Creatine supplements have long been used by bodybuilders and elite athletes to enhance muscle mass and improve athletic performance. Now it’s increasingly being touted for its potential to help middle aged women and men combat muscle loss, and possibly even improve memory and mood.

But is the growing buzz about creatine based on scientific evidence?

“There’s a lot of emphasis today on maintaining muscle health in midlife, which is why creatine has become so popular,” says Dr. Rekha Kumar, an endocrinologist at NewYork-Presbyterian/ Weill Cornell Medical Center. “Muscles are a longevity organ — they protect against falls and pain and help improve metabolism and bone health. So, we want to have all the tools to optimize muscle mass and function, and creatine is one of those tools.”

The potential benefits may also go beyond just increasing muscles, says Dr Kumar. Some research is emerging that creatine could also help control blood sugar among people with type 2 diabetes, recovery from concussions, and improve brain function.

To learn more about the potential benefits and risks of taking creatine, Health Matters spoke to Dr. Kumar.

What is creatine?

Creatine is a compound produced by the liver, kidneys and pancreas, but we can also get it from foods like red meat and fish. It is stored primarily in our muscles and helps generate adenosine triphosphate (ATP), a compound which is a source of energy for the body. When you work out, your muscles burn through energy, so if you supplement creatine, it will create more energy in your cells that you would have burned through, and the extra creatine stores will optimize your strength training and help you build more muscle mass.

Who should take creatine?

Creatine only helps when it’s combined with strength training, so the people who benefit the most from it are:

• Strength and power athletes
• Recreational gym goers
• Older adults
• Perimenopausal and menopausal women
• Vegetarians and vegans (because they have lower baseline stores of creatine)

Is creatine a steroid?

Creatine doesn’t automatically make your muscles grow like steroids; that’s an important distinction. People who don’t touch a weight or exercise will not benefit from taking a creatine supplement.

What does creatine do for women?

It’s really important for women in midlife to prevent muscle loss and keep their bone density up. Women reach peak bone and muscle mass in their 20s; by age 30, they start to lose muscle mass; and beginning at age 40, women lose potentially 3% of muscle mass per year.

So women in their 30s should start incorporating resistance and strength training at least two times a week. And then you can optimize the training by adding creatine.

What are the health benefits of creatine?

The known benefits include:

• Increased strength
• Improved muscle growth
• Faster recovery

Taking creatine combined with strength training will also improve longevity. When you have muscle, it prevents frailty and fractures, and it optimizes your blood sugar metabolism. People don’t realize that one of the ways to prevent diabetes is to have lots of muscle, because muscle uses sugar when it’s active.

Is there a cognitive benefit to creatine?

Research is still emerging on possible cognitive benefits, including mental fatigue, short-term memory and stress resilience. The biology is plausible, and the early data is intriguing — particularly for memory and metabolic stress. But the evidence base remains small, heterogeneous, and not sufficient to definitively support that there is a cognitive benefit. The critical next step must be large, randomized controlled clinical trials.

When is a good time to take creatine?

It doesn’t matter too much. Consistency is key, so take it daily and anytime that’s easy to remember. Post-workout with a meal may also help with any gastrointestinal issues.

Are there side effects from taking creatine?

Creatine supplements have been used for a long time; they are well studied and safe. Some people have gastrointestinal discomfort when they start taking creatine, and that’s why we advise taking it with a meal or mixing it into a shake.

How much creatine should I take? Is the amount different for men and women?

The recommended dose is three to five grams a day for men and women. Strict bodybuilders might take 20 grams per day for five to seven days as part of the loading phase.

Does creatine cause hair loss?

No. If someone is experiencing hair loss, it would be for other reasons.

Does creatine make you gain weight?

Creatine does not make you gain fat, but it will make you retain a little water in your muscles initially. So, you might see the scale go up a little, but that’s not gaining fat — it’s just water retention inside your muscle.

How long does creatine take to work?

If you work out and take the creatine regularly, you can see better muscle recovery within a couple weeks. It’s noticeable.

Who should not take creatine?

People with reduced kidney function or kidney failure should not take creatine or speak to a doctor before they do because creatine is excreted through the kidneys. Creatine is also not recommended during pregnancy.

Where should I buy creatine? How do I know which brand to choose?

The powder form is better than gummies because you can measure the exact amount to take. In terms of brands, look for a label on the bottle to verify third-party testing on the powder, and research the company to see if they make other supplements and have good manufacturing practices. The Food and Drug Administration also has a database of potentially dangerous ingredients found on labels of common dietary supplements.

What should people who are considering taking creatine keep in mind?

Creatine doesn’t replace foundational behaviors for people who are trying to get optimal metabolic health, especially in midlife. So, I would first spend time on things like exercise, nutrition, sleep, and stress management — all of these should come before creatine.