Creatine for Body and Brain—Who Benefits and Who Should Be Cautious?

By Chris Bigelow

Traditionally creatine has been used in the context of sport and fitness for its well supported roles in exercise performance and recovery.  More specifically, it’s often recommended for high performance training like maximal strength training and power training.  It also plays a supportive role in training recovery and seeing improved outcomes from hypertrophy training in those trying to put on muscle mass.  While it’s best known in that context there has been a lot of research both current and classic that show the many benefits of creatine outside of just the context of sport.  Here are some areas of health that may be supported by creatine supplementation that you may not have been as familiar with:

1. Cognitive and Mood Enhancement

1. • Creatine supplementation has been found to improve memory, attention, and executive functions (coordination of cognitive abilities and behaviors), particularly in stressful conditions or during periods of sleep deprivation. It also has mood-stabilizing properties that may help manage symptoms of depression and fatigue (Walczak et al., 2024).  While this is impressive, it's also worth mentioning that  it's not a replacement for any prescribed anti-depressants prescribed by a doctor, but exercise (and possibly creatine) could support the effectiveness of your other treatments,
     
     

2. Neuroprotective and Therapeutic Potential
   
   

   • Recent research suggests that creatine supplementation might aid in stroke recovery, protect against mild traumatic brain injury, and enhance brain function in neurological disorders (Sikora et al., 2024).
     
     

   • Another study indicates its potential benefits in neurodegenerative diseases and mental health conditions like depression (Abod et al., 2023).
     
     

3. Metabolic and Health Benefits
   
   

   • Creatine supplementation has been linked to improved metabolic function, particularly in conditions like diabetes, osteoporosis, and cardiovascular diseases (Kreider et al., 2022).

As you can see there are many other potential benefits to creatine supplementation other than the classic athletic applications.  It’s generally considered safe with a few caveats that are worth mentioning:  

1. Pre-existing Kidney Disease or Impairment

• Creatine is metabolized into creatinine and excreted by the kidneys. Because of this individuals with conditions like chronic kidney disease (CKD) or impaired renal function should avoid creatine supplementation unless under medical supervision (Walczak et al., 2024).
  
  

• Some individual case reports have linked creatine to worsening kidney function, though studies on healthy individuals show no harmful effects, which shouldn’t be surprising given all the positives mentioned earlier.  Remember, individual case reports don’t generalize that well to the public, especially when compared to large studies and systematic reviews, but those case studies can still find their way into the mainstream consensus through poor reporting on social media, legacy media, and public forums.
  
  

2. Use of Nephrotoxic Medications

• Individuals taking medications that affect kidney function should be cautious. These include:
  
  

  • NSAIDs (e.g., ibuprofen, naproxen)

    • Underlined because much of the general population overuse NSAIDs on a regular basis.
      
      

  • Diuretics (which can cause dehydration and kidney strain)
    
    

  • ACE inhibitors and ARBs (used for blood pressure management)
    
    

  • Certain antibiotics (aminoglycosides)
    
    

3. Dehydration or Electrolyte Imbalance

• Creatine causes water retention in muscles, which can lead to dehydration if fluid intake is insufficient.  Remember, dehydration places strain on the kidneys.  This caution is especially relevant for:
  
  

  • Athletes training in hot climates.  If they are taking creatine for performance and recovery then they should be extra vigilant in general about their water intake while in that climate or during the hot seasons.
    
    

  • Individuals on low-water intake diets.  Again, dehydration strains the kidneys.
    
    

  • Those with conditions like hypertension or heart disease, where fluid balance is crucial (Kreider et al., 2022).  The kidneys have very delicate blood vessels that are sensitive to blood pressure and they can be easily damaged with prolonged high blood pressure so we don’t want to strain them further with potential dehydration in these individuals.
    
    

4. Pre-existing Liver Disease

• While this is more rare, excessive creatine supplementation may increase liver enzyme levels, which could be a problem for individuals with conditions such as:
  
  

  • Hepatitis

  • Cirrhosis

  • Fatty liver disease
    
    

5. Pregnancy and Breastfeeding

• There is limited research on the effects of creatine during pregnancy and breastfeeding. While some studies suggest potential benefits (e.g., fetal neuroprotection), pregnant and breastfeeding women should consult a doctor before use.
  
  

6. Individuals with Neurological Conditions

• Creatine has potential neuroprotective effects (as mentioned) but may interact with conditions such as:
  
  

  • Epilepsy (Some reports suggest a possible impact on seizure threshold).

  • Parkinson’s or Alzheimer’s disease (Creatine may be beneficial, but clinical levels of dosing should be medically supervised).
    
    

7. Gastrointestinal Issues

• Some individuals experience bloating, cramping, or diarrhea, especially when taking high doses (>10g/day). Lower doses (3-5g/day) are better tolerated (Sikora et al., 2024).  Realistically, 3-5g/day is an effective maintenance dose. 

All that to say, while it’s generally considered safe it’s still a good idea to know what populations may be at risk for complications from even a largely safe supplement.  ‘Safe’ is a tricky word because it absolutely depends on your health status if something is actually safe or not, and even then the dose is important to pay attention to like we saw hinted at with the recommendation surrounding the liver and the gastrointestinal issues.  

In closing, I did want to mention that the most researched form of creatine in creatine monohydrate.  It’s also the cheapest.  There is little evidence to support other forms of creatine as being superior, even if their marketing may say otherwise.  In my opinion, if you are looking to supplement with creatine, stick with creatine monohydrate from any reputable NSF certified supplement company.

References

Abod, L., Ilnicka, N., Matyja, D., Sadlik, M., & Zuziak, P. (2023). Supplementation of creatine and its role in brain function. Journal of Education, Health and Sport. 15(1), 175-185.

Kreider, R., Stout, J., Serra-Majem, L., & Fernandez, M. (2022). Creatine supplementation for health and clinical diseases. MDPI. Multidisciplinary Digital Publishing Institute. 

Sikora, M., Iskrzyński, D., Gugulski, H., & Suchy, W. (2024). From gym to medicine: Creatine uses beyond athletic performance. International Journal of Pharmaceutical Research and Allied Sciences.  13(3-2024), 51-66.

Walczak, K., Krasnoborska, J., Samojedny, S., Superson, M., Szmyt, K., Szymańska, K., & Wilk-Trytko, K. (2024). Effect of creatine supplementation on cognitive function and mood. Journal of Education, Health and Sport. 73, 51712-51712. 

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