Creatine

Our evidence grading method explains what each grade requires.

Does creatine increase muscle strength and power?

Yes, when combined with resistance training, in trials that mostly enrolled men [1]. A 2026 three-level meta-analysis of 63 studies (1,489 participants) compared resistance training plus creatine with resistance training alone and found larger gains, measured as g (a standardized effect size), in upper-body strength (g = 0.54) and lower-body strength (g = 0.55) [3].

A 2025 meta-analysis of 69 randomized trials (1,937 participants) found small but statistically significant gains over placebo in bench or chest press (1.43 kg), squat (5.64 kg), vertical jump (1.48 cm) and Wingate peak power (47.81 W), and no significant difference for handgrip or leg press strength [2]. A 2024 meta-analysis of 23 placebo-controlled studies of creatine with resistance training in adults under 50 found gains of 4.43 kg in upper-body strength and 11.35 kg in lower-body strength [1]. One author of the 2024 review discloses advisory roles with Alzchem and Create; one author of the 2025 review discloses an advisory role with Bear Balanced [1][2].

Older syntheses point the same way. A meta-analysis of 60 randomized placebo-controlled trials found a small effect on lower-limb strength in exercises lasting under 3 minutes (effect size 0.235) [4]. In older adults, a meta-analysis of 357 participants found that creatine plus training increased chest press and leg press one-repetition maximum more than training alone, with no difference for knee extension or biceps curl [5].

In the 2024 review, 20 of 23 studies involved only men, and women showed no significant strength gains; the sex difference in upper-body strength did not reach statistical significance (p = 0.067) [1]. The 2025 review found benefits most consistent in younger adults and men, with smaller or non-significant changes in older adults and women on several measures, and called for larger trials in both groups [2]. A 2026 meta-analysis of 7 randomized placebo-controlled trials in postmenopausal women (608 randomized) found gains in lean mass (0.37 kg) and leg-press strength (7.5 kg) with at least 5 g a day plus resistance training [29]. One author chairs an Alzchem-supported advisory board, and Alzchem paid part of the publication fee [29].

The International Olympic Committee (IOC) consensus statement lists creatine among the few supplements with good evidence of performance benefit, with the clearest effects in high-intensity tasks under 30 seconds [6].

Does creatine increase lean mass?

In trials that combine it with resistance training, yes [3]. The 2026 meta-analysis found increases in lean mass (g = 0.30) and body mass (g = 0.12), a small reduction in body-fat percentage (g = -0.14) and no significant change in fat mass, compared with training alone [3]. In older adults, creatine plus training increased fat-free mass and total body mass with no effect on fat mass, though the authors note that the number of studies was small [5].

Part of the early weight gain is water: a position stand funded by the Council for Responsible Nutrition reports fluid retention during loading, roughly in proportion to the weight gained [7].

Does creatine improve memory?

Possibly, with a small effect that is concentrated in older adults [8]. A 2023 meta-analysis pooled 8 randomized placebo-controlled trials in healthy people and found creatine improved memory measures (standardized mean difference, SMD = 0.29, 95% CI 0.04-0.53), a small effect with high heterogeneity, meaning results varied between trials (I2 = 66%) [8]. In adults aged 66-76 the effect was larger and statistically significant (SMD = 0.88), while in people aged 11-31 it was close to zero and not significant (SMD = 0.03) [8]. Dose (about 2.2-20 g a day), duration (5 days to 24 weeks) and sex did not change the result [8].

A 2024 meta-analysis of 16 randomized trials (492 participants aged 20.8-76.4) found a memory benefit (SMD = 0.31) and rated the certainty of that evidence as moderate, but found no significant effect on overall cognitive function or executive function [9]. It included patients with specific diseases as well as healthy people, so results may not apply to healthy adults [9]. A 2025 corrigendum changed wording in its attention and processing-speed results, not the memory finding [9].

The largest single trial adds caution. In a preregistered, randomized, double-blind crossover trial of 123 healthy adults taking 5 g a day for 6 weeks, Bayesian analysis supported a small benefit, but the effect on a backward digit span memory test only bordered on significance (p = 0.064), with no statistically significant effect on a reasoning test (p = 0.327) or on the exploratory tasks [12]. A randomized, double-blind, placebo-controlled 6-week trial in 22 young adults who were not sleep deprived found no effect on any cognitive measure [15], and a 2018 systematic review of 6 trials (281 people) found that performance stayed unchanged in young individuals [10].

In older adults, a 2026 systematic review found positive links between creatine and cognition in five of six studies, but four were cross-sectional diet surveys and three were rated poor in quality [16].

Do vegetarians benefit more?

Evidence is mixed. In a double-blind crossover trial of 45 young adult vegetarians, 5 g a day for 6 weeks improved working memory (backward digit span) and a reasoning test compared with placebo [14]. In a randomized, double-blind, placebo-controlled trial of 128 young women, 20 g a day for 5 days improved memory in vegetarians but not in meat eaters [13]. The 2023 trial of 123 adults, about half of them vegetarian, found that vegetarians did not benefit more than omnivores [12].

Does creatine help thinking during sleep loss?

In small trials, it reduced some of the decline in performance caused by a night without sleep [17][18]. In a double-blind, randomized crossover trial, 15 healthy young adults received a single 0.35 g/kg dose of creatine or placebo during 21 hours of sleep deprivation [17]. Creatine improved cognitive performance and processing speed and changed brain energy measures, and the authors suggested that a high single dose can partly counter fatigue-related cognitive deterioration [17]. The trial was funded by Forschungszentrum Jülich and used a commercial AlzChem creatine product [17].

A 2026 double-blind, randomized crossover trial by the same group in 29 healthy adults used a lower single dose (0.2 g/kg) and found less deterioration than with placebo in logic and number tasks, language-related processing speed and the Psychomotor Vigilance Test [18]. Improvements, up to 12%, were smaller than with the higher dose [18]. It had the same funder and creatine product [18].

Two earlier placebo-controlled trials gave 5 g four times a day for 7 days before the sleepless period. In a double-blind trial of 19 adults kept awake for 24 hours with mild exercise, the creatine group showed less decline than the placebo group in random movement generation, choice reaction time, balance and mood [19]. In a randomized trial of 36 hours of sleep deprivation with moderate intermittent exercise, creatine produced a statistically significant benefit only on a complex central executive task at 36 hours, with no significant differences on the other measures [20].

All four were small and effects were task-specific [17][18][19][20]. A 2024 systematic review called the cognition evidence "somewhat equivocal" and called for more research in stressed groups such as sleep-deprived people [11].

What the evidence does not show

Trials do not show a broad effect on thinking: one meta-analysis found no significant effect on overall or executive function [9], and the pooled memory benefit in younger healthy people is close to zero [8].

Skeletal muscle is its largest store and has a finite capacity, and the body clears creatine through muscle uptake, kidney elimination and breakdown to creatinine [28]. How the body absorbs and clears creatine does not change in direct proportion to dose size or frequency, and the review describes the available data as very limited [28].

On timing, the IOC consensus notes that taking creatine with about 50 g of mixed protein and carbohydrate may increase uptake into muscle through insulin [6].

On form, trials have used creatine monohydrate [6][9]. Health Canada's monograph does not permit liquids or solutions, because the finished product is not stable in that form [32].

In the 2023 trial of 123 adults, side effects were reported more often with creatine than with placebo (17% vs 4%; relative risk 4.25), mainly digestive problems (6% vs 2%) and weight gain (3% vs 0%) [12]. The NIH Office of Dietary Supplements states that creatine is considered safe for short-term use by healthy adults and that weight gain is its only consistent side effect [35]. A meta-analysis of 29 studies in females (951 participants) found no deaths or serious adverse outcomes and no increase in total adverse events, weight gain, or kidney or liver complications [23].

Kidney concerns persist largely because creatine intake raises serum creatinine [22]. A 2025 meta-analysis (21 studies reviewed; 12 pooled, with 177 creatine and 263 control participants) found a modest, transient rise in serum creatinine that the authors attributed to metabolic turnover rather than kidney impairment, with no significant change in glomerular filtration rate (GFR) [22]. An earlier meta-analysis concluded that creatine did not cause kidney damage at the amounts and durations studied [21]. A position stand funded by the Council for Responsible Nutrition describes college football players who took creatine for 21 months with no clinically significant differences in kidney markers compared with non-users [7].

Concerns have been raised that creatine promotes hair loss by increasing dihydrotestosterone (DHT) [25]. The concern traces to a 2009 crossover trial of 20 rugby players in which DHT rose 56% after 7 days of loading and stayed 40% above baseline after 14 days of maintenance; the trial measured hormones, not hair [26]. A 2025 randomized placebo-controlled trial of 45 resistance-trained men taking 5 g a day for 12 weeks (38 completed) found no statistically significant differences in DHT, the DHT-to-testosterone ratio or hair measures [25]. That trial had no specific funding, and several of its authors disclose advisory roles with the creatine brands Bear Balanced, Creapure and Create [25].

For long-term use, the position stand funded by the Council for Responsible Nutrition reports supplementation of up to 30 g a day for 5 years as safe and well tolerated in healthy people and in some patient groups [7].

A 2026 evidence-mapping review found no controlled human studies that directly tested creatine with prescription drugs [27]. Across major drug-interaction databases it found no established creatine-drug interactions of moderate or high severity; the signals listed were minor or theoretical and related mainly to kidney excretion [27]. The author cautions that a lack of documented evidence does not mean interactions cannot occur, particularly in high-risk groups, and discloses creatine-related advisory roles and intellectual property [27].

For caffeine, a pharmacokinetics review notes that caffeine and carbohydrate could affect creatine handling through the creatine transporter [28]. A later narrative review, whose authors include several advisers to the creatine manufacturer Alzchem, reports that the pharmacokinetics of creatine and caffeine do not appear to change when they are taken together [24].

These sources describe what has been reported, not what is right for any individual. If you take any prescription medicines, talk to your doctor or pharmacist before combining them with creatine.