TL;DR — Roschel et al. 2021
In 2021, Roschel, Gualano, Ostojic, and Rawson published a thorough review in Nutrients that repositioned creatine from a sports supplement to a broadly applicable clinical nutrient.
The paper systematically reviewed evidence for creatine’s benefits in brain health, aging, metabolic disease, rehabilitation, and mental health (Roschel et al., 2021) .
Their work argued that creatine deserves attention from clinicians far beyond the sports medicine community.
Background and Rationale
Creatine research has traditionally focused on exercise performance and muscle physiology.
However, by 2021, a growing body of evidence had emerged linking creatine to benefits in non-athletic populations and clinical settings.
The ISSN position stand by Kreider et al. (2017) had already acknowledged creatine’s therapeutic potential (Kreider et al., 2017) , but a focused review of clinical applications was needed.
Roschel and colleagues set out to synthesize this emerging evidence, examining every major domain where creatine had shown clinical promise.
Key Clinical Domains Reviewed
Brain Health and Neuroprotection
The review highlighted substantial evidence that creatine supports brain energy metabolism.
The brain consumes roughly 20% of the body’s energy despite comprising only 2% of body mass.
Creatine plays a critical role in maintaining cerebral ATP levels.
Evidence reviewed included cognitive benefits in sleep-deprived individuals, vegetarians, and elderly populations.
The authors referenced meta-analytic evidence from Avgerinos et al. (2018) demonstrating creatine’s positive effects on short-term memory and reasoning (Avgerinos et al., 2018) .
Aging and Sarcopenia
Creatine combined with resistance training was shown to enhance muscle mass and strength gains in older adults more effectively than resistance training alone.
The review noted that age-related decline in muscle creatine content makes supplementation particularly relevant for the elderly population.
Metabolic Disease
The authors reviewed evidence from studies including Gualano et al. (2011), which showed that creatine combined with exercise improved glycemic control in type 2 diabetes patients (Gualano et al., 2011) .
GLUT-4 transporter activity and HbA1c levels both improved with creatine supplementation.
Rehabilitation and Recovery
Creatine’s potential to attenuate muscle loss during immobilization (from injury or surgery) was discussed.
The authors noted that creatine may help maintain muscle mass during periods of disuse and accelerate recovery when training resumes.
Mental Health
Emerging evidence for creatine’s role in depression, bipolar disorder, and post-traumatic stress disorder was reviewed.
Brain energy deficits are implicated in several psychiatric conditions, and creatine’s ability to enhance cerebral energy metabolism may underlie these benefits.
Practical Implications
- Creatine is not just for athletes: Clinicians should consider creatine for aging patients, those with metabolic disorders, and individuals recovering from injury
- Brain health is a key frontier: Cognitive benefits make creatine relevant for students, professionals, and elderly populations
- Standard dosing applies: 3-5 g/day of creatine monohydrate is sufficient for clinical benefits
- Safety is well-established: The extensive safety record supports use in clinical populations
Malaysian Relevance
Malaysia’s aging population makes the clinical applications of creatine particularly relevant. As life expectancy increases, interventions that combat sarcopenia and support cognitive function become increasingly important.
Creatine monohydrate is an affordable, well-tolerated option available throughout Malaysia.
The metabolic health findings are also pertinent given Malaysia’s high prevalence of type 2 diabetes and metabolic syndrome.
Full Citation
Roschel H, Gualano B, Ostojic SM, Rawson ES. Creatine supplementation and brain health. Nutrients.
2021;13(2):586. doi:10.3390/nu13020586
Where This Fits in the Evidence
Roschel and colleagues (2021) is best understood as a map rather than an experiment: it gathers the scattered non-athletic evidence for creatine and organises it into distinct clinical domains — brain health, ageing and sarcopenia, metabolic disease, rehabilitation and mental health. Its argument is one of repositioning, taking a nutrient long filed under sports performance and showing why clinicians treating older or metabolically unwell patients should pay attention. Because it draws together many smaller trials of varying strength, it sets a research agenda more than it settles individual questions. The position stand it explicitly builds on is the ISSN position stand, and the underlying domain-specific studies are catalogued in our research library.
Sources & References
This article is based on the review by Roschel et al. published in Nutrients (2021) and contextualized with findings from Kreider et al. (2017), Avgerinos et al. (2018), and Gualano et al. (2011).
All citations reference PubMed-indexed publications.