Creatine Monohydrate: What Is It, How Does It Help, and Is It Safe for Your Kidneys?

By Dr Hazel Batten, Integrative GP at Remede Wellness Medicine

Creatine monohydrate is one of the most popular and well-researched supplements in the world. While many people know it for its role in sports and muscle building, new research shows it can also support brain health, heart health, and even mental wellbeing. This article explains what creatine is, how it works, its health benefits, and answers common questions about kidney safety and the best time to take it.

What Is Creatine and How Does It Work?

Creatine is a natural substance found in your muscles and brain. Your body makes it from amino acids, and you also get it from foods like meat and fish. When you take creatine as a supplement, it increases the amount of phosphocreatine in your muscles, which helps your body quickly make more energy during short bursts of activity¹.

This energy comes from a molecule called adenosine triphosphate (ATP). ATP is often called the “energy currency” of the cell—it’s what your body uses to power everything from muscle movement to thinking and even healing. When you exercise or do anything that needs quick energy, your body uses up ATP very fast. Creatine helps your muscles and brain make more ATP quickly, so you can perform better and recover faster¹ ².

What Are the Health Benefits of Creatine Monohydrate?

1. Energy and Exercise Performance

• Creatine helps your muscles make energy quickly, so you can exercise harder and recover faster¹ ².
• It increases muscle strength, power, and lean muscle mass in both athletes and older adults² ³.
• It may help reduce tiredness and improve recovery after exercise² ⁴.

2. Brain, Cognitive, and Mental Health

• Creatine supports brain energy and may help protect against stress and some brain diseases⁵ ⁶.
• It can improve memory and thinking, especially in older adults and vegetarians⁵ ⁷.
• Mental health: New research shows creatine may help with depression, especially in women and people who haven’t responded to other treatments. It may also help with other mental health conditions, but more studies are needed¹⁸ ¹⁹.

3. Heart Health

• Creatine may help the heart work better, especially in people with heart failure⁸ ⁹.
• It can lower homocysteine, a risk factor for heart disease (see below)¹⁰.

4. Methylation and Homocysteine Support

• Your body uses a lot of “methyl groups” to make creatine. By taking creatine, you save these methyl groups, which can lower homocysteine—a marker linked to heart and blood vessel health¹⁰ ¹¹.
• This may be helpful for people with high homocysteine or certain genetic conditions (like MTHFR)¹⁰ ¹¹.

Is Creatine Safe for Your Kidneys?

• Decades of research show that creatine is safe for healthy kidneys when taken at recommended doses (3–5 grams per day)¹²–¹⁴.
• Even people with diabetes or mild kidney problems have used creatine safely in studies¹³ ¹⁵.
• Rare kidney problems have only happened in people with pre-existing kidney disease, very high doses, or other risk factors¹² ¹³.

Why Does Creatine Raise Serum Creatinine?

• Creatinine is a waste product made from creatine. When you take creatine, your blood creatinine level goes up—but this does not mean your kidneys are damaged¹² ¹⁶.
• This is a “false alarm” for kidney disease, especially in people who exercise a lot or eat a high-protein diet¹² ¹⁶.

How Should Kidney Function Be Checked in Creatine Users?

• Urine tests: A urine albumin-creatinine ratio (ACR) is a good way to check for real kidney problems. If your ACR is normal, your kidneys are likely healthy¹⁷.
• Other blood tests: Urea and electrolytes can help, but may also be affected by diet and exercise.
• Cystatin C: This is a special blood test that is not affected by creatine or muscle mass. However, in Australia, it is not covered by Medicare and is only available as a private test (usually 40–60). Most patients do not need this unless there is real concern about kidney disease¹⁶ ¹⁷.
• “Washout” trial: If your doctor is unsure, you can stop creatine and intense exercise for 2–4 weeks and repeat the blood test. If creatinine drops, it was likely just the supplement.

Summary:
Creatine can make your blood creatinine look high, but this does not mean you have kidney disease. Your doctor can use urine tests and, if needed, a special blood test (Cystatin C) to check your kidney health.

When Is the Best Time to Take Creatine Monohydrate?

The most important thing is to take creatine consistently every day¹ ²⁰. You can take it at any time—morning, afternoon, or evening—whatever fits your routine.

Some research suggests taking creatine close to your workout (before or after) may help a little with muscle gains, but the difference is small²⁰. The key is regular use, as creatine works by building up in your muscles over time.

Tips:

• Mix creatine powder with water, juice, or a smoothie.
• Take it with or without food.
• If you forget a dose, just take it the next day.

Conclusion

Creatine monohydrate is a safe and effective supplement for energy, muscle strength, brain health, heart health, and even mental wellbeing. It does not harm healthy kidneys, but can make blood tests look abnormal. Your doctor can use other tests to check your kidney health if needed. Take creatine every day at a time that works for you, and enjoy the benefits!

References

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2. Rawson ES, Persky AM. Mechanisms of muscular adaptations to creatine supplementation. Int SportMed J. 2007;8(2):43-53.
3. Candow DG, et al. Effect of creatine supplementation on muscle size and strength in young adults. J Strength Cond Res. 2011;25(7):1831-1838.
4. Branch JD. Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab. 2003;13(2):198-226.
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14. Gualano B, et al. Creatine supplementation does not impair kidney function in type 2 diabetic patients. Eur J Appl Physiol. 2011;111(5):749-756.
15. Pritchard NR, Kalra PA. Renal dysfunction accompanying oral creatine supplements. Lancet. 1998;351(9111):1252-1253.
16. Delanaye P, et al. Serum Creatinine: Not So Simple! Nephron. 2017;136(4):302-308.
17. Kidney Health Australia. CKD Management in Primary Care. 4th Edition. 2020.
18. Roitman S, et al. Creatine monohydrate in resistant depression: a preliminary study. Bipolar Disord. 2007;9(7):754-758.
19. Liao Y, et al. Efficacy of creatine supplementation for major depressive disorder: A systematic review and meta-analysis. J Affect Disord. 2022;308:486-494.
20. Candow DG, Vogt E, Johannsmeyer S, et al. Strategic creatine supplementation and timing for muscle and performance gains: a narrative review. J Int Soc Sports Nutr. 2022;19(1):37.