Author: ND. Mayra Márquez, Prof. Jorge L. Petro & Prof. Diego A. Bonilla

Creatine is a nutrient that plays crucial physiological and energetic roles in the human body, spanning from enhancing sports performance to prevention and serving as part of the treatment for various pathologies (e.g., sarcopenia). However, several aspects of creatine metabolism may differ between men and women. In this blog entry, we highlight the significant benefits that women can experience from using creatine monohydrate supplementation in their adult stage, especially during periods such as menstruation, pregnancy, postpartum, and during or after menopause (1, 2).

Figure 1. Creatine Metabolism in Female Reproduction, Pregnancy and Newborn Health. Taken from Muccini et al. (2021) (3).

Due to hormonal changes throughout various stages of women’s life, it has been shown that sex hormones, predominantly estrogen and progesterone, influence the activities of the main regulator of creatine metabolism, known as creatine kinase. These hormones also impact the expression of key enzymes for natural creatine production and its transport to various tissues, affecting the kinetics and bioavailability of this nutrient (1, 4).

One specific phase that undergoes significant changes is the luteal phase, characterized by an increase in estrogen and progesterone. During this phase, there’s evidence that protein catabolism and oxidation increase, while carbohydrate storage decreases (1, 4). Moreover, there’s a noted increase in extracellular fluid retention and a decrease in intracellular fluids, leading to reduced total body water and an increased risk of dehydration. This, in turn, can negatively affect thermoregulation, sports performance, and overall health (2). Additionally, the luteal phase is associated with a lower heart rate and a higher fatigue index compared to the follicular phase (which begins on the first day of the period). This suggests delayed recovery and lower fatigue resistance (5, 6).

Taken from Ellery, Walker & Dickinson (2016) (7). Creatine for women: a review of the relationship between creatine and the reproductive cycle and female-specific benefits of creatine therapy.

Considering that obtaining sufficient creatine from animal foods might be challenging (8), creatine monohydrate supplementation emerges as a valuable ally for women. Increasing creatine in the human body through nutritional supplementation result in more energy and muscle mass, shorter recovery, maintenance of glycogen levels, and a beneficial increase in hydration markers, counteracting suppressed thermoregulatory responses in the luteal phase. Additional benefits of creatine use in women include increased efficacy of antidepressants, enhanced cognitive function, and improved memory, as well as correction of nutrient deficiency for those women following a plant-based diet (2, 9).

Contrary to common myths, there is no demonstrated significant increase in body mass for women after creatine monohydrate supplementation in any phase of the menstrual cycle. On the contrary, creatine supplementation may counteract the increase in extracellular fluids due to its osmotic effect at the intracellular level, independent of the influence of estrogen and progesterone, enhancing the increase in total body water (almost 60% of total body water is maintained intracellularly) (2, 9, 10). It’s crucial to clarify that the intracellular increase resulting from creatine supplementation should not be confused with edema or water retention, which occur extracellularly. Additionally, creatine helps reduce protein turnover and aids in glycogen maintenance, playing a vital role in preventing muscle mass loss (2, 9, 10).

Creatine monohydrate supplementation in women also contributes to brain health, showing positive effects on mood and cognition, possibly by restoring and increasing brain energy levels. In young premenopausal women who engage in physical exercise, creatine improves strength and exercise performance. Older postmenopausal women may also experience benefits in skeletal muscle size and function with high doses of CrM and no side effects (1, 9, 11, 12). For example, recent evidence in this population has demonstrated that a two-year regimen of creatine monohydrate supplementation (0.14 g/kg/d, equivalent to 8.4 g per day for a 60-kg woman) alongside regular exercise is a safe strategy that might enhance certain geometric properties of bone at the proximal femur (1).

Overall, it is important to emphasize that creatine is an important nutrient that has a physiological role beyond energy and sports performance. Women, with their unique physiological characteristics and challenges, can benefit significantly from creatine monohydrate supplementation in preventing diseases and improving health. This impact extends to body composition, physical fitness (e.g., strength), cognition, and mood (9, 10, 12, 13). As a nutritional strategy, women might consider incorporating at least 0.1 g/kg/day of creatine monohydrate, or even higher amounts for bone and brain benefits.

References

1.            Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DGJN. Creatine supplementation in women’s health: a lifespan perspective. 2021;13(3):877.

2.            Moore SR, Gordon AN, Cabre HE, Hackney AC, Smith-Ryan AEJN. A randomized controlled trial of changes in fluid distribution across menstrual phases with creatine supplementation. 2023;15(2):429.

3.            Muccini AM, Tran NT, de Guingand DL, Philip M, Della Gatta PA, Galinsky R, et al. Creatine Metabolism in Female Reproduction, Pregnancy and Newborn Health. Nutrients. 2021;13(2).

4.            Muccini AM, Tran NT, de Guingand DL, Philip M, Della Gatta PA, Galinsky R, et al. Creatine metabolism in female reproduction, pregnancy and newborn health. 2021;13(2):490.

5.            Gordon AN, Moore SR, Patterson ND, Hostetter ME, Cabre HE, Hirsch KR, et al. The Effects of Creatine Monohydrate Loading on Exercise Recovery in Active Women throughout the Menstrual Cycle. 2023;15(16):3567.

6.            Clarke H, Hickner RC, Ormsbee MJJN. The potential role of creatine in vascular health. 2021;13(3):857.

7.            Ellery SJ, Walker DW, Dickinson H. Creatine for women: a review of the relationship between creatine and the reproductive cycle and female-specific benefits of creatine therapy. Amino Acids. 2016;48(8):1807-17.

8.            Close GL, Kasper AM, Walsh NP, Maughan RJ. “Food First but Not Always Food Only”: Recommendations for Using Dietary Supplements in Sport. Int J Sport Nutr Exerc Metab. 2022;32(5):371-86.

9.            Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. 2017;14(1):18.

10.         Antonio J, Candow DG, Forbes SC, Gualano B, Jagim AR, Kreider RB, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? 2021;18(1):13.

11.         Kreider RB, Stout JRJN. Creatine in health and disease. 2021;13(2):447.

12.         Chami J, Candow DGJTjon, health, aging. Effect of creatine supplementation dosing strategies on aging muscle performance. 2019;23:281-5.

13.         Kreider RB, Jäger R, Purpura MJN. Bioavailability, efficacy, safety, and regulatory status of creatine and related compounds: A critical review. 2022;14(5):1035.

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