>> Recently, a pilot study (single-arm) by Smith et al., recruited 20 patients (73 years of age) with AD and provided them with 20 grams/day of CrM for 8 weeks [20]. Serum creatine levels were increased at weeks 4 and 8 (p < 0.001), and total brain creatine levels (as measured by H-MRS) increased by 11% (p < 0.001). Clinically, there were demonstrated improvements in cognition on global (p = 0.02) and fluid composites (p = 0.004), as well as List Sorting (p = 0.001), Oral Reading (p < 0.001) and Flanker tests (p = 0.05).
Yeah 20 patients is not a lot. I'm inferring this is a pre-post test. However some of those p-values are pretty good (.001 on reading and and sorting). Very promising pilot study but not conclusive imo.
And List Sorting, Oral reading, and Flanker only? The first and last are part of global and fluid composites, so those have to be excluded from comparison. That leaves us with 3 improved scores out of 12 tests. So 9 did not improve, or got worse. Figure 3 (of the original article) shows that the changes aren't big. Just "significant". Since the participants were in the early stages of dementia, this seems well within expectations.
Interesting that you are hearing "dismissal" in the antecedent response. I read it as the poster "studying more" the data, and finding a lot of flaws in both the experimental design and the data analysis.Typically things a reviewer would do when a publication was submitted (or in our case posted here). The author, then goes back and answers the questions raised to show that the effect they are suggesting is durable in face of the flaws. Or perhaps they run an additional experiment and augment their data. After a bunch of back and forths either the effect is sufficiently well expressed in the data or the paper is withdrawn for more work.
When I go through the process of reading the entire paper, analyzing the data myself, and the experimental design. That is the opposite of dismissing the claim. That is me, positing that the claim as stated is 'true,' and then asking the questions if the claim is supported by the provided evidence. If it isn't, then doing the work to express what evidence would be needed to support the claim is the feedback needed to help prove the science.
Don't waste your time responding to people like this. Their post is not much more than a passing thought where they take the headline fully at face value, and therefore are convinced it must be worth something and we should continue to study it. They will never read the paper or have a critical thought of their own.
I don’t really leave thank you notes as they don’t add anything but just to balance out the opinions here:
Thank you for taking the time for that wonderful explanation, may it teach some of us/me to think before we shoot. I found it very enlightening and am sure many other drive by casuals do as well.
I wouldn't even call it "promising but inconclusive" so much as "not conclusively a dead-end for further research". In a single-arm open-label study, with no blinding, both the participants and the researchers know who's getting what. You need a placebo and double-blinding for comparison against the active group and to adjust for any ways in which the researchers may have unwittingly influenced the results. (Or perhaps even wittingly, when there are conflicts of interest. I spent half a minute looking up this study and didn't see any statement attesting that there were none.)
Worse: go look at the MMSE. I bet that, at least for patients with reasonably functional memory, taking the MMSE and then taking it again a few weeks later from the same examiner will tend to improve the score the second time.
.001 for creatine levels isn't surprising; that's a lot of creatine. I'd explain the cognitive tests with the practice effect, because it is unlikely that creatine had such a massive effect and we only discover it now.
I hear about tech bros taking creatine these days with the tone of voice that they use to talk about microdosing. So I can’t imagine it having zero effect.
What I worry about more is that it has more to do with fixing a deficiency. That being deficient in creatine causes a cognitive loss more than supplementing causes a boost.
As someone who's microdosed (though mostly normal-dosed and occasionally megadosed) in the distant past, the whole microdosing fad was equal parts entertaining and baffling. Anecdotal, but from all people I know that has taken psychedelics, only one doesn't find it to be a waste.
Maybe a better analogy would have been the Balmer curve. I wasn’t trying to imply psychedelics are unhelpful, just that we should be careful of suggesting coding productivity gains while on them.
Also IMO, the Balmer peak is a stronger effect than creatine.
I'll add to this: the referenced trial occurred over 8 weeks, so even if we stipulate that the improvements in cognition (which are dubious, as tgv points out in this comment: https://news.ycombinator.com/item?id=48347906) are due to treatment rather than some other effect, we don't know that the effect is disease-modifying as opposed to symptomatic. As with acetylcholinesterase inhibitors, it may just be having a cognition-enhancing effect which, nevertheless, does not alter the underlying disease trajectory (i.e. just shifting the declining trajectory up vertically by a constant amount), and might revert shortly after discontinuing use of the drug.
A controlled trial, over a much longer duration, and ideally with a wash-out period, would be necessary to identify a disease-modifying effect.
FWIW creatine is "one of the most studied supplements for muscle and strength".
But at the same time "creatine’s brain benefits aren’t as exciting as social media makes them out to be. The research at this point just doesn’t support the hype".
I think people often overestimate the effects of these things. It absolutely works for muscle growth but it's not like a steroid or something. Similarly there is enough evidence to suggest that it actually does have some small effect on cognition; I remember a study 10 years ago showing that in people who are creatine deficient (vegans) it improved cognition scores. But it's not going to be a huge effect for someone whose not deficient in some way.
It would actually make sense that as you age and eat less you might get creatine deficient so sure. I don't think it's bullshit, but it's not going to be a huge noticeable effect either.
All of this reminds me of people who don't weight lift "because they don't want to get built." They somehow think you lift some weights and boom you're looking like Arnold. No, it doesn't work that way.
Confusingly they reference a 2026 article (which isn't included in their citation list) that allegedly includes "placebo-controlled trial", but I think it might just be [0], which is based on the same single-arm trial. If they do have a paper using a placebo-controlled trial, they should definitely include that citation.
Normally I wouldn't ask this, but having seen the effects of Alzheimer's I must ask: is there any evidence that taking creatine will harm my brain?
Let's be real: I take a lot of edibles. I smoke sometimes on a hike. Every once in a while I get a Guiness and a gyro. My health is by no means perfect, and if I'm willing to take in literal poison (yes, alchohol is that dangerous that I say such things even about my precious Guiness).
Anyways, for years I've been mostly skeptical of vitamins. I've heard a megadose of Vitamin C can shorten the symptoms of a cold, but a "megadose" is relatively small enough that just some OJ can do that, no need for pills.
But if I'm not giving up my Guiness and gyros, I probably should be willing to be more flexible about my "no vitamins or weird supplements rule".
So TL;DR: Let's flip this around: What are the risks of creatine, presuming a safe supply chain? (It's legal where I am as far as I know, which I'm a fan of for most things since then you can get a receipt and there will be some authority that investigates if you're unlucky to get a "bad batch".)
No sure about brain harm. But I used creatine for a few months and I got cramps in an intensity like I never experienced before.
I then decided it was not worth it for a few watts of cycling FTP increase. So I would not consider it harmless for everbody, but this sideeffect seems pretty rare.
I wasn't while cycling, it was when resting or at night sleeping. Could have been dehydration related, but i usually drink a LOT during and afterwards.
There are scattered reports from people who take it and feel worse. Some don’t notice until they run out or forget to take it for a few days and realize their mood improves.
This happens with a lot of popular supplements. I don’t know how common it is, but it’s a thing that happens. There are proponents of every supplement who will tell you it’s perfectly safe and any negative effect is due to impurities or your imagination, but there are a lot of reports from people who believe it’s helping until they stop, and are surprised that they feel better without.
Long term studies haven't shown any harm. I've taken 30g a day for well over a year now for both the physical performance and the cognitive benefits. I had brain fog following a bad COVID infection which this has helped with. My family also has a history of Alzheimer's and dementia (both sides), I figure it can't hurt.
The only side effects I've encountered have been mild GI discomfort, and that only rarely (mostly when restarting after a vacation etc-- I drop the routine when I travel). Roughly similar to having a morning coffee at its worst.
I've found I get much thirstier when on this high of a dose. If you're not already a big water drinker I'd definitely invest in a nice insulated bottle to drag around.
The standard studied dose _is_ 5g, but the common advice you hear in the gym community is that you will see cognitive benefits from 10-20g or more, depending on your body mass. 30g isn’t uncommon. And, many believe that 5g may be too little for optimal muscle gain, again depending on your body mass.
Adverse effects, as mentioned, are mostly GI-related, some people experience bloating especially with monohydrate. Another effect is an increase in water retention, which, in turn, means you need to drink more water. It’s generally regarded as safe for the kidneys unless you already have reduced kidney function.
So, overall, not really a big deal to take well over the studied 5g dose. Not to mention the recommended loading dose is 5g 4x daily.
It is definitely more than the standard dose. I was already taking 5g for weightlifting purposes. After some of the studies suggesting mental benefits I titrated my dose up to 30g (the high end of the studies). Just added an additional 5g per week until I hit 30. I add it in powder form to my daily protein shake-- usually in the morning. While it could be a placebo, I personally feel there's a noticeable difference. I buy in bulk so it ends up being less than $.90 a day to dose at this level. It's an extremely cheap supplement.
Because there isn't a causative link in any literature available anywhere? (If there is pls cite). That's like saying "caffeine affects your brain you should stop taking caffeine"
I've read that New Zealand study and it's identifying an effect in a small group of heavy users who started using cannabis very young (a full third as teens) and continue to use it heavily (four times a week) three decades later. That's not a huge surprise.
They also state "cognitive functioning among midlife recreational cannabis users was similar to representative cohort norms". It's clearly shown in Figure 1 - midlife recreational cannabis users actually got smarter than people who quit cannabis according to their data.
There may well be some confounding factor in there. The study was done in New Zealand where cannabis was illegal for the majority of participants, and usage was self-reported so there's a basic issue there as well. One of the meta-analysis citing this (Crisafulli, 2026) and finding no effect criticizes the study design.
They also quote a follow up study that sounds more compelling:
> The 2026 multicenter placebo-controlled trial extending this work enrolled 240 participants with early Alzheimer’s... The intervention group showed slower decline on standard cognitive scales by about 30% versus placebo.
But there's no such study in the references section. Not sure what's going on there but I want to see the data before I believe this.
Yeah 20 patients is not a lot. I'm inferring this is a pre-post test. However some of those p-values are pretty good (.001 on reading and and sorting). Very promising pilot study but not conclusive imo.