Creatine & Concussion Recovery (& Prevention)
Evidence for a wide variety of benefits
Some of the posts on Brainwave are quite dense with information and it’s easy to miss items that might prove to be extremely beneficial in one’s concussion recovery.
One of those items is the supplement creatine. It’s mentioned in the posts about supplements and post-acute first aid. I thought I’d take a moment to put a finer point of emphasis on creatine.
The many benefits of creatine, including energy production for the brain
Creatine is one of the most well-researched supplements. It is commonly used by athletes to boost athletic performance.
According to Examine.com (an excellent source of information about supplements with references to many legitimate studies), creatine has proven to be beneficial for a wide variety of other things, including concussion recovery—and even prevention.
The mechanism by which it helps may hinge on boosting ATP production.
It stores high-energy phosphate groups in the form of phosphocreatine which are donated to ADP, regenerating it to ATP, the primary energy carrier in the body. This role in energy production is particularly relevant under conditions of high energy demand such as intense physical or mental activity.
You will see ATP referred to often in the literature about brain injury. For example, transcranial magnetic stimulation and other treatments can help the brain in part because they stimulate processes that involve the brain’s use of ATP.
A reduction in mental fatigue has been observed in various scenarios such as demanding mental activity, sleep deprivation, and traumatic brain injury.
In the aftermath of concussion or TBI, the brain appears to struggle with the regulation and modulation of its energy needs. Neurovascular coupling (the process by which neural activity triggers the vascular activity that brings nutrients to the brain) may be disrupted.
So creatine may help the brain in post-concussion principally by providing energy support.
Beyond energy production
Apart from energy production, creatine appears to have many other benefits (which may be directly or indirectly tied to the mechanisms of ATP production and consumption).
If you look at the Human Effect Matrix on Examine, you’ll see several studies that have validated benefits that are relevant to post-concussion recovery. Among them:
Dizziness as a side-effect of traumatic brain injury is reduced with 400 mg/kg/day.
400 mg/kg/day in children and adolescents subject to traumatic brain injury reduces headache frequency from around 90% down to near 10%.
400 mg/kg/day in children and adolescents subject to traumatic brain injury reduces fatigue frequency from around 90% down to near 10%.
Depression symptoms seem to improve noticeably. This improvement is probably related to serotonin (creatine supplementation appears to enhance SSRI therapy).
Last, but not least, creatine has been shown to prevent post-concussion symptoms in animal studies.
"In rats and mice given creatine injections (3g/kg) for up to five days prior to traumatic brain injury, supplementation was able to reduce brain injury by 3-36% (time dependent, with five days being more protective than one or three), and dietary intake of creatine at 1% over four weeks halved subsequent injuries."
This last result is why I personally plan on taking creatine for the rest of my life, should I ever be injured in the future. I take 5g every morning.
Who benefits most from creatine supplementation?
Creatine is a molecule that the body naturally produces from amino acids. Those amino acids are typically sourced from meat and fish.
The process of making creatine in the body (from the amino acids in meat and fish) comes with a certain energy cost. By taking exogenous creatine, one cuts or reduces that cost.
It may be (and this is pure conjecture on my part) that a brain injury disrupts the mechanisms by which creatine gets produced. Perhaps the normal signalling process (the brain saying, “hey liver, make more creatine!”) gets disrupted by the neurological injury. If there’s any validity to that idea, then creatine supplementation might help the brian in part by supplying baseline needs.
Creatine supplementation seems to benefit the elderly, especially those with age related cognitive decline. Here again, it’s possible that this is related to reducing or eliminating the biological cost of producing creatine.
If you’re a vegetarian, or if you’ve substantially reduced your meat intake, you might see more benefits than someone who eats meat and fish regularly.
Those who take SSRIs may see an added benefit with creatine (there’s evidence of both a synergistic benefit with SSRIs as well as evidence for depression reduction among those who aren’t taking SSRIs). If you’re taking an SSRI, this may be a reason to proceed with some level of caution (and perhaps some level of optimism) when supplementing with creatine.
Should you take creatine?
Obviously, this is a personal decision that should be made after consulting with a relevant medical professional.
If you do decide to take creatine, just note that there is a “loading phase” where the available supply of creatine is increasing, and you may not feel the benefits for a few weeks. In this regard, it isn’t unlike supplements and medications that take time to create the expected result in the brain and body.
Here again, Examine provides some guidance about what to expect during this loading phase.
Creatine monohydrate can be supplemented through a loading protocol. To start loading, take 0.3 grams per kilogram of bodyweight per day for 5–7 days, then follow with at least 0.03 g/kg/day either for three weeks (if cycling) or indefinitely (without additional loading phases).
For a 180 lb (82 kg) person, this translates to 25 g/day during the loading phase and 2.5 g/day afterward, although many users take 5 g/day due to the low price of creatine and the possibility of experiencing increased benefits.
As always, I hope this information has been beneficial to you and your loved ones. If you know anyone who might benefit from this information, please share and subscribe to Brainwave.
Brainwave is an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I endeavor to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve simply had a lot of sports-related concussions and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.