Creatine monohydrate remains a cornerstone supplement for fitness enthusiasts and athletes worldwide, backed by decades of research showing 5-15% gains in strength, power output, and muscle mass during high-intensity training like weightlifting or sprinting. A naturally occurring compound found in meat and fish, it boosts ATP production in muscles for better performance. However, integrative lifestyle coach Luke Coutinho warns in a recent Instagram video that misuse can strain kidneys and cause other issues: "Creatine is good when used right—for the right people, time, and age. Science supports it, but execution matters."
Coutinho outlines four critical mistakes, expanded here with evidence-based details to help users optimize safely.
1. Taking Creatine While Dehydrated
Creatine draws water into muscle cells (intracellular hydration), increasing cell volume for that "pumped" look and aiding protein synthesis. But dehydration forces water retention elsewhere, overburdening kidneys which filter excess creatinine—a byproduct of creatine metabolism.
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Coutinho advises: "Drink 500ml to 1 liter more water than usual." Studies in the Journal of the International Society of Sports Nutrition recommend 3-4 liters daily for creatine users (3-5g dose), as low hydration elevates kidney stress markers like serum creatinine by 20-30% in trials. Symptoms include bloating, cramps, or fatigue—fix by hydrating proactively.
2. Skipping Baseline Kidney Tests
Creatine naturally raises blood creatinine levels (a kidney function marker), potentially mimicking impairment on standard tests (eGFR or BUN). Without pre-supplement bloodwork, underlying issues like chronic kidney disease (CKD) go undetected; up to 10-15% of adults have silent CKD per NIH data.
The International Society of Sports Nutrition urges baseline tests, especially for those over 40, diabetics, or hypertensives. A 2023 meta-analysis in Nutrients found no harm in healthy kidneys but a 2-3x risk elevation in compromised ones.
3. Ignoring Your Doctor with Pre-Existing Conditions
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Always consult a physician—Coutinho emphasizes this. Alternatives like buffered creatine (Kre-Alkalyn) may reduce creatinine spikes, per small studies, but medical clearance is non-negotiable.
4. Choosing Poor-Quality or Contaminated Creatine
Cheap imports often contain fillers, heavy metals (lead, arsenic), or dicyandiamide impurities, per ConsumerLab tests where 20% of samples failed purity. This leads to GI upset (nausea, diarrhea in 5-10% users) or long-term toxicity.
Coutinho recommends third-party tested creatine monohydrate (Creapure brand is gold standard, 99.9% pure). Opt for micronized forms for better solubility, and cycle (8-12 weeks on, 4 off) to prevent downregulation, though recent reviews question cycling necessity for most.
Additional Risks and Best Practices
Beyond Coutinho's list, watch for GI distress (mitigate with 3-5g daily post-workout), hair loss myths (debunked by low DHT evidence), or weight gain (1-3kg water initially). Women and vegetarians benefit most due to lower baseline levels.
Safe Protocol: Load 20g/day (4x5g) for 5-7 days, then 3-5g maintenance; pair with carbs/protein for 60% better uptake; store cool/dry. A 2024 ISSN update confirms safety up to 30g/day short-term for healthy adults.
Prioritize quality over savings to unlock creatine's benefits without the backlash.
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