Creatine’s impact on physical performance and muscle strength has been rigorously studied as far back as the early 20th century, making it one of the most-studied and well-researched supplements. Still, it wasn’t until the 1990s that it became widely available to consumers as a nutritional supplement. Since then it has been marketed to bodybuilders and athletes in search of muscle gains and optimal physical performance. 

More recently, a growing number of researchers are exploring its role outside of athletic performance and bodybuilding, and based on their findings they are recommending that it might be beneficial as a regular daily supplement to support general health, fitness and well-being. 

What is creatine?

As defined in this 2017 study, published by the Journal of the International Society of Sports Nutrition, creatine is a naturally occurring non-protein amino acid compound found primarily in red meat and seafood, with the majority of the body’s creatine, about 95%, found in skeletal muscle, with small amounts also found in the brain and testes. 

“Studies have consistently shown that creatine supplementation increases intramuscular creatine concentrations, can improve exercise performance, and/or improve training adaptations. Research has indicated that creatine supplementation may enhance post-exercise recovery, injury prevention, thermoregulation, rehabilitation and concussion and/or spinal cord neuroprotection”, the authors of the study write.

While there are six main types of creatine, with slight differences informed by what other elements it is bonded to, the most well-researched and most ubiquitous is creatine monohydrate, that is to say it is made by bonding creatine to a water molecule. It is also the focus of this article. 

Benefits of creatine supplementation

A study published in January 2021 sought to review and assess about 1,322 previously published papers on creatine. Quoting some of this peer-reviewed scientific literature, the authors note that creatine supplementation has been found to lead to 10% to 20% performance improvement on various high-intensity exercise tasks, including fitness activities such as weight training, golf, volleyball, soccer, softball, ice hockey, running and swimming. These benefits also span age groups from children to the elderly.

It is these findings and others that have led researchers, over the past two decades, to study creatine use beyond the field of athletics. The abovementioned paper’s authors write: “In this regard, creatine supplementation has been reported to help lower cholesterol, triglycerides and/or manage blood lipid levels; reduce the accumulation of fat on the liver; decrease homocysteine thereby reducing risk of heart disease; serve as an antioxidant; enhance glycemic control; reduce the progress of some forms of cancer; increase strength and muscle mass; minimise bone loss in some studies; improve functional capacity in osteoarthritic and fibromyalgia patients; enhance cognitive function particularly in older populations; and, in some instances, improve the efficacy of some antidepressant medications.”

Based on their assessment of these various finding, they concur that not only can creatine supplementation increase cellular energy availability and support general health, fitness and well-being throughout the lifespan, as well as promote gains in strength and help maintain or increase muscle mass in older individuals, but it “may” also support cognitive function as one ages. Additionally, it “may” support mental health, reproductive health and skin health, among other benefits.

To supplement or not to supplement

On average, the human body requires about two grams of creatine a day, half of which is synthesised in the liver and kidneys, and the rest from an omnivorous diet including a variety of animal-based foods – from human breast milk and infant formulas to meat, poultry and fish, according to yet another 2021 study published in August, just seven months after the aforementioned study.

However, looking specifically at surveyed creatine intake among the US population, they found lower-than-expected dietary intake, with some as low as 50% of the recommended amount. As a possible explanation, they suggest that this reduction in intake might also be related to a reduction in meat consumption, especially red meat.

They write: “Interestingly, preliminary evidence shows a strong relationship between creatine intake and health risks or growth indicators at the populational level. For instance, depression prevalence was 42% higher among US adults in the lowest quartile of dietary creatine consumption (0-0.26 g/day) compared to participants in the highest quartile of creatine intake (0.70-3.16 g/day). After controlling for demographic and lifestyle variables, the risk of screening positive for depression remained 31% lower among adults in the highest, compared to the lowest quartile of creatine consumption.”

After controlling for demographic and nutritional variables, this group of researchers also found that the shortage of dietary creatine was associated with an increased risk of medical conditions in men and women aged 65 years and over, with elderly people who consume less than a gram of creatine a day having 2.62 times higher risk of angina pectoris, a form of chest pain related to coronary artery disease, and 2.59 times higher risk of liver conditions, compared with older counterparts who consumed more that one gram of creatine per day.

With regards to potential side-effects of consuming or overconsuming creatine, they point to studies that show that creatine “poses no adverse health risks in healthy people and clinical populations across various life stages and conditions, at dosages ranging from 0.03 to 0.8g per kilogram of body weight per day for up to 5 years”. While some studies have shown an initial weight gain of 1% to 2% of body mass, this was dependent on dosage. 

In conclusion, the researchers write: “After over 100 years of scientific research about creatine, the time has come to perhaps reconsider this simple yet salient dietary compound as more than just another fancy supplement. 

“The evidence shows that an inadequate intake of creatine from food could not be fully compensated by internal synthesis, suggesting creatine is an indispensable amino acid derivative for humans… Still, creatine has a long road ahead on the way to general acceptance as a food additive for all and sundry. Hopefully, this journey should start beyond sports science and clinical medicine, by encouraging public health authorities to think about creatine as a critical component of the balanced low-meat diet of the 21st century.” DM/ML

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