Muscle for Life with Mike Matthews - Darren Candow on the Latest Research on Creatine Supplementation

Episode Date: February 23, 2022

This podcast is all about creatine. Specifically, I'm talking with Dr. Darren Candow about common questions regarding creatine, myths, and even some of the latest research on how creatine might even benefit people who aren’t looking to gain gobs of muscle or athletes looking to recover faster. While creatine isn’t a new subject for the podcast or my content in general, Dr. Darren Candow is a fantastic guest to dive deeper on the topic. That’s because he’s studied it directly in the field. Not only is Darren a professor at the University of Regina, but his research is focused on creatine and resistance training, and he’s produced 87 peer-reviewed studies and his work has been cited thousands of times. In other words, he knows a thing or two about science and evidence-based supplementation. In our discussion, we talk about . . . Whether creatine affects balding and hair loss How supplementation affects the body’s natural production of creatine Cognitive and brain health benefits of creatine Whether kids and teens should take it Creatin and kidney health Bloating and upset stomachs Why you should probably separate your caffeine and creatine consumption And a lot more . . . So, if you’re interested in learning more about one of the most-researched and best supplements we have available for getting fitter, stronger, and healthier, don’t miss this podcast! Timestamps: 0:00 - Get my best-selling books Bigger Leaner Stronger and Thinner Leaner Stronger for just 99 cents! This week only: https://legionathletics.com/products/on-sale/ 6:21 - What is creatine and what does it do to the body? 11:29 - Does creatine cause hair loss? 19:25 - If you take creatine will your body stop producing it naturally? 21:38 - How much creatine should I take when starting out? 23:19 - Does creatine increase cognitive benefits? 28:06 -  How much protein can I absorb in one sitting? 29:48 - Can children and teenagers take creatine? 33:42 - Can you combine creatine and caffeine? 39:50 - Is creatine better to take post workout? 42:46 - Does creatine cause bloating? 45:28 - What are some myths about how men and women react differently to creatine? 46:53 - Is creatine safe for the kidneys? 48:33 - Why are there many different forms of creatine? 51:43 - What can I do if creatine upsets my stomach? 52:37 - Is it okay to take creatine with food? 53:12 - Is creatine good for endurance training? 54:01 - How does creatine help with recovery? 56:02 - What are other common questions you get about creatine? 57:40 - Where can we find your work? Mentioned on the Show: Get my best-selling books Bigger Leaner Stronger and Thinner Leaner Stronger for just 99 cents! This week only: https://legionathletics.com/products/on-sale/ Dr. Candow’s Instagram: https://www.instagram.com/dr.darrencandow/

Hello, hello, and welcome to Muscle for Life. I'm Mike Matthews. Thank you for joining me today to hear about creatine. This podcast is all about creatine because I'm talking with Dr. Darren Kandow about some of the common questions regarding creatine, some of the myths that are still in circulation, as well as some of the latest research on how creatine can benefit everyone, not just people who are looking to get more jacked. And while creatine isn't a new subject for my podcast, Dr. Darren Kandow is a fantastic guest to dive deeper on the topic and to address some of the thornier concerns that people have these days. Like for example, years ago when I got into the fitness racket, many people were asking about bloating. Does creatine make you bloated? And Darren and I talk about that in this episode,

but not so many people ask about that these days because it's not as much of an issue as it once was, or at least as it once was perceived to be by many people. But these days, there are other concerns, more serious concerns, like many guys who ask me if creatine is going to make them go bald or if it's going to accelerate their balding. And yes, Darren does talk about that in today's podcast. Parents will ask me if their kids, if their teenagers should take creatine. We talk about that. People will ask about upset stomachs because some people, they just don't do well with different forms of creatine. Why is that? And what can they do about that? Caffeine and creatine, is it detrimental to combine them? Is it detrimental to take a pre-workout that has caffeine and creatine or

to take a pre-workout and then add some creatine, maybe some just powdered monohydrate? And so those are all things that Darren and I talk about in today's episode. And in case you are not familiar with Darren, he is a professor at the University of episode. And in case you are not familiar with Darren, he is a professor at the University of Regina. And yes, I checked the pronunciation on that. That is correct. And his research has been focused on creatine and resistance training. He has produced 87 peer-reviewed studies on that, and his work has been cited thousands of times. So he knows a thing or two about the science of creatine and about evidence-based supplementation in general. Okay, listen up. If you want to learn breakthrough diet strategies

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cushions and then head over to wherever you like to buy eBooks online and pick up bigger, leaner, stronger. If you're a guy for 99 cents or thinner, leaner, stronger, if you are a gal for 99 cents. Hey, Darren, welcome to my podcast. Thank you for taking the time to do this. Yeah. Thanks for having me, Mike. It's exciting to be here. Yeah, super excited to talk about creatine. So let's get right to it. Yeah, yeah. When I got the email from you, it immediately, I thought, oh, that's a good idea. Because I've written about and I've spoken a fair amount about creatine over the years. a fair amount about creatine over the years, but it's been more, uh, just general overview. Here's what this molecule is. Here are the proven benefits. Here's why, if you are into weightlifting in particular, into resistance training, uh, it really makes sense for you to take it. And even if you're not, here are some reasons to take it. Uh, but I still get asked

quite a few questions. This is one of the supplements I get asked more frequently about. And I have touched on some of these things tangentially, but I thought this could be a great interview that it's self-serving because I'm going to now be able to send people to it as well, who are going to ask questions that we're going to be discussing. And given your background and how knowledgeable you are in creatine i thought it'd actually be more fun and more informative actually if i brought you on and gave you some of these questions and let you talk about them yeah absolutely and and it's become a multifactorial product now it used to be just for athletes and now it's basically for everybody on the planet

and for different special populations, conditions, and potentially disease treatment. So yeah, there's a lot to talk about, a lot of different areas, and it's still a very popular topic. So super excited to help us provide a bit of information and or discussion on it. information and or discussion on it. So why don't we start with a quick overview of what creatine is, what the molecule is. Many people think of it just as an amino acid. That's not exactly accurate. And maybe a brief overview of the mechanisms of action. What does it do in the body? And then for people, just to give people a little teaser, we might as well go from that right into, is creatine the reason why you lost some of your hair?

Absolutely. Good segment. Well, obviously for everybody listening or have an interest, they've heard of creatine. And creatine, interestingly enough, is not a steroid. We get that asked all the time. So creatine is naturally produced in the body through three amino acids. So arginine, glycine, and methionine in the kidneys and liver. So it's a very basic process that's required for all cellular energy to produce ATP, which is our main energy currency of the cell. So really, we're naturally producing this in the kidneys and liver primarily about two grams a day.

And then, of course, once we produce it for the exercising individuals, it just enters circulation after it leaves the liver and then is taken up primarily into our skeletal muscle. And the more creatine you have there, it just increases the energy status of the cell, i.e. being in your muscles. So when you're exercising, such as weightlifting or performing sports, it should allow you to exercise at a higher capacity or also referred to as an increase in training volume. So that's the basic one-on-one of what creatine does. And there's many other avenues, which we'll probably talk about with bone and brain, but most people take creatine or heard of it from muscle. So when you take a supplement, and this is primarily in the powder form, the creatine

monohydrate molecule, which is the most consistent, well-established form of creatine developed, it's identical to what's being produced naturally in the body. The reason we call it monohydrate, there's just a water molecule attached and that easily dissolves once it gets primarily to your stomach. So when you're taking creatine supplementation in a powder form, it's identical basically to what's being produced in the body. And so for, therefore, if you take more creatine in your diet and or supplementation and from diet, you can get this primarily in red meat and seafood. The issue is to get the amount that's shown to be effective can be difficult. And with the big push now on plant-based diets, or if you're a vegan or vegetarian, it's near

impossible to get dietary creatine. So that's why supplementation is so popular. And so just to provide an illustration to people, how much meat or fish would you have to eat to get to even the supplemental five grams a day? You know, that's the maintenance regimen. And that's an excellent question. So to get five grams or additional grams, you need to have about four salmon fillets or about two servings of red meat. That's on a daily basis. So you can see times by seven over a week. It is very daunting.

And for many ethical or financial reasons, a lot of people don't. The average container of creatine per serving is pennies per serving. So that's why a lot of people will consume the supplement. And overall- Oh, the prices have been going way up. Yes.

With all this supply chain. That's correct. And I think COVID, especially wherever the products are coming from. And so overall, creatine is still the most safest and effective ergogenic aid. It even tops caffeine when you're looking for an overall performance perspective. And there's a multifactorial array of things that it does do. But the one-on-one is it gets in the muscle, it enhances the capacity in the muscle, and that allows the muscle to do more work. So over time,

the muscles should get bigger, stronger and faster. Very minimally, would we ever see experimental research show beneficial effects from creatine without training. So the key here is that the magic of resistance training or weight-bearing exercise seems to unlock the additional boost that creatine provides. It's no different than protein and resistance training exercise. It's very different than steroids in that regard. A hundred percent. And you get enough testosterone, you have to do anything and you're just going to get bigger. Yeah. And know that's 100 correct so again it's not an anabolic steroid that's still a myth and a lot of people think just because it has some anabolic properties but no it's an organic acid naturally

produced in the body and or synthesized and consumed either in red meat seafood minimal amounts in poultry but the most common is commercially manufactured products. And from there, I know some people are wondering, well, does it shut down your own natural production? And what happens when you stop taking it? Is there a period when you have low creatine? But I think we'll get there. However, we might as well just, again, get right to what I get asked most frequently, and that is, it is still the number one question that you get asked. And even in academia, we get asked in rugby players way back in 2009. And they looked at it was a crossover design. So it was a powerful design. But they did not measure any incidence of hair follicle thinning or hair loss. of hair follicle thinning or hair loss. So the whole theory with this is that these individuals supplement with a high dose of creatine. It's 25 grams a day for a week.

And then they went on a maintenance phase. And all they did was measure creatine supplementation during their normal training for rugby. And then, of course, they measured DHT, which is an abbreviation for dihydroxy testosterone. And all that really means is testosterone is enzymatically created to DHT and DHT when it combines or influences the hair follicle can make it shrink or die. So that's where all the theory came from. And lo and behold in this study, and it was the only study to ever look at this, the individual supplementing with creatine increased DHT by 56% during the loading phase. And then it reduced down to 40% during the maintenance phase. Whereas when the same players took placebo, there was no significant increase. So everybody just concluded, well, an increase in this hormone will obviously cause a hair loss. Again, no hair

follicle thinning loss or hair patterns was measured. But if you look closely at the data, when they were on creatine, they actually started with DHT levels much lower. So the rate of change is a little deceiving. And if you have access to the paper, when they went to the maintenance phase, the elevated dose of DHT came substantially down. So all of this is showing over three weeks, the hormone went up, but again, there's no evidence to suggest that it led to hair follicle thinning or loss. It was still within the range of normal, right? If I remember correctly. That's exactly right. The range was normal. So anybody listening, you know, when you go get your, an annual physical

and you get blood work and urinalysis, they'll give you a range because there's a lot of standard deviation and things like that. Uh, but there was no mention of where the creatine came from, what type of creatine it was, their dietary patterns, things like that. Uh, were they already having, um, any increase in the hormone regulation? Cause these individuals were 18 to 19. It's never been a look at an older individuals. I can attest that I was losing my hair before I even started creatine. So it's just like the correlation and causation. So until a study is done where we actually measure hair thinning and loss over time in

both gender, male and female, and specifically at different ages, we just can't conclude. But to that point of science, we can now say there's no evidence to suggest it causes balding, but we don't have any evidence to suggest it doesn't. So as we stand right now, just like science, we need way more research. And that study surprisingly needs to be done, and it hasn't been done yet. And something else that people will ask me about that paper is if there were any effects on testosterone levels, because usually, you know, if you are, if you're going to take exogenous testosterone, DHT is going to go up, for example. Um, and so, so were there any effects to, to test out total

or free testosterone? Yeah. The total testosterone was, uh, marginally increased, but free testosterone, which is unbound was not again. So there you go. There's other factors that are affecting it. The big one that never gets any presses exercise at a high level can increase DHT naturally. And depending on the type of training they were doing, that could have been the caveat, uh, because the placebo was considered 50 grams of glucose. So we still know it was a nutrient. So again, that's where these studies need to be replicated before we can consider, but I know so many people that won't even consider creatine because they think it's going to lead to a hair loss or baldness. Yep. Or, or just maybe speed up the process a little bit. That's what people will say to me.

And it's not, it's not worth it to them is the way they look at it. And I understand that. I do understand that creatine is probably the best supplement that we have natural safe, like you said, for improving performance in the gym and just speeding up, uh, speeding up the gains a little bit, but it is still a little bit, it's a natural supplement. It's totally fine. If you leave it out, you'll still get to where you want to be. Uh, you might just get there a little bit faster with creatine. You might have a little bit more fun along the way because you're getting there a little bit faster. But, uh, so, so I understand when some people, the risk reward analysis to them, they just go, eh, even if there's only a 1% chance that I'm going to lose my hair a little bit faster with this stuff, I'd rather just leave it out.

And I do understand that. Yeah, I do as well. Absolutely. one other question again that people will ask me is mechanistically speaking what is there is there a viable hypothesis as to how creatine could lead to an increase in dht yeah the theory was that it was more the exercise stimulus that could cause some type of anabolic or hormonal regulation i mean creatine has been shown to influence insulin-like growth factor, myostat, and some of the other endocrine markers. But this, again, it was just a short-term study, but it was more of a hormonal regulation. And it just so happened that during the creatine session, it went up.

But again, to your point, it was in normal physiological range. So it's total speculation. So it's total speculation. And if I hear you correctly, then this is a type of effect that has been seen in other studies involving intense exercise. Yeah, that's correct. Exercise training can naturally increase as well. And the authors elegantly even stated that in the paper. But just like that gets lost too late.

That's right. The alarm bells are already going. That's right. Yeah, it is funny. So if the viewers can actually read the paper, there's a lot of interesting information in there about how exercise can actually play a role in this as well. Okay, cool. So I think that's all that can be said at this point.

And so again, anybody listening, if, if you're not taking creatine because you have, uh, maybe male pattern baldness in the family or, or your, your, your hairline is receding and you don't want to take the risk, it's understandable. Um, but, but Darren, would you say it's fair to say that, uh, I guess you already said it. There's certainly no evidence that it is going to cause hair loss. Would you say that there isn't strong evidence to say that it's going to have any effect one way or another on your hair? But we can't say for certain. And unfortunately, this paper has raised a question that it has more raised a question than provided an answer.

That's correct. It's raised a total speculation and multiple studies that have to be replicated had to be done. And again, there's the evidence right now saying it doesn't show that it does, and it doesn't show that it doesn't until we do that. Yeah. Okay. All right, cool. So why don't we now talk about this natural production point that I mentioned previously, which is a natural kind of this natural production point that I mentioned previously, which is a natural kind of follow-up question that I get when, when people learn, oh, my body produces creatine and now I'm swallowing it. So does that shut my, and this kind of goes with the, the thinking of it, like a steroid kind of mindset, right? Where they, it's the idea that um if if you take this stuff and and you add it to your natural

production your body's gonna go whoa whoa this is too much creatine let's shut down the natural production and then what happens if you stop taking it are you supposed to cycle it all these things go together yeah so there was some minimal evidence way back in the early 2000s that showed that high dose creatine, such as a long-term loading phase, can decrease your natural or endogenous production. But as soon as you stop ingesting it, it immediately comes back. So that's got the question of should I cycle creatine because of that myth as well. And the totality of evidence suggests that creatine ingestion, if it does decrease your endogenous production, it's not to any significant level where it's going to have any adverse

effects. As soon as you stop high dose, your body will naturally compensate for that as well. And that's led to- And of course, you wouldn't take a high dose. I mean, I generally don't recommend loading because it's not necessary. And I just know hearing from people over the years, it can cause upset stomachs and why, you know, so I don't even recommend it. I tell people, I guess if you, if you want to get it into your system quickly, sure,

but you don't have to load it. Yeah. And that's an excellent point. The loading phase is probably for the athlete that's short-term big event coming up. Um, and, but you're right, we see a typical increase in mass, and that probably could be some water retention, about one to three kilograms during that first loading phase. And so in our lab, we typically do a relative dosage or a lower dosage.

The population we see that might get some extra benefit from the loading is older adults. That could be because their muscles are shrinking from a type two muscle fiber size, or they're not consuming a lot of red meat. But for the average young individual, there's no evidence to suggest that you need the key where there's need to create a load. You can take a low dose and it will accumulate the muscle in as little as four weeks. And in the case of an older a, of an older adult, uh, so how would that loading phase, would it, how would that work? Cause what it's normally no more than two weeks, right? It's normally a one to two week, or are you looking at it over a longer? And then what

would be the benefit? Let's say, let's just take, take somebody they're middle-aged, maybe even golden aged, right. And they're starting creatine scenario A would be, they just take five grams a day and they let it accumulate at that rate versus the 20 to 25 grams a day. And for how long? Yeah, exactly. So typically if we do the loading phase, it's about 20 grams a day for about five or seven days. In young individuals, you start excreting that creatine after about two or three days. So we think the muscle can be saturated pretty quickly, depending on your habitual diet. If you're a red meat eater, you're probably going to have a lot of creatine naturally. And so you might not need as much whereas vegans or vegetarians would need a lot. But with aging,

we see a huge reduction in meat consumption. We see a decrease in activity levels at high intensity. And then the other big one is a decrease in type two muscle fibers. So the loading phase may be something to consider for an older adult. And we consider this maybe in their 50s, 60s, and so on, to give them a more rapid boost to hopefully engage and continue to perform resistance training. But for the younger individuals, three grams a day for as little as a month has been shown to saturate your muscle. So again, not a lot is needed because you're naturally producing about two grams a day. So if your listeners ever wonder where this five grams seems to come from, it's two grams is about naturally produced and the lowest dose ever been shown to be effective is three grams in addition. So taking five grams a day seems to be a very

viable strategy from a muscle perspective. That's not the case when we get the brain or bone. And that's a perfect segue because my next question is regarding brain cognitive benefits. That's something that has been getting more airtime, more talk recently, and I've been getting asked about. Yeah, it's probably the most emerging area. We actually just submitted a paper today. There was about nine of us that have looked at all the potential effects on brain health. And overall, creatine supplementation can definitely increase brain creatine content. However, the dose seems to be a little bit higher or speculation. It might be needed to be higher for two reasons.

The muscle does not synthesize creatine. So therefore, it could probably uptake all the supplement, whereas the brain does. And the blood brain is a little resistant to supplementation. So you may need more coming in to get enough into that resistant tissue. But that subsequently has been shown to have some beneficial effects on decreasing symptoms of sleep deprivation, depression, PTSD, and anxiety, which is hugely important. And we're thinking of putting a paper together now about the potential adverse effects of COVID, isolation, lockdowns, muscle loss, and all the mental health issues. Creatine has shown some promise for neurodegenerative diseases, such as Parkinson's and Huntington's, but the research is limited and very equivocal.

Sometimes it doesn't show any effect. But the main area we see uh probably the biggest upswing upswing and benefits is concussion and mild traumatic brain injury so these are areas that is showing some phenomenal promise uh and i would say the next 10 years will the majority of clinical trials will be on indices of the neck up uh which is hugely important so for those taking creatine and you know if you like it for muscle mass and performance, lo and behold, you're probably getting a lot of cognitive and brain health benefits, which is enormously potential. And what's the dosing like for that? Because now people are wondering, well, you know, a lot of people listening, they take five grams a day.

Is that enough to get any of those benefits? And if they were to go to more than that, would they, even if they wouldn't necessarily notice it, is it likely or is there evidence of further efficacy? Yeah. So the acute studies have shown that the loading phase plus a maintenance phase of about five grams or so can have some beneficial effects. There's only a few studies that have not done the loading phase and just went with a five gram dose. Um, but it seems that a higher dose, maybe five grams or more for a longer period of time. So I think this is a caveat. If the average individual is

taking creatine for health benefits, part of their training program, and they're like, Hey, I'm going to take this for multiple months or years. They have nothing to worry about. Eventually, it's going to accumulate in the brain. But if an athlete says, I'm just taking creatine for two weeks, they probably won't get the effect. So this really seems to have promise for individuals saying creatine is part of my daily strategy, just like protein and carbohydrates. If they're willing to consider creatine in their diet and or supplementation, this probably will accumulate over time. We do see the greater benefits at a higher dose. And this is where the theory that maybe 10 grams a day for concussion, mild traumatic brain injury could be beneficial. I'm not 100% sold on having a low dose on a daily basis. I'm not seeing any

evidence from all the research that a higher dose is detrimental. And so kind of like you've heard with protein anabolic resistance, we need more protein as we get older. I think a theory is that maybe more protein could be beneficial because now we know it's not just used for muscle. It's used for your bone density, brain health, and probably other areas. So the five grams a day is great for muscle performance, but if you're trying to get a holistic approach, more is potentially better and we're not seeing any negative effects. So again, that's something that we need to do a dosing strategy. But in my opinion, I'm seeing a bit better evidence at higher dosages for cognition and brain health. And that would apply to all age ranges?

higher dosages for cognition and brain health. And that would apply to all age ranges? That would as well. So you can take five grams a day or the ones we use in our lab is 0.1 gram per kilogram. So that keeps it equivalent for everybody, very similar to protein or caffeine. So if you're 70 kilograms, that's seven grams a day. If you're 50 kilograms, it's five grams a day. The theory though, is that the larger you are with more muscle mass, you're going to have these more creatine doorways or transporters into the muscle. So the theory is that if a larger individual, just like 250 pounds playing professional sports, they're probably going to need more creatine on a daily basis or have the ability to take it into the muscle. And that's where you hear about the differences in creatine uptake is no different

than caffeine, small coffee versus extra large. Right. Or even similar to protein absorption, something totally separate subject, but something people will ask me about for everybody listening quickly is the question normally is, Hey, how much protein can I absorb in one sitting? And, um, this has been touched on in different ways in research that I've seen, but I think it's fair to say that a very large individual can eat more protein and, and, and, uh, effectively process more protein in one sitting. Maybe it's a hundred grams plus for the 250 pound linebacker in the NFL.

And maybe it's less than that for my wife who weighs a hundred pounds and has some muscle because she rides horses, but she, she's not yet, not a bodybuilder. Yeah. That makes sense. I mean, we could talk to her blue in her face with the protein, the 20 grams, how much you digest and absorb, but you're totally right. And the analogy is the same. Um, you know, the more training you are, uh, of course, Stu Phillips put up the meta-analysis with protein, you know, 2.2 grams per kilogram seems to be the upper threshold, but even Stu will tell you know 2.2 grams per kilogram seems to be the upper threshold but even stew will tell you about 1.2 to 1.6 is probably about the most we can use

from a muscle protein perspective but again protein is used for everything in the body so maybe having more is is not a bad idea yeah and then there are the other benefits like satiety you know that helps a lot of people just being full so they can better control their, their calories. That's a hundred percent right. Yeah. If you like what I'm doing here on the podcast and elsewhere, definitely check out my sports nutrition company Legion, which thanks to the support of many people like you is the leading brand of all natural sports supplements in the world. So what about children? And this is something I get asked about.

Teenagers in particular, because parents will usually reach out. Sometimes it's the teens themselves, but usually it's parents whose teenaged kids are now getting into weightlifting. Of course, they hear about creatine and they're all excited about it. And sometimes I get asked also for even younger, usually it's kids playing sports, they could be 10, 11, 12. What are your thoughts? Yeah. So it's obviously a cautionary area and we can even talk about pregnancy, but there was a number of us that looked at special issue in Nutrients Journal this year. we looked at all facets. And Andrew from the United States is probably one of the world's leader on creatine and children. And

he's done some really nice review articles looking at all the articles and research. And to this day, creatine can definitely have some beneficial effects on improving some indices of muscle and bone and coordination, even in disease state children, such as boys with muscular dystrophy. And when you look at all the data, there's no adverse effects. And so a lot of people say, hey, can my children or a child take creatine? I say, absolutely. There's not a person on the planet that can't.

And I say, the reason is endogenously or naturally produced in the body. And so since we're taking something in naturally, protein or creatine, there's no difference. Your body's going to adapt to it. Now, if it was a pharmaceutical, that would be different or an anabolic hormone. But yeah, you take creatine into the body at a normal recommended safe dosage. And right now, as it currently stands, we're seeing no reason a child or adolescent cannot take creatine. If anything, it may have some potential protective or neuroprotective effects for brain development and muscle skeletal as well. So as it stands right now, the research or evidence-based research suggests it's very beneficial with no adverse effects to the state.

And also something nice about creatine is there are a lot of third-party tested and validated sources. There are a lot of reputable companies that sell it. If all you want is creatine monohydrate, Now Foods, for example, is one of these brands that has stood the test of time. Whereas with many other supplements, you don't necessarily know what you're getting actually. And so I always tell parents that let um, to, to, to let, let's not get too much in, let's not be shoving too many pills and powders into, into our kids. And let's just focus on, you know, exercise activity, make it fun, eating good food. And there's an asterisk there and creatine, I think fits into that, but there aren't too

many that, uh, getting, getting so so omega three fatty acids is smart as well. I think there are a few things that it makes sense with kids and or even even a well-formulated children's multivitamin. Yes. If it's a gummy like I give one to my kids and there are a few things that make sense. But I've just heard from parents over the years, I think, who are a little bit too enthusiastic, even about my stuff. You know, we're again, it's like your kid doesn't, they don't need to be swallowing like handfuls of pills. I think, you know, I always say supplements and there's only about four or five that actually kind of work or basically the sprinkles or icing on the cake,

but especially in children's sleep, proper nutrition, hydration, um, all that comes first supplements are going to be near the bottom and typically uh most that are purported to work from a health standpoint only work if they're in deficiency there's only a handful that are from an ergogenic perspective but there's a lot of other things for children development and the average individual that should be looked at first if you don't have adequate sleep you can take every supplement as much coffee as you want until you're blue in the face and you'll never train at the optimal level so um there's a lot of other things unfortunately everything just gets worse and worse and worse you can't you can't get around it i wish it were not

that way i know that's the greatest supplement uh there it is uh sleep if you're not getting enough that's for for sure. You mentioned, you mentioned caffeine. How about that? There's the, the question about combining creatine with caffeine because some pre-workouts, for example, have creatine and caffeine or, okay, I had some, I had some caffeine before I trained. Do I need to wait a X number of hours before I take my creatine? That's right behind baldness. This one is right up there. So I'll try to do justice to the small body, body of nature. There's been a handful of studies that have looked at acute creatine ingestion or sorry, acute caffeine ingestion during a creatine load.

So if you take 20 grams a day of creatine, and then all of a sudden on the last day, before you're going to do a time trial cycling or whichever it is, you take a bolus of caffeine, about 300 milligrams or a large coffee that seems to have no interference effect. In other words, caffeine seems to bolster performance and, or doesn't have any negative effect. I don't know who that would be applicable to maybe an Olympic athlete or someone training for a specific task. Where it gets a little gray is that when you look at the studies that did creatine loading and chronic caffeine ingestion during it. So for example, three or more days of caffeine ingestion where the cat or coffee or caffeine was mixed with creatine, that seems to have the interference effect, and they seem to oppose each other at a part of the cell so that's where a lot of people say geez maybe you should spread it out

again all those studies were acute where they did one type of exercise task in the in the lab so we were fortunate to publish the only paper this year where we looked at caffeine and creatine combined and now the caffeine was the powder, during a weight training program for six weeks. The sample size was low, but what it did show is that the group who took caffeine and creatine together on a daily basis for six weeks did not perform nearly as well from a muscle growth perspective as those on creatine alone. So that indirectly suggests that if you combine the two during a long-term program, they may blunt each other. So we didn't measure any. Is it, is it, is it blunting each other or, or is the hypothesis that it's, it's the caffeine blunting the creatine, but.

Yeah, they seem to play tug of war. It's something called the sarcoplasmic reticulum. Caffeine likes to release calcium calcium which is required for muscle contraction and creatine likes to take it up immediately so they kind of interfere with each other so that was the theory we didn't measure that and it was a small case study but it did show that the creatine group increased muscle thickness in the quadricep but the creatine and caffeine group did not. So it's speculating. And although it's minimal, the most general recommendation is to try to spread it out. If you can take your caffeine within 60 minutes before creatine after now, an important distinction is what about in pre-workouts? The vast majority of pre-workouts will have caffeine and creatine,

but keep in mind. This, by the way, is why I did not put creatine in mine. This was years ago when the evidence was even more tenuous than it is now. But I figured, why risk it, so to speak, when people are also accustomed to having creatine in a post-workout meal or supplement or setting. And I would, I would rather not have to come back and eat crow and take it out when, when more evidence comes out, when I felt like I could just avoid this and, and make customers happy that people aren't demanding it to be in the pre-workout. And I totally agree to that point. Like caffeine is immediate stimulant within 60 minutes to sort of peaks in the blood. Whereas creatine takes a few hours to maximize.

So in theory, it makes sense to take caffeine pre-exercise and potentially creatine hours before exercise or more specifically, probably post-exercise seems to be an important factor because exercise blood flow seems to turn on those transporters to allow creatine in the body. So I recommend basically the easy strategy, pre-exercise caffeine, post-exercise creatine. But in a lot of those pre-workouts, there's going to be a totality of other compounds in there that we don't know if they have some synergistic effect. Like maybe if one had nitrates and branched chain amino acids and all these other things, maybe some cancel each other out. So again, until more research is done specifically on the mechanisms, I don't know if I would recommend combining the two, but in those limited studies,

they seem to interfere with each other. Yeah. That, that point of synergistic effects or counterbalancing effects or countervailing effects is something that Curtis, who has headed up research and development for, I mean, really since the beginning. And then, and then now we have more people who work with him on that, but that's something that they were always very cognizant of and trying to avoid things even even if it wasn't concrete it wasn't something that had had enough evidence to say this is a thing or we think this is very likely a thing we try to avoid that really in all of our products as much as possible because i mean especially in the case of a pre-workout or anything, just the kitchen sink approach, it makes for a nice label and it can make for some nice marketing

claims, but it would be unfortunate and it would be dishonest too if the company knew, or at least if they never even looked into it and They're like, ah, just throw everything in there. Who cares? It'll just sound good. And I never liked that approach. Yeah, and I agree. And the other big thing is, based on the acidic profile, a lot of GI tract reports come up when you combine caffeine and creatine.

And that was something that a lot of people said, I probably wouldn't mix them the two. So I said, hey, spread them out. You're going to get the benefits of both. If there is a chance they interfere with each other, the longer you spread them out. You're going to get the benefits of both. If there is a chance they interfere with each other, the longer you spread them out, the greater you'll get the benefits of both. And you mentioned about taking creatine after a workout, also a common question. For some time, it was generally believed or accepted that post-workout with some food, ideally some carbohydrate, that's ideal. And then more recently, at least in the evidence-based fitness space, more people are

saying, eh, it probably doesn't really matter. What are your thoughts? Yeah, as it stands right now, we've done probably the majority of the timing. The timing is probably irrelevant when it comes to creatine, no different than probably protein. Um, but the nice thing is adding in creatine post-workout. And even if you decide to, Hey, I'm going to take it before or during your workout session of the timing doesn't seem to matter that much because it's an accumulating metabolite. Um, but there is some evidence to suggest that by doing muscle contractions in the weight room or on the court whatever it is the blood flow to the muscles seem to act as a vehicle to allow the

creatine to get in the muscle and so it can open those transporters so post-exercise creatine to me is a very viable and easy strategy to consume post-exercise can be probably anywhere before your training or after your training program until you go to bed. There is evidence though around close proximity to exercise is a very viable and beneficial effect compared to morning and evening. But again, the timing is not nearly as crucial, just like protein. We now know you can consume protein throughout the day. And as long as you hit your total daily amount, you're probably going to achieve those benefits. And as far as post-exercise or not, total absorption, I'm assuming doesn't change either way.

I mean, even with this priming effect, so to speak. Yeah, that's right. Because some people, that's what they'll hear is like, oh, so I'm going to absorb it better if I take it after I train, you know? Yeah, no. Once, I mean, creatine is about 99, if not a hundred percent bioavailable. So it'll still get into the blood stream and then take it up to the muscle for your next subsequent exercise bout. And then it takes a while to accumulate. So again, they have the luxury. They don't have to have the blender in

the weight room and go right after they can go home and enjoy a meal and consume it. But to your point, there is good evidence. Or the water water jug the pink water jug so exercise contractions will increase creatine uptake uh but creatine combined with carbohydrate will as well uh but for those who do not want to consume carbohydrates or simple refined carbohydrates that's fine exercise and it will get in the muscle to a significant degree over time. So, um, it's pretty easy strategy. There's not a lot of complications to it. Yeah. Yeah. For, for me, it's just a matter of, um, remembering to take it and it's, it's easy to just stack it with something else, you know, and for a lot of people that's after they work out, it's just a thing. Then they take their

creatine, they eat some food and they move on with their day. So they don't forget. Yep. I agree. I agree. What about bloating? That's another question I get if I, and particularly from women, um, who, uh, let's say these, let's say the question is, this is for people who have not taken creatine. Um, so they haven't experienced bloating, but they want to know, is it going to make them bloated? They hear that, Oh, well, it just, it just increases water weight and that doesn't sound good. Yeah. So the totality of evidence, a couple of things, creatine does not increase even total body water, but it can increase water in the muscle. And that's how we think it unlocks all its potential. So sometimes individuals taking creatine at the

beginning stages, typically within the first 10 days, may experience an increase in mass and or have a bit of bloating. But that's kind of creatine working to take water from the bloodstream into the muscle. And that's typically why individuals gain size. To limit that substantially, do not do the loading phase. The loading phase is typically where we see a huge increase in bloat or GI tract irritation. You can start as little as three grams a day or increase it however you like. That will substantially decrease the amount of water retention during the acute stages. And then once you're over, let's say you're past four weeks or so, and so you've probably reached um reached saturation at that point right and and going from that point forward i mean if you if somebody did what you just said they

probably shouldn't notice anything negative in the way of bloating um and then from there on out it's just again the five grams a day yeah or you could even reduce it to three grams a day if they're on an omnivore diet so if you're still producing about two grams a day and you're consuming the odd serving of red meat or seafood a week, you could reduce that as little as three grams a day, which is probably about half a teaspoon. You're not going to notice it. And that substantially reduces it. You can go higher. But after about 10 days, if you did feel any water retention, it usually your body adapts and you subside that over time. And that also then would apply to a higher dose. Let's say someone is thinking with just based on what you had shared regarding brain benefits. They're like, I'm going to I take five grams a day. I'm going to go up to eight to 10 grams a day. Actually, I'm a bigger guy, you know.

And so what I would suggest there is do it multiple times a day. I'm going to go up to eight to 10 grams a day. Actually, I'm a bigger guy, you know? And so what I would suggest there is do it multiple times a day. Maybe you have a little sprinkle breakfast, lunch, dinner. Uh, the more times you divide it up into smaller dosages, the body will obviously absorb it all, but it probably more palatable. And maybe it's just something you do say, Hey, every time I eat, I put a one third of a teaspoon on and I don't even notice it and it will accumulate and you'll get the effects. That makes sense. Can you talk to us about some of the myths regarding how men and women react to creatine? I know there are some ideas floating around out there that men and women react differently to it. And it's usually people are thinking it's more for men, not for women.

Yep. So both males and females respond very favorably to creating supplementation across the entire age spectrum. There is some evidence to suggest that males get a better response overall. And when we look at the data, we see that females for some reason may be less responsive for two, uh, uh, hypothesis or purposes. One is that they may have higher amounts of creatine in the muscle because their muscles are smaller. So then they might not respond as well to a supplement because it's already fuller, uh, sort of higher concentration, But more specifically, we see the females for some reason, creatine doesn't break down something called muscle protein breakdown in females nearly as well as males. And we think that estrogen could be involved there.

So overall, both males and females respond very favorably from a bone perspective and muscle, but males seem to respond overall a little bit better only specifically based on muscle protein breakdown. Okay. And what about the kidneys and safety? Yeah. So again, a huge question, very similar to high protein diets in my kidneys, and both are emphatically a myth. If, if anything, creatine is an essential nutrient for people on dialysis or some kidney issues. And so of course people have said, Oh, my doctor said, don't take, um, creatine because I had a high or even don't eat a high protein diet. I still get people because they go get some blood work and then creatinine levels are high. And

they don't understand that you should expect that with a weightlifter who's on a high protein diet and supplementing with creatinine. Yeah. So very basically your kidneys are there to clear creatine from the body or specifically something called creatinine. So when creatine goes into your muscles and you're working out, it's breaking down to a by-product called creatinine and it leaves your muscle, enters your bloodstream, and then your kidneys are responsible for filtering it. So sometimes when you go to your doctor and get blood work and they say, oh, wow, you have high creatinine levels. That must mean you have poor kidneys. No, that could mean you're on a high red meat or seafood diet.

You're taking creatine supplements or you've actually just worked out. So it's a proxy marker. But when you look at all the evidence, there's no detrimental effect of creatine supplementation on kidney or liver function at recommended dosages and for continuous over years of supplementation. So just like protein, it's a complete myth. Even in individuals with pre-existing kidney abnormalities, it doesn't expand or accelerate any of the indices there. So based on the totality of evidence, it's a myth for sure. And what about forms? There are many different types of forms of creatine.

And what's going on there? Is it mostly marketing? This is what I get asked. People, I understand that they're always looking for what's new and exciting and creatine monohydrate is neither new nor exciting. And, but, you know, supplement company XYZ says that, ooh, this new form, this has special benefits. And I think the claims, I don't even pay too much attention, but I think they generally revolve around absorption. And bottom line is you're going to get bigger benefits from this special form.

Yeah, no, I totally agree with you. I recently talked to Eric Helms about this. It's funny. You take something that's good, try it and test it. People say, we got to make it better. And I'm like, okay okay so let's backtrack creatine is about 100 if not 99 bioavailable that means whatever you ingest monohydrate goes through your gi tract gets into the blood and this is the key gets transported into your muscle

and so people say well we need to make it bigger stronger and, and better. And I'm like, you can't make 100% better, but let's try. So there's been, oh my God, creatine, hydrochloride is out now. And there's a lot of press there and then rhodes and mice. Is that a thing again? I mean, HCL was a thing. I remember, oh, I must've been 21 or 22 when the first HCL that I saw came out. And I remember they probably sold a lot of it. There was a lot of hoopla.

It's number one right now of the new type and price. And so there's creatine. So after we can go on, but there's all these purported, this is important. All the purported forms of creatine have never, ever been shown to be consistent and effective when it comes to a performance perspective like monohydrate. So this is important. Just because a form of creatine gets in the blood better, that does not mean it gets into the muscle and leads to performance better. Nothing has come close or even comparable to monohydrate from a performance perspective.

There is some reports of some forms of creatine and it has to have the creatine molecule and it might have something attached to it, but it has to have the creatine molecule to get in the bloodstream, then being taken into the muscle through a specific transporter. So just because you might get a form of creatine that gets into the blood better, and it could be increased in the muscles similarly to monohydrate and mice or rodents we need to see this repeatedly done uh in skeletal muscle my opinion and but you already said the uptake is already 99 i mean i know i know so what so my my record so i mean that's why the marketing they're focusing on it's it's just it's sleight of hand.

Yes, it is. Instead of on the bottom line, what are we trying to accomplish? Which, as you said, is already happening about as good as it possibly can happen with monohydrate. Please stay with monohydrate for the consistent proven benefits. Now, what if somebody gets an upset stomach? I do get people who reach out and they would like to supplement with creatine, but it does upset their stomach consistently. And that's with a basic monohydrate product. Is there anything they can do? Yeah. So the most effective strategy we've used is reduce the dosage per serving,

but increase the quantity throughout the day. So let's say if they're taking five grams a day, maybe knock that down to about two and a half twice a day, or even, you know, you can, if you want a gram every five times a day, but reduce the amount per serving. I usually recommend to mix it with food, therefore it's easily digested. And that seems to be a really viable strategy when research participants say, Hey, yeah, it went away. I'm good to go. Uh, that's probably the most effective practical situation. And, and that also answers another question is, is it okay to take with food? Is it better to take with food? Do I need to take it on an empty stomach? Um, yeah, as long as it's bioavailability, it goes with its own pathways and that's fine as well. Yeah.

Yeah, as long as it's bioavailability, it goes with its own pathways and that's fine as well. Yeah. If anything, food might enhance its absorption because of the carbohydrate, although high fat intake may have some detrimental effects with GI tract. But a lot of people will consume creatine in water, even though it's not as soluble as a lot of people think, but by adding it to food is fine as well. Yeah. It's obnoxiously insoluble. Even micronized. It's pretty annoying actually. Right. And what about endurance athletes? I'll get people asking who, maybe they do some resistance training, but that's not really their focus. They're more into endurance training. Yeah. So a lot of accumulating evidence suggests that anybody involved in high intensity anaerobic sports or intermittent, such as basketball and football

and things like that, it can have beneficial effects. A hundred percent, even lower, lower intensity aerobic sports are starting to see some benefits on recovery. So for example, marathon or triathlon post exercise, it seems to decrease some inflammatory markers. Um, so it seems to have some promise either from a performance benefit or more specifically from a recovery period seems to have some beneficial effects for a lot of sports. And mechanistically, if you wouldn't mind just sharing a quick, um, quick breakdown of how does it help with recovery? People will ask me that. They'll understand how it, just with ATP and the, okay, I guess I can see how that can improve performance, but why does it also help me

recover less muscle soreness? Yeah. So some of the strongest evidence with creatine is based on its recovery properties. So it's considered now to have some anti-inflammatory effects. A lot of people will take an Advil or something, but creatine seems to decrease something called a reactive oxidative species. It seems to increase mitochondrial function, which is basically our powerhouse of the cell. But it also really has a positive effect on decreasing proteins called cytokines, which are highly increased during exercise and during times of metabolic stress. which are highly increased during exercise and during times of metabolic stress. So creatine seems to have this anti-inflammatory or anti-catabolic property to allow the body to recover faster.

And then, of course, that could lead into more repetitive training sessions or at a higher intensity. And this is the follow-up question that some of the more educated people will ask me is we'll say, well, but inflammation is some, I mean, inflammation can be good. This is, this is part of what we are trying to accomplish, uh, in the gym. And for example, there's evidence that if I were to take anti-inflammatory drugs after I train and I did that consistently, it'll probably get in the way of my progress to some degree. Will creatine have a similar effect? Yeah. Well, the cool thing with creatine, it's anabolic and anti-catabolic. So it decreases the non-anabolic environment for muscle growth. And then of course it can have the positive effects, but it doesn't jeopardize the natural inflammatory response to jeopardize recovery.

If anything, it just allows it to recover faster. And therefore you can actually get back in the training room over time. It's kind of like protein. It decreases protein breakdown, increases synthesis. So you combine the two and get the synergistic effect. Makes sense. Well, that was all of my questions. Are there any other questions that you get commonly asked that we haven't covered?

I tried to make, I tried with one of the guys who works with me on the podcast. We were like, all right, let's come up with all the questions. Let's make this the definitive Q&A for creatine as of January 25th, 2022. Yeah, the other big one is when we consider we took it, consider aging individuals or people, you know, prone to osteoporosis or sarcopenia or frailty, it's having a lot of promise there in combination with, with exercise. Um, but again, it's something you can get through your diet or through supplementation. Um, but the, the benefits are substantially outweighing any potential adverse effects and we're just not seeing it. So overall, it seems to be a lifelong or overall, uh, product that a lot of people that can take,

or at least consider, uh, from that standpoint. Yeah. Yeah. I mean, it really is, uh, one of, one of the few supplements that everyone can, can benefit from in one way or another, you almost could class it. It's not as essential, of course, as an omega-3 fatty acid or a vitamin D. But it probably deserves similar status in terms of, hey, if you have the budget and if you have the inclination, you don't need supplements. But if you're willing to spend some money on these things, this one should be toward the top of the list for everybody, regardless of what they're doing, right? That's right. 100% correct.

Awesome. Well, thanks again for taking the time to do this. It was very informative. And if people want to check out your work, where should they go? How do they find some of the research you've published? Is there anything else that they should know about? Yeah. I mean, for all our articles, you can just go to PubMed and search creatine monohydrate, or if you want to follow me on Instagram at Dr. Darren Kando, I usually post a whole bunch of our most cutting edge research that way. So yeah, that's probably the easiest ways to go. And thanks again for having me. It was fantastic. Yeah, absolutely. Well, I hope you liked this episode. I hope you found it helpful. And if you did,

subscribe to the show because it makes sure that you don't miss new episodes. And it also helps me because it increases the rankings of the show a little bit, which of course then makes it a little bit more easily found by other people who may like it just as much as you. And if you didn't like something about this episode or about the show in general, or if you have ideas or suggestions or just feedback to share, shoot me an email, mike at muscleforlife.com, muscleforlife.com, and let me know what I could do better or just what your thoughts are about maybe what you'd like to see me do in the future. I read everything myself. I'm always looking for new ideas and constructive feedback. So thanks again for listening to this episode, and I hope to hear from you soon.