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How To Take Creatine: A Guide For Fitness Success

Written by Dr. Michael Ruscio, DC on February 7, 2023

Written by Dr. Michael Ruscio, DC on February 7, 2023 — Reviewed by Aimee Gallo

Why This Non-Essential Amino Acid is Essential For Your Health

• How To Take Creatine|
• Creatine for Fitness|
• What is Creatine?|
• Health Benefits|
• Side Effects and Safety|
• The Bottom Line|

There are countless supplements on the market that promise great results for everything from general health and wellness to cognitive function to muscle building. There aren’t many that can actually deliver on all of those promises, though creatine appears to be one exception. 

Creatine is an amino acid that’s been studied extensively and found to be extremely safe and effective for enhancing athletic performance. But the benefits of creatine aren’t reserved just for athletes and fitness enthusiasts who want to build muscle. This supplement has a variety of applications like preserving muscle mass during periods of calorie restriction (or dieting), improving blood sugar control and heart health, and improving your recovery after an injury, just to name a few. 

Research findings overall suggest most people can benefit from optimal muscle creatine levels [1, 2]. You can get creatine from foods like beef and fish, but creatine powder is a better option if you’re looking for a therapeutic benefit.

In this article, I’ll discuss what creatine is and the health benefits of taking supplemental creatine. I’ll also share how to take creatine to optimize your desired fitness results and why creatine may not be helpful for all types of athletes. Let’s start off with what seems to be the best research-backed creatine protocol.

How To Take Creatine: Creatine Loading and Maintenance

While there are different protocols for creatine supplementation, a review from the International Society of Sports Nutrition (ISSN) found the most effective way to increase muscle creatine stores is as follows [3]:

1. Loading phase: Consume 5 grams of creatine monohydrate (or 0.3g/kg body weight) four times per day for 5–7 days to maximize muscle creatine stores.
2. Maintenance phase: Transition to 3–5 grams per day (or 5–10 grams/day for larger athletes) to maintain creatine levels.
3. Optimize: Take creatine with carbohydrates or a carb/protein combo.

This review, along with another, found taking creatine powder in conjunction with carbohydrates and/or a mix of carbohydrates and protein promotes greater creatine retention [2, 3]. You could easily add creatine to a pre-workout or post-workout shake to get these benefits.

Creatine Supplements For Fitness: Who Can Benefit?

Creatine supplementation has been studied extensively and can improve fitness in a variety of ways. Here’s a chart summarizing what we know about the effects of creatine on fitness:

As you can see, the use of creatine can help to improve overall muscle mass and muscle strength, whether you’re a beginner or at a more advanced fitness level. But keep in mind, resistance training is required for these benefits.

When it comes to endurance athletes, the use of creatine seems to have different effects. One meta-analysis actually found supplemental creatine to have an overall negative effect on VO2 max, which is a measure of exercise capacity [15], and another found no benefit for aerobic performance [4]. 

So, depending on your specific fitness goals, you may or may not want to add creatine. If you’re mostly an endurance athlete, you may not gain any benefit from creatine and it could potentially reduce your exercise capacity. 

On the other hand, fitness enthusiasts, bodybuilders, vegans, and older folks looking to improve muscle mass and strength may experience significant benefits from taking supplemental creatine. Let’s take a closer look at why creatine may be a great option for you if you don’t eat meat.

Creatine for Vegetarians and Vegans

You obtain about half of the creatine you need from animal foods like red meat and fish [1] egetarians and vegans were found to have 20–30% lower creatine levels when compared to people who eat animal foods, likely due to lower methionine content in plant proteins [16]

While there is no research directly comparing the benefits of creatine supplementation in vegetarians/vegans versus omnivores, research does show that vegetarians are deficient, making them good candidates for supplementation [4]. Research has shown creatine supplementation to improve the following in vegetarians [1, 17]:

• Lean tissue mass [1]
• Muscle strength [1]
• Muscle endurance [1]
• Exercise performance [1]
• Cognitive function (memory and intelligence) [1]

Now that you know who can benefit from creatine supplementation, let’s get into what creatine is and discuss some of its health benefits that aren’t exercise-related.

What Is Creatine?

Creatine is an amino acid that helps the body replenish adenosine triphosphate (ATP),  the “body’s energy currency” or energy source, during high-energy demand states like exercise [1, 18]. Creatine and phosphocreatine (when a phosphate molecule is attached) play a crucial role in maintaining ATP concentrations in tissues with high energy demands like the brain, heart, and muscle [16]. A constant supply of ATP is needed to maintain cell growth and survival, making creatine a crucial component for a variety of bodily functions [16]. 

Your body can produce some creatine (about half of what you need), but the other half of your creatine demand has to be met through your diet (mostly with red meat and fish) [1, 16]. Your ability to produce creatine depends on three amino acids (building blocks of protein), glycine, arginine, and methionine [19]. 

You can also obtain creatine from supplements and there are several forms. Creatine monohydrate is the most well-studied and seems to be the best form of creatine overall when it comes to creatine retention in the muscle cells and body [3]. Now let’s take a look at some of the benefits of creatine supplementation aside from fitness. 

Health Benefits of Creatine

Creatine has been used by athletes and fitness lovers for years because it’s a safe and effective way to increase strength and muscle mass, improve athletic performance, and improve body composition [1, 2]. But supplemental creatine has also been associated with a number of other health benefits. One systematic review and a literature review confirmed the fitness benefits and found these additional benefits of supplemental creatine [1, 2]:

• Increases the availability of cellular energy.
• Helps preserve skeletal muscle mass when dieting and restricting calories.
• Improves cognitive function, especially during aging (large improvements in memory for healthy older adults) [20].
• Improves blood sugar control (along with exercise in those with type 2 diabetes) [21].
• Improves heart metabolism and health.
• Improves the health of individuals with creatine synthesis deficiencies (with long-term, high doses).
• Possibly helpful for people with muscular dystrophy and other neurodegenerative diseases.
• Enhances energy availability during ischemic events like heart attacks and strokes. 
• Protects brain health and function in people with traumatic brain injury (TBI) and/or spinal cord injuries.
• Improves rehab and recovery from injury.
• Supports healthy immune function.

In addition to these benefits, creatine supplementation may have anti-cancer and anti-inflammatory effects and may support [1, 2]:

• Individuals with chronic fatigue syndrome and post-viral syndrome
• Mental, reproductive, and skin health
• Healthy pregnancy (although more research is needed)

I want to point out a couple of these benefits specifically –  preserving muscle mass while restricting calories and improving chronic fatigue (post-viral fatigue) syndrome:

• When dieting or restricting calories to lose weight, you’re at risk of losing valuable muscle mass and strength, especially as you age. Creatine supplementation has been shown to actually preserve muscle mass and promote fat loss during periods of calorie restriction [1].
• Post-viral syndrome has emerged as a concern for some people post-pandemic.  Patients can experience negative symptoms that persist for months. Creatine deficiency may play a role in these syndromes, and creatine supplementation may improve functional capacity, quality of life, pain, and depression [1].

It appears most people could benefit from creatine supplementation [16]. Although it’s important to keep in mind that creatine is supplemental to exercise, you can’t expect these benefits from simply taking creatine. If you do make the decision to try creatine, it’s important to know there may be potential side effects, just as there are with any dietary supplement. Let’s take a look at the possible side effects of creatine.

Creatine Side Effects and Safety

Creatine has been researched in over 1,000 studies, and according to ISSN, the only consistently reported side effect of creatine supplementation is weight gain [3]. One literature review found an average of 1–2 kg (2.2–4.4 pounds) weight gain during the creatine loading phase due to water retention and decreased urination [2]. 

Gut distress is more likely to occur during the loading phase, so if you start to experience symptoms, you can jump straight into the maintenance phase. You’ll still reap the health benefits, it might just take a little longer for the creatine to saturate your muscle cells.

Other reported rare side effects include heat intolerance, and muscle cramps [2, 12]. And there are isolated reports of airway inflammation in people with a prior history of allergies [2]. In addition, one systematic review noted 5 cardiovascular adverse events in older people who combined creatine with strength training and endurance exercise – it’s not clear if these events were the result of creatine supplementation or the exercise routine. It’s important to note that these types of side effects are extremely rare [12]. 

Overall, creatine has been found to be safe and well tolerated for both short and long-term use at doses of up to 30 grams/day for 5 years in healthy people [2], and creatine causes no harm to kidney function [22]. You should always speak with your healthcare provider before adding any dietary supplements to your routine though.

Creatine Supplementation May Enhance Your Health

Creatine may be one of those supplements you’ve heard about and wondered whether it’s worth it or not. The research seems to demonstrate that this is one fitness supplement that’s safe and effective. Creatine can increase your muscle mass, improve your strength, and enhance your performance during short-burst high-intensity exercises. However, creatine appears to have no benefit and may even be detrimental for endurance-type exercises.

If you’re wondering how to take creatine, the most effective protocol involves a loading dose of 5 grams four times per day for 5–7 days, then a maintenance dose of 3–5 grams per day. It’s best to take creatine with a carbohydrate or a combination of carbohydrate and protein, so you could include it with a meal or in a shake.

Outside of fitness, creatine has a variety of other health benefits and it seems as though most people could benefit from taking creatine. If you’d like some personalized guidance for your own health journey, contact the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.