Study Overview
Powers et al. (2003) published one of the early thorough reviews examining creatine as a dietary supplement, covering its biochemistry, mechanisms of action, performance benefits, and safety profile.
This review was instrumental in shaping scientific and public understanding of creatine supplementation during a period when misinformation about the supplement was widespread (Powers et al., 2003) .
Key Findings
- Confirmed ergogenic effects: Creatine was shown to consistently enhance performance in high-intensity, short-duration activities including sprinting, weightlifting, and repeated-bout exercise
- Lean mass increases: Supplementation reliably increased lean body mass, attributed to both water retention and genuine muscle protein synthesis enhancement
- Safety profile established: No credible evidence of adverse effects on kidney function, liver function, or hydration status in healthy individuals at recommended doses
- Mechanistic clarity: The review clearly outlined the phosphocreatine energy system and how supplementation increases the intramuscular phosphocreatine pool available for rapid ATP regeneration
- Debunked early myths: Addressed and refuted common myths about cramping, dehydration, and organ damage that had limited creatine adoption
Practical Implications
Powers et al. (2003) helped establish creatine monohydrate as the gold standard supplement for strength and power athletes.
The review confirmed that a loading phase of 20g daily for 5-7 days followed by 3-5g daily maintenance is effective and safe.
By systematically addressing safety concerns, the review provided a scientific foundation for healthcare professionals to confidently discuss creatine with patients and athletes.
The conclusions of this early review have withstood the test of time, with subsequent large-scale reviews and the ISSN position stand reaching similar conclusions with even stronger evidence bases.
Study Limitations
- As a 2003 publication, it predates many subsequent RCTs and meta-analyses that have further strengthened the evidence
- The review had limited data on cognitive and neurological benefits, which were less studied at the time
- Long-term safety data (beyond 5 years) was scarce at the time of publication
- Population-specific effects (women, elderly, vegetarians) were underrepresented in the available literature
Where This Fits in the Evidence
Powers et al. (2003) is valuable less for any single result than for its timing: it arrived when public confusion about cramping, dehydration and organ damage was widespread, and methodically dismantled those claims while confirming creatine’s ergogenic and lean-mass effects. Much of what it established has since been restated with stronger data, so it now functions as an early reference point rather than the last word — its own caveat is that it predates many of the later RCTs and the broader population research on women, older adults and vegetarians. The more recent synthesis that superseded parts of it is the ISSN position stand, and the studies that filled the remaining gaps sit in our research library.
Sources & References
This page summarizes Powers et al. (2003).
Full citation: Powers ME, Arnold BL, Weltman AL, Perrin DH, Mistry D, Kahler DM, Kraemer W, Volek J. Creatine supplementation increases total body water without altering fluid distribution. Journal of Athletic Training.
2003;38(1):44-50.
What This Means for You
The practical value of this older review is reassurance rather than instruction: if you have run into scare stories about cramping, dehydration or organ damage, this is part of the body of work that examined and dismissed them for healthy users. Its dosing guidance — an optional loading phase, then a standard maintenance dose — still holds, but for current, fuller advice lean on the more recent syntheses rather than a 2003 paper. In short, it tells you creatine is safe and works; newer reviews fill in the finer detail.