Creatine
Creatine Monohydrate
For increasing strength, power, and high-intensity performance, creatine monohydrate is among the most well-supported supplements. Confidence is lower for broader claims such as cognition, healthy aging, and clinical uses.
How confident is BioSignal?
Our overall position, and how sure we are of it across each dimension — including where we are not sure at all.
High confidence
For increasing strength, power, and high-intensity performance, creatine monohydrate is among the most well-supported supplements. Confidence is lower for broader claims such as cognition, healthy aging, and clinical uses.
Well-supported by consistent, high-quality evidence.
Biological Role
Creatine's role in regenerating ATP via the phosphocreatine system is well established in foundational biochemistry.
Human Evidence
A large body of human research supports creatine's effects on strength and high-intensity performance, especially with resistance training.
Supplement Benefit
Benefits for strength, power, and lean mass are consistent across many studies for the monohydrate form.
Broader Claims
Evidence for cognition, brain health, aging, and clinical applications is developing and not established.
Safety Confidence
Creatine monohydrate is one of the most studied supplements and is generally reported as safe and well tolerated in healthy people at common doses.
Research Activity
Creatine remains an active research area spanning performance, aging, cognition, and clinical contexts.
Where the evidence stands today
How mature the science is, what kinds of evidence exist, and — the part nobody else prints — what is still missing.
8/9
steps proven in humans
Evidence-rich
Proven at every applicable step — rare, and worth noticing.
Guideline / regulatory support
ProvenSupported by the International Society of Sports Nutrition position stand on safety and efficacy.
Clinical outcomes
LimitedPerformance and lean-mass outcomes are robust. DISEASE outcomes are not: a large long-term trial in Parkinson's found no benefit on clinical progression, and the cognitive evidence remains thin. The gap between the performance rung and this one is the honest shape of creatine.
Large human RCTs
ProvenIncluding long-term trials and multiple meta-analyses.
Small human outcome trials
ProvenHundreds, across strength, power and lean mass.
Human safety data
ProvenExtensive, including multi-year dosing. Renal function unaffected in healthy adults.
Human biomarker / pharmacology
ProvenSupplementation measurably raises intramuscular creatine and phosphocreatine — the mechanism is confirmed in people, not inferred.
Animal
ProvenSubstantial, and largely consistent with the human data.
Cell / in vitro
ProvenCreatine transport and phosphocreatine kinetics are well characterised.
Mechanistic plausibility
ProvenPhosphocreatine regenerates ATP during short, intense effort. Textbook biochemistry.
The bottom line
What we know, what we think, what we don't know — and what would change our mind.
What We Know
Creatine is central to short-term energy supply in muscle, and monohydrate is a well-studied, effective supplement form.
What We Think
Creatine monohydrate reliably supports strength, power, and high-intensity performance, particularly alongside resistance training.
What We Don't Know
The extent of benefits beyond performance — cognition, healthy aging, and clinical uses — is not yet established.
Active Research
Research is exploring creatine in cognition, brain health, older adults, and a range of clinical contexts.
What Could Change Our Mind
Large, long-term trials in non-athletic and clinical populations could expand or temper confidence in creatine's broader benefits.
The biggest myth
“Creatine damages the kidneys”
In healthy individuals, creatine at common doses has not been shown to impair kidney function. Caution is warranted for people with pre-existing kidney disease.
Ask BioSignal
Still have a question about creatine?
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Why people take creatine
Popularity is not evidence — but it is not stupid either. This explains the interest on its own terms.
Creatine is the rare supplement where the popular enthusiasm and the evidence actually point the same way — which makes the myths around it unusually costly. People are interested because it visibly works, and a large number of them do not take it because they believe it damages their kidneys, wrecks their hair, or makes them retain water. Two of those are wrong and the third is trivial. This record exists to make the strongest case in the supplement aisle without letting the surrounding folklore quietly cancel it.
If you're here because…
Jump straight to the part of the evidence that answers your question.
Approval, safety and regulatory
What it is approved for, who should be careful, what remains unknown — and the limits of what this evidence can tell you.
Regulatory status
Not an approved drug. Sold as a dietary supplement
Availability
Over-the-counter supplement
Sport (WADA)
Not prohibited
Known safety profile
Creatine monohydrate is one of the most extensively studied supplements and is generally reported as safe and well tolerated in healthy people at common doses.
Common issues
- Short-term water retention / weight gain
- Occasional gastrointestinal discomfort (often with high single doses)
Use caution if
- People with pre-existing kidney disease (consult a clinician)
- People who are pregnant or breastfeeding (limited data)
- Adolescents (limited long-term data)
- People taking medications that affect the kidneys
Long-term unknowns
Very long-term effects over many years, and effects in some clinical populations, are less fully characterised.
Limits of this evidence
Much research has been conducted in younger, trained males; generalisability to other groups varies. The common belief that creatine harms the kidneys is not supported in healthy individuals, but caution applies with pre-existing kidney disease.
Demand, separated from evidence
Every claim people make about this, counted against what the evidence actually showed.
BioSignal evaluated 7 popular claims about creatine.
Here is where each one landed — including the claims of harm, where “not established” is reassuring rather than damning.
- Supported by evidence
- 2
- Mixed evidence
- 1
- Insufficient evidence
- 1
- Not established
- 3
Popularity is not evidence. This is simply a count of every claim BioSignal evaluated on this page, sorted by what the evidence actually showed — the full reasoning behind each verdict is in the Evidence Review below.
Supported by evidence
- Creatine increases strength and power
- Creatine increases muscle mass
Mixed evidence
- Creatine improves endurance performance
Insufficient evidence
- Creatine improves cognition
Not established
- Creatine causes hair loss
- Creatine damages the kidneys
- Creatine causes cramping and dehydration
The evidence review
Every claim with the reasoning behind its verdict, the doses actually studied, where scientists agree and disagree, and the questions still open.
What people claim
Every popular claim, with BioSignal’s verdict and how confident we are in it. The verdicts are always visible; open any claim to read the evidence behind it.
Creatine increases strength and powerSupportedHigh confidence
Consistently associated with improvements in strength and high-intensity performance, especially when combined with resistance training.
Creatine increases muscle massSupportedModerate confidence
Often associated with gains in lean body mass, reflecting a mix of increased intracellular water and enhanced training adaptations.
Creatine improves endurance performanceMixedModerate confidence
Effects on aerobic/endurance performance are less consistent than for short, high-intensity efforts.
Creatine improves cognitionInsufficient evidenceLimited evidence
Some studies suggest possible cognitive effects in specific contexts (e.g. sleep deprivation), but a general effect in healthy people is not established.
Creatine causes hair lossNot establishedLimited evidence
A single small study reported a change in a hormone marker; hair loss itself has not been established as an effect in controlled research.
Creatine causes cramping and dehydrationNot establishedLimited evidence
Controlled studies have generally not supported increased cramping or dehydration; some evidence points the other way.
Doses used in human studies
What was actually given to participants in the research. These are descriptions of studies, not recommendations.
Healthy adults
- Intervention
- Oral creatine monohydrate (loading)
- Dose
- ~20 g/day (4 × 5 g)
- Duration
- 5–7 days
- Outcome
- Muscle creatine saturation
- Notes
- Common loading protocol; optional
Healthy adults
- Intervention
- Oral creatine monohydrate (maintenance)
- Dose
- ~3–5 g/day
- Duration
- Weeks to months
- Outcome
- Strength, power, lean mass
- Notes
- Most studied maintenance dose
Older adults
- Intervention
- Creatine + resistance training
- Dose
- ~3–5 g/day
- Duration
- Weeks to months
- Outcome
- Muscle mass, strength, function
- Notes
- Typically combined with training
Vegetarians
- Intervention
- Oral creatine monohydrate
- Dose
- ~3–5 g/day
- Duration
- Weeks
- Outcome
- Baseline creatine stores
- Notes
- Larger relative increases reported
Where scientists agree — and don’t
Agreed
- Creatine monohydrate increases muscle phosphocreatine stores.
- It improves strength and high-intensity/power performance, especially with resistance training.
- It is generally safe and well tolerated in healthy adults at common doses.
Debated
- The magnitude of benefit for aerobic/endurance performance.
- Whether creatine meaningfully improves cognition in healthy people.
- The relevance of newer creatine forms versus the standard monohydrate.
Unknown
- Long-term effects over many years and in clinical populations.
- Therapeutic potential in neurological and aging contexts.
- Why some individuals appear to respond less than others.
What remains unknown
- Does creatine produce meaningful cognitive benefits in healthy people?
- What are the long-term effects of continuous use over years?
- Which protocols are optimal for older adults and clinical uses?
- What explains apparent responders versus non-responders?
Questions people actually ask
What is creatine?
Creatine is a compound made naturally in the body (and obtained from foods like meat and fish) that helps supply rapid energy to cells, especially muscle. As a supplement, it is most commonly taken as creatine monohydrate.
How does creatine work?
Creatine is stored in muscle largely as phosphocreatine, which helps regenerate ATP — the cell's immediate energy currency — during short, intense efforts. Supplementing raises phosphocreatine stores, supporting repeated high-intensity work.
How is creatine studied?
Research spans biochemical and cellular studies of the phosphocreatine system, performance trials measuring strength/power/lean mass (often with resistance training), and a growing set of studies exploring cognition and clinical uses. Study populations and protocols vary, which affects how results compare.
What forms of creatine exist?
Creatine monohydrate is the standard, most-studied, and most cost-effective form. Alternative forms are marketed, but they generally lack evidence of superiority over monohydrate for effectiveness.
Do you need to load creatine?
A short higher-dose 'loading' phase can saturate muscle stores faster, but a steady lower daily dose reaches the same saturation over a few weeks. Loading is optional and a matter of how quickly saturation is desired. This is educational information, not a recommendation.
Practical takeaways
- Creatine monohydrate is among the most evidence-backed supplements for strength and power.
- It works by increasing muscle phosphocreatine, aiding short, high-intensity efforts.
- It is generally safe and well tolerated in healthy people at common doses.
- Benefits for cognition and clinical uses are not yet established.
- Monohydrate is the standard, most-studied form.
How it works
The mechanism comes last on purpose. A compelling explanation of how something might work is the easiest part of the story to tell, and the part most likely to outlive the evidence for it.
Creatine's role in regenerating ATP via the phosphocreatine system is well established in foundational biochemistry.
How we found out
Foundational Biochemistry
Creatine and the phosphocreatine system were established as central to rapid cellular energy supply.
Ergogenic Research Era
Studies established creatine monohydrate as an effective aid for strength and high-intensity performance.
Safety & Broader Applications
Accumulating research supported safety in healthy people and began exploring wider uses.
Current Research
Ongoing work investigates cognition, brain health, aging, and clinical applications.
References
Verified sources. BioSignal does not print a citation it has not checked.
- 01
International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine
J Int Soc Sports Nutr 14:18 · 2017
- 02
Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?
J Int Soc Sports Nutr 18(1):13 · 2021
- 03
Bioavailability, efficacy, safety, and regulatory status of creatine and related compounds: a critical review
Nutrients 14(5):1035 · 2022
- 04
The effects of creatine supplementation on upper- and lower-body strength and power: a systematic review and meta-analysis
Nutrients 17(17):2748 · 2025
- 05
Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis
Open Access J Sports Med 8:213-226 · 2017
- 06
Effects of creatine supplementation on cognitive function of healthy individuals: a systematic review of randomized controlled trials
Exp Gerontol 108:166-173 · 2018
- 07
Effects of creatine supplementation on renal function: a systematic review and meta-analysis
J Ren Nutr 29(6):480-489 · 2019
Version history
Version 1.0
First published Signal Record for the Alpha launch, distilled from Gold Standard Record #001. Verified references attached. Future versions will track scientific updates, evidence changes, and review history.
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