Creatine and Concussion Recovery

It has been well-documented for quite some time that creatine supplementation is beneficial for muscle strength and performance. But today, a rising chorus of experts are extolling the use of creatine for clinical use, particularly for optimizing brain function.

For example, a 2024 paper with scientist, coach, professor, podcaster, and influencer Dr. Andy Galpin on the list of authors made a splash: Mitigating Traumatic Brain Injury: A Narrative Review of Supplementation and Dietary Protocols. This paper popularized and sparked curiosity in the nutritional research of concussion recovery that we at Complete Concussions have discussed for years.

Naturally, this has led many individuals to wonder: might creatine supplementation play a role in MY concussion recovery?

You might be surprised—and pleased—to hear the answer.

What is it?

And is it safe?

Creatine Will Not be Ideal for Every Person.

This mainly includes people who suffer from pre-existing kidney dysfunction, people who are taking potentially nephrotoxic medications, or weight-sensitive athletes (e.g., wrestlers). 

Of course, it is always best—and it is our recommendation—that you seek the advice of a trusted medical professional before using creatine as a supplement.

Now, let’s consider creatine specifically as a tool for concussion recovery.

Creatine and Concussion Recovery.

As we noted at the beginning of this article, creatine supplementation has long been used and studied within the context of exercise and performance. Today, interest has shifted toward the clinical and health-related uses of creatine supplementation, especially concerning treating and preventing brain dysfunction.

When supplemented in supraphysiologic doses, creatine may increase the creatine inside our brain cells by 5-10%. This may provide the brain with more energy. The technical term for this energy promoted by creatine is a molecule called “adenosine triphosphate,” or “ATP” for short. 

Creatine’s role in increasing “fuel” for the brain is critical for the health and recovery of brain function since the brain alone consumes about 20% of the body’s total energy. That’s a massive amount relative to the rest of the body!

When a person suffers a concussion, one of the effects of the resultant brain dysfunction is a sudden, rapid increase in brain activity. This is known as the “excitatory” phase of concussion. This abrupt onset of neuronal hyperactivity results in symptoms like headache, nausea, dizziness, and difficulty falling asleep, lasting hours to days.

As one might suspect, this “excitation” phase of concussion burns a lot of energy (i.e., ATP) in the brain, leading to an energy deficiency and “spreading depression” of brain activity (thus leading to more symptoms). This is where researchers and clinicians believe creatine helps with concussion recovery – by increasing potential energy stores in the brain via creatine supplementation, ATP stores can be replenished quickly, hopefully leading to restoring normal brain function and resolution of symptoms.

Dolan, E., Gualano, B., & Rawson, E. S. (2019). Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury. European journal of sport science, 19(1), 1-14.

But how about concussion prevention? Might creatine buffer against the potential neuronal dysfunction of concussion by maximizing brain ATP stores and optimizing cognitive function beforehand?

Creatine and Concussion Prevention.

Across a variety of populations, existing research suggests that creatine supplementation may have a favorable effect on cognition in healthy people. With creatine supplementation, aspects of cognition like memory, attention, decision-making, and mood may improve.

Further, because of supplemental creatine’s ability to increase energy production in the brain, it may help sustain cognitive performance in ordinary instances of brain energy depletion, such as over prolonged cognitive tasks or following sleep deprivation. 

The bottom line is that creatine supplementation is helpful for healthy populations for cognitive optimization.

Although it is certainly plausible that the administration of creatine in healthy populations may decrease the risk of concussion, the jury is still out on this question. 

There is, however, good evidence that creatine supplementation may prevent complications to recovery as a post-concussion intervention. For instance, in one well-noted study, 39 youth (ranging from 1 year old to 18 years old) were given 0.4g/kg of creatine per day over six months following concussion. This resulted in improvements in post-traumatic amnesia, duration of intubation, intensive care unit (ICU) stay, disability, self-care, communication, locomotion, sociability, personality/behavior, and cognitive function.

Type and Dosage.

Although multiple forms of creatine are available on the supplement market today, research indicates that creatine monohydrate is the optimal choice.

Creatine monohydrate has been used widely for several decades. It is also the most researched form of creatine. It may be the most researched supplement available today, next to caffeine. While existing research shows that other forms of creatine may be more soluble when mixed in fluid (say, a post-workout shake), most studies indicate that creatine monohydrate is superior for intramuscular uptake and performance outcomes.

As University of Regina researcher Darren Candow reports in his 2023 article:

“Almost the entirety of creatine supplementation is in the form of creatine monohydrate, which is the most effective and bioavailable form of creatine for increasing plasma creatine levels, tissue creatine content (i.e., brain, muscle), and performance outcome measures.”

This leads us to some practical questions: How much should you take?And when should you take it?

In the past, it was believed that a higher dosage of creatine should be taken at the beginning of supplementation (i.e., the so-called “loading phase”), but more up-to-date recommendations for the average athlete have primarily dispensed with this practice. 

Most people will derive optimal benefits with a basic 3-5g per day “maintenance” dosage from the start.

But then the question remains: What dosage is most effective for someone recovering from a concussion?

To adequately increase the amount of creatine in the brain after a head injury, a higher dose per day is required.

A daily dosage of 10-20g of creatine is an excellent place to start. This dosage range is sufficient to provide an increase in energy in the brain, as well as improvements in cognitive symptoms like memory difficulties, headaches, and dizziness.

Conclusion.

In conclusion,  while further research is needed to understand the potential effects of creatine on concussion prevention entirely, current evidence suggests that it may have a positive impact in both enhancing recovery and potentially reducing risk in healthy individuals. 

With its ability to increase energy production and improve cognitive function, creatine supplementation may be a valuable tool in brain health and injury prevention. However, as with any supplement or medication, it’s essential to consult with a trusted healthcare professional before beginning use.