Understanding the Creatine Craze
I remember the craze in the gym vividly. It was the early 1990s and my new career as one of New Zealand’s first personal trainers for the Les Mills group was getting underway. Having left nursing behind, I had retrained with a degree in physical education – a degree which, at that time, offered very few studies on sport and exercise supplementation.
That’s because, despite sports nutrition emerging in the 1960s, hardly anyone took supplements for their exercise or exercise recovery, especially creatine phosphate.
We just ate real food instead – especially meat, poultry and fish – all of which are a rich source of creatine.
What I didn’t realise however, was how rapidly the sport and exercise supplement market was changing. And it played out right in front of me at New Zealand’s largest gym at the time – Les Mills in Auckland, as I grew the personal training team there. Supplements became the norm, not just for athletes and body-builders, but for clients as well.
As sport and exercise became big business, so has the advances in sports nutrition and supplementation. Advances in laboratory technology and exercise science studies have revolutionized the understanding of athletic performance, muscle metabolism, and exercise physiology.
But this understanding didn’t only arrive with sports nutrition, it arrived advancements in laboratry technology and the groundbreaking investigation of muscle physiology by Dr. Jonas Bergström, and the evolution of muscle biopsies.
This is also where Professor Roger Harris comes in. Because of the muscle biopsy techniques, he was able to publish a highly influential paper on muscle metabolism and the turnover of the primary energy molecule, Adenosine Triphosphate (ATP) and Phosphocreatine (PCr) in human muscles, at rest and in recovery from intense exercise.
So began an academic and practical interest in creatine and whether, by manipulating muscle creatine content, you could enhance athlete performance. The answer was ‘yes’ and this was backed by performances with some members of the British Olympic Athletic Team (sprinters and hurdlers) at the Barcelona Olympics.
Oral creatine supplementation helped athlete performance and this breakthrough in sports nutrition sparked widespread interest in ergogenic aids. [Stout et al., 2025]
That interest continues today, but this time, creatine supplement companies are interested in the marketing of it to midlife women transitioning through menopause.
But before jumping on this marketing bonanza, we must understand ‘why’. Because, creatine supplementation is not for everyone, yet, like many menopause-related supplements, its marketed as a panacea for preventing sarcopenia (muscle wasting), preventing osteoporosis, increasing strength and for helping with brain health too.
An Introduction to Creatine Phosphate
One of my messages for all Health Professionals who join one of the MyMT™ Certified Courses, is that a critical analysis is required about messages that take a ‘one-size-fits-all’ approach to lifestyle solutions for women during their menopause transition.
Today, in an evolving narrative about the role of strength training in the menopause and post-menopause transition, this includes better understanding the various supplements that are marketed to midlife and older women. This includes creatine phosphate (Phosphocreatine, PCr) and whether it is a supplement that may be suited to your clients or not.
The highest creatine (Cr) concentrations are found in skeletal muscle and the brain. Other cells using up a lot of energy also have high Cr levels. This includes cardiac cells, liver cells, kidney cells, inner ear cells, sperm cells and photo-receptor cells in the eyes.
So, yes, creatine is an important substrate for human health and metabolism.
But here’s the thing – your body makes Creatine naturally too.
Meat, poultry and fish provide the richest source of creatine (around 4-5 grams per kg of food). The body makes this creatine in the kidneys, liver and pancreas from certain amino acids (proteins). These are:
- Arginine (peanuts are a rich source of arginine too),
- Glycine (a foundational protein in collagen, so is found in bone-broth)
- Methionine (high levels are found in tuna, salmon, fish, cheese and brazil nuts).
These amino acids reach target tissues through the bloodstream, and enter tissues, especially muscle tissue, through a sodium and chloride dependent creatine transporter. [Smith-Ryan et al., 2021].
Creatine Supplementation
Creatine supplementation has emerged through the sports and fitness nutrition and supplementation research. Creatine Monohydrate (CrH2O) comes a powder, tablet, capsule and stabilised liquid. Studies on creatine monohydrate suggest that after 2 weeks, it can increase intramuscular concentrations of creatine by around 30%.
This is why creatine supplementation is known as offering an ergogenic aid to performance.
The term ‘ergogenic aid’ is important to consider, because by definition, this term refers to ‘the application of a nutritional, physical, mechanical, psychological, or pharmacological procedure or aid to improve physical work capacity or athletic performance‘. (McArdle, Katch & Katch, 2023).
As I’ve mentioned to sport science students for years, the role of creatine phosphate, is to accelerate ATP (adenosine triphosphate) turnover within skeletal muscles to maintain power output during short-term muscular effort. It helps to delay muscle fatigue when working out. It is crucial for cellular energy production.
Studies on athletes reveal that when creatine phosphate is taken as a supplement, it is most effective for high-intensity, short duration activities or repeated bouts of high-intensity exercise with short rest periods such as jumping, sprinting, and resistance training (Smith-Ryan et al., 2021).
The interest in Phospho-creatine supplementation, has therefore, been focused on three main benefits:
(1) Improvements in muscular strength and power activities.
(2) To faciliate and promote short bursts of muscular endurance.
(3) To provide greater muscular overload to enhance training effectiveness.
Of note to Practitioners, is that these benefits were seen in athletes, not women in their menopause transition, who weren’t undertaking strength exercise.
It’s no surprise that with the growth in interest about heavy resistance training for women, that there has also been increasing interest in the role of creatine phosphate for this demographic too.
Heavy resistance training breaks down skeletal muscle fibres and this can lead to the enzyme called Creatine Kinase, leaking into the blood-stream. The same thing is seen in people with damage to heart and brain tissues.
A spike in blood Creatine Kinase levels usually indicates tissue stress or injury – which is why, when women undertake resistance training, creatine as a supplement has become popular for women during menopause. However, this assumes a belief that:
- All midlife women are training at intensity (they aren’t).
- All women are experiencing a decline in creatine in their muscles, brain and heart – but are they really, especially if they are already on HRT (hormone replacement therapy)?
Creatine supplementation studies have mainly been undertaken on perimenopausal females and yes, studies show that it can be effective for improving strength and exercise performance, especially high-intensity, short duration activities or repeated bouts of high-intensity exercise with short rest periods, such as interval training. [Smith-Ryan et al., 2021].
For post-menopausal women losing muscle density, it may also be effective, but comparisons can’t be made between studies on male and female athletes and younger women in perimenopause, because oestrogen production differs in older women. During perimenopause, women are still producing some oestrogen, although levels are starting to decline. This is very different from post-menopausal women.
I mention this, because both oestrogen and phosphocreatine play foundational but distinct roles in musculoskeletal cells. Oestrogen acts as a master regulator and protectant for muscle mass, tissue repair, and mitochondrial health, while phosphocreatine acts as an immediate fuel reserve necessary for muscle contraction and intracellular energy transport. [Chidi-Ogbolu et al., 2019].
In my view, if women in post-menopause are going to take creatine supplementation, then do they also need to be on HRT? It’s a question for all women to consider.
Creatine supplementation is not without problems either. And this is another concern I have. Studies show that gastrointestinal tract disturbances (nausea, indigestion and difficulty absorbing food) may occur. Normal changes to the gastrointestinal tract during and after menopause, may make women more vulnerable to some of these side-effects of synthetic creatine supplements.
Afterall, creatine supplements are man-made, which makes them an ultra-processed food. Creatine supplements are produced synthetically in specialized manufacturing facilities. Two primary raw materials are used as the precursors to creatine – sodium sarcosinate and cyanamide.
For some women therefore, with IBS or other bowel health changes, these compounds which make up the creatine supplement formula may contribute to worsening gut health, especially with the higher doses recommended for athletes. This is because the osmotic properties of creatine draw water into cells, causing digestive side-effects for some women.
So, is creatine for your clients?
Well, like most supplements, the answer is, ‘it depends’!
Gut tolerance, exercise type and amount (they need to be undertaking resistance training to get the effectiveness of creatine) as well as the financial cost of supplementation and whether women have a healthy liver, kidneys and pancreas, in order to process and store excess creatine, are all important considerations.
As is whether or not, the creatine impacts their weight gain, bloating and muscle mass or not. Especially if, like Angela, a Nutritionist from Australia, they are also on a very high protein diet already.
References:
Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2019 Jan 15;9:1834. doi: 10.3389/fphys.2018.01834. PMID: 30697162; PMCID: PMC6341375.
Critchlow AJ, Hiam D, Williams R, Scott D, Lamon S. The role of estrogen in female skeletal muscle aging: A systematic review. Maturitas. 2023 Dec;178:107844. doi: 10.1016/j.maturitas.2023.107844. Epub 2023 Sep 7. PMID: 37716136.
Kerksick C, Gonzalez D, Stout J, Forbes S, Candow D, Ziegenfuss T, Marshall R, Schwesig R, Kreider R. The emerging and evolving evidence supporting creatine as an ergogenic aid: history and applications. J Int Soc Sports Nutr. 2026 Dec 31;23(1):2646627. doi: 10.1080/15502783.2026.2646627. Epub 2026 Mar 23. PMID: 41870601; PMCID: PMC13011109.
McArdle, W., Katch, F., & Katch, V. (9th Ed. 2023). (Eds). Exercise Physiology. Nutrition, Energy and Human Performance, Chap. 23, Special Aids to Exercise Training and Performance. Lippincott, Williams & Wilkins Publ., PA, USA
Stout JR, Kreider RB, Candow DG, Forbes SC, Rawson ES, Antonio B, Antonio J. The birth of modern sports nutrition: tracing the path from muscle biopsies to creatine supplementation-A narrative review. J Int Soc Sports Nutr. 2025 Sep;22(sup1):2463373. doi: 10.1080/15502783.2025.2463373. Epub 2025 Feb 18. PMID: 39964101; PMCID: PMC11837910.
