Ask any bodybuilder or athlete about creatine and they’ll tell you how it builds muscle, improves performance, and helps them recover from hard workouts. But some experts believe it can do more.
In the first human trial (1), researchers explored creatine’s possible therapeutic benefits for those experiencing Post-COVID-19 Fatigue Syndrome (PVFS), The symptoms are similar to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).
What is Post-Covid-19 Fatigue Syndrome?
Viral infections often resolve themselves; the symptoms simply disappear over time. But this isn’t always the case. In fact, post-viral fatigue syndromes are nothing new. After both the Spanish Flu in 1918 and the 2003 H1N1 pandemic, there was an increase in the number of people being diagnosed with chronic fatigue symptoms (2). Links have also been made to Ebola infections, Epstein-Barr, and other non-epidemic viral infections (2).
It has been estimated that 10-30% of those who contracted COVID-19 (in the region of 147 million people) have PVFS (3). Symptoms – which include high levels of fatigue, exertion intolerance and post-exertional malaise, and unrefreshing sleep – resolve within months for some.
But for others, they continue. Many of these people find they can no longer participate in routine daily activities.
Potential Benefits of Creatine in Post-Covid-19 Fatigue Syndrome
Athletes have long recognized creatine’s beneficial effects on muscle mass, aerobic capacity, and physical performance. More recently, researchers have been investigating its potential in conditions such as sarcopenia, neurodegeneration, osteoporosis, and cardiovascular disease (4).
It was recently put forward as a possible therapeutic agent to improve functional capacity and quality of life for people suffering from PVFS. Kreider et al. (2021) note that there may be some evidence that a lack of creatine availability and/or impaired creatine metabolism may be playing a role in chronic fatigue-related diseases such as ME/CFS (4).
Creatine is also believed to play an important role in various physiological functions:
1. It contributes to the transformation of energy within the cells from one form to another (such as adenosine triphosphate (ATP)).
2. It’s involved in the modulation of glutamate levels. Glutamate is an important chemical messenger (neurotransmitter) in the brain; it is involved in learning and memory, as well as being a source of energy.
3. It protects neurons.
4. It displays antioxidant activity.
5. It helps to suppress inflammation.
A Small Study
Slankamenac et al. (2023) (1) conducted a 12-patient randomized, placebo-controlled study to evaluate the effects of creatine supplementation in the medium-term. The study design included patient- and clinician-reported outcomes such as fatigue levels, exercise tolerance, and creatine levels in the tissues. These were recorded at the start of the study, at three months, and at six months when the study ended.
The researchers hypothesized that a standard dose of creatine could be used as a backup when helping patients recover from PVFS, so they gave the creatine group a dose of 4g of creatine monohydrate at breakfast.
Results
Several interesting findings came out of this study.
The researchers were able to show that creatine levels improved in the brain and skeletal muscles after six months and that many features of PVFS, such as lung and body pain, were reduced.
Increased creatine levels were also accompanied by improved concentration and brain performance at three months with no concentration difficulties at six months.
Other features such as loss of smell, loss of taste, and breathing difficulties had also diminished during the six-month follow-up.
What does this mean for those with Post-Covid-19 Fatigue Syndrome?
Researchers noted that the improvements seen could be the result of adenosine triphosphate (ATP) recycling to support energy metabolism in the brain and muscles. Benefits might also be due to the anti-inflammatory and antioxidant qualities of creatine, as well as the modulatory role it plays in protecting neurons in the brain.
Whilst cautiously optimistic, the researchers were also aware that this study was small. Further studies are needed to confirm these initial results.
Given the significant number of people suffering from PVFS following COVID-19, finding an effective and convenient intervention strategy is of utmost importance. A widely available supplement such as creatine may offer some hope and relief following this important trial.
