Safdar A, Yardley NJ, Snow R, Melov S, Tarnopolsky MA. Global and targeted gene expression and protein content in skeletal muscle of young men following short-term creatine monohydrate supplementation. Physiol. Genomics. 2008;32:219–28. Your body produces the other half naturally in your liver, kidneys and pancreas. They deliver about 95% of the creatine to your skeletal muscles to use during physical activity. The rest goes to your heart, brain and other tissues.

Rahimi R, Faraji H, Vatani DS, Qaderi M. Creatine supplementation alters the hormonal response to resistance exercise. Kinesiology. 2010;42:28–35. Francaux M, Poortmans JR. Side effects of creatine supplementation in athletes. Int. J. Sports Physiol. Perform. 2006;1:311–23.

Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults-a meta-analysis. Med. Sci. Sports Exerc. 2014;46:1194–203. Tarnopolsky MA. Potential benefits of creatine monohydrate supplementation in the elderly. Curr. Opin. Clin. Nutr. Metab. Care. 2000;3:497–502. Manufacturers also make creatine supplements. Some people take creatine supplements because they work out a lot or don’t get enough creatine in their diet. Creatine supplements exist as:

Greenhaff, P. L.; Casey, A.; Short, A. H.; Harris, R.; Soderlund, K.; Hultman, E. Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man. Clin. Sci. (Lond) 1993, 84, 565-571. ARJ has consulted with and received external funding from companies that sell certain dietary ingredients and also writes for online and other media outlets on topics related to exercise and nutrition Hayashi AP, Solis MY, Sapienza MT, Otaduy MC, de Sa Pinto AL, Silva CA, Sallum AM, Pereira RM, Gualano B. Efficacy and safety of creatine supplementation in childhood-onset systemic lupus erythematosus: a randomized, double-blind, placebo-controlled, crossover trial. Lupus. 2014;23:1500–11.DHT is a metabolite of testosterone, formed when the enzyme 5-alpha-reductase converts free testosterone to DHT [ 63]. In males, DHT can bind to androgen receptors in susceptible hair follicles and cause them to shrink, ultimately leading to hair loss [ 64]. However, in the van der Merwe et al. [ 61] study, no increase in total testosterone was found in the 16 males who completed the study. Free testosterone was not measured. Moreover, the increase in DHT and the DHT: testosterone ratio remained well within normal clinical limits. Furthermore, baseline (prior to supplementation), DHT was 23% lower in the creatine group (0.98 nmol/L) compared to the placebo group (1.26 nmol/L). Thus the small increase in DHT in the creatine group (+ 0.55 nmol/L after 7 days of supplementation and + 0.40 nmol/L after 21 days of supplementation), in combination with a small decrease in the placebo DHT response (-0.17 nmol/L after 7 days of supplementation and -0.20 nmol/L after 21 days of supplementation) explains the “statistically significant” increase in DHT noted by van der Merwe et al. [ 61]. While it is possible that creatine supplementation upregulated 5-alpha-reductase activity in these males (potentially leading to increased formation of DHT), no study has reported hair loss/baldness in humans. The human body produces some creatine naturally and it’s also present in some foods such as red meat, but only in small amounts, making supplements a good option for those who train regularly. What forms does creatine come in? Hausmann ON, Fouad K, Wallimann T, Schwab ME. Protective effects of oral creatine supplementation on spinal cord injury in rats. Spinal Cord. 2002;40:449–56. Creatine supplementation and resistance training produces the vast majority of musculoskeletal and performance benefits in older adults. Creatine supplementation alone can provide some muscle and performance benefits for older adults.

Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin. Sci. (Lond). 1992;83:367–74. Kayton S, Cullen RW, Memken JA, Rutter R. Supplementation and ergogenic aid use by competitive male and female high school athletes. 2002;34:S193.Bermon S, Venembre P, Sachet C, Valour S, Dolisi C. Effects of creatine monohydrate ingestion in sedentary and weight-trained older adults. Acta Physiol. Scand. 1998;164:147–55. Cannon JG, Orencole SF, Fielding RA, Meydani M, Meydani SN, Fiatarone MA, Blumberg JB, Evans WJ. Acute phase response in exercise: interaction of age and vitamin E on neutrophils and muscle enzyme release. Am. J. Physiol. 1990;259:1214. Greenwood M, Kreider RB, Melton C, Rasmussen C, Lancaster S, Cantler E, Milnor P, Almada A. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol. Cell. Biochem. 2003;244:83–8. Andres S, Ziegenhagen R, Trefflich I, Pevny S, Schultrich K, Braun H, Schanzer W, Hirsch-Ernst KI, Schafer B, Lampen A. Creatine and creatine forms intended for sports nutrition. Mol. Nutr. Food Res. 2017;61. https://doi.org/10.1002/mnfr.201600772 Epub 2017 Mar 30. In summary, accumulating evidence indicates that you do not have to ‘load’ creatine. Lower, daily dosages of creatine supplementation (i.e. 3-5 g/day) are effective for increasing intramuscular creatine stores, muscle accretion and muscle performance/recovery. Is creatine beneficial for older adults?

Volek JS, Ratamess NA, Rubin MR, Gomez AL, French DN, McGuigan MM, Scheett TP, Sharman MJ, Hakkinen K, Kraemer WJ. The effects of creatine supplementation on muscular performance and body composition responses to short-term resistance training overreaching. Eur. J. Appl. Physiol. 2004;91:628–37. Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, Candow DG, Kleiner SM, Almada AL, Lopez HL. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J. Int. Soc. Sports Nutr. 2017;14:18-z eCollection 2017. In summary, while there is some evidence to suggest that creatine supplementation increases water retention, primarily attributed to increases in intracellular volume, over the short term, there are several other studies suggesting it does not alter total body water (intra or extracellular) relative to muscle mass over longer periods of time. As a result, creatine supplementation may not lead to water retention. Is creatine an anabolic steroid? Applied Physiology & Nutrition Research Group; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, Brazil

Appointments at Mayo Clinic

Boost water content in muscle cells. Better cell hydration may increase muscle growth and reduce dehydration and muscle cramps.