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Review
. 2025 Dec;22(1):2441760.
doi: 10.1080/15502783.2024.2441760. Epub 2024 Dec 25.

Part II. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?

Jose Antonio  1 , Ann F Brown  2 , Darren G Candow  3 , Philip D Chilibeck  4 , Stacey J Ellery  5 , Scott C Forbes  6 , Bruno Gualano  7   8 , Andrew R Jagim  9 , Chad Kerksick  10 , Richard B Kreider  11 , Sergej M Ostojic  12 , Eric S Rawson  13 , Michael D Roberts  14 , Hamilton Roschel  7   8 , Abbie E Smith-Ryan  15 , Jeffrey R Stout  16 , Mark A Tarnopolsky  17 , Trisha A VanDusseldorp  18 , Darryn S Willoughby  19 , Tim N Ziegenfuss  20
Affiliations
Review

Part II. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?

Jose Antonio et al. J Int Soc Sports Nutr. 2025 Dec.

Abstract

Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review in 2021 discussing the scientific evidence as to whether CrM leads to water retention and fat accumulation, is a steroid, causes hair loss, dehydration or muscle cramping, adversely affects renal and liver function, and if CrM is safe and/or effective for children, adolescents, biological females, and older adults. As a follow-up, the purpose of this paper is to evaluate additional questions and misconceptions about CrM. These include but are not limited to: 1. Can CrM provide muscle benefits without exercise? 2. Does the timing of CrM really matter? 3. Does the addition of other compounds with CrM enhance its effectiveness? 4. Does CrM and caffeine oppose each other? 5. Does CrM increase the rates of muscle protein synthesis or breakdown? 6. Is CrM an anti-inflammatory intervention? 7. Can CrM increase recovery following injury, surgery, and/or immobilization? 8. Does CrM cause cancer? 9. Will CrM increase urine production? 10. Does CrM influence blood pressure? 11. Is CrM safe to consume during pregnancy? 12. Does CrM enhance performance in adolescents? 13. Does CrM adversely affect male fertility? 14. Does the brain require a higher dose of CrM than skeletal muscle? 15. Can CrM attenuate symptoms of sleep deprivation? 16. Will CrM reduce the severity of and/or improve recovery from traumatic brain injury? Similar to our 2021 paper, an international team of creatine research experts was formed to perform a narrative review of the literature regarding CrM to formulate evidence-based responses to the aforementioned misconceptions involving CrM.

Keywords: Sequel; opinions; research; social media.

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Conflict of interest statement

JA: is the CEO and co-founder of the International Society of Sports Nutrition, an academic non-profit. The ISSN may be sponsored by companies that manufacture, market, and sell creatine-containing supplements, including Creapure, Bear Balanced, and Create.

DGC: has conducted industry-sponsored research involving creatine supplementation and received creatine donations for scientific studies and travel support for presentations involving creatine supplementation at scientific conferences. In addition, D.G.C. serves on the Scientific Advisory Board for Alzchem and Create (companies that manufacture creatine products) and as an expert witness/consultant in legal cases involving creatine supplementation.

SJE: serves on the Scientific Advisory Board of Alzchem.

SCF: previously served as a scientific advisor for a company that sold creatine; has received creatine donations for scientific studies; sold creatine education resources; and is a sports nutrition advisor for the International Society of Sports Nutrition (ISSN); is a scientific advisor for Bear Balanced (a company which manufactures creatine products).

BG: has received research grants, creatine donation for scientific studies, travel support for participation in scientific conferences, and honorarium for speaking at lectures from AlzChem (a company which manufactures creatine). Additionally, he serves as a member of the Scientific Advisory Board for Alzchem.

ARJ and CMK: have consulted with and received external funding from companies that sell certain dietary ingredients and have received remuneration from companies for delivering scientific presentations at conferences. ARJ writes for online and other media outlets on topics related to exercise and nutrition. In addition, ARJ serves on the Scientific Advisory Board for Alzchem.

RBK: has conducted sponsored research, received honorarium for presenting research, served as a scientific expert, and consulted with industry on product development related to creatine supplementation. He serves as Chair of the Creatine for Health Scientific Advisory sponsored by Alzchem.

SMO: serves as members of the Scientific Advisory Board on creatine in health and medicine (AlzChem LLC). SMO co-owns patent “Supplements Based on Liquid Creatine” at European Patent Office (WO2019150323 A1). SMO has received research support related to creatine during the past 36 months from the Ministry of Education, Science, and Technological Development; Provincial Secretariat for Higher Education and Scientific Research; Alzchem Group AG; ThermoLife International; and Hueston Hennigan LLP. SMO does not own stocks and shares in any organization.

MDR: has performed industry- and commodity-based contract work, with recent support being received by the US National Dairy Council, The US Peanut Institute, The Center for Applied Health Sciences, MegaFood, and a three-year laboratory donation from Nutrabolt. MDR also performs consulting for personal fees with industry partners in accordance with Auburn University’s faculty consulting and annual disclosure policies. MDR has no associated creatine grants to support.

ESR: has conducted industry sponsored research involving creatine supplementation, has received creatine supplement donations for scientific studies and travel support for conference presentations involving creatine supplementation. In addition, ER serves on the Scientific Advisory Board for Alzchem (a company that manufactures creatine) and as an expert witness/consultant in legal cases involving creatine supplementation.

HR: have received research grants and supplement donations for scientific studies from AlzChem, Natural Alternatives International, DuPont, J.B.S., and NotCompany.

ASR serves as a scientific advisor for Alzchem and Create (companies which manufacturer creatine products).

TNZ: has no conflict in terms of financial or business interests related to creatine. TNZ has received grants and contracts to conduct research on dietary supplements; has served as a paid consultant for industry; has received honoraria for speaking at conferences and writing lay articles about sports nutrition ingredients; receives royalties from the sale of several dietary supplement products (but not creatine); and has served as an expert witness on behalf of the plaintiff and defense in cases involving dietary supplements. TNZ is also a co-inventor of multiple patent applications in dietary supplements, applied nutrition, and bioactive compounds.

JRS: has received grants and contracts to research dietary supplements, served as a paid consultant for industry, and received honoraria for speaking at conferences and writing lay articles about sports nutrition ingredients and topics.

MAT: is the founder and CEO of Exerkine Corporation and the company sells two products that contain creatine monohydrate. The creatine monohydrate used in the two products is from Alzchem (a company that manufactures creatine).

AFB, PDC, TAV and DSW declare no competing interests.

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