Does creatine work for menopausal symptoms? Doctors weigh in

It may seem the like creatin is all over, with podcasters, wellness influencers and maybe even out your neighbour promoting products. In fact, the creatine market is projected to increase in the U.S. and Canada.

The supplement, favoured by some weightlifters and sprinters, is now touted for healthy aging such as memory and cognitive issues during perimenopause and menopause. But the evidence on that isn't solid, doctors say. 

If you're already taking creatine or considering doing so, here are some factors to weigh on who might benefit, what's less clear, as well as the safety of the product. 

Creatine is a nitrogen-containing compound that people can get from their diet by eating meat and fish. Since creatine is not found in plants, scientists say vegetarians and vegans may benefit from supplements, most of which are synthesized without extracting from animals. 

Animals, including humans, store creatine mainly in muscle. The liver and kidneys also synthesize creatine when we get enough amino acid building blocks through diet, such as by eating oily fish like herring.

As for its role, during muscle activity, creatine helps create a short-term supply of energy that is needed to keep the heart beating, and to grow and repair cells. 

Athletes have used creatine supplements to augment resistance training, such as in bodybuilding. Researchers have also suggested it could improve performance in sports that require surges of intense activity.

While studies have looked at creatine supplementation, doctors say factors like the size, length and quality of research into supplements also matter for reliability. It's worth noting that studies on athletes may not apply to the average person who doesn't work out as much, is sedentary or already gets enough creatine from their diet. 

Like protein supplements, creatine is promoted, along with strength training, by some wellness influencers and podcasters both for bulking up and for anti-aging.

Dr. Mark Tarnopolsky, a professor of pediatrics and medicine at McMaster Children's Hospital in Hamilton, studied the effects of creatine with resistance training in men and women over age 65. 

Taking creatine supplements combined with exercise "clearly shows significant improvements in muscle creatine levels as well as muscle strength and muscle function," said Tarnopolsky, who owns his own company selling creatine supplements.

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A "heaping teaspoon" of four to five grams "is probably a sweet spot," he said. In contrast, some influencers suggest 20 grams a day, he said, which seems like overkill. 

The latest messaging seems to be focused on how creatine can help aging bodies and minds, including those with menopause and perimenopause. That's an extrapolation based on studies that found giving creatine supplements to vegans raised their muscle levels and improved their memory and concentration, Tarnopolsky said. 

Other doctors say the evidence of creatine helping cognition or so-called brain fog is thin. For example, some social media posts recently discussed one trial of 36 perimenopausal and postmenopausal women over two months. The researchers concluded the supplements "may be a promising, safe, effective and practical dietary strategy for improving clinical outcomes and elevating brain creatine concentrations."

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For Dr. Jerilynn Prior, a professor emerita of endocrinology and metabolism at the University of British Columbia, the trial had too few participants and too many objectives to draw firm conclusions.

Prior pointed to another observational study of a sample of women in the U.S., which suggested many women don't meet the estimated requirement of creatine from diet to be healthy. 

"I think it [creatine] should perhaps be on our radar and that we should do better studies," Prior said.

Dr. Christa Mullaly, an obstetrician and gynecologist in Fredericton who promotes awareness of menopausal symptoms, has another caution.

Medical researchers often look for statistical significance of a treatment — evidence that an effect was beyond what could be expected with a roll of the dice. But then there's clinical significance — evidence that a treatment effect is large enough to make a real, meaningful difference in a person’s health, function or quality of life. 

Since they aren't always the same, Mullaly said, results from studies may not apply in the real world. 

What’s needed, doctors say, are randomized controlled studies that enrol large numbers of people to test the effect of the supplement on brain function against a placebo.

One case study raised concerns that creatine is tied to kidney damage in people with kidney disorders and the supplement is not recommended for those with the chronic disease. But it doesn't appear to affect kidney function in healthy people.

Tarnopolsky said he's studied people who've been prescribed creatine and mitochondrial supplements for 25 years with Duchenne muscular dystrophy or primary mitochondrial disease with no signs of any damage, which suggests there’s little risk from taking moderate amounts.

For most people, if they take a large amount of any supplement, including creatine, it can cause gastrointestinal upset such as nausea, vomiting and diarrhea. That's why he recommends taking it with food.

"The only way people should take creatine is as a powder," Tarnopolsky said, instead of gummy forms, which are mostly sugar. "It's not very expensive, which is why people are coming up with all these health-care frauds because they're trying to make a buck."

In one review, researchers concluded there isn't enough known about its safety for adolescent athletes.

Women going through menopause often want to be as healthy as possible and feel as good as possible for as long as they can, Mullaly said. But there's no magic bullet.

Instead, Mullaly suggested:

"We sometimes get caught up in trends and forget the compelling, excellent evidence for basic behaviours that are foundational but don't make for interesting media," Mullaly said.

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