Should You Take Creatine? An Honest Take on the Supplement Everyone's Talking About
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Creatine used to be the domain of bodybuilders and competitive athletes. These days it has quietly become one of the most discussed supplements among middle-aged adults, women in perimenopause, and people in their 60s and 70s looking to stay strong and sharp.
As a cardiologist, I get asked about creatine almost every week. Patients want to know if it is safe, whether it will hurt their kidneys, and whether it actually does anything for the heart. Here is what the science says, and how I think about creatine in the context of long-term cardiovascular health.
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What Is Creatine and Why Your Body Already Make It?
Creatine is a compound your body produces naturally in the liver, kidneys, and pancreas. You also get it from foods like red meat and fish. About 95 percent of the creatine in your body is stored in your skeletal muscles, where it helps generate adenosine triphosphate, or ATP, the fuel that powers nearly every cell in your body, including the cells of your heart.
When you exercise, your muscles burn through ATP quickly. Supplementing with creatine increases the amount of stored phosphocreatine in your muscles, which means you can generate more energy during short, intense efforts and recover faster between them. That is why it has been a staple in strength training for decades.
Why Does Cardiology Care About Muscle?
Here is where things get interesting from a heart health perspective. Muscle is not just for looking good at the beach. It is one of the most important organs for long-term metabolic health and cardiovascular protection. Skeletal muscle is the largest site of glucose disposal in the body, which means more muscle equals better blood sugar control and a lower risk of type 2 diabetes, a major driver of heart disease.
Starting around age 30, most of us begin to lose muscle mass slowly. After age 40, women can lose up to 3 percent of muscle mass per year, and men are not far behind. This age-related muscle loss is called sarcopenia, and it is associated with higher rates of frailty, falls, metabolic disease, and yes, cardiovascular events. Anything that helps preserve muscle as we age is, in my view, a tool worth understanding.
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What Is The Emerging Cardiovascular Evidence?
Most of the conversation around creatine focuses on strength and muscle mass. But over the past several years, a smaller body of research has started to look at what creatine does inside the cardiovascular system itself. The early findings are intriguing.
A comprehensive review published in 2025 looked at creatine and cardiovascular health and noted that supplementation has been linked to modest reductions in systolic blood pressure, improvements in the way small blood vessels function, lower homocysteine levels (a marker associated with cardiovascular risk), and reduced inflammation, including drops in markers like C-reactive protein and TNF-alpha. A 2024 randomized trial in older men found that just seven days of creatine improved arterial stiffness, a measure tied to long-term heart attack and stroke risk.
There is also a real, though still early, line of research in heart failure. A 2024 pilot study in patients with reduced ejection fraction found that creatine improved six-minute walk distance, lowered exertional heart rate, and improved quality of life scores, with no major safety issues. A broader review in the journal Nutrients concluded that creatine stores in the failing heart are depleted, which provides a strong biological rationale for further study.
None of this means creatine is a heart medication. It is not. But the cardiovascular story is no longer just about muscle.
Who Stands to Benefit Most From Creatine Supplements?
Based on the current evidence, the people most likely to benefit from creatine are those who combine it with some form of resistance or strength training. That includes:
Adults over 40 trying to preserve or build muscle mass
Perimenopausal and postmenopausal women, who experience faster muscle loss
Older adults at risk of frailty or falls
Vegetarians and vegans, who tend to have lower baseline creatine stores
Active patients with stable cardiovascular disease looking to optimize functional capacity
If you do not exercise, creatine is not going to do much for you. It is not a steroid, and it does not build muscle on its own.
What Dose of Creatine is Safe and Can It Affect Your Kidneys?
The standard, well-studied dose is three to five grams of creatine monohydrate per day, taken consistently. There is no need for the old-fashioned "loading phase" unless you are an athlete trying to saturate your muscles quickly. Take it with a meal if you find it bothers your stomach.
The most persistent myth I hear is that creatine damages the kidneys. In healthy adults, including older adults, long-term studies have not shown harm to kidney function at typical doses. What does happen is that creatine slightly raises blood creatinine, which is a normal byproduct of creatine metabolism and not a sign of kidney injury. Your doctor should know you are taking it so they can interpret your labs correctly.
That said, if you have known kidney disease, are pregnant, or are taking medications that affect kidney function, talk to your physician before starting. The same goes if you have advanced heart failure or are on a complex medication regimen.
Routine measure of kidney function, the creatinine, can be spuriously elevated (meaning reduced kidney function) due to creatinine. Many doctors do not know this. The workaround is to measure something call cystatin C, an alternative measure of renal function unaffected by creatine. The moral being: include creatine on any medication list when asked, even though it’s a nonprescription supplement (a sagacious approach with all supplements, in fact). Your daily amount should not exceed 5g per day.
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How Should You Choose a Creatine Product?
Stick with plain creatine monohydrate in powder form. Skip the gummies, flavored blends, and anything making bold claims. Look for a label indicating third-party testing, such as NSF Certified for Sport or Informed Choice, which confirms the product contains what it says and is free of contaminants.
Creatine is one of the most studied supplements in the world, and the evidence supporting its benefits for muscle, strength, and possibly cognition is genuinely strong. The cardiovascular research is younger and more limited, but the early signals are encouraging.
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That said, creatine is not a shortcut. The foundations of heart health remain the same: regular exercise that includes cardio and resistance training, a diet rich in plants and lean protein, good sleep, stress management, and treating risk factors like high blood pressure and cholesterol. Build that foundation first. Then, if it makes sense for your situation, creatine can be a reasonable addition.
As always, talk with your cardiologist or primary care doctor before starting any new supplement, especially if you have an existing heart condition.
