Beyond Athletic Performance: The Emerging Role of Creatine Supplementation in Clinical Medicine — A Narrative Review
Abstract
Introduction. Creatine monohydrate is among the most extensively researched dietary supplements, yet it remains widely perceived as a tool of athletic performance enhancement. Its fundamental role in cellular energy homeostasis across metabolically demanding tissues — including skeletal muscle, brain, and myocardium — suggests a broader clinical relevance that has not been systematically addressed in recent literature. Materials and Methods. A narrative review was conducted using PubMed and Google Scholar, focusing on peer-reviewed original research, systematic reviews, meta-analyses, and position statements published up to April 2025. Search terms included combinations of "creatine," "creatine monohydrate," "phosphocreatine," and condition-specific terms covering skeletal muscle diseases, neurodegenerative disease, depression, sarcopenia, type 2 diabetes, cancer cachexia, traumatic brain injury, pregnancy, and renal safety. A total of 98 sources were included. Conclusions. Creatine supplementation demonstrates well-established ergogenic efficacy in sport and clinically meaningful benefits in skeletal muscle diseases, sarcopenia, and cognitive ageing. Promising evidence supports its adjunctive role in depression and type 2 diabetes, while data in traumatic brain injury remain largely paediatric. Evidence in cancer cachexia is predominantly negative. The safety profile of creatine monohydrate is reassuring across age groups; the observed rise in serum creatinine represents a…
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