What the Latest Research Means for Your Clients
If you’ve been a personal trainer for any length of time, you’ll have fielded this question more than once. “Should I be taking creatine?” And for most of us, the answer has been fairly straightforward. Yes, it’s one of the most well-researched supplements on the market, it helps with strength and power output, it supports muscle recovery and it’s safe. Conversation over. Move on to the next set.
But over the past couple of years, the creatine research landscape has shifted dramatically. A string of high-quality studies published in 2025 and 2026 has expanded what we know about this supplement well beyond the weight room. We’re now looking at credible evidence linking creatine to improved cognitive function, better bone health, therapeutic potential in neurological conditions and specific benefits for women at different life stages. The old “it’s just for building muscle” no longer does justice to the data.
Many of us find our clients are increasingly interested in longevity, brain health and holistic wellbeing, not just aesthetics and strength numbers. Understanding what creatine can and cannot do beyond the gym floor puts you in a stronger position to give informed, evidence-based advice.
A Quick Refresher on What Creatine Actually Does
Before we take a look at this newer research, a quick recap for context. Creatine is a naturally occurring compound found primarily in skeletal muscle, with smaller amounts in the brain. The body makes about one to two grams per day from the amino acids arginine, glycine and methionine and we get additional creatine from dietary sources like red meat and fish. When you supplement with creatine monohydrate, you increase the intramuscular stores of phosphocreatine, which serves as a rapid energy buffer during high-intensity, short-duration activities. This is the mechanism behind its well-established benefits for strength, power and repeated sprint performance.
That much has been understood for decades. What’s newer is the growing recognition that creatine plays a significant role in energy metabolism well beyond skeletal muscle, particularly in the brain, bones and other metabolically active tissues.
The Brain: Getting Creatine Past the Blood-Brain Barrier
An exciting development in creatine research is the emerging evidence around cognitive function. The brain accounts for roughly 20 per cent of the body’s total energy expenditure despite making up only about two per cent of body mass. It is an incredibly energy-hungry organ and creatine plays a role in cerebral energy homeostasis through the same phosphocreatine shuttle system that operates in muscle.
The challenge however has always been getting supplemental creatine into the brain. Creatine uptake into the central nervous system is regulated by the creatine transporter SLC6A8, which operates near saturation at the blood-brain barrier. This means the brain doesn’t absorb creatine as readily as muscle tissue does and researchers have debated whether oral supplementation can meaningfully increase brain creatine levels at all.
A landmark study published in 2025, the CONCRET-MENOPA trial, provided some of the strongest evidence to date. Korovljev and colleagues conducted a randomised controlled trial in 36 perimenopausal and menopausal women, testing different doses of creatine hydrochloride over eight weeks. The medium-dose group (1,500 mg per day) showed a 16.4 per cent increase in frontal brain creatine levels compared to placebo, along with significantly improved reaction time and favourable changes in serum lipid profiles (Korovljev et al., 2025). That’s a sizable increase from a relatively modest dose, and it suggests that the blood-brain barrier, while selective, is not an impenetrable wall when it comes to creatine.
The cognitive benefits aren’t limited to menopausal women. A comprehensive meta-analysis published in Frontiers in Nutrition, covering 16 randomised controlled trials with 492 participants aged 20 to 76, found that creatine supplementation produced significant improvements in memory, attention and processing speed (Xu et al., 2024). The benefits were more pronounced in females, individuals with clinical conditions and those aged 18 to 60.
Meanwhile, two pilot trials in patients with Alzheimer’s disease used higher doses of 20 grams per day for eight weeks and reported improvements in total cognition, fluid cognition, working memory and oral reading recognition, alongside an average 11 per cent increase in brain creatine concentration. Eighty-five per cent of participants showed measurable increases in brain creatine levels, though individual variability was notable (Forbes et al., 2025).
Candow and colleagues published an important review in 2026 titled “Creatine Supplementation and the Brain: Have We Put the Cart Before the Horse?” which urged caution alongside the optimism. They acknowledged the promising signals but highlighted that measurement of brain creatine using magnetic resonance spectroscopy is highly sensitive to methodological variables and that standardised supplementation protocols for cognitive outcomes have not yet been established (Candow et al., 2026). In other words, the direction of travel is encouraging but we’re not yet at the point of definitive clinical recommendations for brain health.
What does this mean practically? Creatine supplementation appears to have genuine potential for supporting cognitive function, particularly during periods of metabolic stress such as sleep deprivation, mental fatigue and hypoxia. For personal trainers working with clients who are managing high-stress lifestyles, shift work or cognitive demands alongside their training, creatine’s brain benefits are worth discussing. It’s not a miracle pill for cognition, but it may be a useful piece of the puzzle.
Women’s Health: A Supplement That’s Been Overlooked
Creatine has historically been marketed almost exclusively towards men and much of the early research was conducted in male populations. That’s changed significantly. A major 2025 paper published in the Journal of the International Society of Sports Nutrition by Smith-Ryan and colleagues reviewed creatine’s role across the female lifespan, from menstruation through pregnancy to menopause, and these findings are also compelling.
The main headline figure is noteworthy: females exhibit 70 to 80 per cent lower endogenous creatine stores compared to males. This is partly due to lower dietary intake (women tend to eat less red meat), partly hormonal and partly related to lower muscle mass. The consequence is that women may actually stand to benefit more from supplementation than men in relative terms (Smith-Ryan et al., 2025).
The review highlighted several key points across the lifespan. During the menstrual cycle, hormonal fluctuations affect creatine kinetics and phosphocreatine resynthesis. Supplementation may help buffer some of the performance variability that female athletes and active clients experience across their cycle. During pregnancy and the postpartum period, creatine demand increases significantly due to the energy requirements of foetal development and lactation. While research in this area is still emerging, preclinical evidence suggests potential neuroprotective benefits for the developing foetus.
The menopause data is particularly relevant given the ageing demographics of many personal training client bases. The CONCRET-MENOPA trial mentioned earlier showed that creatine supplementation in perimenopausal and menopausal women improved reaction time, increased brain creatine, improved lipid profiles and showed a trend towards reducing mood swing severity (Korovljev et al., 2025). Combine this with the evidence that postmenopausal women may experience benefits in skeletal muscle size and function from higher-dose creatine supplementation along with the favourable effects on bone density when combined with resistance training, and you have a strong case for discussing creatine with female clients in this age group.
For personal trainer course students and qualified trainers alike, the main point here is that creatine is not a “men’s supplement.” The evidence now supports its consideration across the female lifespan and being able to have an informed conversation about this with female clients is a genuine differentiator.
Bone Health and Healthy Ageing
The ageing population represents one of the fastest-growing client demographics for personal trainers and the research on creatine and healthy ageing has matured considerably.
Candow, Ostojic and colleagues published a comprehensive position statement in the Journal of the International Society of Sports Nutrition (JISSN) in 2025, reviewing the evidence for creatine monohydrate supplementation in older adults and clinical populations (Candow et al., 2025). The findings paint a broad and encouraging picture.
When combined with resistance training, creatine supplementation in older adults has been shown to improve whole-body lean body mass, regional muscle size, upper-body and lower-body strength, bone area and thickness, functional ability (including sit-to-stand performance), glucose kinetics and measures of cognition and memory.
On bone health specifically, the evidence is promising but nuanced. Creatine supplementation enhances osteoblast differentiation and activity in laboratory studies, stimulating bone matrix production and mineralisation. In human trials, a study in postmenopausal women found that those supplementing with creatine at 0.1 grams per kilogram per day during a one-year resistance training programme lost only 1.2 per cent bone mineral density at the femoral neck, compared to a 3.9 per cent loss in the placebo group. However, the effects on total body bone mineral density have been less consistent and more research is needed to establish optimal protocols.
The practical implications for personal trainers working with older clients are significant. Creatine supplementation, when paired with a well-designed resistance training programme, may offer additive benefits for combating sarcopenia, supporting bone health and maintaining functional independence. The JISSN position statement (Candow et al., 2025) specifically noted applications for treating age-related sarcopenia, osteoporosis, frailty and metabolic disorders.
Dosing in this population is pretty straightforward. The evidence supports either a loading phase of 20 grams per day for five to seven days followed by five to seven grams per day, or simply starting with five to seven grams per day (approximately 0.1 grams per kilogram of body weight). The additive effects on muscle strength during exercise training are most consistently observed with supplementation durations exceeding 12 weeks.
The Safety Question: 685 Trials, One Clear Answer
If there’s one area where personal trainers need to be rock-solid in their knowledge, it’s safety. Creatine has been dogged by myths about kidney damage, liver problems, dehydration and hair loss for years. A comprehensive safety analysis published in the Journal of the International Society of Sports Nutrition in 2025 should put most of these concerns to rest once and for all (Kreider et al., 2025).
The study evaluated side effects reported across 685 human clinical trials, encompassing 12,839 participants taking creatine and 13,452 participants taking placebos. The results were unambiguous. Side effects were reported in 13.7 per cent of creatine studies versus 13.2 per cent of placebo studies, with no statistically significant difference between groups across all 35 side effect categories evaluated.
Let’s address the specific myths:
Kidney damage. A 2025 meta-analysis found that creatine supplementation was associated with a small but statistically significant increase in serum creatinine of 0.07 micromoles per litre. This is a known and expected effect because creatine is metabolised to creatinine, but it is not indicative of kidney damage. Markers of actual renal function remain unaffected. The International Society of Sports Nutrition has confirmed that creatine monohydrate does not harm kidney function in healthy individuals.
Liver problems. The large 2025 safety analysis found no increased incidence of elevated liver enzymes or liver problems in creatine groups compared to placebo.
Dehydration and cramping. Based on current evidence, creatine does not cause dehydration or cramping. It may actually protect against these conditions by increasing intracellular water content.
Gastrointestinal issues. The analysis showed that 4.9 per cent of creatine studies reported gastrointestinal issues compared to 4.3 per cent of placebo studies. When evaluated by participant numbers rather than study counts, the difference was not significant.
Hair loss. The 685-trial analysis did not identify hair loss as a consistent or specific side effect of creatine compared to placebo.
The study’s conclusion makes it pretty clear that the claims that creatine supplementation increases the risk of untoward side effects are unfounded. The average dose across the trials was approximately 12.5 grams per day over study durations extending up to 14 years, with no serious adverse effects.
For fitness professionals, this data should give you the confidence to discuss creatine supplementation without hedging. The caveat, as always, is that individuals with pre-existing kidney or liver conditions should consult their GP before starting any new supplement and creatine supplementation should not replace medical advice. But for the general healthy population, the safety profile is exceptionally well established.
Emerging Dosing Guidance: Is More Better?
The traditional creatine recommendation has been straightforward: either load with 20 grams per day for five to seven days then maintain at three to five grams per day, or simply take three to five grams per day indefinitely. This protocol reliably saturates intramuscular creatine stores within a few weeks and has been the go-to advice for decades.
However, the expanding evidence base for creatine’s effects beyond muscle is driving a rethinking of optimal dosing. Researchers at SupplySide Global 2025, including leading creatine scientists, advocated for higher daily doses of eight to ten grams to achieve full-body benefits, particularly for cognition, bone density and healthy ageing.
The logic is physiologically sound. If the creatine transporter at the blood-brain barrier operates near saturation, higher circulating levels of creatine may be needed to drive meaningful uptake into the brain. The Alzheimer’s trials used 20 grams per day. The CONCRET-MENOPA trial achieved significant brain creatine increases with just 1,500 milligrams of creatine hydrochloride (which has higher bioavailability per gram than monohydrate). The JISSN position statement for older adults recommended five to seven grams per day for musculoskeletal benefits.
A reasonable synthesis of the current evidence might look like this for different client goals:
| Client Goal | Suggested Daily Dose | Duration | Notes |
|---|---|---|---|
| Muscle strength and performance | 3–5 g/day (or load: 20 g/day for 5–7 days then 5 g/day) | Ongoing | Well-established protocol. Creatine monohydrate remains the gold standard. |
| Older adults (muscle, bone, function) | 5–7 g/day (≈0.1 g/kg) | 12+ weeks alongside resistance training | JISSN 2025 recommendation. Benefits compound over time. |
| Cognitive support and brain health | 8–10 g/day | Ongoing | Emerging recommendation. Higher doses may be needed to overcome blood-brain barrier transport limitations. |
| Women (general health, menopause) | 3–5 g/day (up to 5–7 g/day for postmenopausal women) | Ongoing | Particularly relevant given lower endogenous stores. Combine with resistance training for bone benefits |
It’s worth noting that creatine monohydrate remains the most extensively researched form and the one recommended by the JISSN. While other forms such as creatine hydrochloride exist and show promise in specific trials, they do not yet have the same depth of evidence.
What This Means for Your Practice
The creatine conversation with clients has evolved from a simple “yes, take five grams a day for your training” into something more nuanced and more valuable. Here are the practical tips for fitness professionals:
First, broaden the conversation. Creatine is no longer just a muscle supplement. When clients ask about it, you can now discuss its potential benefits for brain health, bone density, healthy ageing and women’s health. This positions you as a knowledgeable, up-to-date professional rather than someone who simply echoes decade-old advice.
Second, be confident on safety. The 685-trial safety analysis gives you an evidence base that is difficult to argue with. You can reassure clients that creatine monohydrate is one of the most thoroughly studied supplements in existence, with no meaningful increase in adverse effects compared to placebo across nearly 13,000 participants.
Third, tailor the dose to the goal. The days of one-size-fits-all creatine advice are fading. An 18-year-old male rugby player and a 55-year-old female client focused on bone health and cognitive sharpness may both benefit from creatine, but the rationale and potentially the dose will differ.
Fourth, don’t overstate the brain benefits. The cognitive research is genuinely exciting but it’s still in its early stages. Improvements have been demonstrated, particularly under metabolic stress, but we don’t yet have standardised protocols for cognitive outcomes. Be honest about where the science is and where it’s heading.
Fifth, consider the female client base. Given that women have 70 to 80 per cent lower endogenous creatine stores and may experience specific benefits during menstruation, pregnancy and menopause, creatine supplementation is a conversation worth having with female clients who may have previously dismissed it as “not for them.”
Reference
- Korovljev, D., Ostojic, J., Panic, J., Ranisavljev, M., Todorovic, N., Nedeljkovic, D., Kuzmanovic, J., Vranes, M., Stajer, V. and Ostojic, S.M. (2025). The Effects of 8-Week Creatine Hydrochloride and Creatine Ethyl Ester Supplementation on Cognition, Clinical Outcomes, and Brain Creatine Levels in Perimenopausal and Menopausal Women (CONCRET-MENOPA): A Randomized Controlled Trial. Journal of the American Nutrition Association, 45(3), 199–210. Click here to review the full research article.
- Xu, C., Bi, S., Zhang, W. and Luo, L. (2024). The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis. Frontiers in Nutrition, 11, 1424972. Click here to review the full research article.
- Forbes, S.C., Candow, D.G. and Bhullar, A. (2025). Creatine Monohydrate Supplementation for Alzheimer’s Disease. Alzheimer’s and Dementia, 21(S10). Click here to review the full research article.
- Candow, D.G., Pratt, J. et al. (2026). Creatine Supplementation and the Brain: Have We Put the Cart Before the Horse? Sports Medicine. Click here to review the full research article.
- Smith-Ryan, A.E. et al. (2025). Creatine in women’s health: bridging the gap from menstruation through pregnancy to menopause. Journal of the International Society of Sports Nutrition, 22(1). Click here to review the full research article.
- Candow, D.G., Ostojic, S.M. et al. (2025). Creatine monohydrate supplementation for older adults and clinical populations. Journal of the International Society of Sports Nutrition, 22(1). Click here to review the full research article.
- Kreider, R.B. et al. (2025). Safety of creatine supplementation: analysis of the prevalence of reported side effects in clinical trials and adverse event reports. Journal of the International Society of Sports Nutrition, 22(1). Click here to review the full research article.
Supporting Female Clients at Every Stage
The research in this article highlights just how much the conversation around women’s health and fitness is evolving. From creatine’s role during the menstrual cycle to its potential benefits through pregnancy and menopause, there is a growing body of evidence that demands a more informed approach from fitness professionals. If you work with female clients, and that’s most trainers, having the knowledge to address these areas with confidence is becoming essential.
The TRAINFITNESS Women’s Health and Exercise Specialist and Master Diplomas™ are designed for exactly this. You’ll cover ante and postnatal exercise, menopause and exercise, pelvic floor considerations and much more. Whether you’re a newly qualified PT or an experienced trainer looking to specialise, these CIMSPA-recognised diplomas give you the tools to support female clients at every stage of life.
Women’s Health & Exercise Specialist/Master™ – Distance Study, In-Person & Live-Virtual
Take Your Nutrition Knowledge Further
The research on creatine is a perfect example of why staying current with nutritional science is so important. The supplements we recommend to clients today should reflect the evidence of today, not the assumptions of ten years ago. Creatine is one such supplement. Imagine how many other conversations you could be having with clients about protein timing, micronutrient status, hydration strategies and dietary periodisation if you had the depth of knowledge to back it up.
If you’re ready to take your nutritional knowledge to the next level, the TRAINFITNESS Level 4 Nutrition course gives you the skills and credentials to offer evidence-based dietary advice as part of your personal training service. Designed for qualified personal trainers, this CIMSPA-recognised course covers everything from macronutrient science to behaviour change strategies, giving you the tools to genuinely transform your clients’ results.
Nutrition Coach Course – Distance Study
