Creatine Buyer's Guide

STRONG EVIDENCE

Creatine has STRONG EVIDENCE for athletic performance (PubMed)(PubMed)(PubMed)(PubMed)(PubMed)

Creatine has STRONG EVIDENCE for muscle strength (PubMed)(PubMed)(PubMed)(PubMed)(PubMed)

Creatine has STRONG EVIDENCE for muscle gain (PubMed)(PubMed)(PubMed)(PubMed)(PubMed)

Creatine has STRONG EVIDENCE for sarcopenia (PubMed)(PubMed)(PubMed)(PubMed)(PubMed)

Creatine has MODERATE EVIDENCE for cognitive health (PubMed)(PubMed)(PubMed)(PubMed)(PubMed)

Creatine has MODERATE EVIDENCE for depression (PubMed)(PubMed)(PubMed)(PubMed)(PubMed)

Creatine has WEAK EVIDENCE for testosterone (PubMed)(PubMed)(PubMed)(PubMed)(PubMed)

Creatine monohydrate can reliably attenuate age related sarcopenia and improve athletic performance. Interestingly, creatine improved memory in vegetarians (PubMed).

Recommended Products

USP Approved Supplements

There are no USP Creatine supplements.

NSF Approved Supplements

• Momentous Creatine
• Momentous Collagen + Creatine
• Thorne Research, Creatine, 16oz (450 g)

Informed Sport Approved Supplements

• Momentous Creatine
• Momentous Collagen + Creatine
• NOW Foods, Sports, Creatine Monohydrate, 2.2 lbs (1 kg)
• NOW Foods, Sports, Creatine Monohydrate, 750 mg, 120 Veg Capsules
• Sports Research, Creatine Monohydrate, Unflavored, 1.1lb (500 g)

Informed Choice Approved Supplements

• Optimum Nutrition, Micronized Creatine Capsules, 2.5 g, 100 Capsules
• Optimum Nutrition, Micronized Creatine Capsules, 2.5 g, 200 Capsules

Other Good Options

• Life Extension, Creatine Capsules, 120 Capsules

Other Options for those with dietary limitations

• Bluebonnet Micronized Creatine Powder - 10.58 OZ

For Athletes

Creatine is not prohibited by WADA, the IOC and NCAA. It is expected that creatine use will not be banned in the near future. Is highly recommended.

Verdict: Safe and reliable benefits for performance

Taking creatine improves performance in athletic endeavours, including but not limited to soccer, football, tennis, sprinting and basketball. An overwhelming majority of athletes supplement with creatine monohydrate for these benefits. Whilst Creapure is a trusted branded ingredient, any creatine monohydrate product will have reliable benefits.

In terms of NSF Approved products, Momentous Creatine uses Creapure, whilst Thorne Creatine Monohydrate doesn't. Interestingly, one study into creapure found that it did not confer cognitive benefit, but this is a single study. Thorne is slightly cheaper as of Nov 8 2024.
For non-athletes, supplementing with creatine can improve muscle strength.

Best Product for Athletes

Both Momentous Creatine and Thorne Creatine Monohydrate will perform similarly, and are lab-tested for label accuracy and banned substances.

How to take

Easy Method: Take 2-5 grams of creatine everyday.
Loading Method: Initial Loading Period of 0.3 grams per kg of bodyweight split into four doses throughout the day. For a 70 kg athlete this is 4 x ~5 gram doses for a total of 22.5 grams per day. Loading dose is to be taken for 5 days then maintained at 0.03 g/kg of bodyweight.

Warnings

• It is plausible that creatine may cause hair loss, although is unlikely (PubMed)(PubMed)(HRCAK)
• Supplementation at above 10 grams in a single dose may cause diarrhoea. 

For Healthcare Practitioners

Mechanism of Action

Creatine (methylguanidine-acetic acid) is concentrated in skeletal muscle (95%), but is also present in the testes, retina and other tissues. The body synthesis of creatine totals 1 to 2 grams per day (PubMed). This takes place in the liver, kidneys and pancreas. Dietary sources provide an additional 1 to 2 grams (PubMed).

• Kidney: Synthesis of creatine begins in the kidney whereby arginine and glycine form guanidoacetic acid which travels to the liver.
• Liver: Guanidoacetic acid is methylated in the liver, forming creatine which is transported through the blood to muscles across the body.
• Muscles: In the cytoplasm of muscle cells, the enzyme creatine kinase helps convert some creatine to phosphocreatine. Phosphocreatine acts as a rapid energy source, by donating a phosphate group to ADP, to generate ATP. In muscles, creatine exists in equilibrium with phosphocreatine, and creatine supplementation enhances both creatine and phosphocreatine concentrations, providing a larger total creatine pool in muscle tissues.
• Expected Result: Higher creatine concentrations enhance the ability to make ATP for 10-20 second energy bursts, and may also improve recovery time from said intense exercise.

Whilst the prevailing theory is that a greater total creatine pool improves recovery, evidence is conflicting (PubMed)(PubMed)(PubMed)(PubMed). Individual variances in muscle fiber type, baseline PCr levels and variations in creatine transporter efficiency may contribute reasons as to why.
Fast twitch muscle fibers, may benefit more from enhanced PCr stores than slow twitch muscle fibers. However, the benefit may not be due to faster resynthesis but rather the increased energy available for successive efforts. 
Phosphocreatine resynthesis evidence is therefore mixed, and benefits are attributed to an increased total creatine pool.

Interactions

Drug Interactions

CAFFEINE
Caffeine may reduce the effectiveness of creatine supplementation. Creatine may increase the risk of dehydration. 

CIMETIDINE (Tagamet)
Creatine and Tagamet, when used together, may increase the risk of kidney damage.

DIURETICS
Creatine may increase the risk of dehydration when paired with diuretics.

NSAIDs
NSAIDs including ubuprofin (Advil, Midol, Motrin) and naproxen (Aleve) may increase the risk of kidney damage when taken with creatine.

PROBENECID
Creatine and probenecid may increase the risk of kidney damage.