A Case for Creatine Supplementation in Women
I finished my undergraduate training and entered into the fitness industry at (what felt like) the height of MLM supplement sales. It felt like everyone I knew was selling some type of wellness product. After being hassled by “friends” to purchase cleanses, “nutrient”-dense pills, and energy-boosting drink aids, I swore off supplements altogether. It just all felt so scammy. Over time, education and research has helped convey the efficacy of high-quality supplements. As someone who is most interested in enhancing quality of life and functionality, it’s clear that creatine has the potential to improve long term health.
There are a couple things you should know before bringing any supplement on board as part of your nutrition regimen.
It’s wise to consult with a healthcare provider who can run labs to see if you’re actually deficient in something before you begin adding more of it to your body. You may be getting a sufficient amount of a vitamin or mineral from your diet alone. More isn’t always more.
Supplements aren’t regulated in the same way that pharmaceutical drugs are. While prescription drugs have to go through rigorous clinical trials prior to public access, supplements don’t have to have their efficacy proven in order to go to market. Instead, the regulation relies heavily on post-hoc adverse events, which must be reported by consumers. Once a supplement has been deemed unsafe, then the FDA may pull it from the market based on consumer reports. Marketing claims on supplemental products can be misleading, inaccurate or outright false since efficacy doesn’t have to be proven for this specific class of consumer goods.
This isn’t to dissuade you from using supplements. In fact, the whole purpose of this specific newsletter is to highlight the benefits of creatine, one of the safest and most widely used supplements on the market.
What is Creatine?
Creatine phosphate is an energy containing compound housed in muscle cells. When intense exercise is performed, creatine in the body is utilized by the muscle cells and turned into phosphocreatine (PCr). PCr converts ADP to ATP through the donation of a phosphate group, resulting in creatine + ATP. This system, known as the ATP-PCr system, is a key supplier of energy during anaerobic exercise and contributes to muscle mass in resistance training.
Differences in Males & Females
Females have a massive disparity in creatine stores - 70 to 80% less - than men.
Levels of creatine kinase drop precipitously in menopause.
Males receive more creatine from dietary sources than females.
Surprisingly, females have slightly higher intramuscular stores of creatine, which may require greater levels of supplementation to elicit a response.
Both males and females lose creatine stores as they age, largely in part to the sarcopenia (muscle loss) that occurs across the lifespan.
Creatine supplementation has been shown to offer other physiologic and neuromuscular improvements in addition to sport performance.
Creatine Use in Premenopausal Women
Creatine (Cr) supplementation in women (pre-menopause) has been shown to optimize athletic performance in intensity bouts of exercise. It offers favorable benefits without weight gain and/or adverse side effects. However, it should be noted that during the loading phase when beginning creatine, water weight may be a factor in the short-term. Its use in women who are resistance training and participating in high-intensity exercise has also been noted to offset fatigue, as the PCr system is effective at buffering hydrogen ions that accumulate in response to said exercise.
Even in studies of endurance, Cr supplementation resulted in longer test times for graded exercise tests (meaning subjects didn’t fatigue as quickly) and lower heart rates in the first five stages (improved economy). Cr supplementation has also demonstrated reduced neuromuscular fatigue in female cyclists. Researchers propose that elevated creatine levels within the muscles slow down anaerobic glycolysis and therefore offset the accumulation of lactic acid.
Ultimately, the increase in stored PCr assists in muscle hypertrophy and overall strength. (This is not to be implied as creatine will make you “huge”. Think of it as a tool that allows your muscles to respond more efficiently to exercise and recover quicker.)
Creatine Use in Postmenopausal Women
As estrogen levels decrease in menopause, scientists believe that this places the body in an inflammatory state, negatively impacting the effects of resistance training on menopausal women. Uniquely, in addition to enhancing muscle growth, creatine has shown to offset this inflammatory state and also elicit osteoblastic activity (bone formation). While it can be supplemented for the bone density effects alone, resistance training in postmenopausal women is crucial. It aids in the uptake of creatine into the muscle, while slowing down the process of sarcopenia. Resistance training also offers functional movement throughout older adulthood, helping aging adults complete their activities of daily living independently.
Creatine and Mental Health
Females are twice as likely to experience depression than males. This is especially evident throughout certain milestones in the female lifespan (e.g. pregnancy and perimenopause). Creatine, dopamine, and serotonin are interrelated. When the PCr system isn’t functioning properly (due to low creatine stores), depressive episodes may intensify. Creatine supplementation can positively enhance mood by providing the brain the energy that it needs to maintain hormonal homeostasis. Studies have shown that creatine further reduces depressive symptoms in addition to antidepressants among diagnosed female adults and adolescents. Most importantly, as dietary creatine is increased, incidence rates of depression decrease.
Cognitive function as a whole is optimized through creatine supplementation. Cr reduces mental fatigue and optimizes mental performance. For those who adopt a vegetarian or vegan diet, this is especially important as their circulating levels are lower without meat. Stress levels in females fluctuate throughout the lifespan with the demands of pregnancy, caregiving, and managing the mental load. These demands can also impact sleep. Anyone on the planet who has ever experienced sleep deprivation knows the cascade of mind-altering consequences on cognition, decision making, and alertness. Creatine shown promising effects on sleep, cognition, mood, and mental health - and that’s just the brain benefits alone.
Dosing Recommendations
Creatine requires a loading dose, as noted in the table above. Once a loading phase has passed, maintenance doses are easier to adhere to.
As you’ve now learned, creatine supplements can be purchased anywhere, but not all supplements are equal. Based off recommendations of healthcare providers and professionals I trust, I’d recommend purchasing from the following companies. (I do not earn a commission on any of these recommendations, by the way.) Please consult with your doctor before adding any supplement to your diet.
Reference:
Smith-Ryan, A. E., Cabre, H. E., Eckerson, J. M., & Candow, D. G. (2021). Creatine supplementation in women's health: A lifespan perspective. Nutrients, 13(3), 877. https://doi.org/10.3390/nu13030877
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