Creatine is the most studied sports supplement in existence, and yet a quick internet search still turns up claims that it wrecks your kidneys, dehydrates you, makes you go bald, and somehow causes water retention at the same time. Prof. Rick Kreider, Director of the Exercise and Sport Nutrition Lab at Texas A&M University and Chair of the Creatine for Health initiative, opened the 2025 Creatine Conference with a keynote on exactly this tension. His argument is that creatine has nearly two centuries of research behind it, that the safety evidence is unusually deep, and that public understanding lags badly behind the science.
This article follows his talk, checks the key claims against independent sources, and flags where the evidence is stronger or weaker than his presentation suggested. Kreider disclosed at the outset that he holds no creatine patents and earns no money from creatine sales, though his lab has received research grants over the years.
Two centuries of creatine research
Kreider’s first point is that creatine feels new but is not. He traces the story back to the 1800s, when a German laboratory found that animals which exercised more had more creatine in their muscle, and began selling a meat extract that raised work performance in the people who consumed it. He calls this perhaps the first creatine product.
The details check out, with one correction. The French chemist Michel Eugène Chevreul isolated creatine from meat in 1832, naming it after the Greek word kreas, and in 1847 the German chemist Justus von Liebig identified its chemical structure and funded his laboratory largely by producing and selling a meat broth that contained about 8% creatine. The transcript’s “Luben” is a transcription error for Liebig. Liebig also observed that wild animals carried more creatine than captive ones and concluded that physical activity influenced creatine levels in the flesh.
According to Kreider, the first paper he could locate was from 1909, reporting that dogs given creatine gained weight and improved their work performance, and that a handful of humans, probably people working in the lab, showed increased work capacity too. He notes that health applications also have deep roots: he cites a diabetes study from 1911, an infant study from 1926, and pregnancy studies in the 1940s and 1950s. We could not independently confirm those specific dates, but the broader point is well documented. A 1994 review in Sports Medicine notes that a century earlier, feeding studies had already concluded that some ingested creatine was retained in the body.
The real turning point, Kreider explains, came in the 1960s when researchers in Jonas Bergström’s Swedish lab developed the muscle biopsy technique. This allowed scientists such as Eric Hultman, Kent Sahlin, Roger Harris, and Theo Wallimann to measure what creatine and creatine kinase actually do inside human muscle. A 2025 narrative review coauthored by Kreider describes how the first postdoctoral researchers under Bergström and Hultman, including Harris and Sahlin, did the work on muscle energetics that set the stage for everything that followed. Medical applications followed in the 1970s, including heart patients and children with inherited creatine synthesis deficiencies.
The 1992 paper that changed everything
Kreider identifies one paper as the launch of the modern era: Roger Harris, Karin Söderlund and Eric Hultman’s 1992 study showing that oral creatine raised muscle creatine content. This is the single most cited origin point in the field, and the story behind it is worth knowing. The paper, published in Clinical Science after being rejected by Nature and the Journal of Physiology, clearly demonstrated that oral creatine monohydrate elevated muscle creatine stores. Interestingly, an earlier unpublished attempt by Bergström, Hultman, Harris and Sahlin to raise muscle creatine in two swimmers had incorrectly concluded it could not be done through diet.
Kreider recalls that several athletes at the 1992 Olympics were already taking creatine, including the winner of the 100 m. A McGill University science writer confirms that creatine first drew wide attention after Linford Christie’s win, having previously been a footnote in organic chemistry lectures. Contemporary documentation of exactly who used what is anecdotal, but the association is widely reported.
A cascade of work followed. Kreider names Paul Greenhaff, Paul Balsom, Anna Casey and others who showed creatine affected muscle contraction and fatigue. Greenhaff’s 1993 follow up, for example, tested five days of creatine at 4 doses of 5 g per day against placebo during repeated bouts of maximal isokinetic exercise. Kreider says his own group ran what he believes were the first studies in trained athletes, and that Jeff Volek, William Kraemer and Darren Willoughby demonstrated that the weight gain was muscle mass and strength, not merely water.
Roger Harris received the International Society of Sports Nutrition’s first Career Achievement Award in 2017, and Kreider notes that the community recently published a tribute to him after his death.
How much research actually exists
Kreider describes an explosion of publications since the 1990s, with peaks after the biopsy era, after the 1992 paper, and after the position stands. He puts the numbers at more than 10,000 studies with creatine in the title, over 7,000 in humans, and over 700 human clinical trials. We could not verify those exact counts, and figures vary depending on how databases are searched. The 2021 ISSN misconceptions review cited over 500 peer refereed publications involving creatine supplementation, so Kreider’s broader total likely includes animal, mechanistic and metabolic papers. Whatever the precise count, the body of evidence is very large by supplement standards, and his conclusion that it supports both safety and efficacy is consistent with the position of every major sports nutrition body.
Where the safety scare came from
Here Kreider tells a story that explains much of the confusion that persists today. After the 1990s research wave, USA Today ran a headline linking creatine to the deaths of college wrestlers. He remembers being interviewed alongside William Kraemer and saying there was simply no data behind it. The story nonetheless spawned a generation of internet articles about creatine dangers.
The record supports him. The Centers for Disease Control investigated three previously healthy collegiate wrestlers who died within a five week window in late 1997, and found each had been following a rapid weight loss regimen involving fluid restriction, vapor impermeable suits and vigorous exercise in hot environments, resulting in dehydration and hyperthermia. The FDA did announce it would look into whether creatine played a role. Neither the CDC nor the FDA ever implicated creatine in the wrestlers’ deaths. The cause was the weight cutting practices, which the NCAA subsequently banned.
Kreider observes that if you search “creatine side effects” today you find a contradictory list: it causes water retention, it causes dehydration, it upsets digestion, it disturbs mood, and because it builds muscle it must be some kind of anabolic hormone. He calls this last idea flatly wrong. On this point the evidence is clear. The 2021 review by Antonio and colleagues, written by a panel of creatine researchers, concluded that creatine is not an anabolic steroid, that it does not always lead to water retention, and that it does not increase fat mass. Creatine is a nitrogen containing compound made in the body from three amino acids; it has no structural or hormonal relationship to steroids.
Cramping, dehydration, and heat
Kreider explains that his group knew the safety scare was nonsense because they had already run studies in football players training through hot, humid conditions in Memphis without seeing any of the alleged problems. They then designed studies specifically to test the question. According to Kreider, these showed no difference in problems between creatine users and nonusers, and in fact found less cramping and fewer heat related issues in the creatine group. This work was replicated with the late Mike Greenwood and fed into the ISSN position stands.
The published studies match his description. In one study, 38 of 72 Division IA football players volunteered to take creatine during the 1999 season, training and competing in temperatures ranging from 15 to 37 degrees C, while researchers tracked cramping and injury incidence. A three year study across the 1998 to 2000 seasons, with creatine use ranging from 34% to 56% of players, found that creatine supplementation did not increase the incidence of cramping or injury. One caution worth adding: these were open label designs where athletes chose whether to take creatine, so they cannot rule out that healthier or more careful players self selected into the creatine group. They are strong evidence against harm but weaker evidence of a protective effect.
The independent literature reaches the same conclusion on hydration. A 2009 systematic review with meta analyses in the Journal of Athletic Training screened 95 articles, selected 10 controlled studies, and found none demonstrated adverse creatine induced changes in thermoregulation, dehydration, urinary hydration measures, or plasma volume. The 2021 ISSN review states plainly that creatine supplementation does not cause dehydration or muscle cramping. The persistent dehydration myth is odd on its face, since creatine draws water into muscle cells rather than out of the body, and studies measuring total body water find it goes up, not down.
Kreider says the 2007 and 2017 ISSN position stands, which have been accessed close to a million times by his count, concluded that creatine is safe, is the most effective supplement for increasing strength and performance, and has a long record of clinical use. The 2017 stand states that both short and long term supplementation, at doses up to 30 g per day for as long as five years, is safe and well tolerated in healthy people and in patient populations ranging from infants to the elderly. It cites Kreider’s own work showing football players taking 20 to 25 g per day for 12 weeks during conditioning and spring practice gained more strength and muscle with no adverse side effects.
Hair loss, kidneys, and other persistent myths
Kreider reserves particular scorn for the claim that creatine causes baldness, which he dismisses in a single word: garbage. The evidence largely backs him, though the full story is a little more interesting than a one word dismissal suggests.
The hair loss idea comes from a single 2009 study in 20 rugby players that reported a rise in dihydrotestosterone (DHT), a hormone involved in male pattern baldness, after three weeks of creatine. That study never measured hair. The 2021 Antonio review examined 12 trials measuring testosterone or DHT and found no consistent effect of creatine on either hormone. Then in 2025 the question was finally tested directly. Researchers randomized 45 resistance trained men aged 18 to 40 to 5 g per day of creatine monohydrate or a maltodextrin placebo for 12 weeks and found no significant differences in DHT, the DHT to testosterone ratio, or any hair growth parameter. The authors described it as the first study to directly assess hair follicle health after creatine, providing strong evidence against the hair loss claim. Fair criticism exists: the trial was small, did not screen participants for genetic predisposition to baldness, and did not measure DHT activity at the scalp itself. So the honest summary is that no study has ever shown creatine causes hair loss, the one hormonal signal has not replicated, and the first direct test came back negative. That is not quite the same as proof of impossibility for every genetically susceptible person, but it is far from the confident warning many websites still carry.
Kidney damage is the other claim that refuses to die, and its origin is instructive. According to the 2021 review, the misconception traces to a single 1998 case report in a patient who had already been treated for kidney disease for more than eight years, whose blood creatinine rose after he took creatine; the authors point out that creatine supplementation raises blood creatinine on its own, which makes that marker misleading. Two separate teams of creatine metabolism experts wrote letters to the Lancet in response at the time. The consensus position is that creatine at recommended doses of 3 to 5 g per day does not cause kidney damage or renal dysfunction in healthy individuals. People with existing kidney disease should still talk to a doctor before supplementing, since that population has not been studied in the same depth.
Creatine and mental health
This is the one place where Kreider’s confidence outruns the evidence, and readers deserve to know it. He criticises WebMD for listing side effects including dehydration, stomach upset, cramps and bipolar disorder, and remarks that if anything creatine has been shown to have the opposite effect on mood.
The dehydration and cramping criticisms are justified, as covered above. The bipolar warning is different. In a 2007 open label study, eight patients with treatment resistant unipolar depression and two with bipolar depression received 3 to 5 g per day of creatine for four weeks; the unipolar patients improved significantly, but both bipolar patients developed hypomania or mania, and the authors concluded creatine might precipitate a manic switch in bipolar depression. That signal appeared again in a controlled trial. A 2018 randomized, double blind, placebo controlled study of 53 people with bipolar depression found a significantly higher remission rate with 6 g per day of creatine, but two participants in the creatine group developed hypomania or mania.
So Kreider is right that creatine has shown antidepressant potential, and WebMD is not wrong to flag a caution for people with bipolar disorder. The numbers involved are tiny and nothing is proven either way, but the appropriate summary is “promising for depression, use caution in bipolar disorder”, not “the opposite of harmful”.
Even the depression evidence deserves a measured reading. A 2025 systematic review and meta analysis in the British Journal of Nutrition pooled 11 randomized trials with 1,093 participants and found a standardized effect equivalent to about 2.2 points on the Hamilton depression scale, below the 3 point threshold usually considered clinically meaningful, with very low certainty evidence, substantial heterogeneity, and signs of bias favouring creatine. The authors concluded creatine may offer a small to moderate benefit for people with depression, but that the true effect could be trivial or absent. A separate 2025 systematic review restricted to people with diagnosed mental disorders found only five trials, four in major depression and one in bipolar depression, and no other conditions studied at all. This is an early and promising field, not a settled one.
Monohydrate versus newer forms
Kreider is blunt about the supplement industry’s contribution to confusion. Companies chasing market share promote claims that their form mixes better, absorbs better, causes no side effects, or is safer than monohydrate. He points to a 2022 paper concluding that creatine monohydrate is the only form thoroughly established as safe and effective, and that while a few alternatives show some efficacy, none has been shown to beat it.
That review, by Kreider with Ralf Jäger and Martin Purpura, updated a 2011 analysis and concluded that no other purported form of creatine had been shown to be a more effective source than creatine monohydrate, that regulators internationally recognise monohydrate as safe, and that most alternative forms were less bioavailable, less effective, more expensive, or insufficiently studied for safety or efficacy. The 2017 ISSN position stand likewise names creatine monohydrate as the most extensively studied and clinically effective form in terms of muscle uptake and performance.
Kreider uses creatine hydrochloride (HCl) as his example, without naming a brand. Advertisements claim seven times the absorption of monohydrate, no bloating, and that 750 mg equals 5,000 mg of monohydrate. His response is a single principle: solubility is not bioavailability. HCl dissolves better in water, but dissolving faster in a glass says nothing about how much reaches muscle. By his count only about five HCl studies exist and none shows superiority, and he calculates that the marketed dose works out to roughly $2 per gram of creatine against 5 to 10 cents for monohydrate. We were unable to verify those exact study counts or prices, but the underlying claim that HCl lacks comparative evidence of superiority is consistent with the 2022 review. A separate 2022 analysis of alternative creatine forms sold on Amazon found that the research recommendations for validating a new form have not been adopted by manufacturers nor enforced by the FDA or FTC.
The practical takeaway is simple. If you want the form with decades of safety data and hundreds of trials behind it, buy plain creatine monohydrate.
Children, adolescents, and the case against restrictions
One of the most consequential parts of Kreider’s talk concerns proposed legislation to restrict creatine sales to minors. He describes this as the worst thing you could do, arguing that taking creatine out of the diet of young people removes a nutrient they need. His group responded with a position statement and press release through the ISSN.
The ISSN release, dated February 12, 2025, stated that creatine researchers and the Society had become increasingly concerned about reports of government agencies attempting to restrict sale of dietary supplements containing creatine to children and adolescents. The accompanying paper in Frontiers in Nutrition argues that creatine is essential for normal energy metabolism and healthy growth, that low dietary creatine intake has been associated with slower growth, less muscle mass and higher body fat in children and adolescents, and that adolescents tend to consume less creatine than recommended. It also states that creatine supplementation is not associated with eating disorders and that claims to the contrary are not rooted in scientific evidence, and it notes documented benefits in pediatric conditions including acute lymphoblastic leukemia and Duchenne muscular dystrophy.
This position predates the 2025 controversy. The 2017 ISSN stand already said that with proper precautions and supervision, creatine monohydrate is acceptable for children and adolescent athletes, and that label warnings against use under 18, while perhaps intended to insulate manufacturers from liability, are likely unnecessary given the science. The 2021 review adds that clinical trials in children, some giving 0.4 g per kg per day for six months, included continuous monitoring of kidney, liver and inflammatory markers and found none negatively affected.
Kreider goes a step further and suggests that keeping athletes off creatine may expose them to greater risk of head and spinal injury, based on data he acknowledges is mostly from animals. This is the most speculative claim in the talk and should be read that way. The strongest human evidence is an open label randomized pilot study of 39 children and adolescents aged 1 to 18 with traumatic brain injury, which tested creatine as a possible neuroprotective agent. That study reported fewer post traumatic symptoms and better cognitive performance in the creatine group, and animal models have shown creatine before or after mild brain injury may reduce neuronal damage, but most human studies are small or focused on moderate to severe injury. High quality randomized trials of creatine for concussion recovery in adults remain limited. The idea is biologically plausible and worth studying. It is not a reason to expect creatine to protect any individual athlete from a concussion.
From sports supplement to health supplement
The second half of Kreider’s talk describes the Creatine for Health initiative he chairs, launched to educate the public and, especially, healthcare practitioners who get questions from patients. He describes a scientific advisory board whose members have collectively published around 380 creatine papers and an affiliate board with roughly 550 more. In 2022 the group organised a special issue of the journal Nutrients with 27 review articles covering everything from bioavailability and pregnancy to brain health, glucose management, heart health, immune function, cancer, inflammatory bowel disease, and post viral fatigue. He reports these papers have been cited nearly a thousand times and downloaded 680,000 times. Those metrics are self reported and we did not independently verify them, but the special issue itself is real. The 2022 forms review, for instance, was published as part of the Nutrients special issue titled Creatine Supplementation for Health and Clinical Diseases.
Kreider is candid that even the research community did not know the full breadth of creatine’s applications until they gathered in one place. He recalls Roger Harris leaning over at a 2010 or 2011 conference in Cambridge to ask whether he realised how much creatine research was happening in cancer. The initiative has since run conferences in Chile, Colombia and Mexico, built a website that posts new papers as they appear, and produced podcasts and a YouTube channel. Kreider reports 300,000 website visits, 5.5 million video views, and a sharp jump in monthly creatine searches after the initiative began. These are his figures, not audited ones.
He also describes rapid response efforts: highly cited myth busting papers in the ISSN journal, a joint statement from 30 to 40 researchers rebutting a single rat study that suggested cancer effects, and the 2025 youth restriction response. He jokes about whether all this is urinating into the proverbial wind, but argues the answer is no, and that creatine has visibly shifted from a sports supplement to a health supplement.
The market data broadly supports that shift, though the projections should be treated loosely. Kreider states that creatine purchases have roughly doubled in recent years and are projected to double again by 2031. One market research firm valued the global creatine supplements market at USD 1.4 billion in 2025, with North America holding about 41% of revenue and powder holding about 80% of sales, and projected USD 8.7 billion by 2033. Another projects 12.6% annual growth from 2025 to 2031. A United States focused report attributes growth partly to format innovation attracting first time users who prefer gummies, chewables or capsules over bulk powder, while noting tighter scrutiny of health claims. Firms disagree wildly on absolute figures, but the direction is consistent with Kreider’s picture of a category expanding beyond athletes.
The science behind the aging use case is genuinely growing. A 2025 meta analysis of 20 studies with 1,093 older adults, 69% of them women, found that combining creatine with exercise training significantly improved maximal strength compared with exercise plus placebo. The 2021 review concludes that creatine plus resistance training produces the vast majority of musculoskeletal and performance benefits in older adults, which is an important qualifier: creatine helps most when paired with training. Cognitive effects have also been examined in a 2024 systematic review and meta analysis of randomized trials published between 1993 and 2024. Evidence in brain health is at the promising rather than established stage, and it is worth being clear about which claims sit where.
What this means for you
Kreider’s central message is that creatine is safe, effective, and misunderstood, and on the safety question the independent evidence agrees with him. Nearly two hundred years of research, a large body of controlled trials, and multiple consensus statements from sports nutrition bodies support the conclusion that creatine monohydrate at 3 to 5 g per day is safe for healthy people of all ages. The cramping, dehydration, kidney and steroid claims do not hold up. The hair loss claim rests on one unreplicated hormone study and has failed the first direct test.
Two honest caveats apply. People with bipolar disorder have a small but real signal of manic switching in the trials that exist, and should not take creatine for mood without medical advice. And the newer health applications, from depression to concussion to cognition, are promising areas of active research rather than proven benefits. Kreider presents them with more confidence than the current evidence supports, though he is careful to distinguish animal data from human data.
If you decide to take creatine, the boring answer is the right one: plain creatine monohydrate, 3 to 5 g daily, ideally alongside regular resistance training. That is what the studies used, and that is what the safety record covers.