Creatine Supplementation Beyond Athletics: Benefits of Different Types of Creatine for Women, Vegans, and Clinical Populations-A Narrative Review

Abstract

Creatine monohydrate supplementation is widely used by athletes in high-intensity, power-based sports due to its ability to enhance short-term performance by increasing intramuscular phosphocreatine (PCr) stores, which aid in ATP resynthesis during intense muscle contractions. However, emerging evidence suggests that creatine monohydrate offers benefits beyond athletic performance. This narrative review explores the literature supporting the advantages of creatine supplementation in women, vegans, and clinical populations. In women, who typically have lower baseline intramuscular creatine levels, supplementation may help alleviate fatigue-related symptoms associated with the menstrual cycle, particularly during the early follicular and luteal phases. For vegans and vegetarians, who often have reduced creatine stores due to the absence of creatine-rich animal products in their diet, supplementation can improve both physical and cognitive performance while supporting adherence to plant-based diets. Additionally, creatine supplementation holds potential for various clinical populations. It may mitigate muscle wasting in conditions such as sarcopenia and cachexia, support neuroprotection in neurodegenerative diseases such as Parkinson's and Huntington's, improve exercise capacity in cardiovascular diseases, and enhance energy metabolism in chronic fatigue syndrome. Creatine may also aid recovery from traumatic brain injury by promoting brain energy metabolism and reducing neuronal damage. In conclusion, creatine monohydrate supplementation can enhance physical performance, cognitive function, and overall health in women, vegans, and clinical populations by addressing creatine deficiencies, improving energy metabolism, and supporting recovery from physical and neurological challenges. Most available evidence supports the effectiveness of creatine monohydrate, which should be considered the preferred form of creatine supplementation over other variants. Additionally, proper creatine dosing is essential to maximize benefits and minimize potential adverse effects that may arise from chronic ingestion of excessively high doses.

Keywords: creatine kinase; dietary supplementation; energy metabolism; exercise performance; plant-based diets.

Figure 1

Creatine synthesis, reuptake, and excretion. (1) Creatine is synthesized from L-arginine and glycine in the liver, kidney, and pancreas with the help of L-arginine:glycine amidinotransferase (AGAT) in a first step, and through guanidinoacetate N-methyltransferase (GAMT) in a second step. (2) Creatine is released into the circulation and transported to varying tissues such as skeletal muscle and the brain. Once in the cell, creatine can be transformed into phosphocreatine by creatine kinase (CK). The high-energy stores of phosphocreatine can be used within the cell for ATP-dependent processes via ATPase enzymes. Both creatine and phosphocreatine are naturally metabolized into creatinine via a non-enzymatic reaction. (3) Creatinine diffuses freely into the circulation to be transported to the kidney, and it is finally excreted in the urine.

Figure 2

Graphical representation of the amount of creatine present within the blood circulation and within tissues through foods (normal diet) or with the use of dietary supplements of creatine (with creatine supplementation). The ingestion of dietary supplements with creatine produces higher serum creatine concentrations than the use of foods. Cellular uptake of creatine from the circulation is mediated by a creatine transporter known as SLC6A8. A higher serum creatine concentration implies a higher saturation of creatine within muscles, which in turn allows higher rates of ATP resynthesis.

Figure 3

Infographic of the benefits of creatine supplementation in women, vegans, and clinical populations.