If you've ever mentioned taking creatine around non-gym people, you've probably heard it. "Isn't that bad for your kidneys?" Or maybe: "That's basically steroids, right?"
Neither is true. Not even close.
Creatine monohydrate is the single most studied sports supplement in history. We're talking about over 680 peer-reviewed studies involving more than 12,800 participants, spanning from 1926 to the present day. The International Society of Sports Nutrition (ISSN) has called it the most effective ergogenic nutritional supplement available to athletes for increasing high-intensity exercise capacity and lean body mass.
But the myths won't die. So let's go through what the research actually says—the good, the bad, and the stuff people keep getting wrong.
Here's the thing about creatine and kidneys. Your body naturally produces creatine in the liver, kidneys, and pancreas. When creatine is broken down, it produces creatinine—a waste product that your kidneys filter out. Doctors use creatinine levels as a marker for kidney function.
See where this is going?
When you supplement creatine, your creatinine levels go up. Not because your kidneys are failing, but because there's simply more creatine being metabolized. It's like saying your washing machine is broken because you did more laundry. The machine is fine. You just gave it more clothes.
A 2018 meta-analysis published in the Journal of the International Society of Sports Nutrition looked at creatine supplementation studies ranging from 7 days to 5 years. The conclusion was clear: creatine does not impair renal function in healthy individuals at doses up to 10g per day. A 2019 study in the European Journal of Applied Physiology followed resistance-trained men taking 5g daily for 4 years. No kidney issues.
That said, if you have pre-existing kidney disease or are on medications that affect renal function, talk to your doctor before supplementing. This isn't a creatine-specific warning—it applies to pretty much everything.
Short answer: no issues found. A 12-week randomized controlled trial published in Molecular and Cellular Biochemistry measured liver enzyme markers (AST, ALT, GGT) in creatine users and found no significant changes compared to placebo. Longer-term studies corroborate this. The liver processes creatine, but the dosages used in supplementation don't appear to tax it in any measurable way.
Creatine isn't side-effect-free. But the side effects are generally mild and well-understood.
This is the most common one. Creatine pulls water into muscle cells—that's part of how it works. In the first week or two of use, expect to gain 1-3 lbs of water weight. This isn't fat. It isn't bloating in the traditional sense. Your muscles hold more water, which can make them look slightly fuller.
For most people, this is either unnoticeable or a positive. If you're in a weight-class sport, you'll want to plan accordingly.
Some people experience stomach cramping, nausea, or diarrhea, particularly during loading phases (20g/day). The fix is simple: skip the loading phase. Take 3-5g daily. You'll reach full saturation in about 3-4 weeks instead of one week. Same endpoint, fewer bathroom problems.
Taking creatine with food also helps. An empty stomach is usually the culprit behind GI complaints.
This one is largely a myth. A 2003 study in the Journal of Athletic Training actually found that creatine users experienced fewer muscle cramps, heat illnesses, and dehydration episodes than non-users during NCAA Division I football training. The cramping claim likely comes from anecdotal reports that were never confirmed in controlled settings.
I've seen people on Reddit swear creatine made their hair fall out. The origin of this concern is a single 2009 study involving college-aged rugby players in South Africa. After 3 weeks of creatine loading followed by maintenance, their dihydrotestosterone (DHT) levels increased by about 56%.
DHT is linked to male pattern baldness in genetically predisposed individuals. But here's what matters: the study didn't measure hair loss. It measured a hormone. And no subsequent studies have replicated the DHT finding or demonstrated actual hair loss from creatine use.
Is it theoretically possible? Sure. Is there strong evidence? No. If you're genetically predisposed to male pattern baldness and it concerns you, that's a personal risk assessment. But the evidence base is a single unreplicated study.
| Protocol | Dose | Duration | Notes |
|---|---|---|---|
| Loading (optional) | 20g/day (split into 4x5g) | 5-7 days | Saturates stores faster. More GI side effects. |
| Maintenance | 3-5g/day | Ongoing | Standard dose. Well-tolerated. |
| No loading | 3-5g/day | 3-4 weeks to saturate | Slower but equally effective long-term. |
| Larger individuals (>200 lbs) | 5-10g/day | Ongoing | Higher body mass may require more for saturation. |
Timing doesn't matter much. Morning, night, pre-workout, post-workout—the data on timing is inconsistent and the differences are negligible. Just take it consistently.
Creatine monohydrate is the only form with strong evidence behind it. Creatine HCl, buffered creatine, creatine ethyl ester—none of these have been shown to be superior in peer-reviewed research, despite often costing 3-5x more.
Creatine has a remarkably strong safety profile, but a few groups should exercise caution:
This is where it gets nuanced. The American Academy of Pediatrics has historically discouraged supplement use in teens. But the ISSN's 2017 position stand noted that there's no scientific evidence that short- or long-term creatine use has any detrimental effects on otherwise healthy adolescents.
Practically speaking, many teens already consume creatine through meat and fish (a pound of raw beef contains about 2g). Supplementing 3-5g/day on top of dietary intake hasn't been shown to be harmful in this age group.
The more honest concern with teen supplementation is behavioral: you don't want teenagers to develop a mindset where pills replace training, nutrition, and sleep. If those foundations are solid, creatine is a reasonable addition for serious young athletes.
One of the strongest arguments for creatine safety is that we have genuinely long-term data. A 2001 study followed athletes using creatine for up to 5 years and found no adverse effects on kidney function, liver function, or cardiovascular health. The ISSN's 2017 position stand reviewed the totality of evidence and concluded that creatine monohydrate supplementation is not only safe but potentially beneficial for a range of clinical populations.
There's emerging research on creatine for traumatic brain injury, depression, and neurodegenerative diseases. The safety bar for therapeutic use in clinical populations is much higher, and creatine continues to clear it.
Honestly, the creatine misinformation problem comes down to a few things. First, the creatinine/kidney confusion we covered. Second, creatine is associated with bodybuilding, and anything associated with bodybuilding gets lumped in with steroids in the public imagination. Third, the supplement industry as a whole has a credibility problem, so even well-studied compounds get dragged down by association with less reputable products.
Creatine is one of the rare cases where the supplement actually delivers what it promises, and the safety data is overwhelming. If anything, the research community's biggest frustration is how often they have to re-debunk the same myths.
"Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training." — ISSN Position Stand, 2017
For healthy adults, 3-5g of creatine monohydrate per day is safe. The evidence base is enormous—larger than for any other sports supplement. Kidney concerns in healthy people are unfounded. Real side effects are limited to water retention and occasional GI discomfort, both manageable. Stick with monohydrate, don't overpay for fancy forms, and take it daily.
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