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Getting more creatine through diet could help alleviate chronic fatigue after long COVID, according to research. Mattia/Stocksy
  • Dietary creatine may improve the fatigue associated with long COVID and other symptoms, according to a small new study.
  • Creatine—nowadays often used as a workout supplement—plays an important role in helping cells produce and use energy throughout the body.
  • Participants given creatine for six months after reporting long COVID symptoms showed improvements in fatigue, body aches, loss of taste, breathing problems, and concentration issues that often follow SARS-CoV-2 infection, compared to others given a placebo.

Among the often-mystifying, extended effects of COVID-19 is post-viral fatigue syndrome, or (PVFS). A small new study finds that dietary creatine may help alleviate its symptoms.

The study found that taking dietary creatine for three months substantially improved feelings of fatigue, and by six months, had produced improvements in body aches, breathing issues, loss of taste, headaches, and problems concentrating — or “brain fog” — compared to people given a placebo.

Long COVID is also associated with a bewildering range of other symptoms as well, including sleep problems, dizziness, chest pain, depression, and anxiety.

People with PVFS may be unable to perform activities they had no trouble performing before COVID-19. They may also have unsatisfying sleep and bounce back after exertion only with difficulty.

The study conducted in Germany tracked the effect of creatine on 12 people ages 18 to 65 who had confirmed COVID-19 in the previous three months.

Each participant had at least one lingering post-COVID symptom, such as breathing problems, loss of their sense of smell or taste, pain in their lungs, head or body aches, and issues with concentrating.

Half of the participants received four grams of dietary creatine daily. The dietary creatine was in the form of Creavitalis.

The remaining six participants received an equivalent amount of a placebo, inulin.

Creavitalis is a food ingredient manufactured by Alzchem GmbH, who provided funding for the research along with the Provincial Secretariat for Higher Education and Scientific Research in Trostberg, Germany.

The study is published in Food Science and Nutrition.

Creatine occurs naturally in the human body, where, said Professor Andrew R. Lloyd, infectious disease physician and director of the University of New South Wales (UNSW) Fatigue Clinic and Research Program, who was not involved in the study, “it exists as phosphocreatine, which has a central role in maintaining adenosine triphosphate (ATP) concentrations.”

Prof. Lloyd explained that all of our cellular functions rely on constant ATP regeneration “to sustain motor proteins — e.g., muscle contraction, vesicle trafficking, ion pumping, protoplasmic streaming, and cytoskeletal rearrangement, among others.”

Its corresponding author, Dr. Sergej Ostojic hypothesized that “creatine’s favorable effects in long COVID may encompass not only its role in recycling [ATP] to support metabolism in the brain and skeletal muscle, but also its anti-inflammatory, antioxidant, and neuromodulatory actions.”

Prof. Lloyd expressed concern that prolonged intake of creatine could result in increased levels of cellular creatine and phosphocreatine, as the study itself found.

Prof. Lloyd was concerned that the study was based on two unconfirmed assumptions:

  1. More creatine will improve cells’ energy supplies, including the muscles and the brain.
  2. There is a creatine deficit after COVID-19 or with PVFS.

“There is no evidence for creatine deficiency in post-viral fatigue states or fibromyalgia or long COVID,” cautioned Prof. Lloyd.

Earlier this year, we confirmed that long COVID patients have lower levels of creatine in the brain and muscle as compared to healthy controls. It could be possible that the brain in long COVID patients is particularly susceptible to absorbing more creatine from… circulation [to] offset the creatine deficit seen in the disease.”
— Dr. Sergej Ostojic

While Prof. Lloyd said he found “The study is generally well-designed,” he felt it was “far too small to be meaningful.”

Dr. Ostojic does not particularly disagree, though he feels the study remains “statistically sound.”

He noted that there were unfortunate limits to how many people the researchers were able to recruit due to inconvenience and high cost.

Data for the study were collected from October 2021 to May 2022, in the midst of the COVID-19 pandemic.

“We used a relatively robust methodology that includes a noninvasive assessment of various metabolites inside the brain and skeletal muscle of long COVID patients,” Dr. Ostojic said.

Dr. Ostojic expressed concern that the small size of his study imposed limits on researchers’ ability to identify possible gender-related differences in the data. He called for additional, larger studies to confirm the study’s findings and to look at creatine’s effect on long COVID patients in greater detail.

“It would be great to perhaps analyze the effects of creatine supplementation in different long COVID populations, particularly in elderly, more severe patients, those who didn’t get a COVID-19 vaccine, and patients where creatine is co-administered with other interventions, such as breathing exercises, physiotherapy, or psychological support,” said Dr. Ostojic.

“One more aspect of our study that I would like to comment on is related to the fact that long COVID patients reported no major side effects of creatine intake in our study, so we consider creatine safe when administered in this dosage for up to six months.”
— Dr. Sergej Ostojic

Prof. Lloyd raised some additional issues he had with the study, saying it employed too loose a definition of long COVID by recruiting participants with less than three months of symptoms. He also cited “no clear definition of disability and lack of rigorous exclusion of alternative medical and psychiatric conditions.”

Nonetheless, Prof. Lloyd concluded, “Looks to be safe. Needs independent replication.”