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The Wellness Blueprint: With Dr. Caleb Davis
Welcome to The Wellness Blueprint with Dr. Caleb Davis, where we uncover the secrets to living a long, active, and pain-free life. Hosted by Dr. Caleb Davis, an orthopedic surgeon and fitness enthusiast, this podcast is your ultimate guide to musculoskeletal health, injury prevention, and wellness.
Dr. Davis combines his expertise as a shoulder and elbow specialist with a passion for empowering people to take charge of their health. From deep dives into cutting-edge restorative medicine to practical tips on avoiding surgery and optimizing recovery, The Wellness Blueprint offers valuable insights for anyone seeking to preserve their body and thrive at every stage of life.
Join us each week for professional guidance, fascinating medical discussions, and actionable strategies that help you move better, feel stronger, and stay functional for years to come. Whether you're an athlete, a weekend warrior, or someone looking to age gracefully, The Wellness Blueprint provides the tools to design a healthier you.
The Wellness Blueprint: With Dr. Caleb Davis
Episode 22: Creatine 101: The Most Powerful Supplement You’re Not Taking
Creatine is a well known strength and endurance supplement. While bodybuilders have sworn by it for decades, groundbreaking research reveals it could be the brain-saving, memory-enhancing supplement everyone should consider taking.
This deep dive explores creatine beyond the gym walls. We break down the fascinating chemistry of how this small molecule serves as an energy reservoir for both muscle and brain cells by regenerating ATP – your body's primary energy currency. The research is staggering: studies show creatine can boost power output by 5-15% during high-intensity exercise while simultaneously enhancing short-term memory and reasoning ability, especially under stress or sleep deprivation.
What truly excites me about creatine is its emerging role in neuroprotection. Recent studies suggest it may help shield against neurodegenerative conditions like Alzheimer's and Parkinson's by reducing oxidative stress in brain cells. For aging populations, combining creatine with resistance training not only builds muscle but potentially preserves cognitive function – a powerful two-pronged approach to healthy aging.
Despite thousands of studies confirming its safety, misconceptions persist. We address common concerns including the myth about kidney damage and explain why the standard 3-5 gram daily dose of creatine monohydrate remains the gold standard despite fancier, pricier alternatives on the market.
Whether you're an athlete seeking performance gains, a busy professional wanting sharper mental focus, or simply interested in protecting your brain health as you age, this episode delivers the complete science on what might be the most versatile supplement available. Ready to understand why creatine belongs in virtually everyone's daily routine? Listen now and discover why this powerhouse compound deserves a second look.
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Hey everybody and welcome back to the Wellness Blueprint. I'm your host, dr Caleb Davis, and as usual, I'm joined by my lovely and talented co-host, nicole Davis.
Speaker 2:Hello Dr Big Guy, how you doing.
Speaker 1:Hey Nicole, I missed you.
Speaker 2:Oh, I missed you too.
Speaker 1:It's been a while since we've done this. Doesn't it feel like it's been a while?
Speaker 2:It feels like it's been a long couple of weeks, yeah.
Speaker 1:Yeah, there's been a lot going on. We'll do a couple housekeeping announcements, as some of you may notice, to our 12 loyal listeners. Give or take. We haven't been updating quite as frequently as we had originally hoped. We're doing more like every two weeks now. My goal now is twice a month to do episodes. Might pick up again in the future, but I'm not going to make any promises. We've had a lot on our plates. Work has been very busy A lot of people needing shoulder replacements and rotator cuff repairs and such. You've had a lot of people needing shoulder replacements and rotator cuff repairs and such.
Speaker 2:You've had a lot of really good things going on A lot of good things and. I always told him, Mr Overly Ambitious over there, that a weekly episode is a bit much for a guy who is a surgeon.
Speaker 1:It's true. It's true and, as usual, nicole's right about most things, and this happens to be one of them. That being said, we are in beautiful, sunny San Diego right now for the American Academy of Orthopedic Surgery meeting. So that's the biggest orthopedic meeting in the country, getting to reunite with a lot of friends, talk to a lot of industry, talk to a lot of people, getting up to date presentations on how to modernize orthopedic surgery. It's always a really good time, and we were actually back in Tampa a couple weeks ago for the Tampa shoulder meeting, which is where I did my fellowship. So I got to reunite with my mentors there and listened to a lot of just fantastic, groundbreaking presentations on shoulder surgery. So really nerded out in the shoulder world.
Speaker 2:Oh, he definitely nerded out. Pretty fun to see all of these very talented surgeons get all excited and their eyes lit up when they talk about shoulders. Yeah, it's always a good time and I really wished I had my t shirt made at that point. Talk shoulder to me. Yeah, yeah, it's always a good time.
Speaker 1:I really wish I had my t-shirt made at that point.
Speaker 2:Talk shoulder to me. Yeah, it's going to happen.
Speaker 1:It's going to happen. We'll do it. But this segues into our topic for today. I was visiting my old jiu-jitsu gym in Tampa and one of my friends there introduced me to a young lady. He said oh, dr Davis, we wanted you to talk to her because she'd been asking us questions about creatine, a very common, well-known supplement that people take for athleticism strength, endurance, nicole have you ever heard of creatine before?
Speaker 1:I have heard of it, but I honestly don't know if I could tell you what it is, Uh-huh. Well, hopefully this episode will be a little enlightening to you. Yeah, it's a very common supplement and a lot of people take it and it's been very well researched since the 1990s, so it's considered very safe. But I met this young lady. She had some really great questions and I'm hoping that we'll be able to cover some of these topics in the episode today. Then my sister also texted me and said hey, my 17-year-old son is interested in starting to take creatine. What can you tell me about it? Two different people asked me about creatine. I'd already started writing the show notes for this episode. I was like, okay, this is great. People really want to know about creatine and I think this is going to be a really helpful episode to some people.
Speaker 2:Great, let's get into it.
Speaker 1:Let's dive right into creatine. A lot of people think about creatine as being for bodybuilders Big muscles, lift big heavy weights good for building muscles but it's actually been studied in lots of different areas of athletics and performance not. It's been studied in lots of different areas of athletics and performance, not just bodybuilding. It's been very well studied. Thousands of studies have been done on creatine over the years, so it's considered one of the most researched supplements in the world.
Speaker 2:Nice.
Speaker 1:So let's break down into the basic definitions and chemistry of creatine. I know this is your favorite part the basic chemistry.
Speaker 2:Yeah, no, let's do it, let's do it.
Speaker 1:So the creatine's chemical formula breaks down into C4H9N3O2.
Speaker 2:C4, that's the stuff that explodes right.
Speaker 1:Yeah, a little bit different. It makes your muscles explode.
Speaker 2:It's a big big muscle. Oh yeah, I'm so glad you broke out the Arnold?
Speaker 1:No, but it's a small water-soluble molecule, meaning it dissolves in water, and it's synthesized from the amino acids glycine, arginine and methionine. If you remember about amino acids, we talked about that in the protein episode, remember? We talked about all the different types of amino acids there are. It's a very ideal small molecule that can help your cells produce energy and maintain energy stores and we'll get into that. So creatine is a nitrogenous organic compound and it plays a vital role in energy production, particularly in tissues with high energy demands, like muscle and brain tissue.
Speaker 2:Oh, brain tissue. You're giving people a lot of credit there for using a lot of brain tissue, Caleb.
Speaker 1:Well, I use a lot of brain tissue every day.
Speaker 2:I don't know about you, I know you do.
Speaker 1:I know you have to use your brain a whole lot just to be patient with me.
Speaker 1:Aw, I know you do, I know you have to use your brain a whole lot just to be patient with me. No, so classically, I think everyone has thought about creatine as a muscle supplement, but more and more in the last I'd say even just two to three years I'm hearing more and more buzz about cognitive protection and memory protection and improvement using creatine as a supplement. So that's what I'm really interested in, because this is more of a new area of research in terms of protecting from neurodegenerative disease and giving you better reflexes and memory.
Speaker 1:Gotcha, it's pretty interesting.
Speaker 2:What was that you just said?
Speaker 1:Memory.
Speaker 2:Yeah, and I guess I need some creatine. Yeah, see what I did there, nicole.
Speaker 1:I expect so much better from you, I'm sorry.
Speaker 1:You're going to really have to kick up your game. Okay, your have to kick up your game. Okay. Your body actually does make some creatine on its own. You can make it in your liver and kidneys and pancreas. It makes about one to two grams a day in healthy people. And then you can also get it from your diet, and it's almost exclusively found in animal meat. When you're eating it in your diet A red meat, a standard dose of red meat we might have about five grams of creatine per kilogram of mass, and fish is a little bit less, with 4 grams per kilogram of mass. But beef and lamb is considered to be the richest source of dietary creatine.
Speaker 2:Okay, so sorry you did say that. If someone were vegan, though, they don't eat any of those things.
Speaker 1:They're not going to get much dietary creatine without supplementing Gotcha. That's right. But here's a funny thing If you cook your meat at very high temperatures, that's right. But here's a funny thing If you cook your meat at very high temperatures, creatine can actually turn into a carcinogenic heterocyclic amine. Okay, we'll call that HCA for short. Just focus on carcinogenic. Do you know what that means?
Speaker 2:Oh, I do, that means cancer-causing.
Speaker 1:Right, it's like burnt bacon.
Speaker 2:I know about burnt bacon. There you go, because my family used to say they used to trick me when I was a little kid and I was the youngest in the family. So they were like, hey, nikki, you want to eat this burnt bacon and make it sound really exciting. And of course I was like, yeah, give me the burnt bacon. And then I find out 20 years later that they've pretty much given me cancer. Thanks, brothers.
Speaker 1:Thanks, mom. Do you think your family was trying to give you cancer?
Speaker 2:No, I don't think so. I think they were just like we want to eat good bacon and we're going to siphon this off to the little kid.
Speaker 1:To the little naive girl yeah, who loves burnt bacon? You like burnt bacon now?
Speaker 2:I can't love it. I try not to love things that are bad for me, except for my cat Turk yeah, I wonder how much creatine turk has hey you notice, I said 148 degrees celsius. That's pretty high okay, yeah, can you convert that?
Speaker 2:we're talking about like really charred, like high charred meats like the outside part okay, I don't know who would actually eat that, unless you're maybe dying 140 degrees celsius is 298 degrees fahrenheit, so well above boiling so, like even a well-done steak wouldn't even be that hot not internally, but the external temperature you can.
Speaker 1:People char their meats at 500 degrees oh, that's true.
Speaker 2:A lot of these fancy steak places, you can get a nice char right.
Speaker 1:So the majority of the meat doesn't get above that temperature. But the outside can't. But are you?
Speaker 2:telling me I spend $80 on a steak only to get carcinogens.
Speaker 1:That's right.
Speaker 2:Really.
Speaker 1:Not much.
Speaker 2:Wow. Well, that's okay you combine it with a nice neurotoxin like a glass of wine.
Speaker 1:Yeah, we got ourselves a winner there. Yeah, the way I cook my steak in the sous vide, I only get it up to 120 degrees Fahrenheit.
Speaker 2:Now, of course I do sear it in a cast iron pan briefly, but it's pretty minimal.
Speaker 1:It's pretty minimal on the carcinogens that should be how restaurants advertise these days now, like minimal carcinogens Our steaks are high in creatine and have minimal carcinogens.
Speaker 2:Let's tag it, it's ours.
Speaker 1:I think that restaurants should start advertising that our steaks make you smarter and stronger.
Speaker 2:Oh, I like it. What do you think? Yeah, let's do it. Do you think we should?
Speaker 1:open up a steak shop.
Speaker 2:I think you might have to, Caleb.
Speaker 1:Yeah.
Speaker 2:Yeah.
Speaker 1:All right, we've gone on a tangent already. We haven't even really gotten to the meat of this podcast.
Speaker 2:Oh.
Speaker 1:Yeah, that one was worse than yours.
Speaker 2:Yes, it was.
Speaker 1:So you may have heard, if you've read anything about creatine or gone shopping for creatine, you may see it in multiple forms, but creatine monohydrate is the formula which is most researched. It's most bioavailable, meaning it's most well-absorbed and taken into your bloodstream, and is generally just considered the most superior form. You'll find other things like creatine hydrochloride or creatine ethyl ester. These are all compounds that are not as well studied and sometimes have a higher price tag because people think that they're specially unique, but there's not really much research to show that they're any better.
Speaker 2:Ethyl ester. Is that what you said?
Speaker 1:Ethyl ester.
Speaker 2:Those are like names of two old ladies.
Speaker 1:Yeah, ethyls and esters have to do with the way molecules bond together, so there's a nomenclature. So that's what it's talking about.
Speaker 2:Okay, they're beautiful names. By the way, if you've named your child that, I like those names, especially Esther. I really like that one.
Speaker 1:Yeah, I won't tell Ethel and Esther. You said that they're old ladies. So if you've heard of creatine, have you ever heard of creatinine?
Speaker 2:I have, because I always get the two confused, right.
Speaker 1:I think a lot of people do. Do you know what creatinine is?
Speaker 2:It's not as good as creatine.
Speaker 1:No. So creatinine is a byproduct of creatine metabolism, so it's a marker that we can draw on your blood to see how well your kidneys are functioning, because creatinine is disposed of by your kidneys. So let's say you have a creatinine of 0.5 and all of a sudden we take your blood later and you have a creatinine of 1.5, so it's gone up three times of its original value. That would be a way of saying oh, your kidneys are in trouble.
Speaker 2:That's what happened with my first beloved cat, who passed from kidney failure Charlie, charlie, charlie had kidney failure. Yeah, yeah, you make me cry.
Speaker 1:You brought Charlie up. I didn't. I know I'm sorry. I like Charlie. Charlie was a good cat. Yeah, he was the best, much better than Turk. You know Turk's pretty great too. I think Turk is trying to always eat you and get you creatine. So creatinine is excreted in the urine at a steady state and serves as a marker of kidney function, like we discussed. Elevated creatinine levels often prompt concern about kidney health. But if you're supplementing creatine exogenously, meaning you're taking it outside of the body and you're taking it in pill or powder form, you can have an elevated creatinine. But this is to be expected. It doesn't necessarily mean that you're having any kidney problems. 95% of creatine in your body is scored in skeletal muscle as a compound called phosphocreatine, and when I say skeletal muscle, I'm talking about the muscles you use to move your body, things that are attached to the skeleton. You also have cardiac muscle and you also have smooth muscle.
Speaker 2:Smooth, smooth muscles. Does it play a smooth jazz?
Speaker 1:Smooth muscle is the muscle you find in your GI system that helps move your food. You can't consciously control it, but it's different than skeletal muscle.
Speaker 2:But is it connected to the vagus nerve?
Speaker 1:I'm sure it is.
Speaker 2:Can you?
Speaker 1:consciously or subconsciously control it subconsciously that's why you might have a nervous poop.
Speaker 2:Oh, hold on I was trying to get you there, oh you did.
Speaker 1:It's 12 minutes and 28 seconds. We said poop there you go all right, yep, you did it. Some people do have some autonomic sympathetic, parasympathetic reactions that might control their smooth muscle, but it's not really a conscious thing that can be done. All right, let's get back to creatine in the body. As we said, 95% of creatine is stored in skeletal muscle as phosphocreatine, and the rest of it is usually stored in your brain and some other tissues. Now, have you ever heard of a compound in your body called ATP or adenosine triphosphate?
Speaker 2:Yes, I have.
Speaker 1:Okay.
Speaker 2:I think so.
Speaker 1:This one. I wasn't sure if you'd have heard of it or not.
Speaker 2:It sounds really familiar. I think I've actually read about it one time when I was reading that bodybuilding, weightlifting book. I feel like it was talked about there.
Speaker 1:Yeah, so ATP is one of the main ways that our cells make energy, like it was talked about there. Yeah, so ATP is one of the main ways that our cells make energy, and especially in really high demand activities like sprinting or trying to lift something really heavy for one repetition, exerting lots of force for over a short amount of time. So there was a study in the Journal of Pharmacology called Clinical Pharmacology of Dietary Supplement Creatine Monohydrate. This was published back in 2001,. So it's a fairly old study, but it just reviews creatine's chemical properties, its role in ATP recycling, and it's a good review article for anyone who wants to do a deep dive into the basics of creatine. So let's talk a little bit more about ATP, adp and the concept of phosphorylation.
Speaker 2:All right.
Speaker 1:You want to.
Speaker 2:ATP, ADP.
Speaker 1:So adenosine triphosphate, adenosine diphosphate and the concept of phosphorylation, meaning when you put phosphorus on a molecule. Okay, I know People are still listening, right.
Speaker 2:Well, I think so you might just lose us quickly. Yeah, probably I better go quick, okay.
Speaker 1:So let's just break it down to basics. Atp is the primary energy currency of the cell. Energy is stored in high-energy phosphate bonds between three phosphate groups, which is where we come up with the name adenosine triphosphate. When energy is needed, atp is hydrolyzed down to ADP diphosphate. So basically, when you break that bond of the third phosphate, it creates a large amount of energy. Think of an atomic bond. When you start splitting atoms, it creates large amounts of energy. It's not exactly the same, because we're not great breaking bonds in a single atom, we're breaking different atoms apart. But it'll do for the purpose of imagery, I think.
Speaker 2:Okay, all right.
Speaker 1:Nicole is asleep.
Speaker 2:No, I'm just going to listen politely.
Speaker 1:So during intense exercise or any time that you have high cellular demand, atp is rapidly depleted because your cells can only carry so much Phosphocreatine. The type of creatine that's stored in your cells holds basically an extra reserve of phosphate in your cells. So when you would normally run out of ATP, your phosphocreatine basically is here. Take this phosphate we've been holding onto you so you can keep making ATP. So basically that's the way that creatine is able to give you longer bouts of energy and help you increase your endurance.
Speaker 2:So it's storing it, and then, when your body runs out of its ATP, it's like throwing it out as you as. Come on, buddy, you got it. Get through the final stretch of this marathon.
Speaker 1:That's what creatine does for you.
Speaker 2:Okay.
Speaker 1:So that's the most basic way of thinking about creatine is it is a storage buffer for phosphate, so that your body can create more energy.
Speaker 2:Nice got it.
Speaker 1:Creatine actually helps maintain intercellular pH by buffering hydrogen ions when you're creating all this energy. Now, if you think, the higher the hydrogen ion concentration, the more acidic the environment becomes. So creatine helps make your cellular environment less acidic as well, as you're having to create a lot of energy by exercising. Your acid levels basically build up in your cells.
Speaker 2:Like the lactic acid.
Speaker 1:Like the lactic acid, and creatine helps buffer that and make it less acidic. So the more creatine you have in your cells, you have more phosphate and you're helping buffer acidic environments.
Speaker 2:Cool.
Speaker 1:Okay, so we'll get through a couple little things about the mechanism of action that we haven't covered yet and then we'll move on to the fun stuff. I promise Creatine is directly involved in ATP regeneration. Creatine draws water into muscle cells, promoting cellular swelling and signaling for protein synthesis, meaning building more muscles. It also enhances mitochondrial efficiency by reducing oxidative stress. Enhances mitochondrial efficiency by reducing oxidative stress. Now we've talked about oxidative stress a couple times on the show, thinking about free radicals that are produced during cellular metabolism that might damage DNA, that this is helping reduce that.
Speaker 2:Okay.
Speaker 1:How does it protect neurons and brain function? Creatine provides an energy buffer for neurons during metabolic stress, such as hypoxia or ischemia Hypoxia, meaning oxygen is cut off to tissues, or ischemia, hypoxia, meaning oxygen is cut off to tissues, and ischemia, meaning blood is cut off to tissues. So it helps. Basically lets your cells live longer without good blood flow or oxygen flow. So if you are in a situation where that happens, if you have more creatine, you're in less danger.
Speaker 2:So somebody is trying to win the hold your breath, the longest competition.
Speaker 1:They maybe are like training with a lot of creatine yeah, or let's say you are being choked in jujitsu or let's also say you have uh, someone pulled you out of the ocean and you haven't been breathing for a few minutes. And your brain? You're having brain damage. These would be situations where you had blood flow restriction.
Speaker 2:Right, so you want to just always be on creatine?
Speaker 1:I'll let you take that away from this episode if you want to, but there's not many downsides. Normal muscle holds about 120 millimoles per kilogram of dry mass but supplementation, like millions and millions of moles, it's a way of measuring the number of molecules in a tissue. I like it.
Speaker 2:Millimoles, millimoles.
Speaker 1:So normal muscle holds about 120 millimoles of creatine, but if you start supplementing it you can push it up to about 160. So it's a pretty dramatic increase. So basically, you can have more phosphocreatine, meaning you have more power and less burnout and more endurance. All right, briefly, the history of creatine. You want to go back?
Speaker 2:go back in time with me to france it's 1832, we're in france can you hear the people sing? Chemist michael eugene, chevreul, chevreul oh my, anybody who speaks French is like vomiting right now.
Speaker 1:I don't know how to say his name, michael Eugene Chevroule is tinkering with a water extract of skeletal muscle. He then isolates a crystalline substance and names it creatine, from the Greek krios, which means meat. So this is something he extracted from muscular tissue. Extracted from muscular tissue Fast forward to 1912,. Harvard researchers Otto Fohlen and Willie Glover Dennis show that eating creatine can boost muscle levels dramatically by the 1920s. Studies confirm that bodies store it rather than flushing it out when taken as a supplement. Now that's important because you may have heard that people say oh, you take multivitamins and minerals and things like that and you're just peeing it out right.
Speaker 1:Yeah, like too much vitamin C, you ever heard people say that You're just making expensive urine when you take supplements and vitamins.
Speaker 2:Yes.
Speaker 1:Creatine has been pretty well-roundedly proven that it actually is going inside your body and being utilized when you take it.
Speaker 2:Sounds like it's been proven for the last 100-plus years.
Speaker 1:Sure, but it's becoming much more popular, although it has been popular for a while. In 1927, the phosphocreatine that we talked about was discovered, and by the 1960s we learned that creatine kinase uses it to regenerate ATP from ADP, which creatine kinase is just an enzyme. So all of these puzzle pieces put together start to show the picture of what we just talked about. Creatine hit the spotlight after 1992 in the Barcelona Olympics, when a sprinter named Linford Christie had reportedly used it and had a great performance. Actually, Christie won the gold that year. He would go on later to face charges of using doping for his performance, so it may not be directly attributed to creatine. However, it did start to catch the public's eye In 1993, shortly after a company called Experimental and Applied Sciences, or better known as EAS, which is a company that's still around launches their first form of creatine supplement, which really started the entire creatine revolution.
Speaker 2:I feel like I could come up with a slogan for creatine which is don't be a dope, take creatine.
Speaker 1:You know, keep working on it. We're tired guys. We're in a hotel room.
Speaker 2:I'm probably making my poor granddad roll over in his grave because I'm pretty sure he worked for the Mad Men marketing executives creating slogans and stuff, so it missed the mark on me.
Speaker 1:Personally, I think we're both just tired and we haven't had enough creatine or red meat. I think I think we need more okay, let's get some this is the first time we've ever recorded a podcast in a hotel room and not in our own studio that's true, I think we're just out of our element.
Speaker 1:personally, one of probably the most well-known historic articles regarding creatine was a type was a journal article called muscle creatine loading Loading in Men in the Journal of Applied Physiology in 1996. This seminal study showed that ingesting 20 grams of creatine daily for six days increased muscle creatine by 20%, with no excretion proving that the body is able to store it, and it also showed that pairing creatine with high glycemic carbs, like juiced, actually boosted the uptake, which is something that some people are still doing taking high carbohydrate foods right after exercise to help boost creatine uptake.
Speaker 2:I remember when you used to drink chocolate milk after yeah.
Speaker 1:I miss those days. I wish I still drank lots of chocolate milk.
Speaker 2:I guess you could. There's nothing really preventing you, right.
Speaker 1:No, I guess not All right.
Speaker 2:Yeah, man preventing you right?
Speaker 1:No, I guess not, man. Those were the days I used to drink chocolate milk during my workouts.
Speaker 2:Oh, wow, yeah, in med school.
Speaker 1:So, as we discussed, you don't need to take creatine. Your body can produce it, although supplementation, I think, as we pretty well established at this point, dramatically increases your normal stores and can dramatically increase your endurance and strength, and also protein synthesis, which is not necessarily commonly associated with that in the public eye, I think, but it can actually help grow your muscle tissue. So you've listened to the podcast episode. You want to take creatine. Creatine is awesome. Creatine is awesome. We're going to take creatine. Where do you begin idea?
Speaker 2:yeah, my first. Actually, I have questions more than anything my question is it tasteless?
Speaker 1:yeah, creatine in its powder form is pretty tasteless nice it does dissolve in water to a degree, but it's really more like a suspension rather than perfect dissolving. It does you know, when you slush around sand in the beach? It floats in the water, but it eventually will settle. Okay, creatine is more like that, and so you stir it in your water and drink it. There are other forms where it makes it more dissolvable, easier to drink. They have flavored powders and varieties. We'll get to that.
Speaker 1:There are studies that have showed that you can do something called a loading phase, because you can saturate your muscles with creatine. There are some people that advocate taking 0.3 grams per kilogram of body weight, which comes out to around 20 grams for a 70 kilogram person. So that's 20 grams in a day, which is a pretty high dose. Some people advocate that you do that 20 grams of creatine a day for about a week. They call that a loading dose, where you saturate your muscle tissue to the point where it can't take any more and then after that you just take stick to three grams a day, long term, permanently. If you want to do it long term and it's really not necessary you don't have to. If you want a more dramatic effect more rapidly, you can certainly do that. But most people just take three to five grams per day. Just do that and they start off with that and they'll get to that muscle saturation at some point. It'll just take a little bit longer.
Speaker 2:Gotcha.
Speaker 1:So a five gram dose spikes blood creatine to about 120 milligrams per liter within one to two hours of taking it, but it has a half-life of three hours, so it does start to drop off pretty dramatically. To stay elevated to that level you'd have to dose every three to six hours, which is of course not practical. Hence the maintenance approach of just taking three to five grams a day. My two cents is that creatine monohydrate still reigns supreme. It's cheap, it's effective, it's vegan-friendly, it's synthesized, not made with animal products. Ethyl ester and gluconate and nitrate and these other forms of creatine that are on the market. There's really just not as much evidence to suggest that they're any better, and a lot of times they're marketed as more modern, new forms and they're more expensive. So I'd recommend most people stay away from them.
Speaker 1:Now I will say from my own personal experience they have powder form. You just stir it in water and drink it, or you can do it with juice, milk, anything you want. They also make it in capsules, which is my personal preference. I do find chugging a bunch of water and taking creatine sometimes gives me a little bit of nausea, upsets my stomach a little bit Really. Yeah, just a little, and everyone's different. Some people feel that and some people don't. I like to take it with the gel capsules because it just first off. I'm just swallowing a pill, it's done. You don't have to drink anything, do?
Speaker 2:you dry, swallow your pills.
Speaker 1:No, I don't. What I meant was you don't have to drink water that's filled with a powder. That's what I meant to say.
Speaker 2:I got you See, whereas I would rather drink it.
Speaker 1:Well, everyone's different. I remember the very first creatine I ever tried was like a blueberry-flavored creatine, so it was a little bit more palatable, but it still tastes gritty when you're drinking it because it's not perfectly dissolved. They do make a product called micronized creatine. That is even a finer, smaller supplement and it does dissolve a little bit easier and some people have less nausea and irritation with that. But my two cents. I like the pills, but they are big.
Speaker 2:When I make a protein shake, I just stick the little scoop of creatine in there with it.
Speaker 1:Yeah, how long have you been taking creatine?
Speaker 2:Oh, since I started my program.
Speaker 1:You do seem really smart lately.
Speaker 2:Yeah, thank you, yeah A little more energetic, a little more muscly.
Speaker 1:Oh yeah, you look jacked.
Speaker 2:Yeah.
Speaker 1:I would tell you to experiment with this. I do think you should drink a lot of water when you're taking creatine. You can experiment with micronized versus pill versus powder versus flavored. It's really up to you. I would say that if you are feeling nauseated, you may want to take it with food or with a protein supplement or something else other than just taking it in powder form Okay.
Speaker 1:So where does creatine really give you a lot of benefit? Creatine shines most in high intensity exercise. Think anaerobic work. Anaerobic meaning sprinting, lifting really heavy weights, high intensity interval training. Studies have shown that there's up to a 5% to 15% gain in power and work capacity in people who are taking high dose creatine. Aerobic endurance think like 5K, 10k marathon not quite as much of a help. That's a different energy pathway. That's the body produces energy differently when you're having to do long, sustain exercise. So that's not really utilizing the creatine supplement nearly as much.
Speaker 2:Just a plug for you. I'm pretty sure you go into those two different types of workouts pretty deeply in other episodes.
Speaker 1:We do. So we talk about interval training versus long endurance exercise versus weightlifting, and so we do talk a little bit about those different energy pathways and other episodes as well. Thanks for the plug. Creatine not only helps you while you're in the gym, it also helps you afterwards outside of the gym and helps you have faster recovery by replenishing your ATP stores faster and also boosts muscle recovery by that protein synthesis we talked about. It's been reported that up to 14% of college athletes use creatine now, and that was in a 21,000-person survey, so pretty high-numbered people have studied.
Speaker 1:So let's get into the really interesting part of creatine, and that to me is the cognitive and neurologic benefits of creatine. All the things I've talked to up at this point in terms of endurance and strength and recovery have really been pretty well established and known for 20, 30 years. The stuff that's been much more talked about creatine and why it's got this brand new sort of invigorated push is because of the new research being done on cognition and memory and helping slow down the decline of people with Alzheimer's and Parkinson's disease. So your muscles love ATP, but so does your brain. Your brain has to use a lot of ATP to do all that thinking. Creatine can actually boost short-term memory and reasoning, especially under stressful situations. They actually did sleep deprivation and aging studies with creatine. The brain is high in energy organs that rely on ATP for neurotransmission, synaptic plasticity and cognitive processing, so creatine supplementation has actually been shown to enhance mitochondrial function and ATV availability in brain cells. Pretty fascinating stuff.
Speaker 2:So medical students and residents should be taking that as well then.
Speaker 1:I don't like to give blanket statements. Obviously you should take things into consideration about your health, but I do think that creatine is almost completely safe for almost any age in the general population. I would definitely hesitate to put children on it, just because I don't think there's that many studies done on people under the age of, say, 16, but it's a pretty safe supplement and it seems to have lots of benefits, unless it makes you ill, which some people just makes people throw up. I think that's definitely something people would want to consider. Let's talk a little bit about the neuroprotective effects of creatine. So research indicates that creatine may protect against neurodegenerative diseases like Parkinson's, alzheimer's and Huntington's disease. It might reduce oxidative stress and inflammation in brain cells seen in these disease processes.
Speaker 1:Some studies have also suggested that it may have potential benefits in mitigating damage from traumatic brain injury and after a stroke as well.
Speaker 1:So think hitting your head after a car accident or someone who's had a stroke who loses functional parts of their body, high doses of creatine might actually help either protect the severity of that injury or help even recover. And when we talked about mental performance, obviously sleep deprivation and being able to be sharp and mentally aware and have good acuity during these processes is something that comes up a lot for medical students and doctors. Studies have shown that creatine supplementation improves working memory, reaction time, mental clarity, especially in sleep-deprived individuals. Cognitive performance improvements have also been observed in elderly individuals and those experiencing mental fatigue as well. This is where it gets really promising. As more and more data comes out, I think a lot of primary care doctors are going to have to be forced to at least consider having their elderly patients take creatine as a routine supplementation. There are also potential applications in treating depression, bipolar disorder and schizophrenia, but this is still pretty early in the investigation in terms of research studies, so we're not quite there yet with solid evidence.
Speaker 2:It's starting to feel like one of those cure-alls that they used to sell back in the day. Come here, get your creatine.
Speaker 1:Yeah, I understand why you'd say that Anytime a supplement claims to fix everything, I would definitely take pause too. But it's not like we're saying it cures heart disease and it cures cancer and it cures gout and it cures impotence. It doesn't help you poop better. So I see what you're getting at, but I don't think this really applies. So take your creatine, shut up and take your creatine.
Speaker 2:That's another t-shirt.
Speaker 1:Individuals with conditions associated with impaired mitochondrial function, such as chronic fatigue syndrome, might also benefit from creatine supplementation. As you might imagine, it helps with brain function and muscle function, which are both being affected in those types of health problems. In a study titled Creatine Supplementation and Cognitive Performance in Elderly Individuals, it showed that 20 grams of creatine a day for 7 days improved memory and reaction time in seniors, suggesting that brain creatine storage matters. I don't know how familiar you are with different types of muscular dystrophies people who are born with abnormal muscular cells, essentially but creatine has also shown to boost strength in those individuals. A study titled Creatine for Treating Muscle Disorders, published in 2013, it was a meta-analysis of 12 trials found that creatine increased muscle strength in dystrophies by 8% to 10%. The dose matters and high doses were shown, though, that they can worsen pain in some conditions, so this is one you would definitely want to talk to your doctor about before just taking it if you have a muscular dystrophy condition.
Speaker 2:So muscular dystrophy. Now I'm thinking about the cellist Jacqueline Dupre.
Speaker 1:I thought Jacqueline Dupre had multiple sclerosis. Oh, that's different.
Speaker 2:No, you're right, but I thought multiple sclerosis came with muscular dystrophy.
Speaker 1:No, no multiple sclerosis is an autoimmune disease where your nerve cells are being attacked.
Speaker 2:Oh.
Speaker 1:Where muscular dystrophy is actually something you're born with, where your muscular cells are not able to form correctly Two different conditions.
Speaker 2:I feel like there's somebody famous who has this, though it's not what Stephen Hawking has.
Speaker 1:No, he had ALS. It's a different neurodegenerative disorder.
Speaker 2:Okay, okay, all right.
Speaker 1:So let's talk about some of the other benefits of creatine in aging populations. So the elderly. Aging is associated with decline in muscle mass, sarcopenia, which we've talked about in past episodes, and bone density problems osteoporosis in the past episodes, and bone density problems osteoporosis. Creatine has been showed to improve muscle strength and endurance and can actually stimulate bone mineral density by increasing resistance training capacity. Now, that being said, you have to do the resistance training to increase the bone density. It's not like creatine is just increasing your bone density on its own.
Speaker 2:Gotcha.
Speaker 1:Creatine is just basically making it so elderly people can train more effectively with more endurance, so just taking it on its own is not going to have any effect in those areas.
Speaker 2:So if grandma's having to do some physical therapy after her twisting her ankle or whatever, she falls, breaks her hip, has to go to therapy.
Speaker 1:Some creatine might actually help her be able to tolerate that better and recover faster. But sitting on the couch is not going to do it Exactly.
Speaker 2:So do you tell your patients to take creatine?
Speaker 1:I have not, but I think I'm going to start to yeah. Yeah, after having done all the research for this episode, I think that's definitely something I'm going to consider doing Now. Even though there's really no proof that creatine causes kidney damage, I think that's something we'll have to take care of to think about just as a liability. Think about whether or not they have kidney disease. Maybe something we'd want to consider before just making it a blanket recommendation. Right, there was a study published in 2021 that showed that three to five grams of creatine per day, combined with resistance training, significantly improved muscle mass and functional strength in adults over 60. So it's not just for young people. Pair that along with the neuroprotective effects making you have better memory, better cognition and better neuroprotection from Alzheimer's disease and Parkinson's. I think that this is a no-brainer. I said no-brainer.
Speaker 2:No-brainer.
Speaker 1:For elderly people to take as a protective supplement.
Speaker 2:Right.
Speaker 1:So I asked myself what are novel applications and maybe some future research topics that we may want to consider with creatine, and here's what I found there have been some studies preliminary early studies suggesting that creatine might improve glucose metabolism and may increase insulin sensitivity, which we know is a very important part of managing type 2 diabetes. Right Ongoing trials are examining creatine's role in depression, multiple sclerosis and stroke recovery, which we mentioned before, and I think most of the stuff that is really being pushed right now is the whole depression, anxiety, memory loss, cognitive decline and I think there's a whole lot left to be uncovered for that. We're going to find some really cool applications for something that's already a cheap, effective and safe supplement, so I'm very excited about that.
Speaker 2:Great.
Speaker 1:Now I'd be remiss if we didn't talk about some of the safety concerns of creatine. Since I've basically just said it's safe, it's safe. Let's go ahead and address a couple of these before we wrap up the episode. So common concerns when it comes to taking creatine. Probably the number one thing I hear about is weight gain from water retention.
Speaker 2:Okay.
Speaker 1:Yes, you can gain some weight from water retention because it does pull water into your cells when you take it. So some people have noticed one to two pounds of water is retained in your muscles. It's not generally bloating of the stomach per se, although some people do experience that. Some people experience cramps and diarrhea. It's usually if you're taking too much, and I'd also recommend you take it with food and lots of water. Stay hydrated when you're taking it to try to avoid some of these side effects. So you may want to reduce your dose and gradually increase over time. If you're having any of these problems, make sure you're drinking lots of water, staying adequately hydrated. Try perhaps using micronized creatine monohydrate, which may help reduce some of your gastrointestinal side effects, and maybe split doses throughout the day instead of taking all five grams at once. Maybe take half of that in the morning and half of that at the night might help with some of your gastrointestinal symptoms that you're experiencing.
Speaker 1:Now the big question I always get is creatine safe for your kidneys? I think this has been pretty handily debunked that it is. So a study called Creatine Supplementation and Kidney Function a Systematic Review, published in 2019. This is 15 different studies, a meta-analysis that looked at creatine use and it found no renal damage. Renal meaning kidney no renal damage. With four to 20 grams of creatine a day, even in special populations like diabetics, creatinine the marker in your blood rises slightly but stays normal, and your kidneys are not injured.
Speaker 1:Studies looking at people using creatine regularly up to five years showed no issues in healthy people. Even patients who are on dialysis with severe kidney disease might even be able to benefit from supplementation, as long as it's being monitored by your nephrologist, your kidney doctor. That pretty much wraps up all the stuff I wanted to talk about creatine. I think it's a very safe, effective, cheap drug. I think almost everyone should consider taking this. I put it up in the heights of vitamin D in terms. Of this is very helpful, very effective, something everyone should consider taking. So, that being said, nicole, what questions do you have? Do you want to take some creatine?
Speaker 2:Oh yeah, I do want to take some creatine. I'm just sad that we're traveling and I don't have it with me. Alas, it's in our pantry along with all the other supplements.
Speaker 1:Yeah, I'll have to check it out. I haven't taken creatine in a while, but I'm going to start again after this episode To the people who are asking about creatine. Hopefully this was helpful. I know we rambled on for a while. As usual, I really enjoyed the nitty-gritty details.
Speaker 2:I just really enjoyed the millimoles, the millimoles, the millimoles.
Speaker 1:I have to see if we can find that in a normal everyday usage, but I doubt it. If you have any other topics that you'd like to hear about, I'm happy to do the research on it. We can do a show, a comprehensive breakdown of whatever you'd like to talk about. You can follow us on the Wellness Blueprint on Facebook. We're also at Wellness Blueprint Podcast on most social medias. I'd be happy to talk to you, send me a message and hopefully we'll catch you in a couple weeks with our next episode. In the meantime, be humble, be happy, be healthy. We'll see you next time.
