Creatine is one of the most well-researched and effective sports nutrition supplements. But that isn’t what I’m going to focus on in this post. Instead, I want to profile emerging research linking creatine with improved brain and bone health. I’ll also explain why women, particularly through the midlife reproductive transition and beyond, may have most to gain from taking it.
Creatine is all over social media feeds these days. But a search of Google Trends shows the growing interest is real. There has been a doubling in search queries for this popular sports nutrition supplement in the last year alone.
Have the established sports-performance benefits of creatine driven this interest? Only partly. Much of the recent attention sits outside the gym. Brain, bone and women’s health dominate this interest. And the supplement is proving to be the darling of many social media health influencers.
First, let’s briefly cover what creatine is and its established role in exercise before turning to these emerging areas.
Creatine: what it is and how it works
Creatine is a naturally occurring compound found in our muscles and other body tissues in the form of creatine phosphate. It is the phosphate part of creatine that is a valuable aid in the rapid resynthesis of high-energy ATP from ADP during short-term maximal exercise such as sprinting or power weight training.
Think of creatine as a short-term energy reserve the body can draw on when demand is high. In general, higher muscle creatine-phosphate stores can support more intense training. More intense training stimulates the muscles to grow and adapt, which, in turn, improves performance.
Creatine mainly resides in our muscles, so animal foods such as meat and fish provide excellent dietary sources. But our bodies can also naturally make it from the amino acids arginine, glycine and methionine. And of course, supplementing with creatine can boost muscle stores too.
Creatine for exercise and sports performance
What does the scientific evidence have to say about creatine and sports performance? There have been hundreds of clinical trials, reviews and meta-analyses done so this is one supplement that has been well-researched and is backed by real science, not bro science.
That large research base finds that the greatest benefits of creatine are in recovery from high-intensity bouts of exercise with short rest intervals. So, what that means is that it may not make a person run a faster 100 metres, but they will be able to run faster sprint times if they’re doing it repeatedly. An example would be intermittent activity sports like football where they may be high-intensity bursts of activity for less than 30 seconds followed by periods of relative rest.
There is also evidence that creatine supplementation can enhance endurance performance. This benefit results from increased or improved protein synthesis, glycogen storage and thermoregulation.
But probably the main benefit of taking creatine is in resistance weight training. Positive adaptations including lean mass gains and improvements in muscular strength and power are commonly observed. Benefits have been reported in men and women, although most studies have been conducted on men. Hormonal effects are a major confounding difference between men and women. More about creatine’s role in women’s health later in this post.
How creatine helps with resistance training isn’t fully understood, but several mechanisms are likely involved. These include altering gene expression of the muscle protein myosin, influencing insulin-like growth factor production, stimulating muscle growth regulatory factors, improving cellular hydration, and altering inflammation and oxidative stress responses.
But let’s not forget one of the simpler explanations for creatine’s effect on resistance training. Supplementation increases muscle phosphocreatine stores and supports ATP resynthesis. That may allow a greater training volume or intensity over time, contributing to greater muscle hypertrophy.
How to take creatine for exercise performance
If you want to take creatine for sports performance benefits, the protocol here is pretty simple. You can either load with about 20 grams per day or about 0.3 grams per kilogram of body weight, split into several doses over the course of the day for five to seven days. After loading, a maintenance dose of 3 to 5 grams per day can be used.
Alternatively, skip the loading phase and just take 3 to 5 grams daily. Muscle stores will usually reach saturation after about a month.
Hold those dosing amounts in your mind as they will start to change as I move into some of the possible non-muscle benefits of creatine. So, let’s dive in.
Creatine and brain health: promising, but still emerging
Let’s start with the brain. Creatine supplementation has been studied for its potential to support brain health, particularly in areas such as memory, cognitive processing and neuroprotection.
Research indicates that creatine supplementation can raise creatine levels in the brain and may support memory and other aspects of cognitive performance. Any benefits appear most likely in older adults. They also occur during periods of physiological stress, such as sleep deprivation, or after brain injury.
A key proposed mechanism is improved cellular energy availability in the brain, helping meet the high energy demands of normal cognitive function.
There’s a bit to unpack here so time to go deeper.
Why might creatine affect the brain?
The liver and kidneys mainly synthesise creatine, while other organs such as the brain can also produce it. The brain uses roughly 20 percent of the body’s energy at rest. That high energy demand provides a plausible rationale for supplementing with creatine when cognitive demands are high.
While a healthy brain may produce enough creatine to meet energy demands, supplementation could be beneficial during periods of mental fatigue. This is particularly true during ageing or neurocognitive conditions. Under metabolic stress, the brain may become depleted of its creatine stores. This depletion can lead to cognitive fatigue during sleep deprivation or ageing-related neurodegenerative conditions.
Beyond energy metabolism, creatine could also provide neuroprotective benefits through several mechanisms. For example, creatine may help counter aspects of mitochondrial dysfunction seen in neurodegenerative disease. Animal studies have demonstrated that creatine supplementation could also help prevent losses of neurons that produce neurotransmitters such as dopamine.
Creatine and cognition: the clinical trial evidence
Enough of the theory, what do human clinical trials have to say about creatine supplementation and brain health? Multiple systematic reviews and meta-analyses suggest creatine supplementation can improve memory, particularly in older adults. It may also enhance short-term memory and reasoning in healthy individuals.
The first of these reviews was from 2018. It included six randomised controlled trials involving 281 healthy individuals. Doses of creatine used varied from 5 grams up to 20 grams per day. It found evidence that short-term memory, intelligence and reasoning were improved by creatine supplementation.
However, the research team found conflicting evidence for other aspects of cognitive function. These included long-term memory, attention, reaction time and mental fatigue. One interesting finding was that young adults in their 20s didn’t appear to see much benefit—it was older people who saw the most improvements. This supports the possibility that cognitive benefits are more likely in older adults than in younger people.
Research never stands still and as new studies come out researchers can conduct larger and more informative reviews. Take for instance a systematic review from 2022 that included 10 randomised controlled trials looking at creatine supplementation in healthy adults and its effect on memory. Doses of creatine ranged from 2.2 grams up to 20 grams per day, with 7 of the 10 studies using that higher 20-gram dose.
Onto the results. Overall, there was a small but positive benefit in taking creatine on memory. But when the analysis focussed on older adults aged 66 to 76, the benefit increased and was considered large. This is the most notable finding, in my view. However, differences in study design still limit how confidently we can interpret the overall evidence.
Finally, a systematic review from 2024 examined 16 randomised controlled trials involving 492 participants aged 21 to 76 years. The studies included both healthy adults and adults with specific conditions such as fibromyalgia, mild cognitive impairment associated with Parkinson’s disease and chronic schizophrenia under treatment.
Creatine supplementation again showed a small but significant effect on memory. It also yielded a small improvement in attention and moderate gains in brain processing speed. But here is where it gets more interesting as benefits were more notable in the studies that involved adults with brain-related illnesses. But unlike the other two reviews I just mentioned, this one couldn’t see a significant benefit of creatine in adults over the age of 60.
Despite the mixed findings, several mechanisms could explain any genuine effect on brain function. First, creatine may increase the energy available to brain cells via phosphocreatine, which helps regenerate ATP. Secondly, creatine may improve neurotransmitter function while also acting as a neuromodulator by affecting the efficiency and plasticity of neuronal synapses which are essential for learning and memory. Additionally, creatine’s neuroprotective properties may reduce damage to the brain from oxidative stress.
Creatine, depression and mood
Another area I want to touch on around brain health is the potential role of creatine in mood disorders, particularly depression and anxiety.
This is an emerging and evolving area. Research to date suggests that people with mood disorders are more likely to have lower creatine levels in certain brain regions, particularly the prefrontal cortex, and that increasing levels by supplementation may help improve mood.
While creatine may be helping to alter brain bioenergetics, preclinical evidence suggests that supplementing with creatine could also help with depression by modulating neurotransmitter receptors. Creatine might also improve depression by decreasing oxidative stress and increasing serum levels of BDNF, which is a protein involved in brain development and function.
Lots of ‘mights’, ‘mays’ and ‘maybes’ I know. So, what does the human clinical evidence say here?
In a 2012 proof-of-concept trial, 52 women with major depressive disorder took the SSRI antidepressant Lexapro. They were also assigned to either 5 grams of creatine per day or a placebo for eight weeks. Women taking creatine showed significantly greater improvements in depression scores than those taking placebo. These differences were apparent within two weeks of starting treatment.
A 2025 study helped build on the first trial’s results. In this case, 100 adults (with an equal split of men and women) with major depressive disorder took 5 grams of creatine or a placebo daily for 8 weeks. Unlike the previous study, participants were not taking antidepressant medication. Instead, each person received five 45-minute cognitive behavioural therapy (CBT) sessions during the study.
So, what did they find? Depression symptoms improved in both groups. That is not unexpected as the overall outlook for CBT as a treatment for depression is positive. However, the creatine group showed a clinically significant greater improvement in depression scores.
And strikingly, 12 participants in the CBT plus creatine group achieved what was considered remission from depression. Contrast that with just five participants in the placebo group achieving clinical remission from depression.
The only adverse event of note was a higher incidence of gastrointestinal complaints in those taking the creatine. And this was mostly confined to the first two weeks of taking the supplement.
Creatine supplementation is certainly showing some promise as a low-risk, low-cost adjunct treatment for mood disorders, in particular depression. And yes, absolutely, we need more high-quality trials here rather than the smaller, more specialised studies we currently have as the initial findings are not applicable to everyone at this stage. But considering this supplement is already widely available and has a long history of use and safety, it could end up being part of the therapeutic toolbox in managing mental health conditions.
Concussion, traumatic brain injury and long COVID
Creatine supplementation is also being studied for its potential to reduce concussion risk. It may also help manage some symptoms of traumatic brain injury. However, this remains a nascent and evolving area.
Altered cerebral energy availability, impaired cerebral blood flow and low brain creatine levels observed in traumatic brain injuries has led researchers to propose a potential therapeutic role of creatine supplementation. Driven largely by animal studies, with only limited human research so far, the initial results look promising. What has so far been described is improved recovery outcomes both in cognition and symptoms such as headaches and fatigue.
There may even be a benefit from creatine supplementation in reducing the effects of concussive impacts when taken before activity which has certainly attracted the interest of many athletes participating in high-impact contact sports.
It’s well beyond the scope of this post to go a lot deeper in this area, but if you want to read more, there is an excellent review paper from 2023 on the potential applications of creatine supplementation for brain health and function.
And for something from left field tying together several areas where creatine may be of benefit, we are now seeing research into creatine supplementation for long COVID. Long COVID accompanies reduced tissue creatine levels and impaired bioenergetics, which may contribute to fatigue and cognitive symptoms.
Several recent studies suggest creatine at doses of 4 to 8 grams per day may help reduce fatigue and improve other symptoms in people with long COVID. While the evidence is still preliminary and based on small sample sizes, findings indicate potential benefits so expect more research to come out.
Creatine and bone health
So, that’s the brain. What about bone? Is there any credence to claims that creatine supplementation helps maintain healthy bones? The answer is a qualified ‘yes’ as it likely needs both creatine and resistance exercise together for a synergistic effect as creatine on its own doesn’t seem to impact bone health that much.
Because creatine enhances muscle mass and strength, then stronger muscles mean stronger muscle contractions which means greater loading on bones, potentially improving bone density. Creatine could also have a role in enhancing the activity of the bone osteoblast cells that are part of the bone building mechanism.
Creatine, resistance training and bone health
But intriguingly, an effect of creatine with resistance exercise may not be all about changes in bone mineral density. Instead, changes in bone geometry could be the secret sauce which go on to give greater integral strength properties of the bone, making them more resistant to fracture.
This bone geometry effect was seen in a 2-year randomised controlled trial involving 237 women with an average age of 59 years. Each woman undertook a similar resistance training and walking program over that time, but one group received creatine at a dose of 0.14 grams per kilogram of body weight while the other group took a placebo. Based on their average body weight, that put the daily dose of creatine in the 10 grams per day ballpark.
So, what were the bone health outcomes? Aligned with previous research, creatine showed little impact on bone mineral density when paired with exercise. No notable benefit emerged beyond what exercise provided. However, creatine produced significant between-group differences in bone geometry, particularly at the femoral neck which is a major part of our hip joint and very susceptible to fracture with falls, especially in older people.
More favourable femoral bone geometry in the creatine group corresponded to greater predicted bone strength. It also showed greater resistance to bending. There was also greater thickness of the dense outer layer of bone, called the bone cortex. All the sorts of things that could help reduce the risk of fracture from a fall.
And on top of the bone health benefits, those taking creatine saw a greater increase in lean tissue mass and walking speed. The resistance training program produced substantial strength gains in both groups of women, which may have masked any creatine-related improvements in overall strength.
Why creatine may matter especially for women
Now to the part that consolidates the research I’ve outlined. Creatine may be one supplement with a positive bias in helping women more than men.
Why women may respond differently
On average, women have lower total-body creatine stores than men and may consume less dietary creatine. So already there is a case that supplementation may offer more benefits to women.
And then there is the impact of hormonal changes on creatine metabolism over a woman’s reproductive lifespan, particularly when comparing the pre- and post-menopausal periods. Estrogen and progesterone influence enzymes involved in creatine synthesis and the transport of creatine into tissues. Creatine metabolism may therefore change across a woman’s reproductive lifespan.
The menopause transition: muscle, bone and brain
Let’s focus particularly on the peri- and post-menopausal stages of a woman’s life. These hormonal changes have real biologic effects on bone, brain and muscle health, and the effects are often unfavourable. Creatine is known to have a positive role in those areas. However, its metabolism is altered unfavourably by those same hormonal changes.
This has prompted growing interest in creatine as one possible adjunct for managing aspects of the menopausal transition. That is only magnified when you combine it with the overwhelming benefits that resistance exercise can already have in muscle and bone health.
Then there are the hormonal-related cognitive and mood changes that can happen at this time of a woman’s life. Enter creatine again as a potential supplement that could be one way to help address this.
I’m not going to unpack every study and mechanism here as it relates to women’s health as I’ve already presented a lot of the general literature for brain, bone and muscle health. But if you want to go deeper, then there is an excellent review paper I can recommend covering specifically creatine supplementation in women’s health across the lifespan.
Practical dosing: muscle, bone and brain
Creatine can be taken for muscle, brain and bone benefits, but the dosage needed for each may differ.
For muscle and exercise benefits, start with a loading phase of 0.3 grams per kg per day for five to seven days. Then continue with 3 to 5 grams daily. Or take 3 to 5 grams daily from the start to reach muscle saturation by about a month.
When it comes to brain and bone health , much less is known about the optimal creatine supplementation protocol for improving these measures.
For bone health, doses of 8 grams per day or more have been studied.
For brain saturation, research is still unclear about the effective dose, but it points to higher doses of 15 to 20 grams per day for 3 to 7 days, followed by 5 to 10 grams per day for ongoing use.
Treat these recommendations as guidelines, with scope for individual adjustment. If you experience gastrointestinal symptoms, consider changing the dose, timing or dose distribution.
Based on expert commentary, 10 grams of creatine per day may be a practical dose for people seeking potential muscle, bone and brain benefits. Higher doses could be considered during times of metabolic stress such as cognitive fatigue. And this is where some have advocated that 20 grams per day could be effective for short periods of time.
Why individual responses vary
Evidence and a dosing protocol do not guarantee a noticeable benefit. Individual responses vary according to dose, baseline creatine status and personal context. Some people experience significant benefits while others notice minimal effects, especially for cognitive responses.
As many as 30 percent of people may not respond favourably to creatine supplementation because of factors such as age, sex, muscle mass, initial creatine stores, habitual dietary intake of creatine and physical activity levels. Some factors may matter more for muscle responses, while others may be more relevant to the brain.
There is still much to learn. Treat these dosing recommendations as a starting point, then use your own experience to guide any adjustments.
Which form of creatine should you choose?
As for what form of creatine to take, it is creatine monohydrate that dominates the market. That’s all you need to worry about.
Creatine monohydrate forms when a water molecule binds to creatine, helping it dissolve in the body and release creatine. Just about every study that forms the evidence base for creatine use has used this form. And as a bonus, it is usually the cheapest form to buy.
Micronised creatine is simply a finer powder, which may dissolve more easily. Some people may also find it easier to tolerate if they experience gastrointestinal symptoms. And if you do experience any GI issues with creatine, it is more a signal to lower the dose or spread it out over the course of the day.
Forms such as creatine hydrochloride and creatine malate are often marketed as ‘new and improved’. But there is little evidence that they produce superior biological effects than creatine monohydrate.
Timing, caffeine and safety
The time of day you take creatine does not seem to matter much. Nor is there a strong rationale for taking it pre- or post-exercise. Go with what works for you and your training.
There is though some experimental evidence showing that caffeine and creatine may counteract each other. So this is one case where it may be better to split your coffee and creatine by at least an hour although the doses likely to be a concern are probably more than you would find in a single cup of coffee.
Is creatine safe to take? Creatine has shown an excellent safety profile across a huge number of studies, with minimal adverse effects reported even with long-term use. A small amount of weight gain from increased water retention and some short-term gastrointestinal problems are probably the only side-effects a person is likely to encounter.
Creatine is, after all, a substance naturally present in our diet and one that the body makes on its own. This safety profile is especially important given the research now supporting its benefits in a range of health outcomes that may require extended periods of supplementation to achieve and maintain benefits.
What it all means
Creatine is one of the few nutritional supplements for which research has consistently shown a sports performance benefit. But research into its benefits is now growing well outside of this domain.
Creatine supplementation may support brain health through energy metabolism and neuroprotective mechanisms, particularly in people under metabolic stress or at risk of cognitive decline. However, the clinical evidence remains mixed and is still evolving.
For women, creatine may be especially relevant during life stages in which reproductive hormonal changes affect muscle, bone, mood and cognition. That is a plausible and promising case, though it is far from settled.
But please treat everything I’ve presented here today as a snapshot of the current research landscape—a landscape that will continue to evolve and one that certainly is worth keeping up to date with. For every reader, you can evaluate the research yourself and determine if creatine supplementation could be of value to you for whatever health or performance outcomes you are interested in.
This post has aimed to provide a balanced assessment of the current evidence on creatine. If you want glowing and glossy evangelical hype about the cure-all properties of creatine supplementation then you’ll have no trouble finding that on social media singing its praises. But I’m not singing from that song sheet as creatine is not that.
Creatine can be useful for some people, whether the goal is sports performance or possibly cognitive support. But it is one optional tool, not a magic elixir, and it works best when used alongside consistent training, a good diet, quality sleep and appropriate medical care.
Sally Marchini says
Great blog thanks Tim! I’ve shared it with some of the old lady groups such as boogie boarding that I mix with in my retirement.