Creatine: Beyond the Weight Room

Creatine has a reputation. It is associated with the gym, shaker bottles, and strength athletes. For many people, that is where the story ends. But creatine is also one of the most researched supplements in existence, and over the last several years, attention has begun to shift toward its role in brain energy metabolism, cognitive function, and recovery from neurological stress.

This is not a claim that creatine is a cure or a cognitive enhancer for everyone. It is a discussion of what creatine is, how it works, what it is traditionally used for, what people often misunderstand about it, and what recent research is beginning to explore regarding cognition, brain injury, and neurodegenerative disease.

What creatine is

Creatine is a naturally occurring compound synthesized in the body from amino acids, primarily in the liver and kidneys. It is also obtained through diet, especially from animal foods such as meat and fish.

Once in the body, creatine is stored largely as phosphocreatine in tissues with high and fluctuating energy demands. Skeletal muscle holds the majority, but the brain also relies heavily on creatine for energy buffering.

Supplemental creatine is most commonly consumed as creatine monohydrate, which has been extensively studied for both efficacy and safety.

How creatine works

Cells run on adenosine triphosphate, or ATP. ATP is consumed rapidly during periods of high demand. Creatine helps maintain energy availability by increasing phosphocreatine stores, which can rapidly regenerate ATP when demand exceeds supply.

In muscle, this translates to improved performance during short, high intensity efforts. In the brain, the theory is similar. Neurons are metabolically demanding, and conditions such as sleep deprivation, injury, aging, and neurodegeneration are associated with impaired energy metabolism.

A 2024 systematic review and meta-analysis of randomized controlled trials found that creatine supplementation showed small but significant benefits for memory performance, with additional signals for attention time and processing speed, particularly in populations under metabolic or cognitive stress (Avgerinos et al., 2024).

Traditional uses of creatine

Creatine has long been used to support:

• Increased strength and power output • Improved high intensity exercise performance • Greater training volume capacity • Increases in lean mass over time

It is not a stimulant and does not act on the nervous system in the way pre-workout compounds do. Its effects are cumulative and dependent on tissue saturation.

The loading phase

Creatine supplementation is often discussed in terms of loading versus steady intake.

A traditional loading protocol involves approximately 20 grams per day, split into multiple doses, for five to seven days. This is followed by a maintenance dose of 2 to 5 grams per day. This approach saturates creatine stores more rapidly.

An alternative approach is to skip loading and consume 3 to 5 grams per day consistently. Saturation occurs more slowly but reaches similar levels over time.

Neither approach is mandatory. Loading may be useful when rapid saturation is desired, but it is not required for long term benefit.

Common myths about creatine

Creatine is a steroid Creatine is not a steroid. It is a naturally occurring compound involved in cellular energy metabolism and has no anabolic hormone-like properties.

Creatine damages the kidneys A 2021 review addressing common misconceptions found no evidence that creatine supplementation at recommended doses causes kidney dysfunction in healthy individuals (Kreider et al., 2021). Individuals with pre-existing kidney disease should approach supplementation under medical guidance.

Creatine causes dehydration Creatine increases intracellular water content, particularly in muscle. This is not the same as dehydration. Adequate fluid and electrolyte intake remains important, especially during training.

Creatine causes hair loss The claim originates from indirect hormonal measurements rather than clinical outcomes. No controlled human trials have demonstrated that creatine supplementation causes hair loss (Antonio et al., 2021).

Gastrointestinal issues with high-dose creatine

One of the most common side effects reported with creatine, particularly during loading phases, is gastrointestinal distress. Symptoms may include bloating, cramping, nausea, or loose stools.

A 2025 safety review identified gastrointestinal discomfort as the most frequently reported adverse effect, particularly with higher doses taken at once (de Guingand et al., 2025).

Naturalistic strategies to reduce GI issues

• Skip loading and use 3 to 5 grams per day • Split doses if using higher intakes • Take creatine with meals • Use plain, micronized creatine monohydrate • Maintain hydration and adequate mineral intake • Start low and titrate upward if sensitive

Creatine works through saturation over time. There is no advantage to forcing high doses that disrupt digestion.

Creatine and cognitive decline

Claims about creatine preventing dementia are not supported at this time. However, emerging evidence suggests potential cognitive support, particularly for memory.

The 2024 meta-analysis by Avgerinos and colleagues found modest but consistent improvements in memory performance across randomized trials, with older adults showing greater benefit than younger populations.

In 2025, a pilot feasibility study examined high-dose creatine monohydrate supplementation in individuals with Alzheimer’s disease. The study demonstrated increased brain creatine levels and modest improvements in selected cognitive measures over eight weeks, while emphasizing feasibility rather than efficacy (Smith et al., 2025).

These findings are preliminary. They justify further investigation but do not establish creatine as a treatment for neurodegenerative disease.

Creatine and brain injury

Traumatic brain injury and concussion are associated with impaired energy metabolism, oxidative stress, and mitochondrial dysfunction.

A 2024 narrative review of nutritional interventions for traumatic brain injury identified creatine as a biologically plausible adjunct due to its role in cellular energy buffering and neuroprotection (Ahmed et al., 2024).

Additionally, clinical trials registered within the last two years are actively investigating creatine monohydrate supplementation for persistent post-concussive symptoms, using validated symptom inventories such as the Rivermead Post-Concussion Questionnaire. These studies are ongoing, but their existence reflects growing clinical interest.

At present, creatine should be viewed as a potential supportive strategy under investigation rather than a proven therapy for brain injury recovery.

A grounded takeaway

Creatine is safe, well studied, and foundational for cellular energy metabolism. Its benefits for strength and performance are well established. Evidence for cognitive support is emerging, particularly in contexts of metabolic stress, aging, and brain injury.

For most people, a conservative and sustainable approach looks like this:

• 3 to 5 grams per day of creatine monohydrate • Consistent daily use • Adequate hydration and mineral intake • No expectation of dramatic cognitive effects

Creatine is not a cure. It is a tool. One that works best when paired with sleep, nutrition, movement, and nervous system regulation.

References

Ahmed, S. et al. (2024). Nutritional interventions for traumatic brain injury: mechanisms and clinical considerations. Nutrients, 16(3).

Antonio, J. et al. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? Journal of the International Society of Sports Nutrition, 18(13).

Avgerinos, K. I. et al. (2024). Effects of creatine supplementation on cognitive function: a systematic review and meta-analysis of randomized controlled trials. Psychopharmacology.

de Guingand, D. L. et al. (2025). Safety considerations of creatine supplementation across populations. Nutrients, 17(1).

Kreider, R. B. et al. (2021). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation. Journal of the International Society of Sports Nutrition, 18(1).

Smith, A. E. et al. (2025). Feasibility of high-dose creatine supplementation in Alzheimer’s disease: a pilot study. Alzheimer’s & Dementia: Translational Research & Clinical Interventions.