Creatine for the Brain: Why the Standard 5g Dose May Not Be Enough

When it comes to health supplements, there are none more studied than the molecule creatine. 

Thousands of studies have examined creatine's impact on human health and performance. It's the latter, performance, that initially gained attention as creatine became well established as a muscle performance enhancer, allowing most people who supplement with it to gain additional repetitions when weight lifting, ultimately translating to more muscle [1]. Initially the rage was in bodybuilding for that outcome, though more recently creatine has snatched the spotlight for exciting possibilities outside the realm of muscle: specifically, brain function. 

Let's delve into the clinical evidence that applies to you, the dosing considerations, and the mechanisms of creatine's brain effects.

Creatine: Clinical Data at the Forefront

If you were around in the mid-1990s, you may be familiar with a cartoon called Pinky and the Brain, with "The Brain" being a mouse of extreme intelligence. Now, I'm not here to promise genius level intelligence at the hands of creatine supplementation, but I can say that while many other supplements are tied up in mouse science without promising signals in humans, creatine rips open the door to possibility and promise for not just mice, but humans, as well. And, while again making no promises of extreme intelligence, scientists have multiple lines of evidence indicating creatine may be especially effective in particular groups of people focused on brain health and function.

Vegetarians and vegans are one of these groups, as evidence suggests improvements in intelligence test performance and cognitive function, as a whole, from creatine supplementation [2, 3]. This is primarily believed to be the case due to the fact that vegetarians and vegans do not consume meat, which is a source of creatine, thereby keeping creatine exposure lower than typical meat consumers.

This raises the question of whether meat-consuming individuals might also experience benefit from creatine supplementation.

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The literature is mixed. Some studies indicate benefit [4], while several studies indicate no benefit [5, 6]. The best guess based on the literature is that creatine has only mild benefits in cognitive function for individuals consuming meat, especially young individuals, and may scale with the amount of meat consumption.

However, there are exceptions where creatine's impact is more profound. For example, studies in equally young meat-eaters have shown significant benefit from creatine supplementation if these individuals were experiencing some cognitive stress, such as sleep deprivation or exercise-related cognitive stress [7, 8]. That means creatine may be especially important during stressful days, indicating significant cognitive performance and mood boosting abilities.

Finally, another group that may experience improvement from creatine is people in their 60s and beyond [9]. Critically, there are some studies that indicate no benefit in this age group; however, what has become apparent in the literature is that the dose of creatine may matter quite a bit, with standard doses used for muscle (5 grams) being potentially insufficient for the brain. Studies using larger doses (10 or even 20 grams) indicate robust brain saturation, which may explain the difference in study results [10].

Main Take-Away: Several studies indicate creatine supplementation has a positive effect on the brain, improving cognitive performance (such as memory) and mood. This is especially true in cognitively stressed individuals and those that consume little meat. More research is needed in other groups, but current research leans in favour of using higher doses of creatine (around 20 grams per day) to affect the brain, with the most common effective type being creatine monohydrate. If you experience stomach upset at higher doses, split the intake across the day or start at 5 grams and build up gradually.

Creatine: A Look Under the Hood

If you are not the type of person to care how a molecule works, you can stop reading here. The clinical data we've covered is all you need, and nothing going forward will add anything from an application perspective. However, if you happen to have a curious mind as I do, we can delve a layer deeper and zoom into the brain to find out exactly how creatine enacts its benefits.

There are multiple mechanisms that have been proposed, but the primary one is similar to the one in muscle. Creatine is an energy molecule: your body already produces a certain amount to act as an initial pool of energy quasi-independent of carbohydrate and fat derived energy in your cells. When your cells, like brain cells, need a quick source of energy, they lean on creatine for that quick energy. That's the short of it, but I am a physiologist, so allow me to take you just one layer deeper. I promise you'll come back up fascinated and energised (pun possibly intended).

Your brain cells communicate with one another using bursts of electrical activity. Knowing that, you can imagine these brain cells use up large amounts of cellular energy to fuel those bursts. That cellular energy is primarily in the form of a molecule called ATP. ATP is used like money, as currency, across millions of reactions within the brain cell, ultimately leading to this electrical activity. When the brain cell uses ATP, it only uses a piece of the molecule, a phosphate. This is where creatine comes in. Creatine is normally bound to phosphates and can return spent ATP molecules, called ADP molecules, back to their former full "value" (if we maintain the money analogy) by donating the phosphate on creatine to the spent ATP (called ADP).

If we have more creatine molecules, we have more phosphate-bound creatine that can quickly donate their phosphates to the true cellular energy molecule, ATP. That means creatine supplementation bolsters this energy recycling system within our brain cells, allowing them to activate more often and faster than if creatine were less abundant. Now, imagine that happening across billions of brain cells, all with a larger reserve of this energy recycling system. Therein lies the power of creatine.

Main Take-Away: Creatine recycles cellular energy for faster and more frequent brain cell activity.

Safety

I'd like to touch on this briefly, because there are some consistent concerns related to creatine supplementation. Fortunately, as we discussed at the top, we have thousands of studies on creatine.

Kidney Damage

Creatine was initially feared to raise the risk of kidney damage, because creatine raises blood creatinine levels, which is used to assess kidney function. Multiple kidney tests use creatinine as a measure of kidney failure, so it is understandably worrying to see one's creatinine shoot up when consuming creatine. However, rising creatinine due to true kidney issues and rising creatinine due to creatine consumption are two different things. They do not share the same pathology (true kidney disease). In fact, studies looking at kidney health independent of creatinine (using measures not based on creatinine) show absolutely no real damage to the kidneys by elevated creatinine from creatine consumption [11]. This means that creatine does not harm the kidneys, and the elevated creatinine is simply due to creatine degrading in our cells (a normal process), not kidney disease.

Hair Loss

Creatine has never truly been scientifically linked to hair loss, though there are plenty of stories and even one study that is often pointed to as evidence for creatine's hair loss effect. That study never measured creatine's impact on hair in any way [12]. Fortunately, a recent study investigated this very topic [13], and the result? No hair loss effect. While one study may not absolve all worry, it does at least indicate some comforting evidence.

Weight Gain

Creatine does lead to weight gain, point blank, and it's a good thing. Creatine, when it enters the muscles and likely the brain, also pulls water molecules in with it. As a result, we experience water weight gain. However, this weight gain is intramuscular. If anything, the effect would ever so slightly enlarge the muscles, with no fat gain. This bears out across many studies consistently [14, 15].

The encouraging side of creatine-induced weight gain is that it also offers a robust signal that creatine supplementation is effective in your body. However, if you are worried, ceasing creatine consumption for a few weeks will return bodyweight to previous levels.

Main Take-Away: While there are no long-term studies on the safety of 20 gram, brain-centric doses of creatine, the evidence that does exist on creatine does not indicate harmful effects for the kidneys, hair, or fat gain (though water-based weight gain is expected) from creatine supplementation.

Conclusion: To Creatine or Not?

Creatine is not an essential supplement (your body produces it endogenously), but as far as supplements go, it has robust evidence for its overall effectiveness in improving our health and performance. As it relates to the brain, evidence is more mixed, though it leans heavily in favour of creatine use for vegetarians, vegans, and anyone (meat-eaters included) under significant cognitive stress (sleep deprivation, cognitively demanding tasks, for example). Effective studies use greater than the standard 5 gram dose, usually closer to 20 gram doses per day, using a cheap creatine monohydrate. Safety of creatine supplementation has so far indicated a stellar track record, though studies focus on more modest 5 gram doses, not the emerging 20 gram doses. There are no initial indications this higher dose should be problematic, but consult your physician for individual assessment, particularly if you have kidney disease or other chronic conditions.