Creatine! Not Just for Men and Muscles

If you are paying attention to the health and wellness industry, you will notice that creatine is getting a lot of attention recently. You may be wondering just how impactful it can be, or else what dangers are associated with it. We will first discuss briefly what creatine actually is and how your body uses it. Then we can dive into the established research that currently exists on its impact on health, as well as what to consider if you are thinking of taking it. Finally, we will explore specifics regarding menopause, pregnancy, and the exciting potential benefits to aspects of health that are not fitness related-such as impact on mental health and depression.

What is Creatine?

Creatine is an amino acid compound primarily stored within our muscle tissue (roughly 95%) and brain (5%). While it is mostly sourced as a supplement, you can find small amounts of it in food sources including beef or pork (2g/lb), and fish like salmon or herring (2-4g/lb).

While some of the creatine within our body is referred to as “free creatine,” intramuscular creatine is often found as phosphocreatine, meaning it is bound to a phosphate group (one phosphorus atom bound to four oxygen atoms). This is significant because phosphate groups are an integral component of our body’s form of energy “currency,” ATP (adenosine triphosphate). Energy for exercise (or any metabolic activity for that matter) is produced from cleaving a phosphate group off of ATP, leaving ADP (adenosine diphosphate) in excess. As our muscles struggle to maintain the high ATP demands from high intensity exercise, the phosphate group from phosphocreatine is donated to ADP to quickly resynthesize ATP for that last burst of high intensity energy.

According to the International Society of Sports Nutrition, a standard diet may contain roughly 1-2 grams of creatine per day, yielding roughly 60-80% creatine saturation within the muscle. Supplementing with a minimum of 5 grams per day will typically be enough for most to fully saturate muscle tissue, with larger athletes potentially needing 5-10 grams per day. So how important is it really in the grand scheme of things?

How Effective Is It Really?

Being the most studied supplement on the market aside from caffeine, there are countless studies indicating that regardless of age, creatine can improve performance in strength and bouts of high-intensity training (swimming, ice hockey, sprinting and jumping, etc.), thereby influencing positive effects on muscle growth, muscle retention while in a calorie deficit, and recovery from said high-intensity bouts. While it is hard to determine how much the changes in body composition and recovery can be attributed to creatine use, athletes have been observed to improve performance metrics by roughly 10-20% when muscle creatine stores are fully saturated (Kreider et al., 2023).

How Should I Supplement It?

While the most effective and efficient way to ingest creatine and saturate the muscle would be a 7-10 day “loading phase” of roughly 20 grams spread out throughout the day, most people would see the same effect (albeit slightly slower) by simply ingesting 5 grams per day. The notion that it must precede or follow a workout is a common misconception. Timing of ingestion will have no immediate effect on workout performance, so just making sure you get it into your system once or twice per day-whether in your morning coffee or diluted with water before bed-will have the same effect.

While there are a variety of types of creatine on the market these days, none have been studied as much or proven as effective as creatine monohydrate, which conveniently is the most cost-efficient option as well. The most affordable option is in powder form, but more products are flooding the market in gummies or energy bars. Consistency is the key, but a missed day here and there will not “tank” your progress.

Creatine for Specific Populations

Creatine and Menopause

Women going through menopausal changes may stand to gain more from supplementing with creatine. With up to 20% less creatine synthesis, and an average of 30-40% lower dietary creatine consumed, on top of the vasomotor and psychosomatic symptoms associated with menopause like low energy availability, hot flashes, sleep disturbances, and bone mineral density loss, the simple addition of a creatine supplement has the potential to drastically improve quality of life. The primary benefit supported by the research seems to be the improvement in muscle mass and bone mineral density, which is a clear area for concern with severe menopausal symptoms.

That said, while everyone’s favorite influencer or podcaster preaches the value of creatine supplementation for menopausal women, there is still a gap in the research indicating true measurable outcomes beyond the potential benefits mentioned in the previous section. Researchers are currently exploring in more detail creatine supplementation with specific phases of the menstrual cycle and menopause, notably the potential improvement in water retention and subsequently cellular health during the follicular phase of the menstrual cycle. That said, there is yet to be compelling evidence to make more specific recommendations to the public.

Creatine and Pregnancy

While more research is needed, a few prospective studies posted in the last decade indicate that creatine supplementation on low-risk pregnant women does not seem to implicate significantly positive, nor negative effects on fetal growth.

When in doubt, consult your primary care physician. Even with creatine being the most studied supplement on the market, it is not something to blindly take without weighing potential risks vs. benefits.

Creatine and Mental Health

Perhaps the most compelling outcomes from supplementing creatine is the potential benefit to brain health and depression. As mentioned previously, about 5% of creatine is stored in the brain, and recent research seems to indicate that saturating creatine stores can have positive effects on cognition and memory, particularly when in metabolically stressed states including sleep deprivation or other menopause-related symptoms. Considering our brain consumes up to 20% of our body’s energy consumption, it follows that a high energy phosphagen buffer like creatine may contribute to cognition, particularly in high demand or stressful engagements. While there are some ethical limitations in testing certain states with creatine supplementation, sleep deprivation and memory, reaction time, mood, balance, and executive function have all been shown to be improved with creatine supplementation (Candow et al., 2023).

In a systematic review published in 2024 by Juneja et al., there were several randomized controlled trials indicating that when consumed alongside traditional interventions including antidepressants and SSRIs (selective serotonin reuptake inhibitors), creatine groups responded better than just the traditional intervention groups. While not every investigation found statistically significant results, the overall consensus indicates a roughly 15-20% improvement on depression rating scales with creatine compared to without.

Creatine and TBIs (Traumatic Brain Injury)

There is evidence of creatine improving a variety of symptoms associated with concussions, including reduced time to recover from amnesia, reduced dizziness and fatigue, and improved response to problems of understanding. A 6-month randomized controlled trial investigating creatine supplementation as a neuroprotective agent in adolescents between the ages of 1-18 implicated creatine as a statistically significant intervention with no side effects reported from supplementation (Sakellaris et al., 2006). As TBIs typically dysregulate energy availability and cerebral blood flow, as well as decrease brain creatine content, it follows that supplementation may improve return to normal cognition. There is a need for more research, however, to definitively defend this claim.

Creatine and Neurodegenerative Disorders

Considering neurodegenerative diseases like Alzheimer’s disease are associated with reduced blood flow to the brain, neuron death due to altered glucose metabolism and oxygen flow, and reductions in creatine kinase (the enzyme responsible for creating energy from ATP), there is an argument for creatine playing a strong role in symptom management and prevention. That said, there is very little research thus far on human participants indicating efficacy of a creatine intervention. Similarly, the limited research investigating the effect of creatine supplementation on patients with MS (Multiple Sclerosis) and Parkinson’s disease has not yet shown compelling results to back up the mechanistic logic behind intervening with creatine.

Key Takeaways

• While creatine is not the anabolic fairy dust some make it out to be, it has a distinct, significant impact on sport performance, strength, and muscle mass.
• There continues to be more research investigating the relationship between creatine, the menstrual cycle, and menopause, but preliminary research indicates supplementing is safe and provides a net positive-helping prevent muscle and bone mineral density loss, as well as potentially improving mood and depressive symptoms.
• While there is compelling evidence that creatine can play a role in regulating and improving depression and mood, there is lacking evidence that it can improve or prevent neurodegenerative diseases.
• There do not seem to be any negative effects from creatine supplementation besides mild gastrointestinal distress and some bloating with overconsumption (20+ grams/day). That said, consult your doctor in unique cases or if you have any concerns-and definitely consult your doctor if you experience any reactions to consumption.
• Timing of supplementation relative to workout, sleep, or other daily activities has no impact on performance.
• Supplement with 5-10 grams/day (or 0.3 g/kg of body weight), making sure to consume daily.
• Consume 20 g/day for 7-10 days if you wish to saturate muscle quickly. This loading phase is not necessary for most. Consult your doctor or a dietitian for advice related to your specific body and situation.