Real-world creatine supplementation: a large-scale cross-sectional study of use, knowledge, and experiences.
While most creatine users report high satisfaction, many do not perceive benefits, especially regarding cognitive performance, highlighting a need for better education and expectation management.
Where it sits
this study against the rest of the eloralintide corpusSummary and findings
This study measured real-world creatine supplementation patterns, knowledge, and experiences among 2,178 users, with a median age of 55 years. Participants reported high satisfaction (mean 7.8/10) but only 55% perceived benefits from supplementation. Notably, cognitive performance was the most common goal (67.8%), yet 64.4% of those endorsing this goal did not perceive a matched cognitive benefit.
Abstract
<h4>Background</h4>Creatine is among the most extensively studied dietary supplements in sports nutrition, yet real-world supplementation patterns, knowledge, and outcomes remain poorly characterized. Prior survey research has focused on competitive athletes and younger male samples, even as the evidence base has expanded to support applications in healthy aging, cognition, and female physiology. Whether use patterns, perceived benefits, and adverse effects among the broader and more diverse population now using creatine align with trial evidence, and whether they differ by gender identity and age, has not been systematically assessed.<h4>Methods</h4>An online cross-sectional survey was distributed to approximately 110,000 users of a supplement tracking application (SuppCo, Inc.) with recorded creatine use, yielding 2,178 analyzable responses from individuals reporting current or past-12-month creatine use (1,077 women and 1,101 men; median age, 55 years). The survey assessed supplementation patterns, goals, creatine knowledge (six-item battery scored via generalized partial credit item response theory [IRT] modeling), side effects, satisfaction, and information needs. Multivariable analyses included logistic regression for perceived benefit, modified Poisson regression for side-effect prevalence, and OLS regression for satisfaction, with Benjamini-Hochberg correction for multiple comparisons. As an exploratory analysis, a mixed graphical model (MGM) characterized conditional associations across measurement domains, and IRT discrimination parameters were combined with network centrality to identify candidate keystone misconceptions.<h4>Results</h4>Despite 98% intending to continue supplementation and mean satisfaction of 7.8/10, only 55% perceived benefit. Cognitive performance was the most commonly endorsed goal (67.8%) yet showed the largest within-person unmet-expectation rate (64.4% of cognitive-goal endorsers did not perceive a matched cognitive benefit; McNemar <i>p</i> < .001). Women reported higher self-reported side-effect prevalence (PR = 1.48; 95% CI 1.15-1.91) and lower odds of perceived benefit (OR = 0.66; 95% CI 0.55-0.80) than men, with a flatter dose-benefit slope (women × dose OR = 0.65; 95% CI 0.53-0.80). Knowledge of creatine, scored via IRT theta from a five-item battery, was the most consistent positive correlate across all primary outcomes: perceived benefit, satisfaction, the positive experience composite, and above-common dosing. An exploratory IRT-by-network analysis identified kidney damage as the candidate keystone misconception, with the highest IRT discrimination and above-median cross-domain centrality; the network also identified long-term safety beliefs as conditionally associated with intent to continue, consistent with the hypothesis that safety beliefs track behavioral persistence.<h4>Conclusions</h4>In this middle-aged, gender-balanced community sample of creatine users, behavioral loyalty was high yet substantial knowledge gaps, unmet benefit expectations, and self-reported side-effect burdens disproportionately affected women and older adults, who together comprise an increasingly important share of contemporary creatine users. Knowledge appeared as the most consistent positive correlate of supplementation experience, suggesting education may be a tractable lever for improving real-world outcomes; misconceptions about kidney safety and long-term tolerability may warrant particular attention as educational targets. The cognitive expectation gap may reflect a dose-translation issue rather than absence of efficacy. These findings generate hypotheses for prospective evaluation of education, gender-tailored dosing guidance, and expectation-setting interventions in real-world creatine users.
Background
This paper addresses the real-world use of creatine, a widely studied dietary supplement in sports nutrition. Previous research has primarily focused on competitive athletes and younger males, leaving a gap in understanding how diverse populations use creatine. This study is significant as it explores supplementation patterns and perceived outcomes among a broader demographic, including middle-aged individuals and women.
Methods
An online cross-sectional survey was conducted with approximately 110,000 users of a supplement tracking application, resulting in 2,178 analyzable responses from current or past-12-month creatine users. The survey assessed various aspects, including supplementation patterns, goals, knowledge, side effects, and satisfaction. Multivariable analyses were performed using logistic regression, modified Poisson regression, and OLS regression, with adjustments for multiple comparisons.
Results
The primary endpoint indicated that only 55% of participants perceived benefits from creatine supplementation despite a high intention to continue (98%). Cognitive performance was the most commonly endorsed goal (67.8%), but 64.4% of those endorsing this goal did not perceive a matched cognitive benefit (McNemar p<0.001). Women reported a higher prevalence of side effects (PR=1.48; 95% CI 1.15-1.91) and lower odds of perceived benefit (OR=0.66; 95% CI 0.55-0.80).
Interpretation
These findings reveal a discrepancy between high satisfaction and low perceived benefits, particularly in cognitive performance, which may not align with prior literature suggesting efficacy. The effect sizes reported, while statistically significant, may not be clinically meaningful. Limitations include reliance on self-reported data and the cross-sectional nature of the study, which restricts causal conclusions.
Key findings
- 98% intended to continue supplementation.
- Mean satisfaction of 7.8/10.
- 67.8% endorsed cognitive performance as a goal.
- 64.4% of cognitive-goal endorsers did not perceive a matched cognitive benefit, McNemar p<0.001.
- Women reported higher self-reported side-effect prevalence (PR=1.48; 95% CI 1.15-1.91).
- Women had lower odds of perceived benefit (OR=0.66; 95% CI 0.55-0.80).
Limitations
- Self-reported data may introduce bias.
- Cross-sectional design limits causal inferences.
- Knowledge gaps and unmet expectations may affect results.
- Potential confounding factors not controlled for.