Biohacking Kompakt

Supplement

Creatine monohydrate

Amino acid · Creapure

Creatine monohydrate is one of the most thoroughly studied food supplements of all – and the strength gain is cleanly documented in controlled studies, in older adults as well as in postmenopausal women. For muscle mass, physical function and global cognition the evidence gets thinner: there, the same analyses miss significance.

What creatine is

Creatine is a compound made by the body from amino acids and stored in muscle as phosphocreatine. In the diet it occurs mainly in beef and game, in very small amounts. As a food supplement, creatine monohydrate is by far the most common form.

In the BK-Score it gets 9 out of 10 points for human evidence. This axis rates the state of knowledge, not the substance: well studied does not mean effective for every advertised claim. On the hype gap it keeps 8 out of 10, because the cognitive promises go beyond the data.

How it works

Creatine replenishes the phosphocreatine stores of the muscle cell. During short, intense exertion, phosphocreatine supplies the phosphate group with which spent ATP – the cell's immediate energy carrier – is rapidly rebuilt. This pathway is measurable in humans.

A plausible mechanism is not yet a clinical benefit. Whether fuller stores translate into strength, muscle mass or mental performance is decided by the controlled studies – and their results differ depending on the endpoint.

What is well supported

  • More strength, in two independent analyses. In people aged 60 and over, muscle strength as the primary endpoint reached significance (g = 0.31; 0.18 to 0.45, moderate certainty of evidence). In postmenopausal women, the one-repetition maximum on the leg press rose by 7.5 kg (2.2 to 12.8) – with no heterogeneity at all between studies (I² = 0 %). Two different groups, the same result.
  • A memory finding with moderate certainty. Across 16 studies, memory improved by 0.31 standard deviations (0.18 to 0.44).
  • Officially confirmed. EFSA recognizes the relationship between creatine and muscle strength as causal – from 3 g daily, together with resistance training, for adults over 55. This is a statement by a public authority, not manufacturer advertising.
  • Well-studied safety profile. Lean mass and strength were measured over study periods of up to 104 weeks, with no safety signals reported.

What the studies show

Age 60 and over: strength reached, mass and function missed

Yao 2026 analyzed, in a three-level meta-analysis, 11 randomized controlled trials in people aged 60 and over, creatine plus resistance training versus training alone. The primary endpoint, muscle strength, was reached: g = 0.31 (95 % interval 0.18 to 0.45), moderate certainty of evidence. Muscle mass, at g = 0.35 (−0.09 to 0.78), was not significant, and neither was physical function, at g = 0.47 (−0.08 to 1.03; p = 0.086).

Postmenopausal women: small effects, unchanged bone density

Naddafha 2026 pooled 7 RCTs with 608 postmenopausal women around 62 years old, lasting 12 to 104 weeks, median 38. Lean mass rose by 0.37 kg (0.05 to 0.69), and the one-repetition maximum on the leg press by 7.5 kg (2.2 to 12.8; I² = 0 %). Bone density remained unchanged. Without accompanying resistance training, no measurable effect was seen up to 3 g per day. The review was not preregistered.

Cognition: a finding for memory, none for global cognition

Xu 2024 analyzed 16 RCTs with 492 participants aged 20.8 to 76.4. For memory, the standardized mean difference was 0.31 (0.18 to 0.44), with moderate certainty. Processing speed declined by −0.51 (−1.01 to −0.01), with low certainty. Global cognition and executive function did not reach significance. The finding thus concerns one area, not mental performance as a whole.

Where the data stop

  • More muscle mass and better physical function in older adults. In Yao 2026, both confidence intervals included zero; function missed significance at p = 0.086. Both are usually advertised.
  • Protection against dementia. A scoping review found zero randomized controlled trials on this. The existing cognition finding comes from studies in mostly healthy people and concerns memory performance, not the course of dementia.
  • Benefit in frailty and sarcopenia. Exactly these groups were excluded in Yao 2026. For them, this data set provides no finding, neither positive nor negative.
  • Stronger bones. In postmenopausal women, bone density remained unchanged over up to 104 weeks.

Status, approval and legal

In 2016, the European Food Safety Authority (EFSA) confirmed a causal relationship between creatine and an increase in muscle strength, but under narrow conditions: at least 3 g per day, taken daily, together with resistance training, and exclusively for adults over 55. For intake only on training days, the authority saw no effect. These restrictions are rarely mentioned in marketing.

Safety

The main effect described is water retention, specifically in the muscles, not under the skin. In the BK-Score, safety gets 9 out of 10 points; this axis measures how well safety has been studied, not how safe the substance is. If you have existing kidney disease, consult a physician. This text is for information and does not replace medical advice.

BK-Score Well supported

Human evidence9
Mechanism8
Safety data9
Hype gap8
Track record of use9

One of the most thoroughly studied supplements of all: numerous RCTs and meta-analyses on strength and lean mass, the phosphocreatine pathway is measurable in humans, and safety data span years. Points deducted on the hype gap only because the cognitive promises go beyond the data.

The score rates the state of knowledge, not the substance. “Safety data 9” means well studied – not harmless. “Track record of use 9” means used long and widely – that is not proof of efficacy.
Subjective assessment by Biohacking Kompakt based on published scoring rules – not a scientific rating and not a medical recommendation. Rules and all ratings (German)

Frequently asked questions about creatine monohydrate

How does creatine work?

Creatine replenishes the phosphocreatine stores of the muscle cell. During short, intense exertion, ATP, the cell's immediate energy carrier, is rapidly regenerated from this store. This pathway is measurable in humans and well understood. Whether it translates into a measurable benefit depends on the endpoint, and the studies differ widely on this.

Does creatine really build more muscle mass?

In the Yao 2026 meta-analysis in people aged 60 and over, muscle mass missed statistical significance; the confidence interval included zero. In postmenopausal women, lean mass rose by an average of 0.37 kilograms. What both analyses clearly support is the effect on muscle strength, not on mass.

Does creatine improve memory?

A meta-analysis of 16 randomized studies found a standardized mean difference of 0.31 for memory, with moderate certainty of evidence. Global cognition and executive function, by contrast, did not reach significance. So the finding concerns one area of cognition. Processing speed even declined, though only with low certainty of evidence.

Does creatine protect against dementia?

There is no evidence for this. A scoping review found zero randomized controlled trials on dementia prevention with creatine. The existing cognition data come from studies in mostly healthy people and measure memory performance, not the course of a disease. Anyone marketing creatine as dementia protection goes well beyond the data.

Is creatine allowed in Germany?

Creatine may be sold as a food supplement. In 2016, EFSA confirmed a causal relationship with an increase in muscle strength, but only under narrow conditions: at least three grams daily, combined with resistance training, and exclusively for adults over 55. For intake only on training days, the authority saw no effect.

What side effects does creatine have?

The main effect described is water retention in the muscles, not under the skin. If you have existing kidney disease, consult a physician. In the BK-Score, the safety axis gets 9 out of 10 points, which means safety is well studied. This information does not replace medical advice.

The podcast episode (in German)

Episode 32

AI podcast: Creatine – the honest fact check (muscle, brain, myths)

The podcast by Paul Höser (Episode 32). AI-generated German episode (Paul & Paula) with expert research. Information only – not medical advice, no dosage or usage recommendation.

Listen on Spotify

Related

Sources

Open in the database – with search, filters and comparison (German app)

Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in the hands of a physician. Last updated: 2026-09-13.