Kreider et al. 2017: The ISSN Position Stand on Creatine Safety & Efficacy

Creatine.my Editorial Team · · 10 min read
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This content is for educational purposes only and is not medical advice. Consult a healthcare provider before starting any supplementation.

TL;DR — Kreider et al. 2017: The ISSN Position Stand

The International Society of Sports Nutrition (ISSN) Position Stand on creatine, authored by Kreider and colleagues in 2017, is widely regarded as the single most authoritative document on creatine supplementation (RB et al., 2017) . After reviewing over 500 peer-reviewed studies spanning three decades, the ISSN concluded unequivocally: creatine monohydrate is the most effective ergogenic nutritional supplement available for increasing high-intensity exercise capacity and lean body mass, and it is safe for healthy individuals.

This is the paper that health professionals, coaches, and athletes cite when someone asks whether creatine works and whether it is safe. The answer to both is yes.

500+
peer-reviewed studies reviewed by the ISSN before issuing their position stand
Kreider et al., JISSN, 2017

What is the ISSN?

The International Society of Sports Nutrition is the leading academic body dedicated to sports nutrition research and education. Founded in 2003, the ISSN publishes position stands — comprehensive evidence reviews that synthesize the totality of research on a specific topic and provide clear, actionable conclusions.

Position stands undergo rigorous peer review and represent the consensus of leading researchers in the field. They are not opinions — they are systematic evaluations of the entire body of evidence.

The 12 Key Conclusions

The Kreider et al. 2017 position stand presented 12 formal conclusions. Here are the most significant findings organized by theme:

Efficacy

1. Creatine monohydrate is the most effective ergogenic nutritional supplement currently available for increasing high-intensity exercise capacity and lean body mass during training.

2. Creatine supplementation can enhance post-exercise recovery, injury prevention, thermoregulation, rehabilitation, and concussion/spinal cord neuroprotection.

3. Creatine has potential clinical benefits beyond sports performance, with applications in neurodegenerative diseases, diabetes, and conditions related to creatine synthesis deficiency.

5-10%
greater strength gains during resistance training with creatine supplementation
ISSN Position Stand, 2017

Safety

4. There is no scientific evidence that short- or long-term use of creatine monohydrate has any detrimental effects on otherwise healthy individuals.

5. No compelling evidence supports claims that creatine causes dehydration, muscle cramping, kidney damage, liver damage, hair loss, or gastrointestinal distress at recommended doses.

6. Long-term safety is confirmed by studies lasting up to 5 years showing no adverse health effects in athletes consuming creatine at recommended levels (J & V, 2013) .

Form and Dosing

7. Creatine monohydrate is the most extensively studied and clinically effective form of creatine for use in nutritional supplements.

8. No alternative creatine form (HCl, ethyl ester, buffered, Kre-Alkalyn, liquid) has been shown to be superior to monohydrate in any peer-reviewed study.

9. The loading protocol of approximately 0.3g/kg/day for 5 to 7 days (roughly 20g/day for a 70kg person) followed by 3 to 5g/day maintenance is the quickest way to increase muscle creatine stores.

Regulation and Ethics

10. Creatine should not be classified as a banned substance. It is a legal, natural compound available in food and synthesized by the body.

11. Appropriate regulatory measures should protect consumer quality, but restrictions on creatine availability are not scientifically warranted.

Evidence Tiers Explained

The ISSN evaluated creatine research across multiple evidence categories:

Level A (Strong Evidence) — Performance benefits:

  • Increased phosphocreatine resynthesis rate
  • Enhanced repetitive sprint performance
  • Greater work performed during sets of maximal effort
  • Increased lean body mass and muscular strength during training
  • Enhanced glycogen loading and recovery

Level B (Moderate Evidence) — Emerging applications:

  • Neuroprotective benefits following traumatic brain injury
  • Improved tolerance to exercise in hot environments
  • Enhanced recovery from exercise-induced muscle damage
  • Benefits for aging populations (sarcopenia prevention)

Level C (Preliminary Evidence) — Areas needing further research:

  • Adjunct treatment for certain neurodegenerative conditions
  • Cardiovascular health benefits
  • Benefits during pregnancy

Why This Paper Matters

The Kreider et al. 2017 position stand matters for several critical reasons:

It settled the safety debate. Before this comprehensive review, myths about kidney damage, dehydration, and other supposed side effects persisted in public discourse. The ISSN’s systematic evaluation of decades of research provided a definitive answer: creatine is safe for healthy individuals (JR & M, 2000) .

It established monohydrate as the gold standard. The supplement industry frequently markets newer creatine forms (HCl, buffered, ethyl ester) as superior. The ISSN confirmed that none of these have demonstrated superiority over plain monohydrate in controlled studies.

It provided a single authoritative reference. Rather than citing dozens of individual studies, professionals can now point to one comprehensive document that summarizes 30+ years of creatine research.

It expanded the scope of creatine applications. Beyond sports performance, the position stand highlighted emerging evidence for creatine in clinical settings — brain health, aging, metabolic disorders, and neuroprotection.

Study Characteristics

  • Type: Position stand / comprehensive review
  • Authors: 10 leading sports nutrition researchers (Kreider, Kalman, Antonio, Ziegenfuss, Wildman, Collins, Candow, Kleiner, Almada, Lopez)
  • Published in: Journal of the International Society of Sports Nutrition
  • Studies reviewed: 500+
  • Time span covered: 1992 to 2017 (25 years of research)

Practical Takeaways

Based on the ISSN Position Stand, here is what you should know:

  1. Choose creatine monohydrate. It is the most studied, most effective, and often the most affordable form
  2. Take 3 to 5g per day. This is the maintenance dose for lifelong use — no cycling required
  3. Loading is optional but effective. If you want faster results, use 20g/day for 5 to 7 days, then drop to 3 to 5g daily
  4. Safety is well-established. If you are a healthy individual, there is no credible scientific basis for concern at recommended doses
  5. Creatine is not just for athletes. The evidence supports benefits for aging adults, vegetarians, those under cognitive stress, and potentially clinical populations
30+
years of research confirming creatine monohydrate as safe and effective
ISSN Position Stand, Kreider et al. 2017

Full Citation

Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, Candow DG, Kleiner SM, Almada AL, Lopez HL. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition. 2017;14:18. doi:10.1186/s12970-017-0173-z

Sources & References

This article is based on the ISSN Position Stand published in 2017, supplemented with supporting references from Harris et al. (1992), Poortmans & Francaux (2000), and Antonio & Ciccone (2013). All cited studies are indexed on PubMed.

Further Reading

Frequently Asked Questions

What is the ISSN Position Stand on creatine?

The ISSN Position Stand (Kreider et al. 2017) is the most authoritative scientific review of creatine supplementation. It concluded that creatine monohydrate is the most effective ergogenic nutritional supplement for high-intensity exercise and lean body mass, and that it is safe for healthy individuals at recommended doses with no detrimental effects.

Does the ISSN confirm creatine is safe?

Yes. The ISSN concluded that there is no scientific evidence that short- or long-term use of creatine monohydrate has any detrimental effects on otherwise healthy individuals when used at recommended doses. Studies lasting up to 5 years support this conclusion.

What dose does the ISSN recommend for creatine?

The ISSN recommends a loading phase of approximately 5g four times daily (20g/day) for 5 to 7 days to rapidly saturate muscles, followed by a maintenance dose of 3 to 5g per day. Alternatively, 3g per day without loading achieves saturation in about 4 weeks.

Is creatine monohydrate better than other forms?

According to the ISSN, creatine monohydrate is the most extensively studied and clinically effective form of creatine. No other form (HCl, ethyl ester, buffered, liquid) has been shown to be superior to monohydrate in peer-reviewed research.