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Recently, my best friend’s 14-year-old son presented him with a PowerPoint presentation titled “Why You Should Let Me Take Creatine Supplements.” That’s when I knew creatine had become mainstream. Creatine is traditionally seen as a supplement for pubescent young men eager to develop their bodies and bodybuilders aiming to look ripped. But what about the rest of us? I looked at the research and was pleasantly surprised to discover fairly solid evidence suggesting benefits across a wide range of applications — including improved physical function in older adults and adults with chronic disease, memory enhancement, and as an adjunct to drug- and therapy-based depression treatments. (To be clear, studies didn’t show it as a stand-alone treatment for depression but as a supplement to working with a therapist and medication.) There’s also a suggestion of benefit across many other conditions, from improving function for those with muscular dystrophy to enhancing glucose control in diabetics and improving mobility for people with knee degenerative arthritis. What Exactly Is Creatine? Creatine isn’t a protein, but it’s derived from three amino acids: arginine, glycine, and methionine. It plays a role in the body’s production of adenosine triphosphate (ATP), the chemical we use to move energy within our cells. Creatine occurs naturally in animal products, and the body can manufacture some of the creatine it needs. Taking creatine as a supplement allows the body to turbocharge its energy metabolism by enabling greater availability of ATP within cells for energy-intensive tasks. These tasks can include muscle cells lifting heavy weights or brain neurons working to consolidate memory or process complicated thoughts. Why Muscle Mass Matters Many young people want to improve their muscle mass for aesthetics, but as we age, the importance of preserving muscle mass goes beyond appearance. How strong we are and how much muscle mass we have is linked to how well we preserve functional capacity and reduce fall risk as we age. We’re in the midst of an epidemic of sarcopenia — muscle mass loss. With it comes a decline in function. Therefore, any safe, tolerable method to preserve and enhance muscle strength as we age is valuable. How Creatine Works Improving Muscle Energy Metabolism Creatine improves muscle energy metabolism. Creatine is synthesized into phosphocreatine, which helps rapidly regenerate ATP during high-intensity exercise. This allows us to train more in terms of volume and intensity, leading to more stimulus that grows and maintains our muscles. This improved energy metabolism also enhances mitochondrial function, the energy-generating power plants within our cells. Activating Anabolic Pathways Creatine also activates other signals to maintain our anabolic pathway — the whole host of hormonal signals that cause us to maintain muscle mass. It increases other hormones such as insulin-like growth factor 1 (IGF-1) as well. Anti-Catabolic Effects Additionally, creatine has an anti-catabolic effect — it protects muscle from being broken down. Besides helping young bodybuilders, creatine builds and preserves muscle mass for those of us with a bit more mileage. Reducing sarcopenia has been shown to preserve functional capacity as we age. How Creatine Boosts Brain Health Enhanced Brain Energy Metabolism Just as in muscle, creatine enhances brain energy metabolism. By providing more ATP, creatine allows greater energy access for neurons’ high-energy tasks, such as cognitive processing and memory formation. Increased Synaptic Plasticity Creatine has also been shown to increase signals that allow for synaptic plasticity — how many connections each neuron has, which is how our brain works. Creatine enhances the number of synaptic connections, critical for memory and learning. Neuroprotective Effects Creatine also activates neuroprotective pathways, protecting neurons and brain cells from hazardous oxidative stress and inflammation. Downsides to Taking Creatine In healthy individuals, creatine is safe when taken at low doses (3–5 grams per day). Possible mild side effects include: GI upset Muscle cramping About 1–2 pounds of weight gain from greater fluid content within muscle cells Additionally, because creatine can put a greater strain on compromised kidneys, individuals with kidney impairment or risk factors for kidney problems (such as high blood pressure or diabetes) may need to discuss creatine supplementation with their physician. Who Should Take Creatine? I divide supplements into three categories: Known risks that probably exceed benefits Known benefits that probably exceed risks Not enough data to assess the risks or benefits For most people, creatine is in the second category. Try it and determine if it works for you. That’s what I’m doing, having recently started supplementation myself. I’ll see what happens. Final Thoughts on Creatine Supplementation There’s a vast array of supplements and medical devices available to consumers. Even for someone who’s been in the medical field for almost 40 years, like myself, it’s tough to separate the wheat from the chaff and determine what’s safe and worthwhile. I can’t imagine how hard it would be for a non-medical person to figure this all out, which is why I love my job. I get to do the research and share the results with you.

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