Should you take creatine? The performance-enhancing drug may help non-athletes

If you are an athlete in search of a chemical boost, your options are limited. Many of the drugs that are known to work – anabolic steroids to make you stronger, say, or erythropoietin to boost your endurance – are banned and come with nasty side effects. Many legal supplements, on the other hand, seem not to do anything useful.

An exception is creatine, a staple of sports nutrition and one of the few supplements with a solid evidence base behind it.

Creatine is one of few performance-enhancing drugs that isn’t banned and has a solid evidence base behind it. But should you take it even if you’re not an athlete?Credit: Leo Patrizi

One review paper from 2017 concluded that creatine can give athletes a 10 to 20 per cent performance boost in brief bouts of high-intensity exercise, such as sprinting past a defender or lifting heavy weights.

It appears to be safe too, with no worrying side effects seen even in people who have been taking the stuff for years. Because there is no test that can distinguish supplementary creatine from the sort naturally produced by the body, or indeed the kind found in meat and fish, most sports do not consider taking it to be doping.

Creatine works mainly by increasing the amount of energy that muscles can produce. Cells use a molecule called adenosine triphosphate (ATP) as a carrier of chemical energy.

Aerobic respiration, which uses oxygen to break down fats or sugar, is by far the most efficient way of making ATP. But it is relatively slow.

When muscles need a lot of ATP in a hurry, most of it is supplied instead by the phosphocreatine system, which, as its name suggests, relies on creatine to work. (A third pathway, the glycolytic system, sits between the other two in both power and efficiency.)

When muscles contract, the ATP molecules used to power that contraction lose one of their three phosphate groups, turning into adenosine diphosphate (ADP).

Phosphocreatine stored in the muscles can donate a replacement phosphate group, turning ADP back into ATP, which can then power more contractions. But those reserves are sufficient for only a few seconds of maximal effort (this is why it is impossible to run a marathon at the same pace as 100 metres).

Creatine supplements boost the amount of phosphocreatine that can be stored, allowing users to squeeze out a couple of extra reps or sprint at full power for a second longer.

That may not be the only benefit. A growing body of research suggests creatine may be good for brains as well as brawn. That makes sense: neurons need ATP just as muscle cells do, and the brain is hungry for energy. Despite accounting for about 2 per cent of the body’s mass, the brain is thought to consume around 20 per cent of its calories.

As summarised in a review published in 2021 in Nutrients, some studies have suggested that creatine might sharpen things like short-term memory or reaction times. Others have reported it may lessen the symptoms of mental health problems such as depression, and tentative evidence suggests it improves cognition in those with Alzheimer’s disease. Both may be associated with a misallocation of energy within the brain.

In animals, creatine seems to protect against the effects of concussions, which likewise seem to play havoc with the way brain cells generate energy. In one study, rats given creatine supplements showed a 50 per cent reduction in damage after they were given an artificially induced brain injury.

For now, the evidence regarding brains is not nearly as robust as that regarding muscles. But given that sport is a common cause of concussions, athletes taking creatine might be getting two benefits for the price of one.

The Economist

For the story behind the headlines, listen to The Morning Edition, with a new episode live every weekday from 5am. You can find The Morning Edition on Apple, Spotify, and everywhere you listen to your podcasts.