Creatine, cognition, and concussion: What does the evidence really show?

Recently, there has been increased interest in nutritional strategies that can improve brain performance and health. Creatine monohydrate (CM) supplementation has been extensively studied in skeletal muscles; improves the performance of brief, high-intensity exercise; improves resistance training outcomes like strength and muscle mass; and has an excellent safety profile. CM supplementation could also have a major impact on brain function, including improved cognitive processing and better recovery from brain injury.

infographic showing the creatine loading can affect brain function

Creatine monohydrate supplementation and brain health

The brain has high energy demands and is responsible for about 20% of basal energy expenditure. Like skeletal muscles, to maintain Adenosine Triphosphate (ATP) levels during times of high-energy demand, the brain relies on creatine and phosphocreatine. It is widely reported that when muscle creatine is increased through CM supplementation, the performance of activities that rely heavily on the creatine-phosphocreatine energy system for peak performance can be improved. Fewer data are available on the effects of CM supplementation and brain performance, but 9 of 12 recent studies have shown that creatine supplementation increases brain creatine. Subsequently, in 16 CM supplementation studies, 13 reported improved aspects of cognitive processing, especially under stressful conditions such as sleep deprivation or exhaustive physical or mental activities. More work needs to be done in this area, but these data are promising as the majority of these studies reported a positive effect despite the fact that there were differences between study populations, cognitive function testing, and supplementation protocols.


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Creatine monohydrate supplementation

An additional benefit of CM supplementation may be in reducing severity of, or enhancing recovery from, mild traumatic brain injury (mTBI/concussion). Following mTBI there is a change in energy/ATP demand, reduced blood flow, hypoxia, and decreased brain creatine. The adverse changes to energy metabolism could remain for weeks or even years. In one study of National Football League players who reported cognitive and/or behavioral/mood symptoms in retirement, exposure to repetitive head impacts was related to decreased brain creatine later in life. Other data support that CM supplementation might improve aspects of mTBI, such as calcium influx, nerve damage, mitochondrial dysfunction, oxidative stress, and inflammation. In an animal study, CM supplementation reduced brain damage induced from a traumatic brain injury by 50%. CM supplementation also increased brain creatine and attenuated the disruption to cognitive processing in humans exposed to oxygen deprivation (which mimics effects of mTBI). In a hospital setting, children with brain injuries given CM supplements showed improved cognition, communication, self-care, personality, and behavior, and reductions in headaches, dizziness, and fatigue. Although few human data on CM supplementation and mTBI are available, CM supplementation has been widely studied for safety and efficacy of muscle function and it might be sensible to recommend CM supplementation to those populations who are at high risk for mTBI.


Creatine monohydrate supplementation may reduce the severity of, or enhance the recovery from, mild traumatic brain injury (mTBI/concussion).

Practical application

Athletes who want to increase muscle creatine and improve the performance of high-intensity exercise or resistance training adaptations should follow either CM supplementation protocol as they prefer.


Loading dose followed by maintenance dose:

20 g/d for 5 d (to quickly increase muscle creatine) followed by 3 to 5 g/d (to maintain increased muscle creatine)


Low dose:

3 to 5 g/d to increase muscle creatine more slowly (but to a similar level as the loading protocol) and then to maintain increased muscle creatine


*To improve cognitive processing or benefit mTBI follow either dosing protocol. The exact dose to improve brain health is not known, but the safety of these recommended doses has been well studied.


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References

  1. Roschel, H., Gualano, B., Ostojic, S. M., Rawson, E. S. Creatine supplementation and brain health. Nutrients2021;13(2), 586.

  2. Dolan, E. Gualano, B., Rawson, E. S.Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury.Eur J Sport Sci, 2019;19(1):1-14.

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