Concussions & Creatine


There are different levels of traumatic brain injury’s. Concussions are the most common type and are often referred to as mTBI or mild traumatic brain injury.

mTBI's have a primary and secondary component. The  immediate damage to the brain that is sustained from the trauma is called the primary component. In this component, there is some bruising of the brain and some possible bleeding, shearing and tearing of nerves, other brain cells and blood vessels.  It is here that a significant amount of brain cell death begins within hours of the head trauma. The secondary component of the mTBI starts within minutes of the trauma and may possibly continue for years. In the secondary component, there is aberrant brain cell functioning, a severe energy crisis as well as damaging chemical reactions occurring. This is where creatine and other nutritional approaches create healing.

The damage to the actual nerve cells, particularly the membrane of the cells causes the mineral ions of calcium, sodium and potassium to become imbalanced inside and outside the cells leading to swelling of the cells thus causing brain dysfunction and even nerve cell death.

Since 40% of the energy the brain consumes is to maintain mineral ion balance, a major energy crisis begins as the brain struggles to regain mineral balance. The brain also starts having trouble using glucose or blood sugar as a source of fuel, creating even more of an energy crisis. This was discussed in an interesting journal article from 2000; Bergsneider M, Hovda DA, Lee SM, et al. Dissociation of cerebral glucose metabolism and level of consciousness during the period of metabolic depression following human traumatic brain injury. J Neurotrauma. 2000;17:389-401  [PubMed]

Not only is there the building energy crisis, there are four other major problems mounting in the brain.   Excitotoxicity, Oxidative Stress, Mitochondrial Dysfunction and Inflammation are all adding to brain dysfunction and even brain cell death.  These processes create even more of an energy crisis particularly due to their destructive effects on the cell membranes and mitochondria (the energy organelle in every cell).

Creatine is a compound made up of three amino acids. It is typically found in large amounts in muscle tissue and this is why it is used by body builders to increase muscle mass. Creatine is not only found in muscle tissue, but high amounts are also found in the brain and is intricately involved in energy production. If you remember from biology class, the energy molecule that has always been spoken about is called ATP, adenosine triphosphate. In the central nervous system, creatine works by donating a phosphoryl group to make ATP thereby helping to replenish stored energy. A recent journal article describes the process in more detail. Béard E, Braissant O. Synthesis and transport of creatine in the CNS: importance for cerebral functions. J. Neurochem. 2010; 115: 297–313.

Using very specialized brain imaging called proton magnetic resonance spectroscopy to measure the levels of creatine pre- and postconcussion, it has been demonstrated that creatine levels in the brain decrease after sustaining a concussion.  

There have been two human studies using creatine supplementation in children after sustaining a moderate to severe TBI. These types of TBI’s are much more severe than the mild or mTBI that a concussion is, but we can see in even these more damaging head injuries, creatine has a significantly positive impact. These studies, showed that compared with the control group (didn’t get creatine), the children who were supplemented with creatine had significantly improved cognition, communication, self-care, personality, and behavior and significantly decreased headaches, dizziness, and fatigue. Based on these studies, creatine shows great promise for the treatment of concussions.

I’ve been using creatine in concussion patients for quite some time now and have definitely found it to be helpful, sometimes even within days. Unlike a lot of other supplements that people should take after a concussion, creatine is incredibly inexpensive. The only issue some people have is they do not like the texture as it is a gritty powder that is typically just mixed into water, but does not dissolve easily. A small price to pay for the potential healing of creatine.

Craig is Rubenstein DC CCN DACBN FIACA

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