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Is Creatine Safe? How The King Of Performance Supps Affects Your Organs

Is Creatine Safe? How The King Of Performance Supps Affects Your Organs

Creatine is a vitamin for some, a bogeyman for others. Do you have any reason to fear the king of performance supplements?
"Part of creatine's appeal is due to its effectiveness."

Creatine is, without a doubt, one of the most popular sports supplements of our time. Given how directly people associate it with improved performance and body composition you could even place it ahead of whey protein powder, which many athletes now seem to treat like a food—or, in some cases, a food group.

Part of creatine's appeal is, of course, due to its effectiveness. Most of the people who take it simply see greater strength, power, and muscle growth as a result, and the research backs this up. Creatine also happens to be one of the most studied supplements, both in a sports setting and in how it interacts with various medical conditions. In short, if you're not taking creatine because you're afraid of a certain side effect, that side effect has probably been looked at in a laboratory setting.

Want the straight truth about what creatine will or won't do to your heart, liver, or kidneys? Here's what the existing research has to say.

General Side Effects
and Concerns

First off: Yes, creatine can cause water retention. This is probably no surprise. Regardless, unless you have a specific concern—like hypertension that requires treatment with diuretics—it's not a medical issue. For people concerned about looking bloated, the water retention happens in your muscles, so it actually makes you look a bit larger. This explains why some bodybuilders cut out creatine near the end of their contest prep. The rest of us needn't worry.

Regarding other potential side effects:

  • Stomach distress. This can happen when you take too much creatine at once, perhaps during a loading phase, without much else in your stomach. The remedy is usually simple: either increase your water and food intake when you take creatine or just take smaller doses of creatine throughout the day.
  • Intestinal distress or diarrhea. This also can happen when you simply take too much creatine in a single dose. Since it cannot be absorbed in high quantities, this can cause osmotic diarrhea, a condition where water gets drawn into the bowels. The solution, again, is to take smaller doses.

All of the common side effects associated with creatine stem from its absorption profile in the intestines. At low doses, around 1-3 grams, creatine is absorbed well. As the dose gets higher, the absorption decreases, which is why you can't overdose on creatine—at least, not in a way that would present a medical concern.

There are some claims that creatine can contribute to cardiovascular issues such as arrhythmia, but they seem to be based on anecdotes and the placebo effect.

What About The Liver?

A common knock against creatine is that it's bad for the liver, but this doesn't withstand scrutiny. A number of human studies have looked specifically at creatine usage and liver parameters and found no association between the supplement and liver problems.1,2

If you really want to go cherry-picking, a single study found liver problems in a particular mouse strain after 300 days of supplementation.3 Even with that in mind, human studies done on people with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease, over a span of 9-16 months failed to find any problems with liver enzymes.4-6

What About The Kidneys?

The idea that creatine could cause kidney damage comes from the following logic:

  1. One of the tests for a malfunctioning kidney is for creatinine. If the creatinine levels in your blood are high, your kidneys could be malfunctioning.
  2. Creatinine is a waste product of creatine, and loading creatine will increase your creatinine levels.

Elevated creatinine levels in and of themselves aren't a problem. They can be indicative of kidney problems, but they can also occur independent of kidney problems. On some level, it's understandable that this caused someone to sound the alarm, but it doesn't make it a reason to avoid taking creatine.

Human studies on biomarkers of kidney function during creatine supplementation have shown no significant alterations in BUN (blood urea nitrogen) or urinary glucose or proteins, and GFR (glomerular filtration rate) also remained unaffected. This was shown in people with ALS,4-6 postmenopausal women,7 athletes,8 young adults,9-11 and type-2 diabetics.12 Even a dose of 2 grams was shown to be fine for dialysis patients over the course of four weeks.13

Rat studies on a model with two-thirds nephrectomy—literally removing 66 percent of the kidney—found no issues with creatine.14,15 There is also a case study of a man with a single kidney having no problems with 20 grams of creatine daily alongside his high-protein diet.16

One rat study did show harm in rats with polycystic kidney disease.17 What's more, a single human case study that noted an accelerated rate of kidney damage in a man with focal segmental glomerulosclerosis (FSG). The impairment stopped when the supplement was removed, and started again when reintroduced.18 Both of these conditions are characterized by kidney tissue edema, a swelling caused by water accumulating. It has been suggested that any kidney issues that cause edema could be made worse with creatine—or anything that causes water retention in this organ.

Modern athletes treat creatine like a vitamin, and with good reason.

The Bottom Line

Looking at the current body of research, it's safe to say:

  1. Creatine does not cause damage to skeletal muscle or the heart, liver, or kidneys.
  2. Creatine, at this moment in time, seems to be fine for kidney disorders that are not characterized by edema and tissue swelling.
  3. Based on limited research, it is probably wise to avoid creatine supplementation if you have polycystic kidney disease, focal segmental glomerulosclerosis, or another kidney disorder characterized by tissue swelling.

Creatine is one of the most commonly viewed topics on our website, Examine.com. We've pored over the research, and we see no reason to fear creatine. Modern athletes treat it like a vitamin, and with good reason: It's safe, healthy, cheap, and for most people, it simply works. Get some creatine monohydrate, take 5 g per day, and you're good to go. If only all nutrition was that simple!

References
  1. Mayhew DL, Mayhew JL, Ware JS. Effects of long-term creatine supplementation on liver and kidney functions in American college football players. Int J Sport Nutr Exerc Metab. 2002 Dec; 12(4): 453-60.
  2. Schilling BK, Stone MH, Utter A, Kearney JT, Johnson M, Coglianese R, Smith L, O'Bryant HS, Fry AC, Starks M, Keith R, Stone ME. Creatine supplementation and health variables: a retrospective study. Med Sci Sports Exerc. 2001 Feb;33(2):183-8.
  3. Tarnopolsky MA, Bourgeois JM, Snow R, Keys S, Roy BD, Kwiecien JM, Turnbull J. Histological assessment of intermediate- and long-term creatine monohydrate supplementation in mice and rats. Am J Physiol Regul Integr Comp Physiol. 2003 Oct; 285(4: R762-9.
  4. Shefner JM, Cudkowicz ME, Schoenfeld D, Conrad T, Taft J, Chilton M, Urbinelli L, Qureshi M, Zhang H, Pestronk A, Caress J, Donofrio P, Sorenson E, Bradley W, Lomen-Hoerth C, Pioro E, Rezania K, Ross M, Pascuzzi R, Heiman-Patterson T, Tandan R, Mitsumoto H, Rothstein J, Smith-Palmer T, MacDonald D, Burke D; NEALS Consortium. A clinical trial of creatine in ALS. Neurology. 2004 Nov 9;63(9):1656-61.
  5. Rosenfeld J, King RM, Jackson CE, Bedlack RS, Barohn RJ, Dick A, Phillips LH, Chapin J, Gelinas DF, Lou JS. Creatine monohydrate in ALS: effects on strength,fatigue, respiratory status and ALSFRS. Amyotroph Lateral Scler. 2008 Oct;9(5):266-72.
  6. Groeneveld GJ, Veldink JH, van der Tweel I, Kalmijn S, Beijer C, de Visser M, Wokke JH, Franssen H, van den Berg LH. A randomized sequential trial of creatine in amyotrophic lateral sclerosis. Ann Neurol. 2003 Apr;53(4):437-45.
  7. Neves M Jr, Gualano B, Roschel H, Lima FR, Lúcia de Sá-Pinto A, Seguro AC, Shimizu MH, Sapienza MT, Fuller R, Lancha AH Jr, Bonfá E. Effect of creatine supplementation on measured glomerular filtration rate in postmenopausal women. Appl Physiol Nutr Metab. 2011 Jun;36(3):419-22.
  8. Cancela P, Ohanian C, Cuitiño E, Hackney AC. Creatine supplementation does not affect clinical health markers in football players. Br J Sports Med. 2008 Sep;42(9):731-5.
  9. Gualano B, Ugrinowitsch C, Novaes RB, Artioli GG, Shimizu MH, Seguro AC, Harris RC, Lancha AH Jr. Effects of creatine supplementation on renal function: a randomized, double-blind, placebo-controlled clinical trial. Eur J Appl Physiol. 2008 May;103(1):33-40.
  10. Candow DG, Chilibeck PD, Burke DG, Mueller KD, Lewis JD. Effect of different frequencies of creatine supplementation on muscle size and strength in young adults. J Strength Cond Res. 2011 Jul;25(7):1831-8.
  11. 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. Int J Sports Med. 2005 May;26(4):307-13.
  12. Gualano B, de Salles Painelli V, Roschel H, Lugaresi R, Dorea E, Artioli GG, Lima FR, da Silva ME, Cunha MR, Seguro AC, Shimizu MH, Otaduy MC, Sapienza MT, da Costa Leite C, Bonfá E, Lancha Junior AH. Creatine supplementation does not impair kidney function in type 2 diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial. Eur J Appl Physiol. 2011 May;111(5):749-56.
  13. Taes YE, Delanghe JR, De Bacquer D, Langlois M, Stevens L, Geerolf I, Lameire NH, De Vriese AS. Creatine supplementation does not decrease total plasma homocysteine in chronic hemodialysis patients. Kidney Int. 2004 Dec;66(6):2422-8.
  14. Taes YE, Delanghe JR, Wuyts B, van de Voorde J, Lameire NH. Creatine supplementation does not affect kidney function in an animal model with pre-existing renal failure. Nephrol Dial Transplant. 2003 Feb;18(2):258-64.
  15. Taes YE, Delanghe JR, De Vriese AS, Rombaut R, Van Camp J, Lameire NH. Creatine supplementation decreases homocysteine in an animal model of uremia. Kidney Int. 2003 Oct;64(4):1331-7.
  16. Gualano B, Ferreira DC, Sapienza MT, Seguro AC, Lancha AH Jr. Effect of short-term high-dose creatine supplementation on measured GFR in a young man with a single kidney. Am J Kidney Dis. 2010 Mar;55(3):e7-9.
  17. Edmunds JW, Jayapalan S, DiMarco NM, Saboorian MH, Aukema HM. Creatine supplementation increases renal disease progression in Han:SPRD-cy rats. Am J Kidney Dis. 2001 Jan;37(1):73-78.
  18. Pritchard NR, Kalra PA. Renal dysfunction accompanying oral creatine supplements. Lancet. 1998 Apr 25;351(9111):1252-3.

Related Articles

About The Author

Kurtis Frank and Sol Orwell are co-founders of Examine.com, where they collate scientific research on supplementation and nutrition.

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atokad

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atokad

When I was in high school there was a senior who lifted and was strong as hell and just shredded. People would always talk **** to him because they were under the impression that creatine was a legal steroid and thats how he got like that. Kids are ******* stupid

Dec 23, 2013 7:35pm | report
 
sebackers

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sebackers

Bro be careful about taking about creatine, it almost is like a steroid. I put on at least 2-3 lbs when I used it. My strength shot through the roof and endurance was crazy. Libido = CRAZY , Sex Drive = Insane. I know what you're thinking , I'm probably lying, BUT i'm not . I buy my creatine from Bodybuilding.com ( I like to try all the brands so I don't have a current favorite).

My bench shot up about 3 reps , my squat went up about 2 reps. People started asking me at the gym 'what I was on'' . I had to tell them it was just creatine. When I told them they started treating me different, like I didn't work hard for my results, they would say "oh hey look it's Mr. Creatine" . I had to switch gyms because of this. My arms went from 15.5 inches to 15.76.

Don't talk down about creatine It's legit stuff, just don't tell anyone that you use it unless you have to. My family doesn't know I take creatine , thank god , my family is REALLY against drugs so if they found out I could possibly be in big trouble.

Dec 23, 2013 8:11pm | report
samerym

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samerym

sebackers, you say your family is against drugs, then you have nothing to worry about. Creatine is a supplement--that's it!

Dec 24, 2013 7:38am | report
ajones_duffey

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ajones_duffey

@sebackers

I can't tell if your being sarcastic or not... but I really hope for your sake you are. If you truly believe creatine is almost like a steroid (or a drug) you're a f*cking idiot. A steroid (such as testosterone) directly binds to cells to influence muscle growth, creatine is used to produce cellular energy through the ATP CP pathway.

As far as your libido/sex drive? Most likely a placebo effect as creatine has no effect on testosterone levels or increases in blood flow.

If you started getting different treatment from people after you told them you were on creatine, its either bc you came off like a huge douche when you told them, or bc they're bigger idiots than you.

"Mr. Creatine"? Are you f*cking kidding me?

Dec 24, 2013 7:53am | report
kuenzelton

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kuenzelton

Just wanted to clear something up here... creatine is an organic acid found naturally in food like beef or fish. steroids are a synthetic hormone that resemble testosterone promoting the growth of muscle. They are not even remotely the same thing. they do however both have performance enhancing qualities, although creatine will be to a much lesser degree, for example, the 2-3 extra rep increase you experienced. As far as your sex drive, as stated above, that was placebo effect. I would not worry about telling anyone you are on creatine as it is not a drug any more than sirloin steak is.

Dec 24, 2013 8:14am | report
elglodmo

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elglodmo

were you using test boosters at the same time or something? because that entire statement sounds a little ridiculous

Dec 24, 2013 9:10am | report
Mudvayne24

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Mudvayne24

1 ajones_duffey.... That Mr. Creatine post had me ******* in my pants. I've been taking creatine for probably close to 10 years. I usually don't even cycle the stuff anymore.

If you can't/don't tell people you're taking creatine, then you best cut out chicken, turkey, beef from your diet as they all contain it.

Dec 24, 2013 9:13am | report
ZackMorgan2014

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ZackMorgan2014

@sebackers
What creatine did you take and how did you dose it?
It sounds like you're concerned that you grew so much, if it was me, id be happy as hell to have those gains in performance and size. I understand what you're saying about family, mine is the same.

Dec 24, 2013 10:21am | report
yomuju

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yomuju

@sebackers
I don't know what you're talking about... As far as I know, creatine does nothing for libido. And as far as it being some kind of "legal steroid" it isn't. It really isn't that powerful to be considered a steroid. Also, I don't know what kind of gym you went to where people gave you **** for taking creatine. 99% of the people in my gym are supplementing it. You must have been going to planet fitness or something, with a bunch of the people that atokad was talking. Creatine is a naturally occuring substance too, and I think you get a couple grams of it a day from just eating beef (poultry and fish don't have very much of it, as far as I know). I'm only 16, and everyone knows that I use creatine. I actually don't see that big of a difference when I use it. Sometimes when I forget to supplement it, I usually don't even care, because it really doesn't do ALL that much for me, although I do notice a small difference. I don't know where people get the impression that creatine is some all-mighty supplement.

Dec 24, 2013 3:08pm | report
loganmikeS

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loganmikeS

@sebackers
Man, I use to say that exact same thing when I first started taking creatine. I started lifting weights when I was 15 and I took creatine right off the get go. I never missed a dose of it, when I first started I was only curling 15's and benching like 90 pounds.
I was literally going up about 5-10 pounds a week for each set.
After 4 months of an extreme diet and a solid workout plan, I went from 140 pounds curling 15's , and benching 90lbs, to 165 pounds and curling 30's and benching 180 pounds.
I know the 25 pounds I gained wasn't all muscle, but after 4 months of lifting weights people thought I have been working out for years.
I got lazy last year and stopped taking creatine for a few months, I could tell a noticeable difference In my energy levels and my strength levels.
Creatine isn't as powerful as a steroid, but If you are a teenager, and use creatine correctly with a solid diet and workout routine, It will most definitely feel like a steroid, all of my friends and even a couple of my teachers thought I was injecting steroids.

Dec 25, 2013 7:24pm | report
loganmikeS

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loganmikeS

@yomuju
That is a ridiculous comment you just made.
You have to use creatine every single day, you can't slack off and only use it sometimes. It takes about 2-3 weeks for creatine to actually enter your blood stream and start working.
Creatine is the definition of an all mighty supplement, at least for me it is. I am just speaking for myself I can't speak for you. For all I know your diet is **** and you barely workout. I was taking creatine multiple times a day, lifting weights in the morning, and running at night. I was on an extreme diet pretty much of chicken breasts, eggs.pasta, brown rice, salmon, and all whole foods no junk food whatsoever.
I think Creatine only works to its potential when your diet is 100%, your in the gym day in day out with 100% effort, and proper rest.
I think the most important factor of them all though, is water. You have to drink at least a gallon a day or you are going to get dehydrated fast and it will only be detrimental from then on, maybe that is your problem, not enough water, If you're going to take creatine, you have to make water a priority.

Dec 25, 2013 8:18pm | report
TheCooke98

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TheCooke98

The bottom line is creatine works different for different people, some guys go on it and get nothing, others get a heck of a boost off of it. I've seen guys put on only a pound or two of water-weight with it, and others like me who throw on 5-6 pounds in a week and a half. The same thing applies to the strength and endurance portion of it.

Dec 26, 2013 3:55pm | report
sebackers

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sebackers

Bro's I switch creatine brands, I've used Optimum Nutrition's, BB.com, I also used the unflavored Cellucor Creatine, be careful about the Cellucor kind, it reminded me of the smell that comes when you don't wipe good enough and you wear the same underwear/ briefs/boxers for a few days in a row, imagine that in the form of creatine! I dosed @ 10 grams a day, I use to do 5 grams but I have a high tolerance to drugs and other stuff so I need more usually.

Bros say what you will about Creatine I know what it did for me and what it didn't . This stuff is REAL you need to stock up on it before it gets banned, the guy at GNC tell's me it might get banned soon so I buy it like crazy.

The libido and sex drive IS not placebo, I have taken this before meeting with the Misses for the daily bedroom acrobatics, usually take it pre-bedroom acrobatics with a scoop of Pre- Workout mixed in . I seem to get the job done , I'm not trying to brag either.

Dec 24, 2013 7:03pm | report
 
Danielfp

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Danielfp

ajones may have come off as a douche when addressing you but he was absolutely right. How can you compare creatine to a steroid and say it influences yoru sex drive. the only way it can in some way affect sex is by giving your muscles more energy through the atp system as previously stated. Besides..... the preworkout is what would get you pumped. And...banned.... I can't tell if your serious. If you are then stop buying in huge bulk.

Dec 24, 2013 9:05pm | report
michaelr575

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michaelr575

I dont think its the creatine that is increasing your sex drive, sebackers, it is probably how long you stare at yourself in the mirror before your supposed "misses" comes home that gets you all worked up. I certainly hope your just a douche that made a fake profile to get everyone stirred up, cause you just recently started making posts and they are all pretty much gay (the gay that you call something that is being gay, not the homosexual gay, although that could certainly be applicable in this case as well).

Dec 25, 2013 3:53pm | report
jstanek

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jstanek

Lmfao, I love when people can't spot the troll, so entertaining.

Dec 30, 2013 11:43am | report
ryanbr6

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ryanbr6

hahahaha! You guys are retarded if you think Sebackers is being serious!!

Dec 24, 2013 8:22pm | report
 
Danielfp

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Danielfp

You never know. The stupidity of people extends way beyond what sebackers is saying. I read some comments here that reflect that. For example, one guy said " Im never reading anything from this joker again cuase im here to grow" when obi wrote an article on stretching. Clearly, lack of intelligence is what is not lacking here.

Dec 24, 2013 9:06pm | report
loganmikeS

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loganmikeS

It gets me mad reading comments like this.
Because I was in Sebackers place a couple years ago.
I used creatine when I starting working out, saw amazing results. So amazing to where everyone thought that I was on steroids, I went from a little shrimp to the guy everyone asks what he is on.
I can sympathize 1000% with Sebackers, I know he's not lying, I got such amazing results from creatine I actually lost friends because they thought I was injecting steroids and they were jealous.
I know creatine is not a steroid, but it is the closest thing to it that is legal!

Dec 25, 2013 7:37pm | report
s0ysizzle

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s0ysizzle

Well played, @sebacker. Trolled tons of people LOL.

Dec 26, 2013 3:50pm | report
 
jstanek

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jstanek

So good.

Dec 30, 2013 11:43am | report
Alexburge

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Alexburge

Some people literally concern me sometimes... hahhahaha I love how he completely gave himself away by saying is sex drive went up yet people are still like "WHAT NOWAY?!"

Jan 3, 2014 4:55pm | report
64yoda

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64yoda

What I didn't see in this article is a benefit of creatine that has nothing to do with muscular development. I've read studies on students who supplemented every day with creatine and scored higher on standardized tests than the same students when they were not supplementing with creatine. It may sound like a long-shot, but if you don't believe me, look it up.

Dec 28, 2013 4:13am | report
 
tojo50

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tojo50

Good article.
Along with the reasoning that if you don't over do and keep the proper balance there should be no problem.

Dec 29, 2013 1:47am | report
 
JphnRock

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JphnRock

Great info, especially since a lot of supplememnts are now adding creatine to the protein supplements.

Dec 30, 2013 11:01am | report
 
Showing 1 - 25 of 37 Comments

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