When accompanied by a progressive strength-training regimen, 3 grams of creatine a day may improve muscle performance in older adults.
What Is Creatine? Can It Treat Sarcopenia (Muscle Loss with Age)?
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Creatine is a compound formed naturally in the human body that is primarily involved in energy production in our muscles and brain. It’s also naturally formed in the bodies of many animals we eat, and so, when we eat their muscles, we can also take in some creatine through our diet. (It was named after kreas, the Greek word for “meat,” in which it was first isolated.) We need about two grams a day; so, those who eat meat may get like one gram from their diet, and their body makes the rest from scratch. There are rare birth defects where you’re born without the ability to make it, in which case you have to get it all externally through diet. But otherwise, our bodies can make as much as we need to maintain normal concentrations in our muscles.
When people cut out meat, the amount of creatine floating around in their bloodstream goes down. But the amount in your brain remains the same, because your brain just makes all the creatine it needs. The level in vegetarian muscles is lower, but that doesn’t seem to affect performance, as both vegetarians and meat-eaters respond to creatine supplementation with similar increases in muscle power output. And if vegetarian muscle creatine was insufficient, then presumably they would have seen an even bigger boost. So basically, when you eat meat, that just means your body doesn’t have to make as much.
If creatine muscle content dropped as we grew older, that might help explain age-related muscle loss. But that doesn’t seem to be the case. Biopsies taken from the muscles of young and old adults show no difference in creatine content. Still, if it improves performance, maybe it would help. According to the International Society of Sports Nutrition, creatine monohydrate is the single most effective ergogenic supplement available to athletes for increasing exercise capacity and lean body mass during training. It’s no wonder surveys show as many as 70+ percent of collegiate athletes have used creatine supplements. What can it do for older adults?
Without exercise? Nothing. Most studies on creatine supplementation alone show no benefits for muscle mass, strength, or performance. This makes sense, given the mechanism. Creatine supplementation delays muscle fatigue. This enables people to work out longer and harder, and it’s that additional volume and intensity that leads to the muscle benefits. So, creatine alone doesn’t help, and creatine taken in the context of the same training that’s carefully controlled and deliberately equalized doesn’t help either. But let people exercise as much as they can, and most studies on creatine supplementation for the prevention and treatment of sarcopenia (meaning age-related muscle loss) show augmented lean mass, as it does in young adults.
Adding three to five grams of creatine a day to two to three days of resistance training a week added an additional three extra pounds of lean mass over an average duration of about four months. Now, some of this lean mass may be water weight, not muscle. Creatine causes water retention that can show up as lean mass. But compared to placebo, creatine combined with resistance exercise increases muscle strength as well. And the additional gains in mass and strength can persist as long as 12 weeks after stopping the creatine in older adults, as long as the resistance training is maintained. So obviously, it’s not all just water weight.
A reason I never advocated for creatine supplementation in older adults for muscle preservation was because systematic reviews up through 2017 concluded that adding creatine to training shows mixed results for muscle mass and strength, and it did not appear to translate to improved functioning. However, an updated meta-analysis found a significant improvement over placebo in sit-to-stand test performance, which is a decent predictor of reduced falls risk. Again, this was mostly only when accompanied by strength training. There have still been no consistent benefits discovered for just supplementing with creatine alone. So, creatine should always be prescribed with a progressive strength training regimen.
The Society for Sarcopenia, Cachexia, and Wasting Disease convened an expert panel that, despite the lack of long-term trials, suggested creatine be indeed used for the management of sarcopenia. The recommended dose to achieve muscle saturation is three grams a day. Within a month at that slow steady rate, you achieve the same muscle levels as loading with 120 grams over a period of a week. Note, though, it takes at least 12 weeks of creatine-supplemented resistance training to see a significant additive effect. Recent evidence suggests taking it after exercise might be slightly preferable to before, but this has yet to be verified.
Are there any side effects? We’ll find out next.
Please consider volunteering to help out on the site.
- Balestrino M, Adriano E. Beyond sports: Efficacy and safety of creatine supplementation in pathological or paraphysiological conditions of brain and muscle. Med Res Rev. 2019;39(6):2427-2459.
- Blancquaert L, Baguet A, Bex T, et al. Changing to a vegetarian diet reduces the body creatine pool in omnivorous women, but appears not to affect carnitine and carnosine homeostasis: a randomised trial. Br J Nutr. 2018;119(7):759-770.
- Kraemer WJ, Beeler MK, Post EM, et al. Physiological basis for creatine supplementation in skeletal muscle and the central nervous system. In: Bagchi D, Nair S, Sen CK, eds. Nutrition and Enhanced Sports Performance. 2nd ed. Elsevier; 2019:581-594.
- Navrátil T, Kohlíková E, Petr M, Pelclová D, Heyrovský M, Přistoupilová K. Supplemented creatine induces changes in human metabolism of thiocompounds and one- and two-carbon units. Physiol Res. 2010;59(3):431-442.
- Yazigi Solis M, de Salles Painelli V, Giannini Artioli G, Roschel H, Concepción Otaduy M, Gualano B. Brain creatine depletion in vegetarians? A cross-sectional ¹H-magnetic resonance spectroscopy (¹h-mrs) study. Br J Nutr. 2014;111(7):1272-1274.
- Steenge GR, Verhoef P, Greenhaff PL. The effect of creatine and resistance training on plasma homocysteine concentration in healthy volunteers. Arch Intern Med. 2001;161(11):1455-1456.
- Shomrat A, Weinstein Y, Katz A. Effect of creatine feeding on maximal exercise performance in vegetarians. Eur J Appl Physiol. 2000;82(4):321-325.
- Beaudart C, Rabenda V, Simmons M, et al. Effects of protein, essential amino acids, b-hydroxy b-methylbutyrate, creatine, dehydroepiandrosterone and fatty acid supplementation on muscle mass, muscle strength and physical performance in older people aged 60 years and over. A systematic review on the literature. J Nutr Health Aging. 2018;22(1):117-130.
- Sumien N, Shetty RA, Gonzales EB. Creatine, creatine kinase, and aging. Subcell Biochem. 2018;90:145-168.
- Wu G. Important roles of dietary taurine, creatine, carnosine, anserine and 4-hydroxyproline in human nutrition and health. Amino Acids. 2020;52(3):329-360.
- Buford TW, Kreider RB, Stout JR, et al. International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr. 2007;4:6.
- Gualano B, Rawson ES, Candow DG, Chilibeck PD. Creatine supplementation in the aging population: effects on skeletal muscle, bone and brain. Amino Acids. 2016;48(8):1793-1805.
- Riesberg LA, Weed SA, McDonald TL, Eckerson JM, Drescher KM. Beyond muscles: The untapped potential of creatine. Int Immunopharmacol. 2016;37:31-42.
- Antonio J, Candow DG, Forbes SC, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021;18(1):13.
- Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access J Sports Med. 2017;8:213-226.
- Stares A, Bains M. The additive effects of creatine supplementation and exercise training in an aging population: a systematic review of randomized controlled trials. J Geriatr Phys Ther. 2020;43(2):99-112.
- Candow DG, Forbes SC, Chilibeck PD, Cornish SM, Antonio J, Kreider RB. Effectiveness of creatine supplementation on aging muscle and bone: focus on falls prevention and inflammation. J Clin Med. 2019;8(4):488.
- Dolan E, Artioli GG, Pereira RMR, Gualano B. Muscular atrophy and sarcopenia in the elderly: is there a role for creatine supplementation? Biomolecules. 2019;9(11):642.
- Morley JE, Argiles JM, Evans WJ, et al. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc. 2010;11(6):391-396.
- Hultman E, Söderlund K, Timmons JA, Cederblad G, Greenhaff PL. Muscle creatine loading in men. J Appl Physiol (1985). 1996;81(1):232-237.
- Ribeiro F, Longobardi I, Perim P, et al. Timing of creatine supplementation around exercise: a real concern? Nutrients. 2021;13(8):2844.
- Beaudart C, Dawson A, Shaw SC, et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int. 2017;28(6):1817-1833.
- Syrotuik DG, Bell GJ, Burnham R, Sim LL, Calvert RA, Maclean IM. Absolute and relative strength performance following creatine monohydrate supplementation combined with periodized resistance training. J Strength Cond Res. 2000;14(2):182-190.
- Candow DG, Chilibeck PD, Chad KE, Chrusch MJ, Davison KS, Burke DG. Effect of ceasing creatine supplementation while maintaining resistance training in older men. J Aging Phys Act. 2004;12(3):219-231.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Creatine is a compound formed naturally in the human body that is primarily involved in energy production in our muscles and brain. It’s also naturally formed in the bodies of many animals we eat, and so, when we eat their muscles, we can also take in some creatine through our diet. (It was named after kreas, the Greek word for “meat,” in which it was first isolated.) We need about two grams a day; so, those who eat meat may get like one gram from their diet, and their body makes the rest from scratch. There are rare birth defects where you’re born without the ability to make it, in which case you have to get it all externally through diet. But otherwise, our bodies can make as much as we need to maintain normal concentrations in our muscles.
When people cut out meat, the amount of creatine floating around in their bloodstream goes down. But the amount in your brain remains the same, because your brain just makes all the creatine it needs. The level in vegetarian muscles is lower, but that doesn’t seem to affect performance, as both vegetarians and meat-eaters respond to creatine supplementation with similar increases in muscle power output. And if vegetarian muscle creatine was insufficient, then presumably they would have seen an even bigger boost. So basically, when you eat meat, that just means your body doesn’t have to make as much.
If creatine muscle content dropped as we grew older, that might help explain age-related muscle loss. But that doesn’t seem to be the case. Biopsies taken from the muscles of young and old adults show no difference in creatine content. Still, if it improves performance, maybe it would help. According to the International Society of Sports Nutrition, creatine monohydrate is the single most effective ergogenic supplement available to athletes for increasing exercise capacity and lean body mass during training. It’s no wonder surveys show as many as 70+ percent of collegiate athletes have used creatine supplements. What can it do for older adults?
Without exercise? Nothing. Most studies on creatine supplementation alone show no benefits for muscle mass, strength, or performance. This makes sense, given the mechanism. Creatine supplementation delays muscle fatigue. This enables people to work out longer and harder, and it’s that additional volume and intensity that leads to the muscle benefits. So, creatine alone doesn’t help, and creatine taken in the context of the same training that’s carefully controlled and deliberately equalized doesn’t help either. But let people exercise as much as they can, and most studies on creatine supplementation for the prevention and treatment of sarcopenia (meaning age-related muscle loss) show augmented lean mass, as it does in young adults.
Adding three to five grams of creatine a day to two to three days of resistance training a week added an additional three extra pounds of lean mass over an average duration of about four months. Now, some of this lean mass may be water weight, not muscle. Creatine causes water retention that can show up as lean mass. But compared to placebo, creatine combined with resistance exercise increases muscle strength as well. And the additional gains in mass and strength can persist as long as 12 weeks after stopping the creatine in older adults, as long as the resistance training is maintained. So obviously, it’s not all just water weight.
A reason I never advocated for creatine supplementation in older adults for muscle preservation was because systematic reviews up through 2017 concluded that adding creatine to training shows mixed results for muscle mass and strength, and it did not appear to translate to improved functioning. However, an updated meta-analysis found a significant improvement over placebo in sit-to-stand test performance, which is a decent predictor of reduced falls risk. Again, this was mostly only when accompanied by strength training. There have still been no consistent benefits discovered for just supplementing with creatine alone. So, creatine should always be prescribed with a progressive strength training regimen.
The Society for Sarcopenia, Cachexia, and Wasting Disease convened an expert panel that, despite the lack of long-term trials, suggested creatine be indeed used for the management of sarcopenia. The recommended dose to achieve muscle saturation is three grams a day. Within a month at that slow steady rate, you achieve the same muscle levels as loading with 120 grams over a period of a week. Note, though, it takes at least 12 weeks of creatine-supplemented resistance training to see a significant additive effect. Recent evidence suggests taking it after exercise might be slightly preferable to before, but this has yet to be verified.
Are there any side effects? We’ll find out next.
Please consider volunteering to help out on the site.
- Balestrino M, Adriano E. Beyond sports: Efficacy and safety of creatine supplementation in pathological or paraphysiological conditions of brain and muscle. Med Res Rev. 2019;39(6):2427-2459.
- Blancquaert L, Baguet A, Bex T, et al. Changing to a vegetarian diet reduces the body creatine pool in omnivorous women, but appears not to affect carnitine and carnosine homeostasis: a randomised trial. Br J Nutr. 2018;119(7):759-770.
- Kraemer WJ, Beeler MK, Post EM, et al. Physiological basis for creatine supplementation in skeletal muscle and the central nervous system. In: Bagchi D, Nair S, Sen CK, eds. Nutrition and Enhanced Sports Performance. 2nd ed. Elsevier; 2019:581-594.
- Navrátil T, Kohlíková E, Petr M, Pelclová D, Heyrovský M, Přistoupilová K. Supplemented creatine induces changes in human metabolism of thiocompounds and one- and two-carbon units. Physiol Res. 2010;59(3):431-442.
- Yazigi Solis M, de Salles Painelli V, Giannini Artioli G, Roschel H, Concepción Otaduy M, Gualano B. Brain creatine depletion in vegetarians? A cross-sectional ¹H-magnetic resonance spectroscopy (¹h-mrs) study. Br J Nutr. 2014;111(7):1272-1274.
- Steenge GR, Verhoef P, Greenhaff PL. The effect of creatine and resistance training on plasma homocysteine concentration in healthy volunteers. Arch Intern Med. 2001;161(11):1455-1456.
- Shomrat A, Weinstein Y, Katz A. Effect of creatine feeding on maximal exercise performance in vegetarians. Eur J Appl Physiol. 2000;82(4):321-325.
- Beaudart C, Rabenda V, Simmons M, et al. Effects of protein, essential amino acids, b-hydroxy b-methylbutyrate, creatine, dehydroepiandrosterone and fatty acid supplementation on muscle mass, muscle strength and physical performance in older people aged 60 years and over. A systematic review on the literature. J Nutr Health Aging. 2018;22(1):117-130.
- Sumien N, Shetty RA, Gonzales EB. Creatine, creatine kinase, and aging. Subcell Biochem. 2018;90:145-168.
- Wu G. Important roles of dietary taurine, creatine, carnosine, anserine and 4-hydroxyproline in human nutrition and health. Amino Acids. 2020;52(3):329-360.
- Buford TW, Kreider RB, Stout JR, et al. International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr. 2007;4:6.
- Gualano B, Rawson ES, Candow DG, Chilibeck PD. Creatine supplementation in the aging population: effects on skeletal muscle, bone and brain. Amino Acids. 2016;48(8):1793-1805.
- Riesberg LA, Weed SA, McDonald TL, Eckerson JM, Drescher KM. Beyond muscles: The untapped potential of creatine. Int Immunopharmacol. 2016;37:31-42.
- Antonio J, Candow DG, Forbes SC, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021;18(1):13.
- Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access J Sports Med. 2017;8:213-226.
- Stares A, Bains M. The additive effects of creatine supplementation and exercise training in an aging population: a systematic review of randomized controlled trials. J Geriatr Phys Ther. 2020;43(2):99-112.
- Candow DG, Forbes SC, Chilibeck PD, Cornish SM, Antonio J, Kreider RB. Effectiveness of creatine supplementation on aging muscle and bone: focus on falls prevention and inflammation. J Clin Med. 2019;8(4):488.
- Dolan E, Artioli GG, Pereira RMR, Gualano B. Muscular atrophy and sarcopenia in the elderly: is there a role for creatine supplementation? Biomolecules. 2019;9(11):642.
- Morley JE, Argiles JM, Evans WJ, et al. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc. 2010;11(6):391-396.
- Hultman E, Söderlund K, Timmons JA, Cederblad G, Greenhaff PL. Muscle creatine loading in men. J Appl Physiol (1985). 1996;81(1):232-237.
- Ribeiro F, Longobardi I, Perim P, et al. Timing of creatine supplementation around exercise: a real concern? Nutrients. 2021;13(8):2844.
- Beaudart C, Dawson A, Shaw SC, et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int. 2017;28(6):1817-1833.
- Syrotuik DG, Bell GJ, Burnham R, Sim LL, Calvert RA, Maclean IM. Absolute and relative strength performance following creatine monohydrate supplementation combined with periodized resistance training. J Strength Cond Res. 2000;14(2):182-190.
- Candow DG, Chilibeck PD, Chad KE, Chrusch MJ, Davison KS, Burke DG. Effect of ceasing creatine supplementation while maintaining resistance training in older men. J Aging Phys Act. 2004;12(3):219-231.
Motion graphics by Avo Media
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What Is Creatine? Can It Treat Sarcopenia (Muscle Loss with Age)?
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Stay tuned for Are There Any Side Effects to Taking Creatine?, the follow-up video.
Learn about the connection between creatine and homocysteine in Should Vegetarians Take Creatine to Normalize Homocysteine? and The Efficacy and Safety of Creatine for High Homocysteine.
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