At last month’s Active Nutrition Summit in Vienna, Sergej Ostojic, a professor of nutrition at the University of Agder, presented research showing that creatine malnutrition may increase the risk of multiple health conditions, including cancer, depression and even all-cause mortality.
This, he says, is a key reason creatine should be considered a semi-essential nutrient.
“Creatine is much more than just an energy-rich molecule,” he said. “All cells in the body use creatine to produce energy, […] and it contributes to many of the body’s essential roles, similar to choline or other semi-essential nutrients.”
“I imagine creatine will be recognized in the next five years as a kind of creatine 2.0,” he said. “People should consider implementing creatine as a low-dosage protocol—it should be considered the new vitamin D or magnesium.”
Creatine intake in the general population
Researchers have been studying creatine for a century, with the first paper published in 1926. Now, there are nearly 70,000 research papers on creatine on PubMed alone, with newer studies shining a light on its benefits beyond athletic performance.
“Creatine is not just for athletes, but also for children and the elderly,” he said. “My team, and others across the world, are now trying to put creatine forward as a concept for public health nutrition.”
Dr. Ostojic says creatine is now fairly well recognized as an important nutrient for vegetarians and vegans who do not consume creatine-rich food sources, as well as for older people since muscle creatine declines with age.
However, he argues it is also an important nutrient for the general population, highlighting that 65.2% of the population are not consuming enough dietary creatine.
In fact, people are now consuming less dietary creatine than they were in the past, according to a study using the NHANES database. It found that, over the last 20 years, there has been a significant negative trend in creatine intake in infants, children and adolescents, and a strong downward trend in adults.
“We require around two grams of creatine per day, one gram coming from food and the other from internal sources such as glycine, arginine, and methionine,” he said.
“In Scandinavia, people are probably consuming enough creatine because they are eating a lot of herring and salmon, but people who are not consuming rich sources of creatine might be facing creatine malnutrition.”
What are the consequences of creatine malnutrition?
Low creatine intake results in low creatine levels in the plasma, brain and skeletal muscles. This can cause side effects such as fatigue and brain fog, Ostojic said.
“If you are deficient in creatine, you are probably going to feel fatigued, and you might also have movement disorders and behavioral problems,” he said. “Brain fog and concentration difficulties might also accompany a lack of creatine.”
Recent research has also shown that low creatine levels may be linked to poor mental health. A study using the NHANES database found that depression prevalence was 42% higher among adults in the lowest quartile of creatine consumption.
Studies in the older population have also found that low creatine intake is associated with increased risk of heart and liver conditions, with higher intake associated with improved cognitive function.
A study published in Food Science and Nutrition found that elderly people with suboptimal intake of creatine were found to have more than double the odds of developing angina pectoris (a symptom of coronary artery disease) and liver conditions after controlling for nutritional variables. This is compared to participants who consumed 1 g or more of creatine per day.
Another, published in Aging Clinical and Experimental Research, found that older people who consumed more than 0.95 g of creatine per day had higher cognitive function scores.
“I’m talking about very low doses, not 20 grams a day, just one gram per day every day might be all that is required,” Ostojic said.
More recent research has found that creatine intake may even be linked to cancer risk, with one study published in the Journal of Functional Foods reporting that consuming a diet rich in creatine is associated with a reduced risk of cancer or malignancy.
In fact, for every additional milligram of food creatine per kilogram of body mass consumed daily, the cancer rate reduced by approximately one percent.
“This is a big deal, and it’s a big deal because the study is controlled for BMI, age, gender and also for dietary intake including protein,” Dr. Ostojic said. “This suggests that creatine by itself might be a factor that could reduce the risk of cancer and other disorders.”
Finally, a recently published study which tracked a large population for 20 years showed that people who consume at least 1 g of creatine a day have a lower risk of early death.
“This finding was true even when corrected for other dietary components that affect all-cause mortality, including important vitamins, minerals and micronutrients,” he said. “So, creatine, by itself, is an indicator for all-cause mortality.”
How much creatine is needed to be of benefit?
Ostojic highlighted that creatine is a safe nutrient, with no major adverse health risks noted in the one thousand interventional studies in humans.
The evidence suggests that consuming just 1 g per day can prevent creatine malnutrition, while somewhere between 3 to 5 g can boost energy stores and muscle performance, particularly when co-administered with exercise.
Whether higher doses are needed to see significant cognitive improvements is still up for debate, with some research suggesting a dose of 20 g per day may be needed in order to cross the blood-brain barrier. This goes beyond the EFSA-recommended daily allowance of 3 g per day.
Overall, however, Ostojic says the benefits of creatine at low doses are clear, and consuming even small amounts could therefore be viewed as a ‘preventative strategy’ for numerous health conditions.
“The idea of fortifying food with creatine might be something that should be considered in the future, particularly now that there are so many guidelines across the world from the UN and other authorities to cut down on meat intake,” he said. “But if you cut out meat, you are going to lose creatine, so maybe adding creatine to food may help everyone to tackle creatine malnutrition.”
