Long Covid, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), refers to a condition where individuals experience a range of symptoms that continue for weeks or even months after initially contracting COVID-19. Symptoms can continue well beyond the initial infection and may fluctuate over time.
Common symptoms of Long Covid may include:
- Fatigue
- Shortness of breath
- Chest pain
- Joint pain
- Cognitive difficulties often described to as “brain fog.”
Some individuals may also experience ongoing inflammation or changes affecting multiple body systems. Long Covid can affect people of all ages, regardless of the severity of their initial COVID-19 infection, and its exact mechanisms and duration can vary widely from person to person, which can make recovery feel confusing and unpredictable.
As research into Long Covid evolves, there is growing interest in interventions that may support energy production, cognitive function, and recovery capacity.
More generally, you can learn a little more about the impact of viral infections on Chronic Fatigue in my previous blog, here.
What is Creatine?
Creatine is a naturally occurring compound found in small amounts in certain foods and synthesised by the body, primarily within the muscles. It plays an important role in how the body produces and rapidly recycles energy at a cellular level.
Specifically, creatine is involved in the Adenosine Triphosphate-Phosphocreatine (ATP-PC) energy system, which helps provide quick bursts of energy during periods of increased physical or cognitive demand.
Supplementing with creatine has been shown to increase the body’s stores of phosphocreatine, which supports the regeneration of ATP — often referred to as the primary “energy currency” of the cell. In sports and exercise research, creatine supplementation has been associated with improvements in strength, power output, and exercise performance in some populations.
Beyond athletic performance, creatine is also being investigated for its potential role in muscle recovery, cognitive function, and cellular resilience.
Because fatigue and reduced energy capacity are such prominent features of Long Covid, researchers are increasingly exploring interventions that may support cellular energy production and recovery processes.
Anecdotally, I’m hearing increasing positive feedback around the use of creatine in fatigue recovery generally, and Long Covid specifically. That said, research in this area is still limited and emerging.
This blog aims to explore the current evidence, potential mechanisms, and practical considerations surrounding creatine supplementation in Long Covid.
Creatine: Beyond Energy Production
Creatine is one of the most researched performance supplements in the sporting world. However, interest in creatine now extends beyond its role in cellular energy production.
Research has also investigated creatine for its potential neuroprotective, immunomodulatory, and antioxidant effects — all of which may be relevant in conditions involving fatigue, inflammation, and altered energy metabolism, including Long Covid and chronic fatigue syndromes more broadly.
Understanding the Potential Mechanisms
Neuroprotection
The exact mechanisms behind creatine’s potential neuroprotective effects are still being explored. One proposed mechanism is its role in supporting cellular energy metabolism, particularly in tissues with high energy demands such as the brain.
Because neurons require significant amounts of energy to function optimally, researchers are investigating whether creatine may help support cognitive resilience and reduce the impact of cellular energy depletion.
Immune Modulation
Creatine’s role in modulating the immune system is an area of ongoing research, and the exact mechanisms are not yet fully understood. However, some studies suggest that creatine may have immunomodulatory effects, which means it can influence the functioning of the immune system.
Here are some potential ways in which creatine may interact with the immune system:
- Creatine has been shown in some studies to have anti-inflammatory effects. It may help reduce the production of pro-inflammatory molecules, which play a role in various immune responses.
- Some research has indicated that creatine supplementation may enhance T-cell function, potentially improving immune defence mechanisms.
- Creatine may act as an antioxidant, helping to reduce oxidative stress. This can be beneficial for immune cells, as excessive oxidative stress can impair their function.
- Immune cells require energy to carry out their functions. Creatine’s role in ATP regeneration may indirectly support immune cell activity by providing a readily available source of energy.
- Some studies suggest that creatine may influence the production and release of certain cytokines, potentially affecting immune function.
- Some preliminary research suggests that creatine supplementation may have a positive impact on autoimmune conditions, although more research is needed in this area.
Antioxidant Activity
Creatine has also been investigated for its potential antioxidant properties. Oxidative stress occurs when there is an imbalance between free radicals and the body’s ability to neutralise them, which may contribute to cellular damage and fatigue-related symptoms.
- Creatine can directly neutralise harmful reactive oxygen species (ROS) and free radicals. This is important because excessive ROS can lead to oxidative stress, which can damage cells and tissues.
- Creatine has been shown to help regenerate another important antioxidant, glutathione. Glutathione is a potent cellular antioxidant that plays a crucial role in protecting cells from oxidative damage.
- Creatine can chelate (bind to) transition metal ions like iron and copper, which are involved in generating harmful free radicals. By sequestering these ions, creatine can help prevent them from contributing to oxidative stress.
- Creatine may help maintain proper function of mitochondria, the cellular structures responsible for energy production. When mitochondria are functioning optimally, they produce fewer free radicals, reducing oxidative stress.
- By supporting the rapid regeneration of adenosine triphosphate (ATP), creatine helps ensure that cells have a sufficient energy supply. This can indirectly reduce oxidative stress by preventing energy depletion-related damage.
- Creatine may help protect cell membranes from lipid peroxidation, a process where free radicals attack and damage the lipids in cell membranes. This is a common consequence of oxidative stress.
These proposed mechanisms are still being researched, but they may help explain why creatine is generating interest in conditions associated with fatigue, cognitive symptoms, and altered energy metabolism.
The Science Behind Creatine and Long Covid Specifically
To date, there is little research on creatine and long covid specifically. However, one study showed that when patients with post-COVID-19 fatigue syndrome supplemented with 4g of creatine monohydrate per day the participants showed an increase in brain and muscle creatine levels across a 3 and 6 month period. The increase was significant when compared to the placebo group.
The increase in tissue levels was also associated with a reduction in fatigue and improved syndrome related symptoms such as body aches, headaches, breathing difficulties and difficulty concentrating. The sample size of this study was only small, but, given that creatine is often a safe and affordable intervention, the results are promising.
A recent study found that the total creatine concentration in the skeletal muscle and the brain of long covid patients were significantly lower when compared to reference values from the general population.
Although this does not establish causation, it has increased interest in whether altered creatine metabolism may play a role in fatigue-related symptoms and reduced energy capacity.
Overall, the current evidence remains preliminary. However, these early findings suggest creatine may have potential as part of a broader, individualised support approach in some people experiencing Long Covid.
Creatine and Muscle Function in Long Covid
Creatine is being explored for its potential role in supporting muscle function and cellular energy production in Long Covid.
Because creatine helps regenerate adenosine triphosphate (ATP) — the body’s primary cellular energy source — researchers are interested in whether it may help support physical capacity and muscular energy availability in fatigue-related conditions.
In sports and exercise research, creatine supplementation has been associated with improvements in muscle strength, exercise performance, and recovery in some populations. Researchers are now investigating whether some of these mechanisms may also have relevance in Long Covid.
Creatine has also been studied for its potential role in muscle recovery, oxidative stress, and cellular resilience following physical exertion.
Importantly, this does not mean individuals with Long Covid should push beyond their energy limits or attempt to exercise through Post Exertional Malaise (PEM). PEM is a complex physiological response and careful pacing remains an important part of symptom management for many people.
However, in some cases, supporting muscle energy metabolism and recovery capacity may still be clinically relevant — particularly where muscle fatigue, deconditioning, or reduced physical capacity are present.
Creatine may also help support muscle mass in situations where reduced activity levels or prolonged illness have contributed to muscle loss.
Cognitive Function
Because cognitive symptoms and “brain fog” are so common in Long Covid, researchers have also explored whether creatine may play a role in supporting brain energy metabolism and cognitive function.
While creatine is often associated with muscle energy production, it is also involved in energy regulation within the brain. Creatine supplementation can increase phosphocreatine stores in brain tissue, which may help support cellular energy availability during periods of increased cognitive demand.
Supporting cellular energy metabolism in the brain may be relevant for cognitive processes such as attention, memory, mental clarity, and concentration.
Researchers have also investigated creatine for its potential neuroprotective and antioxidant effects. Some evidence suggests it may help support neuronal resilience by reducing oxidative stress and protecting against cellular energy depletion.
Creatine may also influence inflammatory processes that could contribute to cognitive symptoms in some individuals.
These proposed mechanisms may be particularly relevant for people experiencing Long Covid-related cognitive symptoms such as brain fog, reduced concentration, and mental fatigue.
Creatine and The Menstrual Cycle
Recent research has explored how creatine metabolism and energy production may vary across the menstrual cycle.
Some researchers have proposed that hormonal fluctuations — particularly changes in oestrogen — may influence creatine metabolism and creatine kinase activity.
In a typical menstrual cycle, oestrogen levels peak around ovulation and remain relatively elevated during the luteal phase (the second half of the cycle). Emerging theories suggest this may influence how some women respond to creatine supplementation at different points in the cycle, although research in this area is still limited.
If you have a menstrual cycle, you may notice subtle changes in your response to creatine supplementation across the month. As with many aspects of physiology, individual responses can vary considerably.
Dosage and Safety Considerations
There is currently no universally agreed dosing protocol for creatine supplementation in Long Covid specifically, and individual responses can vary considerably.
In research and sports nutrition, creatine monohydrate is the most studied and commonly used form of creatine.
A typical approach to supplementation may include:
Loading Phase (Optional):
Some individuals choose to begin with a short loading phase to increase creatine stores more rapidly.
A common loading protocol involves taking approximately 20g daily for 5–7 days, divided into smaller doses throughout the day.
However, a loading phase is not essential, and many people choose to skip this step entirely.
Maintenance Phase
Following a loading phase — or from the outset — a typical maintenance dosage is around 3–5g daily.
The small study conducted in post-COVID-19 fatigue syndrome used a dosage of 4g daily over a 6-month period.
Some people with Long Covid or ME/CFS may be more sensitive to supplements or physiological changes. In these cases, starting with a lower dose and increasing gradually may help assess tolerance.
Maintaining adequate hydration is also important when supplementing with creatine.
While alternative forms of creatine exist, creatine monohydrate remains the form with the strongest evidence base and is generally the most widely studied.
Important Note
Individuals with Long Covid, ME/CFS, and complex chronic health conditions can sometimes be more sensitive to supplements and physiological changes. While supplements may offer support for some people, they are not universally tolerated and responses can vary significantly between individuals.
For this reason, it’s important to introduce new supplements cautiously and ideally under the guidance of a qualified healthcare professional who understands your individual health history and needs.
This article is intended for educational purposes only and should not be considered personalised medical advice.
Food Sources Of Creatine?
Creatine is naturally found in small amounts in various food sources, particularly animal products. Here are some examples Creatine occurs naturally in a range of animal-based foods, particularly red meat and fish.
Some of the richest dietary sources include:
- Beef and other red meats
- Fish such as salmon, tuna, herring, and trout
- Poultry including chicken and turkey
- Wild game meats such as venison
Smaller amounts are also found in some dairy products.
While creatine can be obtained through diet, the amounts naturally present in food are generally lower than the dosages commonly used in supplementation studies.
Cooking methods may also influence creatine content, with prolonged boiling tending to reduce levels more than roasting or grilling.
Individuals following vegetarian or vegan diets may have lower creatine stores due to lower dietary intake, and some research suggests these groups may notice more pronounced responses to creatine supplementation.
Safety Considerations
Creatine supplementation is generally considered well tolerated for most individuals when used appropriately. However, there are some important considerations to be aware of.
Individuals with pre-existing kidney conditions, those taking certain medications, or those with more complex health presentations should consult a qualified healthcare professional before beginning supplementation.
Creatine can alter fluid balance within muscle tissue, so maintaining adequate hydration is important.
Some people may also experience mild digestive symptoms such as bloating or gastrointestinal discomfort, particularly when starting supplementation or using higher doses. Beginning with a lower dose and increasing gradually may help improve tolerance.
Supplement quality also matters. Choosing a reputable, well-tested creatine monohydrate supplement may help reduce the risk of unnecessary additives or contaminants.
Current evidence suggests creatine is generally well tolerated in healthy populations when used appropriately, although research in people with Long Covid and complex chronic illness remains more limited.
Individuals with Long Covid or ME/CFS may also respond differently to supplements or dosage changes. Introducing supplements cautiously and monitoring individual responses is important.
This article is intended for educational purposes only and should not replace personalised medical advice. Working with a qualified healthcare professional can help ensure supplementation is appropriate for your individual circumstances and health history.
Conclusion
Creatine is a relatively affordable and generally well-tolerated supplement that is generating increasing interest in the context of Long Covid and fatigue-related conditions.
While research specifically investigating creatine in Long Covid remains limited, early findings suggest it may have potential to support areas such as energy metabolism, muscle function, and cognitive symptoms in some individuals.
However, Long Covid is a complex and highly individual condition, and no single supplement is likely to address every contributing factor. Recovery and symptom management often require a broader, more personalised approach that considers physiology, nervous system function, pacing, nutrition, sleep, and overall capacity.
Responses to creatine supplementation may also vary between individuals, including across different stages of the menstrual cycle in some women.
As with any intervention, introducing supplements cautiously and in the context of your own health history and needs is important.
Referenced Articles
Reduced tissue creatine levels in patients with long COVID-19: A cross-sectional study
Creatine Supplementation in Women’s Health: A Lifespan Perspective
Creatine Supplementation and Brain Health
Diagnostic and Pharmacological Potency of Creatine in Post-Viral Fatigue Syndrome
