For bodybuilders, creatine is as close to a no-brainer supplement as you’ll find.
Among healthy aging researchers – things quickly become nuanced.
Creatine is proven to boost muscle mass. This effect alone has healthy aging benefits, both at the molecular level and by protecting against falls. Add neuroprotective qualities, plus a reduction in cellular waste – and the use case becomes compelling.
All that said, there are concerns. Muscle gains quickly disappear when you stop taking creatine. While that extra power potential while taking it will ensure longer-term growth with reps, I’m yet to be convinced this is a likely outcome for older / frailer people.
This deep dive into the role of creatine in longevity was triggered by the results of a recent DNA test. My genes show that I’d benefit more from creatine than the population average.
How this Healthy Aging and Creatine Deep-Dive is Organised
After three full days reading clinical papers, meta-analyses, watching videos of specialist conferences and considering countless individual opinions, I decided not to take creatine.
While I have little doubt that it is safe, I’m not sold on the benefits for a middle-aged guy that does not push hard while resistance training.
I’ll return to this decision at the end of the page. First, here is how I’ve broken down the topic.
- What is Creatine? How Does it Work?
- Creatine and Healthy Aging Summary (Sarcopenia, Neuroprotection and Cell Waste Management)
- Muscles, Water and Creatine
- Investigating the Drawbacks of Creatine (Kidney Health, Hair Loss, and Water Retention)
- Dosing and Cycling of Creatine Supplements
- Why I Decided Not to Take Creatine (at least for now).
Creatine and Healthy Aging: What is Creatine and Why is it Popular?
Creatine is a non-protein organic compound.
We get it from food and produce it in our livers. Creatine is stored in muscle fibres, in the form of phosphocreatine. Its primary function is in the ATP / ADP energy cycle. By donating a phosphorous molecule to ADP (which boosts concentrations of ATP), creatine increases cellular energy potential in the muscles.
Athletes use that extra energy to enhance performance in sports requiring power. Examples are weightlifting and sprinting.
Image Credit: Wikipedia
Creatine supplements have been available since the 1990’s. They are hugely popular among athletes, and increasingly popular among people seeking muscle definition and bulk. As well as aiding power, creatine has biochemical roles in muscle repair and growth.
Water retention in the muscles won’t help you live longer – though it has a role in increasing confidence and aesthetics. You will typically lose that extra bulk and power 4-6 weeks after you stop taking creatine supplements.
That said, the extra power will help you lift heavier weights (all else being equal), which will improve strength and definition for longer.
Solid Safety Profile
This supplement has a solid safety profile. Highly publicised side effects on kidney function and cramps have not been clinically replicated outside of at-risk groups. Bloating and stomach problems are possible when you first start to supplement creatine.
My deep dive into the science tackled this question: Does Creatine have a use for healthy aging, or is it something that weight trainers use to look better?
Three Ways Creatine Boosts Healthy Aging
This section covers the research-backed ways that creatine contributes to longevity.
There are three key areas of interest:
- Muscle Growth, Maintenance and Age-Related Sarcopenia
- Brain Health and Neurodegenerative Diseases
- Lipofuscin (Cell Toxins) Reduction
While sports science has studied creatine for decades, the link with healthy aging is under-researched. I think of the sections below as ‘promising areas of research,’ rather than agreed upon solutions.
Muscles: Creatine to Treat Sarcopenia in Older People
Muscles atrophy with age. This process, called sarcopenia, is a major contributing factor to physical decline and eventually to death.
Lack of muscles prevent older people from enjoying an active life, creating a vicious cycle of further declines. Sarcopenia also contributes to falls. Combine those falls with brittle bones, and they are a huge risk factor for older people.
A controlled study investigated the role of creatine in reversing sarcopenia.
The participants were in their 70’s and 80’s. They combined resistance training with creatine or a placebo. Muscle gain and weight lifted was measurably better for the creatine group.
Getting older people involved in resistance training is a big win without any supplements. That said, I do wonder whether the effect was maintained? Creatine returns to base levels in the muscles after 4 to 6 weeks. In this case, increased power during training would be the factor improving muscle mass (after water retention bulking was removed). Is this likely in the 70+ age-group?
An interesting study, though for me, way more research is needed before drawing firm conclusions.
Video: Creatine Conference 2022
YouTube is an amazing resource.
It allowed an interested amateur to enjoy presentations from a super-specific medical conference.
The video below stood out. This is by Professor Darren G. Candow a specialist in Aging Muscle and Bone Health- it covered the effects of creatine on sarcopenia in the elderly population.
His analysis did show net muscle gain (1.7kgs). Though not to statistical significance, this is an impressive boost in a placebo-controlled setting. My concern about losing this mass rapidly after stopping creatine remains.
Creatine and the Aging Brain: Parkinson’s, Huntingdon’s, and Dementia
Creatine’s mitochondrial energy boosting properties may boost brain function as well as muscle power.
Improvements in cognitive function were measured in this paper. Notably, vegetarians (who frequently consume lower dietary creatine) were boosted significantly in memory tests.
Brain function benefits from the same ATP increase that muscle fibre does.
While in vitro and animal studies have shown neuroprotective effects from creatine, these benefits have not translated into protection or relief from serious neurological disorders.
This meta-analysis looked at studies into Parkinson’s disease. It found no significant benefits over a placebo over five clinical trials.
Early trials into the effect of creatine on Huntingdon’s disease showed promise. Unfortunately, long term studies have not backed this – with patient outcomes. In fact, recent analysis shows that creatine does not slow functional decline. This article has more details on the papers.
A similar pattern emerges with ALS, Alzheimer’s, and dementia.
On a positive note – this is an exciting area of research and trials are ongoing. I’d like to understand how creatine boosted cognitive function in healthy adults in more detail.
Reduction in Intercellular Toxins (Lipofuscin)
An exciting new area of research involves the ability of creatine to reduce toxic compounds within brain cells.
In mouse studies, with those receiving creatine living measurably longer. I’ll ignore the headlines about 7 years extra life, as mapping mouse models to real longevity is fraught with issues.
What is interesting is the proposed mechanism.
As we age, misfolded proteins accumulate in our cells, eventually becoming a burden to healthy cell function. This build up is called lipofuscin. Drugs and behaviours promoting autophagy are one solution. Adding creatine to this list would be an exciting development.
More research needed would be an understatement in this area – despite the hugely positive potential.
This detailed piece at BioMedCentral covers the papers (and lots more creatine science).
Muscles and Creatine: Dosing, Maximum Effort and Water Retention
We produce 1 gram of creatine each day.
This is created in the liver from the amino acids glycine and arginine. The remainder comes from food. High concentrations come from meat, oily fish, and dairy. Herring is the best source of all.
If you don’t have a diet high in creatine, then the combination of food and our own production will not meet the 3 grams a day average requirement for healthy adults.
Stages of Creatine Supplementation:
- Loading Stage: Up to 20 grams per day for 5 to 7 days, spread throughout the day.
- Maintenance: 3 to 5 grams daily, depending on your size and dietary intake.
Cycling Creatine Supplements:
- This adds a pause of between 7 and 14 days where you don’t take any creatine.
If you wish to be more precise, online calculators based on your size and BMI will give extra precision. Note that water retention is a common effect at the start of the loading phase. Users expect to add between 1kg and 3kg in weight at this point.
When you stop taking creatine, the muscle bulk will subside. It takes 4 to 6 weeks for creatine levels to return to base – and for that muscle mass to gradually disappear.
Extra power from extra ATP means lifting heavier weights. Those muscle gains remain for longer (assuming exercise continues).
Creatine and Healthy Aging Drawbacks: Myths, Concerns and Clinical Research
Legacy media loves to take a simple line in a complex paper and turn it into a scare story.
You’ll find creatine is a popular supplement to bash on TV and in newspapers. That said, it is important not to downplay genuine risks. Research does not support the narratives for most reported side-effects, including hair loss and kidney issues. I have some ongoing questions about water retention.
Kidneys: Potential damage to kidney function from creatine has not been supported in clinical trials. There is a caveat here – this is for otherwise healthy individuals. Anyone with kidney problems should not take creatine. This meta-analysis covers the topic in depth.
Water Retention: Short-term water retention is a known effect from beginning creatine supplementation – especially during the loading phase. There is an element of water retention in muscles too. This helps bulking and definition and is not seen as a problem for bodybuilders. I have two questions here. First, how much of muscle growth is water and how much is lean mass? Second, how quickly would extra muscle size shrink after taking creatine if this is simply water?
Creatine Hair Loss Myths Debunked
Hair Loss: The more I examine this, the more ‘wet roads cause rain’ springs to mind. Creatine is not causally linked to hair loss. What the papers show is that hormone changes for people that enjoy significant resistance training are linked to this. A perfect example of something the press is happy to run with, despite the science being flaky at best. This excellent paper has more details.
Stomach Issues: Most drugs and supplements have the potential for stomach cramps, nausea, and diarrhoea on the labels. Creatine is no exception. This is thought to affect only a small percentage of users.
Cramping: Another area where the science and anecdotes don’t match is muscle cramps. Higher doses of creatine have been linked to both cramping and to dehydration. This would be a factor during the loading stage. Controlled and season-long monitoring clinical studies have not been able to demonstrate a causal link.
Creatine Interference with Other Drugs: Despite the solid safety profile, supplements can interfere with pathways used by other drugs. I’m including this notice partly as a reminder, and partly as a disclaimer. Speaking with your doctor before starting with any new supplement is a must.
Why I’m Holding Off with Creatine (at least for now)
I need an outsize benefit and a miniscule risk profile to consider taking any supplement.
Creatine ticks all the boxes as low risk. What I’m yet to be convinced on is the magnitude of the benefits.
As a middle-aged guy with a varied exercise routine, I’m nowhere near pushing my boundaries for resistance training. Those aesthetic benefits appeal a little, though realistically, the best outcome there would be ‘good for his age.’
Importantly, I’m not convinced that any muscle gains would last post-supplementation. This makes creatine a different decision from a bulk-and-go setup. Muscle bulk would be a benefit in the short-term, though are the modest improvements worth life-long (or at least regularly cycled) supplementation?
For me, no.
The neuroprotective and cell waste science is fascinating. It has yet to create convincing results, aside from small increases at cognitive function. I’ll be keeping a close eye on this – along with combination therapies for sarcopenia.
If you are young, healthy and want to safely build bulk and muscle power – then go for it – creatine has a pristine safety profile.
For the rest of us, lets follow the science closely.
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