In Part 1 of this series, I reviewed the basics of creatine—its function, metabolism, common forms, and potential benefits for muscle strength and performance. In this post, I shift the focus to creatine supplementation in populations beyond healthy young athletes, including females, older adults, and individuals with various health conditions.
This discussion is based on findings from the 2025 systematic review by Gutiérrez-Hellín and colleagues, Creatine Supplementation Beyond Athletics: Benefits of Different Types of Creatine for Women, Vegans, and Clinical Populations (Nutrients 2025;17(1):95).
For background information, see:
? Part 1: Creatine Supplements – The Basics of What Clinicians Need to Know
Why Consider Creatine in Special Populations?
Creatine plays an essential role in energy metabolism, particularly within tissues that have high, fluctuating energy demands such as skeletal muscle and the brain.
Emerging research is exploring creatine’s potential benefits beyond athletic performance, specifically in:
- Older adults experiencing age-related muscle loss (sarcopenia)
- Females, who may have lower baseline muscle creatine stores
- Vegetarians and vegans, due to lower dietary intake
- Individuals with chronic illness where muscle mass and energy metabolism are compromised
Creatine and Aging: Potential Role in Sarcopenia Prevention
Sarcopenia—characterized by progressive loss of muscle mass and strength—is a major contributor to frailty and functional decline in older adults.
Some studies have demonstrated that creatine supplementation combined with resistance training can help improve muscle strength and lean mass in this population. The mechanism likely relates to enhanced phosphocreatine availability, supporting muscle energy metabolism during training.
However, not all studies show consistent benefit. Differences in training protocols, creatine dose, and duration make comparisons challenging. At this point it is possible that when coupled with structured resistance exercise, creatine could become a nutritional intervention of benefit for muscle function in aging.
Creatine Supplementation in Females
Research suggests that females may have lower baseline creatine stores than males, likely due to lower muscle mass and differences in dietary intake.
Supplementation in females has been shown to enhance high-intensity exercise performance, but findings are mixed for improvements in body composition.
Additionally, most studies indicate that females tolerate creatine supplementation well, and side effects are similar to those observed in males (mild gastrointestinal discomfort or transient water retention).
Further research is needed to explore the potential role of creatine across the menstrual cycle, during pregnancy, and postmenopause—where muscle loss, energy metabolism, and fatigue are clinically relevant issues.
Creatine for Vegetarians and Vegans
Dietary creatine is found almost exclusively in animal-based foods such as meat and fish. As a result, vegetarians and vegans typically have lower muscle creatine concentrations compared to omnivores.
This lower baseline may make these individuals more responsive to supplementation. Research indicates that creatine supplementation can improve performance, muscle phosphocreatine content, and cognitive outcomes in vegetarians.
Creatine monohydrate remains the preferred form for this group, as it is effective, widely available, and free from animal-derived components.
Creatine in Clinical Populations
Several clinical populations have been investigated for potential benefit from creatine supplementation. At this point, the research remains in it’s infancy.
| Clinical Context | Potential Role | Notes |
|---|---|---|
| Neuromuscular disorders | Support energy metabolism in muscles | Results inconsistent; small improvements in strength reported in some studies |
| Heart failure | Improve skeletal muscle energetics and exercise tolerance | Limited data; no clear effect on cardiac outcomes |
| Neurodegenerative diseases (e.g., Parkinson’s, ALS) | Enhance brain energy metabolism | Human studies have not shown consistent benefit |
| Depression | Augment brain phosphocreatine and antidepressant response | Preliminary findings; more data needed |
| Diabetes | Support muscle energy metabolism and glucose transport | Research ongoing; theoretical benefit |
| Kidney disease | Safety and impact on renal function remain under investigation | See Part 3: Creatine Supplements and Kidney Health |
Overall, evidence supporting routine use of creatine in clinical populations remains limited and heterogeneous. More high-quality trials are needed.
Safety and Dosing Considerations
- Form: Creatine monohydrate is the form most studied and recommended for all populations.
- Dose: Typical maintenance dose is 0.03 g/kg/day; lower doses may be advisable in older adults or those with reduced renal function.
- Adverse effects: Mild gastrointestinal discomfort, transient water retention, or increased body weight (1–2 kg) are the most common.
- Monitoring: Clinicians should interpret increases in serum creatinine with caution, as these may be reflective solely of creatine metabolism rather than renal injury.
Summary
- Creatine’s hypothesized applications extend beyond athletic performance though more studies are needed before routine creatine supplementation can be recommended.
- Theoretically, supplementation may benefit older adults, females, vegetarians, and individuals with certain chronic diseases, though benefits appear contingent on being combined with exercise.
- Creatine monohydrate remains the safest and most evidence-supported form.
- Caution and clinical judgment are warranted when recommending creatine in populations with reduced kidney function or complex medical conditions.
For the next part of this series, we will explore what clinicians should know about creatine and kidney health, including interpretation of lab results and evidence on renal safety.
? Continue to Part 3: Creatine Supplements and Kidney Health
4 thoughts on “Creatine Supplements in Special Populations”