Clarity on Creatine Monohydrate: is it worth the hype?

Dearest Reader, 

I have put it off long enough as I get asked about this about 8 times a day these days, so here it is: my assessment of the research; a concise, evidence-based perspective. I don’t embrace wellness trends with a knee jerk reaction in general, but especially with supplements because let’s be honest, none of us need more to add to our list.

For the purposes of this missive, I am focused entirely on the research as it pertains to perimenopausal and postmenopausal women. From perimenopause onward, we must be aware that maintaining muscle, bone, and brain health becomes increasingly important and yes, there are decent studies on this population and creatine in terms of how it can positively impact these areas of our health.

What is Creatine Monohydrate?

Creatine is a naturally occurring compound found in small amounts in foods like meat and fish. It plays a vital role in energy production and cellular function. As we age, our body's creatine stores decline, making supplementation particularly beneficial. It is a fact that we have less creatine production post menopausally which surely is what prompted the research.

Benefits of Creatine Monohydrate for Postmenopausal Women

1. Muscle Health

• Preserving Muscle Mass: Menopause leads to sarcopenia (age-related muscle loss). Creatine supplementation, when paired with resistance training and taken consistently, can help maintain and even increase muscle mass and strength.
• Improved Physical Performance: Studies show that creatine enhances the benefits of exercise, making it easier to stay active and strong as you age[1][2][3].

2. Bone Health

• While creatine alone may not significantly increase bone mineral density, it has been shown to improve bone geometric properties (e.g., femoral neck strength) when combined with resistance training and taken consistently[4][5].
• Preventing Bone Loss: Creatine may help counteract the effects of declining estrogen on bone health by supporting exercise-induced bone remodeling [2].

3. Brain Health

• Cognitive Function: Creatine supplementation has been linked to improved memory and cognitive processing. It may also restore brain energy levels, which can decline with age[1][3].
• Mood and Depression: Some evidence suggests creatine can enhance the effectiveness of antidepressants and improve mood by supporting brain bioenergetics[1][3]. There is also evidence that it can help you fell better, faster if on an SSRI (anti depressant). There are no studies yet using it as a stand alone therapy*.

How Much Creatine Should You Take?

3–5 grams daily, which is safe and effective for most women. For real improvements in bone density we are looking for higher doses (up to 0.14 g/kg/day) that may be more beneficial for improving bone-related outcomes when combined with resistance training[4][6]. Additionally, for those lifting weights/ resistance training and looking to more rapidly gain muscle, studies show that doing a loading dose of 20 grams daily for 5-7 days, then decreasing to 5 grams daily can improve lean muscle mass.

Given the data, who then might consider creatine supplementation?

• women experiencing muscle weakness or loss
• those engaging in regular resistance training (ie 3 times a week).
• women looking to support cognitive health
• women on an antidepressant
• those looking to combat age related depression (which is in part due to low brain energy)
• in terms of improving bone density, this will only help if you are definitely doing resistance training*

Safety and Side Effects

Creatine monohydrate is one of the most studied supplements and is considered safe for long-term use at recommended doses. It does not cause weight gain from fat but may lead to slight water retention in muscles—a sign that it’s working! The many myths out there have all been debunked, from kidney or liver damage, to weight gain, to hair loss, to it only being of use to body builders, to you must do a loading phase - all of it is not based in facts.

Incorporating Creatine into Your Routine

For best results:

1. Pair creatine supplementation with a consistent resistance training program.
2. Combine it with a balanced diet rich in protein and calcium.
3. Stay hydrated to maximize its benefits.
4. Work up to the dose you are going to stay at over a week..

Can We Get Creatine from Food Alone? 

Yes—but not always enough to make a clinical impact, especially post-menopausally when production declines.

Creatine is found naturally in food, particularly in animal products. For example, beef and game meats provide about 1–2 grams per 8 oz cooked, and some fish like herring or salmon offer up to 2.5 grams. Pork and chicken come in a little lower, closer to 0.4–1 gram per 8 oz. Even dairy sources like Parmesan and cheddar contain small amounts, as do eggs—but you’d have to consume them in fairly large quantities to match the doses used in research.

Top animal sources and dairy sources:

• Parmesan (highest): ~0.3–0.4 g per 3.5 oz
• Milk, cheddar, yogurt: ~0.1 g per serving
• Eggs: ~0.1 g each
• Beef, game meats: ~1–2 g per 8 oz
• Herring, salmon, tuna: up to ~2.5 g per 8 oz
• Pork, chicken: ~0.4–1 g per 8 oz

On the other hand, plant-based diets contain almost no direct creatine, which makes supplementation even more worth considering for vegetarians and vegans. That said, supporting your endogenous creatine production (the kind your body makes on its own) is still possible through amino acid-rich plant foods. 

Plant-based support for creatine synthesis (via glycine, arginine, and methionine):

• Pumpkin seeds, hemp seeds, sunflower seeds
• Soy products like tofu and tempeh
• Chickpeas, lentils, spinach, quinoa
• Almonds, Brazil nuts

If you're eating an omnivorous diet rich in high-quality protein, you may already be getting some baseline creatine from food. But remember—most clinical studies showing benefit used amounts far beyond what can realistically be consumed through diet alone.

To take...or not to take, Creatine Monohydrate?

Creatine monohydrate is worth considering, but as to whether you should take it? It really comes down to your unique health status and your priorities. When I strategize supplements for patients I individualize, prioritize and look for win/wins in an effort to keep it as simple. I want evidence and I want results and I don’t want to overwhelm patients. 

For products you want to stay with brands that are known for doing third party testing for purity. Quality Canadian brands are: Organika, Thrive Protein, Maple Life Nutrition, PVL and Canadian Protein. Quality American brands are: Thorne, Designs for Health, Metagenics. 

Go find a forest to take a long walk in, give yourself some solitude and find some spring shoots, a reminder that we always get to turn a new leaf. 🌳

Warm regards,

Dr Kirsten

References

1. https://creatineforhealth.com/creatine-and-womens-health/  

2. https://thepauselife.com/blogs/the-pause-blog/creatine-benefits-in-menopause 

3. https://pmc.ncbi.nlm.nih.gov/articles/PMC7998865/  

4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10487398/ 

5. https://pubmed.ncbi.nlm.nih.gov/37144634/

6. https://pubmed.ncbi.nlm.nih.gov/31257405/