Evidence sheet · 22 October 2026
Creatine monohydrate
THE FOCUX · 22 October 2026 · All PMIDs/DOIs checked in PubMed.
1. What it is
A nitrogen-containing compound that the body makes (liver, kidney) and that also comes from the diet (meat, fish). It is stored mainly in muscle as phosphocreatine, which replenishes ATP during short, intense efforts. Reference review: ISSN position stand, Kreider et al. 2017, PMID 28615996, DOI 10.1186/s12970-017-0173-z (narrative review).
2. EU status
- A conventional food ingredient: not a novel food (significant consumption before 1997). Used in food supplements (Directive 2002/46/EC) and sports foods.
- Health claims: Regulation (EU) 432/2012 (physical performance) and Regulation (EU) 2017/672 (adults over 55 doing resistance training).
- In 2024 EFSA assessed and rejected a cognitive-function claim (art. 13.5): PMID 39564533, DOI 10.2903/j.efsa.2024.9100. There is no authorised cognitive claim.
3. Authorised EU health claims (educational context)
The EU has authorised a claim on creatine and physical performance in successive bursts of short-term, high-intensity exercise (Regulation (EU) 432/2012, for adults performing high-intensity exercise), and one for adults over 55 combined with resistance training (Regulation (EU) 2017/672). Both claims may only be used on products that meet the daily intake condition set in those regulations, and the second only together with regular resistance training at least three times a week. This sheet describes them as context; it does not apply them to any product.
4. What has been studied
| Study | PMID / DOI | Population | n | Duration | Result |
|---|---|---|---|---|---|
| Lanhers 2017, Sports Med (meta-analysis of RCTs) | 27328852 / 10.1007/s40279-016-0571-4 | Varied ages, sexes and activity levels; efforts <3 min | 53 studies | Variable | Greater upper-body strength vs placebo |
| Chilibeck 2017, Open Access J Sports Med (meta-analysis) | 29138605 / 10.2147/OAJSM.S123529 | Older adults (mean age 57-70) doing strength training 2-3 days/week | 22 RCTs, 721 participants | 7-52 weeks | More lean mass and greater chest and leg press strength vs placebo |
| Liu S 2025, Eur Rev Aging Phys Act (meta-analysis) | 41388441 / 10.1186/s11556-025-00392-9 | Older adults doing resistance training | 8 RCTs, 482 | 8-104 weeks | More lower-body strength (SMD 0.29) and lean mass (SMD 0.27); no difference in upper-body strength |
| Rawson 2008, Physiol Behav (RCT) — not an authorised claim in the EU | 18579168 / 10.1016/j.physbeh.2008.05.009 | Healthy young adults (~21 years) | 22 | 6 weeks | No effect on any of 7 neurocognitive tests |
| Prokopidis 2023, Nutr Rev (memory meta-analysis) — not an authorised claim in the EU | 35984306 / 10.1093/nutrit/nuac064 | Healthy people | 10 RCTs (8 in meta-analysis) | 5 days-24 weeks | Small overall effect (SMD 0.29; I² 66%); null in young people aged 11-31 (SMD 0.03) |
| Xu 2024, Front Nutr (meta-analysis) — not an authorised claim in the EU | 39070254 / 10.3389/fnut.2024.1424972 | Adults aged 20-76, healthy and with disease | 16 RCTs, 492 | Variable | Effects on memory (moderate certainty); no effect on global cognitive or executive function |
| Lugaresi 2013, J Int Soc Sports Nutr (RCT, kidney safety) | 23680457 / 10.1186/1550-2783-10-26 | Strength-trained people on a high-protein diet | not reported in the abstract | 12 weeks | Glomerular filtration (51Cr-EDTA) unchanged |
| de Souza e Silva 2019, J Ren Nutr (kidney meta-analysis) | 31375416 / 10.1053/j.jrn.2019.05.004 | Various | 15 studies (6 in meta-analysis) | Variable | No significant change in kidney function |
5. Evidence against and limitations
- Cognition: EFSA (2024, PMID 39564533) concluded that a cause-and-effect relationship between creatine and improved cognitive function has not been established: an acute effect on working memory seen at a very high single intake was not seen at lower intakes or with continued use. Null RCT in young people (PMID 18579168). Systematic review with scarce, heterogeneous evidence (Avgerinos 2018, PMID 29704637, DOI 10.1016/j.exger.2018.04.013).
- Upper body in older adults: no significant effect in the 2025 meta-analysis (PMID 41388441). Effects in older adults depend on combining creatine with training.
- Weight/water: initial increase in body water and weight, especially with loading protocols (Antonio 2021, PMID 33557850, DOI 10.1186/s12970-021-00412-w; narrative review with industry-linked authors).
- Serum creatinine: may rise without indicating kidney damage; creatinine-based filtration estimates may overstate decline (PMID 23680457, 31375416).
6. Safety and warnings
- In healthy adults, reviews describe a good long-term safety profile (PMID 28615996). RCTs and meta-analyses found no change in kidney function (PMID 23680457, 31375416).
- Tell your health professional you take creatine before a creatinine blood test.
Mandatory label information for food supplements (EU Directive 2002/46/EC; in Spain, Royal Decree 1487/2009, art. 5.5): the label must include the recommended daily portion, a warning not to exceed the stated recommended daily dose, a statement that food supplements should not be used as a substitute for a varied diet, and a statement that the product should be stored out of the reach of young children.
Educational information, not medical advice. Food supplements should not replace a varied and balanced diet and a healthy lifestyle. Talk to a health professional before taking supplements, especially if you are pregnant, breastfeeding or take medication.
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