The Biggest Creatine Meta-Analysis Yet Confirms the Strength Gains, and Exposes a Trust Gap

A new three-level meta-analysis pooling 63 studies and 1,489 participants has delivered the most statistically robust confirmation to date that stacking creatine monohydrate on top of resistance training builds more strength and lean mass than training alone. Published this week in the Journal of the International Society of Sports Nutrition, the analysis found consistent, meaningful benefits for upper-body strength, lower-body strength, and lean mass, while also settling a few smaller debates about fat loss and who benefits most.

At almost the same time, a separate large-scale survey of over 2,100 real-world creatine users found that despite decades of research, most people using the supplement still don't understand it, and a persistent myth about kidney damage is quietly shaping who takes it and how much. Put together, these two papers tell a useful story for anyone coaching clients: the science on creatine keeps getting stronger, but the education gap around it hasn't closed at all.

What the research found

The meta-analysis, led by Hai Wang and colleagues at the Capital University of Physical Education and Sports in Beijing, searched five major databases (PubMed, Web of Science, Cochrane Library, Embase, EBSCO) through April 2025 and combined 63 randomized and controlled trials using a three-level random-effects model, a more rigorous statistical approach than a standard meta-analysis because it properly accounts for studies that report multiple outcomes from the same sample, rather than treating each measurement as fully independent.

Compared with resistance training alone, resistance training plus creatine supplementation produced:

• Upper-body strength: a moderate, statistically significant increase (Hedges' g = 0.54, p < 0.001)
• Lower-body strength: a similar moderate increase (g = 0.55, p < 0.001)
• Lean mass: a small-to-moderate increase (g = 0.30, p < 0.001)
• Total body mass: a small increase (g = 0.12, p = 0.04), consistent with added lean tissue and water, not fat
• Body-fat percentage: a small but significant reduction (g = -0.14, p = 0.02)
• Fat mass: no significant difference between groups

In plain terms: creatine didn't melt fat away, but it didn't add it either. The modest weight gain some people worry about came from muscle and intracellular water, and body-fat percentage actually nudged down because lean mass increased while fat mass stayed flat.

One caveat worth flagging for coaches: an exploratory subgroup analysis found that age appeared to be associated with the size of the strength gains, with younger participants showing larger effects than older ones. The authors were careful to note this should be "interpreted cautiously" because the age subgroups weren't evenly represented across the 63 trials, so this is a hypothesis worth watching, not a settled finding. Neither age, sex, nor training experience reliably predicted the size of the body-composition changes, and things like dosing protocol (loading vs. no loading) and weekly training frequency didn't meaningfully change the outcome either, reassuring news for anyone worried that skipping a loading phase means missing out.

The trust gap nobody's talking about

The second paper adds context that matters for anyone actually coaching people through supplementation. Researchers surveyed roughly 2,178 people (a mix of long-time and newer creatine users, median age 55, split almost evenly between women and men) recruited through a supplement-tracking app. The findings, published in the same journal, are a reality check on how the science translates into practice:

• Only 55% of regular users felt they'd actually gotten a benefit from creatine, despite 98% intending to keep taking it and average satisfaction scores of 7.8 out of 10, a disconnect the authors call an "unmet-expectation gap."
• Cognitive performance was the single most common reason people took creatine (68% of respondents), yet it was also the goal with the largest gap between expectation and perceived result. Nearly two-thirds of people chasing a cognitive benefit didn't feel they got one, which the authors suggest may reflect dosing that's too low for a brain effect rather than creatine simply not working.
• Women reported roughly 48% higher rates of self-reported side effects and lower odds of perceiving a benefit than men, even after adjusting for dose.
• The single strongest predictor of a positive experience across every outcome measured wasn't dose, sex, or age; it was how much the person actually understood about creatine. And the most common misconception the researchers flagged, using a statistical technique to find the most "central" myth in the data, was the belief that creatine damages the kidneys, a claim that has been repeatedly tested and not supported in people with healthy kidney function.

This is a cross-sectional, self-reported survey of app users, not a clinical trial, so it can't prove that fixing someone's knowledge causes better results, but the association is striking and consistent with what most coaches see anecdotally: clients who understand why they're taking something stick with it and report feeling better about it.

Why it matters for training and coaching

For a coach or gym owner, this pair of studies is really one message in two parts. First, the physiological case for creatine as a strength and lean-mass tool for resistance-trained clients keeps getting more solid, this isn't a single small study, it's 63 trials distilled into one estimate. Second, the outcome your client experiences depends heavily on whether they actually understand the tool they're using. A client who's quietly worried creatine will wreck their kidneys, or who expects it to sharpen their memory within a week, is a client who's likely to quit before the muscle and strength gains show up.

This is especially relevant for two groups: women, who are a fast-growing share of creatine users but reported both more side effects and less confidence in the benefit, often a sign of under-dosing relative to body mass or simply less access to good information; and older clients, where the strength-gain effect may be somewhat smaller per the exploratory age analysis but where preserving lean mass and function matters just as much, if not more.

Practical takeaways

• Standard dosing works. 3-5g/day of creatine monohydrate, taken daily and consistently, is enough to see the benefits reported in this meta-analysis. A loading phase (about 20g/day split across the day for 5-7 days) speeds up saturation but isn't required, the meta-analysis found no significant difference in outcomes tied to dosing protocol.
• Timing is not the lever. Nothing in this body of research suggests pre- vs. post-workout timing meaningfully changes results, consistency day-to-day matters far more than the clock.
• Set expectations before someone starts. If a client's primary goal is cognitive, tell them upfront that the evidence there is weaker and dose-dependent, so they're not disappointed and quitting the one thing that's reliably building their strength and lean mass.
• Address the kidney myth directly and early. It's the single misconception most tied to satisfaction and continued use in the survey data, a short, clear explanation (creatine is not harmful to kidneys with normal function, and the "elevated creatinine" some people see is a measurement quirk, not organ damage) removes a real barrier for hesitant clients.
• Don't expect a body-fat transformation from creatine alone. Treat it as a strength and lean-mass tool that supports a body recomposition, the fat-loss signal in this data was small and only showed up as a percentage effect, driven by muscle gain rather than fat loss.

Sources and references

• Wang, H., Wang, H., Xin, X., & Yi, Z. (2026). Resistance training combined with creatine supplementation: a three-level meta-analysis of multidimensional outcomes from strength enhancement to body composition remodeling. Journal of the International Society of Sports Nutrition, 23(sup1), 2718316. PubMed PMID: 42765482 · DOI: 10.1080/15502783.2026.2718316
• Burridge, J., Boolani, A., Zhang, Z., & Glenn, J. M. (2026). Real-world creatine supplementation: a large-scale cross-sectional study of use, knowledge, and experiences. Journal of the International Society of Sports Nutrition, 23(1), 2702952. PubMed PMID: 42479961 · DOI: 10.1080/15502783.2026.2702952
• Gonzalez, D. E., et al. (2026). International Society of Sports Nutrition position stand: effects of dietary antioxidants on exercise and sports performance (creatine dosing reference: 0.1 g/kg/day). Journal of the International Society of Sports Nutrition, 23(1), 2629828. PubMed PMID: 41701327 · DOI: 10.1080/15502783.2026.2629828

According to PubMed, all findings above are drawn from peer-reviewed articles indexed in the National Library of Medicine's PubMed database.