More Questions on Creatine

May 18, 2022

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Open container of white powder with scoop on wooden table surrounded by white supplement capsules. Creatine is an extremely popular supplement with thousands of studies attesting to its effectiveness in humans. It works well in athletes, older people, women, men, teens, vegans and vegetarians, and probably even children. It’s well-tested, safe in normal amounts, and there are very few downsides.

But because so many people use it, creatine also generates a lot of questions. Every time I do a post on creatine, I get more queries in my inbox.

Does it cause hair loss?
How much should you take every day?
Is there a good time to take it?
Will creatine make you gain weight?
And is creatine bad for the kidneys?
What about side effects—anything we should worry about?

Let’s dig right in and answer those questions.

Does creatine cause hair loss?

This is a persistent concern, but there’s not much solid research lending credence to it. The majority of the “evidence” lies in an older study where college rugby players took creatine for a few weeks and saw their dihydrotestosterone, or DHT, rise over baseline. (The placebo control group saw no rise in DHT).¹ DHT is a more active or potent form of testosterone that has powerful anabolic effects. It can also bind to hair follicles and cause them to shrink, reducing your ability to support a dense, healthy head of hair.

However, the creatine group had lower DHT levels at baseline, so it may be that the creatine was simply correcting lower starting levels. Other studies on creatine and testosterone have failed to find any consistent links between creatine and higher testosterone, free testosterone (from which DHT is produced), or DHT itself.

Finally, there are no studies showing that taking creatine causes hair loss. It’s not impossible or even improbable. It simply hasn’t been definitively shown.

Anecdotally, some people notice hair loss after starting creatine, but those are the toughest connections to draw without a control group and good methodology. Would they have lost the hair anyway? Were there other factors at play?

How much creatine per day?

There are two basic strategies people commonly employ.

If you want to speed creatine uptake in the muscles, you can do a “loading phase” of 20 grams a day (split up into 4 doses) for a week before dropping down to 3 to 5 grams a day.

If you don’t, you can just take 3 to 5 grams a day from the get-go.

Both strategies work just fine.

If you have a lot of muscle mass—and thus higher creatine storage capacities—or if you burn through a lot of creatine with intense activity, you might benefit from larger daily doses in the 8 to 10 grams range.

Once you’ve been taking creatine consistently enough at high enough doses to saturate your muscle stores (20 grams a day for 5 to 7 days, or 3 to 5 grams a day for 28 days, to give two common examples), you can probably get away with “cycling” your creatine. Taking days off, doing lower doses here and there. Maybe even taking creatine “as needed” around resistance exercise, when you’re really going to use it. I’m just speculating here, but I think I’m right.

Whenever you take creatine, make sure you’re drinking plenty of water—more than normal. Otherwise it can cause stomach cramps.

Does creatine make you gain weight?

In the first week or so, you will gain water weight as the body stores water along with creatine. This is completely normal and usually subsides after a few weeks. But what about “real” weight? Does it cause real weight gain?

Kinda.

Studies in both older men and older women have found that creatine use increases body mass.² ³ In other words, their BMI would have “worsened.”

What’s going on? Is creatine bad, then?

On the contrary, while creatine will increase body mass, creatine has never been shown to cause fat gain. Creatine will likely help you gain lean muscle mass by helping you lift more weight in the gym, maintain higher exercise intensities, and do higher-volume sets. The creatine isn’t directly causing the weight gain, but it is helping to enable it. This is “good weight.” This is the weight you want to gain. In all those “increased body mass” studies, the creatine also increased the amount of weight they were lifting and their performance in a broad range of physical activities. It was making them more robust.

Creatine may make you gain weight, but it’s the good kind of lean mass.

When should I take creatine?

Creatine is more of a long-term supplement. It’s something that you “load” into your muscles and once it’s there, it stays until you expend it with intense activity. This is why many people go through the “loading” phase with 20 grams per day for a week until tapering off with lower doses—they want to speed up the saturation of creatine storage.

However, there are indications that timing your creatine intake can affect how well it works in your body.

One study found that taking creatine immediately after a workout led to better strength gains in the bench press, more lean mass, and lower fat mass than taking creatine immediately before a workout.⁴

Another study using a creatine/carbohydrate/protein supplement found that it didn’t really matter whether you took it before or after a workout as long as you took it close to the workout. Both pre- and post-workout creatine were far more effective than taking it in the morning or night, well away from your workout.

Whatever you do, taking it close to training (before or after) seems to have the best effect.

Is creatine bad for the kidneys?

If you have healthy kidney function, creatine is proven to be safe. Creatine excretion in the urine will rise, but this is considered to be a normal response to increased creatine intake and the sign of a healthy kidney function. Creatine supplementation has never been shown to cause impaired kidney function in healthy people with healthy kidneys at baseline. While there are case studies of renal dysfunction “accompanying” creatine supplementation, these cases were all confounded by variables like preexisting kidney disease, excessive dosing (100x what’s normally recommended), steroid use, and other medicines they were taking.⁵

If you have poor kidney health or function, supplemental creatine may be contraindicated. However, there is a case report of a young adult male with one kidney who was able to take creatine while eating a high protein diet and suffered no health consequences.⁶ Whatever you do, if you’re worried about your kidneys or have impaired kidney function, check with your doctor before proceeding.

Are there any creatine side effects?

Nothing is perfect. There are some potential complications or side effects, but they aren’t inevitable and you can usually avoid them with a few basic tips.

Cramps: Drink enough water and drink less alcohol. Creatine tends to increase water requirements, so make sure you drink enough water and get enough electrolytes. Read all about hydration here. Or just mix Gerolsteiner mineral water with sea salt and the juice from a lemon or lime. For serious electrolyte requirements, you can also make my “better Gatorade” by blending blackstrap molasses into coconut water with some lime or lemon juice and salt.

Gas, bloating, diarrhea: You took too much. Make sure you’re weighing and measuring your creatine doses. Also try taking creatine with some calories, with a meal (how you’d usually get creatine in natural settings).

That’s about it, folks. If you have any other questions about creatine, drop them down below.