A practical guide to one of nutrition’s most researched — and most misunderstood — supplements.
Guest post by Dane Baker, Performance Dietitian, Axis Sports Medicine
If you’ve spent any time on social media lately, you’ll have noticed creatine is having a moment. Once the domain of rugby players and bodybuilders, it’s now being recommended for everything from menopause to memory, bone density to depression. As a Performance Dietitian who has spent years trying to convince elite athletes to take creatine — only to now field questions about it from people of all ages and walks of life — the shift is genuinely exciting. But with that excitement comes a need for context. So let’s look at what creatine actually is, what the science says, and where we still have a lot to learn.
What Is Creatine?
Creatine is a naturally occurring compound your body produces — primarily in the liver, kidneys, and pancreas — and that you also get from food, with red meat and fish being the richest sources. In muscle tissue, creatine is stored as phosphocreatine, a high-energy molecule that acts as a rapid reserve for regenerating ATP — the fuel your muscles run on. During intense effort, phosphocreatine releases stored energy to restore ATP almost instantly; at rest, the system quietly recharges. What makes supplementation worthwhile is that most people operate well below their full muscle creatine stores through diet and natural production alone — supplementation allows those stores to be topped up more completely, and it’s this expanded reserve that underpins the performance and health benefits.
What we learned in the early 1990s is that we can meaningfully manipulate these creatine stores through supplementation. When we do, the research consistently shows small but significant improvements in strength, power, and performance across sports that rely on short, high-intensity efforts — sprinting, weightlifting, team sport. Since that early work, the research lens has widened considerably. We now have emerging evidence for creatine’s role in brain metabolism and cognitive function, bone health, mood, and metabolic health — areas that are generating considerable interest, particularly for women.
Common Misconceptions
Over the years, a number of myths have followed creatine around — some born of poor science, others from early misuse.
Does it cause cramping? This claim was prominent in the mid-1990s and has since been thoroughly investigated. The research does not support a link between creatine supplementation and increased muscle cramping or injury risk.
Will it make you retain water? This one has a grain of truth, but context matters. For every creatine molecule stored in muscle, approximately three water molecules are drawn in alongside it — this is an osmotic process. In practice, this may translate to somewhere between 0.5 and 2 kg of additional body water, and it varies meaningfully between individuals because creatine storage capacity differs from person to person. What this is not is the dramatic fluid retention that early high-dose users reported in the 1990s — those athletes were often consuming far more than necessary.
Will it give you significant muscle mass or cognitive gains on its own? This is where social media tends to get ahead of the science. Creatine is not a shortcut to lean muscle — consistent, progressive resistance training is. Similarly, while there are promising early signals for cognitive function, creatine won’t compensate for poor sleep, chronic stress, or a diet that isn’t supporting your brain. It may play a small supporting role; it won’t be a magic bullet.
Who Is It For? More People Than You Might Think
The perception that creatine is only relevant for performance athletes is understandable — the first four decades of research were heavily focused on sport. But creatine is a compound that influences multiple systems in the body, and we are increasingly understanding its relevance well beyond the gym.
The good news is that we have over 40 years of research, and that includes an excellent long-term safety record. Studies have followed participants taking creatine supplementation for up to five years without adverse effects on kidney or liver function. For a supplement, that level of safety data is relatively rare, and it provides confidence in recommending it across a broader population — including older adults, women at various life stages, and those who may not be training competitively but want to support their health.
Getting the Dose and Form Right
Not all creatine is created equal — and this matters more than many people realise.
Creatine monohydrate is the form used in over 90% of the research. It is the most bioavailable, most studied, and most cost-effective option available. When you see creatine gummies, flavoured powders with exotic branding, or “enhanced bioavailability” formulas at a premium price, it is worth asking whether the clinical evidence supports the form being sold — in most cases, it does not.
Dosing matters to reach meaningful levels in muscle tissue. The two established approaches are a loading protocol (typically around 20g per day split across four doses for five days, followed by a maintenance dose of 3–5g daily) or a slower approach of 3–5g daily from the outset, which achieves the same saturation over three to four weeks. For most general health applications, the slow-load approach is practical and well-tolerated. There is no strong evidence that creatine needs to be taken with specific foods or electrolytes, though some research suggests post-exercise timing alongside carbohydrate and protein may be modestly beneficial.
Creatine and Women’s Health: Promising but Proportionate
This is arguably the area generating the most interest right now — and rightly so, because the female-specific research, while still developing, is genuinely encouraging.
Women naturally consume less creatine through diet than men and, due to differences in muscle mass, store less total creatine — making supplementation potentially meaningful. Hormonal transitions across a woman’s life — including the menstrual cycle, pregnancy, and menopause — appear to influence how creatine is synthesised and stored in the body, which adds another layer of relevance.
In the context of menopause specifically, the conversation often centres on muscle and bone loss. It is worth being precise here: the relationship between oestrogen decline and muscle loss is real but not as straightforward as it is sometimes portrayed. A significant contributing factor is a reduction in mechanical loading — many women simply move less, lift less, and place less demand on their musculoskeletal system as they age. This is a modifiable factor, and it is the most important one. Creatine may help support the quality and intensity of resistance training sessions, which in turn drives the adaptations that matter — but the training itself remains the primary driver. Creatine is the amplifier, not the signal.
Research from Chilibeck and colleagues in post-menopausal women found that creatine supplementation combined with resistance training helped preserve hip geometry — a meaningful marker of fracture risk — even when bone mineral density on DXA scanning did not change significantly. There are also early signals for benefit in mood and cognitive function in peri-menopausal women. These findings are promising, but the studies are relatively small and longer-term trials are still needed.
One important note: if medical management of menopause is appropriate for you — including hormone replacement therapy — creatine is not a substitute. It is a potential adjunct that may complement a broader strategy involving adequate protein, calcium and vitamin D, consistent resistance training, and appropriate medical support. That conversation belongs with your specialist.
Keeping It in Context
The supplement industry moves fast, and social media faster still. Creatine is genuinely one of the most studied, safest, and most affordable supplements available — and the emerging evidence suggests its benefits may extend well beyond sport performance. But “promising early evidence” in areas like bone health, cognitive function, and menopause is not the same as established clinical benefit. Many of the key studies in these areas are yet to be done, and we should be honest about that.
What we can say with confidence is this: creatine monohydrate, taken at an appropriate dose, is safe for long-term use, unlikely to cause harm, and may provide a meaningful additive benefit when used alongside the fundamentals — consistent resistance training, adequate protein and energy intake, good sleep, and appropriate medical care. That is a genuinely positive picture, and it is built on four decades of solid science rather than a social media trend.
References
Kreider RB et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition. 2017.
Rawson ES, Venezia AC. Use of creatine in the elderly and evidence for effects on cognitive function in young and old. Amino Acids. 2011.
Candow DG et al. Heads Up for Creatine Supplementation and its Potential Applications for Brain Health and Function. Sports Medicine. 2023.
Chilibeck PD et al. Effect of creatine supplementation during resistance training on bone mineral density in older women. Medicine & Science in Sports & Exercise. 2015.
Smith-Ryan AE et al. Creatine Supplementation in Women’s Health: A Lifespan Perspective. Nutrients. 2021.
Forbes SC, Candow DG et al. Effects of creatine supplementation on properties of muscle, bone, and brain function in older adults. Journal of Clinical Medicine. 2022.
Gualano B et al. Creatine supplementation in the aging population: effects on skeletal muscle, bone and brain. Amino Acids. 2016.
About Dane Baker
Dane Baker is a New Zealand Registered Dietitian and Performance Dietitian with expertise in body composition, metabolic health, and sustainable nutrition strategies across different stages of life.
Alongside his work with high-performing athletes, Dane also works with everyday people looking to improve their energy, relationship with food, strength, confidence, and long-term health. He has particular experience supporting women navigating midlife body composition changes, including challenges with muscle loss, changing metabolism, appetite regulation, exercise fuelling, and sustainable weight management during the menopausal transition.
Dane’s approach focuses on evidence-based, practical nutrition strategies that support health, strength, and resilience.
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