Creatine For Women: All Hype Or Performance-Enhancing?

Creatine is an increasingly popular supplement, especially among fitness devotees. 

According to the American Society for Sports Medicine, creatine is the highest-selling nutritional supplement in the US. The annual market is worth an estimated $400M.¹

Creatine can be found naturally in food, and your body produces it too. 

However, adding creatine to your diet as a supplement is generally intended to boost athletic performance, reduce recovery time, and enhance your ability to build muscle mass. 

Some studies even show that creatine intake has a connection with performance benefits for your brain. For example, it may improve your memory.

Still, most research examining creatine's risks and benefits has featured male participants. 

This leaves women wondering if creatine is appropriate and safe for them too. And if so, will it offer the same performance benefits?

It’s sensible to be discerning about using supplements and have a good understanding of the risks and benefits before moving ahead.

Suppose you're exploring supplements as a way to enhance athletic performance. In that case, it's wise to chat about it with your doctor or perhaps a registered dietitian. 

In the meantime, here’s a closer look at whether creatine is overhyped or helpful for women.

What exactly is creatine? 

 Creatine is an amino acid. Amino acids are chemical compounds that build protein

Creatine is in your body, in meat and fish, and ingested via dietary supplements. 95% of creatine is in skeletal muscle — the type of muscle that’s attached to your bones and responsible for movement — while the rest is in your tissues and organs, including the liver, kidneys, and brain.² ³

Typically, the body uses creatine for energy, which is why it’s favored by athletes and those wishing to build muscle and improve their recovery. 

Creatine in the spotlight

Creatine was first discovered in 1832 by extracting it from meat.⁴ However, public awareness of the supplement soared following the 1992 Summer Olympics in Barcelona, Spain.

Two track and field gold medalists — Linford Christie and Sally Gunnell — credited creatine as having an important role in their success.⁵

Today, creatine is very popular with both professional and amateur athletes.

The World-Anti-doping Authority does not classify creatine as a performance-enhancing drug.⁶ Olympians are allowed to use creatine if they choose.

Your body produces creatine

Although supplements are popular, creatine is already produced naturally in your body and found in common foods.

Creatine is readily available to those who consume meat, poultry, and fish. Foods like salmon, red meat, and chicken are all sources of creatine. 

In order for the body to produce creatine, it requires three amino acids: glycine, arginine, and methionine.⁷

Consuming foods with these amino acids can encourage your body to produce creatine.⁸

Plant-based amino acid sources

It's possible to boost creatine stores by eating certain seeds, greens, legumes, and nuts. 

Glycine is in:

  • Spinach

  • Sesame seeds

  • Pumpkin

  • Spirulina

  • Seaweed

Arginine is in:

  • Walnuts

  • Beans

  • Peas

  • Seaweed

Methionine is in:

  • Brazil nuts 

  • Tofu

  • Quinoa

Typical levels and creatine production

The body produces creatine primarily in the liver but also in the kidneys.⁹

Your liver and kidneys can produce roughly 1g of creatine per day.¹⁰

For males, typical creatine levels are between 0.6-1.2mg/dl, and for females, the range is usually between 0.5-1.1gm/dl.¹¹ You can assess your levels with a simple blood test (serum creatine).

Creatine supplements can grow muscle by 5–15%

Creatine supplements work in the body by increasing the amount of cellular phosphocreatine (sometimes known as creatine phosphate).

Phosphocreatine gives energy to adenosine diphosphate (ADP), which then turns into adenosine triphosphate (ATP). These metabolic processes carry energy to your cells necessary for high-intensity exercise.¹²

In other words, creatine can increase available energy, facilitating strength, power, and endurance.

In a 2003 literature review¹³ examining findings from 500 research studies about creatine supplementation, reports indicated that creatine could increase power and strength by 5–15%.¹⁴

More findings about creatine

A 2001 research study about creatine was conducted with 25 male college football athletes. Researchers found that coupled with resistance and anaerobic training (like weight lifting and other strength training), creatine had a positive effect on performance compared to training only.¹⁵

In 2008, in a study of men aged 59–77, creatine helped participants grow upper body muscle mass and reduced bone breakdown (resorption).¹⁶ Usually, aging is associated with reduced bone density and muscle loss, so these findings suggest creatine can help counter this effect.¹⁷

That said, not all studies indicate clear benefits in connection from taking creatine. 

A 2020 study found that elite male endurance athletes who received creatine supplements increased aerobic (heart and lung) power. However, the same study found no improvement in participants’ muscle mass.¹⁸

A 2019 systematic review and meta-analysis studied the effects of creatine supplementation on the performance of soccer players. Findings from the analysis indicate that taking creatine did not show beneficial for improving aerobic (heart and lung) performance. However, it did improve anaerobic power (explosive movement).¹⁹

Creatine and strength in women 

It's important to examine whether creatine might have different effects in male and female bodies, but it's rather understudied.

Many studies researching the benefits of creatine supplementation feature exclusively male participants. 

A 2020 systematic review found that creatine can help reduce the chances of pregnancy complications, including low oxygen levels during birth.²⁰

The 2021 review Creatine Supplementation in Women's Health: A Lifespan Perspective, notes that while there is less inquiry into creatine’s effects in women than in men, creatine supplementation for pre-menopausal females improves strength and physical performance.¹³

Similarly, post-menopausal women may also increase muscle, but with relatively higher doses of creatine (0.3g per day, per kg of body weight).¹³

The authors also mention that “[S]upplementation may be particularly important during menses, pregnancy, post-partum, and post-menopause.” 

Creatine did not show benefits for improving aerobic (heart and lung) performance. However, it did improve anaerobic power (explosive movement).

Creatine increases brain power

It’s believed that creatine enhances brain function by improving the energy supply to the brain. 

In a 2003 study¹³, participants supplementing increased creatine levels in the brain by 10%.²¹

Pre-clinical and clinical evidence shows that creatine supplementation can benefit mood and cognition — the effects may even be more pronounced in women.¹³

Data from the 2005–2012 National Health and Nutrition Examination Survey (NHANES) found that an 8-week treatment of creatine supplements and antidepressant therapy helped reduce symptoms of major depressive disorder in females. However, researchers say that further study is needed.²²

Creatine may also reduce cognitive fatigue (brain exhaustion). In a 2002 study, participants were supplemented with 8g of creatine daily for five days. They were asked to work out math problems repeatedly. Those who took creatine had less mental fatigue compared to the placebo group who did not take creatine.²³

In 2018, a systematic review²⁴ ​​of six randomized controlled trials found that creatine improved short-term memory and reasoning ability.²⁵

The authors suggest creatine is safe enough to trial with patients experiencing cognitive decline and dementia.²⁵

Which creatine is best?

Creatine supplementation appears to be the most reliable way to increase levels in your body (also known as your creatine stores). 

Most creatine studies examine the effects of creatine supplements (not dietary sources).

So, suppose you eat a standard diet — as defined by USDA Dietary Guidelines — you might expect to get 1-2g of creatine per day without supplementing.²⁶

Your muscle creatine stores might be 60–80% full in this case.²⁶

By supplementing, it may be possible to bring your body's stores to 100% and experience a range of associated benefits.²⁶

There are many types of creatine on the supplement market. A few examples include:

  • Creatine monohydrate

  • Creatine ethyl-ester

  • Micronized creatine

  • Creatine kre-alkalyn

Most studies feature creatine monohydrate. It’s also the least expensive form of creatine. Some other types of creatine are marketed as having features and benefits like better absorption, enhanced performance results, or fewer side effects. However, there is a lack of consistent evidence, and, in some cases, a lack of human studies.²⁷

The International Society of Sports Nutrition recommends taking creatine in the creatine monohydrate form. 

The organization’s official statement says: “The most effective way to increase muscle creatine stores is to ingest 5g of creatine monohydrate (or approximately 0.3g/kg body weight) four times daily for 5–7 days.”²⁸

How to use creatine

Creatine comes in both powder and tablet forms.

The powder can be mixed with water or juice and taken before or after workouts. You can also take tablets orally with water. 

Stay well-hydrated while taking creatine. Take creatine supplements according to the manufacturer's recommended dosage range and do not exceed the suggested amount.  

Follow any instructions from your healthcare provider when supplementing with creatine.

Creatine loading vs. creatine maintenance 

Creatine loading

Creatine loading is the fastest way to up the body’s creatine stores. 

The goal in this instance would be to make creatine available in the body quickly, and then maintain its stores over time. This is reportedly the fastest way to attain benefits. 

This approach is also in line with recommendations from The International Society of Sports Nutrition: 

​​“The most effective way to increase muscle creatine stores is to ingest 5g of creatine monohydrate (or approximately 0.3g/kg body weight) four times daily for 5–7 days.”²⁹

Creatine loading involves the following two steps:

  1. Take 20–25g of creatine (split into 4–5 equal doses) for 5-7 days.³⁰

  2. Take 3–6g per day (at a rate of 14mg/lb or 30 mg/kg of bodyweight) to maintain creatine stores. 

Creatine maintenance

Creatine can also be consumed without a loading phase. 

In this case, you would simply take a maintenance dose of 3–6g per day. 

This method is still effective, but achieving results may take closer to a month.³¹

What are the risks?

Creatine is generally considered safe as long as you follow recommended guidelines for using it.

While supplements are not reviewed by the FDA, the ingredients within supplements — including creatine — are reviewed for safety. 

The International Society of Sports Nutrition (ISSN) regards creatine supplements as safe. They have not found any evidence of short or long-term use having harmful effects.³²

The ISSN’s official position on creatine is as follows:

“These studies show that short and long-term supplementation (up to 30g per day for 5 years) is safe and well-tolerated in healthy individuals and in a number of patient populations ranging from infants to the elderly. Moreover, significant health benefits may be provided by ensuring habitual low dietary creatine ingestion throughout the lifespan.”³³

Side effects associated with creatine

Digestive

Digestive complaints such as diarrhea have been reported in otherwise healthy people, but usually when taking high doses of creatine, which suggests these side effects are dose-dependent.³

Kidneys/liver function

The risk of liver and kidney dysfunction is possible if very large amounts of creatine are consumed. If you have kidney disease, high blood pressure, consume alcohol, or have liver disease speak with your doctor before taking creatine.

Weight gain

Some weight gain from increased muscle mass or fluid retention is possible.

Possible food or medication interactions

Creatine may also interact with some food and drugs, including:

  • NSAIDs Over-the-counter pain medications including ibuprofen, and naproxen may be unsuitable while using creatine.³⁵

  • Water pills Diuretics may increase the risk of dehydration and kidney damage while supplementing with creatine.³⁵

  • Gout medications Probenecid, a medicine for treating gout, can also increase the risk of kidney damage while taking creatine.³⁵

As with all manufactured supplements, there’s a risk of contamination, which makes it essential to get all supplements from a trusted source. 

Can you take too much creatine?

When consuming supplements it’s always best to opt for moderation in hopes of avoiding the risk of side effects. Taking more than the recommended amount of creatine can cause kidney damage.³⁶

When to avoid creatine

It’s important to speak to your doctor first if you have any underlying health conditions.

Do not take creatine if you:

  • Are under the age of 18 

  • Pregnant or breastfeeding

  • Live with diabetes

  • Have kidney or liver disease

(There may be other contraindications not listed here, which is why it's worth talking to your doctor before taking any supplement).

The lowdown

Regardless of whether you’re a professional athlete or just looking to boost your performance and strength, supplementing with creatine may be a simple way to better your results. 

In some research studies, creatine shows positive effects on muscle, athleticism, and brain health. 

There are early but promising studies that suggest women, as well as men, can benefit from the use of creatine supplements. Creatine monohydrate is the most commonly studied form of supplement and it also tends to be the most cost-effective. You should always consult your doctor before taking supplements if you have any underlying health conditions or concerns. Supplements aren’t meant to replace eating a healthy, balanced diet.

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing health care professional(s).

Have feedback? Email content@healthmatch.io.

Sources:
  1. Creatine | Sports Med Today

  2. Clinical pharmacology of the dietary supplement creatine monohydrate (2001)

  3. Creatine | NIH: PubChem

  4. Overview of creatine metabolism (2008)

  5. Athletes taking a powder creatine: Though the focus has shifted to another substance, this supplement is more widespread -- but still a question mark. | The Baltimore Sun

  6. The prohibited list | World Anti-Doping Agency

  7. Muscle fatigue: General understanding and treatment (2017)

  8. 20 foods high in creatine: Natural sources of creatine for bodybuilding | Best for Nutrition

  9. Extrahepatic creatine synthesis in the rat. Role of the pancreas and kidney (1967)

  10. Creatine use in sports (2018)

  11. Creatinine clearance (2022)

  12. Creatine | Examine

  13. Creatine supplementation in women's health: A lifespan perspective (2021)

  14. Effects of creatine supplementation on performance and training adaptations (2003)

  15. Creatine supplementation during resistance training in college football athletes (2001)

  16. Low-dose creatine combined with protein during resistance training in older men (2008)

  17. Effectiveness of creatine supplementation on aging muscle and bone: Focus on falls prevention and inflammation (2019)

  18. Effect of ten weeks of creatine monohydrate plus HMB supplementation on athletic performance tests in elite male endurance athletes (2020)

  19. Effects of creatine supplementation on athletic performance in soccer players: A systematic review and meta-analysis (2019)

  20. Risk of adverse outcomes in females taking oral creatine monohydrate: A systematic review and meta-analysis (2020)

  21. Multinuclear magnetic resonance spectroscopy of high-energy phosphate metabolites in human brain following oral supplementation of creatine-monohydrate (2003)

  22. Dietary creatine intake and depression risk among U.S. adults (2020)

  23. Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation (2002)

  24. Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials (2019)

  25. Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials (2018)

  26. International society of sports nutrition position stand: creatine supplementation and exercise (NIH: 2007)

  27. pH-dependent stability of creatine ethyl Ester: Relevance to oral absorption (2015)

  28. International society of sports nutrition position stand: creatine supplementation and exercise (BMC: 2007)

  29. International society of sports nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine (2017)

  30. Creatine supplementation with specific view to exercise/sports performance: an update (2012)

  31. Timing, optimal dose and intake duration of dietary supplements with evidence-based use in sports nutrition (2016)

  32. International society of sports nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine (NIH: 2017)

  33. International society of sports nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine (BMC: 2017)

  34. Gastrointestinal distress after creatine supplementation in athletes: Are side effects dose dependent? (2008)

  35. Possible interactions with: Creatine | St. Lukes Hospital

  36. Creatine | Drugs.com

Chloe Garnham is a writer exploring a broad range of topics, including healthcare, education, and technology.

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