Study Overview
Dalbo et al. (2008) published a thorough safety review in the Journal of the International Society of Sports Nutrition systematically evaluating the evidence for and against common safety concerns about creatine monohydrate supplementation.
The review examined claims regarding kidney function, liver function, dehydration, muscle cramping, gastrointestinal distress, and other purported adverse effects (Dalbo et al., 2008) .
Key Findings
- No kidney damage: The review found no evidence that creatine supplementation causes kidney damage in healthy individuals. Elevated serum creatinine levels are expected (creatine is metabolised to creatinine) but do not indicate renal dysfunction
- No liver damage: No evidence supported the claim that creatine adversely affects liver function in healthy users
- Dehydration myth debunked: Contrary to popular belief, creatine does not cause dehydration. The review noted that creatine increases total body water, and some evidence suggests it may actually improve hydration status
- Muscle cramps not supported: No controlled study found creatine to increase muscle cramping. Some evidence suggested creatine users actually experienced fewer cramps during intense exercise
- GI distress is dose-dependent: Mild gastrointestinal discomfort can occur, particularly during high-dose loading phases. This is typically resolved by using lower doses or taking creatine with meals
- Weight gain is water, not fat: Reported weight gain is primarily intracellular water retention in muscle cells, not adipose tissue accumulation
Practical Implications
This review is essential reading for anyone concerned about creatine safety. It systematically addresses every major safety concern and finds them unsupported by the scientific evidence.
For Malaysian consumers who may encounter fear-based marketing or misinformation about creatine on social media, this review provides a solid evidence base for confidence in creatine’s safety profile.
The key practical points for Malaysian users: take 3-5g of creatine monohydrate daily (skip loading if you experience GI discomfort), stay hydrated (especially important in Malaysia’s tropical climate), and inform your doctor you take creatine so that elevated creatinine on blood tests is not misinterpreted as kidney dysfunction (Poortmans & Francaux, 1999) .
Those with pre-existing kidney or liver disease should consult their doctor before starting creatine, as the safety evidence applies specifically to healthy individuals.
Study Limitations
- As a review article, the conclusions are only as strong as the underlying primary studies
- Most safety studies have been conducted in relatively young, healthy populations — long-term safety data in elderly or medically complex populations is more limited
- Industry funding of some primary studies may introduce bias
- Safety studies typically track outcomes for months to a few years — multi-decade safety data is limited (though no signals of harm have emerged from observational data)
Where This Fits in the Evidence
Dalbo et al. (2008) carries weight precisely because it is not alone: independent safety reviews and long-term renal studies — including the ISSN position stand and Poortmans’ kidney-safety work — reach the same verdict of no harm in healthy users at recommended doses. The honest limit is that this evidence is strongest in young, healthy people; anyone with existing kidney or liver disease should still clear creatine with their doctor first. For the full picture, see our research library.
Sources & References
This page summarises Dalbo VJ, Roberts MD, Stout JR, Kerksick CM. Putting to rest the myth of creatine supplementation leading to muscle cramps and dehydration. British Journal of Sports Medicine.
2008;42(7):567-573.