Creatine, Menopause and the Brain: Why More Is Not Always Better

No. Dr. Rose says most women have either never heard of creatine or assume it belongs to men and to people trying to bulk up. She describes it as a naturally occurring compound built from three amino acids, arginine, glycine and methionine, stored mostly in skeletal muscle as phosphocreatine and used to regenerate ATP, the energy your cells run on. Muscle, brain and heart are all high demand tissues, and she says creatine fuels all three. She says she talks about creatine with many of her female patients.

Creatine pulls water into muscle, so the number on the scale can rise early on. Dr. Rose says that is water and lean mass, not body fat. The episode describes it as a one or two time shift while the muscles fill with water, and one that does not last long. It is also why she prefers an InBody scan to a bathroom scale: the scan breaks the number into lean mass, water weight and body fat, which she says tells you far more than one number on a scale.

Dr. Rose names people with known kidney disease, and people whose kidney labs have come back abnormal while their medical team is still working out why. She generally does not recommend creatine for women who are pregnant or breastfeeding, and she is careful with certain complex medical conditions, often because the medications involved are already taxing the kidneys. She also counsels people down from the very large doses some of them started after seeing something online.

Dr. Rose says she gets this question a lot, because the two words look so similar that people often confuse them. Creatinine is a marker on the basic kidney panel she includes in the labs she orders, part of the regular monitoring she does with patients, and it is not a measure of the creatine someone is taking. She says people often assume she is measuring creatine in the blood when she is not. Anyone with a known kidney condition, she says, should have that conversation with a provider before starting.

More is not always better, according to Dr. Rose. She says the right amount depends on the person's goals, what they tolerate, their body size, kidney history, how much they already get through food, and their training. She generally recommends creatine monohydrate from a brand that clearly states it has been third-party tested, and she usually starts people lower than the amount they plan to reach, because a full dose straight away can be more than the gut will tolerate. Hydration has to be optimal alongside it, and she says anyone who struggles to drink enough water should not be on a high dose.

Dr. Rose does not give patients a specific time of day. Host Brian, who takes this question in the episode, says it does not matter much as long as you take it regularly. On form, Dr. Rose says powder and capsules are the same product and mostly it comes down to what is easier for you, though she would rather have one scoop in a large glass of water than four to eight capsules, and she thinks powder may push you to drink more water. She also points out that creatine has roughly a three hour window once it is mixed, so a smoothie made the night before will not give you the same benefit.