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Creatine is a natural substance produced by our own bodies, which is also present in most people's diet. Becoming popular in the early 90s, Creatine monohydrate is probably the most widely used sports nutriton supplement outside of protein powder, and it is also one of the best studied. Because of this, we know a lot about the efficacy, safety, and side effects of creatine monohydrate. There are quite a few misconceptions about what creatine does, and does not do. Let's take a look at some of these.

Creatine Monohydrate Side Effects Diarrhoea

Diarrhoea and other digestive complaints are the most common side effect of creatine monohydrate use, estimated to affect 5-7% of all users (2). Thankfully, there are a number of ways these can be minimised.

Ensuring that the creatine is completely dissolved before drinking has been known to prevent stomach upset, and may also enhance absorption. Pharmaceutical grade products like Creapure are highly soluble, and using a high quality product ensures that the supplement is free from unknown contaminants.

Research has shown that the prevalence of stomach upset is dose dependent, with a study of top athletes showing that a 10g dose caused double the prevalence of stomach upset as a 5g dose. Breaking larger doses of creatine up into a number of smaller doses is an effective way of avoiding symptoms, particularly during the loading phase of supplementation, when doses of up to 20g per day are commonly used (2).

Creatine Monohydrate Side Effects Hair Loss

There is no evidence that creatine monohydrate causes hair loss, although this enduring rumour does have some basis in fact. A paper was published in 2010 looking at the association between creatine monohydrate use and levels of testosterone and dihydrotestosterone (DHT) in 20 college age football players. The study showed that whilst creatine did not increase testosterone levels, it did increase levels of DHT, and the DHT: Testosterone ratio. The method by which this occurs remains unknown (3).

DHT is widely known to be the more potent form of testosterone, and it is also the form of testosterone that is loosely associated with male pattern baldness.

It is hard to make definitive conclusions from a single, small study, and even harder to extrapolate these to creatine monohydrate having any effect on hair loss, without further, direct research. Anecdotally, creatine users do not report hair loss as a side effect of using this supplement.

Creatine Monohydrate Side Effects Kidneys

Creatine monohydrate is one of the most extensively researched supplements available, and there has been no indication that use within normal, therapeutic levels, can cause damage to the kidneys, nor the liver, heart or muscles (4). A review of the research that has been performed on creatine monohydrate suggests that doses anywhere up to 5-20g per day, over the long term, are generally tolerated with no adverse effects by healthy people (5).

Creatine Monohydrate Side Effects Acne

While creatine monohydrate does not have any properties which are known to cause acne, skin conditions are very occasionally reported as a side effect by users of this supplement.

Creatine is stored in the muscles alongside water. If the water intake is not adjusted to meet the increased demands of creatine storage, t is possible that the body may sequester water from other organs, which may then become dehydrated.

The skin needs moisture to remain healthy, and depriving it of this may cause acne.

Additionally, a very intense training regime may cause depression of the immune system, which can leave the body open to opportunistic illness and infections such as acne. There are a number of supplements, such as zinc and glutamine, that can support the immune system, which, in addition to a healthy diet and adequate rest, may help alleviate this condition.

Creatine Monohydrate Side Effects Anger

Creatine monohydrate is an amino acid that is stored in the muscle, and enhances power by facilitating the generation of energy donor ATP. Contrary to the beliefs of some people, creatine is not hormone or steroid based, so unlike a number of anabolic and androgenic steroids that can affect mood and promote aggressive behaviour, creatine does not influence anger or impulse control.

As detailed above, a single piece of research has tied creatine use to a possible rise in DHT levels. As with hair loss, there is nothing in the anecdotal reports from creatine users that suggests this supplement promotes aggression (3).

Creatine is a very safe and effective supplement for the majority of users, however people with pre-existing conditions or concerns about creatine use are advised to consult their doctor before using creatine monohydrate. Anybody who experiencs side effects is advised to immediately cease using creatine monohydrate and consult a medical professional.

(1) Tarnopolsky MA. Caffeine and creatine use in sport. Ann Nutr Metab. 2010;57 Suppl 2:1-8.
(2) Ostojic SM, Ahmetovic Z. Gastrointestinal distress after creatine supplementation in athletes: are side effects dose dependent? Res Sports Med. 2008;16(1):15-22.
(3) van der Merwe J, Brooks NE, Myburgh KH. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clin J Sport Med. 2009 Sep;19(5):399-404.
(4) Persky, A. M.; Rawson, E. S. (2007). "Safety of creatine supplementation". Sub-cellular biochemistry. Subcellular Biochemistry 46: 275–289.
(5) Bizzarini E, De Angelis L (December 2004). "Is the use of oral creatine supplementation safe?". The Journal of Sports Medicine and Physical Fitness 44 (4): 411–6

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