Should you take creatine at all?

Philip Pape 0:00

Should you take creatine? Should you take it now that you're over 40? Should women take more of it than men? Today I'm reevaluating the claims and the primary creatine research. You'll learn about the numbers, what it does, what it doesn't do for things like your bone, your brain, and how much creatine you actually need. Welcome to Wits and Weights, the show that puts a popular piece of fitness advice under the microscope, finds the hidden reason it doesn't work, and gives you the deceptively simple fix that does. I'm your host, certified nutrition coach, Philip Pape, and today is all about creatine. And I actually like creatine, so it's always good to re-examine the numbers and the research behind it. I personally take creatine. I recommend it to almost every client we work with. It's recommended in our supplement builder when people, you know, plug in their information and their situation, and it's almost always recommended unless you have some exotic issue like an allergy, which is very rare. I don't have any affiliate deals with any creatine company or supplements, commission, none of that stuff either, which is helpful today because I'm not trying to push creatine, which is dirt cheap anyway, if you buy it from any reputable source. And this is also not a takedown of creatine, not at all. We're gonna evaluate the reasons that you've been given for taking it. And I find that a lot of those reasons pass the scrutiny. Some of them do not. So it's good to understand why. Then stick around to the end because I'm gonna give you a 30-second fix for the most common creatine problem there is. All right, so for today, we are gonna talk about various claims around creatine, where the numbers come from, because it's good to connect: hey, this is the research. Here's how people interpret the research, and maybe here's how we ultimately should interpret it. Second, what is being measured when we talk about creatine usage. And then third, the size of the effect in, especially women, older women over 40, versus what some of the marketing is. Because I think there is some language in there about creatine and women needing to take a lot more of it and things like that. And then, of course, we're gonna cover the dosage, the form, and then some claims that don't hold up.

The big social media claim about women and creatine

Philip Pape 2:12

So let's start with what a lot of people are hearing on the internet, what I get questions about. Uh, you've probably heard some version of this recently, and it goes like this women have 70 to 80% lower creatine stores than men. Estrogen affects creatine metabolism. So when estrogen drops in perimenopause and menopause, the problem gets worse. Therefore, women need creatine more than men do, and probably at a higher dose. So you should be taking, say, five to 10 grams a day versus the typical recommendation of five, and it will help your muscle, your bones, your brain, your mood, all of that. Okay, now I love the fact that people on social media are really good at marketing these tidy mechanistic claims, I guess, and kind of flatter you with the sense that, hey, you've been left out of this research and you need to take more because you're a woman, because you're older. But a lot of this is tied to one statistic, and we're gonna see very quickly how this falls apart. So, where does the 70 to 80 percent number come from? 70, 80% lower creatine stores in women than men.

Where the 70 to 80% number comes from

Philip Pape 3:13

It comes from a 2021 review in a journal called Nutrients, and it was on creatine and women's health. And it's a real paper by real researchers, Abby Smith Ryan, and Darren Kandau. They've done a lot of legitimate work in the field. And the review that they did says that females exhibit 70 to 80% lower endogenous creatine. That means your body makes it yourself, stores storage, you know, creatine stores compared with males, and it cites a 2007 review of creatine metabolism by Brosnan and Brosnan to get the figure. Now, there's a couple things about the paper that people conveniently leave out. The first one is the funding. The publication costs for the review were paid by Alcim, which is a creatine manufacturer. And two of the authors disclosed that they serve as scientific advisors to the company, but they disclose it in the paper. So I don't always think that that in and of itself is a problem. And Stacy Sims is a paid scientific advisor to Momentous and helped develop a supplement stack that contains creatine. And the 70 to 80% figure appears on the company's own website under her name. Mary Claire Haver sells a branded creatine through her business and promotes creatine for menopause in national media. And Darren Kandau advises multiple creatine manufacturers, and he's been an expert witness in creatine litigation. Okay, now I'm not saying any of these people are lying. Financial interest itself, in and of itself, doesn't mean that a claim is false. I uh I have my own offers and products and things, right? And what sometimes I don't always disclose it, you know, not nefariously or on purpose, but you you have to be aware of what people's interests are and who's saying things louder than other people, especially when there's one thing that's often repeated, but it's only repeated by specific few people. You want to kind of compare to the original data and see if it holds up. And if it holds up, okay, so what if they have a conflict of interest? It still holds up, regardless of that. So let's look at that. All right. In that same 2021 review, in the sentence, right after the one everybody talks about, the authors write that females have roughly 10% higher resting intramuscular creatine concentration than males. So higher, not lower. And they cite a 1991 study by Forsberg for that number. That study took muscle biopsies from 23 women and 18 men and measured total creatine per unit of muscle tissue, which is which is a direct measurement. So it's almost like they have both claims back to back in the review, but that's because they're measuring different things. Let me explain. The 70 to 80 percent figure is about total whole body creatine plus dietary intake plus synthesis. Whereas the 10% figure is the concentration, how much creatine is sitting in each kilogram of muscle. So why is the total pool of creatine smaller? Well, mostly because women have less total muscle to hold that creatine and women eat a little bit less meat and fish on average, which is where dietary creatine often comes from, but the tissue itself isn't depleted at all. If anything, it's it's slightly more saturated. So if you think about this like a fuel system, okay, a smaller tank, it's not an empty tank. A smaller tank does not mean you need higher octane or higher quality fuel in the tank. But that's the leap of logic being made here that, hey, you have a smaller pool of creatine. So therefore, your daily dose should be larger. But there's no dose response trial in women that show that. There aren't any. The dosing recommendation is just an inference from this whole storage capacity model or relationship. And then I think it gets a little bit worse for their argument because we can actually check that inference. If women were genuinely creatine deficient in the tissue, women should load more creatine into muscle than men do when they supplement. Well, guess what? There was uh some researchers, Tarna Polski and others, that looked at that. And the magnitude of the increase in muscle creatine and phosphocreatine after supplementation does not, I repeat, does not differ meaningfully by sex. Same dose gives the same response. Okay. So the premise of the same, the premise of a sex-specific dosing argument falls apart at the tissue level. And then the conclusion also has no research behind it anyway. So that if we have a hidden flaw in our episode today, that is it. And it's not a small one because it's the whole premise by which people are being yelled at, or women being yelled at and told, oh, you really have to take more creatine. This is an urgent problem. And by the way, I sell some. Now, before you go throwing out your creatine, hold off because the next part goes the other direction in that you still want to take creatine, but it's not that women have to take a lot more than men, et cetera. The reason to take creatine is a very boring, boring but true reason that still holds up. Okay.

The ONE thing that makes creatine worth taking

Philip Pape 8:27

And speaking of boring reasons that happen to be true, everything I'm about to tell you about creatine depends on something creatine cannot actually do for you, which is you need to have a training stimulus in the first place. So I want that to get that out of the way earlier. Creatine multiplies that signal. It's kind of like protein, right? We you can eat protein till the cows come home, but if you're not lifting weights, it's not gonna be that beneficial. Maybe it's slightly more beneficial than not having enough protein, but nowhere near as beneficial as if you're also resistance training, which we have to be doing. So I'm gonna give you a nice segue into my app Fitness Lab with this discussion because it was built around this exact problem. Just hear me out for a second. Fitness Lab doesn't just hand you a calorie number from a calculator, it doesn't just hand you a random workout. It builds your training around what you can recover from. It adjusts your nutrition from your data as you go, tells you when to push, when to back off, which is what a lot of people struggle with. If you're supplementing with creatine on top of that, but the training is not progressing, then you're kind of wasting your money and it's not doing much for you. So we have to have that progressive resistance training as part of our lifestyle. So if you want to check out Fitness Lab, go to wits and weights.com slash app. That is witsandweights.com slash app. Okay, go take a look at that app, come back because I want to give you numbers now on what creatine does for you in terms of

How much creatine adds to your performance and muscle

Philip Pape 9:57

the results. Okay, because people want to understand, okay, if let's say I'm a woman in menopause who is lifting, I've heard all this other stuff about creatine that Phillips saying you don't really have to worry about like getting a ton more than men, but creatine is still hugely beneficial. So let's do the good news first. And then I'm gonna take two things away that are that are less good news. Okay, so let usually I like bad news first, but let's start with the good news. The good news is that the strongest evidence for creatine in this population, so we're talking women in peri postmenopause, is the muscle and strength alongside resistance training. There's a meta-analysis of 22 trials in older adults, about 721 people, where their average age was from the late 50s into their 70s. All of them were lifting two or three times a week, anywhere from seven weeks up to a full year. Creatine plus lifting produced about 1.4 kilograms more lean tissue than lifting alone. So about three pounds of muscle or lean tissue with small improvements in chest press and legs, leg press strength. Now, when we talk about meta-analysis of trials, you know, some trials might have showed a benefit, some might have showed nothing at all. They don't show, they didn't show a negative from creatine. So that's that's at least good. When you narrow it down to older women specifically, it gets a little bit more of a modest improvement. A female-only meta-analysis of 10 trials in 211 older women found improved upper body strength, no significant effect on lower body strength, and no significant effect on muscle mass overall. The trials that did show benefits in upper and lower body were at least 24 weeks or longer. So it's like six months minimum before you judge whether it's doing anything for you, which I think is an important thing. I don't want to gloss over the fact that, you know, a lot of people have this like quick fix mentality. Even though we talk about things taking time, for whatever reason, they'll start taking creatine and within like two weeks, oh my God, it's not doing anything for me. And you got to remember there's a whole process. There's a saturation effect, there's you in your training. I mean, there's a whole bunch of factors involved. Having said all that, the bulk of the creatine research is still in young men. And we have very thin data on females, which is often the case in this industry. Sorry to say. When someone is super, super confident and they're like, this is exactly what creatine does for a 55-year-old woman. You know, ask them how many, you know, what studies they're using, how many women were in the studies. Are we studying women as a population? And the honest answer is eh, that's the funding hasn't really gone that direction very often. There's another piece about muscle that's interesting, a 2025 trial that what we call washed out the water weight before measuring. Okay, because remember, you gain some water weight from creatine when you start taking it. That's a separate thing we can touch on. But the five grams a day, the typical loading protocol without a training stimulus, produce no measurable muscle beyond what training alone produced. Without lifting, therefore, this supplement doesn't do anything for you. Okay, not a big surprise. I just mentioned that several times. It is not a hormone, it's not a drug, it's not going to change your body while you're just sitting on the couch. It just gives you a little bit of an edge to your performance. It amplifies what you're already doing in terms of your training.

Creatine and bone density

Philip Pape 13:06

All right. Now there are two other claims related to creatine that I need to put the brakes on right now. And I might have even talked about these in the past. It's speculative at best. The first one is bone, and the second one is on cognition or brain and mood. Okay. So on bone mass, bone density, which of course is very much packaged hard to or sold very hard to women, especially women in menopause, you know, osteopenia, osteoporosis. I mean, I'm talking about this all the time in the context of lifting weights. I would say this actually has a lot of research, but the most tepid result or the worst result. Philip Chelebeck, kind of cool name. I don't mean the Philip part, but that's cool too. Has probably done more work on creatine and bone than anyone. And I like how he handled the research because he ran the trials that could have confirmed his own hypothesis, and then they did not, and he published them anyway, which I love. That's great. Like that's good science right there. He ran a two-year trial in 237 postmenopausal women with creatine plus exercise. And it found no benefit to bone mineral density at any site where they measured it. And then there was a separate two-year trial on postmenopausal women with osteopenia. They used three grams a day of creatine and they found no effect on bone density, no effect on bone markers, no effect on what they call the micro architecture. They also didn't find effect on lean mass or muscle function. And so when you pull the older adult trials, creatine during resistance training does not increase bone mineral density. Now, these are some of these things that they measure are signals in bone geometry. Some of them are shape and bending strength measures, like at the hip. And they're secondary outcomes that have never been shown to reduce fractures anyway. So, really, what I take away from all of this is load up your skeleton with resistance training if you want your bones to respond, because that's going to work the most, right? Creatine's not going to do that for you. The second piece

Brain and mood benefits of creatine

Philip Pape 15:05

here is the brain and mood stuff that's been talked about. And it's a little bit more promising, but it's still thin and mixed on the research, which is why I bring it up. I always like to hedge a little bit on what we really, really know. And the core problem here is really related to the dose. The standard dose of five grams a day raises muscle creatine by about 20%. When we look at brain imaging studies, brain creatine rises somewhere around 3 to 10%. But the doses that actually move it or increase it are around 20 grams a day and higher. So the five grams a day that we're all taking has a lot going for it in terms of muscle and performance, but maybe not your brain. There is a menopause cognition study that a lot of people have been citing that had 36 women split across four groups. So about nine women per group, kind of a small sample size, I admit, running over eight weeks. They use creatine hydrochlorite, or I forget how you pronounce it, but HCl, right? Which is like hydrochloric acid. So creatine, HCl, and ethyl ester instead of creatine monohydrate. So creatine monohydrate's the form that I recommend people get. It's cheap, it's proven. You don't have to get it mixed with anything or sold by any special brand, you know. But that's the difference in this study. They use creatine HCl and ethyl ester instead of monohydrate. The reaction time improved in just one of the groups. And the mood finding was not statistically significant. It's also pilot with small sample size, as I already mentioned. And maybe if they can scale it up, run and replicate it at scale could be helpful to see if taking more creatine is helpful. On depression specifically, there were people in some of these trials diagnosed with major depression, as opposed to say healthy women in menopause, right? So we had to be careful what population we look at. When they look at those trials, the average effect came out to like 2.2 points on a depression scale, and three points is like the smallest change considered clinically meaningful. So again, I don't think you can really conclude anything. If anything, authors of the trials conclude that it's trivial or not, not an effect. Okay. So those are two big claims that get a lot of attention, I guess, in social media about bone health and about brain health, but they really don't have strong support yet. The brain piece, like I noted, maybe there's something happening at higher dosages. I personally take like anywhere around 15 or 20 grams a day, just in case there's some little benefit there, but we really don't know. Maybe they'll come out eventually and say, no, look, actually, when you exceed 20 grams a day, there is some statistically significant benefit, but we're

Creatine dosage and loading

Philip Pape 17:44

not there yet. So what do I want you to do? Let's talk about practicality. It's simple, it's cheap. Here we go. Just take three to five grams of creatine monohydrate a day, every day, at whatever time you'll remember to take it. That's it. If you're on the larger side, body weight, maybe hit the top of that range, five grams. Like I said, I take, I don't know, 12, 15, you know, I put it on a scale and just dump it in roughly around there. Some days it's 12, some days it's 18. It's kind of in that range. But you're good enough taking probably around five. And it's hard, you can't really, don't really worry about taking too much, again, if you're not far beyond that. That's the protocol. So that's it. That's it. Okay. You don't have to load it either. That in the old days, you would have to load with like, I don't know, what was it, 20 grams a day for two weeks or something like that. It only changes how fast your body gets saturated, not how saturated you get. We've seen studies like by Holtman that three grams a day for 28 days produce the same 20% increase in muscle creatine as 20 grams a day for six days. And then if you skip this loading phase and just do it straight from the beginning as like three to five grams, then you don't get like the bloating and stuff that happens very quickly that people often complain about. You're gonna buy plain creatine monohydrate powder. That is it. Just find a brand that does third-party testing. No form has beaten creatine monohydrate in trials. Not HCl, not buffered, not ethyl ester. In fact, ethyl ester degrades faster into creatinine. Definitely not the gummies, which I'll come back to at the end of the episode. And then there's the sequencing here. Okay. Creatine is less important than two other things. One, are you training hard enough to actually make use of the creatine? And number two, are you eating enough protein to build with it? Because if you're not there on those, creatine to me is in that 1% of optimization that you really shouldn't worry about until you've got the lifestyle basics dialed in, strength training and protein. Okay. Fix those first and then add the creatine in. Also, I like to not add it in while you're also changing your phase. Like if you're changing to a fat loss phase, it can screw things up a little bit because you're gonna gain some weight from the water absorption and it's gonna mess up your calculations and you're gonna think you're not losing fat or whatever. You're gonna have to wait for that to kind of wash out, as they say, or to stabilize. So I like doing it when I'm at maintenance, noting the increase in weight. It might be a pound for some per people, it might be three,

3 creatine myths

Philip Pape 20:08

four, five pounds for others. I also want to address three creatine myths right now, okay? Myth number one is on the bloating. Now, the water that gets absorbed or retained goes inside the muscle cell. It's not under the skin, and it's usually about one to two kilograms of total body water in the first week or two. So it's gonna show up on the scale. It does not show up in your face, okay? If you skip the loating, like I said earlier, just go straight to the small dose that you need forever, the three to five grams, it's usually gradual enough that most people don't notice it. Most people, some people do. I mean, I we do have plenty of clients and members that will know notice a little bit of bloating, but in many cases, not the bloating so much as the slight weight gain that they kind of mentally convert into I'm bloated. But it's not body fat. Remember, it's it's good weight gain. Okay, the second one is hair loss. This is an old one that still persists for some reason. Goes back to one study from 2009 and some rugby players, and they measured DHT, which went up, but it was in the normal range. It was actually never measured in hair directly. Nobody counted hair follicles, assessed hair density, followed anyone individually to see the longitudinal results. And then back and then recently in 2025, there was a trial that found no difference in DHT or in hair outcomes. So we don't worry about creatine and hair loss anymore. And the third one is kidneys. So this is an important one, and it's always worth consulting with your medical professional, your doctor. Creatine raises serum creatinine because creatine or creatinine is literally what creatine becomes and turns into. So that can make your estimated GFR look a little worse on a standard blood panel, but your kidneys are perfectly fine. And the trials in healthy people consistently show no harm to kidney function, just like with higher protein. You know, we people get scared over proteins. For whatever reason, even though there's no data to support it. So tell your doctor or whoever's taking your labs that you do take creatine. And if the number looks off, ask about things like cystin C, which measures kidney function. You can do a urine test. I've done that myself a few times, like with my rheumatologist, who says, Hey, maybe we should just do the urine test to make sure your kidneys are good. I do. She was like, Yeah, perfectly fine. It must be because you take creatine. Also, think about when you lift weights, there's byproducts of lifting weights that show up in your blood. And that's why they they tell you to not lift for like at least 24 hours before a blood draw. But I found even like having to wait two days for it not to affect it is important. So being a lifter, you're gonna have a little bit of a different profile with some of these things. But again, consult the professionals at the end of the day just to make sure and correlate everything. Now, if you have existing kidney disease, I'm not even gonna go there. It's out of my scope. Have a conversation with your physician. Okay, so I'm not saying don't take creatine. I hope you can tell. I take it. I think most people, most women, everybody over 40, whatever, who's lift who lifts weights should take it. I'm also not saying it's useless for the brain and the cognitive stuff. I'm saying the evidence is very early, very preliminary right now. The dose is probably much higher than what you're taking. It could be 15, 20, 25 grams. We just don't know. I'm not gonna recommend it directly. If you want to experiment on yourself, go for it. I don't even know when when the results would show up, how you would know, et cetera. It's almost like one of those, well, should you just do it just in case? That's totally your call, right? I take a higher amount, I don't take a super high amount, but that's kind of what goes through my head. So the reason to take creatine is pretty simple. It adds a little bit amount, a little bit of muscle and strength on top of your training. It can move the needle a little bit, maybe get you an extra rep or two in the gym. It is very, very inexpensive, and it's one of the most well-studied supplements that we have on safety. You could totally not take it and probably be totally fine. That's kind of my take on this. It's like take it or leave it. But I would say give it a shot, see if it helps you. It's not this dramatic thing. And the other stuff about how women need a lot more than men, it's just not supported by the evidence. All right, before we wrap up, I do have a fix that I promised you for the most common creatine problem there is. But if the, you know, creatine information in this episode or the stuff about menopause or women were helpful or useful to you, I do have a free guide called Menopause Fat Loss Over 40 that I think you're really gonna like. You go to witsandweeights.com slash free or click the link in the show notes. It's called menopause fat loss over 40. It walks you through how to set up your calories and protein through perimenopause and after, how to train for muscle and bone in a way that loads skeleton, what to do in the scale stalls for a few weeks, all of those sort of things. No supplement noise or affiliate stuff in there. Just go to witsandwaist.com slash free or click the link in the show notes. All right. So here's the creatine thing. Now I mentioned earlier I was going to talk about gummies, and I actually pivoted as I was developing this episode. Real quick, though, I wouldn't take creatine gummies at all because there have been studies that show the amount of creatine in those gummies is way off from what they advertise. Sometimes almost no creatine in there. Total waste of money. So that's one thing. But the if you take creatine, one interesting thing about creatine monohydrate is it's not water soluble. So it doesn't, what do you call it? It doesn't blend in, dilute into the water. So the type I get is called it's called micronized creatine monohydrate. So it's even smaller particles where you can stir it up really quick and just gulp it down. If you're not careful, if you don't do that properly, you can get all this grit in the bottom of your glass that is like leftover creatine that you didn't take because creatine monohydrate really only dissolves at about 14 grams per liter in room temperature water. So if you have a five gram scoop, you need at least 12 ounces of water to fully go into what we call a solution. And even then, you have to like really stir it up. A lot of people use too little liquid, and then some of it falls and gets stuck to the glass, and then you're not taking the dose. Now, is that a big deal? Probably not. But some people I've seen it do more than others, or they buy the type of creatine that has larger particles, and then there's a ton of it that they don't actually drink. Kind of the same problem you have with psyllium husk if you're not careful. So, really, that's it. If you're someone who gets stomach cramps or upset from taking creatine, oftentimes you're just not dissolving the powder enough, or you're not having enough liquid. So this can fix it too. And by the way, warm liquid is fine, by the way. And you might have heard things about not taking it with coffee or this or that. Don't worry about any of that stuff. As long as you drink it down, you're gonna be fine because creatine only breaks down into creatinine in acid over many hours. So again, your coffee doesn't destroy it. Whatever you read, it's all nonsense. Just drink it however you want, get it down, make sure the glass is clear and you're good to go. All right, until next time, keep using your wits, lifting those weights. And remember, creatine adds to what your training is already doing. So build the foundation first. I'm Philip Pape, and I'll talk to you next time here on the Wits and Weights podcast.