Why don't doctors always recommend creatine?
Creatine is well supported for building muscle during strength training and is safe for healthy people. For other goals, such as mental health complaints or fat loss, the evidence is too mixed to base a recommendation on.
Creatine demonstrably works for muscles. Combined with strength training, it produces an average of just over 1 kg of extra lean mass in adults under 50 compared with training alone, while body fat percentage drops slightly. The effect is modest but consistent. Part of the weight gain comes from water retention, not purely muscle tissue.
Whether a doctor recommends it depends heavily on the goal. For muscle strength and muscle mass during strength training, creatine monohydrate is well supported: 3 to 5 grams per day for at least 8 to 12 weeks. Vegetarians miss out on the creatine found in meat and may gain extra benefit from supplementing, including for memory and muscle strength. For fat loss as the primary goal, however, the case does not hold up: the effect on fat mass is small, and body weight rises because of water retention.
Doctors are more cautious when the goal goes beyond sport and muscle. For depression, the research points to a small effect, but it stays on average below the threshold considered meaningful enough to matter in real life. International psychiatric guidelines therefore do not recommend creatine as a stand-alone treatment for depression. The evidence is too mixed. For bipolar disorder, results were largely inconclusive.
For the kidneys, creatine monohydrate has been found safe at recommended doses in healthy people, including with use of up to five years. In postmenopausal women, kidney function markers remained unchanged and side effects were comparable to those seen with a dummy treatment. That reassurance does not extend to people with existing kidney disease, diabetes, or high blood pressure: for them, caution is warranted. Discuss it with your doctor in those cases.
Doctors therefore do not have a single reason to pass on creatine. They look at the goal: for building muscle during strength training, the backing is solid; for mental health complaints, it is not, at least not yet. In addition, part of the research has been funded or guided by researchers with ties to creatine manufacturers, which is worth bearing in mind when reading the most positive claims.
This answer draws on many studies combined, including large pooled analyses. For muscle mass and strength training, the evidence is reasonably consistent. For mental health applications, the authors themselves judged that the studies they reviewed carried a moderate to high risk of bias. In the pooled analysis on depression, variation between individual studies was high, and there are indications that results favouring creatine were more likely to be published than others. Half of the included studies had a low risk of bias, 41% gave some cause for concern, and 7% had a high risk. Several of the review authors are paid advisers to Alzchem, the largest creatine manufacturer; this colours, in particular, the most positive claims about athletic performance.
What is best not to combine with creatine?
Combining creatine with caffeine powder adds nothing to your performance and increases the risk of gastrointestinal complaints; ready-made pre-workout blends with many ingredients carry additional risks due to possible contamination and unknown long-term effects.
Does creatine cause hair loss?
Current research shows that creatine does not raise DHT and has no effect on hair follicle health. 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 fast results, or simply take 3 to 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.
How many grams of creatine per day is worthwhile?
For muscle strength and explosive performance, 3 to 5 grams of creatine monohydrate per day has a clear effect; a loading phase is convenient but not obligatory. For other goals the evidence is thinner, but safety for healthy adults is reasonably well supported.
Does creatine also help ordinary people, not just athletes?
Creatine also helps ordinary people, especially older adults who combine it with some strength training: more muscle mass, more strength, and in those aged 66 and over, better memory as well. Combining at least 5 grams per day with strength training gives the best results.