Creatine: Foundational for the Body. Plus, Benefits for the Brain?

Creatine is widely accepted as one of the most efficacious, safe, popular and cost-effective ways to boost athletic performance.

A 2017 review by the International Society of Sports Nutrition (ISSN) named creatine monohydrate the most effective dietary supplement available to athletes aiming to improve high-intensity exercise capacity and lean body mass while training (Kreider et al., 2017). It likewise cited enhanced recovery, injury prevention, heat tolerance, rehabilitation, and brain and spinal cord neuroprotection as added applications for increased performance (Kreider et al., 2017).

Despite the robust collection of evidence and available information on creatine supplementation, gaps in understanding its benefits and uses continue to exist within various performance-minded populations. These include high-performance athletes, master’s athletes, “weekend warriors,” and individuals who move their bodies but do not identify as athletes at all!

Confounding this knowledge gap is a growing body of research on creatine and cognition. Like performance, “cognition” casts a wide net. The American Psychological Association (APA) (2024) defines cognition as all forms of knowing and awareness. This includes perceiving, conceiving, remembering, reasoning, judging, imagining and problem solving.

Current studies on creatine supplementation and cognition look at outcomes related to everything from neurodegenerative diseases like Alzheimer’s and Parkinson’s to traumatic brain injury’s including concussions. Most relevant for the healthy active and aging adult are studies considering the impact of creatine supplementation on basic cognitive functioning such as attention, decision making and memory.

Knowing the full scope of potential application, how then, as reader, do I know if creatine supplementation could be helpful for me?

In the spirit of appealing to both the athlete striving for performance gains and the active individual striving for whole health, let us look at some key findings in each category.

Creatine for Athletic Performance

Hypertrophy

In Peak, Dr. Marc Bubbs refers to creatine as “the most proven strategy to support training, performance, and lean muscle gains” (Bubbs, 2019, p. 102). He describes how it impacts the proteins and growth factors that help support muscle growth and refers to it as “head and shoulders above other supplements when it comes to hypertrophy and athletic support” (Bubbs, 2019, p. 102). In short, creatine for hypertrophy: Check.

Recovery

Not interested in lean gains or muscle growth? A later chapter reveals that creatine accelerates recovery. From a physiological perspective, post-training recovery-related benefits include 1) enhanced capacity to refuel, 2) increased muscle protein synthesis, 3) stimulated genetic growth factors, and 4) decreased muscle damage and inflammation from exercise (Bubbs, 2019).

Practically, reductions in muscle damage and inflammation alone mean greater capacity to compete fresh and train more effectively. Considering the scheduling demands in scholastic, collegiate and elite categories in sport, this outcome holds weight.

The Female Athlete

A final finding worth noting is that creatine, along with iron, was identified as “highly efficacious for female athletes” in a 2023 position stand on female athlete nutritional considerations compiled by the ISSN (Sims et al., 2023). The paper points to ergogenic benefits from both short- and long-term supplementation in both trained and untrained female populations (Sims et al., 2023). It also cites improved bone health, mental health and skeletal muscle size and function in post-menopausal female populations (Sims et al., 2023).

Given the sheer range and volume of nutritional and therapeutic supplements available, it is compelling that the ISSN specifically pointed to creatine as advantageous for the female athlete.

Creatine for Cognitive Performance

When we pivot to cognition, a 2023 review article called, “‘Heads Up’ for Creatine Supplementation and its Potential Applications for Brain Health and Function” appears to offer the most recent and comprehensive compilation of findings. For the healthy, active adult, the paper highlights how creatine supplementation can “improve cognition and memory, especially in older adults or during times of metabolic stress” (Candow et al., 2023, p. 49).

This type of finding should have big impact. Separate from the risks and concerns about cognitive decline in older adults, everyone—young and old, athlete and non-athlete—experiences waves and varying degrees of life stress. In the review article, Candow et al. (2023) use sleep deprivation and mental fatigue to exemplify metabolic stress. Yet stress manifests in relation to everything from exercise to nutrient gaps to emotional and spiritual strain.

Given that creatine is safe and accessible and now shows promise if not clear outcomes for positively influencing cognition, I wonder…

Will we start seeing it among the broad supplementary recommendations for good health? Will we eventually consider it a staple similar to high-quality multivitamins, high-quality fish-oil, vitamin D3, and antioxidants and mineral support (Murray & Pizzorno, 2012)?

Author’s Note

Hello, my friends! Creatine. I’ve got to say that I pored over this post, and even after review upon review—reading, rereading and revisiting the literature time and again—I continue to feel less than satisfied with the outcome.

Throughout the process, I found myself wanting to appeal to my parents and peers. Writing for two generations proved challenging. While there is clearly some overlap, there are also definitive differences in exercise goals, health goals, and health and wellbeing concerns.

Second, I confess: I was partly drawn to creatine and cognition because the topic is trending. Creatine has long been a personal staple, but I have always thought of it as performance and recovery support.

Today, we increasingly see creatine monohydrate discussed in relation to cognition. I was curious: What was behind this “new” benefit? What was prompting these brain health and cognitive performance-based claims?

I found that the science is far from straightforward.

Studies and Science

As we saw earlier, studies looking at creatine and cognition are incredibly wide-ranging. When we see new research findings, or headlines and product labels linking creatine supplementation to brain health, we must know that layers exist underneath.

The goals of supplementation and the state of the brain in someone recovering from a concussion is different than in someone suffering from sleep deprivation or at risk for a neurodegenerative disease. Likewise, nutrient gaps and natural brain creatine stores will look different in vegan, vegetarian and omnivore populations. Each of these variables (and more) impact findings and efficacy claims.

So…

Where does this leave us? What does that mean?

Well, my friend, that is up to you to conclude! Is creatine monohydrate supplementation the right fit for you?

I Would Love to Hear from You!

What did you find most surprising? What piqued your interest? And what links or gaps did you see?

How do you think about cognitive function? How do you do to take care of your brain?

As always, thank you for reading! Cheers to a great week ahead!

References

American Psychological Association. (2024). Cognition and the brain. https://www.apa.org/topics/cognition-brain

Bubbs, M. (2019). Peak: The New Science of Athletic Performance That Is Revolutionizing Sport. Chelsea Green Publishing.

Candow, D. G., Forbes, S. C., Ostojic, S. M., Prokopidis, K., Stock, M. S., Harmon, K. K., & Faulkner, P. (2023). “Heads Up” for Creatine Supplementation and its Potential Applications for Brain Health and Function. Sports medicine (Auckland, N.Z.), 53(Suppl 1), 49–65. https://doi.org/10.1007/s40279-023-01870-9

Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., Candow, D. G., Kleiner, S. M., Almada, A. L., & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14, 18. https://doi.org/10.1186/s12970-017-0173-z

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine (3rd ed.). Atria Books.

Sims, S. T., Kerksick, C. M., Smith-Ryan, A. E., Janse de Jonge, X. A. K., Hirsch, K. R., Arent, S. M., Hewlings, S. J., Kleiner, S. M., Bustillo, E., Tartar, J. L., Starratt, V. G., Kreider, R. B., Greenwalt, C., Rentería, L. I., Ormsbee, M. J., VanDusseldorp, T. A., Campbell, B. I., Kalman, D. S., & Antonio, J. (2023). International society of sports nutrition position stand: nutritional concerns of the female athlete. Journal of the International Society of Sports Nutrition, 20(1), 2204066. https://doi.org/10.1080/15502783.2023.2204066