We all know about creatine, right, the stuff that body builders and gym rats buy in tubs to help pump up their physiques. Nothing against those folks, but what does that have to do with most of my patients and readers? 

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A lot, as it turns out. The natural compound creatine (technically, creatine monohydrate) is all about energy. Raising the body’s creatine levels replenishes the supply of the energy molecule ATP which gets used up very quickly in high-intensity activities like sprinting or, yes, lifting weights. 

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But it isn’t only muscles that need energy. Your brain has to do a lot of thinking, that and overseeing virtually every process in your body, all of which requires a generous fuel supply. So, it stands to reason that supplementing your natural creatine levels—increasing energy production in the mitochondria of the cells – may generate a significant brain function pay-off. That’s what researchers are beginning to uncover in the admittedly early days of creatine brain research. We’re talking gains in cognitive sharpness, memory, even protection against dreaded neurodegenerative diseases like Alzheimer’s. And that makes creatine a potentially very powerful longevity enhancer. Given that creatine levels decline with age, I now recommend it to my middle-aged and older patients, in measured and monitored doses. Why the fuss about this stuff that’s been around for ages? Here’s the topline on what you need to know about this surprisingly versatile and, well, muscular supplement that comes with plenty of potential bonuses for your brain: 

It's all about energy!    

Let’s start with the basics. Creatine, made from amino acids inside the body as well as consumed in protein-rich foods like meat, fish and dairy, is a major component of one of the body’s primary energy systems (the ATP-phosphocreatine system, if you’re curious), responsible for quick bursts of power. And remember, we’re not just talking about muscles. Your brain accounts for only 2% of our total body weight and yet it consumes 20% of the total energy we produce. According to the working theory, if we raise creatine levels by supplementing, that means more ATP produced by the mitochondria in the neurons and more energy available to do the brain’s business. Much of that business is thought to be happening in the hippocampus, the brain region responsible for learning and memory. But there’s more. Higher creatine levels are associated with greater insulin sensitivity which translates to more glucose fuel entering the cells, in both muscles and the brain. Again, that should translate to more ATP and more energy on tap everywhere, including the brain.  Small randomized controlled trials have shown creatine supplementation conferring improvements in memory, attention time and “information processing speed.” I’d call that promising.

The muscle-brain axis.

You’ve probably heard the put-down term ‘muscle heads’ aimed mostly at dudes who spend a lot of time pumping iron. Well, contrary to their slightly dim-witted image, it turns out they were on to something.  The muscles that move your body and the brain that orchestrates the whole show are in constant conversation – we call it the “muscle-brain axis.” And when higher creatine levels help make possible more vigorous or more frequent contractions – during exercise for instance – that conversation just gets livelier. The muscles behave like an endocrine gland, producing hormone-like molecules called myokines that travel the bloodstream, cross the blood brain barrier, and positively impact the brain. Myokines like irisin and IL-6 look to have an anti-inflammatory effect which is always welcome, inflammation being one of the key, if not the key, driver of the aging process. (That’s why some researchers use the term, “inflammaging.”) And the brain has its own immune defenses as well, the microglial cells which protect the neurons. That’s a big job that takes a lot of energy so once again, more creatine/more ATP is a winning equation. 

What’s BDNF got to do with it? 

Brain-derived neurotrophic factor (BDNT) stimulates the growth of new brain cells and helps repair and maintain neural connections inside the brain – the brain’s synapses – which is what we need to actually generate thoughts. Most of our BDNF is, not surprisingly, produced in the brain, but the muscles, when they’re firing, look to contribute their share. That may mean your brain, when topped off with creatine, can learn, remember, and alertly respond to your environment that much better. 

The stress connection. 

Most of the creatine in the body is stored in muscle, with only about 5% distributed in organs like the brain and heart. But that relatively small amount may make a noticeable difference when the brain is stressed, for instance, if you’re sleep-deprived or just plain mentally fatigued. Then you need mental energy that may not be readily available. In purely physiological terms, you’ve “spent” the ATP on hand and need a fresh energy deposit. That’s where creatine shines, allowing the body to recycle ATP more efficiently to keep your mitochondria powered up. Same is true as we push into middle age and especially our senior years when our mitochondrial function heads south. Stress and sleep accelerate aging. Creatine may help us put on the brakes. 

Creatine: protecting mind and brain.

Researchers have begun to look at creatine therapy as a mood lifter and a  complementary therapy for depression. Take for example one small study where creatine was added to the therapeutic mix for 8 weeks and the depression scores of the five young female subjects dropped over 50%. Then consider the research investigating creatine as one way to protect against neurodegenerative diseases like Alzheimer’s and Parkinson’s. The hope is, by enhancing energy production at the mitochondrial level and reducing inflammation and oxidative stress, creatine can slow down the progression of these terrible pathologies. 

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The most exciting piece of evidence so far? A pilot study from the University of Kansas Medical Center in which 20 individuals with Alzheimer’s received 20 grams of creatine a day for 8 weeks. That’s a lot, at least quadruple what I, and most physicians, would recommend for our patients. But it raised creatine levels by 11%, the side-effects were mild and the results eye-opening. Statistically significant improvements showed up on cognitive tests measuring working memory, attention and language processing. There are some obvious caveats here. The study was tiny and there was no placebo control, in other words, no group who didn’t take the creatine against which to compare the results. But given the safety and inexpensiveness of creatine, and the current lack of good AD drugs, it’s certainly an invitation to pursue this research further. 

Muscle is your longevity ally.

Yes, creatine, the bodybuilder’s friend, may help protect the brain from the ravages of time. But let’s not forget that its primary therapeutic benefit, helping to build and preserve muscle tissue, is also your longevity ally. Beyond age 30 or so, we progressively lose muscle mass, that is, unless we push back with strength training and adequate protein intake. By the time we hit our senior years, sarcopenia, or age-related muscle loss, is just a fact of life. But creatine can slow the muscle slide, promoting muscle strength as well as mass, something that the research has definitely pinned down. However impressive those ripped pecs and biceps may look on the gym floor, they’re nothing compared to what a robust musculoskeletal system can do for you in the elder years – preserved mobility, protection against falls and, big picture, maintaining your independence. Or, in other words, a most enviable healthspan.

But first, some important rules of the road.

Creatine supplements are not hard to come by. You’ll find them in powders, tablets, capsules, even tucked away in energy bars. And, fortunately, for most people,  they’re quite safe, as long as you stick to a moderate dose, typically 3-5 mg a day. (Some of the participants in the Kentucky Alzheimer’s study experienced mild muscle cramping and digestive complaints, at much higher doses.) Some may notice water weight gain but that seems to be a temporary effect. However, the risk calculus changes if you are pregnant, have kidney or liver disease, or suffer from a psychiatric condition like bipolar disorder. On prescription meds to manage a chronic condition? Then here too, consult with your physician to determine the path that’s best for your physiology.