Creatine: Why Should You Really Take It?

What the 2024–2026 Studies Say — Initial Weight Gain, Strength, Brain Function, Age… and the Role of Osteopathy

Creatine is no longer a “gym secret.” It is one of the most extensively studied dietary supplements in the world: more than 680 clinical trials, dozens of recent systematic reviews and meta-analyses, and an official position statement from the International Society of Sports Nutrition (ISSN). Yet two misconceptions are still widely held: “it causes bloating” and “it’s dangerous for the kidneys.” This article reviews the evidence—based solely on published data—to explain why taking creatine can make sense —and why it is never a substitute for a musculoskeletal assessment, a tailored training plan, or an osteopathic consultation when pain, stiffness, or compensatory movements set in.

Warning: This text is for informational purposes only. It is not a medical recommendation. If you have kidney disease, are pregnant, are taking medication, or have any concerns, consult your doctor before taking any supplements.

Creatine is a compound naturally found in muscle, the brain, and other energy-demanding tissues. The body synthesizes some of it (in the liver, kidneys, and pancreas) from amino acids; the rest comes from food, especially meat and fish. An omnivorous diet typically provides about 1 to 2 g per day. Vegetarians and vegans generally consume less, which can result in lower initial muscle stores.

In the cell, creatine is stored primarily in the form of phosphocreatine. This store acts as a “buffer battery”: it very quickly replenishes ATP—the muscle’s immediate energy currency—during brief, intense efforts (sprints, heavy repetitions, changes of direction, lifting a load, getting up from the ground). When intramuscular reserves increase through supplementation—typically by 20 to 40 percent—the muscle can perform more high-quality repetitions. This is the central mechanism, well established since the 1990s and confirmed by contemporary research.

Creatine monohydrate remains the standard form. It is the form used in virtually all randomized trials. Other forms (HCl, ethyl ester, etc.) have not demonstrated convincing clinical superiority at equivalent doses. The ISSN considers monohydrate to be the most effective nutritional supplement currently available for increasing high-intensity exercise capacity and lean body mass during training.

A meta-analysis published in *Nutrients* in October 2024 (23 trials, adults under 50) compared strength training plus creatine versus strength training plus a placebo. The result: an average additional gain of approximately 4.4 kg in upper-body strength and 11.4 kg in lower-body strength. This isn’t “magic”: it is a statistically significant benefit that builds on the effects of training. Another meta-analysis from 2025 (69 studies, nearly 2,000 participants) found more modest but consistent effects on the bench press, squat, vertical jump, and anaerobic power (Wingate test), again particularly when creatine is combined with strength training.

People who are not very fit often make greater relative progress. On average, men seem to benefit slightly more than women on certain upper-body strength measures, but the data for women is growing: a 2026 multilevel meta-analysis of women who exercise found a small but positive overall effect (g ≈ 0.23), with gains in performance and body composition. Among postmenopausal women, a 2026 review (7 trials, 608 participants) shows a gain in lean body mass of approximately 0.37 kg and a 7.5 kg increase in leg press performance when the dose is at least 5 g/day combined with strength training. At doses below 3 g/day without training, the effect is not measurable.

A large dose-response meta-analysis published in 2024 (143 studies) estimates that creatine increases body weight by about 0.86 kg and lean body mass by about 0.82 kg, with a very slight decrease in body fat percentage (−0.28 points). The effects are more pronounced with a maintenance dose and resistance training. In other words: the scale goes up a little, but this is mostly intramuscular water at first, followed by a bit more lean tissue if you train. It is not a fat burner.

The ISSN and several recent journals highlight potential benefits following intense exercise, injury, or immobilization: improved energy resynthesis, sometimes less perceived muscle damage, and, above all, better recovery of muscle mass and strength during rehabilitation. In older adults, creatine combined with strength training is now considered one of several tools for combating sarcopenia. An updated review found an increase of approximately +1.18 kg in total lean body mass compared to placebo plus strength training in older adults. For an osteopath, this has clinical significance: less muscle loss and a greater ability to gradually increase the load on a tendon or joint often translate to greater functional stability.

The brain also utilizes the creatine-phosphocreatine system. A meta-analysis published in *Frontiers in Nutrition* (2024, 16 trials, 492 participants) found a positive effect on memory (SMD ≈ 0.31), attention span, and processing speed. The effect on overall cognition and executive functions was not significant. The benefits appear to be more pronounced in people with health conditions, women, and sometimes under metabolic stress (sleep deprivation). The level of evidence for several cognitive domains remains low to moderate: it’s worth discussing, but we cannot promise guaranteed “mental clarity.”

Bone cells need energy. One-year trials in older adults have shown that creatine combined with strength training has beneficial effects on certain measures of bone geometry (tibial bone area, leg muscle density) and, in postmenopausal women, better preservation of femoral neck density in a 12-month trial. In contrast, the 2026 meta-analysis of postmenopausal women found no overall effect on bone mineral density. Honest conclusion: creatine can support the muscles that load the bones; it is no substitute for strength training, adequate vitamin D and calcium, or osteoporosis screening.

Yes, the scale can go up. No, it's usually not fat.

The mechanism is osmotic. Creatine enters the muscle fiber and draws water with it (primarily intracellular water retention). During a typical loading phase (about 20 g/day for 5 to 7 days), studies and safety reviews typically report a weight gain of 1 to 3 kg over one to two weeks, mainly due to total body water. Without a loading phase, at a dose of 3 to 5 g/day, weight gain is slower and sometimes barely noticeable.

What it is not: a buildup of adipose tissue. Meta-analyses of body composition show no increase in fat mass; rather, they show a slight decrease in body fat percentage when training is involved. Muscles may appear slightly “fuller.” Some people experience digestive bloating, especially if they consume 20 g all at once or take a product with an incorrect dosage. In this case, dividing the doses (4 × 5 g) or starting directly at 3–5 g/day is often sufficient.

After two to four weeks, weight often stabilizes. If you stop taking creatine, some of the water leaves the muscles within a few weeks. The lean muscle mass you’ve actually built through improved training, however, doesn’t disappear overnight—as long as you keep exercising and eating enough protein.

For whom is initial weight gain a real drawback? Athletes in weight-class sports (judo, weightlifting, combat sports) need to plan ahead. People who weigh themselves every morning and interpret a gain of 1.5 kg as a “failure to lose weight” need to be prepared: this is not a failure; it’s the pharmacokinetics of the product. Those with heart failure or on a very low-salt/low-fluid diet should discuss this with their doctor: they are not the target audience for standard “sports and health” trials.

The “kidney myth” stems mainly from a laboratory misinterpretation. Creatine breaks down into creatinine. A blood test may therefore show slightly elevated creatinine levels without any actual change in glomerular filtration rate. Controlled trials—including a 21-month follow-up study of athletes and the 2025 safety review covering hundreds of trials and more than 20,000 participants—found no more adverse effects than those seen with a placebo across 35 categories of events evaluated, including kidney function in healthy subjects.

The ISSN (2017 position statement, still cited and updated in the literature as of 2025) concludes that both short-term and long-term supplementation (up to 30 g/day for 5 years in certain clinical populations) is well tolerated in healthy individuals. Caution is advised, however, in cases of known kidney disease, pregnancy (insufficient data), or nephrotoxic medications. In these cases, the decision rests with the physician, not with a blog post.

Cramps, dehydration, heat stroke: Experimental data do not confirm an increased risk; several studies even show an increase in total body water without any clear disruption of sweating. Digestive problems: Possible with high single doses. Hair / DHT: A single small, often-cited rugby trial that has not been convincingly replicated; this is not an established fact. Male fertility: no strong evidence of an adverse effect in the review literature. Cancer: no evidence of an increased risk linked to creatine itself; the real risk with supplements is sometimes contamination (product quality, third-party testing).

There are two proven strategies. The fastest: about 0.3 g/kg/day (often 20 g) for 5 to 7 days, followed by 3 to 5 g/day. The simplest, which is just as effective over 3–4 weeks: 3 to 5 g/day from the start, without a loading phase. Heavy athletes sometimes increase their maintenance dose to 5–10 g. Taking creatine with a meal containing carbohydrates or protein can aid absorption. The exact time (before or after a workout) matters less than daily consistency: muscle stores become saturated over several days, not in 20 minutes.

Hydration: Drink as usual, possibly an additional half liter to one liter if you’re training hard, without overhydrating. Quality: Monohydrate, with the actual dose clearly labeled, ideally tested by an independent laboratory. Creatine won’t make up for a severe calorie deficit, five hours of sleep, or terrible squat form.

A supplement improves energy availability in the muscle fiber. It does not correct a hip that no longer extends, a scapula that does not glide, a restrictive scar, chronic diaphragmatic apnea, or a protective movement pattern following a sprain. Yet it is precisely in these gray areas that patients get injured, plateau, or “take creatine without noticing any effects.”

In the context of musculoskeletal health, osteopathy focuses on tissue mobility, load distribution, quality of movement, and compensatory mechanisms. When strength increases through creatine and weight training, the stress on joints, discs, tendons, and fascia also increases. If the knee is valgus, if the foot no longer pronates, or if the thoracic cage is less mobile, continued training can lead to localized overload. This is why a clinical evaluation is important before piling on the weight on the bar—or before resuming running after a tendinopathy.

Conversely, after immobilization, surgery, acute lower back pain, or a period of inactivity, creatine can—according to rehabilitation data—help limit muscle loss and improve the body’s response to reconditioning. However, this reconditioning must be carefully calibrated: range of motion, tolerable pain, motor control, and a gradual return to load. It requires the combined efforts of the physician, the physical therapist (if applicable), and the osteopath to remove the restrictions that prevent efficient movement patterns.

For people over 50, the “muscle and joint” combination is the real issue. Sarcopenia and osteopenia often go hand in hand. Creatine and strength training support muscle health; osteopathy helps people move without pain, restore hip rotation, improve thoracic extension, and regain confidence in standing on one leg—all of which reduce the risk of falls far more effectively than any single supplement.

If you’re reading this, it’s probably not because you want to “become a bodybuilder.” It’s because you have back pain at the end of the day, a shoulder that seizes up when you put on a coat, a knee that swells after playing padel, morning stiffness, or simply because you want to age with strength. Creatine can be part of the solution—as long as you treat it as a tool, not a magic wand.

At our practice, we don’t sell miracle cures. We assess how you’re straining your body. We look for why one side is overworking. We restore mobility where the body has adopted a protective response, and stability where it has become lax. Only then does a movement plan—and, if your doctor sees no contraindications, an informed discussion about creatine—stand a chance of lasting over time.

Making an appointment isn’t an admission of athletic failure. It’s about refusing to let a good supplement lead to poor form. If you’ve started taking creatine and the scale is stressing you out, if a pain changes in nature, if you’re recovering from an injury, or if you’re over 50 and want to step up your training again: come see us. An osteopathic evaluation, advice on progressive training, and an honest discussion about supplements are worth more than ten conflicting news feeds.

Relevant, according to the literature: athletes engaged in intermittent-effort and strength sports; people who do weight training; adults seeking to limit sarcopenia; perimenopausal and postmenopausal women who exercise; vegetarians with lower nutrient reserves; patients undergoing rehabilitation (medical advice required). Less relevant as a first-line option: the sole goal of fat loss without exercise; highly aerobic endurance training (smaller or indirect benefit); expectations of a dramatic cognitive effect; medical contraindications. For adolescents, data exist, but the decision should remain with parents and healthcare providers, not “influencers.”

We take creatine because it’s one of the few supplements whose effects on strength, power, and lean mass are consistent when training. We accept an initial weight gain of 1 to 3 kg of intramuscular water—not fat. Choose the monohydrate form, 3 to 5 g per day, a pure product, and stay properly hydrated. It is not intended to treat a herniated disc, severe osteoporosis, or depression. Monitor kidney function only if there is a predisposition, and interpret blood creatinine levels in consultation with a knowledgeable clinician.

The smartest thing to do isn’t to open a jar. It’s to figure out whether your body is ready to use that excess energy without getting injured. This is exactly when osteopathy stops being just “a wellness bonus” and returns to what it should be in the clinic: an assessment of movement, a smart approach to restoring load, and guidance so that the science of creatine finally serves your daily life—and not just your social media feed.

Kreider et al., ISSN Position Stand, J Int Soc Sports Nutr, 2017 (sécurité et efficacité ; doses 3–5 g/j d’entretien ; charge 0,3 g/kg/j). Antonio et al., questions et idées reçues, JISSN, 2021. Wang et al., Nutrients 2024 : musculation + créatine, force haut/bas du corps chez les < 50 ans. Ashtary-Larky et al., JISSN 2024 : composition corporelle, +0,86 kg de masse, +0,82 kg de masse maigre. Xu et al., Front Nutr 2024 : cognition (mémoire, attention, vitesse de traitement). Nutrients 2025 : force et puissance haut/bas du corps. PeerJ 2025 : force en population générale. JISSN 2026 : femmes ménopausées, masse maigre et force, DMO inchangée en pooled analysis. Candow / Chilibeck, Med Sci Sports Exerc : os et muscle chez l’adulte âgé. Analyses de sécurité 2025 : pas de sur-risque d’effets indésirables vs placebo chez le sujet sain. Les chiffres cités sont des moyennes de groupes : l’effet individuel varie.

This article is intended to provide information to patients. Any supplementation should be tailored to the individual. Osteopathy does not prescribe creatine and is not a substitute for medical advice.