Lower creatine intake associated with greater depression and anxiety

A large epidemiological study from South Korea provides new evidence that people who consume more creatine in their daily diets tend to have better mental health. The research, published in Nutritional Neuroscience, found that lower creatine intake was associated with greater depression severity, more frequent suicidal thoughts, and higher anxiety symptoms. While the results are not definitive, they point toward a potential role for creatine-rich diets in supporting psychological well-being.

Creatine is a compound made naturally by the human body, but it is also found in certain foods, especially animal-based proteins like meat, poultry, and fish. It plays a key role in maintaining energy levels in cells, including in the brain. The average adult needs about two grams of creatine per day, roughly half of which is typically obtained from diet. While creatine is most commonly known as a supplement used by athletes to improve muscle performance, research has been expanding into its effects on brain function.

Previous studies have suggested that creatine may support cognitive function and may even reduce the risk of depression, particularly in older adults. Some small clinical trials have explored creatine as a treatment for depression or post-traumatic stress disorder. However, no large-scale study had examined its effects across a general population that includes both adolescents and adults, or outside of a Western context. The new study aimed to fill that gap by focusing on individuals living in South Korea, where dietary patterns differ significantly from the United States and other Western countries.

“This study is part of a larger, ongoing research program aimed at understanding the potential role of food-derived creatine in public health nutrition,” explained study author Sergej M. Ostojic, a professor of nutrition at the University of Agder.

“Over the past several years, we have explored various health risks associated with low dietary creatine intake, including its links to impaired cognitive function in older adults and an increased risk of all-cause mortality. Personally, I am particularly interested in investigating how dietary creatine intake relates to mental health outcomes, given my background as a physician trained in psychiatry. This intersection of nutrition and mental health represents an exciting and understudied area with significant implications for prevention and treatment strategies.”

The researchers used data from the 2022 Korean National Health and Nutrition Examination Survey, a government-led initiative that gathers health and nutrition information from a representative sample of the population. In this analysis, they included 5,257 participants aged 12 and older who had provided complete dietary intake information and underwent at least one mental health assessment.

Daily creatine intake was calculated based on the types and amounts of food reported by each participant, focusing on known creatine-rich sources such as meat and dairy. The researchers excluded any creatine obtained through supplements. They then grouped participants into four levels—or quartiles—based on their creatine intake per kilogram of body weight. These ranged from the lowest intake group (3.71 milligrams or less per kilogram of body weight per day) to the highest group (more than 13.80 milligrams per kilogram).

Mental health outcomes were assessed using several standard questionnaires. Depression was measured using the Patient Health Questionnaire (PHQ-9), and anxiety was measured using the Generalized Anxiety Disorder questionnaire (GAD-7). Participants were also asked about their experience of suicidal thoughts, suicide planning, suicide attempts, and whether they had received mental health counseling in the past year.

The researchers applied a variety of statistical models to examine the relationships between creatine intake and mental health outcomes. These models accounted for factors such as age, gender, household income, education level, physical activity, smoking, sleep, and overall nutritional intake.

Mean creatine intake for the full sample was 10.3 milligrams per kilogram of body weight per day, which is relatively low compared to levels reported in Western populations. The researchers found that people in the lowest quartile of dietary creatine intake consistently showed worse mental health outcomes across multiple measures.

“Our study confirmed and reinforced the findings of previous epidemiological and interventional research on creatine, providing further evidence of its potential role in mental health,” Ostojic told PsyPost. “Importantly, we expanded the scope of investigation beyond prior studies, which were predominantly conducted in U.S. populations, by examining a non-U.S. cohort.”

“In addition, our analysis included participants across a broader age spectrum, encompassing not only adults and older individuals but also adolescents. This wider demographic perspective offers valuable insights into the relationship between dietary creatine intake and mental health outcomes across different life stages and cultural dietary patterns, thereby strengthening the generalizability and relevance of our findings.”

On average, depression scores among those in the lowest quartile of dietary creatine intake were higher than those in the higher intake groups. The prevalence of clinically significant depression was also highest in this group at 6.9 percent, compared to 3.3 to 4.3 percent in the other quartiles. Suicidal thoughts, plans, and attempts within the past year were also more commonly reported by participants in the lowest intake group, and the prevalence of these outcomes tended to decrease across higher creatine intake levels.

Anxiety symptoms showed a similar pattern, though the evidence was less consistent. While the highest creatine consumers had slightly lower anxiety scores, the relationship was statistically significant only when adjusting for age, gender, education, and income. Once additional factors such as exercise and other nutrients were taken into account, the association between creatine and anxiety became weaker and was no longer statistically significant.

When looking at daily stress levels, the researchers found that higher creatine intake was associated with a greater likelihood of reporting mild or no stress, and a lower likelihood of reporting severe stress. This trend remained even after adjusting for basic demographic variables.

“I believe that creatine obtained from dietary sources—found exclusively in animal-based foods—may offer modest protective effects against several mental health conditions, as observed in the Korean population studied, including depression and anxiety,” Ostojic explained. “However, creatine should not be viewed as a ‘magic bullet’ for mental health. Rather, it may serve as one important component of a balanced, nutrient-rich diet aimed at supporting brain function and psychological well-being.”

“Creatine likely plays a supportive role by enhancing brain energy metabolism, which is essential for optimal neuronal activity and resilience under stress. In addition, its potential antioxidant and anti-inflammatory properties may help reduce oxidative stress and neuroinflammation, both of which are implicated in mood disorders. Through these mechanisms, creatine could contribute to maintaining neurotransmitter balance and overall mental vitality, complementing other lifestyle and therapeutic interventions for mental health.”

The study, like all research, includes some caveats. Because the study was cross-sectional, it only provides a snapshot in time and cannot prove that low creatine intake causes depression or other mental health problems. People who are already experiencing poor mental health may eat less or have less balanced diets, which could influence their creatine intake.

Another limitation involves how creatine intake was measured. The calculations relied on average creatine content in various food groups, without distinguishing between different types of meat or preparation methods. Additionally, important variables such as genetic risk, use of psychiatric medications, and environmental stressors were not fully captured in the dataset.

“Future longitudinal studies are needed to clarify these relationships,” Ostojic said.

Still, the researchers see the findings as an important step toward understanding the broader role of diet in mental health. They suggest that creatine could be an overlooked nutrient with potential benefits for psychological well-being, especially in populations that consume low levels of meat or animal-based products.

“My research group is dedicated to advancing the understanding of creatine as a semi-essential nutrient with broad relevance for public health,” Ostojic explained. “Our aim is to rigorously investigate creatine’s role in supporting normal energy metabolism across the entire population, moving beyond its traditional view as merely a dietary supplement for athletes or muscle performance. We emphasize that creatine is not just important for skeletal muscle but also plays a critical role in brain function and neurodevelopment.

“Adequate creatine availability is essential for maintaining neuronal energy balance, supporting cognitive processes, and fostering healthy brain maturation, particularly during periods of rapid growth such as childhood and adolescence. By reframing creatine as a key nutrient rather than solely a sports supplement, our work seeks to highlight its potential for preventing deficiencies and promoting lifelong metabolic and neurological health.”

“Many populations may be at risk of inadequate creatine intake from food sources, including vegans, vegetarians, the elderly, and individuals following restrictive diets,” Ostojic continued. “These groups could benefit most from increasing their consumption of creatine-rich foods to support mental well-being. Ideally, they should first consider adjusting their dietary patterns to include more animal-based foods, such as fish, which is an excellent natural source of creatine.”

“Alternatively, they can turn to creatine-fortified foods or dietary supplements to correct deficiencies and ensure sufficient intake of this important nutrient, which plays a key role in maintaining brain function and overall neurological health.”

The study, “Dietary creatine intake and mental health among the Korean population,” was authored by Sergej M. Ostojic, Sonja Baltic, and Dragana Zanini.