Overview

Creatine is a naturally-synthesized amino acid derivative (from Glycine and Arginine) made in the body. A number of studies have reinforced the benefits of creatine in muscle recovery between workouts and performance maximization in athletes and fitness trainees. Consequently, creatine monohydrate (a creatine supplement) has become a widely-known exercise training aid in the sports and fitness spheres. 

Despite the popularity of its use, concerns about the safety and efficacy of creatine monohydrate continue to prevail. In light of the confusion around the use of the supplement, the International Society of Sports Nutrition (ISSN) has declared that the use of creatine supplements, either in the short-term or long-term, does not cause any harmful effects. In addition, ISSN also provides regular updates, based on ongoing research, about the accurate effects of creatine supplements.

Common Misconceptions and Scientific Clarifications about Creatine Monohydrate Supplementation

Here is a list of five common misconceptions and the scientific rationale behind why creatine monohydrate is safe to use under the recommended dosages. We at DNA believe that this list will provide clarity and help bring fitness enthusiasts out of the misconceptions.

❌ Misconception 1: Creatine monohydrate negatively affects kidney function and physiology

✅ Science-based evidence: A study performed on resistance training individuals showed that creatine monohydrate supplementation (0.3 g/kg per day) did not cause any abnormalities in the functioning of the blood cells, kidney, and liver as observed by the normal results for 41 blood and urine parameters (1). The study further substantiated the effect of creatine monohydrate in increasing the training performance of the participants.

❌ Misconception 2: Creatine monohydrate is a steroid

✅ Science-based evidence: Steroids are a class of drugs that can alter the expression of certain genes in the muscles resulting in the gain of muscle strength and weight. The use of steroids for physical performance enhancement has been illegalized by the Drug Enforcement Association. Since creatine monohydrate has a similar effect in boosting muscle mass and strength, there is a misconception that it is a steroid. However, studies explain that not only the structure of creatine monohydrate is different from that of steroids, but also their mechanisms of action in muscle-building are as well exclusive of one another (2).

❌ Misconception 3: Creatine monohydrate causes muscle cramping and dehydration

✅ Science-based evidence: A study analyzed the adverse effects of muscle cramping reported by some creatine monohydrate consumers. It was found that the reporters had exceeded the dosage limit of 5g/day of the supplement. A parallel experimental study performed on football players showed that taking the recommended dosage of creatine monohydrate rather lowered the occurrences of muscle cramping, dehydration, and muscle tightness by significant percentages (2).

❌ Misconception 4: Creatine monohydrate increases fat mass

✅ Science-based evidence: Over multiple studies done across multiple age groups (spanning from children, and adolescents to older adults) and genders, it was observed that the net weight gain in individuals taking creatine monohydrate is due to the increase in lean body mass and not fat mass (2). For instance, a study conducted on an older population with creatine supplementation during a 32-week resistance training program showed an increase in lean tissue and in fact a decrease in fat mass (2).

❌ Misconception 5:  Creatine supplement formulations other than creatine monohydrate are equally effective. 

✅ Science-based evidence: Creatine supplements come in several formulations of which ISSN recommends creatine monohydrate owing to its high safety and efficacy levels. Large volumes of studies are available to show that creatine monohydrate has the highest creatine storing capacity in the muscles among all other supplements (2).  

A combination of creatine monohydrate and beta-hydroxy-beta-methylbutyrate (HMB) has also recently been studied to be effective in boosting muscle mass and recovery. A long-term study conducted on rowers revealed that those who took a combination of creatine monohydrate and HMB showed an increase in the testosterone levels and testosterone/cortisol (T/C)  ratio than those who either took a placebo or the individual supplements (3). The increase in these two blood parameters is an indicator that the body is not under stress despite actively adapting to intense training.

Conclusion

While there can be a plethora of information available about creatine monohydrate, athletes and training individuals must consult their dieticians or rely on research-based results before consuming creatine supplements. In addition, exercising individuals can make the most of creatine supplementation by being aware of the effective formulations and adhering to the recommended dosages (3-5 g/day or 0.1 g/kg of body mass/day).

References

1. Almeida, D., Colombini, A., & Machado, M. (2020). Creatine supplementation improves performance, but is it safe? Double-blind placebo-controlled study. The Journal of sports medicine and physical fitness, 60(7), 1034–1039. https://doi.org/10.23736/S0022-4707.20.10437-7 
2. Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Kreider, R. B., Rawson, E. S., Smith-Ryan, A. E., VanDusseldorp, T. A., Willoughby, D. S., & Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition, 18(1), 13. https://doi.org/10.1186/s12970-021-00412-w 
3. Fernández-Landa, J., Fernández-Lázaro, D., Calleja-González, J., Caballero-García, A., Córdova, A., León-Guereño, P., & Mielgo-Ayuso, J. (2020). Long-Term Effect of Combination of Creatine Monohydrate Plus β-Hydroxy β-Methylbutyrate (HMB) on Exercise-Induced Muscle Damage and Anabolic/Catabolic Hormones in Elite Male Endurance Athletes. Biomolecules, 10(1), 140. https://doi.org/10.3390/biom10010140