Can Creatine Cause Constipation? (Fix It By Doing This)

Creatine is a highly effective supplement proven to be safe in various populations, from young athletes to older adults and even clinical patients. That being said, many athletes are wary of using it because of the fear of side effects, one of which is constipation. Does creatine cause constipation, and should you, as an athlete, worry about it?

No evidence exists that creatine causes constipation if taken in the recommended dosages. You should not take more than suggested (especially in one dose), as it will lead to no further benefits and increase the risk of gut issues. If you are constipated, it is also important to look at your fiber intake, overall gut health, and water intake.

Why, then, do some athletes experience constipation while using creatine, and where does this myth come from?

Does Creatine Cause Constipation?

A popular belief is that creatine causes constipation because it “draws water from the gut” due to water retention.

However, some water retention only occurs during the loading phase of taking creatine ^[1], and even when water retention occurs, it does not change the distribution of water, i.e., where water is located in the body ^{[2, 9]}.

Numerous studies have looked at the side effects of using creatine. Some gastrointestinal problems (gut issues) have been reported in studies, mostly diarrhea and gas, but also, in some cases, constipation ^{[3, 4, 5]}.

These symptoms were predominantly observed in athletes who exceeded the recommended creatine dosage, particularly by consuming more than 10g at once.

The suggested intake is 20g of creatine distributed throughout the day in four servings of 5g each, followed by a maintenance phase of 3–5g per day to sustain optimal muscle creatine levels. ^[1].

Not all studies found a difference in gut issues between the creatine and placebo groups.

In this case, a similar amount of athletes experienced constipation, possibly due to outside factors rather than the creatine ^[5].

Practices like taking heaped scoops (more than the recommended amount in grams), “dry scooping,” or taking two tablets of creatine at once can increase the risk of taking in too much creatine at once and, therefore, increase the risk of getting gut issues like constipation.

Does The Type Of Creatine Matter?

No evidence is available to show that other forms of creatine, like creatine HCl, lead to a lower risk of gut issues ^[6].

In addition, micronized creatine (broken down into smaller particles) has also not been found to be more effective in preventing side effects than creatine monohydrate.

Its smaller particle size might make micronized creatine more soluble in water, but it does not necessarily mean you absorb more of the creatine once it is in your stomach ^[6].

The most widely used form of creatine is creatine monohydrate, and it has been proven to be safe with concrete evidence of leading to gut issues when taken in correct dosages^[7].

How To Avoid Constipation Or Treat It If You’re Experiencing It

Constipation can be treated by what you consume and increasing your physical activity. Even just going for a walk can help to provide movement to the gut.

From a nutrition side, it is essential to increase the amount of insoluble fiber in your diet, which is fiber that essentially acts as a “broom” in your gut.

This type of fiber is found in fruits and vegetables, especially in the skins of “harder” bits of the fruit, as well as whole grains, nuts, seeds, and legumes.

Guidelines for sufficient dietary fiber intake vary globally and across age groups; however, a widely recommended target for adults is to consume 25-30 g or more of dietary fiber daily ^[8].

The average American only consumes about 17 g per day ^[8].

If you follow a keto or low-carb diet, you are at a higher risk of not getting enough fiber; that is why it is important to include a lot of vegetables and consider adding psyllium husk or a similar type of fiber supplement to your diet.

In addition to fiber, it is also important to get in enough water to prevent constipation. Because you can train harder and longer while using creatine, you can lose more fluids than usual.

Ensure you replace all the fluids you lose in training and monitor your urine to be a light yellow or clear color to check if you are hydrated enough.

Lastly, it can be worth adding probiotics to your routine if you struggle with chronic constipation ^[10].

Summary

There is no evidence that creatine can cause constipation if it is taken in appropriate dosages. Avoid taking >10 g creatine at once and dry scooping, and also look at lifestyle factors like fiber intake and hydration if you are constipated.

References

1. Almeida, D., Colombini, A., & Machado, M. (2020). Creatine supplementation improves performance, but is it safe? Double-blind placebo-controlled study. J Sports Med Phys Fitness, 60(7), 1034-1039. doi:10.23736/s0022-4707.20.10437-7
2. Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Kreider, R. B., . . . Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr, 18(1), 13. doi:10.1186/s12970-021-00412-w
3. Dimidi, E., Christodoulides, S., Scott, S. M., & Whelan, K. (2017). Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr, 8(3), 484-494. doi:10.3945/an.116.014407
4. Francaux, M., & Poortmans, J. R. (2006). Side effects of creatine supplementation in athletes. Int J Sports Physiol Perform, 1(4), 311-323. doi:10.1123/ijspp.1.4.311
5. Kreider, R. B., Jäger, R., & Purpura, M. (2022). Bioavailability, Efficacy, Safety, and Regulatory Status of Creatine and Related Compounds: A Critical Review. Nutrients, 14(5). doi:10.3390/nu14051035
6. Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., . . . Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr, 14, 18. doi:10.1186/s12970-017-0173-z
7. McKeown, N. M., Fahey, G. C., Jr., Slavin, J., & van der Kamp, J. W. (2022). Fibre intake for optimal health: how can healthcare professionals support people to reach dietary recommendations? Bmj, 378, e054370. doi:10.1136/bmj-2020-054370
8. Ostojic, S. M., & Ahmetovic, Z. (2008). Gastrointestinal distress after creatine supplementation in athletes: are side effects dose dependent? Res Sports Med, 16(1), 15-22. doi:10.1080/15438620701693280
9. Powers, M. E., Arnold, B. L., Weltman, A. L., Perrin, D. H., Mistry, D., Kahler, D. M., . . . Volek, J. (2003). Creatine Supplementation Increases Total Body Water Without Altering Fluid Distribution. J Athl Train, 38(1), 44-50.
10. Stephen, A. M., Champ, M. M.-J., Cloran, S. J., Fleith, M., Van Lieshout, L., Mejborn, H., & Burley, V. J. (2017). Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutrition research reviews, 30(2), 149-190.