Creatine has more folklore attached to it than almost any other supplement, and most of it is wrong in the same direction: it makes creatine sound both more dangerous and more magical than the studies support. The short answer is that the big safety scares don’t hold up in healthy adults, the weight gain fear is mostly a men’s phenomenon that gets projected onto women, and the brain benefits are real in narrow conditions but smaller, more dose dependent, and more contested than the marketing suggests.
This piece started with a recorded panel from a 2022 creatine research conference, where Jose Antonio of Nova Southeastern University interviewed Scott Forbes of Brandon University and Trisha VanDusseldorp of Kennesaw State University about the creatine myths they hear most often. I’ve used their answers as the spine and then gone back to the primary literature, including papers published since, to check each claim. Where the evidence has moved, or where it was never as tidy as the panel implied, I say so.
What the Evidence Actually Shows
Before going deep, here is the honest scorecard. The claim that creatine damages healthy kidneys is contradicted by two meta analyses and decades of trial data, though people with existing kidney disease are a separate question. The claim that creatine is a steroid is a category error. The claim that it makes women gain a lot of weight is not supported by the trials in women, and the claim that it adds body fat is contradicted at every duration studied, from one week to two years.
The brain is where the story gets complicated. Creatine supplementation does raise brain creatine, but by less than it raises muscle creatine, and the cognitive benefits reported in meta analyses have been challenged on statistical grounds, rejected by the European food safety regulator, and look most convincing when the brain is under stress, such as sleep deprivation. That is the part of this topic where I’d urge the most caution about what you read online, including on supplement labels.
Who Said What, and Why It Matters
Forbes, VanDusseldorp, and Antonio are three of the eleven authors of a 2021 review in the Journal of the International Society of Sports Nutrition titled Common questions and misconceptions about creatine supplementation, which worked through twelve myths one by one. The panel is essentially a spoken version of that paper, and the paper is the best single starting point for anyone who wants the primary citations.
Two things are worth knowing about the 2021 review. First, it is a narrative review by experts, not a systematic review with a preregistered protocol, so it reflects a group judgment rather than a mechanical synthesis. Second, its competing interests section is long: several authors advise or have received funding from companies that manufacture or sell creatine, and Antonio runs the International Society of Sports Nutrition, which receives sponsorship from creatine companies. None of that makes the review wrong, and I think its conclusions on safety are well supported by independent work. But it is the kind of thing a reader should know, and it is why I’ve leaned on independent meta analyses and regulator assessments wherever they exist.
The Kidney Myth and the Creatinine Trap
Forbes opened the panel with the kidney question because it is the complaint he hears most from coaches and parents, and his explanation is the one every creatine user should understand. Creatine and phosphocreatine break down spontaneously into creatinine, a waste product that the kidneys filter out. Doctors use blood creatinine as a rough proxy for kidney function, on the assumption that more creatinine in the blood means the kidneys are filtering less. But creatinine also rises with muscle mass, with a meat heavy diet, and with creatine supplementation, none of which reflect kidney damage. Antonio confirmed that the worried phone call after a routine blood test comes up often.
The 2021 review traces the myth to a 1998 Lancet case report of a young man with preexisting kidney disease on an immunosuppressant who happened to start creatine, and notes that two separate teams wrote letters at the time pointing out the problems with the interpretation. The trial evidence since then has gone consistently the other way. A 2019 systematic review and meta analysis in the Journal of Renal Nutrition pooled 15 studies and concluded that creatine did not induce renal damage at the doses and durations studied. A larger 2025 meta analysis in BMC Nephrology covering 21 studies found exactly what the physiology predicts: a small, statistically significant rise in serum creatinine, concentrated in the first week and again beyond twelve weeks, with no significant difference in glomerular filtration rate, the measure that actually reflects kidney function. The authors describe the creatinine bump as a predictable consequence of a larger creatine pool rather than injury.
Two caveats the panel didn’t dwell on. The reassuring data come almost entirely from people with healthy kidneys, and reviewers on both sides of this debate agree that evidence in people with existing kidney disease is thin. And isolated case reports of kidney problems in creatine users continue to appear, including a 2025 pediatric report following a loading phase. Case reports can’t establish cause and are usually confounded by other supplements, drugs, or preexisting conditions, but they are a reason to interpret an elevated creatinine with your doctor rather than dismiss it. If you have kidney disease or take medication that affects the kidneys, that conversation should happen before you start, not after.
Is Creatine a Steroid
Antonio said he gets this question from undergraduates every year, and Forbes answered it in a sentence: no. Creatine is made in the body from three amino acids, arginine, glycine, and methionine, and its chemical structure has nothing in common with a steroid hormone. The 2021 review adds the regulatory distinction, which is useful for US readers. Anabolic steroids are Schedule III controlled substances that require a prescription. Creatine is a dietary supplement under DSHEA, and in 2020 creatine monohydrate received a no questions letter from the FDA for a GRAS notification covering its use in foods such as drink mixes and protein bars at one gram of creatine per serving.
Why does the myth persist? My guess is that creatine and steroids both increase strength and lean mass, and people reason backward from outcomes to mechanisms. The mechanisms are unrelated. Creatine increases the phosphocreatine available to regenerate ATP, the cell’s immediate energy currency, during hard efforts, which lets you do a little more work in training. It doesn’t act on androgen receptors. The one study that raised eyebrows, a 2009 trial reporting a rise in DHT in college rugby players, has not been replicated, and the review counts ten of twelve subsequent studies finding no change in testosterone.
Women, Water, and the Fear of Weight Gain
VanDusseldorp’s section was the part of the panel I found most useful, because it explains where a persistent belief came from. In 1991, a Swedish group led by Forsberg published a muscle biopsy study of fifty healthy adults that, almost in passing, reported roughly 10 percent higher total creatine in women’s muscle than in men’s. The inference that followed was that women were closer to their storage ceiling and therefore had less room to benefit from supplementation. VanDusseldorp’s view is that the data since then, though thinner than for men, show that women gain strength, power, and athletic performance from creatine, and that this holds in both premenopausal and postmenopausal women.
The independent literature broadly agrees, with caveats. A 2021 review in Nutrients on creatine across the female lifespan concluded that supplementation in premenopausal women appears effective for strength and exercise performance, and that postmenopausal women may see muscle benefits at higher doses around 0.3 grams per kilogram per day, especially alongside resistance training. The same review is candid that not every female trial is positive. Forbes’s own 2017 study found that creatine did not improve fitness, performance, or body composition in young women doing four weeks of high intensity interval training, and a 2014 study found no effect of creatine loading on neuromuscular fatigue in young women. Those null results appear in the 2021 misconceptions review too, to its credit.
On weight, VanDusseldorp was blunt: women are scared of it, and the fear is largely unfounded. Her reading is that trials in women, whether they used loading, no loading, or longer protocols, do not show meaningful increases in body mass, and that the weight gain data come mostly from men, where a loading phase can add a pound or two. The 2021 review notes that a loading phase of 20 grams a day for five to seven days typically adds one to three kilograms, mostly water. It sums up the water question this way: studies of a few days do show increased total body water, but several longer training studies of five to ten weeks don’t, and when water does go up it goes up inside the muscle cell, in proportion to the muscle itself. If avoiding any scale movement matters to you, the review’s practical advice is to skip loading and use 3 to 5 grams a day, which reaches similar muscle saturation in about four weeks.
Does Creatine Add Body Fat
This is the myth VanDusseldorp said drives her a bit mad, and she’s right to be irritated, because the data are unusually consistent. People notice a gain in body mass, assume it’s fat, and stop, but trials that actually measure body composition tell a different story. The 2021 review lists studies of one week, three weeks, six to eight weeks, twelve weeks, 24 weeks, 32 weeks, one year, and two years, in college aged men and women, swimmers, rugby players, recreational bodybuilders, older men, and postmenopausal women, and none reported an increase in fat mass from creatine.
The paper VanDusseldorp highlighted is Forbes’s 2019 meta analysis of randomized trials combining creatine with resistance training in adults aged 50 and older. Across 19 studies and 609 participants, the creatine groups had a greater reduction in body fat percentage than placebo, and lost about half a kilogram more absolute fat, though that second difference was not statistically significant. So the honest statement is not that creatine burns fat. It’s that creatine plus training does not add fat and may allow slightly more fat loss than training alone, in older adults. In younger people, the safest summary is no effect on fat mass either way.
Creatine for Endurance Athletes
Antonio, who competes in an endurance sport, pushed Forbes on whether creatine helps or hurts endurance, and Forbes gave what I think is the right answer: it depends on the event. Creatine taken with carbohydrate increases muscle glycogen storage, which is useful for anyone who depletes glycogen in training. But creatine also adds a small amount of body mass, and in a weight bearing sport like running that can cancel out any benefit. Forbes suggested the calculus is different in cycling, paddling, and kayaking, where the equipment carries the weight, and in any race that involves changes of pace or a finishing kick.
The study he cited is worth reading in full because it is less flattering than the summary. In 2018, Tomcik and colleagues had 18 well trained male cyclists complete a 120 kilometer time trial with six sprints spaced every 10 kilometers, followed by a climb to exhaustion, after either creatine loading, 20 grams a day for five days and then 3 grams a day for nine days, or placebo. Overall time trial times and climb times did not differ between groups. Creatine did increase power in the final 4 kilometer sprint, alongside greater muscle creatine and glycogen, despite adding more body mass than placebo. That is a real effect on one part of a race, not a faster race overall, and the study shouldn’t be cited as more than that.
What Creatine Does in the Brain
When Antonio asked about cognition, VanDusseldorp said the data are looking positive, and Forbes laid out the mechanism and the findings as he sees them. Supplementation can increase the amount of creatine in the brain. That appears to benefit cognitive processing, including attention, executive function such as decision making, and memory, and the effects seem largest when the brain is stressed by sleep deprivation, concussion, traumatic brain injury, or low oxygen.
The first part of that is established but modest. In 1999, a German group used magnetic resonance spectroscopy, which measures chemical concentrations in living tissue, to show that 20 grams of creatine a day for four weeks raised total brain creatine by about 8.7 percent in six healthy volunteers, with a wide spread from 3.5 to 13.3 percent and the smallest gains in the heaviest men. A 2025 review by Candow and colleagues puts the typical brain increase at roughly half of what muscle shows, around 10 percent versus 20 percent, and attributes the gap to the creatine transporter the brain relies on and to the blood brain barrier. A 2026 review in the Journal of Dietary Supplements goes further and warns that spectroscopy measurements of brain creatine are sensitive enough to scan placement and analysis choices that real responses can be obscured or manufactured, so the measurement literature is noisier than the headline numbers suggest.
The second part, that more brain creatine means better cognition, is where I part company with the panel’s confidence.
The Cognition Evidence Is Messier Than the Headlines
Two meta analyses are usually cited to support cognitive benefits, and both have been challenged. A 2023 meta analysis in Nutrition Reviews led by Prokopidis, with Forbes and Candow as coauthors, pooled eight randomized trials and reported that creatine improved memory in healthy people, most robustly in older adults aged 66 to 76. A letter from Eckert and Pascher pointed out that the analysis had counted multiple memory tests from the same participants as if they were independent observations, which inflates statistical power. When the authors reanalyzed with an appropriate method, the overall memory effect was no longer significant, and only the older adult subgroup survived.
The second is a 2024 meta analysis by Xu and colleagues in Frontiers in Nutrition covering 16 randomized trials and 492 participants aged roughly 21 to 76, mixing healthy people and patients. It reported benefits for memory, with moderate certainty, and for attention time and processing speed, with low certainty, and no significant effect on overall cognition or executive function. This paper has since had a corrigendum correcting a mistranslated sentence in its attention results, and in 2026 a commentary in the same journal identified the same double counting problem: some included trials contributed seven or more memory subtests from the same participants, so the pooled analysis contained more observations than randomized people. The commentary asks for a reanalysis. As of this writing I haven’t seen one.
The most consequential assessment came from a regulator. In November 2024, EFSA’s nutrition panel evaluated a proposed health claim that daily creatine supplementation can contribute to improved cognitive function, submitted by a creatine manufacturer. The panel reviewed 21 human intervention studies plus two more, noted that effects seen at 20 grams a day over short periods did not persist at the 3 grams a day that would actually be marketed, found no consistent benefit on memory, attention, executive function, or response inhibition in healthy people under normal or stressed conditions, and specifically flagged the pooling of test results that were not independent in the Xu meta analysis as inflating sample sizes. Its conclusion was that a cause and effect relationship had not been established. In 2026 the European Commission formally refused the claim, which means creatine products sold in the EU cannot advertise cognitive benefits.
That is an EU decision, and it doesn’t bind US products, where the FDA and FTC regulate supplement claims under different rules. But the reasoning behind it applies everywhere, because it is about the studies, not the jurisdiction. A separate 2024 systematic review by McMorris and colleagues, who have run several of the cognition trials themselves, reached a similar verdict: creatine does raise brain creatine, the cognitive results are equivocal, the supplementation regimens across trials are inconsistent, and future studies need to measure brain creatine rather than assume it changed.
To be fair to Forbes and VanDusseldorp, most of this criticism postdates their 2022 panel, and they were careful to say the field was still developing. But a reader in 2026 should not walk away thinking the cognition question is settled in creatine’s favor. It isn’t.
Dosing for the Brain Is an Open Question
Antonio raised a question the panel was honest enough to leave unanswered: given that creatine enters muscle more easily than brain, is 5 grams a day enough for the brain, or does it need to be 10, or more? Forbes said the optimal dose is unknown, that a higher dose is speculated to be needed because the brain has fewer creatine transporters, and that the brain also synthesizes its own creatine, which complicates the picture.
The literature since then reinforces every part of that answer. A 2017 study cited in a 2025 US Department of Defense information paper gave people aged 10 to 84 a standard muscle loading dose of 0.3 grams per kilogram per day for seven days and found a measurable rise in muscle creatine but no change in brain creatine. The Department of Defense paper’s summary is that raising brain creatine appears to require a higher dose, a longer duration, or both, and that the optimal strategy is unknown. Candow’s 2025 review is titled “More Is Likely Better for Brain Bioenergetics” and argues the same point while conceding that the doses used in trials, often 20 grams a day, are not the doses people actually take.
This matters for anyone reading brain claims on a label. The trials that show cognitive effects mostly used 20 grams a day for a week, or a single dose of 0.35 grams per kilogram, which is roughly 25 grams for a 70 kilogram adult. A 3 or 5 gram daily serving is a muscle dose that has not been shown to reproduce those results, and EFSA said so explicitly.
Sleep Deprivation, Concussion, and Stressed Brains
The one area where I think the panel’s optimism has held up is the stressed brain. Forbes’s claim that creatine helps most when the brain is under metabolic stress has gained its best supporting evidence since 2022. In a 2024 study in Scientific Reports, a group at Forschungszentrum Jülich gave 15 healthy adults in their early twenties a single dose of 0.35 grams of creatine per kilogram or placebo at the start of a 21 hour period without sleep, then ran spectroscopy scans and cognitive tests at three, five and a half, and seven and a half hours. Creatine preserved brain phosphocreatine and ATP, prevented a drop in brain pH, and improved processing speed and short term memory relative to placebo. A 2026 follow up from the same group in 29 people used a lower single dose of 0.2 grams per kilogram and found a smaller but still measurable reduction in the decline on logic, numerical, and vigilance tasks, up to about 12 percent, with women benefiting more than men.
These are small, single night studies of a single large dose in young healthy adults. They say something about a firefighter on a night shift, which is exactly the population Forbes wants to study next, and nothing about whether a daily maintenance dose sharpens an ordinary rested brain. The two should never be blurred together.
Concussion is thinner still. The human evidence the 2021 review leans on is a 2006 open label pilot trial in 39 children and adolescents with moderate to severe traumatic brain injury, given 0.4 grams per kilogram per day for six months, which reported fewer complications. It was not blinded, it was not in adults, and it was not in sport concussion. A 2025 scoping review of creatine for concussion in contact sport athletes concluded that the evidence is limited, that most of it comes from animal models, and that dose, timing, and outcomes remain to be established. The Department of Defense paper is equally direct: some evidence, no large placebo controlled trials, and no clinical guidelines for using creatine to manage or prevent brain injury. Anyone recovering from a concussion should be talking to a clinician, not a supplement label.
What Remains Unknown
The closing question of the panel was about future work, and the answers double as a map of what the field still can’t say. VanDusseldorp wants more research in women, specifically on the menstrual cycle and on time efficient training combined with creatine across perimenopause and postmenopause, with bone density, body composition, and mood as outcomes. Forbes wants a trial comparing cycling on and off creatine with continuous daily use, and clinical work on concussion recovery and on occupational groups such as firefighters, who are sleep deprived, make fast decisions, and do heavy physical work in the same shift.
Some of that has started. A 2025 review in the Journal of the International Society of Sports Nutrition on creatine from menstruation through menopause concludes that data on perimenopausal women specifically remain limited. A 2025 randomized trial in 36 perimenopausal and menopausal women tested low doses of creatine hydrochloride, 750 to 1,500 milligrams a day for eight weeks, with cognitive, clinical, and brain creatine outcomes, and reported improvements on some cognitive measures. It is small and short, and it used a form and dose that don’t map onto the monohydrate literature, so I’d treat it as a reason to run a bigger study rather than a result. The cycling versus continuous question, as far as I can find, still hasn’t been tested directly.
VanDusseldorp also offered a candid note about why women are underrepresented in these trials: they are harder to recruit, partly because of the weight gain fear, and the studies that succeed tend to use supervised, one on one training that requires staff most labs don’t have. That is a structural problem, and it is why male data still dominate the literature on a supplement all three panelists said they take every day.
What would change the picture? On safety, nothing much; the kidney, steroid, and fat myths are as close to closed as nutrition science gets for healthy adults. On the brain, three things: a reanalysis of the existing meta analyses using methods that respect the number of people actually randomized, trials that measure brain creatine alongside cognition so we know whether the dose did anything, and a properly powered study of a realistic daily dose in rested, healthy adults. Until those exist, the fair statement is that creatine myths about danger are mostly false, and creatine myths about the brain are mostly premature.