Creatine is a naturally occurring compound found in animal-based foods such as beef, pork, herring, and salmon. However, emerging research suggests that approximately 60% of people are not getting enough of it—raising concerns about what some experts are calling “creatine malnutrition.”
At the recent Active Nutrition Summit in Vienna, Professor Sergej Ostojic of the University of Agder presented findings that link creatine deficiency with increased risks for several health issues, including cancer, depression, and even premature death.
This evidence, he argues, supports the case for recognizing creatine as a semi-essential nutrient.
“Creatine is much more than just an energy-rich molecule,” he said. “All cells in the body use creatine to produce energy, and it contributes to many of the body’s essential roles, similar to choline or other semi-essential nutrients.”
“I imagine creatine will be recognized in the next five years as a kind of creatine 2.0,” he said. “People should consider implementing creatine as a low-dosage protocol—it should be considered the new vitamin D or magnesium.”
Population-Level Creatine Intake
Creatine has been studied for nearly a century, with the first scientific paper appearing in 1926. Today, PubMed lists close to 70,000 studies on creatine, many of which go beyond athletic performance to explore broader health applications.
“Creatine is not just for athletes, but also for children and the elderly,” he said. “My team, and others across the world, are now trying to put creatine forward as a concept for public health nutrition.”
Ostojic points out that creatine’s role is especially recognized for vegetarians, vegans, and older adults, given that their diets or age-related changes often lead to lower creatine levels. Still, he emphasizes that creatine is vital for the general population as well.
According to his analysis, 65.2% of people do not consume enough creatine from their diet. A study using NHANES data indicates that creatine intake has declined significantly over the past 20 years across all age groups—including infants, children, and adults.
“We require around two grams of creatine per day, one gram coming from food and the other from internal sources such as glycine, arginine, and methionine,” he said.
“In Scandinavia, people are probably consuming enough creatine because they are eating a lot of herring and salmon, but people who are not consuming rich sources of creatine might be facing creatine malnutrition.”
Consequences of Low Creatine Intake
Insufficient creatine in the diet can lead to reduced levels in the plasma, brain, and muscles, contributing to various health issues.
“If you are deficient in creatine, you are probably going to feel fatigued, and you might also have movement disorders and behavioural problems,” he said. “Brain fog and concentration difficulties might also accompany a lack of creatine.”
Research further links low creatine levels with mental health issues. One NHANES-based study showed that adults with the lowest creatine intake had a 42% higher prevalence of depression. In older adults, low intake has been associated with an increased risk of heart and liver conditions, while higher intake correlates with improved cognitive function.
One study in Food Science and Nutrition found that seniors with suboptimal creatine intake had more than double the odds of developing angina pectoris or liver issues, compared to those consuming at least 1 gram daily. Another study in Aging Clinical and Experimental Research found that those consuming more than 0.95 g/day scored higher in cognitive function tests.
“I’m talking about very low doses, not 20 grams a day, just one gram per day every day might be all that is required,” Ostojic said.
More recent findings suggest a potential role for creatine in cancer prevention. A study in the Journal of Functional Foods reported that diets rich in creatine were linked to a reduced risk of cancer. Specifically, for every additional milligram of creatine per kilogram of body weight consumed daily, cancer rates dropped by about one percent.
“This is a big deal, and it’s a big deal because the study is controlled for BMI, age, gender and also for dietary intake including protein,” Dr. Ostojic said. “This suggests that creatine by itself might be a factor that could reduce the risk of cancer and other disorders.”
One long-term population study showed that people who consumed at least 1 gram of creatine daily had a lower risk of early death.
“This finding was true even when corrected for other dietary components that affect all-cause mortality, including important vitamins, minerals and micronutrients,” he said. “So, creatine, by itself, is an indicator for all-cause mortality.”
How Much Creatine Is Enough?
Ostojic stresses that creatine is safe, with more than 1,000 human studies showing no major adverse effects. A daily intake of just 1 gram appears sufficient to prevent deficiency, while 3 to 5 grams per day may help enhance energy metabolism and muscle function—especially when paired with exercise.
There’s still some debate over the dosage required for cognitive effects. Some studies suggest a high dose—up to 20 grams per day—may be necessary to impact the brain, exceeding the EFSA’s daily recommendation of 3 grams.
Regardless, Ostojic maintains that even small amounts of creatine could offer preventative benefits.
“The idea of fortifying food with creatine might be something that should be considered in the future, particularly now that there are so many guidelines across the world from the UN and other authorities to cut down on meat intake,” he said. “But if you cut out meat, you are going to lose creatine, so maybe adding creatine to food may help everyone to tackle creatine malnutrition.”
