Creatine Truths: Side Effects, Best Type, Safety, Uses


Creatine Truths: Side Effects, Best Type, Safety, Uses

Is it safe?

Yes, Creatine is naturally produced in the liver but it is also created in the kidney and pancreas.  It travels from these areas to the muscles via blood circulation. Generally high protein foods like red meats, fish, and poultry contain creatine. Prime sources of creatine can be obtained through consumption of beef, steak, pork, tuna , salmon, and herring. Meat contains about 2 grams of creatine per pound. Most fish contain over 2 grams per pound and Herring contains about 4.5 grams of creatine per pound.

Bad for your Liver?

2008 Creatine supplementation does not affect clinical health markers in football players.
Dosage: Creatine Monohydrate 15 g/day for 7 days and 3 g/day for 49 days.
Method:  14 Football players performed football specific training for 8 weeks.
Results:  Blood and urine tests showed no negative health effects.
2003 Long-term creatine supplementation does not significantly affect clinical markers of health in athletes.
Dosage: Creatine Monohydrate 15.75 g/day for 5 days and an average of 5 g/day over 21-months in 5-10 g/day doses
Method:  98 Division IA college football players were given creatine after training sessions for 21 months.
Results:  Blood and urine markers showed that health status was not negatively affected by long-term creatine use.


Creatine is essential for providing energy during short-duration of highly demanding exercises in the form of Creatine Phosphate. Creatine Phosphate levels decline during strenuous training.  As these levels decline so does the ability to meet maximal performance. Glucose and fats are used for energy consumption during less intense conditioning.

High Intensity Training Creatine Phosphate Levels
6 seconds -35% to -57%
10 seconds -64% to -80%
16 seconds -88% to -100%
3-4 minutes of rest +80% to +95%

Overall performance is heightened when creatine concentrations are maximized. Significant improvements are present in strength, recovery time, and fatigue resistance. In general creatine increases the overall quality of each workout session.

Increased weight is often noticed from creatine use. Body weight increase of 2-4 pounds can occur at first from an increase in lean muscle and water absorption. Muscle gains result in an increase in lean muscle weight. Long term use of creatine increases the water absorption levels of your cells thus adding to your body water weight. Since the cells are absorbing more water staying hydrated is very important.

2007 Reliability and detecting change following short-term creatine supplementation: comparison of two-component body composition methods.
Dosage: Creatine 20 g/day and Dextrose 140 g/day.
Method: 55 Healthy male athletes were tested, 30 of which were given creatine for 7 days.
Results: Creatine significantly increased body mass by 4lb and fat-free mass increased by 2lb.

Supplementation: Loading and Maintenance

Supplementation allows for creatine concentrations to remain high, resulting in longer duration of strenuous conditioning. Supplementation can increase creatine concentrations in the muscles by 20%. Once we reach this level of concentration our muscles are considered saturated with creatine. When the muscles are saturated creatine concentration is maxed out and will not increase anymore. After stopping creatine supplementation it takes about 4 weeks for creatine levels to return back to base level.

Loading Phase

The loading phase occurs during the first 5 days of supplementation. About .135 g/lb or 20-25 grams of creatine should be consumed during this time.  I recommend splitting up the dosage throughout the day in increments of 5g at a time to minimize nausea. The goal here is to saturate the muscles in order to see quicker elevations in creatine concentration. Loading is not necessary but by doing so creatine levels will reach saturation within 5 days as opposed to a month of just maintenance.

Maintenance Phase

After the initial loading phase only 2-4 grams or .0135 g/lb of creatine a day is needed to keep up muscle saturation. Maintenance can be done without loading but it can take 25 days longer to maximize creatine concentrations.


Creatinine is the by-product of creatine degradation. Creatine is degenerated in the gastrointestinal intestinal tract at a rate of 0.1 g of a 5 g dose per hour. The skeletal muscle is the main source of creatinine production. As muscle saturation of creatine increase, creatinine levels increase due to reduction in the skeletal muscle uptake.

Creatinine, urea and urate levels increase as the kidney’s ability to filter fluid in the body weakens. High creatine intake also increases creatinine levels. High levels of Creatinine are often used by doctors as a indicator for kidney failure. This leads to the misconception that creatine is harmful to your kidneys.

Types of Creatine

Creatine Monohydrate

27mg/lb…60mg/kg…150lb= 4.05g/day

This is the most common and basic form of creatine. Other forms of creatine were created to improve this original formula. Most people still use Creatine Monohydrate and it is often considered the best form of creatine because it’s benefits are backed by the most studies.

  • 40% Muscle Cell Absorption Rate: resulting in a need for high dosages
  • Bloating
  • Loss of Definition: due to water retention
  • Not Very Soluble in Water
  • Upset Stomach
  • 5g of monohydrate = 4.40g of creatine
  • Loading Dosage: 20g
  • Maintenance Dosage: 5g

Creatine Ethyl Ester (CEE)

  • Loading Dosage: 10g
  • Maintenance Dosage: 5g

This form of creatine was engineered to absorb into the muscles quicker by combining ethyl alcohol found in beer with creatine monohydrate. It was also thought to decrease bloating by having less creatine sitting outside of the muscles, lower dosage, and avoid nausea.

”…creatine ethyl ester is very unstable in the bloodstream. Within a few minutes the ester completely breaks down into creatine and ethanol. The decomposition is most likely much faster than absorption into the muscle cells. As a result, taking creatine ethyl ester is no different from taking creatine.” Analysis of Creatine Ethyl Ester from Tulsa University

So before creatine ethyl ester even reaches your muscles the ethanol (that was suppose to help absorption) is already decomposed. This makes creatine ethyl ester no better than taking creatine monohydrate. Creatine ethyl ester contains 17.4 g of creatine for a 20 g dose and 4.37 g for a 5 g dosage. Don’t waste your money on Creatine Ethyl Ester.

2009 The effects of creatine ethyl ester supplementation combined with heavy resistance training on body composition, muscle performance, and serum and muscle creatine levels
Dosage: Creatine Ethyl Ester 20g/day for 5 days and 5g/day for 42 days. Creatine Monohydrate 20g/day for 5 days and 5g/day for 42 days.
Method: 30 Recreationally active healthy males participated in leg press and bench press maximal strength tests. Along with a  resistance-training program 4 days a week. They were tested on days 0, 6, 27, and 48
  1. Total Muscle Creatine Content

    • Creatine Ethyl Ester: Increase muscle creatine content in 27 days.
    • Creatine Monohydrate: Increased in 6 and 27 days.
  2. Serum Creatine Concentrations
    • Creatine Ethyl Ester: Did not have any significant increase.
    • Creatine Monohydrate: Increased in 6, 27, 48 days.
  3. Serum Creatinine Concentrations
    1. Creatine Ethyl Ester: Increased in 6, 27, and 48 days.
    2. Creatine Monohydrate: Did not have any significant increase.

Micronized Creatine

Micronized Ceatine

The process of micronization refines monohydrate molecules at a particle size of 200-300 mesh. Micronized Creatine reduces the powder’s molecule diameter from 300-500 microns to 45-75 microns.

The smaller molecule size benefit water solubility and decreases bloating. More creatine is absorbed quicker minimizing nausea by decreasing the amount that sits in your stomach. Micronized Creatine is more effective than Creatine Monohydrate that is not micronized.

When buying Micronized Creatine it is important to look for one that is milled with a mesh of at least 200 with a molecule size of at most 75 microns. Some companies use a mesh as small as 80, with a diameter of 180 microns and still market it as micronized.

Creatine Malate

Creatine Malate is Creatine Monohydrate bonded with Malic Acid. This acid bonds with water very quickly helping to increase the rate of creatine transfer into the muscles. L-malate by it self has been proven to help improve stamina and muscle damage during exercise.

The problem is the bond created between Malic Acid and water is so strong that it has a hard time releasing.  This causes some Creatine Malate to be flushed through the body without ever reaching the muscles.

Creatine Nitrate

APS Creatine Ntirate

In 100mg of Creatine Nitrate there are 77mg of creatine and 23mg of nitrate. As a salt once it interacts with a solution it disassociates itself.  Meaning it no longer maintains its bond and separates in creatine and nitrate.

Nitrate offers effects of nitric oxide such as increased hyperemia and vascularity. The same effects of creatine nitrate can be obtained through separate monohydrate and arginine supplementation.

Creatine Kre-Alkalyn


Kre-Alkalyn consists of Creatine Monohydrate and alkali-buffering salt. This combination was thought to increase the pH level protecting the creatine from the digestive tract saving it from being broken down into creatinine before it reaches the muscle. This buffer is suppose to eliminate the need for a loading phase.

Tallon and child found that, “Kre-alkalyn supplementation has no beneficial effect on creatine-to-creatinine conversion rates”. They set up an environment with 1 pH solution and compared the breakdown rate of both Kre-Alkalyn and Monohydrate. Contrary to what was expected the Kre-ALkalyn actually broke down 35% more. This study was done to emulate the low pH environment of the stomach.

Class Action Lawsuit: Dino Bruce v. Ultimate Nutrition, Inc.

Ultimate Nutrition is facing a class action lawsuit for false marketing claims. Dino Bruce argues that the product Ultimate Nutrition Kre-Alkalyn is being falsely advertised as better than creatine monohydrate.

  • “Kre-Alkalyn is creatine which is 100% stable and will not break down into creatinine. This stability allows the creatine to be absorbed more efficiently into the bloodstream”
  • “Kre-Alkalyn allows athletes to use smaller serving sizes while experiencing even more explosive results.”
  • “Kre-Alkalyn has been referred to as a new form of creatine; however, it is actually the best form of creatine (creatine monohydrate) that has been fully stabilized.”
2012 A buffered form of creatine does not promote greater changes in muscle creatine content, body composition, or training adaptations than creatine monohydrate
  • Creatine Monohydrate 20g/day for 7 days and 5g/day for 21 days
  • Creatine Kre-Alkalyn 20g/day for 7 days and Creatine Monohydrate 5g/day for 21 days
  • Creatine Kre-Alkalyn 1.5g/day for 28 days (manufacturer’s recommended dose)
Method: 36 resistance-trained participants performed Wingate Anaerobic Capacity (WAC) tests at 0, 7, and 28-days and 1RM strength tests at 0 and 28-days.
Results:  No significant difference in muscle creatine content, body composition, strength, anaerobic capacity or side effects.

Creatine Hydrochloride(HCl)



Creatine HCl has a pH of 2 protecting it from being converted into creatinine since the stomach is a similar pH. It is water soluble which helps it absorb quickly and avoid bloating. Increased absorption requires only .75g/100lb and does not require a loading phase vs monohydrate’s 3g/100lb.

Creatine HCl is about 50% more bioavailable than creatine monohydrate. Bioavailability refers to the rate and amount of a supplement that reaches the systemic circulation of a patient following administration of the supplement. A study in a patent administered 5g of both creatine monohydrate and creatine HCl a week apart. Peak creatine plasma concentrations were significantly greater with creatine HCl. This bioavailability stems from it’s enhanced solubility.

According to the same patent, Creatine HCl has a solubility ranging from 250 mg/ml to about 1000 mg/ml. Other creatines like creatine monohydrate and creatine citrate have a solubility ranging of 10 mg/ml to about 16 mg/mL.

“The aqueous solubility of the creatine HCl is preferably 42 times greater than that of creatine monohydrate when tested at room temperature (25° C.) after a time period of about 1.5 hours.”
2009 Effects of BIOCREAT supplementation on strength and body composition during an 8-week resistance training program
Dosage: Dextrose 75g (Placebo), Creatine Monohydrate 5g + Dextrose 75g, Creatine HCL 900mg + Creatine Monohydrate 3.5g
Method: 47 Resistance trained men trained for 8 weeks, 4-day per week. At 0, 4, and 8-weeks they were tested on body composition, 1 RM strength, muscular endurance, and anaerobic capacity.
Results: Those who took Creatine HCl + Creatine Monohydrate had a significantly greater Wingate peak power performance. Overall there was no significant difference between the creatine groups in upper body strength and body composition.

Creatine Citrate

As a salt creatine citrate disassociates into citric acid and creatine monohydrate. Since creatine has a slower solubility than citric acid this leaves creatine monohydrate behind to absorb in the muscle or degradate into creatinine. The amount of time it take to reach peak concentration of creatine citrate is identical to creatine monohydrate.

This form of creatine has a very low creatine per gram rate. For every 5 grams of Creatine Citrate there are 2 grams of actual creatine. This requires double of the recommended dosage to be as effective as monohydrate.

2007 Comparison of new forms of creatine in raising plasma creatine levels
Dosage: Creatine Monohydrate 4.4g, Creatine Citrate 4.4g, Creatine Pyruvate 4.4g
Method: Six healthy subjects consumed 1 dose of creatine and plasma concentrations were tested within 8 hours.
Results: There was no significant difference between creatine monohydrate and creatine citrate.

Creatine Phosphate

When creatine enters the body it must bond with a phosphate group to be effective in producing ATPs. By combining the two before consumption it is thought that it would be better than taking monohydrate but there are no significant improvements.

At a composition of 63% creatine and 38% phosphate, 5 grams of Creatine Phosphate contains 3.12 grams of creatine.

2005 Effect of creatine phosphate supplementation on anaerobic working capacity and body weight after two and six days of loading in men and women.
  • Dextrose 18 g as placebo
  • Creatine Monohydrate 5.0 g + Dextrose 20 g
  • Creatine Monohydrate 5.0 g + Sodium and Potassium Phosphates 4 g + Dextrose 18 g
Method:  Sixty-one men and women were tested on anaerobic working capacity and body weight.
Results: There is no statistical significant increase in anaerobic working capacity between creatine monohydrate and creatine phosphate.


Creatine Monohydrate

  • 40% Muscle Cell Absorption Rate: resulting in a need for high dosages

  • Dosage 3g/100lb

  • Bloating

  • Loss of Definition: due to water retention

  • Not Very Soluble

  • Upset Stomach

  • 5g Monohydrate = 4.40g Creatine

#1 Creatine Hydrochloride(HCl)

Con-Cret Creatine

  • Increased Absorption Rate: +50% Bioavailability 

  • Dosage .75g/100lb

  • No Bloating

  • No Water Retention

  • +42% Soluble

  • No Nausea

#2 Micronized Creatine

Miconized Creatine

  • Increased Absorption Rate

  • Decreased Bloating

  • Very Soluble

  • Decreased Nausea

#3 Creatine Nitrate

Creatine Nitrate

  • Same as Monohydrate

  • Nitric Oxide Production

 #4 Creatine Citrate
  • Goal: Increasing solubility
  • Result: Citric acid and Creatine disassociate before reaching the muscle
  • Same as Monohydrate
  • Con: 5g Creatine Citrate = 2g Creatine

#5 Creatine Phosphate

  • Contains 63% creatine vs the 88% in monohydrate
  • Same effects as Monohydrate

 #6 Creatine Ethyl Ester (CEE)
  • Goal: Greater absorption rate
  • Result: Ethanol and Creatine decompose before reaching the muscle
  • Same effects as Monohydrate


#7 Creatine Kre-Alkalyn

  • Goal: Protect Creatine from breaking down in the stomach
  • Result: Creatine wound up breaking down 35% more
  • Same effects as Monohydrate

#8 Creatine Malate

  • Not guaranteed to reach the muscles before leaving the body.

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