Experts urge caution over creatine for older adults after reports of kidney and liver harms

Health experts are urging caution over the use of creatine among older adults after reports and studies tied the widely used supplement to gastrointestinal side effects and, in rare cases, kidney and liver injury.

Creatine, a compound produced naturally by the liver, pancreas and kidneys that helps cells generate energy, has long been used by athletes to improve performance and build muscle. In recent years it has gained popularity among older people after research suggested potential benefits for cognition, bone health and mood. But clinicians now say more long-term safety data are needed, especially for older and perimenopausal adults.

Doctors and researchers have reported common short-term adverse effects such as diarrhoea and vomiting and warned that, on rare occasions, creatine may be associated with more serious kidney or liver problems. Some experts cited in recent media coverage said that extreme overdoses can lead to organ failure, though they stressed such outcomes are uncommon.

"Creatine has lots of positives, but I wouldn’t be too evangelical about taking it," said Dr. Brendon Stubbs, a senior lecturer at King’s College London. He told reporters that longer-term studies are needed to clarify benefits and potential side effects for older people and perimenopausal women.

Use patterns vary. Around a third of elite athletes take creatine, typically sold as a white powder dissolved in water, while a 2024 study found roughly 6% of people over 65 reported regular use. Manufacturers and some clinicians generally advise a daily limit of about 5 grams. Online influencers, however, sometimes recommend much higher single doses — up to 20 grams — a practice experts say increases risk.

Clinicians warn that people with existing kidney disease should avoid creatine because the organs that filter waste must process the supplement and could be placed under additional strain. A 2010 study from Turkey cited in recent coverage warned that "even the recommended doses of creatine monohydrate supplementation may cause kidney damage," though investigators and reviewers have reached different conclusions in subsequent research.

The Daily Mail reported the case of a 79-year-old man, Andy Cole, who said a routine urine test showed kidney inflammation after he began taking creatine. According to the account, doctors told him to stop the supplement and his kidney readings later returned to normal. Such single-patient reports cannot establish causation, but clinicians say they underscore the need for careful monitoring and more robust trials in older populations.

Some public figures and clinicians have promoted creatine to older patients to help preserve muscle mass and reduce fall risk. ITV’s Dr. Hilary Jones recommended creatine to older patients in recent commentary, reflecting a broader conversation in primary care and fitness communities about potential benefits.

Nutritionists emphasise alternative, evidence-based options to support brain and bone health. "Green tea and dark chocolate — as well as berries, citrus fruits and other brightly coloured fruits and vegetables — are brilliant for brain health," said nutritionist Rob Hobson, noting antioxidants may protect brain cells. He also noted that calcium, magnesium and adequate protein support bone health in older adults.

Regulatory guidance on supplements varies by country, and health professionals typically urge patients to discuss any supplement use with their clinician, particularly when they have chronic conditions or take prescription medication. Researchers and practicing physicians who spoke to the media called for larger, longer randomized trials to better define the risk–benefit profile of creatine in older and medically vulnerable populations.

Until more definitive evidence is available, experts advising in the recent coverage recommended older adults consider clinical history, existing kidney or liver disease, and follow dosing guidance when deciding whether to use creatine. They also urged clinicians to monitor renal and hepatic function in patients who choose to take the supplement.