Study
International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine
The ISSN position stand states that creatine loading raises muscle creatine and phosphocreatine by 20 to 40% and improves high-intensity or repetitive exercise performance by 10 to 20%, with no adverse health effects found at up to 30 g/day for 5 years.
Richard Kreider and nine co-authors wrote the current ISSN position stand on creatine. It is a narrative review, not a meta-analysis. The paper states that over 1,000 creatine studies have been conducted since the early 1990s but does not give the number included or a search protocol.
The dosing position is specific. A normal diet supplying 1 to 2 g/day leaves muscle creatine stores roughly 60 to 80% saturated. Loading at about 0.3 g/kg/day, or 5 g four times daily, for 5 to 7 days raises muscle creatine and phosphocreatine by 20 to 40%. Maintenance is 3 to 5 g/day, and 5 to 10 g/day for larger athletes. An alternative is 3 g/day for 28 days without loading. Stores return to baseline 4 to 6 weeks after stopping.
On performance, high-intensity or repetitive exercise capacity generally rises 10 to 20% after loading. On recovery after muscle damage, creatine gave 10% greater isokinetic and 21% greater isometric knee-extension strength, with creatine kinase 84% lower. On brain creatine, supplementation raised content 5 to 15%. On safety, the paper reports 1,687 neurodegenerative-disease patients taking a mean 9.5 g/day for 5,480 patient-years, with weight gain as the only consistently reported side effect.
These studies show that short and long-term supplementation (up to 30 g/day for 5 years) is safe and well-tolerated in healthy individuals and in a number of patient populations ranging from infants to the elderly.
This is a position stand, not a systematic review. No search strategy, eligibility criteria, effect sizes, confidence intervals, p-values or heterogeneity statistics are reported, so its numbers cannot be checked the way a meta-analysis can. The conflict-of-interest disclosure is extensive: preparation was funded by the Council for Responsible Nutrition, a supplement-industry trade body. Richard Kreider co-founded the ISSN, has industry-funded creatine grants and advises Nutrabolt. Jose Antonio is ISSN CEO. Robert Wildman was Chief Science Officer at Post Active Nutrition. Anthony Almada is CEO of a supplement company. Several authors hold supplement patents or consult for firms selling creatine. The paper itself notes most studies were conducted in men and that women may gain less strength and muscle mass. It also reports that creatine produced no clinical benefit in Parkinson's disease or ALS. Some safety and neuroprotection claims rest on rodent data. Published 2017; no newer ISSN creatine position stand was found as of 2026-08-24.
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