Supplemental creatine monohydrate has been on the market for 20 years. The good news is that hundreds of studies report that supplemental creatine improves performance in short duration maximal intensity exercise. Weight training benefits the most from supplemental creatine; both strength and lean body mass increases are maximized. Supplementation also benefits sports requiring repeated short bursts of intense activity and superior muscularity including football, rugby, and gymnastics.

Creatine with a phosphate group (phosphocreatine) replenishes energy stores in muscles during maximal intensity short duration exercise. Fast twitch (Type II) muscle fibers use more creatine than Type I. Adenosine triphosphate (ATP) is the molecule that powers muscular contraction. Biochemical energy for muscular contraction is derived by the loss of phosphate group to form adenosine diphosphate (ADP); phosphocreatine then reprimes ADP to ATP for the next contraction.

The bad news is that after 20 years creatine remains mainly sold to young men who weight train or play football. It is not marketed well to vegetarians, athletic women, or older people.

Creatine is synthesized by our liver and naturally ingested from omnivorous diets. Red meat has the highest levels of creatine, followed by white meat and fish; creatine is absent from plant foods, eggs, and dairy products. Vegetarians and especially vegan athletes can have such low levels of creatine that maximal performance is unattainable.

Couple low creatine with low iron, zinc, calcium, and carnitine from an unsupplemented vegan diet and you have females—young and old—whose chronic fatigue prevents them from working out with much intensity or regularity. Supplemental creatine monohydrate is nearly 100 percent absorbed when taken with a small amount of sugar as a beverage. It has no side effects other than weight gain, which--ahem!—is the point of the exercise. Other forms of supplemental creatine do not provide better results and cost more.

As both men and women age they unavoidably lose muscle mass. Severe muscle loss, (sarcopenia) causes significant impairments in daily activities and balance/coordination, which greatly increases the risk for falls. With sarcopenia mostly Type II muscle fibers atrophy, which are the type that respond best to weight training and creatine supplementation.

Sarcopenia can avoided (or deferred) by men and women with regular resistance training and creatine and protein supplementation. Further, brain activity also utilizes the ADP-ATP energy cycle. In older people, creatine supplementation has been linked to better cognitive processing and quality of sleep. While it’s thought that the brain synthesizes much of its creatine, and thus does not rely on dietary sources as much as the muscles, I believe the next frontier with this supplement will be its effect on “brain fatigue.”