Creatine: how much, when, which form and which myths

What it is

Creatine is one of the most asked about and most myth-laden. Most questions fall into four: how much?, when?, which form? and "is it true that…?".

The regimen with the most studies is 3-5 g a day of creatine monohydrate, every day, rest days included. At 3 g there is an authorised claim for repeated short, intense exercise in adults. A "load" (about 20 g a day split over 5-7 days) saturates the muscle sooner but does not change where it ends up and is tolerated worse.

The myths, one by one

What studies say in healthy people at usual doses:

• "IT DAMAGES THE KIDNEY": in healthy people, studies of up to several years show no harm. It raises blood creatinine without the kidney being worse. With prior kidney disease, do not offer it without their doctor.
• "IT CAUSES BALDNESS": it comes from one small 2009 study that measured DHT, not hair, and has not been replicated. There is no proof it causes alopecia.
• "IT DEHYDRATES AND CAUSES CRAMPS": reviews do not confirm this; creatine holds water inside the muscle, it does not pull it out of the body.
• "IT MAKES YOU FAT": the initial gain is intramuscular water, not fat. For someone seeking weight loss it may be unwelcome, and that is said.
• "YOU HAVE TO CYCLE": there is no basis for stopping and starting; the effect depends on keeping the muscle saturated.

At the counter

When to recommend it

• Creatine monohydrate from a brand with analysis, at 3-5 g a day every day
• Dissolved in water, juice or a shake; the time of day does not change the effect, consistency matters
• Drink water normally; there is no need to force hydration
• A trial of 4-8 weeks to see whether they want to continue

When not to

• Under 18
• Kidney disease or low filtration without checking
• Mixing with megadoses of caffeine "to boost it": no proof and effects add
• Paying extra for "special forms" (HCl, ethyl ester, buffered) for the price: they have shown no advantage over monohydrate

Warnings

• Important KIDNEY AND BLOOD TEST: creatinine rises with the supplement; the customer should tell their doctor. If there is kidney disease, it is not offered.
• Caution "SPECIAL" FORMS: none has been shown to beat monohydrate in trials; they do not justify a higher price and have no different claim.
• Caution PREGNANCY AND BREASTFEEDING: not enough data; not recommended.
• Worth knowing Digestive upset with high loads: avoid by taking 3-5 g a day with food.
• Worth knowing If the customer takes protein powder, add them up: creatine neither replaces nor improves it.