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A sports supplement helps against COVID-19 fatigue syndrome

4.12.2023

Translation: Patrik Stainbrook

Creatine is one of the most popular performance-enhancing food supplements among athletes. But can it also help against fatigue syndrome after a Covid19 infection?

Post-viral fatigue syndrome is a long-term neurological disease, formerly known as chronic fatigue syndrome. It’s characterised by the inability to participate in everyday activities which were previously achievable. The symptoms stick around, lasting more than 6 months and are associated with fatigue and non-restorative sleep. As the name suggests, it’s associated with a viral infection [1]. The pandemic, caused by a member of the coronavirus family, has led to more people suffering from fatigue syndrome. Up to 45% of COVID-19 survivors are affected by fatigue syndrome [2-5]. Can creatine help here?

Before I can answer this question, I first need to explain what creatine actually is and how it works in the human body:

What even is creatine?

Creatine was discovered in 1832 by French scientist Michel Eugène Chevreul as a naturally occurring component of meat [6]. Creatine is also found in fish [7,8] and plays a central role in muscle metabolism. At 6.5 - 10 g/kg, herring provides the most creatine, while salmon contains around 4.5 g/kg. Beef has about the same amount of creatine as salmon [6].

The enzymes for the production of creatine are found in the liver, pancreas and kidneys. Biochemically, it’s produced by three amino acids and enters the muscles through the blood, where more than 95% of available creatine is found. The remaining creatine is located in various tissues, including the brain, eyes, kidneys, large and small intestine and testicles [9-12].

In the course of a day, about 2 g of creatine is synthesised and consumed again. Stored creatine makes up 14 - 20 g/kg of dry muscle mass [13]. The breakdown of creatine produces creatinine, which, like creatine, is excreted from the body via the kidneys. Creatine is actively absorbed through the gastrointestinal tract and reaches the corresponding tissue via the bloodstream [14]. The absorption rate of creatine monohydrate – the most commonly sold form of creatine – is practically 100% [15]. As early as 1992, Harris et al. [16] showed that supplementation of 20 to 30 g/day, administered in single 5 g doses, can increase intramuscular creatine content in humans by up to 20%. Today, creatine is one of the best-studied and scientifically substantiated dietary supplements on the market [7,17].

How does creatine work in muscle?

Creatine is phosphorylated in the muscle [14], meaning a phosphate group is attached to creatine. The resulting phosphorylated creatine is now called phosphocreatine and plays a fundamental role in muscle metabolism. Phosphocreatine can produce and recycle adenosine triphosphate (ATP). In order for a muscle to perform mechanical work, it needs energy, which it receives in the form of ATP. ATP can be produced in the muscle via several metabolic processes. It can be obtained through the breakdown of fatty acids, carbohydrates, glycolysis or phosphocreatine. However, these metabolic processes are produced at different rates. While the breakdown of fatty acids provides the most ATP, it’s also the slowest process [18]. In contrast, ATP can be synthesised very quickly via phosphocreatine, but has a lower capacity compared to fat or carbohydrate degradation [18]. Increasing the phosphocreatine content in the muscle increases the capacity to produce and recycle ATP, which increases the supply of energy during training. This allows the mechanical work to be extended.

And now back to my original question: can creatine be used as a form of therapy against COVID-19 fatigue syndrome thanks to its properties and functions in the body?

Combatting long Covid with creatine

A research group led by Slankamenac et al. [19] has now addressed the question of whether creatine can help against fatigue syndrome after a COVID-19 infection and investigated what happens when creatine is supplemented with placebo or creatine monohydrate in a double-blind randomised clinical trial. The researchers recruited 12 patients suffering from COVID-19 fatigue syndrome. The creatine monohydrate group received 4 g of creatine monohydrate daily for 6 months. The placebo group received the same amount of inulin (prebiotic). Fatigue, creatine content in the tissue, patient reports, walking time to exhaustion and the occurrence and severity of side effects were evaluated at the start and after 3 and 6 months of the study period.

The results

Creatine content in the vastus medialis muscle (anterior thigh muscle) was significantly higher in the creatine monohydrate group (P<0.01) compared to the placebo group. This also applied to creatine content in the brain (P<0.01). Creatine also reduced lung and body pain in the creatine monohydrate group and increased concentration. One patient reported mild transient nausea after taking creatine monohydrate. No other side effects were reported.

Creatine isn’t the one magic bullet against COVID-19 fatigue syndrome. However, it increased available energy in tissue and alleviated clinical symptoms of the syndrome. In conclusion, supplementation with creatine monohydrate can provide relief and can be used as a safe dietary supplement to combat COVID-19 fatigue syndrome.

References

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Claudio Viecelli

Biologe

claudio.viecelli@keyoniq.com

Molecular and Muscular Biologist. Researcher at ETH Zurich. Strength athlete.

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