How creatine could benefit women’s health

At the Creatine Conference in Munich in March, pioneers in creatine research demonstrated a wealth of evidence, explaining its potential uses for bone health, cognition, sleep and mental health.

These benefits are crucial for many aspects of female health, according to Dr. Darren Candow, a sports science expert and professor at the University of Regina in Canada.

“There are substantial benefits to females across the lifespan,” he told NutraIngredients. “Creatine, primarily when combined with exercise training, has been shown to increase lean body mass, muscle size, strength, endurance, power, functionality, decrease bone mineral loss and preserve bone strength, reduce fat mass and increase cognitive abilities.”

However, women are significantly less likely to take creatine than men, with global data from Lumina Intelligence showing that just 36% of creatine consumers are women. Dr. Abbie Smith-Ryan, a sports nutrition expert and professor at the University of North Carolina, says this is partly due to the misconceptions surrounding the supplement.

“One of the main barriers is that creatine started in bodybuilding—it’s still very much seen as a bodybuilding supplement and a lot of women are afraid of getting bulky,” she told NutraIngredients. “Even now a lot of the marketing and where creatine is found is in these really male-centric products.”

“It’s important to note that the evidence for weight gain is mainly in men taking a loading dose,” she added. “For the last 20 years, we haven’t seen this in women. This could be related to baseline creatine stores or the amount of baseline muscle, but in general, women do not see a weight gain with creatine.”

Creatine during menopause

Speaking at the conference, Dr. Smith-Ryan said middle-aged women have one of the lowest consumptions of dietary creatine.

However, even fewer women within this age bracket take creatine supplements, with the same data from Lumina Intelligence showing that just 5% of European women between the ages of 45 and 54 take creatine supplements and women between the age of 55 and 64 reporting creatine use.

There is also a significant void in research on creatine among this female population, particularly among women in perimenopause.

“There’s a lot of good data on creatine after menopause, but it’s really that transition to menopause when women begin to struggle with sleep, bone health, muscle loss, joint pain, fatigue, brain fog and even inflammation,” Dr. Smith-Ryan said.

Creatine has been shown to target many of these key menopause symptoms, with a review by Dr. Smith-Ryan and colleagues showing that creatine supplementation among pre-menopausal women can be effective for improving strength and exercise performance, as well as boosting mood and cognition, possibly by restoring brain energy levels and homeostasis.

Another study conducted by Dr. Candow and colleagues showed that creatine has favorable effects on bone health when combined with resistance training. The two-year, placebo-controlled study, which included 237 post-menopausal women, found improvements in bone geometry in the creatine group compared to placebo.

Taken together, the findings suggest creatine can be a beneficial supplement for women in peri- and post-menopause, but Dr. Smith-Ryan warns that it is not a panacea.

“Will creatine fix all [menopause symptoms]? No, but it can be really helpful in many indirect ways—for example, by reducing fatigue, which gives you the motivation to exercise, which then benefits your muscles and bones,” she said.

Creatine and pregnancy

Creatine has also shown promise during pregnancy, with research suggesting that maternal creatine supplementation could improve fetal outcomes, particularly in cases of hypoxic events.

At the conference, Dr. Stacey Ellery, a research fellow at the Hudson Institute of Medical Research, discussed a number of studies which indicate these potential benefits.

While there are currently no randomized controlled trials on creatine supplementation in pregnant women, some small-scale studies and preclinical research has been conducted. Pre-clinical data in rodent models shows promising outcomes during hypoxic events, not only in the survival of the offspring but also across multiple organs.

“More of the babies survived when the mums were given a creatine supplement, and we also saw some benefits for the brain, kidneys, diaphragm and skeletal muscles,” Dr. Ellery told NutraIngredients.

In sheep, creatine supplementation reduced the production of reactive oxygen species (ROS) in the brain and reduced the total number and burden of electrographic seizures in the 72 hours following a hypoxic insult.

A population study using NHANES data also found that maternal creatine concentrations were positively associated with newborn head circumference, suggesting its potential role in neurodevelopment.

Dr. Ellery says more researchers are also beginning to ask about whether creatine supplementation could aid in postpartum recovery, pelvic organ prolapse and changes in the muscle.

“Your muscles, particularly the pelvic floor, get put under a lot of strain and stress during pregnancy and can be damaged during the labor process, either through a cesarean section or through a traumatic birth injury,” she said.

“Creatine promotes a fundamental cellular process, and those cellular processes are heightened through pregnancy because you’ve got a lot of tissue growth, you’ve got a lot of changes in the dynamics of energy, both in growing a whole new organ in the placenta and a whole new person in the fetus,” she added. “And then there’s the energy expenditure associated with actually having the baby, so it’s important to educate people on those elements of where creatine could be helpful.”

She also highlighted that while there are no specific recommendations for creatine supplementation in pregnant women, there is no evidence to suggest it is unsafe for the mother or baby.

“The evidence that we’ve got suggests that the pregnant body responds the same way to a creatine supplement as the non-pregnant body,” she said. “So if you’re taking 5 grams of creatine a day and you want to keep doing that, our data suggests that you can, but it’s a personal choice for women.”

Creatine use in adolescence

Creatine has also been shown to have benefits in the younger female population, particularly throughout the menstrual cycle.

Speaking at the conference, Ann Brown, associate professor at the University of Idaho, said early-to-middle adolescence is a period of significant divergence in development between females and males, which has made it more difficult to conduct accurate research in this female population.

Dr. Brown and her team therefore set out to investigate creatine supplementation in adolescent women, taking into account hormonal changes due to the menstrual cycle and oral contraception.

The study found that creatine supplementation (5 g/day) combined with resistance training (twice a week) led to an added hour of sleep on workout days compared to a placebo group.

Another study demonstrated that creatine supplementation during the luteal phase increased total body water, with a greater increase in intracellular fluid, suggesting a shift of fluid into the cells.

“Creatine, specifically monohydrate, carries a water molecule, so it brings water into the cell which is really valuable in preventing dehydration and stimulating muscle protein synthesis when taken alongside weight training,” Dr. Smith-Ryan said.

The study also found no change in body weight with creatine supplementation when controlling for the menstrual cycle, but a “pretty good increase in lean mass and a slight decrease in fat mass” compared to placebo, she added..

This indicates potential benefits even with lower doses and suggests weight gain should not be of concern for women considering creatine supplements.

The importance of education

Despite how far the scientific literature has come, the researchers who attended the conference said more research is needed on creatine consumption in women to account for the vast hormonal changes women undergo throughout the lifecycle.

“Researchers need to include more women,” said Dr. Smith-Ryan. “At a minimum, [they should] start to characterize the hormonal landscape, even if it’s through a questionnaire as this can be really valuable. Midlife is an optimal target, as there is such little data in this area.”

It is clear that education on creatine is also needed, with the same data from Lumina Intelligence showing that 40% of the general population do not know the benefits this supplement brings.

Dr. Smith-Ryan says creatine brands should therefore teach their customers about the wide variety of potential benefits, particularly when targeting women, rather than simply altering the appearance of their products.

“Education is so important. Women want to know the benefits, yet most brands just put a female on the label or change the color of the packaging,” she said. “They want to see the data—this can be really valuable and arming for consumers.”