise. Therefore, its evidence base is based not only on test results, but also on direct confirmation of the mechanism.
In a 2017 position statement, the International Society of Sports Nutrition (ISSN) named creatine monohydrate the most effective ergogenic supplement available to athletes for increasing high-intensity performance and lean mass gains. The 2018 International Olympic Committee consensus also placed creatine among a small group of supplements with a solid evidence base.
It is important that most of the studies were performed with monohydrate. When we talk about the "proven benefits of creatine," we're primarily talking about this form—other salts and "enhanced" options mostly don't have a comparable amount of data.
Strength, power and muscle mass
The most consistent effect of creatine is increased adaptation to strength training. A review by Rawson and Volek (2003), which summarized dozens of studies, found that combining creatine with strength training produced, on average, significantly greater gains in maximal strength and endurance than placebo training. The authors estimated an additional increase in strength of approximately 8% and in submaximal repetitions of approximately 14%.
A meta-analysis by Branch (2003) confirmed that the effect is most pronounced in short repetitive efforts lasting up to 30 seconds, that is, exactly where the phosphocreatine system plays a major role. A later meta-analysis by Lanhers et al. (2017) separately for the upper limbs also found a statistically significant increase in strength in the bench press and other exercises.
Regarding muscle mass, the picture is more complicated than it appears from the advertisement. Part of the early weight gain is water that gets trapped inside the muscle cells along with the creatine. However, long-term studies with measurement of fat-free mass by DXA or MRI methods also show a real additional increase in tissue against the background of training.
Probable mechanisms of this effect: greater volume of high-quality training work, cellular hydration as an anabolic signal, effects on the expression of growth factors and activity of satellite cells. None of these mechanisms "work" without training - creatine enhances the response to exercise, not replaces it.
Individual variability should also be remembered. Some people, especially those with a high initial level of creatine in the muscles (for example, those who eat a lot of meat), respond to the supplement less. In research, they are sometimes called "non-responders", although the clear boundary here is arbitrary.
Sprinting, team sports and endurance
In sprint and game sports—football, hockey, basketball, rugby—the primary requirement for a player is the ability to repeat short, explosive efforts with incomplete rest. Studies with repeated sprints and cycle ergometer interval tests generally show that creatine helps maintain power in subsequent repetitions better.
The effect on a single sprint is less stable than on a series of sprints. This is logical: in the first effort, the stores of phosphocreatine are still full, and the difference is manifested when they need to be quickly restored between repetitions. Therefore, sports and interval training are the main "target audience" of creatine among non-strength athletes.
In pure aerobic endurance - marathon, long-term cycling - almost no direct benefits of creatine for the result were found. In addition, an increase in body weight of 1–2 kg may be undesirable where every kilogram counts. At the same time, creatine can be useful during training phases with high-intensity intervals or for finishing acceleration.
In the table below, we have summarized how convincing the data is for different load types.
| Load type | Strength of evidence | Editorial comment |
|---|---|---|
| Strength training, maximum strength | High | Agreed results of meta-analyses |
| Lean mass against the background of training | High | Part of the increase is intracellular water |
| Repeated sprints, game types | Moderate-high | The greatest effect in series of efforts |
| Single sprint | Moderate | Results are heterogeneous |
| Long-term aerobic endurance | Low | Benefits for the result have not been proven |
| Cognitive functions | Preliminary | Stronger effect for stress and lack of sleep |
For athletes of weight categories, the trade-off between performance gain and weight gain should be evaluated separately. In many cases, the decision depends on the stage of the season and not on the supplement itself.
Recovery, injury, ageing and the brain
In addition to direct performance, researchers have studied the effects of creatine on recovery from injurious loads, on muscle preservation during immobilization, and on rehabilitation after injuries. The results here are less clear-cut: some works show a faster recovery of strength and a smaller decrease in mass during limb immobilization, while others did not find such an effect.
Much more convincing data has been accumulated for older people. A meta-analysis by Chilibeck et al. (2017) showed that creatine combined with strength training in older adults produced greater gains in lean mass and strength than training without the supplement. This is practically an important conclusion for the prevention of sarcopenia.
Separate direction — brain. Creatine and phosphocreatine are also in nervous tissue, although it is more difficult to increase their content there than in muscles. A systematic review by Avgerinos et al. (2018) concluded that creatine can improve short-term memory and thinking, especially under conditions of stress, sleep deprivation, and in the elderly. The authors emphasize the small number of studies and their heterogeneity.
Interestingly, vegetarians who receive little creatine with food have shown a more pronounced response to the supplement, both muscular and cognitive, in a number of studies. This is consistent with the idea that creatine is most beneficial to those whose baseline stores are lower.
The potential role of creatine in some neurological and muscle diseases is also being studied, but these data relate to clinical medicine, not sports practice, and are not a basis for self-medication.
Who benefits the most
Summarizing the evidence base, the editors single out several groups for whom taking creatine monohydrate makes the most reasonable sense:
- athletes of strength and speed-strength disciplines — weightlifting, powerlifting, sprinting, throwing;
- players of team game sports with repetitive explosive actions;
- people who train with weights to gain muscle mass;
- vegetarians and vegans with low intake of creatine with food;
- older people who perform strength training to preserve muscle.
Long-distance runners, athletes who are critically underweight, and people who do not exercise regularly will experience less or questionable benefit. In them, the effect is either not manifested, or does not outweigh the unwanted weight gain.
It is also worth considering that creatine does not remove limitations of the training program, sleep and nutrition. Studies show additional gains with properly structured workouts, but these gains are relatively small compared to the effect of the load itself.
Finally, in real life, product quality matters. Supplements can be contaminated or contain what is not indicated on the label, so it is advisable for athletes undergoing doping control to choose products with independent batch certification.
Editorial conclusion
Creatine monohydrate has one of the strongest evidence bases of any sports supplement. Its benefits for strength, power, strength endurance and lean mass growth against the background of weight training have been most convincingly proven.
In competitive sports, creatine helps maintain power in repeated sprints, while no benefit has been demonstrated for long-term aerobic endurance. Data on cognitive function and recovery from injuries are promising, but still preliminary.
People with low baseline creatine levels, particularly vegetarians and older people who exercise, benefit the most.
To get a complete picture, we advise you to read our materials "How to take Creatine monohydrate: dosage, time of administration, duration", "Side effects of Creatine monohydrate" and "Myths about Creatine monohydrate".
References
- Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18.
- Harris RC, Söderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci (Lond). 1992;83(3):367â374.
- Rawson ES, Volek JS. Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J Strength Cond Res. 2003;17(4):822â831.
- Branch JD. Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab. 2003;13(2):198â226.
- Lanhers C, Pereira B, Naughton G, et al. Creatine supplementation and upper limb strength performance: a systematic review and meta-analysis. Sports Med. 2017;47(1):163â173.
- Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access J Sports Med. 2017;8:213â226.
- Avgerinos KI, Spyrou N, Bougioukas KI, Kapogiannis D. Effects of creatine supplementation on cognitive function of healthy individuals: a systematic review of randomized controlled trials. Exp Gerontol. 2018;108:166â173.
- Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439â455.
