9. Creatine -- not just for body builders!

 In this episode, Drs. Lemanne and Gordon discuss the use of Creatine as a supplement with both aging patients and patients with cancer. Turns out it's a useful addition to protocols for aging men, aging women, those who are athletes, as well as people simply wanting better health in the face of cancer and other health challenges. Let's listen to their discussions and reasons for looking forward to unfolding of additional research about the use of Creatine. 

Dawn Lemanne, MD
Oregon Integrative Oncology
Leave no stone unturned.

Deborah Gordon, MD
Northwest Wellness and Memory Center
Building Healthy Brains

Transcript

[00:00:00.090] - Dr. Lemanne

Well, back to creatine. It matters in cancer as well. And there are several studies open right now I've found, on clinicaltrials gov looking at Creatine supplementation in cancer patients, and most of them have to do with building up the muscle mass in cancer patients. You have found your way to the Lamont Gordon podcast where docs talk shop, happy Eavesdropping. 

I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:00:39.140] - Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:42.930] - Dr. Lemanne

We've been in practice a long time.

 [00:00:45.390] - Dr. Gordon

A very long time.

 [00:00:46.990] - Dr. Lemanne

We learn so much talking to each other.

 [00:00:49.200] - Dr. Gordon

We do. What if we let people listen? 

In this episode, Dr. Lemanne and I discuss our interests in the use of Creatine as a supplement with both of our patient populations. Turns out it's a useful addition to protocols for aging men, aging women, those who are athletes, as well as people wanting better health in the face of cancer and other health challenges. Let's listen to why we're both impressed and both looking forward to learning even more about the use of Creatine. 

 Good morning, Dawn. How are you doing today?

 [00:01:36.670] - Dr. Lemanne

Hey, Deborah. I'm well. How are you?

 [00:01:39.970] - Dr. Gordon

Great. I'm really excited about this topic. I love Creatine, and it's gone from kind of an add on after the fact to an integral part of my protocols with almost all my patients.

 [00:01:54.130] - Dr. Lemanne

You use it on everybody?

 [00:01:55.640] - Dr. Gordon

Almost everybody. And I think there's good evidence for using it, perhaps in the water. I think I've said that before.

 [00:02:07.270] - Dr. Lemanne

There are a lot of things I'd like to put in the water, and Creatine might be one of them. I think I'm with you on that one.

 [00:02:12.860] - Dr. Gordon

Right. Since a lot of my practice is older, I've put it in there, and my thinking has been that I'm putting it in there to help the muscle, to help counter the muscle atrophy that happens with aging. That whether you're not exercising enough, or even actually, if you are exercising, and particularly if you're older, there's a huge risk of muscle wasting and sarcopenia. And a low dose creatine supplementation, 5 grams a day, seems to be moderately modestly, sometimes greatly effective in helping increase muscle density and probably muscle strength. So, yeah, should be with everybody

 [00:03:01.630] - Dr. Lemanne

 and with your specialty. It's also beneficial in terms of brain health, I understand 

 [00:03:13.400] - Dr. Gordon

It is, and that's something that I've expanded my thoughts on recently. So there was an interesting review article that came out last summer out of Liverpool, a group, an international group, but it came out of Liverpool that really talked about how memory was, and we'll put a link to it. Memories definitely improved with as little as seven days of treatment for I think they use high doses when they only treated for seven days. They use 20 grams a day, which can be irritating for some people, or lower doses for six weeks. There were definite improvements in memory function and more so in those that had impaired memory function to start with. So I'm thinking, oh, maybe it's really just good for people who have memory impairments or brain energy impairments, and it's my older folks. But what I've learned since then is to think of two other groups for whom Creatine supplementation for brain health is really important. And one of those groups is this should have been obvious, but vegetarians, right.

[00:04:27.190] - Dr. Lemanne

Oh, because Creatine is low in the diets of people who eat only plants, is that true?

 [00:04:33.460] - Dr. Gordon

That's right. And since it's primarily in muscle meat, I think even if they are ingesting eggs and dairy, I think it's still going to be quite low.

 [00:04:43.610] - Dr. Lemanne

Okay, well, I think there's some research looking at brain and muscle function in vegetarians compared to omnivores. Is that something that you're interested in?

 [00:04:56.290] - Dr. Gordon

It is, and I think there's good evidence to show that without supplementation, of course. And most notably, we've thought in the past, B12 -- vegetarians can be markedly impaired compared to omnivores. But what this pointed out was really that in addition to B12, you need to be thinking about Creatine. Because creatine -- so it's interesting, the two groups that stood out to me in another article that came out of Brazil, interestingly enough, this is a topic of international interest -- was that where the two groups where Creatine supplementation best helped brain function were vegetarians and people with traumatic brain injury. I'm not saying those are the same, I'm just saying that was the finding of where Creatine seemed to help the most.

 [00:05:50.820] - Dr. Lemanne

Well, it's really hard to do nutritional intervention studies, and it's hard also to gain clear data from retrospective non-interventional observational studies. But I have been impressed by the literature that suggests that women who have a lower body store of Creatine than males because of the lower muscle mass, and older people who may process energy a little bit differently compared to younger people are especially, and possibly vegetarians, are people who may benefit the most from Creatine supplementation. So I find this a really interesting topic.

And do you use creatine?

[00:06:35.450] - Dr. Gordon

I do, and in fact, I'm pretty good with my supplements. I don't care where they are, if I want to take them, I'll find them. But to enhance--

[00:06:48.850] - Dr. Lemanne 

What do you mean, finding them. You've seen my house with the countertops full of supplements. I don't have any trouble finding them, right?

 [00:06:53.840] - Dr. Gordon

No, mine are-- 

 [00:06:55.040] - Dr. Lemanne

Yours are in a drawer.

 [00:06:55.800] - Dr. Gordon

I put mine in a drawer and in two different cupboards, so I know where I keep them. But if I want my wife to take Creatine, I keep thinking that putting it in her mother's, we've inherited a beautiful little sugar bowl with a nice little lid and a nice silver teaspoon. I keep thinking that's going to enhance her taking it. She is younger than I am, but she's much more of an athlete. So as an athlete, I need it because I'm older. Older people, as you just said, need more help building and restoring their muscle mass. But athletes need it, too, and both for performance, but also for recovery-0athletes, particularly, who work out in some way every day, they're breaking down their muscle mass and potentially losing creatine as creatinine.

[00:07:43.770] - Dr. Lemanne

Do you mean performance athletes who compete, or do you just mean anyone who is working out in the gym active is trying to keep themselves in good physical condition?

[00:07:55.690] - Dr. Gordon

It's important that you say that. That's great. I was just making the point of the full gamut from performance athletes of whom I know very few, to consistently active athletes who are training seemingly, in my mind, excessively every day, like, perhaps yourself on some weeks.

[00:08:18.460] - Dr. Lemanne

Right. Last week, I trained every single day, and this week I've only been able to go in twice. So I overtrained last week, and I'm having to make up for it this week. But I've been taking creatine, and I'm very impressed with the results I've gotten, both after athletic endeavors and my recovery time, and with my cognitive abilities, it seems to help. And you know how I test this?

[00:08:44.170] - Dr. Gordon

How?

[00:08:44.660] - Dr. Lemanne

I like to play this computer game called Jumble, and it's an anagram. You unscramble words.

[00:08:50.480] - Dr. Gordon

Oh, I love Anagrams.

[00:08:51.700] - Dr. Lemanne

And they time jumble. Yeah, there's an app, and you can play it, and you can time yourself. And when I've taken creatine, oh, my goodness, I'm down to unscrambling four words in 13 to 20 seconds, whereas it would take me 30 to 60 seconds without creatine. So I have a semi.

[00:09:09.240] - Dr. Gordon

So I'd say we need it.

[00:09:10.870] - Dr. Lemanne

We need a measurable way of looking at the effect of creatine on my brain.

[00:09:17.020] - Dr. Gordon

So the next step, I'd like you to blind tha--to get us to stir your creatine into something, but have somebody else prepare it for you. And some days, not stir the creatine into something or stir something else into the liquid that you're drinking because you have such a good brain that I suspect you have a healthy placebo response.

[00:09:43.530] - Dr. Lemanne

We certainly could do that. That would be a really interesting n of one experiment, I think. I'll get you to we'll do it double blind. I'll get you to mix my drinks.

[00:09:53.890] - Dr. Gordon

There we go.

[00:09:54.240] - Dr. Lemanne

I love instant coffee. You can mix it in my instant coffee. It's flavorless. And I will have somebody else serve me my instant coffee. So they're blinded too, and we'll take a look and see how I do. That would be very interesting.

[00:10:10.610] - Dr. Gordon

Yeah. I do want to say, as an aside, I think it's a real boon to health to be a healthy placebo responder, don't you?

[00:10:18.810] - Dr. Lemanne

I do. There was some interesting work about ten years ago looking at the placebo response as it is encoded in the DNA, and I remember that there were some findings that approximately 30% of people either do or don't respond to placebos. So not everybody does, according to this research. And I wish I remembered which direction this was in, whether it was 30% do or 30% don't. But that was quite interesting. So there are some people who don't respond to placebos and it seems to be genetically it is.

[00:10:53.650] - Dr. Gordon

And I think one of the genes that that's attributed to is the comt gene. And if you have two variants of one form, you are more of a no SIBO responder, meaning you're sure it's going to hurt. So it does. If you have mixed variants, you could go one way or the other. And I bet the 30% is those of us who have two variants making us likely to be placebo positive responders. I think you're right. I bet it's about a third. 

[00:11:24.080] - Dr. Lemanne

That's really interesting. I don't know as much about those things as you do, but I find that quite fascinating. And so I don't know where I fall on that. I could look it up. I've done 23 ANDME is that gene evaluated?

[00:11:38.260] - Dr. Gordon

It is, and I'll give you the specifics of which variant matters. I'm going to have to look that up and maybe we'll put that in there.

[00:11:44.880] - Dr. Lemanne

Well, back to Creatine, it matters in cancer as well. And there are several studies open right now I've found on clinicaltrials gov looking at Creatine supplementation in cancer patients and most of them have to do with building up the muscle mass in cancer patients. And I think we're going to talk about this next week. We're going to talk about muscle mass and health and longevity. But I just wanted to mention that there are several studies in breast cancer, prostate cancer right now looking at things like Creatine supplementation along with resistance training for building muscle in cancer patients. Because building muscle or maintaining muscle, at least in cancer patients, has to do with their longevity, how well they're going to do with their treatments, and whether they're going to survive and how long they're going to survive. So this is really interesting that Creatine is being looked at. One of the things that I like about Creatine is that it's awfully safe. I don't see that there is a long list of detrimental effects from supplementing with Creatine, even in large doses. And do you want to talk a little bit about whether Creatine loading is important and what types of Creatine are available and what you recommend for your patient patients?

[00:13:00.990] - Dr. Lemanne

You mentioned 5 grams a day. Is that creatine monohydrate?

[00:13:03.760] - Dr. Gordon

Creatine monohydrate. And there is some suggest, so I would say the main downside of Creatine is people forget to use it. It's a little powder. I have to stir it into something. I just took my capsules, I'm done.

[00:13:18.990] - Dr. Lemanne

Do you find it tastes funny?

[00:13:21.010] - Dr. Gordon

I have had brands that do taste a little something, but nothing significant.

[00:13:27.730] - Dr. Lemanne

I've been using Thorne and I find it very light and quite tasteless. It dissolves easily into my morning coffee. I can't taste it.

[00:13:38.630] - Dr. Gordon

Oh, you've risked your morning coffee.

[00:13:40.640] - Dr. Lemanne

I did. It tells you how committed I am.

[00:13:44.780] - Dr. Gordon

Sacrosanct. So I would have said in the past that the only difference between different Creatine monohydrates is how well they mix into water and that people should just buy the version that mixes the way they like it. Recently, though, and I'd like to give a shout out to Lucy Mailing, a microbiology PhD who has her own podcast, and maybe we can have her on as a guest on our podcast sometime. Who referenced that Thorne Research Creatine is actually a variant of Creatine monohydrate called CreaPure, and it is thought to be better absorbed and better tolerated. Because I think the rare side effect of Creatine is some gastrointestinal upset.

[00:14:33.040] - Dr. Lemanne

So the Thorne version is always CreaPure and that is supposedly better for the GI tract in terms of side effects.

[00:14:40.550] - Dr. Gordon

Yes. Recent Thorne research Creatine is CreaPure. I think five years ago it probably wasn't, but you asked about loading, and that's an interesting question because if somebody pulls up an article about creatine after I've mentioned it, they will call me and ask me about loading and I'll ask them if they're training for a weightlifting competition the following weekend. And if their answer is no, my answer is no. Now, you can just start with 5 grams a day because this is a lifelong habit. It's not something that you need to get all over and done with in one week. Better to just start with 5 grams and keep using it.

[00:15:18.860] - Dr. Lemanne

And is 5 grams a day the top?

[00:15:22.310] - Dr. Gordon

Some people do use 10 grams a day and some of the studies have been done with 10 grams a day and equally low side effects for all of them. But I think in general, there's agreement that 5 grams is adequate.

[00:15:38.350] - Dr. Lemanne

So Creatine works because it helps recycle ATP from ADP and so it has to do with fast energy. Is that correct? Is that your understanding in the brain and in the muscle?

[00:15:54.350] - Dr. Gordon

Well, I think of it as working at both at that molecular level for energy, but also just creatine as a building block of bone health. And that's what I was actually going to ask you about, the cancer treatments, and I don't mean to deflect, except to go back. The cancers you mentioned are cancers that would have improved by people who reduce their insulin resistance, is that right? You mentioned breast cancer, breast cancer, prostate.

[00:16:25.700] - Dr. Lemanne

Cancer, certainly in many cases, insulin overload, let's call it that, plays a role in the development of these types of cancers in general. Not in everyone, but in general. So, yes, I think that's true. And in that case, muscular health is truly important in aiding recovery, and muscular health is obtained through muscular exercise, particularly resistance training, to a certain extent aerobic training as well. We need both, as you like to point out, and that I've learned from you. And particularly resistance training has to do with strengthening the muscles. When you strengthen muscles, you also strengthen bones because muscles pull on bones and bones are strengthened by application of tension. So yes, you get both things going at once, improvement in muscle and improvement in bones. They certainly go together. And one of the things that seems to apply in both of these diseases, which are common breast cancer and prostate cancer, especially hormone receptor positive breast cancer, which tends to metastasize to the bone if it metastasizes, is the addition of bone hardening treatments in the form of pharmaceuticals, denosumab, which is ex jiva or Prolia certain types of bisphosphonates. And these are powerful drugs.

[00:17:47.820] - Dr. Lemanne

They have side effects. In some people, these side effects can be serious. And so if you're able to do similar things without using as much of those medications, you're always in a better situation. So if Creatine is helpful and it's now being tested in these situations, I think that will be very important for patients who do have these terrible conditions and will help them strengthen their muscles and their bones and live longer.

[00:18:14.590] - Dr. Gordon

Great. Those two cancers you mentioned, and I assume in that same category, be breast, prostate, colon cancer, I think of as the ones I've learned from you, are more sensitive to insulin perhaps than lymphoma and leukemia.

[00:18:30.470] - Dr. Lemanne

And glioblastoma, again, it depends on the case. Glioblastoma certainly has very, very many metabolic pathways that are aberrant and including the insulin pathway. It's not the only pathway. And glioblastomas are really good at getting around almost anything you do. So that's a bit of an outlier in that place. Colon cancer certainly has a lot to do with insulin resistance, especially lower colon cancer, meaning rectum and left sided colon cancer. The colon can be divided into several parts and certain parts have different susceptibilities to treatment and to different types of treatment and actually to different risk factors. So there's a little bit of complexity there. But in general, nobody's going to hurt their health by making sure that they have strong muscles and strong bones. And Creatine certainly can do that. And if you have good underlying health, if you do develop a cancer, you're going to be more likely to be able to tolerate whatever treatments are needed. So just on that level, right, having good muscle function is important. So Creatine certainly plays a role there and it helps with body composition. I think that's what you're getting at too. It's easier to decrease your fat load and increase your muscle density and proportions with the use of Creatine.

[00:19:55.160] - Dr. Lemanne

I think studies have been very clear about that.

[00:19:58.670] - Dr. Gordon

And so even if you're having a non classically, overweight associated cancer like lung cancer, you're saying Creatine with exercise gives you a healthier body so that you can better tolerate whatever treatments might be required to help you survive your lung cancer.

[00:20:20.910] - Dr. Lemanne

Yes, absolutely. And I want to point out that, and I think most of our listeners know this, but it's not just overweight, it's metabolic health. And you can be unhealthy metabolically, even if you're thin. And the way that you get there is by having too little muscle mass, you may or may not have too much fat mass, but if you have too little muscle mass for your body size, you will have a poor metabolic health situation, meaning that you will be unable to metabolize glucose. It's on the spectrum of diabetes. So we call those people skinny fat.

[00:20:57.020] - Dr. Gordon

Did you know there's an acronym for that?

[00:20:59.460] - Dr. Lemanne

No.

[00:21:00.000] - Dr. Gordon

It's called TOFI

[00:21:03.520] - Dr. Lemanne

Tell our listeners what TOFI is.

[00:21:06.610] - Dr. Gordon

T-O-F-I learned about this from Dr. Ann Childers, a psychiatrist in Portland area who now puts continuous glucose monitors on all of her psychiatric patients because she discovered herself a number of years ago, that runner, that she was looking lean and mean and terrific. She had early diabetes because she was tofi. Thin on the outside and fat on the inside.

[00:21:30.510] - Dr. Lemanne

That's really interesting. There's a South African scientist, I'm blanking on his name, but who had the same situation, and he --

[00:21:44.310] - Dr. Gordon

Tim.

[00:21:44.530] - Dr. Lemanne

Noakes. Yes. Who was a runner and became diabetic in spite of long distance running because he did not have enough good lean muscle mass. He had lots of endurance, but not the muscle strength and mass that you need to process glucose and keep your insulin levels normal. Very interesting. So Creatine can certainly help with that.

[00:22:04.940] - Dr. Gordon

Right? So we went full circle from your suggestion about ATP, and so I just pulled up my notes about Creatine while we were taking that circuitous route. And yes, the regeneration of ATP in reaction with inorganic phosphate is what helps regenerate the muscle and the energy in the cell. And that, again makes me wonder about vegetarians who might need some extra help because the phosphorus content of their diet and their circulating phosphate is probably lower than that of those who are omnivores. Is that right about vegetarians, or am I mistaking that?

[00:22:49.700] - Dr. Lemanne

Well, I think that that's possibly the case. I know that studies show that vegetarians do have an improvement in their muscular function and possibly their cognitive function, I believe, with Creatine supplementation. So I think that the bottom line is that if you're a vegetarian, you may try Creatine to see if it improves those two parameters.

[00:23:19.720] - Dr. Gordon

Right. And as we've said several times before, we're not giving anyone any particular medical advice. This really is a discussion about repeating currents and research that are found in your day to day average athletic chat box. Right. Or TikTok. I bet there's an athlete who has a TikTok video about taking Creatine as a daily supplement. What do you think?

[00:23:47.130] - Dr. Lemanne

I bet there's more than one. There are worries about a dark side of Creatine that I just want to bring up. And certain preclinical studies have suggested that Creatine can increase the ability of cancer cells to change into a more metastatic form. I don't think those studies are worrying to me at this point, but it's something that whenever we have a supplement, we want to make sure that we look at all sides of all of its possible side effects. And so that's one that I just want to bring up for our readers. You don't want to go crazy with creatine. Maybe there's a downside. I do think that you certainly want to make sure that whatever supplement brand you use, that you make sure that it's very, very pure and maybe has been tested. I haven't looked@consumerlab.com to see what they think of various Creatine versions, but that might be something to do.

[00:24:48.440] - Dr. Gordon

That's a good idea.

[00:24:49.810] - Dr. Lemanne

I think I'll go ahead and do that. And just keep in mind that you don't want to overdo anything. I think that in my case, my worries fall more on the side of not having enough muscle mass as I age, now that I'm getting older. And so I do take some creatine and find it useful. I notice the difference cognitively and physically and am not too worried about cancer. But if I had cancer, I'd talk to my oncologist about Creatine and how I would use it and make sure that you're not doing something that possibly could be harmful for you.

[00:25:26.250] - Dr. Gordon

Do you have any insight as to what the rationale for how it might promote metastases or metastatic tendencies?

[00:25:35.620] - Dr. Lemanne

I'm not an expert in this, but the general idea is that the extra energy that creatine supplies could be used by cancer cells to enhance their mobility so that they could metastasize to new areas in the body, and there may be a differential effect on the primary tumor. In fact, the primary tumor may actually shrink in response to creatine exposure, whereas metastatic disease Might get a boost. So there could be a differential there. And there's also some studies showing that in patients who've undergone certain types of cancer immunotherapy involving T-cell activation, that creatine is very important for recovery, that the extra energy given to the T-cells that have been activated by these treatments provided by creatine may improve the response of the patient to this treatment. So that's really exciting. And that's a newer branch of research, and we'll keep an eye on that.

[00:26:34.690] - Dr. Gordon

Can I ask you to clarify that a little bit more? So, is that immune therapy that might be useful in any kind of cancer?

[00:26:41.830] - Dr. Lemanne

No. So immune therapies are used in certain types of cancers. Right now, the use is expanding. It started in things like melanoma and certain blood cancers, but now the treatments Are expanding to other types of cancer, but they're not to all the types of cancers yet. So we'll have to see.

[00:27:04.310] - Dr. Gordon

My question really, being that if somebody's doing an immune therapy for a breast cancer and someone else is doing an immune therapy for a different kind of cancer, what happens to the T cells when they get their immune therapy that the creatine helps them recover from?

[00:27:20.830] - Dr. Lemanne

The creatine provides extra energy for these T cells so that they can be more active in killing the cancer.

[00:27:25.880] - Dr. Gordon

I see. So that would be I have a patient facing some immune therapy for a breast cancer, and I told her I didn't think she needed to expect some of the harsh realities of conventional chemotherapy, but now I will have to give her a special call and say the Creatine would help her chemotherapy be more useful. She should ask her oncologist if that's okay.

[00:27:50.250] - Dr. Lemanne

Sure. So I want to differentiate between immunotherapy and chemotherapy. And immunotherapy works on the immune system. Chemotherapy, in the classical sense are drugs that kill fast growing cells whether they're malignant or not. So we would want to make a differentiation between those two. And we're talking about the immunotherapy here now rather than chemotherapy.

[00:28:13.300] - Dr. Gordon

The immunotherapy. Yes. And good to think about that. Immunotherapy was popularized in a recent medical television series. I watched a little bit of do you watch medical TV shows at all?

[00:28:28.360] - Dr. Lemanne

I avoid them.

[00:28:30.530] - Dr. Gordon

It's horribly frustrating when they get things wrong.

[00:28:34.630] - Dr. Lemanne

No, I just watch my taste tends to be toward really, well, kind of dumb. One of my favorite movies, I'll just tell you, is Dumb and Dumber, and my next favorite is Dumb and Dumber.

[00:28:49.610] - Dr. Gordon

I am shocked. That's funny. Well, New Amsterdam, he has a head and neck cancer, which requires this is a drama. It's a drama. Okay. And it's in season two or three or something. He undergoes immune therapy and he keeps working. He just has to interrupt his schedule to get his immune therapy. But it's clear he doesn't lose his hair, things like that. So if he'd known about Creatine, he might have even danced through the halls after his immunotherapy.

[00:29:23.950] - Dr. Lemanne

Well, I just looked up the abstract of one of the studies that talks about this, and this is from the journal Nutrients, published in 2021. And the authors are Bo Lee and Lily Yang, and they are out of UCLA. And they say in the abstract I'm just going to read one of the sentences. Creatine has been identified as an important metabolic regulator, conserving bioenergy to power CD eight T cell antitumor reactivity in a tumor microenvironment. Creatine supplementation has been shown to enhance antitumor T cell immunity in multiple preclinical mouse tumor models, and importantly, to synergize with other cancer immunotherapy modalities. So it goes on, but the idea is that, yes, it interacts with the energy systems of T cells, which are cancer fighting immune cells, and helps them out, gives them a boost. So it's just like your muscles.

[00:30:22.050] - Dr. Gordon

Yeah. So I was going to circle around, but maybe it links with this. I'm not sure. Now, I'm going to have to look up some of the details of this, but there was a study in Parkinson's patients where they really watched them for two years, and that's kind of an unusual length of time for a lot of Creatine supplementation. And Creatine has been used in pretty much every neurodegenerative disease you can think of parkinson's, Huntington's, ALS, Alzheimer's. And there's a lot of knowledge yet to be gained, but hopefulness in all those areas. So they took on these Parkinson's patients, 20 of them, and they got them up to 4 grams a day, not five. I don't know why, but anyway did it for two years. They had no adverse effects and what they noticed in their monitoring was some marked antiinflammatory effects in such a way that they thought it might be useful in inflammatory bowel disease. And now I'm going to have to look up and see what the role of T cells might be in inflammatory bowel disease, but sounds like it's a potential, not just cancer immune and antiinflammatory aid for all of us again, should be in the water.

[00:31:43.010] - Dr. Lemanne

I agree with you. And I'm looking up here on PubMed and I found an article. Creatine supplementation for patients with inflammatory bowel diseases. A scientific rationale for a clinical trial. So it sounds like people are thinking about how we might study this to see if it's of use in that particular realm.

[00:32:04.630] - Dr. Gordon

I have a feeling this is going to be one of those suggestions that I start passing on really to all my patients rather than just 75% of them. And then I get reports back that supplement made all the difference in the world. I think we talked about this recently. We were talking about hair falling out. It was one of my patients who told me that, oh, when I finally got my protein uo, my hair stopped falling out. Well, now we're going to learn other things from casting out the pearls of Creatine wisdom to as. I'd love to hear what people's stories are about this and what kind of response they have. And what I particularly am waiting to hear from some of my more sensitive patients is are there any people who do have any downsides from it? Because so far I don't really know of any, do you?

[00:32:50.310] - Dr. Lemanne

I don't. Again, there are a couple of preclinicals trials that suggest that metastasis might be affected, but again, that's really early information and other trials in looking at whole people suggest that Creatine is mostly good. So I would summarize by saying that if you're an athlete, if you're an older person, if you're female because females have lower body stores of creatine in general, if you're a vegetarian, if you have a neurodegenerative disorder, if you have cancer, especially if there is any wasting of the muscles from your cancer. If you're a cancer patient on immunotherapy, all of those people will want to consider creatine supplementation. Of course, discuss it first with your own doctor or healthcare provider to make sure that it's safe for you. But if it is, 5 grams a day is a good place to start and you may see some benefit. You may want to. Do some N-of-1 testing to see if you feel better on or off of it for various periods of time and take notes, let us know.

[00:33:59.600] - Dr. Gordon

That's great. And if you figure out a way to get people who are not intentional supplement takers to self dose regularly, please let me know.

[00:34:09.230] - Dr. Lemanne

I think the little sugar jar on the table is the little antique. I think that's a good plan.

[00:34:14.600] - Dr. Gordon

That's a good start I'm working on. I think it has to be given better pride of place to garner the proper attention it deserves. Well, this has been a lot of food for thought because this is a topic that I've really just thought of as muscle and muscle feeding brain. But there's so much more to it, so I imagine we'll even have more to talk about as research accumulates.

[00:34:42.450] - Dr. Lemanne

Oh, definitely.

[00:34:44.330] - Dr. Gordon

Great. Good talking to you today.

[00:34:46.220] - Dr. Lemanne

Great talking to you.

[00:34:47.120] - Dr. Gordon

See you next time.

[00:34:47.870] - Dr. Lemanne

Bye. Bye.

[00:34:48.340] - Dr. Gordon

Bye. You have been listening to the Lemanne Gordon podcast where Docs? Talk shop.

[00:34:56.720] - Dr. Lemanne

For podcast, transcripts, episode notes and links, and more, please visit the podcast website@docstalkshop.com. Happy eavesdropping everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[00:35:33.040] - Dr. Gordon

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[00:35:45.070] - Dr. Lemanne

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[00:35:59.610] - Dr. Gordon

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[00:36:06.380] - Dr. Lemanne

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