What clinical applications of creatine did Roschel 2021 identify?

Roschel et al. (2021) identified clinical applications for creatine in brain health and neuroprotection, aging and sarcopenia, metabolic diseases including type 2 diabetes, rehabilitation from injury, and mental health conditions including depression and traumatic brain injury.

Does Roschel 2021 support creatine for brain health?

Yes. The review compiled evidence showing creatine supports cognitive function, may protect against neurodegeneration, and could benefit individuals with traumatic brain injury. Brain creatine deficiency syndromes demonstrate the essential role of creatine in neural function.

Is creatine only useful for athletes according to this review?

No. Roschel et al. explicitly argued that creatine's benefits extend well beyond sport performance. The review presented evidence for its role in clinical populations including elderly individuals, patients with metabolic disorders, and those recovering from neurological trauma.

Roschel et al. 2021: Creatine's Clinical Applications Beyond Sport

TL;DR — Roschel et al. 2021

In 2021, Roschel, Gualano, Ostojic, and Rawson published a comprehensive 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 (H et al., 2021) . Their work argued that creatine deserves attention from clinicians far beyond the sports medicine community.

distinct clinical domains where creatine shows therapeutic promise

Roschel et al., Nutrients, 2021

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 (RB 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 (KI 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.

20%

of the body's total energy is consumed by the brain — creatine helps fuel it

Roschel et al., 2021

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 (B 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

Study Design and Methodology

Understanding how a study was designed helps assess the strength of its conclusions. Key methodological factors to evaluate include:

Sample size — larger studies (n=50+) provide more reliable results than small studies (n=10-15). Small sample sizes increase the risk of false positives and limit the ability to detect moderate effect sizes
Study duration — creatine research requires adequate duration for muscle saturation (minimum 4 weeks for maintenance dosing, 1 week for loading). Studies shorter than this may miss the full effect
Blinding — double-blind, placebo-controlled designs (where neither researchers nor participants know who receives creatine) are the gold standard for minimising bias
Population studied — results from trained athletes may not fully apply to untrained individuals, and vice versa. Age, sex, and dietary habits (particularly vegetarian status) also influence creatine response
Outcome measures — direct measures (muscle biopsy, MRS imaging) are more informative than indirect proxies (blood markers, performance tests) for assessing creatine uptake and metabolism

Clinical Implications and Practical Relevance

This research contributes to our understanding of creatine in several practical ways:

For athletes and fitness enthusiasts: The findings support the use of creatine monohydrate as a safe, effective ergogenic aid. The standard dosing protocol of 3-5g daily remains well-supported by the cumulative evidence base including this study.

For healthcare professionals: Understanding the specific mechanisms and safety data from studies like this helps clinicians provide evidence-based guidance to patients who ask about creatine supplementation. The research consistently shows a favourable safety profile at recommended doses.

For the Malaysian context: While most creatine research is conducted in Western populations, the fundamental biochemistry (ATP-phosphocreatine system) is universal. Malaysian consumers can apply these findings with confidence, adjusting for local factors like tropical climate (increased hydration needs) and halal dietary requirements (synthetic creatine monohydrate is permissible).

How This Fits Into the Broader Evidence

No single study should be used to make definitive claims about creatine supplementation. Instead, this research should be viewed as one piece of a much larger evidence base:

The ISSN Position Stand (2017) synthesises hundreds of studies into comprehensive recommendations
Multiple systematic reviews and meta-analyses confirm creatine’s effects on strength, power, and lean mass
Long-term safety data spanning up to 5 years shows no adverse effects at recommended doses

For a complete overview of the evidence, explore our Research Library which covers 60+ landmark creatine studies.

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.