Unless you’ve recently arrived from another planet, you probably know already that creatine is one of the few supplements out there that actually works.
Creatine has been used as a way to improve athletic performance a lot longer than most people think.
As far back as the 1970s, Soviet scientists knew that creatine supplements improved athletic performance, and it was routinely given to athletes representing the USSR .
Despite the massive amount of research that’s been done on creatine, there are still a number of legends, myths and fairy stories that surround its use.
Are creatine supplements safe? What are the side effects? Why doesn’t it work equally well for everyone? And does creatine cause hair loss?
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Let’s start at the top.
What Is Creatine and What Does It Do?
The value of creatine lies mainly in its ability to raise creatine levels in muscle. This in turn improves recovery between sets, which enhances both the quality and quantity of work you’re able to do during a workout. Over time, this leads to faster gains in both strength and size.
Besides elevating muscle creatine levels, which has a direct effect on your performance in the gym, creatine may boost muscle growth via an effect on satellite cell proliferation and differentiation , myostatin levels , and IGF-I signaling.
New benefits seem to pop up all the time, particularly in the area of cognitive function. It’s cheap, it’s safe and it works.
Are Creatine Supplements Safe?
Creatine is often criticized in the press, mainly on the basis of individual case studies where a small number of people do stupid things at the same time they happen to be taking creatine.
There are also a few reports of renal health disorders linked with the use of creatine . Again, these are mainly isolated case studies where someone with a pre-existing medical condition developed further health problems while using creatine.
If you have a history of renal disease, or you’re taking nephrotoxic medications (i.e. drugs with the potential to affect kidney function), using creatine may aggravate the condition. But in healthy individuals, there are numerous studies to show that creatine supplementation is safe .
- Eight weeks of creatine supplementation had no negative effects on blood and urinary clinical health markers in football players taking 15 grams per day of creatine for 7 days and 3 grams per day for the remaining 49 days .
- Over a 21-month period, 98 American football players took either creatine or non-creatine containing supplements after training sessions . Blood and urine samples were collected on nine separate occasions. Creatine had no adverse effect on various markers of health status compared to athletes not taking creatine.
- Twenty-three members of an NCAA Division II American football team were divided into a creatine group and a control group who took no supplements . Subjects in the creatine group averaged 14 grams of creatine a day for three years. The researchers could find no detrimental effects on either kidney or liver function.
There are also claims that creatine users are more susceptible to cramps, muscle spasms, and even pulled muscles.
But again, the research tells a different story. A three-year study shows that creatine (5 grams per day) had no effect on the incidence of injury or cramping in a group of American footballers .
In a retrospective study of 26 athletes using creatine for up to four years, there was no difference in the reported incidence of muscle cramp or injury compared with athletes not using creatine .
Is Taking Creatine Good for You?
When you take creatine, it affects more than just your muscles. Creatine supplementation also raises levels of creatine in the brain .
Not only is higher brain creatine associated with improved neuropsychological performance, creatine has shown promise in the treatment of a variety of neurodegenerative diseases, including Parkinson’s disease .
Creatine can also improve mental function during periods of sleep deprivation. Sleep deprivation has a negative effect on cognitive performance and mood state, which is partially due to a decrease in brain creatine levels.
By supplementing with creatine, you can offset the decline in mental performance that normally happens when you’re short on sleep.
In one study, subjects were divided into a creatine group and a placebo group . Before the experiment, they took 5 grams of creatine monohydrate or a placebo 4 times a day for 7 days.
Subjects then undertook a series of tests before and after 6, 12 and 24 hours of sleep deprivation. It was only the creatine group that showed no major change in performance, choice reaction time, balance and mood state. The placebo group, on the other hand, got significantly worse.
In a group of elite rugby players, both low and high doses of creatine (50 or 100 milligrams of creatine per kilogram of bodyweight) worked just as well as caffeine at wiping out the effects of sleep deprivation on the performance of a simple rugby skill test .
There was no significant difference between the high and low doses. But there was a trend for the higher creatine dose to have a greater impact on skill performance than the lower dose.
Can Creatine and Caffeine Be Used Together?
The concern around using creatine and caffeine together comes from a 1996 study, where Belgian researchers showed that caffeine interferes with some of the performance-enhancing effects of creatine .
The Belgians thought that the addition of caffeine might actually make creatine work better. Instead, the opposite was true. Even though creatine and caffeine elevated muscle creatine levels to the same extent as creatine alone, it was only the latter that improved performance.
However, subjects in this study consumed very high doses of caffeine (5 milligrams per kilogram of bodyweight per day) for three of the six days they were loading with creatine. That’s the equivalent of 400 milligrams of caffeine for someone weighing 80 kilograms.
To put that number in context, one cup of coffee contains 65-115 milligrams of caffeine. Soft drinks contain 10-50 milligrams of caffeine per 12-ounce serving.
The dosing protocol was set up so that subjects had high levels of caffeine in their blood at the same time as they took the creatine. But in some of the early studies showing that creatine improves performance during high-intensity exercise, it was actually given to subjects dissolved in warm caffeinated drinks, such as coffee or tea.
In other words, only high doses of caffeine have been shown to interfere with the performance-enhancing effects of creatine. Smaller doses, such as the amount found in a cup of coffee or tea, won’t have the same negative impact.
Which Type of Creatine Should You Take?
You might have come across a product called Kre-Alkalyn, a so-called “buffered” form of creatine that’s promoted on the basis that it’s safer and more effective than regular creatine.
The makers of Kre-Alkalyn claim that creatine monohydrate is converted into useless creatinine – an end product of creatine metabolism that gets excreted in the urine – long before reaching your muscles.
But this claim is not backed up by any credible research. Even when high doses (20 grams) of creatine monohydrate are ingested, the amount of creatine converted into creatinine in the stomach and gut is negligible .
And if creatine didn’t survive transit through the “treacherous environment” of the stomach, you’d need to find an alternative way to explain the rapid rise of creatine in the blood after consumption of an oral dose of creatine monohydrate , the large rise in muscle creatine levels after several days of supplementation with creatine monohydrate, and the many studies showing that creatine monohydate improves performance during repeated bouts of high-intensity intermittent exercise .
A 2012 study that put Kre-Alkalyn to the test found that it was neither more effective nor had an improved safety profile compared to regular creatine monohydrate . In fact, the recommended daily dose of Kre-Alkalyn did not increase muscle creatine levels to the same extent as creatine monohydrate.
A study back in 2007 actually shows an increase in the creatine-to-creatinine conversion rate with Kre-Alkalyn compared with creatine monohydrate.
Some have also warned that mixing creatine with acidic drinks, such as orange juice, will break creatine down into creatinine and render it useless. However, orange juice, which has a pH of around 3, is less acidic than the gastric juice in your stomach, which has a pH of about 1.4.
Given that the conversion of creatine to creatinine in the stomach is very small, you don’t need to be Sherlock Holmes to realize that creatine will survive quite easily in orange juice for as long as it takes to mix and drink the stuff.
New and “improved” versions of creatine seem to appear all the time. None have consistently proven themselves to be any better than regular creatine monohydrate . In some cases, such as creatine ethyl-ester  or liquid creatine , they’ve actually performed significantly worse.
Does Creatine Need to Be Taken with Carbs And/Or Protein?
The hormone insulin assists the transport of creatine into muscle. That’s why combining creatine with an insulin-releasing agent (such as dextrose) is often recommended as a way to increase creatine uptake, which refers to the rise in muscle creatine levels.
However, taking creatine with carbohydrate and/or protein does not increase creatine uptake. It may produce a faster rate of uptake. But that’s different to saying it will increase the amount of creatine your muscles can store.
Your body has a “pool” of creatine. Supplementation helps to increase the amount of creatine in that pool. And, just as a swimming pool can only hold so much water, there’s only so much creatine your body can store.
If you plan to use creatine for any length of time, there’s little need to take it with carbohydrate, protein or any of the so-called creatine “transport systems” such as fenugreek or alpha-lipoic acid. Doing so may lead to a faster saturation rate. But that won’t make the slightest bit of difference once your creatine “pool” is full.
In addition, the effect of insulin on creatine uptake seems to occur only during the first 24 hours of creatine and carbohydrate co-ingestion , which means that this strategy is only likely to be effective in the early stages of supplementation.
Does Creatine Work Equally Well for Everyone?
Despite its popularity, not everyone will get the same results when they take creatine.
Research shows three different levels of response to supplementation: responders, quasi-responders, and non-responders . Normally, two or three people out of every 10 fall into the non-responder category. They see little or no improvement when using the supplement.
The people who get the best results from creatine are usually the ones who 1) have the lowest initial levels of muscle creatine and take up a greater amount through supplementation, 2) have a greater percentage of type II muscle fibers, 3) have bigger muscle fibers and 4) have more muscle mass .
Because they don’t eat meat or fish (two foods that contain creatine), vegetarians usually respond very well to creatine. They have very low levels in their muscle cells to begin with, and have a greater ability to take up creatine when compared to their omnivorous counterparts .
Does Creatine Cause Hair Loss?
Much of the concern about creatine and hair loss comes from a 2009 study showing that creatine raises levels of a hormone called DHT in a group of college-aged rugby players .
DHT levels rose by over 50% after a week of creatine loading (25 grams of creatine per day). They remained 40% above baseline after two weeks on a lower maintenance dose (5 grams of creatine per day).
High levels of DHT seem to play a part in male-pattern baldness, and have been linked with a higher rate of hair loss in those who are sensitive to its effects [23, 24].
As a result, some people claim that creatine may increase the rate of balding in men with male-pattern baldness.
However, saying that there “may” be a link between creatine and hair loss is just another way of acknowledging that the possibility exists, but you don’t really know for sure one way or the other.
It’s an interesting study. But it does leave us with more questions than answers.
First off, have the findings been replicated? In other words, have other researchers repeated the study and got the same set of results?
One study by itself is not really news. It’s only when you get several studies showing the same thing, ideally from different scientists acting independently of each other, that it’s worth sitting up and paying attention.
Unfortunately, I could find no follow-up studies to look at the link between creatine and DHT. That doesn’t mean that they haven’t been done, only that they haven’t been published.
Second, the normal range for DHT in adult men ranges from 0.8 to 3.4 nmol per liter. In the rugby players, it ranged between 1 and 1.5 nmol per liter. So even though DHT levels rose by over 50%, they were still well within the normal range.
In other words, it’s possible that the rise in DHT actually had nothing to do with creatine at all, and was part of the natural fluctuation in DHT levels that would have happened anyway.
Third, the rugby players used creatine for just three weeks. Where would DHT levels sit after three months? Or three years?
But that’s not all.
Was the increase in DHT levels large enough to have an impact on hair loss? What was happening to DHT levels in the scalp, as it was only measured in the blood? The subjects taking part in the study were 18-19 years old – would we see the same results in older men?
The case for creatine increasing hair loss is not a strong one. You’d need to measure hair loss directly in a very large group of subjects taking creatine for a much longer period of time to get a better idea about what’s really going on.
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About the Author
Christian Finn is an exercise scientist and former “trainer to the trainers” based in the UK. He holds a masters degree in exercise science, and has been featured in or contributed to major media on two continents, including the BBC and Sunday Times in the U.K. and Men’s Health and Men’s Fitness in the U.S.