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September 05, 2022 3 min read

In the early 2000’s, The American College of Sports Medicine recommended that people controlling their weight and exercising intensely or in hot environments should abstain from creatine supplementation [1].

The physiological justification suggesting that creatine supplementation may cause dehydration and muscle cramping is based on the premise that creatine is an osmotically active substance found primarily in skeletal muscle.

This means that it attracts water and may alter whole-body fluid distribution by preferentially increasing intracellular water uptake and retention, particularly over the short-term.

Initially, there can be a 1-3 kg increase in body mass after the creatine loading phase (i.e., 20 g/day for 5-7 days), which is mostly a feature of net body water retention [3].

Interestingly, there is anecdotal evidence of a negative perception that is evident in some creatine users, such as cramping and reported symptoms of dehydration. 

It’s important to understand that these studies failed to control for the use of other supplements and the dosage of creatine ingested.  In fact, it’s been noted that over 90% of participants in these studies exceeded the recommended creatine maintenance dose of 5g/day [4].

These anecdotal, self-report surveys are in contradiction to experimental and clinical evidence.

For example, Division IA NCAA collegiate football players that used creatine had significantly less cramping, heat illnesses and dehydration, muscle tightness, muscle strains, and total injuries compared to non-creatine users [5].

Another study examined the effects of long-term creatine supplementation on a 69-item panel of serum, whole blood, and urinary markers of clinical health status in athletes.

Over a 21-month period, 98 Division IA college football players were administered in an open label manner creatine or non-creatine containing supplements following training sessions.

Subjects who ingested creatine were administered 15.75 g/day of creatine monohydrate for 5 days and an average of 5 g/day thereafter.

Results indicate that long-term creatine supplementation (up to 21-months) does not appear to adversely affect markers of health status in athletes undergoing intense training when compared to athletes who do not take creatine [6].

Creatine has also been used in a clinical setting with hemodialysis patients, where a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately.  Although muscle cramps are a common complication of hemodialysis, the exact mechanism of this complication is still unknown.

Many approaches have been used to relieve the muscle cramping but have had variable effects.

One of the possible mechanisms of hemodialysis-associated muscle cramps is the disturbance of muscle energy metabolism.

Creatine monohydrate can enhance muscle metabolism. 

In support of this, evidence indicates that the frequency of symptomatic muscle cramps decreased by 60% in the creatine monohydrate treatment group with no difference in the placebo group during the treatment period. This decreasing incidence of muscle cramps disappeared in the washout period in the creatine group indicating that this was a direct effect of creatine. 

These data suggest that creatine monohydrate can reduce the incidence of hemodialysis-associated muscle cramps and that it may be a safe agent [7].

In summary, experimental and clinical research does not validate the notion that creatine supplementation causes dehydration and muscle cramping.

1.    Terjung, R.L., et al., American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Med Sci Sports Exerc, 2000. 32(3): p. 706-17.
2.    Powers, M.E., et al., Creatine Supplementation Increases Total Body Water Without Altering Fluid Distribution. J Athl Train, 2003. 38(1): p. 44-50.
3.    Deminice, R., et al., Creatine Supplementation Increases Total Body Water in Soccer Players: a Deuterium Oxide Dilution Study. Int J Sports Med, 2016. 37(2): p. 149-53.
4.    Greenwood, M., et al., Creatine supplementation patterns and perceived effects in select division I collegiate athletes. Clin J Sport Med, 2000. 10(3): p. 191-4.
5.    Greenwood, M., et al., Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cell Biochem, 2003. 244(1-2): p. 83-8.
6.    Kreider, R.B., et al., Long-term creatine supplementation does not significantly affect clinical markers of health in athletes. Mol Cell Biochem, 2003. 244(1-2): p. 95-104.
7.    Chang, C.T., et al., Creatine monohydrate treatment alleviates muscle cramps associated with haemodialysis. Nephrol Dial Transplant, 2002. 17(11): p. 1978-81.

Dr. Paul Henning

About Dr. Paul

I'm currently an Army officer on active duty with over 15 years of experience and also run my own health and wellness business. The majority of my career in the military has focused on enhancing Warfighter health and performance. I am passionate about helping people enhance all aspects of their lives through health and wellness. Learn more about me