WHOOP Podcast - The Creatine Craze: Benefits and Myths of Creatine with Dr. Darren Candow

Episode Date: December 20, 2023

On this week’s episode, WHOOP VP of Performance Science, Principal Scientist, Kristen Holmes is joined by Dr. Darren Candow. Darren is the Professor and Director of the Aging Muscle and Bone Health Laboratory in the Faculty of Kinesiology and Health Studies at the University of Regina, Canada. Kristen and Darren will discuss creatine’s surge in popularity (3:00), creatine’s role within the body (4:48), the best ways to produce creatine (5:56), the benefits of creatine (8:16), the safety aspect of creatine (19:25), kids using creatine (21:15), benefits for the brain and sleep (23:42), bone health (33:00), topical creatine and anti-aging (36:54), the biggest myths about creatine (40:30), if the timing of creatine matters (43:37), and what Darren is obsessing over (47:14).Resources:Dr. Darren's Instagram January Jumpstart Sign UpSupport the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

What's up, folks? Welcome back, Whoop podcast. We sit down with the best of the best, athletes, researcher, scientists, more, learn what the best in the world are doing to perform at their peak. I'm your host, Will Ahmed, founder and CEO of Whoop. We're on a mission to unlock human performance. Before we dive in today, I want to highlight our upcoming January jumpstart challenge. Through this in-app challenge, our members can kick off.

the new year by focusing on their health and fitness goals, sign up before December 28th, and the challenge begins on January 1st. This week's episode, our Fearless WOOP VP of Performance Science, our principal scientist, Kristen Holmes, is joined by Dr. Darren Kandau. Darren is professor and director of the aging muscle and bone health laboratory in the faculty of kineshesiology and health studies at the University of Regina Canada. In addition, Dr. Kandau serves on the editorial review boards for the Journal of the International Society of Sports Nutrition, Advanced Exercise and Health Sciences.

He has published over 125 peer-reviewed journal manuscripts. Kristen and Darren discuss creatine's role within the body, the best ways to get creatine both naturally and through supplements, the benefits of taking creatine. He touches on how it can help neurological function as well as sleep, how creatine can impact bone health and aging, some of the biggest myths around creatine. It's not a steroid and anyone can take it. And some of the creatine research, Darren, is obsessing over. If you have a question was answered on the podcast, email us, podcastooop.com. Call us 508-443-4952. Without further ado, here are Kristen Holmes and Dr. Darren Kandau. Dr. Kandau, welcome. Thank you for having me.

I'm so pumped for you to give us a rundown of all the ways. Literally every human on the planet can benefit from creatine monohydrate. You are just one of the leading experts, and we're just super grateful for the opportunity to talk to you. You know, we have a lot of members and a lot of folks who listen to this podcast are interesting and optimizing their health and performance and, you know, paying down injury and illness burden. And it sounds like, you know, creatine is just such an, you know, an important supplement that has really proven to help folks. So you can't wait to hear you break all of that down for us. I'm going to start with a quick stat that I want you to react to.

So on the Woot Platform, our members can track various behaviors. So anything from, you know, reproductive health to supplements to, you know, light viewing and kind of circadian behaviors. And so they can track all sorts of things. So one of the things that we've seen the biggest uptick is in, in fact, an 118% increase in general tracking has been creatine. So I'm just wondering, you know, Why is there this kind of surge in popularity? It's an interesting finding. I probably wouldn't have expected that.

I think probably because what's old is new again. In the late 1990s, even in the early 2000s, we kind of already knew what Creeteen did primarily for young males. It seemed to make individuals bigger, stronger, faster. And that was great for the athletes and the high performance exercising individuals. But there's a lot of other people on the planet that are not elite athletes or structured exercise individuals on teams. They like to exercise or get up each day for the health benefits.

And then sure enough, we started to see some new evidence that creatine may have some potential benefits for bone, primarily females, which has massive implications potentially for young females, but then you look at postmenopausal females. And then, of course, the big area push right now is the neck up. We're starting to see some emergence on anxiety, depression, potentially. for concussion? What about sleep deprivation? We're not getting enough sleep and and great teens sort of rescue that. So I think that's the emergence. It's sort of hit everybody can consider this instead of just the athletes. And I think that's why it's

probably been a big uptake. And hopefully the other big thing is we're getting more evidence based research out there to the public. It's not just our opinion. It's actually doing a lot of hours in the lab, as you know, and we're producing viable and reliable research to that. Yeah. I love it. You've been certainly leading the way. And I want to dig into the brain health and the, you know, just the concussion research with children is just fascinating and just the most recently published paper on postmenopausal. We'll dig in sleep deprivation. So before we kind of get into all that, why don't you just give us a rundown of just creatine's role and purpose within the body just to give everyone a little bit of a framework? Yeah, its main role is based on high energy metabolism. So it helps maintain adenosine triphosphate or ATP, which is an ourselves. But the theory is if you have more ATP during exercise, you may be able to perform greater training volume. So maybe more repetition, sets, or recovery. So all those pioneering studies simply showed more creatine in the muscle led to an improvement in exercise or sport performance. And that has applications for a lot of individuals now when we look at older adults,

losing muscle mass, losing bone mass. What about the young children and young females, especially for bone density? So the theory there was from a high energy. standpoint, creatine could just maybe give more energy to the cell. But then it's sort of really exploded looking at other mechanisms of how it may improve muscle mass, strength, and those other capacities. So it went from an energy status to now having about 10 to about 12 purported mechanistic steps of why the muscle may grow and or why you may get an increase in strength, endurance, recovery, so on and so forth. What are some of the best natural ways to get creed treats. And so maybe we start there. Yeah. So the best natural way is how you're actually

producing it right now in the liver and the brain. We produce about one to three grams. So for the vegans and vegetarians out there, that's a minimal amount that's been shown to be still effective to the human physiology aspects. But from a dietary perspective, it gets a bit more tricky. The highest concentrations are in animal based flesh or meat. So red meat, seafood, and some of the poultry lines. Minimal amount in dairy. and minimal amount if any in other traces such as vegetables so if you're an omnivore or a carnivore you're probably getting about maybe one to three extra grams a day in addition to what we're naturally producing um but again the big push plant-based diet vegan vegetarian ethical treatment

of animals allergies to seafood whatever it is those are the populations they that may uh sort of consider supplementation instead of the diet now i should point out the low dose ever been shown to be effective in the muscle is an additional three grams a day. So that sort of says, okay, I can get it through the diet. I mean, a red steak or maybe a serving and a half of salmon would give you about three to five grams. But that's every day and that's probably not viable, especially with the cost of food nowadays. So that's why I think supplementation is one of those things that has been looked at to help offset habitual dietary intake or even augment what we already have.

And we'll probably talk about dosing today. It's sort of taken on a new life. Does the tissue of the body determine the dose? And that's still up for debate. But I have some opinions on that as well. Yeah, I want to make sure we talk about kind of responders versus non-responders and what that actually looks like. Because I think that's a, that's, I think, such an interesting take, you know, to kind of

understand how it fits into your life and what to be looking out for. So in terms of just benefits, you know, What can folks expect? And maybe this is actually when we get it. We can talk about dosage. You know, if we're wanting to improve brain health, for example, how much do we have to take? If we're looking for just athlete, you know, athletic recovery, how much do we need to take? If we're looking for, you know, to offset, you know, bouts of sleep deprivation, how much do we need to take?

Maybe you can just give us a rundown. Yeah, this is quite interesting. So I'm going to divide it up into two parts. From the neck down, you all the benefits. that you get from creatine are highly and primarily driven from exercise. So from the neck down, I would say any of the benefits from creatine, 95 to 98% come from exercise. And the additional small percentage, 1 to 2% is from creatine. So the mechanical stimuli from exercise stimulates creatine's potential. But the dosing from a muscle perspective, you can take as little as three

grams a day and that'll probably be a viable dose if you're taking it for maybe the rest of your life or for longer periods of time up to five grams that's that's very viable and very safe but again it has to be combined with exercise we're not seeing any benefits if you just sort of take creatine as a flintstone vitamin and sort of sit on the couch you're not going to get any benefits do that so it can augment the the small benefits now from a bone perspective the issue here is there's small body of research and it's primarily been based on individuals postmenopausal or into the fifth decade or above. And again, no bone benefits without exercise, okay?

But when you combine creatine with resistance training and or walking, the lowest dose that we see or seem to be effective, it was about eight grams a day. So maybe there's something going on that that tissue is secondary to muscle. Maybe aging is having a detrimental effect or blunting effect. But that's about eight grams. So all of a sudden, now you have a difference between muscle and then bone. They're related, but you're like, oh, I can't take different dosages. And then finally, the third big area, now we'll focus on the neck out.

And then maybe if I could just ask a couple of questions related to neck down. So just if you're female versus male, you know, does this eight grams kind of hold regardless of body size? How long does it actually take for to see the benefits of that, that dosis? for men and women. Yeah, that's excellent. So compared to, let's look at biological sex. Males and females do respond favorably to supplementation,

but males respond better, primarily from muscle accretion or muscle mass perspective. The relative increase in strength is usually about the same. Now, when it comes to bone mass, we see almost a better benefit in females, and you may speculate, okay, cessation of estrogen, they're probably having a natural decrease in bone loss, maybe create come to the rescue for that as well we don't see a lot of favorable benefits in older healthy males and maybe because the skeleton is is healthy we haven't looked at disease state populations there as well so the dose anywhere between three to five grams for muscle

maybe higher for bone but of course it's very hard to take different doses throughout today so you may want to just take a slightly higher dose uh the cool thing with creating the timing is irrelevant you can actually take it in one bolus dose. You can take your total daily amount and split it up into multiple dosages. I wouldn't go any lower than one gram. That didn't seem to rise in the blood enough. So I think anything two, three grams, that's half a teaspoon a few times a day. That'll also help decrease any chance of GI track irritation or bloating that a lot of females complain about. So I recommend smaller, or more frequent dose, you just maybe put it in your food. That way it doesn't cause as much cute water fluctuation into the cell.

You know, I haven't really experienced any bloating, but I know, you know, women are afraid of, and maybe you can tell us, is this a myth, is this truth? You know, do you gain weight from creedin? And if the answer is yes, you know, are there any things that we can do strategies to kind of mitigate that, you know, that water gain or that weight gain? Because I know that that's a important topic for maybe anyone who's not interested in putting... It's probably the biggest fear tactic that a lot of individuals, primarily females, experience with creatine. So I'll put it two ways. If you were to only take creatine for a week, you would probably be a little hesitant because

typically, not always, but typically the first week is when you get a net increase in water retention and or mass on the scale. But that subsides over a long period of time. So if you're taking it more like two weeks, a month or whatever, when you go on the scale and your 50 kilograms and after six weeks of creating you're maybe 51, it's kind of hopefully an increase in muscle mass and or fluctuations minimally in water. We actually don't see a huge increase, if any, primarily in females, with body weight fluctuations. And as you know, Abby Smith, Ryan, she did that a really good study on different

phases of the mental psych and we're not seeing any difference. So if you do experience a small increase in body weight, it's probably likely it's intracellular in the muscle and or if it is outside the muscle, we're not seeing any increase in body fat. So we've got a couple meta-analysis here. And I think if you're doing a creatine supplementation with exercise for more than maybe three weeks, you're probably starting to put on an increase in muscle size or hopefully bone will take a while but I think that's the potential there so for the females the loading phase I would not recommend that's 20 grams a day for five days you will certainly put on water weight and get some potential adverse effects that's typically only for the athletes but for any females

listening here you can start with as little as three grams a day you could probably divide that up into two 1.5 servings put it in your yogurt or smoothie you won't even notice you're taking it and I pretty much guarantee you're not going to notice any fluctuations. Great. So for the ladies out there, this is kind of what I prescribe to my friends. I'm like, all right, take, you know, one and a half gram, breakfast, lunch, dinner, to divide it out. And then, and just do that for 30 days.

And then after 30 days, you know, consider going to 2, 2.2. And then after 30 days, go to 333. So that's kind of what I've done. And I haven't seen any, you know, I don't know, I don't feel bloated. I don't notice it. I love it. I might use school that for our next time. I love that because you're progressing slowly.

Everybody is different, hormone, medications. And then you say, geez, I respond or that's too much for me. Let's go back. I love it because at the end of it, you're right. It needs to accumulate. The timing is kind of irrelevant. And so why not do what's best for you? It's kind of like saying, what's the best exercise to do for the body?

I say the one you're going to do consistently. So whatever is easier for you to do, now some people say, only can remember to take it in the morning a bowl of stoves? Sure. But other people say it's kind of like adding sugar to something over a meal. Obviously, it's not sugar, but it's just getting in the habit of adding it. And I personally take five grams in the morning with my breakfast. And then I actually put it in your yogurt and just sit around. And then I put five in my bottle and I drink that during my workout. So there's my 10 grams. I don't have to worry about, oh God, I forgot or whichever. And I think you mentioned how long does it.

stay in our body. This is really important. So once after 30 days, you could be well assured that your muscle is totally saturated with creatine. That means the room is full of creatine. There's not really much more to go. And if you suddenly stop and you maintain activities of daily living, the elevated creatine stays about 30 days. So I think this is huge for people traveling, not wanting to take a bag of white powder across a border, the inconvenience. You know, if you've been taking creatine for month, two months, and you say I'm traveling or I'm injured or whichever, it stays about 30 days in the muscle. We think about a little bit longer in the brain. The brain doesn't like to release it as well. So I think that has applications for people. Do you need to cycle it? We don't think so.

We have no direct evidence to say cycling is better than continuous or not, but I take it every day for the last probably 15 years and, well, I haven't died yet. I've lost my hair. Maybe we can talk about that later, but I don't know. Amazing. So if someone were to go on vacation for seven days, it's still going to be in the tissues and they can just resume taking when they get back, for example, like if they can travel with that. That's 100% correct. And then when you're on vacation, if you're getting your steps in, physical activity will help maintain creatine stores. It won't increase it. And then again, if you are an omnivore or a carnivore and you see red meat or seafood, that's a viable source to get into the diet. The vegans, again, this is probably

more applicable for those individuals or vegetarians where creatine is not found in plant-based products, exercise would help maintain those levels more. But even if you said, I'm just going to lay on the beach in Mexico and do nothing, we see the elevation state for about 30 days after. And the study that showed that was in young individuals and in young females. So again, there's no big sex difference there. Amazing. Amazing. Okay, so let's, anything else with just neck down that you think is important to touch on? The other big one is recovery. We start to see anti-cadabolic effect.

So yes, it improves, but there's evidence that it'll sort of speed up cellular recovery. And that it may allow the individual to train what if it's twice a day, what if it's every day? This is the area that creatine doesn't really get talked about a lot. But I really see that the anti-cadabolic or any inflammatory properties, especially for endurance athletes, is there. That may allow you to exercise every day. So that's something to consider as well. But again, the dose is small, but really nothing happens without exercise. I can't stress that enough.

Yeah. And I think, too, that's the other, I think, important point is, you know, if you can train, if you're available to train consistently, obviously you're just going to make more gains, right? And I think, I think, too, for women who are weight sensitive, I try to get all my friends to stop stepping on the scale because that's not a measure of health necessarily. it's really a because you're going to gain weight, right? The more you're able to train, the harder you can train, the more muscle mass you're going to put on and the heavier you're going to weigh.

And I think kind of coming, like recognizing, I think that is important. And I've definitely seen, you know, my ability and my capacity improve over the course of the last year, you know, ever since we talked, I think, a little, you know, where I start. And I was like, all right, I'm going to just make this a consistent part of my life. And I really have, I really have seen an increase in muscle hypertrophy. You know, I've gotten, you know, more muscular, I think, in a good way. And I haven't had my muscle tissue, you know, tested, but I would imagine that's improving. And, yeah, my visceral fat, like all of these things, I'm getting a deck skin soon.

So I'm excited for that. But I really think, you know, for me personally, creatine has been a big part of that story, I think, for me over the course of the last year. And that's an excellent segue. And the other big thing is people say, well, is it safe? And yes, we've given higher dosages looking at kidney and liver function. And it's probably one of the safest most effective ergogenic aids on the planet. You throw that in there with the caffeine and the protein and beetroot juice. But the safety profile is excellent unless you have a certain medical disease that would interfere with it.

But if you take a little bit too much, your kidneys just filter that out. And of course, that's why some people get these false. positives with high creatin or kidney issues when they go to their doctor because creatine leaves the muscle as creatin and that's what's causing it. So the safety profile and recommended dosages is excellent. If I'm going to do blood work, I just tell my provide, I'm like, hey, my creatin is going to be high, like whatever, just ignore it. So would you say basically doing a washout before blood work or just being aware that, hey, I take creatine and it's going to, yeah, what would I simply is that necessary? Yeah, I just think I agree with you. I would tell my doctor, hey, I'm taking creatine here for dose. It's well known that creatine leaves the muscle and it forms creatin and that's what they use and measure filtration rate. And if you tell your GP or nephrologist, there's a good chance. I hope they know the path of physiology. And they're like, okay, that makes sense. Now, if your liver enzymes are through the roof and your kidney enzymes are through the roof and your hematicrit and the blood is high, that could be caused by other things.

And time after time, what seems to happen is people just take off creatine for a little bit. Everything comes back to normal. So then they're more rest assured it was the supplement. But if anybody is worried about that, always get medical clearance. Talk to your doctor and just say, hey, I'm thinking of taking creatine or I'm on creatine. But study after study is shown the same consistent pattern of safety. Amazing. Let's talk about kids in terms of safety.

I know I pinged you. You know, I have two kids, and I was just, I really wanted to get them on creatine for all the reasons, but I wasn't exactly sure around the safety profile. And then you sent me the, I think the prelim data at the time of the concussion study with kids. So maybe just talk a little bit about that and we can segue into neck up, just safety profile for kids, you know, a lot of our members of force have children and play, you know, contact sports like football and hockey. And so, yeah, maybe just give us the rundown of how it can benefit kids and what your recommendations would be. The theory is no different than an adult. I mean, we recognize that we synthesize. It is no different than carbohydrate or protein or fat.

And two good, excellent colleagues in the states, Andrew Yagom at Mail Clinic and Chad Gers. They're probably the leaders in looking at creating supplementation and children. And all the review papers clearly show when it's taken in low, safe, effective dosages, it has no. adverse effects subjectively, like GI track irritation or other potential issues. And it seems to improve sport-related performance and or other health measures. They're currently looking at blood biomarkers, which hasn't been done and which is absolutely crucial before we can say for sure it's 100% safe. But I would be very surprised, if not shocked, it comes back as potentially detrimental because

they're synthesizing creatine just like an adult. They're consuming it if they eat any amount of red meat or seafood. food and the dose per se, three to five grams or based on their size is very viable. I mean, we're even starting to see benefits for pregnancy into developing fetus, older adults. So since it's recognized by the body, if the body doesn't like it, it'll just excrete it down the toilet. It kind of makes sense there's probably not going to be any adverse effects. If you took a super physiological dose, that's kind of like anything. You'd probably get an adverse effects, but I'd be very surprised if there was a pattern

and where there was adverse effects. Amazing. That's great. Yeah, the whole, yeah, fetal medicine is interesting. That's go to my wheel. Stacey L.Rey and Australia can handle that one. Yeah, exactly. Okay, perfect.

So let's talk a little bit about neckup now. You know, what are the benefits and the brain that we're seeing? I love to hit on sleep, too. Yeah, so this is the area of the hot topic, so to speak. So we're all very familiar that liver will create our own creatine. and then now we know that the brain will create creatine at a small amount as well. But the brain is different than muscle. Muscle likes to suck up creatine as much as possible because it doesn't make it.

The brain makes it so it's very resistant. So we're all familiar with the blood brain barrier. It's there for a vital process. And it's very hesitant to take in peripheral creatine through circulation and or supplementation. It does occur, but it's at a really reduced rate. So to get across the blood brain barrier and overcome what the brain is, naturally making the theory is that we need a lot longer term dosage or higher amount so this is where it gets different from muscle and brain when you look at the small body of research it seems

that it takes about 20 grams for a short period of time or about four grams or more for several months to accumulate but yes creatine can accumulate in the brain and then when you look at the studies that seem to show a benefit from creatine supplementation it's in popular that may have compromised creatine to start with. So I'll put it this way. If you're a young, healthy individual, adequate sleep, no contraindications to exercise, you may not experience a noticeable benefit from creatine, but in populations such as concussion, depression, anxiety, some neuropathological diseases, one common denominator is they have a reduction in brain creatine at the beginning. Is there a neuroprotective effect of creatine? So if you have it all

ready in the brain and I were to get a concussion, for example. Is there any research kind of supporting that, you know, this can kind of help you get ahead or, you know, protect your brain in some way? So there's two lines of evidence. The best comes from a rodent model, which is hard to extrapolate, but those rodents who were given a concussion and then with creating supplementation, that really improved the recovery. But the only study, as you alluded to earlier on in children, when these poor children suffered TBI or a concussion, they were randomized to 0.4 grams of creatine, so a higher dose for up to six months or placebo, and they experienced significant improvements in speech, self-care, and self-efficacy. So there's indirect evidence

to suggest that creatine can speed up recovery. So creatine has been shown to speed up some aspects of recovery from concussion in children. It's been shown to definitely speed up some aspects of recovery in the road model. The issue becomes, does it prevent or will it decrease severity of concussion in an athlete we have no idea the theory is there but i'm not seeing any reason why it wouldn't have some potential it's certainly not having any detrimental effect so that's why most athletes are already taking creatine and if they do get a head trauma maybe it'll speed up better but we need a huge randomized control trial and this is where it gets tricky you need to give everybody randomized creatine or placebo first and then you take back have a coffee and

and then wait for a concussion. Wait, I know. And you would need over 200 athletes in that. So you would need a multi-country randomized control trial to do it. And that's probably why it hasn't happened. I like that you've already done the power analysis on that one. We've talked to everybody because I think it's a funding model.

Yeah. I think what we should do is we should just tap, you know, like the Big Ten, for example, that's my conference. but just talk to the chief medical officer and just literally just let's just do this. You know, I mean, they're getting, I mean, if you look at how many concussions are logged in the Big Ten or the ACC or the PAC 12, like, I mean, I feel like this is not a heart that we can do it. I mean, yeah, that's totally a great segue. If you took even half the NCAA or NFL, the problem is you need to convince these football players to stop taking creatine for several months in advance to get baseline measures. So that's right.

Well, that's what I'm saying, NC2A, they're probably not supplementing with creatine. Like you're likely to get, you know, if we take football, ice hockey, soccer, like all of the contact sports, males and females, I bet we'd get enough of a sample size. We're trying to get the individual, the medical doctors to sign off on the proper concussion protocol and testing. It's a really daunting challenge, especially to get through ethic boards. It's very, very tough. But we're trying. Yeah. So at the end of the day, it has potential.

I think if anybody is engaged in contact sports, I think creatine could be something to consider. And then when you look at individuals with depression and anxiety, on medication, it's definitely showing some promise there by decreasing some of the symptoms of depression or speeding up recovery. Again, that's in combination with their medication. So I think that's a huge area, especially since post-COVID, or it's an area that we're always looking at. Creatine really has not been shown to have a lot of benefit for Alzheimer's or Parkinson's or Huntington's. The theory was there, but again, the issue is long-term trials with large sample sizes. There's benefits for muscular dystrophy in young boys, but we also don't see a lot of promise in MS. I think that's because the sample sizes are so small that the treatment effect over time is minimal.

But I'm really excited about concussion, other forms of traumatic brain. injury and depression, I think, are the big areas moving forward. And at the end of the day, it doesn't have to be with exercise. So this is kind of cool. We think activities of daily living walking blood flow. There in those studies, we see some benefits. But I think the hottest topic from a non-disease perspective or condition is sleep deprivation. And that's where we see some of the best evidence. And the question is, geez, you know, staying up overnight students, cramming for midterms, overnight flight to Italy, your shift works from midnight to 8 a.m. You wear the watch or whatever and they're saying, hey, you're sleep deprived. The theory is that creatine seems to decrease

either the amount of sleep you need to perform activities of daily living. And when you go into the cellular data, it's a very interesting mechanism. It's just like in the muscle. It decreases oxidative stress or inflammation in the mitochondria in the brain. So it seems like, It's sort of clearing out the garbage that's created when we're sleep deprived, when you're foggy and you're like, oh, God, I'm jet lagged. I would put jet lag exactly with sleep deprivation. And then when people, anecdotally, have told me I've increased my creatine, I feel way better with even less sleep. That's anecdotal. But there is some studies that have shown that some of the best evidence, actually, is that it can overcome some of the negative effects of sleep deprivation.

yeah i wonder how long you know that that holds right like we know we need to spend time in bed like there's all sorts of things happening during biological sleep that are are not going to happen during wakefulness right during so um it's very acutely right you got coffee an ivy drip of caffeine and you just nothing can overcome a good night's sleep no matter what anybody will uh give you but this is acute sleep deprivation but if you're chronic oh you're going to need a lot more sleep the time for sure. Yeah. I think that's an important, it's an important distinguish that we're talking about acute bouts of sleep deprivation. The all-nighter, you know, that you're studying for or, you know, just you're on call for 48 hours or whatever. Yeah, we definitely, as you know,

I do a lot of sleep research. So this is an area that I spend a lot of my time thinking about. And we do see declines, you know, in markers of recovery. We see declines in cognitive functioning. we see declines and, you know, things like psychological safety, you know, other performance metrics, I think, that people care about. So there's something there. But if we know that, you know, being on a consistent regimen of creatine will help us mitigate the impact of these acute bouts of sleep deprivation, I think that is just an incredible strategy.

And we have planned next term similar lines of this. There's other people that are really stressed, such as students or do a lot of medical, physical task at job and they come home and they're saying, I'm really mentally tired. So our plan is in the winter term to give 30 grams a day, the highest dose in young individuals, but they're going to perform a long Stroop test, which if you've ever tried it, will make you go cross-eyed at about two minutes. I've used it in many of my studies and back end strupe. And then we're going to do a whole bunch of cognitive tests right after.

Could creatine not only allow them to get through the Stroop test that's extended, but allow them to perform cognitive. So we think of studying for a test. They cram for a test and then can they actually perform the test better? That would be interesting for the MCAT or law school. So we're going to be planning that right after Christmas. Amazing. All right, Darren, what do you feel like we're missing here? What are some other headlines that like folks have to have to understand? I think the big area that's emerging is bone health, especially in the U.S. I was at the American College of Sports Medicine last year. And that was the biggest area of interest. And this, seems to have the greatest line of evidence because we had such high sample sizes.

And the big paper we just put out last year, two years in post-menopausal women, over 200 individuals. So it was one of the rare studies that were adequately powered. We gave 11 grams of monohydrate a day for two straight years. And it had some beneficial effects on preserving the bone integrity of the skeleton primarily around the hip. So the theory was those individuals on creatine and which obviously performed exercise. They may withstand a fall or fracture later in life.

We don't know that, but if you strengthen the bone, that could be very beneficial. It also improved lean mass as well as gait functionality, tasks of daily living. So we're really starting to focus more on postmenopausal females. And then we want to get into really young individuals and old, old adults over the age of 80. And maybe could this cause any motivation to exercise and maintain activities of daily living? The other big thing there is we looked at side effects, liver and kidney annually. There was no more side effects in creatine compared to placebo. And we gave 11 grams of monohydrate a day for two straight years.

It was the only study to ever do it. And we're pretty confident by that in a population where organs start to sort of decline in function. That's triple the amount that we usually recommend for younger individuals, had no detrimental effects over placebo. so we're confident that the safety profile is there. And the other big one is, what about other forms of creatine? I can't stress this enough. I would only ever consider monohydrate. It's identical to what we're naturally producing.

So if you're going to go buy creatine, at least make sure it's monohydrate and make sure it's third-party test it. You don't want to have any impurities or anything else in there. I'm only talking about monohydrate when we refer to creatine. Okay, perfect. Just to go back to the bone study, so you had 200 women, two years, receiving 11 grams of creatine monohydrate daily. You said you controlled for exercise.

Did you have how much experience did those women's have resist trading coming into the study? How much did they do over the course of the study? Was it two times a week, three times a week? Just very curious about, you know, just what is the, you know, what is the main? maybe minimum dose of resistance training, does someone have to do in order to get the benefits of this dose of your treatment? No, that's an excellent point. So these were classified as healthy, non-trained, and especially at that population age,

we typically don't get a lot of individuals in a large sample size that were training three or four days a week. So they had minimal resistance training experience. But what we did, we tried to adhere to the U.S. and Canadian guidelines for physical activity. So they did six days of walking at about 20 to 30 minutes a day. So that achieved their 150 minutes per week of what we consider aerobic exercise. And then we did three days a week of resistance training, which was like machine-based. It was supervised.

That's slightly more than basically what's recommended two days a week as a minimum. Some weeks, if they didn't get the three days, they could extrapolate that over. So not a lot of expectation. However, the average individual who says I have no time barely to work out. how am I going to do this? All that simply showed is in an experimental study that exercise plus creatine was effective more than exercise alone. Amazing. I love it. Darren, what do you know about the topical creatine for anti-aging? And I'm very interested in this. I'm like, did not even know that that existed. So it's interesting you bringing up my mentor, who is one of the best

researchers ever, and he's probably one of the best creatine researchers and probably no one Here's a vote on social media. But he did a study on kind of like this topical creatine. And you're thinking, wait a minute, how in the world is it going to get in like an anti-inflammatory subtopical cream? But they actually showed some potential improvements in muscle force production. And so I had to go back and say, okay, the epidermis, how does it get into the capillaries to get into the tissue? We still don't know. The study's never been replicated.

So I can't really comment on the reliability or if it works over time. But when you see these companies promoting anti-aging creams with creatine or whichever, I'm really skeptical on the efficacy of those as well because creatine needs to go intracellular. There could be some potential benefit on Alastin proteins, but I don't know the link between creatine and collagen from a skin perspective, maybe bone. So I'd be very skeptical. Maybe, hopefully you're probably buying the cream for moisture. perspective, but I don't know what is creatine and antich, but I actually have seen it market it when

I was in Las Vegas. And I was like, oh, look, if I buy this, I'm going to get creatine. It kind of doesn't work that way, but maybe down the line, a dermatology research firm will come up with a cool idea for it. I mean, I think just generally, given everything that you've just kind of described in terms of creatine's ability to increase capacity, potentially to, you know, move more, lift more, get stronger, improve muscle tissue quality, I would imagine that actually helps with anti-aging, right? There's a, you know, I would think. Yeah, for me, anti-aging is exercise. I mean, the force field increase. Like, you could have the crappiest diet, but if you exercise, you're still going to get all the benefits. But if you don't exercise and you have the best

diet, I think you probably wouldn't get the same effect. So I think exercise acts as almost a protective force field. I love Stu Philip and Mike Joyner's idea that you can outrun a bad diet because all we consider that is about weight loss. What about all the other benefits about it? And I really love those two researchers. I think they're exceptional and they put out excellent work from a practicality. I can listen to Mike. Let's talk all day, like all day.

Same. Every podcast is on. I just listen to them and it's like, it's fantastic. I know, I know. Like just talk about VOT too much, Mike. Thank you. Yeah. He sort of remembers everything.

But yeah. And then that goes in line with, you know, the fountain of youth is excellent. exercise, creatine will give potentially a small beneficial effect. And I use the analogy of the cake is exercise, the icing is protein, and then the sprinkles on top may be creatine. At the end of the day, 95, 90% of anything you get is from exercise. And then the maybe extra boost, if you will, is from ergogenic age. There's only five or six that the ILC endorses.

Two happen to be creatine and protein. And I think those are the two that we get through our doctors. diet, plant base, primarily protein and, but creatine can come from both and again, or supplementation. So at the end of it, if you're exercising, you should sit back and be very proud of yourself. 30% of the North American population doesn't even move. So if you're exercising, great. And then if you can take some proper nutrition food first and then maybe a little bit of this dietary compounds, you might get an extra benefit from it.

what are some of the big myths you hear out there well the biggest is when you look at me is baldness and i've changed my answer on this because i used to have hair and spiky and all that stuff and then but i also started to lose my hair before i started taking creatine but they say i'm a messenger of creatine and they look at me like well look at you it's it's there so we've never been able to measure this there was one study that looked at a hormone dht which is not even correlated to follicle loss So when someone says this creatine cause baldness, I say there's no evidence to suggest it does. There's no evidence to suggest it doesn't. We've actually never measured it.

But I've tested over a thousand individuals, easily over a thousand. And not a single one has come to me and says, hey, my hair is stinting, whatever you're giving me. And so maybe that's some subjective evidence. So there's no evidence to suggest it causes baldness. The other big one, it does not destroy kidney or liver function at healthy, recommended dosages. What's the other big way? It's not a steroid.

Anybody can take it, including females. That's a big one we're trying to emphasize. And it doesn't increase fat mass. If that number on the scale goes up, we've looked at two meta-analysis now, and it actually has been shown to decrease body fat percentage in both, or 18 years and above,

only by about 1%. But at the end of the day, you can conclude it doesn't increase fat. So bodybuilders, always worried about water retention. I'm like, no, you should be taken. It's going to make your muscles probably more full, and that might allow you to perform more exercise. So I think for you, especially for recovery,

it may allow you to train multiple times. And so it's something that we've gone from the athlete, I think, to now the general population, and it might have some benefits. What about, I would imagine just thinking about it mechanistically, it's shuttling water to the muscle, So cramping, would it help with cramping? So that's probably the third biggest myth.

A lot of people said, oh, I experience more muscle cramps with it. No, it's super high treatment for muscle, so you actually get less. When creatine comes into your muscle, it drags a bit of water, and then it unlocks things called satellite cells, insulin-like growth factor, proteins in the mTOR pathway, blah, blah, blah, all this cellular stuff, which might explain why people experience an increase in strength, endurance, performance, muscle mass, and maybe some of those recovery agents as well. So it doesn't directly stimulate protein synthesis like a protein molecule, but it certainly does everything around it. And it's likely it probably would if we just did long-term studies.

Amazing. Dang, this is so good. So you mentioned, you know, you take it during workout, you take it, you put it on your breakfast. Is there, Does timing matter at all? Like, can I take it before bed? Like, does it matter? So currently the answer is no. However, there is some evidence to suggest that prior muscle contractions seem to stimulate creatine transport into the muscle.

So logically, you would say, well, prior muscle contractions means a workout. Why not take it post exercise? And so that seems to be a very viable time to take it. And there's been evidence to suggest that exercise does increase blood flow and transport kinetics. So taking it after exercise or like I do during or you could take it right before blood flow is going to be enhanced that way. So I usually like to take it in close proximity to exercise. But then you can spread it out and take it other times of the day. Now I'm taking 10 grams a day. But if someone says, well, I just want to start with three. I would say take it after you work

out. Put it in your meal, post-exercise meal or your smoothie. That's a great way to get in the habit. And then once you work yourself up, you may take it multiple times throughout the day. But we are having three studies planned in 2024 looking at the timing. And one of the coolest designs is we're going to give individuals creatine only on the days they work out. And then another group is creatine only on the days they don't work out. So that'll totally answer. Does blood flow or the timing matter? The theory here is if the timing matters, the people who take creatine on the days they work out should get greater effects. But if the group on rest days get the same benefits, we know for sure it doesn't really matter

when you take it. I would definitely, there's a circadian component there that would be important to consider. So, you know, just before noon, afternoon, you know, kind of, yeah, I think that would be important to isolate because in theory, we're more prime to do everything metabolically before 3 p.m. Right. After 3 p.m., we're just not as good. And luckily, for females, of course, we now know that the menstrual cycle and control concepts that really have no effect on performance and things like that.

And luckily with creatine, we don't see that effect as well. So that's one thing we can control, but we still ask and try to monitor. But the fluctuations from the Luteel to the follicular phase fluctuates from pre-testing to post. It's something we try to monitor, but it's very difficult. Yeah, yeah. So you'll have, what you have in that study, you'll have women on hormonal birth control, women not on it?

We probably will for the issues of recruitment and what we'll do is we'll just track that and then do sub-statistical analysis with vegans versus omnivores, oral contraception versus not. And then if we can try, I don't know how to do this, I'll have to talk to Abby maybe, how to measure females in the luteal

phase versus follicular and we don't even know if they know. We're not going to do blood markers to measure that. So it would be subjective, but we at least can ask the medications they're taking. As long as, you know, you know, when they start their period, when they end their period, you know, you'll obviously be able to identify

by those phases of the metro cycle and pinpoint that. Yeah. Yeah. And fortunately, like a lot of the, you know, on who we are able to track the central cycle. And, you know, there's lots of apps out there. Women, I think, are getting a lot more knowledgeable about their own body. And it's more common for women to track. So I think you'll get your data that all I'm saying is going to be.

You really struggle since COVID for recruitment. I'm not sure why, especially. but we'll sort of ask anybody who's willing to come into the study. And then it's up to us as scientists to try to put sub-analysis into it. But we're really struggling for some reason to get volunteers. We didn't before. Really? And then now it's really difficult.

Yeah. I'm not sure why. But, yeah, it's something that I've been thinking about, yeah. Wow. All right. Final question. What are you obsessing over right now? Well, we're really interested in the aging population and what we're going to try to do is look at creatine for people who can work out at home because we still think the barrier of exercise is time.

So we're going to be looking at rubber tubing or at home exercise with creatine. Can that improve some functionality in older individuals, especially in retirement homes or long-term care facilities? We're really interested in finally putting this notion to rest us, the timing of creatine really make a difference. And then thirdly, what about the effects on cognitive performance? in young individuals, and those are the three main areas. So we have seven studies planned for this year and moving into 2025. So pretty excited to get new data out and see where it takes us. I love it.

It's such exciting stuff, Darren, and just appreciate your time today and just everything that you've done to educate folks on this really, really cool efficacious compound. Thanks so much for your time. Thank you for having me. Appreciate it. Thanks. Big thanks to Dr. Dern. hand out for breaking down all things creatine on this episode, wishing you all a phenomenal holiday season. Big thank you to all of our WOOP members for what's been a great year. Don't forget to sign up

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As always, stay healthy and stay in the green.