Since the early 1990s, creatine supplementation (as creatine monohydrate) has been reported to improve high-intensity exercise performance and training [1, 2]. For this reason, creatine supplementation has been a nutritional strategy to enhance performance and training adaptations among individuals initiating training and athletes . However, we now know there is much more to creatine supplementation than exercise and sport performance enhancement.
Creatine supplementation increases cellular energy availability and supports general health, fitness, and well-being throughout the lifespan [4 – 6]. Research over the last 30 years has shown that creatine supplementation has a number of potential health benefits and uses in clinical populations . In fact, as the public has become aware of the potential health benefits of creatine, worldwide sales of products containing creatine have more than doubled . The following describes the role of creatine supplementation on health as we age. For more information on each of these topics, see CreatineForHealth.com.
1. Promote Reproductive Health
Creatine plays a key role in metabolism, including in reproductive health, pregnancy and newborn health . In this regard, there is evidence that creatine availability affects sperm quality, motility, and viability . Consequently, creatine supplementation has been suggested for men with low sperm count as well as added to medium during intrauterine insemination in order to enhance sperm motility and fertilization success . Moreover, there is a greater maternal need for dietary creatine during fetal development [8, 10]. Low creatine availability during pregnancy has been associated with low birth weight and pre-term birth [11, 12]. Increasing the dietary availability of creatine during the third trimester has been reported to reduce the risk and complications of fetal asphyxia during childbirth (i.e., lack of oxygen) and brain trauma in animals [8, 10 – 12]. Creatine has also been suggested as a means to enhance the ability of the mother to withstand and recover from contractions during natural childbirth as well as promote women’s health throughout the lifespan . Although more research is needed, these findings suggest creatine plays an important role in reproductive health for both men and women.
2. Promote Maturation in Children and Adolescents
Some children are born with creatine synthesis enzyme deficiencies and can’t synthesize enough creatine to maintain normal brain and muscle levels. This typically presents with delayed motor and cognitive maturation. Creatine supplementation in children with some forms of creatine synthesis deficiencies has been reported to have better neuromuscular and cognitive development [13 – 15]. Additionally, low dietary intake of creatine has been correlated with a shorter stature, lower body weight, and higher percentage of body fat in children and adolescents aged 2 – 19 years [16, 17]. These findings suggest that dietary availability of creatine is important for normal growth and maturation. Since dietary creatine is primarily obtained from red meat, chicken, pork, and fish like salmon (e.g., 0.4 – 0.8 grams per serving), parents should ensure their children consume sufficient amounts of these foods in their diet and supplement their diet with pure creatine monohydrate if dietary intake is inadequate (e.g., 1 teaspoon is about
3. Enhance Fitness in Active Adults
While there are a number of studies indicating that creatine supplementation (e.g., 0.3 g/kg/d for 5 – 7 days and 0.03 g/kg/d thereafter) increases strength, muscle mass, and performance in athletes engaged in strength and conditioning programs , it can also help individuals starting exercise programs observe greater success, recreational athletes improve performance and training adaptations, and active individuals maintain fitness and muscle mass . In fact, while creatine is often thought to be a supplement for athletes, the largest consumer market for sports nutrition supplements are middle-aged adults trying to maintain strength, muscle mass, and fitness as they age. Consequently, creatine is commonly used by active adults to enhance fitness levels and performance in recreational sport activities [5, 10, 19].
4. Maintain Health, Fitness, and Cognitive Function as we Age
One of the greatest potential uses of creatine is as a nutritional countermeasure to slow the negative effects of aging . As we age, we typically lose strength and muscle mass while gaining body fat (i.e., adult onset of obesity). We also experience cognitive decline and memory loss. Dietary intake of creatine and/or the ability to digest foods containing creatine generally declines as we age leading to lower muscle and brain creatine content. Creatine supplementation in older populations has been found to increase strength and muscle mass as well as help maintain bone mass and reduce risk to falls [19, 20]. There is also evidence that creatine supplementation increases creatine content in the brain and thereby enhances cognitive function and memory in older individuals [21, 22]. Additionally, creatine supplementation while maintaining an energy-restricted diet may be an effective way to preserve muscle and help manage adult-onset obesity. Consequently, daily supplementation of pure creatine monohydrate (e.g., 3 – 5 g/d) may be more important as we age to maintain functional capacity, cognitive function, and memory.
5. Help Manage Chronic Disease and Reduce Risk to Injury
In addition to general health benefits, there is also evidence that a lack of availability of creatine impairs cellular function and can complicate management of a number of diseases [4, 6]. For example, creatine has been reported to improve glucose homeostasis  and have anti-inflammatory [4 – 6, 10, 21, 24], antioxidant [5, 24, 25] and immunomodulating  effects. There is also evidence that creatine serves as an important energy source during ischemic conditions (e.g., ischemic heart disease, heart attack, stroke) [5, 24], brain and spinal cord injury/trauma [3, 5, 21, 27, 28], T-cell antitumor immunity [29, 30], and the pathology of some mitochondrial dysfunction conditions . For this reason, creatine supplementation has been studied as an adjunctive therapeutic strategy in various clinical populations. For example, creatine supplementation has been reported to help individuals with type 2 diabetes mellitus better manage blood glucose levels when combined with resistance-training . Moreover, some therapeutic benefits have been reported related to vascular disease , heart disease , and slowing the progression of some cancerous tumors [29, 30]. Feeding animals creatine has been reported to reduce the size and severity of heart, brain, and spinal cord damage in response to experimentally-induced ischemic conditions, traumatic brain injury, and spinal cord injury [3, 5, 6, 21, 24, 27, 28]. In fact, the International Society of Sports Nutrition recommends that individuals at risk to head and/or spinal cord injury consider taking creatine for neuroprotection . Finally, there is evidence that creatine supplementation reduces the incidence and severity of musculoskeletal injuries in athletes engaged in intense training [1, 31, 32] and can promote recovery from musculoskeletal injury . Therefore, creatine supplementation may play an adjunctive role in the management of several chronic diseases, reduce risk to injury, and/or promote recovery and rehabilitation.
6. Therapeutic Nutrient for Chronic Viral Fatigue and Long-COVID?
People often experience chronic fatigue and lethargy after exposure to viral infections. For example, millions of people who have had COVID19 complain of symptoms of fatigue, mental or brain fog, lack of energy and endurance, and lethargy for months or more after recovering from COVID (i.e., long-COVID). People experiencing these symptoms often reduce physical activity which can complicate recovery, promote obesity, and increase risk and/or progression of chronic disease. Since creatine can increase brain bioenergetics and has been shown to provide some therapeutic benefit for patients with chronic fatigue-related syndromes such as post-viral fatigue syndrome (PFS) or myalgic encephalomyelitis (ME), it is possible that creatine supplementation can help people with long-COVID increase physical activity and cognitive function [6, 34]. Future research should assess this potential therapeutic role of creatine supplementation.
The benefits of creatine supplementation go well-beyond enhancing high-intensity exercise performance and training adaptations for athletes. Research has clearly shown a number of health and/or potential therapeutic benefits as we age and in clinical populations. Although additional research is needed to further explore the health and potential therapeutic benefits of creatine supplementation, it is recommended that people consume at least 2 – 3 grams (i.e., 0.03 g/kg/d) of creatine per day from food (e.g., red meat, chicken, pork, salmon, tuna) and/or dietary supplementation of pure creatine monohydrate to support general health . For those interested in optimizing performance, training, and recovery, we recommend loading with a pure source of creatine monohydrate for 5 – 7 days (0.3 g/kg/d) and then ingesting maintenance doses (0.03 g/kg/d). For those interested in taking creatine to help manage chronic disease, we suggest you share some of the peer-reviewed articles and presentations available at CreatineForHealth.com with your healthcare provider and discuss whether creatine supplementation may be something to consider to help you manage your health condition.
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PHD, FACSM, FASEP, FISSN, FACN, FNAK is Professor and Director, Exercise & Sport Nutrition Lab, Department of Kinesiology & Sport Management, College of Education & Human Development, Texas A&M University, USA.