Are creatine (muscle strength supplement) supplements effective for improving cognition?

Creatine Supplementation for Cognitive Enhancement

Creatine supplementation shows modest benefits for cognitive function in specific populations, but evidence does not strongly support its widespread use as a cognitive enhancer for the general population.

Evidence on Cognitive Benefits

• Current evidence suggests creatine supplementation may provide small, targeted cognitive benefits, particularly in conditions characterized by brain creatine deficits or during periods of cognitive stress 1
• The UEFA nutrition guidelines acknowledge that creatine "may support brain function" beyond its established physical benefits 2, 3
• A 2023 randomized controlled trial (the largest to date) found only borderline significant improvements in backward digit span tasks (p=0.064) and no significant improvement in other cognitive measures 4
• Systematic reviews indicate that short-term memory and intelligence/reasoning may be improved by creatine administration, but effects on other cognitive domains remain unclear 5

Populations Most Likely to Benefit

• Individuals experiencing acute cognitive stressors such as sleep deprivation or hypoxia may experience more noticeable cognitive benefits 1, 6
• Older adults may see cognitive improvements due to age-related decreases in brain creatine levels 6
• Vegetarians and vegans might respond better to creatine supplementation in memory tasks compared to meat-eaters, as dietary creatine intake is lower 5, 7
• Those with pathological conditions affecting brain creatine levels (creatine synthesis enzyme deficiencies, mild traumatic brain injury, Alzheimer's disease, depression) may potentially benefit 1

Supplementation Protocol

• For potential cognitive benefits, protocols similar to those used for physical performance enhancement can be followed 2, 3:
  • Loading phase: ~20g/day divided into four 5g doses for 5-7 days
  • Maintenance phase: 3-5g/day as a single dose
• Alternative approach: Lower-dose protocol of 2-5g/day for 28+ days 3
• Taking creatine with protein/carbohydrates (~50g) may enhance uptake through insulin stimulation 2, 3

Safety Considerations

• Creatine is generally considered safe when used following appropriate protocols 2, 3
• Primary side effect is a potential 1-2kg increase in body mass, typically due to water retention 2, 3
• Side effects were reported significantly more often for creatine than for placebo in the largest cognitive study to date (RR = 4.25) 4
• If kidney function is compromised, caution is warranted as creatine has been associated with rhabdomyolysis in rare cases 3
• An RCT of creatine in Duchenne muscular dystrophy patients recommended discontinuation if renal dysfunction is present 8

Research Limitations

• The optimal creatine protocol specifically for increasing brain creatine levels (as opposed to muscle) is still undetermined 1
• Studies simultaneously assessing brain creatine content and cognitive function are limited 1, 7
• Research designs, especially supplementation regimens, need standardization 7
• Most studies show small effect sizes that may not translate to clinically meaningful improvements for healthy individuals 4, 5

Conclusion

• While creatine supplementation is safe and may provide modest cognitive benefits in specific populations (elderly, vegetarians, sleep-deprived individuals), the evidence does not strongly support its use as a general cognitive enhancer for healthy individuals 4, 5, 7
• Given creatine's safety profile and potential benefits, it remains a reasonable supplement to consider for those in high-risk groups for cognitive decline or under cognitive stress 1, 6