Creatine and the Brain: Beyond athletic performance

Dr. Tracy Tranchitella, ND | Sunrise Functional Medicine

For years, creatine has been quietly sitting on the shelves of workout gym and supplement cabinets, known primarily for its role in muscle strength and athletic performance. But as research continues to evolve, a broader picture is emerging. Creatine is not just about biceps and bench presses. It is fundamentally about cellular energy — and that includes the brain. At Sunrise Functional Medicine, conversations around supplementation often begin with a simple question: what is happening at the cellular level? In the case of creatine, the answer is straightforward and compelling.

Creatine’s Core Role: Cellular Energy

Creatine is a naturally occurring compound synthesized in the liver and kidneys from amino acids, and we also obtain small amounts from foods like meat and fish. About 95% of the body’s creatine is stored in skeletal muscle. The remainder is found in the brain and other tissues. Its primary role is to support the production of ATP (adenosine triphosphate), the body’s universal energy currency. Mitochondria convert nutrients and oxygen into ATP, and creatine helps buffer and transport that energy where it is needed most. In tissues with high energy demands — such as muscle and brain — this buffering system is essential.

The brain, despite representing only about 2% of body weight, consumes roughly 20% of the body’s energy. When energy production falters, cognitive function often follows. From a functional medicine perspective, supporting mitochondrial health and bioenergetics is foundational in addressing cognitive decline, mood disorders, and neurological resilience.

Emerging Research in Cognitive Health

Recent research has expanded creatine’s relevance beyond sports performance. A pilot study conducted at the University of Kansas Medical Center examined creatine supplementation in individuals with Alzheimer’s disease. Participants received higher-than-standard doses of creatine monohydrate over eight weeks. The study demonstrated that supplementation was well tolerated and led to an increase in brain creatine levels, along with moderate improvements in working memory and executive function.

Although preliminary and small in scale, these findings are noteworthy. Alzheimer’s disease is associated with impaired energy metabolism in the brain. If mitochondrial dysfunction contributes to cognitive decline, then enhancing the brain’s energy reserve may offer a meaningful therapeutic strategy. Larger clinical trials are needed, but the mechanistic rationale is strong.

Beyond neurodegenerative conditions, research in healthy adults suggests that creatine supplementation may improve memory, attention span, and processing speed — particularly under conditions of stress or sleep deprivation. This is consistent with the idea that when cognitive demand rises, energy availability becomes a limiting factor.

Mood, Stress, and Brain Resilience

Another area of interest is mental health. Emerging data suggest that creatine may have adjunctive benefits in depression, particularly when used alongside conventional therapies such as SSRIs. While the exact mechanisms are still being clarified, improved cellular energy availability may support neurotransmitter synthesis and neuronal signaling. From a systems-based perspective, this is logical. The brain’s chemistry does not operate independently of its energy supply. If neuronal cells lack adequate ATP, their ability to maintain optimal signaling, repair, and resilience diminishes.

There is also growing discussion around creatine’s potential neuroprotective role in traumatic brain injury (TBI). The injured brain has dramatically increased energy demands during recovery. Ensuring sufficient creatine availability may help buffer this metabolic stress, although more large-scale trials are needed to establish standardized protocols.

Women, Hormones, and Creatine

An especially compelling area of research involves women’s health. Women generally have lower total creatine stores than men, likely due to lower average muscle mass and dietary intake. Hormonal shifts also appear to influence creatine metabolism. During perimenopause and menopause, declining estrogen levels can affect muscle mass, bone density, and cognitive clarity. Some early research suggests that creatine supplementation, particularly when paired with resistance training, may help mitigate muscle loss and possibly support cognitive function during this transition.

For practitioners working with women in midlife — an area frequently addressed in functional medicine — creatine may represent a supportive adjunct within a broader strategy that includes nutrition, strength training, hormone balance, sleep optimization, and stress management.

Dosing and Safety Considerations

Creatine monohydrate remains the most studied and well-supported form. For most adults, a daily dose of 3–5 grams is sufficient to gradually saturate tissue stores. Some protocols include a short loading phase of 20 grams daily for five to seven days, divided into smaller doses, though this is not required and may increase the likelihood of gastrointestinal discomfort.

Consistency is more important than timing. Creatine is metabolized daily, so regular intake is necessary to maintain tissue levels. Common side effects are typically mild and may include bloating or gastrointestinal upset, particularly at higher doses. A small increase in body weight can occur due to water retention within muscle tissue — not fat gain.

Concerns about kidney function are common but often misunderstood. In healthy individuals, long-term studies have not demonstrated kidney damage from creatine use. However, individuals with known kidney disease or those taking medications that affect renal function should consult their healthcare provider before initiating supplementation. Monitoring may be appropriate in certain cases. Quality also matters. Third-party tested creatine monohydrate, free of proprietary blends and unnecessary additives, is preferred.

Who May Benefit Most?

While research is ongoing, certain groups may derive particular benefit:

• Individuals experiencing cognitive fatigue, high stress, or sleep disruption
• Older adults seeking to preserve muscle and cognitive function
• Vegetarians and vegans, who may have lower baseline creatine stores
• Women navigating perimenopause or menopause
• Individuals recovering from neurological injury (under medical supervision)

As always, supplementation should not be viewed in isolation. Creatine is not a substitute for adequate protein intake, nutrient-dense food, restorative sleep, hydration, or movement. Rather, it can serve as one piece of a comprehensive, personalized plan.

A Whole Body Approach

Creatine’s expanding research base reflects a broader shift in how we understand health. Energy production is central to nearly every physiological process. When cellular energy is optimized, tissues function more efficiently, adapt more effectively to stress, and recover more reliably. In that context, creatine is less about athletic enhancement and more about metabolic support.

As with any intervention, individualized assessment is key. Not every patient requires creatine supplementation, and dosing should align with overall health status, goals, and laboratory findings. But as evidence accumulates — particularly in the realm of cognitive health — creatine deserves thoughtful consideration. The conversation is evolving. What began as a performance supplement may ultimately find a meaningful place in brain health protocols grounded in mitochondrial support and whole-person care.

If you’re interested in taking a more personalized, preventive approach to your health Dr. Tracy Tranchitella, ND offers comprehensive care designed to support your long-term health. Learn more and request a consultation >>