We’ve previously covered what creatine does, what benefits it provides to performance and muscle mass, how it is used in the body, but what about the widely asked question of “will creatine make you hold water”?
The idea that creatine contributes to an increase in total body water likely came from early research like that from from Hultman et al., (1996). This study showed that creatine supplementation of 20g/day for 6 days was associated with water retention. Several other short term studies (Hall and Trojan, 2013; Rosene et al., 2015) have shown that one of the most common adverse side affects of creatine supplementation is water retention or an increase in total body water in the first few days of use. Based on these short-term responses, the idea that creatine increases water retention over the long-term has been widely accepted.
Longer term studies (5-10 weeks) have shown that this may not be the case. Jagim et al., (2012) showed that resistance-trained males who supplemented with creatine (20 g/day for seven days followed by 5 g/day for 21 days) had no significant increase in intracellular water (ICW), extracellular water (ECW), or total body water (TBW). Andre et al., (2016) also showed that resistance-trained males who received creatine at a dose of 0.3 g/kg lean body mass/day for 7 days (appx. 20 g/day) followed by 4 weeks at 0.075 g/kg lean body mass/day for 28 days (appx. 5 g/day) experienced no significant change in ICW, ECW, or TBW.
Ribiero et al., (2020) showed that creatine supplementation when combined with resistance training induces higher increases in skeletal muscle mass and ICW but does not change the ratio between skeletal muscle mass and ICW in resistance-trained young men. This suggests that whilst ICW increases, it may be due to increases of muscle mass as a whole, therefore explaining the ratio remaining the same.
In contrast, Powers et al., (2003) found that after 28 days of creatine supplementation in 32 healthy males and females, creatine supplementation increased muscle creatine content which was associated with an increase in body mass and TBW but did not alter ICW or ECW distributions.
It’s worth noting that creatine acts as an osmolyte (meaning it ‘pulls’ water wherever it goes), causing an increase in intracellular water (ICW), which, in turn, can increase protein synthesis and so contributes to muscle mass growth – hence its use as an ergogenic aid for athletes. Creatine is stored in our muscles as phosphocreatine – with this it makes sense that creatine should pull water into the muscle cells. This is a good thing!
GI discomfort is a different story. This can sometimes be experienced with individuals loading creatine and is likely due to excess creatine that is not absorbed making it into the GI tract, acting as an osmolytic and ‘pulling’ water into the GI, causing discomfort. Once on a maintenance dose of creatine (3-5g/day) these adverse effects usually dissipate.
While there’s some evidence to suggest that creatine supplementation is linked to increased water retention (mainly due to increases in intracellular volume over the short term), there are several studies that suggest it doesn’t alter TBW (neither intra or extracellular) relative to muscle mass over longer periods of time. Reviewing the information above, creatine supplementation is unlikely to contribute towards water retention that is not directly linked to intracellular water and total body water and weight linked to muscle growth.
In summary, while there is some evidence to suggest that creatine supplementation increases water retention, primarily attributed to increases in intracellular volume, over the short term, there are several other studies suggesting it does not alter total body water (intra or extracellular) relative to muscle mass over longer periods of time. As a result, creatine supplementation is not likely to lead to water retention in the way we often hear spoken about in the fitness community on a long term scale.
Andre, T.L., Gann, J.J., McKinley-Barnard, S.K. and Willoughby, D.S., 2016. Effects of Five Weeks of Resistance Training and Relatively-Dosed Creatine Monohydrate Supplementation on Body Composition and Muscle Strength, and Whole-Body Creatine Metabolism in Resistance-Trained Males. International Journal of Kinesiology and Sports Science, 4(2), pp.27-35.
Antonio, J., Candow, D.G., Forbes, S.C., Gualano, B., Jagim, A.R., Kreider, R.B., Rawson, E.S., Smith-Ryan, A.E., VanDusseldorp, T.A., Willoughby, D.S. and Ziegenfuss, T.N., 2021. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition, 18(1), pp.1-17.
Francaux, M. and Poortmans, J.R., 2006. Side effects of creatine supplementation in athletes. International journal of sports physiology and performance, 1(4), pp.311-323.
Hall, M. and Trojian, T.H., 2013. Creatine supplementation. Current sports medicine reports, 12(4), pp.240-244.
Hultman, E., Soderlund, K., Timmons, J.A., Cederblad, G. and Greenhaff, P.L., 1996. Muscle creatine loading in men. Journal of applied physiology, 81(1), pp.232-237.
Jagim, A.R., Oliver, J.M., Sanchez, A., Galvan, E., Fluckey, J., Riechman, S., Greenwood, M., Kelly, K., Meininger, C., Rasmussen, C. and Kreider, R.B., 2012. A buffered form of creatine does not promote greater changes in muscle creatine content, body composition, or training adaptations than creatine monohydrate. Journal of the International Society of Sports Nutrition, 9(1), pp.1-18.
Powers, M.E., Arnold, B.L., Weltman, A.L., Perrin, D.H., Mistry, D., Kahler, D.M., Kraemer, W. and Volek, J., 2003. Creatine supplementation increases total body water without altering fluid distribution. Journal of athletic training, 38(1), p.44.
Ribeiro, A.S., Avelar, A., Kassiano, W., Nunes, J.P., Schoenfeld, B.J., Aguiar, A.F., Trindade, M.C., Silva, A.M., Sardinha, L.B. and Cyrino, E.S., 2020. Creatine Supplementation Does Not Influence the Ratio Between Intracellular Water and Skeletal Muscle Mass in Resistance-Trained Men. International journal of sport nutrition and exercise metabolism, 1(aop), pp.1-7.
Rosene, J.M., Matthews, T.D., Mcbride, K.J., Galla, A., Haun, M., McDonald, K., Gagne, N., Lea, J., Kasen, J. and Farias, C., 2015. The effects of creatine supplementation on thermoregulation and isokinetic muscular performance following acute (3-day) supplementation. The Journal of sports medicine and physical fitness, 55(12), pp.1488-1496.
Wyss, M. and Kaddurah-Daouk, R., 2000. Creatine and creatinine metabolism. Physiological reviews, 80(3), pp.1107-1213.