The case for creatine

It wasn’t so long ago that creatine lived firmly in the realm of weight-lifting bros, credited with helping them get stronger and faster. “Creatine isn’t a magic bullet, but it’s a well-studied supplement that can support muscle, strength, and training performance — especially when paired with resistance exercise,” says Ali McGowan, R.D., a registered dietitian in Rhode Island specializing in sports nutrition and hormonal health. 

But nowadays, you can’t scroll a perimenopausal newsfeed without creatine inevitably entering the chat. That’s thanks to a growing body of research that has coaxed this supplement out of the locker room and into the midlife algorithm. “Studies are exploring whether creatine may be helpful for people managing conditions like diabetes, osteoarthritis, and depression,” says Theresa Gentile, R.D.N., a registered dietitian nutritionist and spokesperson for the Academy of Nutrition and Dietetics. “It has also been shown to support aging-related concerns, especially in post-menopausal women, when the drop in estrogen can cause loss of muscle, bone mass, and strength.” The result: Every woman in their 40s and 50s feeling like they should have started taking creatine yesterday. But do you really need it? Keep reading to unravel what creatine can — and can’t — do for you.

Creatine is a compound made from three amino acids (the building blocks of protein): arginine, glycine, and methionine. You can get creatine through your diet — it’s found in red meat and seafood — and your body also produces some creatine itself via your kidneys, liver, and pancreas. In the body, creatine’s job is to replenish a molecule called adenosine triphosphate (ATP), which provides energy to cells. This is why creatine is so often linked to athleticism. Your body stores most of its creatine supply in your muscles, where it can be relied on to keep them energized for quick bursts of power or speed, as in heavy weightlifting or sprinting. 

But that’s not all. ATP supplies the energy to brain cells as well; by regenerating ATP, creatine essentially helps recharge the brain’s battery, especially when it’s under extra strain, like from lack of sleep or illness.

Between the creatine in foods and the amount the body makes, most people’s muscles store about 60% to 80% of the total creatine they can hold — meaning there’s room for a top-off. “Most non-vegetarian diets provide about 1 to 2 grams of creatine per day, which only partially saturates muscle stores,” says McGowan. “Supplements offer a reliable way to increase creatine levels compared to food alone, even for people who eat meat.” Here’s what that extra creatine can do:

• Better athletic performance…: Taking a creatine supplement can increase the amount in your muscles by about 20% to 40%, allowing them to perform better during exercise, according to decades of research. That means more dumbbell reps or sprints, increased strength and muscle-building, and easier recovery from workouts and injuries. 

• …as long as you lift weights. To see the above benefits, you need to pair creatine supplements with strength training. “This is because it helps people train harder or longer, which leads to better muscle results over time,” says McGowan. “Without training, creatine alone is unlikely to meaningfully improve strength or muscle mass.” It won’t do damage, but it won’t help either. That said, you don’t need to train like a bodybuilder — especially if you’re in your 40s or beyond and are worried about losing muscle as you age. “In older adults, creatine combined with light resistance training can help maintain muscle, support strength, and reduce the risk of frailty,” says Gentile. 

• And maybe some brain benefits, too: Early studies are increasingly showing that supplementing creatine may deliver an extra dose of energy to the brain as well, potentially boosting cognition, memory, and mood. However, gaps in research on this topic still remain, and the body of evidence is small. “Creatine may help reduce mental fatigue during demanding tasks (especially in menopausal women), and may help restore your energy and keep you sharp if you're sleep deprived,” says Gentile.

More than most supplements, creatine seems to be surrounded by the fear of downsides. But when you look at the science, they turn out to be more fiction than fact. For instance, you may have heard that creatine supplements are bad for the kidneys, but that’s a misconception. 

“Creatine is considered safe for healthy individuals, with no consistent evidence of kidney harm at doses up to 5 grams per day, even with long-term use,” says McGowen. “Most studies report few to no side effects, but people with existing kidney disease should consult a healthcare provider before taking it.” 

The other most common myth: that creatine increases body fat. Some people may experience water retention when they first start taking it, which could show up as a couple extra pounds on the scale. But research shows this is temporary and doesn’t happen for everyone.

More bang for your buck from exercise, a potentially clearer mind in midlife — with selling points like those, who wouldn’t want to jump on the creatine bandwagon? But it’s not necessarily for everyone. “Although creatine can benefit many people, not everyone needs to take it,” says Gentile. “If you eat a balanced, varied diet, it's probably unnecessary to supplement with creatine unless you fall into one of the categories of people it most benefits.” Those include:

• People engaging in strength training, interval workouts, sprinting, or other quick-burst-of-activity sports (like soccer, basketball, or tennis) several times a week

• Adults over 40 worried about declining muscle mass who can commit to light resistance training several times a week

• Vegetarians and vegans who may not be getting enough creatine from food 

If you do fit into one of those buckets, look for a supplement containing creatine monohydrate, the form with the extensive research backing it. Also keep in mind that supplements aren’t regulated by the FDA in the same way as prescription medications, so quality can vary by brand; look for products that have third-party testing by an organization such as NSF, and talk to your healthcare provider before starting on creatine.

While some people start with a high dose of 20 grams a day for up to a week, this “loading phase” (designed to max out creatine stores as quickly as possible) isn’t necessary and can up the chance of side effects like water retention and gastrointestinal upset. Instead, you can start with 3 grams per day and increase to 5 grams per day over time.

Creatine isn’t just for bodybuilders — it’s one of the most well-researched supplements available, with proven benefits for strength. If you strength train a few times a week, follow a plant-based diet, or want to preserve muscle and mental sharpness as you get older and do some resistance training, it may be worth discussing starting a creatine supplement with your healthcare provider.