Dr. Darren Candow, PhD, CSEP-CEP, serves as Professor and Director of the Aging Muscle and Bone Health Laboratory within the Faculty of Kinesiology and Health Studies at the University of Regina, Canada. His research program is internationally recognized, focusing on developing lifestyle interventions that combine nutrition, particularly creatine monohydrate, and physical activity, specifically resistance training. These interventions aim to address the practical and clinical aspects of improving musculoskeletal aging while also reducing the risk of falls and fractures.
Dr. Candow's expertise in creatine left us astounded, delving into a myriad of myths, facts, and the broad-ranging benefits of creatine supplementation for individuals of all backgrounds.
Dr. Darren Candow, PhD, CSEP-CEP, serves as Professor and Director of the Aging Muscle and Bone Health Laboratory within the Faculty of Kinesiology and Health Studies at the University of Regina, Canada. His research program is internationally recognized, focusing on developing lifestyle interventions that combine nutrition, particularly creatine monohydrate, and physical activity, specifically resistance training. These interventions aim to address the practical and clinical aspects of improving musculoskeletal aging while also reducing the risk of falls and fractures.
Dr. Candow's expertise in creatine left us astounded, delving into a myriad of myths, facts, and the broad-ranging benefits of creatine supplementation for individuals of all backgrounds.
Welcome to the Sports Science Dudes. I'm your host, Dr Jose Antonio, with my co-host, Dr Tony Ricci. You can find us on Spotify, Apple Podcasts and YouTube. Our special guest today is Dr Darren Kandau. Dr Kandau is a full professor. He's the past associate dean of graduate studies and research. I can't imagine how much fun being a dean is. Supervises the aging muscle and bone health lab in the faculty of Kinesiology and Health Studies at the University of Regina, that is, in beautiful Canada. He serves on the editorial board for Nutrients Frontiers, the Journal of the International Society of Sports Nutrition. He also serves as a Sports Science Consultant for everybody. He is the expert. Now, the best news, though I'm not even sure Tony's aware of this, but Dr Darren Kandau will be the Holtman Harris the Harris Holtman keynote speaker at this year's ISSN conference.
Speaker 3:We like that All right, Anybody that springs by the way.
Speaker 2:That's right. Yeah, an amazing honor, thank you.
Speaker 1:So we are very happy to have Dr Kandau back on the show. And before we start, tell us you know we get in some of the creatives and stuff Tell us about. You just attended a sarcopenia conference. I'm sure you'll address this, but my difficulty with the sarcopenia field is I have yet to see a definition that says hey, you're sarcopenia, yeah, so tell us about the conference.
Speaker 2:Yeah, this conference goes on annually. They always switch it from Europe to someplace in the United States and this year was in Albuquerque and they literally just came out with a new consensus definition. To your point. It came out yesterday, over 107 different bodies and nothing's really changed. It seems like the majority of the definition, if you will, will hinder on muscle strength, then muscle mass and we can get on the nuances of actually determining that. But then they actually added in a third category, which is a little surprising, sort of regional or relative muscle size in relation to strength. So that sort of refers to a muscle quality. They've taken functional ability out and sort of now are considering that as a symptom of poor muscle strength and mass. It used to be in there but you know, performing activities of daily living, that's probably a product of low muscle strength, which is associated with muscle mass. But this conference is fantastic.
Speaker 2:They bring in all the heavy hitters and again they sort of go against the BIA and the DEXA's, and all that because we're measuring lean and it's almost near impossible to measure muscle mass. But they're really starting to promote MRI in combination with this D3 creatine. It's probably a way to do it. I sort of still support the DEXA because at the end of it, even if half of it is muscle, you're still seeing some change, highly likely that organ and bone and that will change, especially as we get older. But if an older adult puts on 1.5 kilograms of lean, even at a rough estimate that's 700 grams that's a lot of increase. Keep in mind we're losing. So if we can halt that process, so it is. I understand the nuances, but it's something for our graduate students and undergrads to accept. When they go on the in body or the DEXA there's always a bit of caveat and without doing an autopsy, even with MRI, there's going to be a little bit of a trade-off. So that's something to consider.
Speaker 1:So there's not. Age is not part of the definition. You know age-related loss with skeletal muscle mass and strength. You could be sarcopenic at age 30.
Speaker 2:Yeah, there's actually saying now that that age number is sort of not as important, because we're look at some of our university students in act of not really performing activity, poor diet they could actually have some biological traits of aging muscle that we never thought was possible. So again, the age is still there, but it's now becoming a global idea. Looking at all age ranges.
Speaker 3:So so, Dr Dan, so actual skeletal muscle or the actual cellular loss, even at that young age?
Speaker 2:What we're starting to seize. The inactivity can cause a whole catastrophic events. It's called a disuse atrophy and a lot of individuals who are completely sent here. Look what happened to COVID in Canada. Here the government says you can't go outside, you need to stay at home, and so people were forced to be inactive even if they were able to go outside. And then you look at some areas of harsh winters and things like that.
Speaker 2:But obviously starting in the fourth decade, accelerating fifth, sixth, seven decades, when the biological process really occurs. But around the start of that fourth decade, alina Volpe actually shows some really good data that we don't need to wait till the fifth or sixth decade. The processes are occurring and the big new thing is we've kind of had an idea about sarcopenia. You know all the muscle fiber loss and hormones. But this low grade inflammation is really coming to the forefront where we're having these cytokines in the blood. And it kind of makes sense when you ask someone in their 40s and 50s, compared to their 20s, they're like God, I'm hurting myself more, I can't lift nearly as much heavy weight, I seem to be taking Advil more just to get through the day, and it's this low grade inflammation that we start to see as being a main factor in this catastrophic loss of muscle and or strength.
Speaker 1:Yeah, now you know, we have operational definitions for a variety of things and, whether or not we agree with them, at least there's a definition Like, for instance, if your BMI is over 25, you know you're supposedly overweight, Right? So in terms of strength, how low does your strength gotta be before you're sarcopenic? Now, I do mostly upper body exercise because that's what paddling is. Is it possible? Cause you know, I wrote down in my notes you're talking about regional muscle mass and strength Is possibly sarcopenic in one region and strong in another. I mean, I could see that happening.
Speaker 2:That's a million percent correct. So this is interesting, that the global measure is still the hand grab. So you look at the amount of muscles and anatomical areas involved in this highly correlated. There's been a few new studies coming out that maybe lower body, like leg press or whatever, is a better surrogate because we're losing those greater muscle fibers in the leg. But they simply use either chair stand, which they consider a measure of strength, but hand grip seems to be the global measure. It's easiest cost efficient. But you're right, you would think of someone in the Tour de France lower body, highly endurance strength, upper body why would they need to worry about that so much? But there's now a push that I personally think lower body is more important than upper body because the larger muscle groups are ratifying. But getting off the toilet, carrying groceries, doing things still require upper body strength. So I'd like to look at it from a global perspective. But you're right, you could have segmental areas and that could be catastrophic.
Speaker 1:yeah, but then the question is when are you sarcopenia? I guess I'm trying to get to the definition. I mean BMI over 25, you're overweight? Okay, we may or may not agree, but at least there's a definition.
Speaker 2:They're approaching now just north of 20 kilograms of strength in both hands for the hand grip. But we don't really know calf quadricep, things like that, so it's a low threshold. Usually it's having a hand grip strength of 20 kilograms or more is the minimum or the barrier for sarcopenia. That's for men and women. It would range a little bit more for men, but that is the low point. When you're diagnosed with sarcopenia, gate speed is 0.8 meters per second and then lean tissue. We just don't know because we can't really measure exactly what's happening.
Speaker 1:Tony, I'm sure you've done a lot of hand grips in your labs and I'm telling you, there's a lot of college-age women whose hand grip is not 20 kilos.
Speaker 3:Definitely not. It's a matter I do it a lot in fighters. It's not used a lot in fighters, but I think it's a valuable tool actually. But yeah, we do the grip dynamometer. Dr Janine does it more now but nevertheless I've had a lot of people not reach that, to be honest with you.
Speaker 2:Yeah, and keep in mind those numbers are primarily based on adults in their fourth or fifth decade and above. To have the numbers relevant down to a young age is very difficult to extrapolate. I think what's gonna happen is the percent change when they start. Let's put them on an exercise program, high protein, and then see if they can approve over time. But the hand grip is very isolated movement. I know it's correlated with a lot of functionality and foam morbidities, but it's a very unique tool. If you've never tried it, it's squeezing isometrically on this hand grip. If you're not used to it it's very odd. But if you put a young female under a squat or a leg press, they're probably gonna have a lot greater strength because it's more specificity. It's very interesting to take our athletes and say we want you to grip this isometric device and they're like geez, I'm always underestimating because I'm not used to it. So that's a caveat, it's a measure, but I think gloating the percent change over time is way better. Yeah.
Speaker 1:And you have guys on social media that argue over the best predictors of longevity and we're sort of digressing to another area. But this is kind of interesting. So you can use hand grip, which it's a basic measure of functional strength, and some people say VO2 max, which is now you're doing something else. So I know Peter Atia. He loves saying, well, max VO2 is the greatest predictor of longevity, when to be honest, I don't even know my own max VO2. Tony, have you ever measured yours? I have no idea.
Speaker 2:I have actually. Oh, yeah, yeah so most people that doesn't even be a problem. Yeah, and I would totally disagree with that. I mean, how many people go in and choose their max VO2 when they're unaccustomed to it? Yes, that'll measure the amount of oxygen coming in, but we have way better biological markers that you can now profile. That's like saying your bench press 1 RM is the best predictor of longevity. You mean, that's all a caveat, yeah.
Speaker 1:Right, yeah, because by the way, tony, what was your max VO2? I'm curious about it.
Speaker 3:I was not 49. Hey, that's not you know what I bet.
Speaker 1:You're higher than a lot of your students.
Speaker 3:Well, I would say this for my body weight, I think it's pretty good. I'm not let me be. You know what I'm saying. When I stretched 5'7", 211 pounds and you know a 30 inch waist, I mean I don't think that's a good VO2 build, but yeah, so if it is according to VO2. Guys, by the end of this podcast you'll be reading my last rights.
Speaker 2:And it's interesting, although it was a circle peony conference, a big emphasis was on the mitochondria, which is primarily aerobic based. Here we have circle peony. We always thought lifting weights was the only thing and now a lot of new research is suggesting the mitochondria is really implicating and predicting longevity. So maybe not VO2 peak or max, but it's that cellular aspect, telomeres, reactive oxidative species. And so the question comes what's the best form of exercise to increase mitochondria? And if you look at the data, it's aerobic, it's not resistance training. Both are good. But then we look at this low load, high volume training which is kind of like resistance training, cardio, especially for older adults. Could that lead to mitochondrial biogenesis? But one of the hallmark things from this conference was that how the emergence of the mitochondria is really predicting mortality, morbidity, falls and fractures. And it kind of makes sense.
Speaker 2:This organelle does everything right Successful aging. It sort of spits out reactive oxidative species, creates ATP. We'll talk about creatine, it shuttles it. So it's one organelle we've all heard of for the ATP or power host of the cell. But when we think of circle peony we always just thought of weightlifting. But if we can do both, I think that's the biggest prescription we can take home is you got to do cardio, you got to do weight training and that's going to be the fountain of youth, I think.
Speaker 1:Well, what if you do an exercise like I? Talked to a lot of rowers and for people who've actually rowed in a race you'd almost have to admit there's a resistance training component. And I paddle out here in the St Lucie River in Audley. I never see paddlers but I see rowers like single rowers and to me I'm thinking they're using their legs, they're using their upper body. Is that not sort of a combination of aerobic training with resistance training?
Speaker 2:100%. If you look at their body, they're extremely muscular, strong. Their endurance is off the chart. If you were to do a biopsy, their mitochondria would completely fill the size of the cross-sectional area. So if you look at some of these athletes, like the resistance against wind, current and absolutely so, it's a form of concurrent training but you're sort of getting everything out of it. And I'll be honest, if you put me on a roll where I'm gasping about four minutes because of the resistance and I'm like geez, that's really really difficult. It's kind of like doing a wind gate. You put resistance on and it's really really daunting. And I agree, anything that you can add in resistance to a cardio or overall longevity is probably better off for you.
Speaker 1:So you're giving the Harris Hultman keynote at ISSN Again. The conference is June 18 to 20. The website for it to register isisnnet. That's isisnnet. Can you give the audience a little sneak peek? I know there's new stuff coming out with Creighton. It's sort of like if you go back 15 or 20 years. My advice is always hey, take five grams a day it's great for your muscle. You'll saturate it, you'll be a little stronger, it might help your brain a little, but there's really new stuff coming out and it's really kind of fascinating.
Speaker 2:Yeah, I'm super excited. So I've titled it the Evolution of Creatine Research and, to your point, I think we're gonna sort of open the door and look at all the new areas, including dosing, frequency. That creatine has sort of been looked at and it was originally designed to be for bodybuilders and athletes and now we're gonna start to look at does the tissue of your body dictate how much? What are some of the benefits? So we're gonna go all the way back to 1832 and look at the pioneers and then we're gonna go to all the other areas. So I think it's gonna be super exciting. I've started to work on it already because I really wanna sort of bring in all those new facets. Like when did we ever think pregnancy or children would come into the realm of creating supplementation? What about concussion and depression? So it's taken on a whole evolution, not just for getting bigger, stronger, faster. So I'm super excited. To sort of put it all into a nutshell, if I can, yeah, Very neat.
Speaker 1:Is there population data on who consumes the most creatine, what country, what nation?
Speaker 2:To my knowledge, serge Ossi would have that. He's put out a few papers on dietary creatine. I don't know. My guess is the Scandinavian countries with the high seafood content, but I'm not off the top of my head. I don't know the country that would lead that Then you would bring in Asia. My God, seafood would be the highest concentration. I don't know. Those are the two areas that come to my mind.
Speaker 1:Yeah, I mean, I don't know either. I've always guessed that it's Japan only because Japan. But again Japan. The population in Japan exceeds all of Scandinavian countries combined, but they consume 20% of the world's fish. That's a lot of damn fish.
Speaker 3:And a lot of it's top water and speed fish like tuna.
Speaker 2:I mean some bottom, but a lot of it's more of the those fish with the higher creatine loads too, and another big thing is now, with a huge focus on plant-based diets, vegans, vegetarians it's almost becoming a push now that creatine may be considered essential for certain individuals. If they're not getting enough and there's been some papers now looking at just your dietary creatine If it's not getting a substantial amount or a minimal amount, could that be impairing your not only performance, but what about cognition and brain function? And you know I always think of now, with the Paris Olympics coming up, athletes may be taking creatine for performance, but what about late in the quarter? You know the mental clarity and focus and fatigue is going to come to that and I think creatine is something to at least consider and I'd be shocked that the Paris Olympics, if not a lot of athletes, have heard it or at least consider and taken it, not for the performance, but maybe the cognitive and mental activity affects you.
Speaker 1:Tony, do you take creatine?
Speaker 3:I do. Yeah, I use low dosing, no more than five, and I know that the cognitive benefits, I think Dr Darren and Dr Scottie Forbes, you know they want 10 or more. The only problem with that is I am high responding, you know I'll put on 11 pounds and 10 pounds on 10 grams and I just don't need that extra weight. So it's been challenging to balance the right amount.
Speaker 2:Yeah, and at the I says, ann, I'm going to try to break it up with some strategies to help decrease that. You know, maybe acute water retention or weight gain. And now we're looking at some studies with multiple, smaller, frequent dosages and the 10 grams. In my opinion it seems to be hitting the whole body. But Serge has put out some few papers. If you're looking at it from a cognitive perspective, and four grams can get into the brain, if you're you know, okay Over time. But I still would probably say, from a simplistic standpoint, three to five grams. If you say, hey, I'm taking this for the health benefits, that's still going to be viable.
Speaker 2:My guess is it has to eventually accumulate in the bone and brain to give you those benefits. And if you're worried about the weight gain and all that, that's why I think the loading phase is probably only for those high caliber athletes, or post immobilization is some area we're thinking. You need a really rapid boost, obviously concussion or things like that.
Speaker 2:You would need something If you're, you know, adequate and healthy. I think the three to five grams, maybe even up to a little bit more, that could be beneficial. I'm always sleep deprived so I take 10 grams just for the weight and it can help out. But I've really noticed it's almost like I require less sleep now that I've increased my dose and the thought here is it maybe increases brain bio and energetics and it recovers the brain quicker. But if I'm flying to Europe or I just got back from New Mexico no time change, but I do notice air flight I get really foggy and I try to take 10 grams as much as I can. I break that up into two five gram dosages, but you could break that up into multiple smaller or I trade it up. Whatever works for you is great. I think the key is exercise and if you're having adequate protein and creatine on top, that would be more than sufficient, way more than what the population is getting.
Speaker 3:Did this, uh yeah, I mean that. I'm sorry. Just wanted to add that, by the way, if I don't have mercury poisoning, I don't think you can get it, because. I eat two fish meals a day almost every day anyway, so and mostly tune on some stamina and sardine. So those are pretty good, right, Dr Daren? Their load for creatine.
Speaker 2:Yeah, so there's something that's always overlooked, right, we always think of a powder, but you've admitted now you're eating maybe two to three servings of seafood a day, your natural production in the liver and brain. You may only need a small amount and then it adds up to 10 grams, right? So it's interesting that we often forget what we're eating and then naturally making. And if you're eating two or three servings of seafood a day, you could be well-rest assured. You're probably synthesizing of three to four grams and then if you add in a few more, that's gonna accumulate over time and the whole thing clearly showed three grams was adequate to saturate your muscle. Now the question comes in do we excrete that extra down the toilet or could some trickle into your bone and brain? That's what we really need to determine?
Speaker 1:yeah, is there data on? If you get untrained people and you supplement them with creatine, but one group would resistance train and one group does aerobic training. Is there a difference in uptake into skeletal muscle?
Speaker 2:So no study has done that. Bruno Gualianos has been the closest. But the thought is from Rogers' elegant study in 92 that prior muscle contractions will increase the uptake. My guess is actually aerobic might do more because you have more continuous muscle contraction. We don't think it's the load that's causing the transporters to open, we think it's the stimuli from the muscle. So maybe aerobic exercise would cause more creatine uptake. And in his study, to his point, he did cycling. So there goes the show that maybe cycling or continuous muscle contractions is a way to augment it. I always tell people they say oh, how much sugar? Should I put it in protein? I said you know the best way to do it is if you exercise, exercise first. That'll accelerate it in. If you're really worried about boosting it protein not sugar I would go with protein because it's gluconeogenic and you get all the benefits of protein. Go ahead, tony.
Speaker 3:Now just and the. So the we know that obviously we would think a type two fast switch would have a greater capacity for uptake. But that said, even with the endurance activity, I mean the fast switch are still going to be involved. But would we potentially do we know, darren, if we see an increase in that type one fibers ability to pull it in as well?
Speaker 2:You do. You see it in both the cross sectional inquiry and the increase. Obviously, the greater the demand on the type two fibers will have greater capacity to store it. But of course I'm sure that data is gonna be very nuanced now that we know we don't even express type two X fibers anymore. So our new technology is coming out with having a muscle fiber and of course, jose, you can talk about this from your PhD. But now the fiber is hybrid and and we're gonna wave in Belgium and Andy Galvin says we don't even have type two X anymore.
Speaker 2:I'm like, oh my God, now we're down to two A and so this is always changing and we're trying to always give people the best advice to at least exercise first and then try to understand. But you're right, when we start to do biopsies and we're you know Mike Roberts, I talked about his he comes up with the hyperplasian circle, plasma chiropractic. All of this is coming back to new life because I think when new technology and some advancements in other labs with sophisticated techniques, it's going to show in hand the fiber split. I agree, I'd be shocked if there's not hyperplasian. Some of these Olympic bodybuilders you know, 300 pounds and or lifting thousands of pounds. Maybe the fiber just splits and we just didn't have the technology to measure it. And I know from the clay all to the cat, why would the human muscle look different? And I'm really excited for the next 20 or 30 years when we start to get all this new data to come out and sort of challenge the central dogma. Yeah, it's going to be fascinating.
Speaker 1:You know what, when you mentioned hyperplasian, it brought up something to have thought about which I have no intent intention of pursuing. It would be hard as hell. But the idea, way back when, when I did some of that work in birds and quail, of all things, looking at if there was a critical cell size, that muscle cells get so big and then they start to split because you got to, you got to have some sort of diffusion distance, you know, from outside to sell the inside, to sell water. What about this scenario? What if you did?
Speaker 1:You were doing regular, pretty high volume, high intensity aerobic training from a young age, you know, and you're competitive. Your cells, obviously you don't want them getting bigger because you want, you want to decrease the diffusion distance. Would there and again I'm just purely making stuff up Would it make sense for them to split so you have smaller fibers that decrease the diffusion distance from the capillary to inside the cell? I'm thinking it kind of makes sense, but it's not a question anyone's ever asked. I mean, I asked myself these questions on it. I never get an answer.
Speaker 2:It kind of. It falls out logical capillary density, right, you want to have less room for the mitochondria to grab hold at ATP and and all that. And if there's less space or more of the organelle, the cell has to work less or more challenging and it is more efficient. So yeah, that's absolutely correct, you know.
Speaker 1:I mean, I don't know about you, Tony, but I asked myself these questions only to come up with no answer.
Speaker 3:Well, I say that to my students all the time. Yeah, I'm more impressed if you ask the right questions when you leave, then they've given me the answers, because you know what, tomorrow the answers might be different.
Speaker 2:It's funny, it's the more we learned, the less we know it's exactly almost like now, the answers I don't know. I don't know. It's just it's becoming so and it changes every day.
Speaker 1:Like it's quite fascinating yeah now what one of the more controversial issues with creatin is supplementation in children and kids. And just Personal anecdote, my kids were young, they played travel softball for not quite a decade and we gave our kids creatin, we gave them protein and they actually were really good. I mean, our travel softball team was at times ranked number one in the country, which I mean there's a lot of travel softball teams. Now, whenever we, whenever the other parents were aware of it, they thought well, that's kind of crazy that you're giving creatin to kids, and I know it's difficult to do longitudinal studies on kids. You know it creates in supplementation. What are your thoughts on that, darren?
Speaker 2:Yeah, I really struggled to understand why a child or anybody can't take creatin for a few reasons. We're naturally producing it. If our body doesn't like it, it'll be excreted in our urine. It's made up of three amino acids and when you look at all the data, especially from Chad and Andrew, and now they're looking at blood biomarkers, I'd be shocked if there's any adverse effects. At a low dose, like if you're saying three to five grams a day, or zero point one gram per kilogram based on the size, I'd be shocked that a child or anybody can't take creatin because it's naturally produces, not a drug effect like a high dose caffeine. So I really do struggle. I understand the caution, for sure, just like pregnancy, but it's naturally in our body and if you take in more, our body just adapts or it gets rid of it. And when I look at all the data, I'm not seeing any adverse effects and I know Andrew and Chad are actually currently looking at the Blood biomarkers right now in children and I'd be shocked if there's any adverse effects compared to CBO.
Speaker 1:Yeah, I mean, if children are eating a lot of fish Meat, I mean obviously they're getting creatin, so but I mean I don't know about you, but outside of exercise science departments, and even sometimes within exercise science departments, but outside of it, whether it's in the Department of Medicine, department of Nutrition, it's actually quite a bit of a pushback it's, I mean, that's why we got to get these papers out.
Speaker 2:You know part one and part two, the miss and misconceptions and and ironically we'll still be. You know lectures and whatever it is and it's it's almost close. Creatine was so effective and we didn't have a lot of information on. People thought it was a steroid or whatever it is, and when it comes in a jog or a powder a lot of individuals are like, oh, you got to make sure it's safe and things like that.
Speaker 2:And but it's our job to try to just get evidence-based research. And what we're talking about Comes from laboratories and experiments were which are highly controlled and we've measured liver and kidney function, a cardiovascular function and in really high dosages and Again, it seems to be the safest, most effective ergogenic aid at normal dosages. The study we talked about in post-menopausal women 11 grams a day for two straight years and not a single adverse effect, more than 11. If you're giving 11 grams a day, that you know, that's almost four times as much as what's normally recommended For two consecutive years and there was no greater adverse effects. And you look at all the totality of evidence. I that's why I kind of put Creatine right at the top from a safety and efficacy standpoint and that would be 11 grams.
Speaker 3:Then you know generally probably we as body weight in the mail. So if you looked at the percentage you would be saying you're going up to 15, 16, maybe even 17 grams in the mail, right, if you equate it for body weight.
Speaker 2:That's correct and the key is that we Focus on a population that, as we get older, organ deterioration already can occur. And then we sort of saw no adverse effects there as well. And again, monohydrate it's identical to what's being produced in the brain and liver. The body recognizes it and, to be honest, if you have a little bit of a urinary creatine or creatinine elevated, that's fine. It doesn't cause any pose and more stress. And that's why we're super excited to get these myths and misconception papers out from Isis and the sort of tell the public, even in the sports industry, that hey, we're sort of looking at this from an evidence-based perspective.
Speaker 1:Now I have a question about. This is one of the more common ones I get about Pre-workout supplements that have creatinine they're like. Well, I read somewhere that caffeine can somehow counteract the effects of creatinine and and I mean I can do a lot of caffeine every day and I take creatinine, so I don't know. I know there's that one study, I forget the author, but it was got it, I think was 20 years ago. You know what?
Speaker 2:are your thoughts on that? Yeah, so my, my, my answer to this has changed a little bit, because people sort of went a little bit Crazy is like the intermittent fasting and killing you the other day it was on social media. So there's been about five or six studies done, and four have been very cellular and Peter Peter Hetzel was the study you've been thinking of and sure enough, they've shown that if you take creatine loading and then you take a high dose of caffeine, that's not coffee. So what would a high dose be? It was over 300 milligrams After the creatine loading phase. So in the US that would be what a large Starbucks or a medium Starbucks Maybe that you would find 300 milligrams and coffee maybe. And they've shown that they do oppose each other at the sarcoplasma reticulum.
Speaker 2:However, when you look at the other studies, if the dose of caffeine is lower than maybe 200 milligrams, which is the average coffee they're probably is not going to be an interference effect. To your point, we're actually doing this study now because people think caffeine is coffee and we're actually looking at creatine in different dosages of caffeine in black coffee. The sea doesn't interfere. My thought is I try to split it up just because we don't know. So I do pre caffeine workout and Licking coffee, and then I'll take creatine at the other times a day because really the timing doesn't really matter. But if someone says I can only put my creatine in my cup of coffee, I'm like go ahead.
Speaker 2:That small dose of caffeine and you take it really acutely is probably not going to interfere For those taking a pre-workout. By the way, there's a lot of other things in that compound. You're never going to know what's working, but if it works for you, great. I think a lot more long-term data needs to be done. But if you do look at the data, they do seem to oppose each other from a muscle relaxation standpoint. We don't know. Does it impair muscle growth or strength?
Speaker 1:Which is really what almost that's what everybody's wanting. Yeah, so as long as my, my lean body mass goes up, who cares about muscle relaxation right?
Speaker 2:If you had to choose to Ergogenic ace for performance, you got to put caffeine and creatine right up there. Protein is sort of the staple of everything beta aline and bicarbonate and beetroot juice. But if you're looking for performance, creating and caffeine are pretty much neck-and-neck. When it comes to performance, protein does everything and creating kind of has a multifactorial approach. But for those interested in caffeine, we just put it with that phenomenal paper we answered and addressed a lot of questions and at the end of it is funny there's only maybe five to ten things that seem to have good evidence that work, but a lot of other things don't. And that's why some of these influencers or podcasts and some of these talk shows that are promoting things that Everybody knows doesn't work and if Huberman puts an eye you know it's just you got to take it with a grain of salt to make sure it does work and it doesn't right.
Speaker 1:So Well, you know the saying, it's like simple works but complicated cells. So yeah, create I would just like you. I say creatine and caffeine, those are my top two, and then After that maybe throw in some beta alanine, maybe throw in some beetroot or nitrates, yeah, and then it, you know, and then it gets kind of tricky. It's like, okay, you could do carbon take, maybe during a race, or you know, if you need to go like it's Absolutely.
Speaker 2:I've never taken beta alanine or beetroot juice and stuff, but you can get a lot of that through the type of foods. But it's for specific right. If it depends what you're trying to achieve, yeah for sure.
Speaker 1:Now you, recently, I think it was this year there was a paper you were an author on it dealing with hemodialysis patient, which I thought was interesting, because when I think of creatine I'm not thinking of hemodialysis patient. I mean there's just, there are clinical issues that I don't you know, they just don't jive, but Someone thought about it and tell us a little bit about that study, because I was along, what I thought of yeah, long term study clinic population Out of Brazil and one of the big caveat team dialysis is the substantial loss of muscle mass and strength.
Speaker 2:So creatine could overcompensate some of those negative aspects, very similar to sarcopenia, and it had some profound, not beneficial effects there. No adverse effects on the kidney. Even further and again. So there again we're starting to branch off into the health aspects for clinical populations, which is a big area to move forward.
Speaker 1:Yeah, so there were no Untoward effects on renal function, liver function nothing, nothing, yeah and it was the dose.
Speaker 2:I can't recall right off the top of my head, but the dose, was it within a recommended average, for sure?
Speaker 1:Yeah, that's. I mean that's interesting that You're seeing a lot of the really cool research being done clinically it's. You know I've always thought, Okay, if you need a master's thesis, just do something on creative.
Speaker 1:We know it works. However, it's almost gotten to the point I don't know what you guys think, but it's like okay, I don't really need another study to show that creatine makes me stronger. Yeah, I know it makes you stronger. I know it'll increase lean body mass. I mean, obviously there's gonna be some variation, but some of this clinical stuff is really kind of cool.
Speaker 2:Yeah, oh, tony's on mute there, but it's, it's become almost more health aspect type of compound that we're looking forward to. And In my talk at ISIS and that's probably I'll focus how we the evolution is quite changed and, um, it's quite. We hit the roller coaster.
Speaker 1:now we're sort of having the momentum again, so that's really really good, yeah, you know it would truly be the wonder supplement if it decreased the risk of cardiovascular disease. Imagine to that, tony. It's like Decreases risk of CV disease. It's like, okay, what you know? There's a running joke, at least amongst a lot of my friends who I'll see here. It's like okay, what doesn't this stuff do? Does it treat ed? I don't know, does it Tony?
Speaker 2:I get that question almost every day what doesn't it do? And because it's quite shocked and some of the things will come out and I'm like you know we take it, you know if it's in a rodent model, you know it's extrapolate, but we got to have these long-term and and then you know some surprising Maybe didn't have the promise for the neurophysiological, like Parkinson's and ms and and things like that, but more research on concussion and things like that. So it's really going to be Something to consider and I think the neck up for the next 20 or 30 years sleep deprivation, hypoxia, Mental acuity is huge. Yeah.
Speaker 1:Tony, how much of this is known in the fight world in terms of creatinine, you know, sort of as a prophylactic for, you know, treating brain injury?
Speaker 2:Yeah.
Speaker 1:Oh, you're muted.
Speaker 3:Biopology. Gentlemen, we've had some technical. You can hear me now Correct. Yeah, okay, yeah, I think we're getting there. I think Um that, regarding that, I think the I think you have CPI has made this, you know, relatively well known, at least in the smallest circle of the combat world, because they have the opportunity to converse with these fighters, see them with great frequency and have that kind of an impact. So you know, of course Charles does wonderful work there. He's certainly um making sure that fighters are cognizant of the therapeutic benefits regarding the trauma and not only that potential cognitive performance. Um, but I think in it wrestling, I think Joey and Darren would probably be At the collegiate level. If you're at the Penn State level, you're probably learning about this because you're going to have the best.
Speaker 3:Rds you're going to have great staff, you're going to have great athletic trainers, you're going to have physical therapist and strength coach. I'm telling you, hey, let you know. Providing you can still make weight, let's get this creatinine. I think the UFC is making some advancements now because of the performance institute. Now, if you go back to sports such as kickboxing and boxing in itself, where there's really no, there's no central, if you will, a medium in order to dispense information like that, it's probably still well behind.
Speaker 2:Yeah, I'm, I'm. I get calls quite a bit, even from the national hockey league recently, and I was shocked that, uh, not all athletes have even heard or considering it and and, uh, you know, we, we always think we're doing a good job promoting it, but, to your guys's point, a lot of people just don't know. And you would think, at the professional athlete level, especially with the Olympics coming up, if something can help, and it's, it's approved by the IOC, it's safe and effective. But it's shocking to me when people say, oh no, we just eat whatever we want and I'm like, oh wow, that's kind of could be the big difference between a gold medal and a silver, or not even placing, and it's a big issue.
Speaker 1:Yeah yeah and uh, not just in a fight world, but in the endurance world At least. We know bodybuilders, powerlifters. They're cognizant of Creatin intake, protein intake and whatnot and, as you well know, in the endurance world it was very carbohydrate-sensing for many, many years, and convincing them to take at least consume protein, extra protein, to promote recovery, that by itself was really quite a task. Now we're telling them to take creatin. They're like oh my god, I just, you know you just convincing about protein. I don't know if I will this slow me down and and like for instance, my wife is a national class cyclist and I have run every supplement note Including a lot of creatin. But when you talk to cyclists at these races, yes, they're. They're like well, I just eat food and I'm like and okay, well, that's good, I mean, we'll keep the advantage. You guys just keep eating food and don't take supplements.
Speaker 2:Yeah, I think one of the most interesting findings was the benefits of creatine on long duration cardio. By decreasing inflammation post exercise, those cytokines are really suppressed and when you look at the mechanisms of creatine from being an anti-catabolic effect Any athlete that needs to train multiple times a week leading up to it it seems to have a lot of recovery, not just growth, perspective. So that's why in that paper for soccer, swimming Longer race by athelon iron man, when you're putting your body through hell for hours on end, this is where this compound can really help from a recovery standpoint. And of course, protein has to be elevated for the recovery process. But when people say I just eat food, I'm like, well, you're probably getting a lot of this anyway, but you know it's. It's okay to have a little bit more education on what might even help you a little bit more. Yeah.
Speaker 1:One last question and then, because we're running out of time, and this is again sort of a controversial area creates, in supplementation during pregnancy, the effect on the child? Yeah, so, hard to do a human study. I mean, and honestly I'm not sure how much you know how much I could put into animal, animal data. What are your thoughts on that?
Speaker 2:So, Stacy Ellery in Australia leading the charge here, and she's put out some good proposals or review papers and they use the animal model primarily and there's been a couple of cute, well supervised, medically supervised studies looking at some brain bio energetics and the developing fetus. So as it currently stands, a gun, you know, medical caution is highly advised. We don't know if creatine is going to get in the breast milk. We don't think so. But the theory of the oxidative stress and the high bio energetic demand for not only the mother but the fetus and creatine works exactly the same way for brain bio energetics. It could have some potential for decreasing some abnormalities. But I would say again, just like the neck up, that will be a focus for the next 20 or 30 years.
Speaker 2:When you read all of Stacy's papers you know it seems to be very safe at a low dose if it's monitor. But again, a randomized clinical trial, which is the gold standard, is not the meta analysis, is the RCTs that sort of drive. All these reviews, those need to be done with an adequate sample size and medical supervision. And the question often gets asked, you know, can I take creatine during pregnancy? And when? I always put it back to those articles. I say, as it currently stands, the answer is yes, but please talk to your doctor to make sure that it's safe and effective for you. So please start at the lowest dose and then question yourself why are you even taking it? Is it for the child? Is it for you for whatever reason? And and again, the caution is there, just like children. But again, it's naturally produced and we can see why there's potential for it.
Speaker 1:Yeah, yeah, and I would imagine one way to sort of get around the creates and supplementation would be to have pregnant women consume a lot of fish. Know, I don't know how much fish that would be, but I would imagine it's a lot of fish.
Speaker 2:Yeah, and I mean one kilogram of meat is about five grams, right? So if you're sure you're having one or two servings of seafood and your natural production, it could be elevated a little bit. And again, this is the area I think will be a real big push in the in the industry, from the health aspects.
Speaker 3:Yeah, just quickly know, joey, that's a great recommendation, but then a lot of physicians want the pregnant female to avoid. A lot of people certainly a large cross section of it due to the potential mercury implications. Yeah, but, but that would be a great option, assuming you're getting high quality seafood, yep.
Speaker 1:Yeah, exactly Now. Before before I let you go, darren, I do want to mention the ISIS and conference. It is June 18 to 20. It's in Bonita Springs, florida. If you need to fly in, you're flying into Fort Myers. The initials for the airport or RSW, so just keep that in mind. Rsw and Dr Kanda will be giving the Harris Holtman keynote lecture, so everyone will be there. So, darren, you got a razzle and dazzle the audience, because this will be all over social media. Give them good sound bites. They're going to want sound bites.
Speaker 2:I'll do my best. I can't wait, and it's a huge honor. I can't thank you enough.
Speaker 3:Yeah, tony any final words? No, just always. I learned a lot, dr Darren, and I appreciate that, and you know it's fantastic. We got a great, we got a great molecule here, so I hope we can make more people cognizant of it. Hopefully we'll have a topical one day, and I could just run on that's right, it's probably coming the same least.
Speaker 1:Hey, gentlemen, hey, thank you for being on the show. Dr Kanda, I will see you in South Florida very soon, absolutely. Thanks so much for having me on.