Creatine: A Review of Mechanism and Effects on Muscle and the Brain

Creatine: A Review of Mechanism and Effects on Muscle and the Brain

I’ve been asked about creatine supplementation by a few different clients over the past couple of weeks. It was time for me to brush up and I decided to share what I found in this review. Below I discuss the mechanism of action and relevant physiology, effects on muscle health and strength, brain function and performance, safety, and dosing information.

How It Works

Creatine is a precursor to creatine phosphate (CP) which acts as a quick energy reserve, helping regenerate ATP, the body’s primary energy source. Creatine is normally present in muscle cells. Supplementation leads to higher intracellular levels, muscle growth (mostly by drawing water into cells), and reducing protein breakdown. Increased muscle size and substrate availability translates to increased strength, power, and faster recovery.

Although neurons and muscle cells have much different jobs, they use the same energy currency. Higher CP levels in neurons have been shown to correlate with increased memory, learning, and mental endurance. The brain comprises 2% of body weight but accounts for 25% of energy demand, so it makes sense that a little support to the massive metabolic activity of the brain has trickle down effects on cognitive performance.

Safety

Often touted as 'the single most researched supplement', research consistently confirms that creatine is safe in healthy individuals. Creatine is metabolized into creatinine (a marker of kidney function that may be elevated in those with kidney disease) which likely led to a belief that it was categorically bad for the kidneys. While those with impaired kidney function should use caution, creatine is very safe when used by healthy individuals.

The Evidence

Creatine enhances muscle strength (by ~8%) and power (~14%), with additional benefits for endurance and aging muscles. Research on cognition is equally promising - creatine has been shown to improve memory, reduce mental fatigue, and support brain health, particularly in individuals with lower baseline levels, such as vegetarians or older adults. Most studies had subjects take 3-5g per day. Notably, the effects of creatine are reversible and muscle size and performance will decrease once supplementation stops.

The Takeaway

To be clear, the purpose here is to educate. I realize that the above may sound like a compelling case to start or continue taking creatine, but that isn't my intent. It's up to each individual and their health and fitness goals to make a decision around nutrition and supplementation. We're happy to discuss further, so just drop us a line or ask at your next visit!

References

Rae C, Digney AL, McEwan SR, Bates TC. Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci. 2003 Oct 22;270(1529):2147-50. doi: 10.1098/rspb.2003.2492. PMID: 14561278; PMCID: PMC1691485.

Watanabe A, Kato N, Kato T. Effects of creatine on mental fatigue and cerebral hemoglobin oxygenation. Neurosci Res. 2002 Apr;42(4):279-85. doi: 10.1016/s0168-0102(02)00007-x. PMID: 11985880.

Burke R, Piñero A, Coleman M, Mohan A, Sapuppo M, Augustin F, Aragon AA, Candow DG, Forbes SC, Swinton P, Schoenfeld BJ. The Effects of Creatine Supplementation Combined with Resistance Training on Regional Measures of Muscle Hypertrophy: A Systematic Review with Meta-Analysis. Nutrients. 2023 Apr 28;15(9):2116. doi: 10.3390/nu15092116. PMID: 37432300; PMCID: PMC10180745.

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