ISSN Position Stand: Safety and Efficacy of Creatine Supplementation in Exercise, Sport, and Medicine
Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, Candow DG, Kleiner SM, Almada AL, Lopez HL
High-confidence evidence from multiple solid studies
Summary
The International Society of Sports Nutrition's official position on the safety and efficacy of creatine supplementation, synthesizing 500+ peer-reviewed studies. Covers the standard loading/maintenance protocol (~0.3 g/kg/day for 5–7 days, then 3–5 g/day), the absence of serious adverse effects at recommended doses for short- or long-term use, and the transient fluid retention (~0.5–1.0 L) that appears as early weight gain during loading.
Key findings
- 1
The recommended loading protocol is ~0.3 g/kg body weight/day, split into 3–4 doses, for 5–7 days, followed by a 3–5 g/day maintenance dose
- 2
Starting directly at 3–5 g/day without loading still reaches a comparable level of muscle creatine saturation within about 3–4 weeks
- 3
No scientific evidence indicates serious adverse effects in healthy individuals from short- or long-term use at recommended doses
- 4
Early in loading, transient fluid retention of roughly 0.5–1.0 L occurs, which is roughly proportional to the acute weight gain observed
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Related research
Muscle Creatine Loading in Men: High-Dose 6-Day vs Low-Dose 28-Day Regimens
Journal of Applied Physiology, 1996
A foundational mechanistic study in 31 healthy men examining, via muscle biopsy, how different creatine intake protocols affect muscle total creatine concentration. There is no mention of randomization or a placebo control; it compares rapid loading (20 g/day for 6 days, then 2 g/day for 30 days as maintenance) against a no-loading protocol of 3 g/day for 28 days. Both protocols increased muscle total creatine concentration by a similar amount (approximately 20%), reaching the same final level. Continuing at 2 g/day after loading maintained the elevated concentration, but it returned to baseline within 30 days of stopping supplementation.
Creatine supplementation augments gains in strength and lean mass from resistance training (meta-analysis)
Open Access Journal of Sports Medicine, 2017
A pooled analysis of RCTs in older adults. Adding creatine to resistance training produced significantly greater gains in lean mass and upper/lower-body strength than placebo.
Comparison of creatine monohydrate with other forms (ethyl ester, HCl, buffered, etc.): a systematic review
Amino Acids, 2011
A review comparing creatine monohydrate with alternative forms (creatine ethyl ester, HCl, buffered creatine=Kre-Alkalyn, micronized, etc.) for efficacy, safety, and cost-effectiveness. Creatine monohydrate has the strongest evidence base; no alternative form has demonstrated superiority.
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