Creatine is generally safe for most healthy adults and many athletes, but it’s not suitable for everyone. Here are the key groups and considerations for who should take creatine and who should avoid it or proceed with caution. Who should consider taking creatine

• Endurance and strength athletes wanting to improve high-intensity performance, power output, and lean mass, especially in short, explosive efforts like sprints, weightlifting, and repeated sprint workouts. Creatine can help replenish ATP during intense efforts and support training adaptations.

• Older adults aiming to maintain or improve muscle mass, strength, and potentially cognitive function, as some studies show benefits in muscle quality and brain health with appropriate dosing. Consult a clinician to tailor the plan.

• People seeking faster recovery between high-intensity sessions or those looking for a low-cost supplement with a strong evidence base for muscle performance.

Who should be cautious or avoid creatine

• Individuals with known kidney disease or impaired kidney function should avoid creatine or use it only under medical supervision, as the safety profile in kidney disease populations is not fully established. Preexisting kidney concerns warrant professional medical evaluation first.

• People with bipolar disorder or other psychiatric conditions should discuss potential mood-related interactions with a healthcare provider, as some reports suggest possible mood destabilization in susceptible individuals. Medical guidance is advised.

• Young children or adolescents: while data in pediatric populations are growing, creatine use in youth should be guided by a pediatrician or sports medicine clinician, with attention to dosing and safety monitoring.

Practical considerations for use

• Quality and dosing: a common approach starts with a loading phase (optional) of about 20 grams per day divided into 4 doses for 5–7 days, followed by a maintenance dose of 3–5 grams daily. Some people skip loading and use 3–5 grams daily from the start; both approaches can be effective. Always choose a reputable product.

• Timing: evidence suggests taking creatine after exercise may be slightly more effective for some individuals, but total daily intake matters more than exact timing. Consistency over time yields better results.

• Safety: for the vast majority of healthy adults, creatine is considered safe when used at recommended doses and with adequate hydration. Side effects are uncommon but can include weight gain from water retention and, rarely, GI discomfort. Monitoring kidney function is prudent for those with risk factors.

Bottom line

• If healthy and engaged in high-intensity training or aiming to preserve muscle mass with aging, creatine is a well-supported option to enhance performance and possibly recovery, with a favorable safety profile for most people. Before starting, especially for those with medical conditions or under 18, consult a healthcare professional to tailor dosing, monitor safety, and ensure it aligns with individual health status and goals.