The effects of creatine supplementation on cognitive performance-a randomised controlled study

Julia Fabienne Sandkühler; Xenia Kersting; Annika Faust; Eva Kathrin Königs; George Altman; Ulrich Ettinger; Silke Lux; Alexandra Philipsen; Helge Müller; Jan Brauner

doi:10.1186/s12916-023-03146-5

The effects of creatine supplementation on cognitive performance-a randomised controlled study

BMC Med. 2023 Nov 15;21(1):440. doi: 10.1186/s12916-023-03146-5.

Authors

Julia Fabienne Sandkühler^{1

2}, Xenia Kersting^{3

4}, Annika Faust³, Eva Kathrin Königs³, George Altman⁵, Ulrich Ettinger⁶, Silke Lux³, Alexandra Philipsen³, Helge Müller^{3

7}, Jan Brauner^{7

8

9}

Affiliations

¹ Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany. jf.sandkuehler@gmail.com.
² Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany. jf.sandkuehler@gmail.com.
³ Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
⁴ Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany.
⁵ Manchester University NHS Foundation Trust, Manchester, UK.
⁶ Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany.
⁷ Department of Health, Witten/Herdecke University, Witten, Germany.
⁸ Department of Computer Science, University of Oxford, Oxford, UK.
⁹ Future of Humanity Institute, University of Oxford, Oxford, UK.

Abstract

Background: Creatine is an organic compound that facilitates the recycling of energy-providing adenosine triphosphate (ATP) in muscle and brain tissue. It is a safe, well-studied supplement for strength training. Previous studies have shown that supplementation increases brain creatine levels, which might increase cognitive performance. The results of studies that have tested cognitive performance differ greatly, possibly due to different populations, supplementation regimens, and cognitive tasks. This is the largest study on the effect of creatine supplementation on cognitive performance to date.

Methods: Our trial was preregistered, cross-over, double-blind, placebo-controlled, and randomised, with daily supplementation of 5 g for 6 weeks each. We tested participants on Raven's Advanced Progressive Matrices (RAPM) and on the Backward Digit Span (BDS). In addition, we included eight exploratory cognitive tests. About half of our 123 participants were vegetarians and half were omnivores.

Results: Bayesian evidence supported a small beneficial effect of creatine. The creatine effect bordered significance for BDS (p = 0.064, η²_P = 0.029) but not RAPM (p = 0.327, η²_P = 0.008). There was no indication that creatine improved the performance of our exploratory cognitive tasks. Side effects were reported significantly more often for creatine than for placebo supplementation (p = 0.002, RR = 4.25). Vegetarians did not benefit more from creatine than omnivores.

Conclusions: Our study, in combination with the literature, implies that creatine might have a small beneficial effect. Larger studies are needed to confirm or rule out this effect. Given the safety and broad availability of creatine, this is well worth investigating; a small effect could have large benefits when scaled over time and over many people.

Trial registration: The trial was prospectively registered (drks.de identifier: DRKS00017250, https://osf.io/xpwkc/ ).

Keywords: Backward Digit Span; Cognition; Cognitive performance; Creatine; Deductive reasoning; Intelligence; RCT; Randomised controlled trial; Raven’s Advanced Progressive Matrices; Working memory.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Bayes Theorem
Brain
Cognition
Creatine* / adverse effects
Dietary Supplements*
Double-Blind Method
Humans

Substances

Creatine