In case you hadn’t noticed creatine is now mainstream. For many years creatine was for sports people only, and then about 5 to 10 years ago those of us in the nutrition/functional medicine world began to use it more and more as research emerged as a simple principle was applied.
When you create energy, you make a molecule called adreno TRI- phosphate or ATP.
You knock a phosphate group off, releasing energy, and you are left with adreno DI- phosphate or ADP.
Now ironically in order to create a molecule of ATP, you need a lot of nutrients and energy. Thus once ADP is created, we need to recycle it by adding on another phosphate group to re-create ADP.
And that job is done by CREATINE.
So important is the creation of creatine, that 40% of all methylation reactions are dedicated to this one molecule.
We make 1–2 grams endogenously daily by combining glycine + arginine + methionine.
Methylation happens billions of times a second in every single cell and is how we create, amongst other things: Myelin, new DNA/cells, phosphatidylcholine, converting nor-adrenaline to adrenaline, serotonin to melatonin and how we remove and detoxify dopamine, histamine, oestrogen, and other toxins.
Plus, we can also build up the toxic molecule HOMOCYSTEINE, which is linked to increase risk of cancer, strokes, heart disease, depression/anxiety, chronic pain.
The reason the ACN’s course is called Core Concepts in Chiropractic nutrition (CCCN), is because at the root of most ill health is two core features dysfunctional mitochondria and a sustained inflammatory response.
If you improve these two things, you significantly reduce oxidative damage and that will mean a significant reduction in peripheral and central hypersensitivity, meaning far less pain for the issues you have. Plus less ongoing damage for better healing and more flexible collagen.
And that is why creatine is becoming so popular. If you can improve mitochondrial function and thus improve energy, everything improves.
It has near universal applications because of its central role in the recycling of ADP back into ATP.
Chiropractors increasingly see patients whose pain experience is intertwined with chronic stress, PTSD, anxiety, low resilience, or cognitive fatigue.
Creatine is highly relevant because:
- The brain stores very little phosphocreatine.
- Neural activity spikes during pain, worry, sleep disturbance, and rumination.
- Creatine supplementation increases brain phosphocreatine by ~5–15%.
- Clinical trials suggest benefits for:
- depression (significant improvements when added to SSRIs)
- cognition under sleep deprivation
- memory and executive function
- speed of complex information processing
Improved brain energy often manifests as higher resilience, lower stress reactivity, better mood, and improved adherence to rehab & lifestyle change.
It may also help type 2 diabetics.
Note, vegan/vegetarian patients are at a higher risk of lower creatine/more benefit from supplements, because they have no natural diet sources.
This is one of the most important, and least understood, aspects for clinicians.
Dietary creatine comes almost exclusively from animal products.
Meat and fish contain 2–5g per day.
Plant foods contain essentially none.
Research shows:
- Vegetarians have 20–50% lower muscle creatine stores.
- Vegans often have even lower levels.
- These groups see the biggest improvements from supplementation, sometimes dramatically larger than omnivores.
- Cognitive gains in vegetarians/vegans are particularly strong.
For chiropractors treating patients with:
- chronic fatigue
- pain with hypersensitivity
- stress/anxiety
- low mood/depression/anxiety
- high training loads
Discussion with patients eating a vegetarian or vegan should be approached with tact. No one likes to be “wrong” and in a modern social media work of echo chambers, they can easily be upset when presented with evidence that contradicts everything they have learned previously.
Other common gaps/suboptimal status in vegan/vegetarians are:
- Carnitine – Used to burn fat for energy (better mitochondrial function), also helps block pain.
- Iron – Non-haem iron found in plants is far harder to absorb, more easily affected by other nutrients in foods and in lower amounts. Remember you do not need to be anaemic to be iron deficient. If they are symptomatic and ferritin is under 80 ng/ml, then I want it up with red meat and if they will liver, and iron bisglycinate. Certainly if ferritin is under 50, they will usually be symptomatic.
Re-read here:
https://www.academyofchiropracticnutrition.com/introducing-non-anaemia-iron-deficiency/
Creatine is one of the simplest and most effective interventions for bridging nutritional gaps.
Creatine monohydrate remains the gold standard, and we used a 200 mesh (which means ultrafine), do not fall for any weird jazzy stuff at exorbitant prices.
Trade price of £13.10, retail of £17.
At 5 g a day that is a 60 day supply.
Dosing options:
- Standard: 3–5g per day (body size dependent)
- Loading (optional, but recommenced): 10-20g/day in 4 doses for 5–7 days, then 3–5g/day.
- Vegan/vegetarian: often benefit more from 5g/day long-term.
- Older adults: 5g/day for neurological and sarcopenic benefits.
- Patients with high training loads: 5g/day minimum.
Timing is flexible, just take it.
Creatine is safe, extensively studied, inexpensive, and clinically meaningful.