Creatine has passed the time test and is still regarded as a safe and effective supplement. It is not a gimmick and has been well researched. There are several known side effects of creatine supplementation, including upset stomach, diarrhea, and bloating.

Some of the weight gain that the user experiences is due to water retention, but research shows a gain in muscle mass as well. It has been noted that this water retention is good, and may be one of the reasons the body mass can be gained. By increasing the amount of water inside of the muscle, the body is better able to synthesize proteins, thus leading to muscle growth.1 Other concerns, such as damage to the kidney and liver, have yet to be proven with research. Though always cautious, the scientific community seems to be giving creatine a safe rating. Of course there will always be exceptions, and there will never be a way to rule a supplement safe for everyone. Again, though, recent experiments have yet to show truly detrimental effects while supplementing with the recommended doses of creatine. 2,3,4

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Though usually used by people wanting to improve their performance, creatine is being tested by other populations too. Other conditions being examined are: congestive heart failure, muscular dystrophy, neurological disease, mental fatigue, Huntington’s disease, and motor neuron disease.5 Due to their dietary requirements, vegans and vegetarians have also been recommended to supplement with creatine in order to help maintain adequate stores of creatine in the body.6

Many years ago, creatine was known to be riddled with impurities. Creatine is manufactured in a lab, not made by putting meat in a blender and then extracting the creatine. Since the price has decreased dramatically, manufacturers do not try to cut corners by mixing the creatine products with other substances. In 2003, Melanie Johns Cupp & Timothy S. Tracy reported that the majority of the lab-tested creatine products were found to be safe, and contained the amount of creatine that was stated on the label. 7 Remember, though, that claims about benefits should be backed with scientific proof. No butcher will ever tell you that they sell bad meat, and no manufacturer is going to claim to have an inferior product.  

Creatine doses vary, and may or may not include a loading phase. The loading phase lasts about one week and can include ingestion of 10-20 grams of creatine. This is followed by a maintenance phase of 3-7 grams. Creatine is usually best taken with some form of high glycemic index carbohydrate (fruit juice, sports drink). This allows the body to more quickly absorb the supplement. Although there is conflicting evidence brought out by manufactures, the literature backs taking creatine in a form of simple sugar. Self experimentation and detailed record keeping are good methods of determining your creatine needs. Too much creatine ingestion at one time may cause upset stomach, and cause disturbed bowel movements, 8 therefore, it seems wise to start with the lowest dose (ie maintenance) and then track what changes your body/workout experience.

The bottom line: creatine increases power, strength, and muscle. Creatine improves performance and decreases fatigue. The scientific literature is out there to prove it, and is too voluminous to cite here. It works by allowing the body to perform harder for longer, so it still requires challenging exercise sessions to see the results. Train hard, and supplement.

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References

1.    Challem , Jack. User's Guide to Nutritional Supplements: Become an Expert on What Nutritional Supplements Can Do for Your Health. Basic Health Publications, Inc., 2003. pp 270
2.    Cancela P, Ohanian C, Cuitiño E, Hackney AC. “Creatine supplementation does not affect clinical health markers in football players.” British Journal of  Sports Medicine. 2008 Sep;42(9):731-5.
3.    Poortmans JR, Francaux M. “Adverse effects of creatine supplementation: fact or fiction?” Sports Medicine. 2000 Sep;30(3):155-70.
4.    Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke JH, van den Berg LH. “Few adverse effects of long-term creatine supplementation in a placebo-controlled trial.” International Journal of Sports Med. 2005 May;26(4):307-13.
5.    Braun, Lesley, Marc Cohen. Herbs & Natural Supplements: An Evidence-Based Guide. Elsevier Australia, 2007. 267
6.    Larson-Meyer, D. Enette. Vegetarian Sports Nutrition. Human Kinetics, 2007. pp 142
7.    Johns Cupp, Melanie & Timothy S. Tracy Dietary Supplements: Toxicology and Clinical Pharmacology. Humana Press, 2003
8.    Williams, Melvin H., Richard B. Kreider, J. David Branch. Creatine: The Power Supplement.  Human Kinetics, 1999.  pp 14

Manny Escalante, Jr. MA, ATC, CPT has a Master's Degree in Sports Medicine,
Certified Athletic Trainer, and Certified Personal Trainer.
Competed in bodybuilding and a 3 time Ironman Triathlon Finisher