You might already be familiar with creatine as a muscle-building supplement. The compound, which the body makes and is found in meat and seafood, helps form adenosine triphosphate (ATP). 

Whether you’re squatting 300 pounds or simply walking down the street, your muscle cells are powered by the breakdown of ATP. Your brain also uses ATP — a lot of it. In fact, the brain uses about one quarter of your body’s ATP. 

“Creatine is like fuel,” says Ali Gordjinejad, PhD, a researcher at the Forschungszentrum Jülich research institute in Germany. “If the tank is empty due to the enormous consumption, it is quickly refilled with creatine.”

Gordjinejad published a small study last year in the journal Scientific Reports in which 15 women either took 20 grams of creatine or a placebo before staying awake through the night until 4 a.m., and then took cognitive tests. The women did better on the tests after taking the creatine than after taking the placebo. 

Other studies have found that taking a creatine supplement may improve memory, speed healing after a concussion or brain injury, and reduce feelings of depression. 

That research is still in its early stages, so the benefits aren’t certain. But it makes sense in certain situations, says Kate Patton, a sports dietitian at the Cleveland Clinic Center for Human Nutrition.

“That ATP system needs more creatine during times of stress, or what we call metabolic demand,” Patton says. “So in times of sleep deprivation, or maybe if someone has a mental health condition or some kind of neurological disease, we need that energy just for cognitive functioning.”

Thanks to creatine’s long history as an athletic performance enhancer, it’s one of the most thoroughly studied supplements, and it’s widely regarded as safe for anyone with healthy kidneys. But while there’s little downside to taking creatine, the extent to which it can help manage or even prevent ailments in the brain is still being explored.

Here, Gordjinejad and Patton answer questions about creatine for brain health. These interviews have been edited for length and clarity.

How would you describe the overall amount and quality of the research on creatine and brain health? 

Ali Gordjinejad, PhD: Creatine is one of the best researched dietary supplements with regard to its physiological effects. The results have led to creatine becoming an integral part of physical performance enhancement in the sports world. For two decades, after it was discovered that it also has an effect on cognitive abilities, more and more research has been done in this field. 

I would say we are at the beginning of a development where we increasingly understand that creatine also has the potential for cognitive improvement. This could have enormous implications for therapies for brain diseases associated with cognitive disorders such as neurodegenerative diseases.  

However, since there are not many studies in this field, the results are not yet reliable enough. Therefore, many more studies are needed.

Kate Patton: We're definitely at the beginning. It's not really controversial, but more consistent research and long-term studies are necessary. A lot of the studies are just very different, based on the techniques, the dosing, the duration, and the population.

Who should be taking creatine? 

Gordjinejad: Since older people and vegetarians have lower creatine levels, they would generally benefit the most. But so far there is no range — or at least no research — on the age at which creatine is most effective. Furthermore, many studies have reported about neuroprotective effects of creatine. Recent studies in mice showed that creatine supplementation attenuated cognitive impairment, oxidative stress, and damage to hippocampal structural plasticity and led to increased creatine kinase activity. Therefore, it is very likely that creatine could prevent cognitive decline. However, since there are not enough studies on humans, further studies would be necessary.

Patton: There really aren't any consensus statements or specific recommendations from any neurological society, or board, or nutrition group. So what I would say is that you don't really have to start taking it. I don't think that the research is there yet.

However, what's really interesting is that it may be helpful for certain populations who are at risk of sleep deprivation and working long hours. So medical residents and fellows, pilots, especially when traveling over different time zones, and that sort of thing. Maybe that small population. And athletes who are at risk for concussions. 

If you're someone who is still active and exercising, then obviously you could get both the mental and physical benefits. But for your average healthy adult who's trying to take it for protective reasons, I think it's still a little bit too early for that. 

How much creatine should people take, and what should they look for in a supplement?

Gordjinejad: A daily dose of around 3-5 grams is recommended. Whether this dose is sufficient to prevent cognitive decline remains to be seen. Of all the creatine compounds, creatine monohydrate has been the most researched so far. All the results we talked about are related to this dose. Even all the additives have not proven to be more effective so far.

Patton: Look for brands that are third-party tested, so that we can ensure that the product really does have the ingredients they say and don't include any kind of banned substances. A couple of different organizations who do that are NSF and Informed Choice. The brands will send their products to those organizations to confirm their ingredient list and the efficacy. 

Research has shown that you don't have to take the loading dose of creatine, which would be around 20 grams to build it up in your muscles. It’s not necessary. So then the maintenance dose is just 3-5 grams of creatine per day, and you should take it consistently. 

Can food sources provide enough creatine to have a beneficial effect, or is it necessary to take a supplement?

Gordjinejad: I'm afraid it might not be enough. One hundred grams of meat or fish, for example, have a creatine content of around 0.5 grams. That is too little to have any effect, at least in terms of cognitive improvements.

Patton: No. 1, your body does synthesize it, so your kidneys are synthesizing it, and your liver, and even your brain, but it's questionable how much the brain's really getting. And yes, we can get it from our diet, mostly from meat and fish. But even a pound of meat, which is plenty of protein for the average person, really only gives you 1-2 grams of creatine. So, yes, supplementation is needed to get closer to 3-5 grams of creatine.

How safe is creatine, and is there any downside to taking it regularly?

Gordjinejad: If you don't have kidney problems, the recommended 3-5 grams shouldn't have any downsides, even taken regularly. Whether you take it or not depends on the person. For my part, I wouldn't take it permanently just to avoid making the body dependent. But that's just my personal opinion.  

Patton: The only contraindication would be if you have chronic kidney disease, or if you have any kind of kidney condition. Maybe even people with liver disease might want to avoid creatine. The only other downside is sometimes when patients are taking the high dose or the loading dose, that's when they tend to notice more of the bloating, and sometimes nausea, cramping, and diarrhea.

What sorts of studies would you like to see on creatine in the future?

Gordjinejad: It would of course be interesting to know whether creatine actually has the potential to have a therapeutic effect on neurodegenerative diseases. But as far as we are concerned, we would like to find out in the future whether a lower dose of creatine can also prevent the negative effects of sleep deprivation. The dose of 0.35 g/kg that we used for our study was quite high, which is a strain on the kidneys. However, if a considerably lower dose also proves effective, creatine would indeed be interesting for many professions that have to deal with unexpectedly long sleepless nights. This could include pilots, nurses, firefighters, or students during exam periods.

Patton: A lot more research, and consistent results from the research, so that studies are consistently finding value and benefit for different populations and different conditions.