When Does an Evidence-Based Supplement Outgrow Its Purpose?

From My Clinic Notebook

Not every lesson has an answer. Sometimes it starts with a question. Sometimes it changes the way I think. Sometimes it simply reminds me how much there still is to learn.

THIS MONTH’S OBSERVATION

Last week I found myself in a physician workroom between patients when the conversation unexpectedly shifted to creatine. Within a few minutes, the room had split into two camps — one viewing it as one of the most thoroughly studied, underutilized supplements in medicine; the other questioning whether the enthusiasm had begun to outpace the science.

For athletic performance, I don’t think the debate is particularly controversial anymore. What interested me was what came next: could creatine support recovery after concussion? Preserve muscle during perimenopause? Influence cognition? Those are very different questions than we were asking a decade ago.

Driving home that evening, I realized I wasn’t asking whether creatine works. I was asking something more interesting — when does an evidence-based supplement outgrow its original purpose?

What We Know

Not just what the literature says — how confident we should be that it changes clinical practice.

HIGH CONFIDENCE

ATHLETIC PERFORMANCE

One of the most effective ergogenic supplements available.

—Multiple randomized trials and the ISSN position stand support creatine as a top-tier ergogenic aid.

—It raises phosphocreatine availability, speeding ATP regeneration during repeated high-intensity efforts.

—Paired with resistance training, it consistently improves strength, power, and lean muscle mass.

—At recommended doses in healthy adults, long-term safety data are reassuring.

GROWING EVIDENCE

HEALTHY AGING & WOMEN’S HEALTH

A promising adjunct during perimenopause — not a replacement for exercise.

—Appears to augment strength and lean-muscle gains from resistance training in older adults.

—Interest is expanding to peri- and postmenopausal women, where declining estrogen affects muscle, bone, and recovery.

—Exercise remains the primary intervention; creatine may enhance the body’s adaptation to it.

GROWING EVIDENCE

BRAIN HEALTH & CONCUSSION

A compelling rationale, but the clinical trials aren’t there yet.

After a concussion the brain faces an acute metabolic challenge — energy demand rises while ATP production may be impaired. As an energy buffer through the phosphocreatine system, creatine could in theory support this period. The biology is compelling and early research encouraging, but high-quality human trials remain limited. This is exactly the type of research worth following closely.

EARLY / UNCERTAIN

BODY COMPOSITION & WEIGHT LOSS

Creatine doesn’t directly cause fat loss.

It’s increasingly marketed for weight loss, but that framing overreaches. What creatine may do is improve training capacity, support recovery, and help preserve lean muscle. Train more consistently and hold more lean mass, and better body composition may follow — a very different claim than creatine itself causing weight loss. Sometimes the headlines move faster than the science.

CLINICAL PEARL

Evidence evolves faster than opinions.

Question to Consider

How much evidence is enough before an emerging therapy becomes part of routine clinical practice — and how do we balance curiosity with healthy skepticism along the way?

Medicine is constantly evolving. So are the questions worth asking. I’ll keep sharing what I’m learning — from research, from colleagues, and from the patients who continually remind me that good medicine begins with curiosity. If this perspective resonates with you, I’d be honored to have you join me for the next edition.

UNTIL NEXT TIME,

Melissa Burman, MD

WANT TO READ THE RESEARCH?

HIGH CONFIDENCE

International Society of Sports Nutrition Position Stand: Creatine Supplementation.

Kreider RB, et al. Journal of the International Society of Sports Nutrition.

GROWING EVIDENCE

Forbes SC, et al. Creatine Supplementation in Women’s Health: A Lifespan Perspective. Nutrients.

Smith-Ryan AE, et al. Research on creatine in women, aging, and resistance training.

Reviews on creatine and traumatic brain injury, concussion, and cerebral energy metabolism.

EARLY / UNCERTAIN

Reviews evaluating creatine and body composition — benefits largely mediated through improved training performance and lean-mass preservation rather than direct fat loss.