Bodybuilders love this supplement. Should older adults take it too?

San Francisco Chronicle​

18-05-2025

Creatine, once thought of as strictly for bodybuilders and gym enthusiasts, may benefit a much broader swath of the population, especially older adults.
Creatine is produced naturally in the body and increasingly becoming mainstream as a supplement. Some doctors are warming to the idea of recommending low daily doses of creatine to older patients looking to preserve muscle strength.
Creatine is a compound that is produced in small amounts in the liver and kidneys, and is found in red meat and fish. When metabolized, creatine helps make ATP (adenosine triphosphate), a main energy source in cells.
Many athletes take creatine for its 'energy-granting' benefits, particularly for short, explosive movements like HIIT (high-intensity interval training) and sprints.
Studies show that when paired with resistance training, creatine supplements can increase muscle strength and endurance, prevent or reduce injury, promote muscle recovery and increase lean body mass.
'That's a good thing,' said Dr. Michael Fredericson, a Stanford sports medicine specialist who recommends people of all ages take a low dose of creatine, between three to five grams a day.
More recently, studies have found it may also help prevent sarcopenia — muscle loss that starts around age 30, worsens with age, and can increase risk of falls among older adults.
One 2015 meta-analysis found that 357 elderly adults with an average age of 64 who did 12 weeks of resistance training and supplemented their diet with creatine saw greater gains in muscle mass, strength and function. A 2014 meta-analysis similarly found that 405 elderly adults with an average age of 64 saw greater gains in muscle mass and upper body strength with creatine supplementation during resistance training compared to training alone.
'In the same way it can help boost muscle-building for people trying to get bulky, it's thought it can prevent sarcopenia in older adults who are not trying to bulk up,' said Dr. Linda Shiue, an internal medicine physician and director of culinary and lifestyle medicine at Kaiser Permanente in San Francisco.
Fredericson, who himself takes three grams of creatine each day, said he 'really recommends it for people once you get past 50, definitely past 60, because you're starting to lose muscle mass.'
'Creatine supplementation, along with resistance training, is safe, simple to do and it's one of the best things you can do in terms of maintaining your muscle mass,' he said.
More recent research is emerging that suggests creatine may also benefit cognitive function, including processing and short-term memory after sleep deprivation, Parkinson's and dementia. But those findings are considered preliminary and not definitive enough to make recommendations to patients to take it for these reasons, experts said.
Shiue, a longtime primary care physician who generally does not recommend a lot of supplements to her patients, said she is considering recommending a small dose to her elderly patients and parents for the muscle-preserving potential, since many older adults have a hard time consuming enough protein to preserve muscle mass.
'I'm not a big supplement recommender,' she said. 'I find that people want to take a lot more supplements and I usually pare them down. But this is one I'm going to think about a little bit more because of its safety profile and because studies have been done in humans, and the benefit to harm ratio seems really very good.'
While creatine is considered safe, some side effects may include weight gain and stomach upset.
Creatine is found in meat and fish, but it's hard to get enough from diet alone, especially since people should be careful about eating too much meat, Fredericson said. And vegetarians don't get it through diet because plant products do not contain creatine.
'If you're a vegetarian athlete, that might be the subset that could really use it, besides the elderly,' Shiue said.
If you're considering creatine supplements, experts say to look for a formulation called creatine monohydrate, read the label to make sure there aren't additives you're not looking for, and look for third-party verification by NSF or USP. These groups conduct safety testing for dietary supplements.
Scientists previously thought that people with kidney disease should not take creatine, but those concerns have more recently been disproven. Still, experts say if you have a history of kidney problems, talk to your doctor first before starting creatine supplements.