Creatine Benefits Beyond the Gym: Athletic Performance, Brain Health, and More

What is Creatine and How Does it Work?

Creatine is best known for its role in ATP production and exercise performance, but its bioenergetic benefits reach far beyond the gym. Creatine benefits extend to:

• Cognitive health

• Depression

• Head injury recovery

• Reproductive health

Given its important role in energy production, creatine can be found in tissues with high energy needs, such as skeletal muscle and the brain [1]. In addition to its critical role in energy production, creatine has antioxidant properties and may protect against oxidative stress [2].

Creatine is both synthesized by the body from amino acids (arginine, methionine, and glycine) and consumed via muscle meats in the diet, but supplements are a popular choice for athletes [2].

How Creatine Improves Athletic Performance and Muscle Recovery

In the muscle, creatine is stored as phosphocreatine, which helps regenerate adenosine triphosphate (ATP) from adenosine diphosphate (ADP). Using creatine supplements can help maximize muscle creatine stores, and by doing so, the body is able to rapidly regenerate ATP during intense exercise lasting approximately 6-8 seconds [1].

Enhanced ATP production can improve power and strength while ultimately delaying fatigue. In turn, this might feel like an extra repetition or heavier loads during weight training, a powerful rock climbing movement, or sprints. When combined with resistance training, creatine supplementation can help increase lean body mass.

Additionally, athletes often face cognitive demands for coordination, reaction time, decision making, and motor control. Some evidence suggests that creatine could improve mental performance in athletes [3].

Creatine and Brain Function: What the Research Shows

Creatine’s impact on muscle performance may be well known, but its role in cognition and even brain injury recovery is gaining attention. As mentioned, the brain is an energy-intensive organ, and it relies on ATP to function properly. In fact, the brain is the highest ATP consumer in the human body despite only being 2% of the body’s mass [4,5]. Using creatine for brain health can enhance the bioenergetics of the brain - among several other benefits.

Creatine for Concussions

Mild traumatic brain injury (mTBI), which may be simply referred to as a concussion or head injury, is the most common type of traumatic brain injury (TBI) [6]. It’s characterized by loss of consciousness lasting no more than 30 minutes, if at all, and less severe symptoms compared to moderate or severe TBIs [7]. Most sport-related injuries fall under mTBI [6].

Following a mTBI, brain creatine is reduced and there is an “energy crisis” [8,9]. Research suggests that creatine supplementation may help after mTBI by:

• Alleviating oxidative stress and inflammation

• Improving brain energy production

• Improving mitochondrial dysfunction

• Reducing and restoring membrane disruption

• Reducing nerve damage

Creatine can pass the blood-brain barrier, but uptake can be slow as it’s dependent on the presence of limited creatine transporters [9]. Therefore, in populations at higher risk for head injuries (e.g., tactical athletes, football players, or “extreme” athletes), it may make sense to use creatine preemptively to offer the most neuroprotection. Nonetheless, the effects of TBIs can last for months and even decades, but it is never too late to support the brain’s recovery.

Creatine for Cognition

Creatine may be particularly effective for improving memory by reducing oxidative stress and increasing cellular energy [10]. Creatine supplementation may also help counteract the cognitive deficits associated with lack of sleep. A small study found that a single dose of creatine monohydrate (0.35 g/kg) improved processing speed and cognitive performance after sleep deprivation compared to placebo [11]. The effect lasted up to 9 hours but peaked at 4 hours after creatine was administered.

Creatine for Depression

Creatine is being researched as an adjunct treatment for depression due to its ability to restore energy balance by increasing ATP, protect the brain from neuroinflammation, and potential to modulate neurotransmitters, such as serotonin and dopamine [12,13]. One study involving women with major depressive disorder (MDD) found that when creatine was combined with a selective serotonin reuptake inhibitor (SSRI), antidepressant effects were more rapid compared to those taking an SSRI and placebo [14]. Some participants receiving both creatine and an SSRI experienced improvements in depressive symptoms after only 2 weeks of treatment.

While nutrition can play a supportive role in mental health, it’s essential to acknowledge that medications are often life-saving and central to managing depression. At the same time, not all supplements are safe to combine with antidepressants. Creatine shows promise as a well-tolerated option, but it’s important to work with a qualified healthcare provider before adding creatine - or any supplement - to your mental health regimen.

Practical Application: What Athletes Need to Know About Taking Creatine

How do I take creatine?

Creatine is naturally available in foods such as red meat, poultry, fish, and cheese. However, creatine supplements can increase serum creatine levels and “top off” creatine stores while offering therapeutic potential.

For optimal results, athletes can follow these guidelines:

• Creatine Type: Creatine monohydrate

• Creatine Dose: 3-5 grams per day, added to liquids, such as water, juice, smoothies, and protein shakes.

• Creatine Timing: Take any time of day - consistency is what matters most!

It’s important to know that creatine supplements can take 3-4 weeks to become effective. A loading phase may increase muscle stores more rapidly, but it is not necessary. A loading phase involves 20 grams per day for 5-7 days before lowering to the standard dose.

Creatine for brain health may require a higher dose. This is an evolving area of research, but some evidence suggests a loading dose (15-20 g/day) for 3-7 days followed by a maintenance dose of 5-10 g per day [15,6].

Though taking creatine supplements before exercise could increase uptake, research doesn’t show that this is critically important [16]. It’s most important to take creatine every day; therefore, it may be best not to tie your creatine supplement to your workout schedule, especially if you value your rest days! However, combining creatine supplements with a source of carbohydrates, such as juice or simply a meal, may improve uptake and is recommended.

What is the best type of creatine?

Creatine comes in various forms, including creatine monohydrate, creatine gluconate, and creatine magnesium chelate [1]. Creatine monohydrate is the type most commonly used in research and therefore has the most evidence. This form is effective, affordable, and accessible.

Should women take creatine?

Creatine is safe for women, but there are some sex differences in its effectiveness. Though endogenous creatine production in women is shown to be 70-80% lower compared to men, they tend to have ~10% higher intramuscular creatine concentrations [17]. Additionally, creatine bioavailability and the effects of creatine can vary throughout the menstrual cycle. For example, creatine may improve cellular hydration in the luteal phase by shifting water from outside to inside of the cell, which may relieve bloating during this phase [18]. These factors may explain why there are some discrepancies in research on creatine use in women.

Most of the research on creatine is done on males. However, a 2025 systemic review investigated the effectiveness of creatine supplementation for exercise performance in females and found that most of the 27 studies included did not show an improvement in performance when taking creatine compared to placebo [19]. More research is needed to fully understand the effectiveness of creatine for women.

However, creatine may be particularly beneficial for reproductive health in women. Given its role in ATP production, creatine can be considered a “mitochondrial nutrient” with the potential to support mitochondrial dysfunction, which can impair egg development, compromise fertility, and even contribute to ovarian aging or menopause [20]. Research also suggests that women who have a higher dietary intake of creatine are less likely to have irregular menstrual cycles compared to those with suboptimal intake [21].

Why doesn’t creatine work for me?

Not everyone finds creatine to be effective. Remember that creatine supplements are not the only source of creatine - those who consume high amounts of muscle meats may not notice a significant benefit to taking creatine supplements because their muscles already have high phosphocreatine stores. On the other hand, vegans and vegetarians tend to have lower muscle phosphocreatine stores and may especially benefit from creatine supplementation [22].

If creatine doesn’t seem to make a difference for your athletic performance, then don’t take it. It may be that you already have a high dietary creatine intake or there’s a different factor impacting your performance, such as poor sleep or under-eating. However, other clinical uses for creatine, such as for head injury recovery, may not have such evident effects. In this instance, I recommend continuing its use as is appropriate for you, especially given its good safety profile and affordability.

Does creatine cause bloating, dehydration, cramping, or other side effects?

Despite being one of the most researched supplements on the market, creatine supplements have generated a number of concerns from the public. A recent study investigated creatine supplement side effects [23]. Results showed that although more clinical trials noted gastrointestinal discomfort and muscle cramping in participants using creatine supplements compared to non-users, the actual number of individuals affected was small. Moreover, there was no significant difference in the occurrence of these side effects between those taking creatine and those receiving a placebo.

On the other hand, creatine supplementation may cause transient water retention. This means that water retention may happen initially, but tends to subside with longer term (4-6 weeks) use [1].

In my private practice, I am much more likely to see adverse reactions to supplements that many people take without second thought, such as protein powders, pre-workout supplements, and even multivitamins. Creatine is widely recognized as both safe and effective, but it receives much more negative attention than more worrisome products on the market.

Final Thoughts: Should You Take Creatine?

Creatine is a well-researched and effective supplement that will benefit most athletes. When it comes to the many sports nutrition supplements available today, creatine stands out as one worth taking. As with all supplements, ensure creatine supplements are third-party tested for contaminants.

If you have questions or concerns about whether creatine supplements are appropriate for you, do not hesitate to speak with your healthcare provider or a qualified nutritionist.

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References:

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