Should Women Take Creatine?

Woman facing away from camera, hair up, wearing black sports bra, flexing back and biceps muscles with black background.

“We want to pump…you up!”.  Remember Hanz and Franz from Saturday Night Live in the ‘90s?  Maybe I’m dating myself a little…if you’re not familiar I encourage you to look it up for a good laugh. 

So, how does a silly skit relate to creatine?  Well, mention of creatine often makes people think of bodybuilders trying to bulk up.  And while creatine supplements are still popular among those who want to build muscle, that’s not the only thing creatine is good for.

Creatine is one of the most widely researched supplements marketed for athletes.  In addition to benefits for athletes, recent research has uncovered links between creatine levels and bone mass, mental health, endurance, and more. 

In this article we’ll discuss who can benefit from increasing creatine intake, the best forms to consume, and side effects/safety issues.    

What is Creatine?

Creatine is a compound necessary for energy management and maintenance of cellular pH in the body. (1)  Creatine also contributes to antioxidant activity in cells. (2)

While creatine is not an amino acid (the individual molecules that make up proteins), the liver and kidneys are able to synthesize it from the amino acids arginine, glycine, and methionine. (1,2,3)

Your body only produces about half of your daily creatine needs, so it must also be consumed via diet or supplements.  Estimated creatine needs are about 2-4 grams per day and any extra can be stored, mostly in muscles. (3)

Why is Creatine Important?

Athletic Benefits

As noted, creatine plays a crucial role in energy availability in the body.  Specifically, creatine restores your body’s source of energy, ATP (adenosine triphosphate), after it has been used.  As such, increasing muscle creatine stores via supplementation has been shown to improve muscle strength, power, and recovery.   Increased creatine stores also help maintain muscle pH, which helps prevent fatigue. (1)

While creatine supplementation is known to be most effective for shorter, high intensity exercises, studies have also shown improvements in recovery from aerobic exercise and in resistance training. (1)

In men, creatine supplementation has also been shown to reduce protein breakdown.  While that does not seem to be the case for women, the reproductive hormone estrogen provides protection against muscle damage. (2) Research in post-menopausal females, who have very low estrogen levels, supports a combination of creatine supplementation and resistance exercise for gaining muscle and strength and improving physical performance. (1)

For older adults of both genders, several studies have shown improvements in physical function and quality of life as a result of creatine supplementation combined with resistance exercise. (1)

Body Composition

I’ll give you the bad news first: creatine doesn’t seem to have a direct impact on body fat.  The good news, however, is that it does increase lean mass (AKA muscle) in both men and women, young and old, when combined with resistance exercise.  Men tend to gain more muscle than women, however the benefit to women can’t be ignored, especially as we age and are prone to muscle loss. (2

Bone Health

As with all of your body’s tissues, bone cells are constantly turning over throughout your life; meaning old cells die and new ones replace them.  The process of generating new bone cells requires a lot of energy.  Creatine is beneficial for ensuring sufficient energy availability for this process.

One study of supplementation with creatine monohydrate combined with resistance training in post-menopausal females resulted in decreased loss of bone mineral density in the hip region.  The study also indicated increased bone strength and upper-body strength. (1)   

Another study involved adding creatine to bone-producing cells in a laboratory.  This study resulted in increased bone cell growth with the addition of creatine, suggesting that creatine may help heal bone fractures and slow development of osteoporosis. (2)

Mental Health

Creatine isn’t just for muscles.  As a major consumer of energy in your body, the brain benefits from adequate creatine levels as well. 

There is significant evidence that there is an inverse relationship between creatine levels in the brain and depression.  Meaning, the less creatine available to transport mood enhancing hormones like serotonin and dopamine in the brain, the higher incidence of depression. (1)

The impact of creatine on mood/depression is particularly important for women, who have lower levels of creatine in the frontal lobe of the brain, which is where mood, cognition, memory, and emotion are controlled. (1

Additionally, during times when individuals are under high levels of stress, the brain requires more energy.  Higher intake of creatine via diet or supplements during these times helps to reduce mental fatigue and maintain cognitive function. (1)

Another issue that depletes creatine levels in the brain is sleep deprivation.  Lack of sleep is known to impair cognition and low creatine is thought to play a role in this phenomenon. (1)

Women especially have certain phases of life during which mental stress, sleep deprivation, and depression tend to be more common.  Specifically, hormone changes during puberty, menopause, and after childbirth are often accompanied by some level of depression.  Pregnancy, post-partum, and perimenopause are phases of life in which sleep doesn’t come easy.  During these times, increased creatine intake may support mental health. (1

Creatine and Women’s Health

In general, women have roughly 70-80% less creatine stored in the body compared to men.  Some potential reasons for this include the fact that women typically have less muscle, and the fact that the average woman eats less than men.

Additionally, several studies indicate that sex hormones play an important role in how much creatine your body produces.  Specifically, estrogen and testosterone have been shown to increase levels of key enzymes needed for creatine production. (1,2)  As such, the body’s creatine synthesis should be higher when estrogen is elevated right before ovulation and right before menstruation. (1)

Despite the body’s increased ability to produce creatine when estrogen is elevated, the high estrogen luteal phase of the menstrual cycle (between ovulation and menstruation) is marked by higher protein breakdown.  Increased creatine intake during this time can help offset potential muscle loss. (1)

On the other hand, when estrogen levels are low, not only is creatine production decreased, but inflammation and cell damage increase (‘cause remember, estrogen is an antioxidant…).  Both factors contribute to muscle and bone loss, which creatine can offset. (1)  This is particularly important after menopause, when estrogen levels are consistently low.

Multiple studies have shown that supplementation with creatine monohydrate combined with resistance training is effective in increasing muscle mass and strength in post-menopausal females. (1)

How to Get Creatine Through Diet

Creatine is found mostly in red meat and fish, and a little is found in pork.  Individuals who follow a vegetarian or vegan diet are at risk for low creatine levels.

Beef, pork, and fish contribute about 1-3 grams of creatine per pound of meat.  Creatine is lost through the cooking process, so a well-done steak is going have significantly less creatine than a rare one. Fruits and vegetables only contain trace amounts of creatine. (4)

Are Creatine Supplements Safe?

The short answer is yes, healthy individuals are able to safely consume creatine supplements in the recommended doses. 

It should be noted, however, that creatine monohydrate is the only form of creatine supplement that has been granted GRAS (Generally Recognized as Safe) status by the FDA. (3) Creatine monohydrate is also the most extensively studied form of creatine supplement, and a large body of research supports the safety of this supplement.

Many other forms of creatine, including creatine citrate, creatine nitrate, or creatine hydrochloride (HCl), make claims of superiority to creatine monohydrate.  Such claims include “more soluble” or “better bioavailability”.  To date, the evidence does not substantiate these claims. (3)

The one notable side effect of creatine monohydrate supplementation is weight gain.  This is likely mostly due to increased muscle, however it is believed that it could also be from increased water retention.  There are claims that it can cause bloating, gastrointestinal issues, or even kidney stress.  The research, however, has not shown these claims to be true. (3

Recommended Dose for Creatine Supplementation

As noted above, creatine monohydrate is the only form of creatine supplement claiming GRAS status with the FDA, so all dosing recommendations are based on studies using this form of supplement.

There are two dosing strategies that have consistently been effective for increasing creatine stores in muscles and achieving results.  The first involves a loading phase that rapidly builds up muscle creatine.  The second involves a consistent dose that more slowly increases creatine concentrations in muscles over time.

Typically, a loading dose will involve taking 5 grams of creatine 4 times per day for 5-7 days.  After the loading phase, the body’s creatine levels will stay elevated for up to 30 days. (1)

The second creatine dosing strategy involves taking a single dose of 5 grams daily over the course of 3-4 weeks.  While it takes significantly longer to build up creatine stores, it is just as effective. (1)

Regardless of which dosing strategy is used, to maintain optimal creatine levels in muscles and in the brain after the initial supplement period, a maintenance dose of 5 grams per day may be recommended if you are unable to meet at least half of your daily needs via diet. (1)

Wrapping It Up

Creatine is used by our bodies to “recharge” our source of energy, ATP, when it is used.  It also helps to maintain pH balance in cells and provides some antioxidant benefits.  While our bodies can produce a small amount of creatine, we must consume the remainder of the 2-4 grams we need daily via diet or supplements.

Dietary sources of creatine include mostly red meat and fish.  Vegetarians, vegans, or anyone who doesn’t regularly consume red meat and fish likely do not obtain sufficient amounts of creatine.

Creatine is well-known in sports as an athletic supplement used to increase muscle synthesis, improve performance, and enhance recovery.  Creatine has also been found to have benefits for maintaining bone health, supporting mental cognition, and improving mood and depression.

Increased creatine intake may be particularly beneficial during times of increased stress or low estrogen levels, such as certain phases of the menstrual cycle, peri- or post-menopause, or post-partum.  Studies of creatine supplementation in post-menopausal women have supported its use for offsetting some of the effects of low estrogen levels, such as muscle and bone loss.

Creatine monohydrate is the most studied and widely available form of creatine supplement.  It has been found to be safe for healthy adults in proper doses.

If you are considering adding creatine supplements to your regimen, talk to your healthcare provider. Also, look for a brand that does third-party testing of their products. This ensures you’re getting what you paid for.

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