Is it time to reconsider creatine dosing?

Nearly 30 years after it was launched as a commercial supplement, creatine monohydrate is in the midst of an immense redefinition. Its usage has been inextricably linked from the earliest days to bodybuilders and strength athletes, but increasingly, researchers are studying it to help with a wider range of potential health benefits—many of which have nothing to do with the weight room, or solely aiding male athletes.

To name just a few, studies are linking creatine monohydrate to attributes of brain health, including improved cognition while sleep deprived, neuroprotective benefits for aging populations and improved concussion recovery. Researchers like Abbie Smith-Ryan, Ph.D., at the University of North Carolina, have also dived deep into creatine as a women’s health supplement. Most recently, she co-authored a paper examining the effects of creatine supplementation on fluid distribution across menstrual phases.

These two research threads could be seen as falling into two camps: creatine for muscle and performance, and creatine for health. The latter was highlighted in the 2022 Creatine for Health online conference, which examined the research surrounding supplementation for a wide variety of demographics. Indeed, a growing number of creatine’s supporters in academia and online have begun referring to it as a “conditionally essential nutrient.”

Related:Creatine works better combined with other ingredients for aging, body composition and cognition

But the idea of taking creatine for health or longevity raises a question. Does the traditional way that companies recommend dosing creatine match up with these new uses? Or do muscular/athletic and health/cognitive benefits play by different rules?

Creatine dosing for lifters and athletes

Pick up a creatine supplement from 10 years ago, and it will likely have the same dosing recommendations on the back as today: 3-5 grams daily. Often, this is simplified to just 5 g, and the scoop inside is nearly always that amount. Depending on the product, users might be recommended an optional higher dose “loading protocol” as well. This approach typically includes four to five doses of 5 g for five days, followed by a daily “maintenance dose” of 3-5 grams.

Numerous studies have concluded both approaches (loading vs. taking a consistent “maintenance dose”) get users to the same level of blood creatine saturation, just on slightly different timelines: one week if loading, four weeks if taking maintenance dose.

Complicating things slightly, more specific creatine research has recommended .03 g of creatine per kilogram (kg) of bodyweight for a maintenance dose, and .3 g / kg during the loading phase. For a 175-pound (or 80 kg) male, that breaks down to either 25 g in a day for loading, or just 2.5 g per day for maintenance.

So how much creatine should a man of this size take? Smith-Ryan said that depends on his goals. “For smaller people, especially if the goal is performance or just lifting, or post-loading phase, a 2-gram scoop might actually be enough,” she said.

With this rationale in mind, some companies have begun including 2-gram scoops in their creatine products. One is True Nutrition, whose co-founder Dante Trudel said he views the inclusion of a 5-gram scoop as a way to ensure people “go through creatine quickly to buy again.”

“Most people take a heaping scoop [with a 2-gram scoop], so it comes out to about 3 grams,” he said of the True Nutrition smaller scoop. “But a lot of literature says once creatine stores are saturated, continually doing 5 or more grams is probably overkill.”

Higher-dose creatine possibly better for health, non-lifting populations

If someone like Trudel—a large man and well-known bodybuilding coach—recommends 2-3 grams, then it may seem like that much or less might be best for elderly or less active users. But Smith-Ryan said she favors higher doses for non-athlete populations, or for people taking creatine for non-athletic reasons such as cognitive health.

Here’s why. Non-athletes tend to include less consistent dietary protein in their diet than serious lifters (animal protein being the major dietary source of creatine). Everyday people also tend to take supplements less systematically than bodybuilders and athletes.

What’s more, “optimal” creatine levels for brain health might be different than muscular needs. A 2021 review study in Nutrients, edited by pioneering creatine researcher Richard Kreider, Ph.D., noted that “optimal creatine protocol able to increase brain creatine levels is still to be determined,” and he called for more research to decide the best approach. But Smith-Ryan said her reading of the existing research makes her lean slightly higher than a standard maintenance dose, toward 5 grams.

“For something like cognitive benefits, we don’t know exactly [what’s optimal], we aren't necessarily dosing based on body mass,” she said. “We might actually need more.”

Until that exact amount is known, Smith-Ryan offered one big reason to stay at 5 grams: inconsistency. Despite the deluge of articles telling users to take creatine daily if they are going to take it at all (I have written or edited many of these articles over the years), the vast majority of people simply aren’t going to live up to the challenge. And yes, that includes researchers like Smith-Ryan.

“I guarantee that someone who is taking that 2-3 g dose doesn’t take it every day, or forgets a day,” she said. “And so that 5 g dose builds it up just a little bit, allowing you to be somewhat inconsistent if the goal is to maintain your creatine stores.”

The creatine loading protocol: Yay or nay?

Years ago, “loading” creatine monohydrate with several days of high-frequency doses was considered all but mandatory. Experts are less likely to recommend it these days, since a lower dose will get users to the same place quickly enough. And the most common “adverse effect” associated with creatine use— water retention—happens during the loading protocol, according to the International Society of Sports Nutrition (ISSN) Position Stand: Safety and Efficacy of Creatine Supplementation in Exercise, Sport and Medicine.

Smith-Ryan recommended loading protocols only for people who could theoretically benefit from raising their creatine levels quickly. A few include:

In conclusion, with non-athletic creatine studies flourishing, it’s likely that a more concrete cognitive dosing protocol will become clear in the near future. Until then, the traditional standards of 3-5 grams (possibly as low as 2 g) for athletic uses, trending toward the high end for cognitive and non-athletic populations, appears to still be “good enough” for the vast majority of creatine monohydrate users and products.