Creatine: Not Just for Bodybuilding Bros Anymore

I have been curious about the supplement creatine for a long time, but about six months ago I started taking it myself. I decided to do this after several conversations with Jane, a friend I often swim with who is very savvy about fitness and supplements. She was raving about how she felt stronger and mentally sharper after she began to take fivegrams of creatine daily. I had always shied away from taking it myself or recommending to patients due to worries about potential adverse effects on the kidneys. But my conversations with Jane piqued my interest and motivated me to dive into creatine and the science behind it. 

Creatine is present naturally in cells throughout the body and is also available as a dietary supplement. It has been popular for years with bodybuilding bros, and then serious athletes discovered that creatine not only augments muscular strength but also improves athletic performance. Intriguingly, recent studies have shown that creatine may offer broader health benefits, such as conferring increased energy levels, brightening mood and enhancing mental functioning.

What is Creatine?

Creatine is an amino acid derivative primarily stored in muscles, where it plays a crucial role in energy production. It helps regenerate adenosine triphosphate (ATP), the body’s primary energy source, which acts as a molecular battery to temporarily store energy. During high-intensity activities like exercise or deep thinking, the demand for ATP increases, and creatine supplementation can help replenish ATP more efficiently, improving physical performance and enhancing cognition—aka brain function and thinking.

Health Benefits of Creatine

Improved Muscle Function and Strength

Creatine supplementation is best known for its role in augmenting muscle strength and performance. This is beneficial not only for athletes but also for those who may experience muscle weakness due to aging or medical issues like arthritis. Creatine has been shown to improve muscle mass and strength, particularly for people who make a habit of doing weight training at least twice a week and consume plenty of dietary protein—about 0.7 to 1 gram per pound of body weight. Some individuals also note that creatine reduces joint and muscle pain, especially after strenuous exercise.  

Enhanced Brain Function

Beyond muscle benefits, creatine boosts cognitive performance. In other words, it sharpens thinking and mental acuity. Research suggests that creatine not only increases ATP in the brain but also helps to shuttle the stored energy into the neuronal synapses—the connections between brain cells. This may explain its abilities to improve mental clarity and memory, especially among middle-aged or older individuals. Creatine could even turn out to be helpful for preventing neurodegenerative disorders like Alzheimer’s or Parkinson’s disease, though this is still just a theory that will require future studies to clarify.

Cardiovascular Benefits

Creatine may support heart health, particularly in individuals with heart conditions. Some studies have shown that creatine supplementation can help improve exercise tolerance in people with heart failure, enabling them to become more physically active. Additionally, creatine’s role in energy production could potentially reduce the workload on the heart during periods of high exertion, which is crucial for maintaining optimal cardiovascular function.

Mood and Depression

The brain is our most energy-intensive organ, burning 20% of the body’s energy despite comprising only about 2% of body weight. Creatine increases levels of ATP—the energy currency of life. Thus, interventions that crank up cellular energy production should benefit cognition and mood. When taken as a supplement, creatine crosses the blood-brain barrier and improves the brain’s energy balance or “bioenergetics.” A recent study of women with major depression found that adding 5 grams of creatine daily to escitalopram, a popular SSRI antidepressant marketed under the brand name Lexapro®, led to faster and more substantial mood improvements than escitalopram alone. Creatine has also been reported to reduce brain fog or mental fatigue associated with menopause.

Hydration Is Key

While creatine is generally considered safe for most people, there are a few key factors to consider when taking this supplement: Creatine can increase water retention in the muscles, which is part of its mechanism for improving performance. However, this also means that proper hydration is essential when taking creatine. Dehydration can lead to muscle cramps, digestive discomfort, and other issues. So, if you start creatine, you must drink plenty of water throughout the day to ensure that your body stays well-hydrated. A simple rule of thumb for adequate hydration: Your urine should be almost colorless—like water. If it’s noticeably yellow, you need to drink 8 to 12 ounces of water immediately. The other way to know you’re consuming enough fluid is that you should feel annoyed by the need for frequent bathroom breaks. 

Serum Creatinine Levels and Kidney Health

Creatine supplementation can affect blood tests, particularly the serum creatinine, which is most common test we order to assess kidney function. Creatine is broken down into creatinine, a waste product excreted through the kidneys. Supplementing with creatine can lead to an increase in serum creatinine levels, potentially giving a false indication of impaired kidney function. To avoid this, it is recommended that you refrain from taking creatine for at least two days prior to having a serum creatinine test. Or ask for a cystatin-C test, which is a more accurate measure of kidney function that is not affected by creatine supplementation. 

Bottom Line

Creatine is a safe, inexpensive, and well-studied supplement that improves muscular strength and power by about 15% and may even sharpen thinking and improve mood. I have been taking about 5 grams per day for nine months, and I can attest to its noticeable benefits to muscular strength, mood, and energy levels. However, it is important to stay well-hydrated and to be aware of how creatine might falsely elevate blood creatinine levels. Feel free to talk to us in the CardioWellness Center at Saint Luke’s Hospital of Kansas City if you have questions about creatine.