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Creatine monohydrate

Amino acid · Creatine

11 min read 18 sources, checked November 13, 2026

In the BK-Score: Well supported – human evidence 9 out of 10, safety data 9 out of 10. The data in humans are solid.

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.

Without training: somewhat more lean mass, partly water

“No training, no effect” no longer holds across the board. In a randomized trial from Texas (Chun 2026) with 64 adults aged 45 to 65, lean mass rose under creatine without training and without diet by 1.1 kg (0.2 to 2.0) after 12 weeks, significantly more than under placebo. The creatine was supplied by a manufacturer, and the principal investigator sits on its scientific advisory board. After just seven days without training, an Australian study (Desai 2025) measured 0.51 kg more lean mass than in the control group; the authors consider this most likely a short-term effect of body water on the measurement. How much of it is actual muscle cannot be cleanly separated with the usual measurement methods.

Brain: first data in Alzheimer’s and sleep deprivation

In a pilot study from Kansas (Smith 2025), 20 people with Alzheimer’s disease took creatine for eight weeks. Total brain creatine, measured by magnetic resonance spectroscopy, rose by 11 percent, and participants did better on several tests, including working memory, reading and attention. The study was single-arm, without a control group; it shows that creatine reaches the brain, not that it changes the course of the disease.

In sleep deprivation, a study from Jülich in 2024 had measured better mental performance after a high single dose. A follow-up study by the same team (Gordji-Nejad 2026) in 29 healthy people after 21 hours without sleep found a milder drop in performance in logic, arithmetic, language processing and reaction time even with a smaller single dose, by up to 12 percent; women benefited more on some tests. A systematic review (Williams 2026) counts only five studies so far on creatine and acute sleep deprivation – with a positive trend, but a thin evidence base.

Menopause: first exploratory data

A study from North Carolina (Baker 2026) followed 51 perimenopausal women around 46 years old through six weeks of resistance training, with creatine, with placebo or without training. On an attention test all groups improved, with no difference between them. Under creatine, oxygenation in the prefrontal cortex was higher, sleep was more regular (plus 7.4 percentage points), and there were fewer days with temperature sensitivity. The authors themselves call their analysis exploratory; one co-author works for a wearable manufacturer.

Weight-loss injections: plausible, but not yet tested

Under GLP-1 drugs, muscle is lost along with weight, and creatine is an obvious candidate to counter this. A 2026 review (Ostojic) notes that no randomized trial has yet directly tested creatine during such therapy. The first has been running since May 2026 at the University of Saskatchewan: around 40 participants, blinded, creatine versus placebo during twelve weeks of resistance training under GLP-1 therapy, expected to finish in 2027 (NCT07625202).

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 only human study is the pilot study with 20 people with Alzheimer’s, without a control group. The remaining cognition finding comes from studies in mostly healthy people and concerns memory performance, not the course of dementia.
  • Preserving muscle under weight-loss injections. There is no completed randomized trial on this yet; the first is expected to run until 2027.
  • Menopausal symptoms. The data on sleep and temperature sensitivity come from a single exploratory six-week study.
  • 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.

Two 2026 meta-analyses support the kidney question in healthy people. Across 19 randomized trials and one crossover study, serum creatinine rose slightly by 0.13 mg/dl, while urea and estimated filtration rate (eGFR) showed no difference (Tsiaras 2026). A second analysis of 26 studies found that the filtration rate calculated from creatinine falls, but the directly measured rate does not (de Souza Almeida 2026) – a change in creatinine metabolism, not kidney damage. Anyone taking creatine should mention it if a blood test shows an unusual creatinine value.

A quality issue concerns creatine gummies. In a 2025 lab test by a supplement app company, all five powders tested were within their label claim, while four of six gummies failed: two with no detectable creatine, two with only traces, one with roughly a thousandth of the stated amount. In 2024, a manufacturer had found five of 12 gummy brands with little or no creatine. The failed samples each contained a lot of creatinine, the breakdown product – presumably creatine was present and degraded, but the mechanism has not been shown. Both tests come from companies and were not published with peer review; there has been no German lab test of creatine gummies so far.

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. A high safety-data value means well studied – not harmless. A high track-record value 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. A single 2026 study found a good kilogram more lean mass after 12 weeks even without training; part of such gains is likely water in the muscle.

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. A 2025 pilot study in 20 people with Alzheimer’s showed that brain creatine rose by 11 percent and some test scores improved, but without a control group. That shows creatine reaches the brain, not that it changes 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. Two 2026 meta-analyses found no sign of kidney damage in healthy people; the creatinine value in the blood may rise slightly without the directly measured kidney function declining. 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

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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: 2026-11-13.