Dynamic Dialogue with Danny Matranga - 178 - Dr. Darren Candow: Creatine Masterclass *The Ultimate Creatine Pod*

Episode Date: March 28, 2022

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Welcome in everybody to another episode of the Dynamic Dialogue podcast. As always, I'm your host Danny Matrenga and today I'll be sitting down with Dr. Darren Kandao from the University of Regina in Canada, and we will be discussing all things creatine. Dr. Kandao specializes in sports science research, specifically sports nutrition research, and he is my go-to resource when it comes to all things creatine monohydrate and resistance training. He's produced over 87 peer-referenced publications in high quality journals and is a very, very well-respected researcher specifically on the topic of creatine and creatine monohydrate, which is why I brought him on today so we can go through and work through all the questions you guys ask me. Whether it's, is creatine safe for women? Is creatine effective for hair loss? How much should I take depending on my body size? Can it affect my sleep, water retention? Every question you have ever asked me about creatine is getting answered on this episode

today. So sit back and relax and enjoy my discussion today with Dr. Darren Kandow. Okay, guys, I'm joined today by Dr. Darren Kandow. We're going to talk quite a bit about creatine. He's somebody that I came across very recently when I was perusing some of the creatine info space. And I found a really good podcast that he did where he answered a ton of questions. And I said immediately, I need to talk to this guy because there are so many questions I get from you guys, from listeners, from social media about creatine, from the most basic questions to stuff that is way outside of my area of expertise. And I want to kind of shed some light on this because I do think it's a supplement worth taking for most populations, but you always want to be careful. And Darren really

seems like the guy when it comes to unpacking this and communicating the science in a way that's easy to understand. So Darren, before we get into the creatine, if you wouldn't mind, give everybody kind of a primer on how you got into the field of sports science and nutrition. Yeah, well, first off, thanks for having me. And it was kind of by accident. I took an undergrad cell biology degree at a university in Eastern Canada, and I thought it was fascinating, but I just happened to lock in to taking an undergrad exercise physiology class. And at about the same time, I started to lift weights and exercise more vigorously. And things just sort of came together from a visual perspective. And you start to learn about this compound called phosphocreatine and how it's really important for increasing potentially energy status of the cell, allowing an individual to potentially exercise longer.

And sure enough, I started to supplement with this product when I was 18. And I sure noticed gains. I sort of got bigger, stronger and actually faster. actually faster. And then it's taken on its whole life. My entire career for the last two decades has primarily involved researching the misgenic compound. I got very fortunate in my graduate work to work on creatine during my PhD. And we focused on older adults because we thought that was a population that may benefit with overcoming some of the negative consequences of aging, specifically muscle and bone loss. And ever since then, I mean, we've published, I don't know, 70 or 80 studies now just on creatine. And ironically, as we'll talk about today, I'm sure there's still so many myths and misconceptions, and in fact, lies about creatine that it's a bit ironic in a sense. There's over

a thousand studies published, but a lot of the public still are misinformed or they're getting information that's not true. And so hopefully today we can provide a little bit of context and focus on evidence-based research moving forward. I'd love to do just that. I think you kind of nailed it for a supplement that has such a robust body of literature. I often compare it to something like omega-3, which has quite a robust body of literature as well, but there seems to be substantially more fear-mongering and misinformation associated with creatine supplementation. And I think perhaps the first reason for that is that at a fundamental level, people don't understand what creatine is. Because it is a performance enhancer, people assume that maybe this is a performance-enhancing drug or a steroid or some

type of compound that might augment my physiology in a way that's likely to cause some pretty serious negative impacts. So I think the first and most obvious question is just at a simple biological level, what the heck is creatine? Why does it help sports performance? Yeah. And it's an excellent place to start. So you're right. Creatine is not a steroid, but people thought it had steroid properties because it was seeing the work in the majority of people. They'd say, Hey, I can get stronger. I put on muscle mass, I lost fat mass. majority of people, they'd say, hey, I can get stronger, I put on muscle mass, I lost fat mass. So let's do the 101 Coles knows version. creatine is naturally synthesized in all of us,

it's naturally synthesized from three amino acids you get from food products in the kidneys and liver. And we're producing about two grams a day on average, if you're on a high red meat or seafood diet, you're maybe producing or synthesizing or intaking a bit more. And we simply excrete about two grams in our urine per day. So if it's two grams being synthesized, two grams is treated, there's a nice equal balance. And you can live healthy and exercise quite easily, just on normal biological synthesis and breakdown. just on normal biological synthesis and breakdown. But what sort of blossomed in the 1990s, or sorry, 1992 specifically, is when the first study came out saying,

if you take in about 10 times as much creatine as we naturally synthesize, this is familiar to a lot of people called the creatine loading phase or 20 grams a day. It seemed to maximize the amount of storing capacity in our muscle. So therefore we maximize this high energy phosphate compound in our muscle. And I should preface this, the interesting thing with creatine, 95% is stored in our muscle, but our muscle does not make it.

So it has to be created or ingested through a supplement travel in our bloodstream and get access into our muscle. And once it's in our muscle, it's trapped, it becomes very, very difficult to leave, and therefore we get all the magic. And so if you take in this loading phase, or in times as much as we naturally produce, it was leading to phenomenal gains in muscle mass, strength, power, endurance, people's recovery went up. And if you look at the basic physiology, it kind of makes sense. It allows the cell to have a higher energy status. It decreases inflammation and oxidative stress. So the athlete or exercising individual, when you would ask them, how do they feel? They say, I feel phenomenal. I can exercise at a higher intensity. I do more work and therefore I can recover,

allowing me to get back in the gym, on the field, whichever it is. So creatine is just naturally synthesized from three amino acids, arginine, glycine and methionine. Or what's more popular is when people go buy a commercially manufactured product, it's easy to digest, there's no adverse effects if you take that a recommended level. And again, ever since 1992, there's 1000 studies potentially published and the totality, the vast majority of evidence says it's very effective for the majority of individuals consuming it. It's perfect. So I think it's a nice segue into question two, one of the more common questions I'm asked. And again, speaking specifically to the commercialization of creatine,

most of the literatures on creatine monohydrate, but that is not the only form of creatine. Most of the literature is on creatine monohydrate, but that is not the only form of creatine. There are multiple different forms of what people call designer creatine. And many of these creatine analogs are marketed as being more efficient or somehow safer or somehow more effective. From what you understand, is there any reason to take any of the designer creatines over the more prevalent and commonly studied? Because you're talking about the body of literature, which is mostly on creatine monohydrate. Is there any reason at all to bother with these designer forms if you're a consumer? There's absolutely no reason to ingest any designer purported form of creatine. And I'll sort of try to put this into

a nice context. Creatine monohydrate is a creatine molecule linked to water. It's identical to the ones we naturally synthesize. And when you consume creatine monohydrate, the water molecule just simply dissolves in our GI tract. So the creatine molecule is identical. When you have all these other purported brands of creatine, and I really want to preface this for your listeners, please make sure it actually contains the creatine molecule. If it doesn't, it's never going to raise your blood creatine levels. And then subsequently, it will never get in the muscle, the doorway or transporter in the muscle is very, very specific, just like the lock and key idea to your house, to creatine. So first off, the compound that they're purported or marketed has to have creatine.

But just because something gets in the blood quicker doesn't necessarily mean it gets into the muscle and leads to it. So there's been a couple studies that have looked at other forms of creatine, such as creatine salts. It may get in the blood quicker, but it's never been shown to be more effective than monohydrate. Monohydrate bioavailability, that means getting into the blood and being taken up by the target tissue is near a hundred percent anyway, even in the powder form. So I argue, I know monohydrate has been around forever. It's kind of boring because it's true or tried and tested, but why mess with a good thing? If it works, it has no adverse effects. Why not stick with it?

So we only use monohydrate in the lab. I think all my colleagues would only recommend monohydrate. If you're considering creatine, please only recommend or consider creatine monohydrate and make sure it's in the powder form. The speculation on liquid or beverages has not been supported. The stability of creatine in liquid is very questionable. I've not come across any literature to say that the creatine molecule stays intact. If anything, it could be degraded in the GI tract. So mix your powder in food or water or whichever it is. If you don't like the solubility, you can heat the solution a little bit. Some people like to consume it with fruit juice or whichever. That's fine.

Again, there's a lot of ways to consume it. And again, the safety profile is second to none. Yeah, I think that's a great point too. That's the direction the literature points. That's what the people who are the most initiated and understand it the best are using. I do think that just as consumers, we go, but this is so cheap. I can get a ton of it for very low out-of-pocket expense. The more expensive stuff must be better, right? These designer forms of they must be more effective. They're newer, They're more expensive. And I think that's just how the supplement industry works. If they

can nickel and dime you and take you for a ride, they're going to do just that. But with regards to dosing, a lot of these designer creatines, they tout reduced dosing criteria. You don't need to take as much for them to be effective, but we know that those are kind of bogus. So focusing then on the dosing of monohydrate, it is popular to load creatine, taking up to 20 grams a day. But do you need to do that to eventually reach a point where it's effective? Because I think for some people, that's quite a lot to take in a day, or it's an intimidating amount to think about taking. Can you get the benefits without loading? And if so, does it take longer? Yeah. And so this is probably one of the most important things we'll talk about today. There's in general three strategies with creatine. So as we talked about the creatine loading, that's where you take five grams a day for about

four times a day for five to seven days. In other words, 20 grams a day for seven days. That was the method that was shown in 1992. And again, in 1996, to be extremely effective. The downfall with this is this is where you hear some people say I have GI tract irritation, bloating or water retention. So again, creatine loading is really effective for increasing creatine stores in the muscle, but also very effective for increasing muscle mass and strength. That's typically a strategy used for individuals, athletes competing in a competition that's upcoming, they really need a maximal boost. I think the other strategies

which we employ, and I think if the average individual is looking for health or exercise benefits, there's two other strategies that seem to not result in any adverse effects. And this is very applicable to females. The one that we use a lot in our lab is based on the size of the individual. So we use it based on kilograms and it's 0.1 gram per kilogram. So again, 0.1 gram of creatine per kilogram. So if I go on the scale and I'm 80 kilograms, I get eight grams a day. If a female goes on the scale and they're only 50 kilograms, they're getting five grams a day and so on. And this is based on the idea that the larger the person is, the more creatine transporters or doorways they have. So they can utilize more or less. Sure. Very intuitive. Makes

a ton of sense. Very similar to caffeine based on milligrams per kilogram or protein. And so we liked that one because we've shown multiple times across the entire lifespan that that relative dosing is very effective and safe. It has no adverse effects on the liver, kidney, or blood. And is this a loading dose or is this a long-term maintenance dose? Yeah, this is without a loading phase. This is start from day one. You just take in, it's probably roughly a half a teaspoon, nothing that's crazy or takes a calculator. You just kind of estimate as you go. And the interesting thing is maybe after three months, you weigh yourself again. And if you've increased mass, you could

probably increase the amount of creatine or vice versa. So that one's, you know, you start right at the gate, no problem. And so again, on the supplement bottles, you're ignoring their recommendation. But there's a high amount of evidence to support that third one is what we consider the lowest effective dose. And this is three grams a day right out of the gate, no loading phase, that will accumulate in your muscles by about 30 days. Three grams a day is a quarter of a teaspoon, you would hardly ever notice it. If you start taking three grams a day, research has shown that over 28 days, it'll maximize your muscle stores. And then again, if you take that continuously, you'll maintain or get the

extra boost from what we're achieving. So those seem to be the three general recommendations. If you combine all three, excluding the loading phase, this is where the general recommendation of five grams a day comes. Five grams a day is two grams excreted, add in the minimal amount of three in addition, that gives you five. Therefore, we say, hey, if you're looking for health benefits, and this is, I want to preface this, this is primarily from muscle. Five grams a day seems to be very effective. We don't see the effects on bone or a consensus on brain health at that low of a dose. So we might talk about this a little bit later for older adults. In my opinion, we may need more as we get older. And I can talk about why I think

that is. But for the average person, three to five grams a day is a really viable, safe, effective strategy. And the other cool thing for females listening is very difficult to keep females in a research study when we do a creatine loading phase, primarily because during the rapid creatine loading phase, that can drag a lot of water into storing in the body. And so on average, anywhere between one to three kilograms of mass can go up and females specifically and obviously males too. But the rapid weight gain in our, in our, uh, experiences cause a lot of individuals to withdraw. Uh, the nice thing with doing a really, really small dose, hardly get any water retention that's noticeable. Um, and then a lot of individuals can adhere to it. You do want the water retention that actually unlocks all the magic of creatine. So if someone

says, Oh, creatine only leads to water retention, high five them. You're saying absolutely right. And then when the cell in the muscle will swell, that causes an increase in a whole cascade of things, transcription factors, satellite cells. And, and that's one of the reasons you get bigger, stronger, leaner muscle. And of course, there is some evidence that if muscle goes up, your fat mass will actually go down as well. So even bodybuilders competing should never stop taking creatine. It increases intracellular water, not extracellular over time. Well, I think that's kind of the big one is, specifically for women, water retention is something that they're very familiar with because of the hormonal differences between men and women. Women tend to be more susceptible to

volatility with regards to water retention, especially if they're in that age where they're menstruating. They see these water fluctuations change almost like clockwork every single month. And so adding to that is very intimidating. But from what I'm understanding, it sounds like most of the water retention is going to be inside of the muscle tissue. It's not going to be subcutaneous. It's not just going to go to your face or to your belly. And that's the mechanism by which it works. And if you're particularly conservative with, I do not want to experience much water retention, I want to experience the minimum amount possible, then you would start at that three gram a day dosage and then just kind of play it by ear from there. Does that sound pretty spot on?

Yeah, it's 100% correct. And you're right. It's during the follicular phase and then luteal phase. So the water and body water retention with creatine. And the other cool thing is we've talked about creatine already, and we'll talk about the importance of resistance training. There's very minimal research that creatine by itself, like a Flintstone vitamin is effective. It can be, but resistance training kind of unlocks the potential. And if this metabolite allows

male or female to exercise at a higher intensity, inevitably they can put on lean tissue, decrease body fat, get stronger for functionality later on in life and there's evidence that creatine it can actually increase thermogenesis or energy expenditure uh and again another side thing with the dosing is what we found is if the dose per recommendation three five eight grams whatever it is is too much the cool thing with creatine it accumulates in the body so maybe you can reduce that to multiple small dosages a day. Like if you're taking five grams, there's no reason you can't take two grams with breakfast, maybe two and a half grams post-exercise. Caffeine's different. It sort of hits you all at once, but creatine accumulates. And again, if you want to split it up into multiple

frequent dosages, there's no plausible explanation why that shouldn't be beneficial over time. Maybe a big bolus dose of tram shot at once, you're not going to absorb and you might excrete a lot in the urine. So we actually think smaller, more frequent dosages are the way to go. It's going to have a minimal effect, if any, on GI tract for those who are susceptible to IBS or something like that. I think that's spot on. And just anecdotally, from what I've seen working with clients,

if in fact there are some gastrointestinal issues, which is rare, I'd say that's 10 to 15% of individuals who I've seen start supplementing with creatine. Going to a smaller dose or spreading that dosage out across the day almost seems to eliminate that with a high degree of efficiency. A question though, before we segue out of this, because I think we really hit on something interesting, which is creatine metabolism and these water retention impacts seem to be somewhat acute, but the performance benefits aren't as acute. I've had many people say, hey, I've been taking creatine for a week and I don't notice any difference. And you gave a 28-day

figure where you said after about 28 days, you've reached a saturation point or a point at which you can say like, hey, I'm good to go. And unless you're doing 20 grams, you might not see something after seven days. So creatine supplementation isn't going to lead to acute performance enhancement. You have to reach a certain point is what I'm kind of getting here. Yeah. Yeah. As it accumulates in the muscle specifically, you're probably going to eventually notice an increase in muscle mass and strength. The one that we see almost right off the bat is an increase in recovery. The body or the person says, geez, I don't feel as sore or I have a lot more energy to get back. So all these things accumulate over time, but it can happen as little as potentially three to four weeks, depending on

the dosage. And then we'll probably talk about timing. But for those who say, geez, I'm taking creatine and I don't really notice anything, There is something called a non-responder to creatine supplementation. Um, and we kind of have this mythological maximum amount of creatine storage in our muscle. Of course, it'd be remiss if a 350 pound lineman has the same storing capacity as myself. So that's a little bit of a gray area, but in theory, if you're consuming a lot of red meat on a daily basis, you're probably not going to respond the same way as a vegan or vegetarian. So if you're already getting dietary creatine through red meat, seafood on a daily basis, you may not get the same response to supplementation where vegans and older adults seem to respond very well based on some of the physiological or habitual dietary patterns. I like that. And I do want to talk specifically about populations here in a second, but just to kind of circle the wagons here and tie up this

kind of 101, I love this, but the timing, is there an ideal timing for creatine supplementation for athletes or just in general for somebody looking to reap the benefits. Some of the literature that I've seen would lead me to believe that if you can do it around your training, you've got probably a small chance for a slightly better uptake. Is that true or does it really just boil down to taking it every day? Yeah. So I'll sort of do a double-edged sword here. So I agree with you that in close proximity to training before, during, or after consuming creatine has never been shown to be detrimental, but if anything, it's a viable strategy to increase muscle mass and performance. They've also looked at creatine in the morning or evening on a day's

individuals workout and they get the same benefits. So one interesting thought was, They also looked at creatine in the morning or evening on the days individuals work out, and they get the same benefits. So one interesting thought was, does the timing of creatine really matter? And the totality of evidence suggests it does not. Now, I need to preface this a little bit. If you take creatine in the morning, before training, during training, after training, or before going to bed, the key there is that they've exercised the stimulus to the body usually lasts for muscle synthesis anyway at a young age of 24 hours and that study in 1992 simply showed that if you do muscle contractions

and consume creatine in combination the muscle contractions sort of increase blood flow or set they sensitize the muscle taking more creatine and that's where this timing really came into play but when we look at all the evidence comparing studies that looked at creatine before uh versus after training or in the morning or even you get the same benefits the ironic thing is there hardly has been any studies that have looked at the timing of creatine in relation to a placebo. In the one study that did and we performed this in older adults, creatine before or after was identical, there was no difference. However, in the group who took creatine just after their weight training sessions,

they did get a greater increase in muscle mass compared to placebo. So that's the only line of evidence that we have that post exercise creatine may give you a small greater effect over just resistance training alone. Gotcha. When you bring it all together, it doesn't really matter when you consume creatine, just take it and make sure you work out. really matter when you consume creatine. Just take it and make sure you work out. Very, very, very concise. And one last point here, you hit on something that really popped, which is if in fact contraction of the tissue is what helps with stimulating or sensitizing the muscle to uptake creatine, is it sensible to take it on the days you don't train?

Is there a threshold of activity that somebody needs to hit in order for it to be effective? How might one reconcile that? That's an excellent question. So in older adults, older adults actually still get the same benefits or some benefits on just taking creatine on the days they work out. Hence, going back to this muscle contraction idea. In young individuals and older individuals, we see equal benefits by taking creatine on your non-training days. So you get benefits from both, but I would probably encourage people to take it on their off days for a couple of reasons. We now know that creatine has phenomenal benefits on indices

of cognition and brain health and recovery. And by taking creatine on non-training days, that still, you may get other health benefits. So it's another strategy to make sure you're getting enough in the diet and or in the muscle. But for those who say financially, they don't want to take supplements or whatever other reason, you will get benefits on the days that you train. It'll just take you a bit longer. Perfect. I think it's a nice transition into the cognitive benefits, which has kind of exploded within

the last one to two years. I've been pretty familiar with this for a surprisingly long amount of time because my dad has Parkinson's disease. And when I started bodybuilding recreationally, I started taking supplemental creatine and doing all of the research in the world because there's so much misinformation and fear-mongering. I wanted to make sure that I was doing my due diligence. And somewhere along the line, I found that there were different groups doing studies, seeing if in fact creatine could have any impact on Parkinson's disease. And I know the research there is mixed, but I asked myself, why is anybody doing research on this? How is it

at all possible that this bodybuilding supplement could be impacting a neurological, what is effectively a form of cognitive decline that impacts the motor centers of your brain? How is this possible? And then fast forward a couple of years, I start hearing people talking about creatine being able to affect acute cognition and long-term brain health. And it appears that as much of a role as creatine plays in our muscular system, it does play a small role in our neurological system. So in what ways does creatine interface with the brain? How long have we known about this relationship? It's a very promising body of evidence. And one of the main reasons I'm so passionate about recommending creatine supplementation is,

it's obvious that it does quite a bit for your skeletal muscle tissue, but this might be one of the best and most promising lines of supplement literature that we're kind of heading down now. Yeah, 100% agree. It was kind of lost in translation, if you were the first paper that looking at creatine and brain accumulation was in the late 1990s as well. But we were all focused on bigger, stronger, faster from the neck down. And if COVID has taught us anything, from the neck down. And if COVID has taught us anything, the mental health impact that something can cause in addition to other traumatic things going on in the world, the neck up has become more probably popular and probably more important. Most people would argue, just like our muscle and bone cells, sure enough, our brain cells rely on creatine for energy. And

if the cells in the brain rely on creatine for energy during times of stress, so think of sleep deprivation, depression, anxiety, all these neurodegenerative diseases, you mentioned Huntington's, Parkinson's, MS. And then, of course, we talk about concussion and mild traumatic brain injury. So the big emergence, and we just published a paper a month ago on a big review on creatine and brain health, and it seems to have the most momentum and rightfully so. And as it stands right now, the brain is a bit unique. Our muscles like to take in creatine because they don't make it. Well, the brain says, well, we're a bit different. We actually like to

make our own creatine. So we don't really want supplementation. And there's parts of the brain that are very resistant. So the theory with concussion, mild traumatic brain injury, or these neurodegenerative diseases is that it may require higher dosages of supplementation to accumulate and longer periods of time. But just like our muscle cells, our brain cells use creatine for energy. And what we're seeing is creating really decreases inflammation and oxidative stress in many parts of the brain. Wow. So our big area coming up is on concussion. Can creatine decrease the prevalence of concussion and or speed up recovery and that would have massive implications worldwide but we're also looking at the effects on depression can the energetic status of the brain potentially offset some of the impacts of depression so for last 20 years it's been the neck down looking at and now we're focusing on a neck up you combine the two and it's a whole body.

What I would consider now a health ingredient. It used to be just for athletes, but now it's more of a health compound. Hey guys, just wanted to take a quick second to say thanks so much for listening to the podcast. And if you're finding value, it would mean the world to me if you would share it on your social media. Simply screenshot whatever platform you're listening to and share the episode to your Instagram story would share it on your social media. Simply screenshot whatever platform

you're listening to and share the episode to your Instagram story or share it to Facebook. But be sure to tag me so I can say thanks and we can chat it up about what you liked and how I can continue to improve. Thanks so much for supporting the podcast and enjoy the rest of the episode. It's such a good point. Like when I was introduced to creatine, it was as a pure performance enhancing agent, which most of those agents are actually deleterious to the overall It's such a good point. When I was introduced to creatine, it was as a pure performance-enhancing agent, which most of those agents are actually deleterious to the overall health of the organism in many ways. There are trade-offs. You're like, okay, I know this is going to improve performance and I will deal with whatever the negative health implications may or may not be.

And with creatine, it's like, okay, this is something that you can take for less than a dollar a day that might help with your long-term muscularity, performance, and metabolic health. Oh, and by the way, it also might be the single most affordable neurological enhancing neuroprotective agent that we know of. And we're just starting to scratch the surface. I remember I went to a sports science symposium maybe four years ago, five years ago at this time. Everything's blurred post-pandemic. It could have been 10 years ago. It could have been three years ago. But there was a woman from UC Davis talking about the utilization of omega-3 and creatine for treatment of traumatic brain injury and concussion. And I was like, concussion? And

I was like, what can this not do? And since that point, the literature has really exploded. You brought up depression, you brought up anxiety. I've even seen things that say creatine can acutely improve cognition. So if somebody says, I'm taking creatine, you had me sold on it when we were talking about muscularity, let alone what it can do for your brain. Do those dosage recommendations change if you're taking it to get the cognitive benefits? Do they stay the same? If you're only interested in the cognitive benefits, does it matter? Because you kind of mentioned that the brain likes to create and synthesize its own creatine. It's not maybe as susceptible to supplemental. Yeah, no, those are excellent segues. We have a study right now or a paper and review on creatine and memory. And once it gets accepted, I can divulge.

But anyway, it has promise. And I think the easiest way to look at it is I think if someone is going to orally ingest creatine, just take a dose that will eventually accumulate in the tissues and you will get the benefits. Perfect. For someone saying, I just want the brain benefits. I need to take a high dose. Well, you're still going to get the muscle benefits as well. The difference becomes to the individual who does not exercise. Gotcha. There's minimal, minimal evidence that creatine will improve indices of

muscle performance without exercise. Gotcha. But there is theory that obviously, exercise may not be needed to get brain health benefits. So I think an average dose of five, even a little bit higher per day will eventually accumulate in all those areas. And it's something you can take on a daily basis, mix it in yogurt, take it with water, whatever, and it just becomes easy. I think we, for the last, probably a decade ago with protein, we were getting very scientific about if you missed the specific ingestion time period, you need to set an alarm clock. Well, we don't. Just consume it. It's the total daily amount or at least you're taking it seems to be effective.

I love that. So segwaying now into populations that should or maybe should not consider creatine supplementation, I think most of the people who listen to my podcast and most of my audience are active, healthy adults interested in progressing their physique or their performance. So they're probably very high quality candidates for creatine supplementation. But within that population, assuming you're active, are there any particular things that somebody should be aware of? Are there any contraindications? Before we talk about women specifically, older adults, vegans, all that, you're pretty healthy. Are there things you should know about and be aware of? I'll give you an example. When I was 17, I went to the hospital to have some labs drawn up because I was particularly dehydrated and my blood urea nitrogen and creatinine levels came back high and everybody was freaked out. And I was like, but guys, I take creatine.

And so there are plenty of healthy people who may be aware that there's potentially some red flags, of course, with the liver and the kidneys. What do healthy adults need to be aware of before they start supplementing? And then we'll segue into kind of these unique populations. Yeah. So one is the safety profile on creatine overall is magnificent. But you hit the nail on the head. So one of the things with creatine is when you take supplementation or increase the amount in the diet, creatine gets in the muscle and then through its turnover, it produces something called creatinine. And creatinine is a metabolic byproduct, it leaves the muscle gets into the blood. Now the issue here is when you go for your blood work, if you don't tell your medical

practitioner or nephrologist that you're taking creatine supplementation, or that you perform weight training, because weight training will increase creatinine as well, that will give a false positive that your kidneys are not working properly. So I can't stress this enough, make sure when you go for blood work, you tell the nurse practitioner, medical practitioner, that you're taking creatine supplementation and you exercise, you should expect high creatinine levels in the blood. That's all that's indicating is that you're basically some byproduct of creatine supplementation that does not mean your kidneys are failing okay so that's why kidney measures can be uh overestimated but regarding a population perspective there's probably no one

on the planet and this includes pregnant females that can't benefit from creatine i can't think of a population yeah i can't think of a population that would not or would have any adverse effects from taking this naturally produced in the body compound and that's why the ioc will never ban creatine even though it's really effective and it's on there but one of five ergogenic aids at work you naturally produce it it's not a and it's on their one of five ergogenic aids that work, you naturally produce it. It's not a testosterone. It's not a steroid. So again, it's very clean, but it works.

So people speculate there's something kind of fishy about this product. But again, hey, we just back it by evidence-based research in the lab and bring it to the practitioners. I love it. Secondary population that I think we both know probably would benefit this, but I'd like to talk a little bit about why, and that's those who eat a plant-based vegetarian or vegan diet. Now, we could also talk about whether or not creatine is a vegan-friendly supplement. I think the way it's manufactured in most instances it is, but why does that population benefit so much from creatine supplementation?

Yes. So that population benefits the most. And we've done a few studies with this. So let's look at vegans or vegetarians. They have no meat or red meat or seafood or minimal amounts, depending on the type of vegetarian they are. So therefore their amount that's already in the muscle is probably going to be half the amount of someone who's on an therefore, their amount that's already in the muscle is probably going to be half the amount of someone who's on an omnivore diet that consumes red meat or seafood pretty much on a semi regular basis. So for example, if you have 100% of your muscle capacity for creatine, vegetarians are about 50%. And that doesn't necessarily mean they're only working at 50%. That means they only have 50% of creatine storing capacity.

They're exercising fine and everything is great. But when you give a vegan or vegetarian creatine supplementation, they double the storing capacity in the muscle. And therefore, they experience phenomenal benefits from an increase in lean tissue, loss of fat, increase in performance. The individuals already consuming high amounts of red meat or seafood a day, they're classified technically as a non-responder. They already might be at 90% of their capacity, and then giving a supplement, they might only get that small, greater effect. On average, the average person gets an increase of either 20% to 40%

in their muscle from creatine supplementation. That totally depends on where they're starting with. So if you know anybody who says, Hey, I take creatine. It doesn't do anything for me. When you look at your, your normal food intake, you're like, geez, you're already taking a lot in your diet. Make no wonder you're not responding. Whereas you talk to a vegan, they're like, what's in this stuff. I feel amazing. I'm exercising at really high capacity. And that's really why. So like the carnivore this stuff? I feel amazing. I'm exercising at really high capacity. And that's really why. So like the carnivore dieters can probably skip it.

The vegan dieters absolutely need it. It's funny because the amount, even on the carnivore diet, people say, well, I'm getting a lot of creatine. I'm like, yeah, you are from a muscle perspective, but the lowest dose ever been shown to increase bone mineral has been eight grams a day. Wow. So we think as we get older, especially in postmen increase bone mineral has been eight grams a day. Wow. So we think as we get older, especially in postmenopausal females, eight grams might be the minimum. And then we have no idea the optimal dose in the brain. So I think someone would still benefit even if you're on a caveman or carnivore diet.

But the big push on plant based foods right now is, hey, this is something to at least look into. You may exercise and be healthy the rest of your life, but this is something that might give you a small beneficial effect. Again, though, exercise needs to be the driving force. I can't stress that enough. It's a fair point. And it's a nice segue. You mentioned postmenopausal women, I'd like to start first with women who have not quite gotten to the perimenopausal window. And it's usually these questions come from women between the ages of, I'd say, the teenage years into their mid to late 50s worried about the masculinizing or potential masculinizing effect of a performance enhancing supplement. Because it just goes back to that fundamental misrepresentation of, look, creatine is an effective performance enhancer, so is testosterone,

so is Dianabol, so is Trenbolone, and they're not the same. They're all very different, not just in how they act in the body, but in what they do outside of their intended purpose. Is there any reason for a woman to be concerned about the masculinizing effect of creatine, if that's even a thing, or any of the downstream physiological byproducts like DHT, for example, which we're going to talk about when we talk about the hair thing? Are those kind of fears relatively misguided? Yeah, and they're 100% fear and myths, and there's no scientific evidence behind that. Yeah, and they're 100% fear and myths, and there's no scientific evidence behind that. So females substantially benefit from creatine supplementation or dietary creatine. And so if you're taking a recommended dosage, we've already talked about as little as three grams a day or up to five, whichever you prefer. I probably wouldn't recommend the loading phase unless the female is an athlete competing for a really upcoming event that could lead to water or

weight gain. So taking a small dose, spread it out to meals or whichever it is, it's going to increase the potential to exercise at a higher intensity, then you would argue, well, if I'm exercising at a higher intensity, I'm getting a greater metabolic and energy expenditure stimuli. And lo and behold, over time, the individual says I put on lean tissue, I potentially lost fat mass, and I got stronger, and then metabolic health and functionality goes up. So again, there's no reason females should not be taking creatine. If anything, I think it has massive beneficial effects. We've seen some beneficial effects in females on bone density in older adulthood. But why not start younger and start building up that bone mineral earlier on? And that's our next line of thinking in young females.

Yeah. You'll habitualize it, right? Like if you've been taking creatine every day in your twenties and thirties, you can continue it into your sixties, seventies, and eighties. The bone density stuff is relatively new to me. It's something I've heard people discuss, but it's not my area of expertise. It sounds like creatine is particularly promising for older adults for three reasons now, one of which is obvious, it's its ability to stave off sarcopenia because it's going to help you train hard. But now we've got the cognitive benefits, which we touched on, which is really exciting. But talk to me a little bit about the bone density, specific benefits and bone mineral density, because this is kind of new to me, not my area of expertise at all. Yeah, there's been about 10 studies published

and we're fortunate to have published with seven of these. Now there's a little bit of different distinction with bone. So bone takes a long time to turn over. So that's why it's very difficult to do really clinical trials. They take at least a year to notice an effect and you need imaging and fancy technology. But as it stands right now, if you take creatine without resistance training, there's no bone beneficial effects. Gotcha. But when you combine creatine about eight grams a day or more with weight training, maybe three days a week for at least a year, we see postmenopausal females have a beneficial effect around the hip and the lower part of the body in the tibialis, which is really applicable for falls prevention.

Yeah, it is. That's big time. I work with a lot of older adults and those are the two things that break the most when they fall. And so if we can strengthen the bone or at least cause them to have a little bit better balance around the ankle and the calf muscles, that could withstand the incidence of falls and fractures. So there's a small body of evidence to suggest that creatine, about eight grams a day or more, and again, this is always monohydrate with weight training, can decrease the rate of bone mineral density loss or increase bone strength. So we're thinking this could, with longer-term studies,

have application for osteoporosis or osteopenia, more specifically for reducing the risk of falls and fractures in the lower limbs. I love that. And to kind of close this out, talking about special populations, these are all mostly largely beneficial, but there are three kind of physical phenotypical things that I find people tend to be the most concerned about when it comes to creatine. We already checked the box with water retention. The second one, and again, I think a lot of this has to do with just the general misconception that this is steroidal, but acne and skin quality. Is there any relation or correlation between creatine consumption and prevalence of acne or cystic acne?

Yeah, and there's no evidence whatsoever. I've heard this anecdotally quite a bit. And my only thought here, and there's no evidence to support, is maybe the person is exercising at a higher rate. And so their sweat rate has gone up. And depending on the material of clothing, that could be contributing it. But again, that's all speculation, but from a physiological reason, um, creatine has no, um, adverse effect on hypertension or blood pressure or things like that. And, uh, um, so again, I, I'm always speculating there when it comes to acne or skin irritation.

I'm inclined to kind of lean that way too, just because so many of the individuals who are, you know, they're finding this correlation. They're oftentimes, as you said, they've increased their exercise, they've increased their sweat rate, maybe they're wearing tight fit clothing for, 16, 17, 18 years old, when you're at the peak of that hormonal cycle, at which point you're oftentimes dealing with some of these things like acne. So there's so many correlations there that it's easy to go, when I started taking that, that's when I had the acne without there actually being a direct link, which kind of leads to the last one, which is hair loss. Everybody's familiar with the, I think there's one rugby study, which again, it might be interesting to talk about the correlations there, but it did appear to maybe those who didn't parse it apart that here you go, this is it. You take creatine, you lose your hair and creatine can increase DHT, which when people

talk about male pattern baldness, they often look at DHT and you have all these different companies now that are kind of these direct-to-consumer pharma clinics where you can just call and they'll write you a prescription for DHT blockers, all kinds of stuff. So people understand more about DHT than they ever have, and they understand creatine might increase it. So is there reasons here to be cautious? Who should be cautious? Is it all overblown? Where are we at with creatine and hair loss? It is by far, by far the number one question and myth and misconception across the entire spectrum of creatine. And so obviously if people can see me i have receding hair and a

lot of other prominent creatine researchers are going bald too but i was losing my hair before creatine i'll preface that um so this study as you mentioned it's probably the most famous creatine study done yeah in australia and they took a really high dose of creatine about 25 grams a day for seven days and a nice thing about this study was a crossover design so they sort of controlled a lot of genetics and environmental factors and these males went about their training for rugby and took a high amount of creatine and they measure the rate of DHT or dihydroxy testosterone which which is simply a precursor for follicle death and hair thinning. So no hair thinning measure, hair loss was measured in this study, only an increase in this hormone DHT. And lo and behold,

it went up by about 50%, but it was still within the physiological range. So we've, we just briefly talked about going to a doctor and you get, you know, blood work and you get your cholesterol checked and triglycerides, there's always a range. Well, this still, it went up and it was significantly gone up, but again, it was in the healthy range. And then of course, when they went on placebo, it didn't hardly go up at all. And people don't realize this from the study, but resistance training or training will increase DHT by itself. Sure. Um, so obviously they said, no, it had to be creatine. And oh, by the way, creatine is going to make you bald. And I argue, well, this study, all it simply did was show an increase in a hormone,

which has been linked to hair thinning. And it was still within a physiological range. And in the thousands and thousands of participants that had been through my lab and other labs, research participants are super amazing and smart. Do you think if they thought they were losing their hair, they wouldn't tell the researcher? Not a single person in my lab or any other lab that I'm aware of or read in any paper has said, Hey, I'm losing my hair on this stuff. We would have to report that to our ethics board because that's a substantial adverse effect.

Yeah. There's some adverse effects, but people are amazing and they will be honest. And if a male, especially if I started to lose my hair and the only thing I did was take this supplement, I would immediately tell the researcher and stop. And we would have to disclose that. I would immediately tell the researcher and stop. And we would have to disclose that. And it's never been done. So an increase in hormone, you know, the way to look at this is there's never been a study to suggest it doesn't, but there's certainly no evidence to suggest it causes hair loss. Until a study does, we have a myth as it stands right now, but I really rely on our participants. They volunteer and spend a lot of time. And I have to believe if they're willing to tell me about a headache or something, they're sure going to tell me about hair loss, male or female. So I leave it to them and I just don't see it. I mean, maybe that's something we can do in the future. We're just going to have to design a perfect study where we make sure that we isolate. Look, if you have this male pattern baldness, you're out. I want the fullest, nicest heads of hair we can get. Half of you are taking placebo, half of you are taking 20 grams a day. We're tracking you for two years and we're going to count those follicles one by one. I think you hit the nail on the head.

You've got a bunch of health conscious, potentially even image conscious people coming in and out of your lab all the time. They'd absolutely notice if their hair was thinning. I went through a period where I had some stress induced alopecia and I noticed almost immediately. And then interestingly enough, once you notice your hair is falling out, whether it's because of genetic predisposition for balding or stress, the stress of knowing your hair is falling out is making it worse.. I think that's probably the best place to jump off. We've answered pretty much every question I get and I really appreciate your time, Darren. Can you tell everybody where they can find you and your work? Yeah. If you want to reach me, probably on Instagram at Dr. Darren Candle, that's probably the easiest. You can direct message me for questions or follow me. We try to promote and put a lot of the creatine research that's coming out immediately on

there. So yeah, give me a follow. It'd be great. And thanks again for having me. Dude, man, anytime. I'm very appreciative of your time. Thank you so much for coming on. Thanks so much.