Why don't doctors always recommend creatine?
Creatine monohydrate is well supported for strength sports and its safety profile in healthy adults is reassuring, but safety data for children and teenagers are lacking and some proven applications are more limited than the marketing suggests.
Creatine monohydrate is well supported for strength sports: the substance increases the amount of energy-rich compounds in muscles by roughly 15 to 40%, leading to demonstrably better performance during short, maximal efforts. That is the best-supported application in the scientific literature. Whether it also helps during actual competitions in field settings is considerably less clear.
The safety picture is clearer than many doctors realise. A large review of 685 clinical studies (more than 12,800 participants) showed that the rate of adverse effects in creatine groups (13.7%) was almost identical to that in placebo groups (13.2%). The difference was less than half a percentage point. The widely heard concern about kidney damage is also not supported by the available evidence.
There are, however, legitimate reasons for caution. Very little research has been done on safety in children and teenagers, which means that restraint for that age group is justified. Newer forms of creatine such as creatine ethyl ester have no evidence showing they are better or safer than plain creatine monohydrate. And creatine users also turn out to use other anabolic supplements more often, supplements whose safety is genuinely questionable.
A practical problem is that in 2000 doctors played almost no role as a source of information: only 14% of users consulted them, while the majority followed popular magazines. The knowledge gap between scientific evidence and the consulting room is therefore decades old. Added to this, several authors of influential creatine reviews have financial ties to creatine manufacturers, which can cloud the picture and calls for additional independent studies.
For cognitive effects the indications are mixed and preliminary. The largest study in this area (123 participants, 5 grams per day for six weeks) found a small, non-significant hint of improvement in working memory, but no effect on reasoning skills. Notably, the creatine group in that study reported adverse effects significantly more often than the placebo group.
Safety conclusion based on a review of 685 studies (PMID 40198156). Efficacy in strength sports based on multiple reviews (PMID 21424716, 29059531). Cognition: one RCT, n=123 (PMID 37968687). Children/adolescents: insufficient evidence (PMID 29059531, 33557850). Conflicts of interest among authors noted at the relevant source (PMID 33557850, 40198156).
What should you preferably not combine with creatine?
Combining creatine with caffeine produces no additional athletic performance benefits and can cause mild gastrointestinal complaints. If you want to use both, it is better to take them separately.
Does creatine cause hair loss?
Current research shows that creatine does not raise DHT and has no effect on hair follicle health, so there is no need to avoid creatine out of fear of hair loss.
Do you need to do a loading phase with creatine?
A loading phase is not necessary, but it does speed up the build-up of creatine in your muscles. Choose a loading phase if you want quick results, or simply take 3-5 grams daily if you have more patience.
Will a doctor prescribe rapamycin?
Most doctors will not prescribe rapamycin to healthy people to slow ageing, simply because the evidence for doing so is still lacking. For certain rare conditions a specialist may consider it off-label, but always with a careful weighing of the risks.
Does creatine also help ordinary people, not just athletes?
Creatine is not just for athletes. Combined with resistance training, it helps older adults gain muscle strength, and probably also improves memory.
Does creatine help with weight loss?
Creatine does not make you lose weight, but it improves your body composition if you also train alongside it: slightly less fat, more muscle mass. Do not expect significant fat burning, but those who combine it with strength training get the most out of it.