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Beyond the Gym: How Creatine Fuels Muscle, Mind & Resilience with Dr. Scott Forbes

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In episode #159 we talk with premier creatine researcher Dr. Scott Forbes about:

  • Creatine supplementation improving cognitive functions like memory, attention, and reaction time.
  • Creatine during times of stress, including sleep deprivation and hypoxia, and its potential effects in aiding in recovery from traumatic brain injuries

Dr. Scott Forbes is a professor and chair in the department of Physical Education Studies at Brandon University. He is also a scientific advisor and fellow for the International Society of Sports Nutrition, and a clinical exercise physiologist and high-performance specialist through the Canadian Society for Exercise Physiology. Dr. Forbes has published over 150 peer-reviewed manuscripts and 5 book chapters, with a primary focus on the interaction of exercise and nutrition to optimize muscle, bone, and brain health.

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Hello everybody and welcome back to the Nutritional Revolution podcast. Today we have for you guys Dr. Scott Forbes and he's a professor and chair in the Department of Physical Education Studies at Brandon University. He's also a scientific advisor and fellow for the International Society of Sports Nutrition and a clinical exercise physiologist and high performance specialist through the Canadian Society for Exercise Physiology. Dr. Forbes has published over 150 peer-reviewed manuscripts and five book chapters. with a primary focus on the interaction, exercise and nutrition to optimize muscle, bone and brain health. Love this episode. I know you guys will too. Have a blast and enjoy. Hello everybody and welcome back to the Nutritional Revolution podcast. We have for you guys, Dr. Scott Forbes. Thank you so much for joining us. Thanks for having me. Happy to be here. I'm super excited. We're going to and I'm sure listeners are going to be super excited. Everybody's talking about creatine these days, so we are just going to dive all into it. But before we jump into the creatine conversation, I'm going to have you break down your two truths and the lie for me. Okay, so uh here's the three things. uh So number one, I competed in this obscure sport called canoe polo. And I competed at the World Games, which is essentially the Olympics for obscure sports. Okay, so that's number one. Number two, I once bowled a perfect game. That's rad, if that's true. Number three, I've run a sub 33 minute 10K. Oh, whoa. 10K. That's fast. That's fast. Hmm. Okay. These are good ones. It's always fun when the guest brings up their truth and lies that are stuff that's not easily found on the internet. Okay. I've never heard of this obscure games situation ever. I don't even know if that exists. and canoe polo. That sounds entertaining. But going to the World Games, I have not heard of that. I feel like bowling a perfect game can certainly happen. I feel like you look athletic and tall, like you could you might be able to run a sub 33 minute 10 K. I'm going to go the first one is lie, canoe polo. But do not don't tell me the answer. We will wait to reveal it at the end of the episode for our listeners and find out if you are. super fast 10K runner or or what? OK, so why don't you tell us just a little bit about what you are involved in research wise and then we can dive into this study. think the study actually came out in twenty twenty two, but with the common frequency of TBIs and all that happening in cycling, I think this is a good topic to cover today. So. I'll let you take it, take it off and share a little bit about you and your research. Okay, so yeah, most of my research involves creatine supplementation. And I've actually been studying creatine for about 17 years. When I was a graduate student at the University of Saskatchewan, I got to collaborate with somebody you might know, Dr. Darren Candow And my supervisor at the time was Dr. Phil Chillebeck. And they were some of the first to essentially study creatine combined with exercise in older adults and to show some of the benefits in that population. But over the past 17 years, yeah, we've kind of explored creatine's benefit for muscle performance across the lifespan in both males and females. And we've also gone beyond just muscle. We've also examined kind of the impacts on brain and bone health as well. Amazing. And today the article that we're going to primarily dive into is called, just for our listeners, effects of creatine supplementation on brain function and health. And why don't you share with us a little bit about why do we start looking at creatine supplementation and brain health? What maybe drew that together and what drove you to kind of start looking at the study that we're going to dive into today? For sure, so about 95 % of the creatine that you have within your body is stored in the muscle. And so I think that's why a lot of the research has focused on muscle per se. But we also have creatine within our brain. The brain is a little bit different than muscle. It's a little bit more challenging to get it into the brain. The brain can synthesize its own creatine. But essentially, creatine is just one of those, it's a part of a specific energy system. And different cells in our body need energy at different speeds or different times, I guess. And yeah, your brain needs a lot of energy. It uses a lot of energy despite its small mass. So it uses about 20 % of your daily energy intake despite only weighing about 2 % of your body mass. So it punches way above its weight for energy use. And again, that creatine energy system could be a benefit for the brain. That is really neat to think about how much of your daily energy, 20%, that is a significant amount that your brain is using to put all the stuff you do with your brain kind of makes sense. So you mentioned m PCR ATP as an energy buffer. What does that do in neurons for plain language listeners? And why would this be something that athletes or even shift workers tactical professionals, why would we want to think about this and know about this? sure. So I kind of mentioned that creatine is part of an energy system. So we need energy. That's very important. And one particular molecule that's called ATP, or adenosine triphosphate. So anytime a cell requires any sort of uh needs to do any sort of work, um and your neurons, your brains obviously use a lot of energy as well. then uh it needs to uh resynthesize or make a, you need to make this ATP molecule. And the creatine energy system can make that molecule very, very quickly. So anytime uh you need that energy quickly, could be like a really stressful situation. That particular energy system seems to be quite useful. the muscle perspective, again, it supports the same things, that high intensity uh energy. And that's why it's been used quite frequently with uh like bodybuilding or high intensity exercise, um that particular system. So we have other ways to make ATP. We could use carbohydrates or glucose. uh Yeah, you can break down fat molecules as well. But those are generally a little bit slower and not as big of a benefit when you're in these stress situations. That's interesting. Okay. So that makes sense from what I know physiology wise of different sport intensities and what the body is pulling from initially. like you mentioned the muscle, the immediate like quick go you're pulling from phosphor creatine and then subsequently, depending on how long you're trying to go for, you're going to utilize different energy systems. So the brain is similar trying to do something. Is it the same like trying to do something really quick, like maybe sleeping to like trying to do something is you're going, is it going for creatine first before mobilizing glucose and other things? Wow. works in a very similar way. And as I'm sure we'll get into, that's why kind of that energy system and creatine seems to be a benefit, particularly when you're in these really stressed situations, such as traumatic brain injury or sleep deprivation, hypoxia. Yeah, there's a variety of different ways to kind of stress the brain. And that's where creatine seems to play a bigger role. And just based off of how fast that energy system can work. and how it supports that ATP production, it makes perfect sense. Wow. And so you had mentioned that the brain can make its own creatine, but then we have external or exogenous supplemental creatine. What are we looking at in terms of dose and how long does it take to get into the brain? It's a great question. So yeah, the muscle level, it's very well established that, well, the muscle can't actually synthesize its own creatine. So it relies purely on dietary creatine or exogenous sources. So our liver and kidney can create creatine as well. That can get into the bloodstream and our muscles can take it out. And it's being taken up by a specific transporter called SLC 688 or or creatine transporter one. Mm. And we have a lot of those creatine transporters at the muscle. So if you supplement with creatine, most people get about a 20 to maybe even 30 % increase in the amount of creatine that's now stored within your muscle. At the brain, it's much different. So we have very few creatine transporters. So it's much more challenging to get creatine into the brain. And then as you mentioned, our brain could actually synthesize its own creatine as well. So it kind of looks after itself a little bit better than I think our muscle does. And uh what we know is that it's pretty challenging to actually get big increases of creatine into the brain. So at the brain level, it might range from, you know, 5 % to 10 % increase in brain creatine content. Whereas at the muscle level, it's very robust. pretty consistent between people, but at the brain it seems to be quite variable between individuals. And to be honest, we just, we don't know why. And so, I mean, if someone is supplementing with creatine, a good portion of that's going to muscle and maybe a smaller portion going to the brain. Is that kind of what we can take from that information? Yeah, so we don't know exactly how it's kind of separated, I guess, within the body. I'm not 100 % sure if the body would try to saturate the muscle first. To me, maybe it's trying to saturate the brain first. And maybe that's why it kind of looks after the brain first. And it's harder to get any increase in the amount of creatine within the brain. But we don't know exactly how it's being partitioned. Yeah. gets into the body, but we do know that most of it gets stored within the muscle. Hmm. And for, which is my own curiosity, brain creatine levels. We're not testing that in humans, are we? Can we? Yes, you can test that in humans. Yeah. So with a magnetic resonance spectroscopy, so MRS or an MRI, essentially, so a big magnet, yeah, they can, you can go inside and they can look at, everything from how much phosphocreatine that you have, how much creatine you have, and they can look at different areas of the brain as well. OK, OK, I was picturing rats and sampling and, you know, that kind of stuff that I didn't think we could like. But that makes sense. And MRI, that makes a lot more sense. And that's great that we we were able to test in humans, right. And translate that there. So tell us a little bit about why someone would want to utilize creatine for brain functioning. What what are you seeing in the literature that it is benefiting? from a brain lens. For sure, so anything that requires a lot of energy could benefit from this particular supplement. everything from attention to reaction time to executive function, like your ability to make decisions have all been shown to be improved with creatine. And probably the most kind of benefit is actually an improvement in memory. So for main memory and learning, requires a ton of energy. And yeah, there's there's evidence that creatine could be a benefit for that cognitive domain. Wow. And what sample or I guess population are we looking at when we test the memory? Do we see this benefit in like elderly or pre dementia Alzheimer's or are we talking younger, maybe sleep deprived teenagers or something? So we did a systematic review and meta analysis. Essentially, we just look for all the individual studies that have been published on creatine and memory. And we subdivided it. So we did a sub analysis looking at younger individuals and older adults. And the benefits seem to be greater in the older adults. So they're about 65 to 75 years of age. were the participants in the studies that were conducted and they found improvements in cognition. The younger individuals, there was actually, there was no benefits on improving memory. So as you kind of mentioned, there could be some benefits when you're stressed and I alluded to that earlier as well, but in young healthy individuals and non-stressful situations, it did not improve their cognitive performance or memory. Interesting. OK. And that the group it did improve, you said, was 60 and up, 60 to 75-year-olds? OK. OK. That's really fascinating. But then if we take the younger population and they're sleep deprived or got a concussion, potentially then there's a use for improving memory and cognition with creatine? Absolutely. Yeah. So anytime your brain is really stressed and there's a variety of different ways that, uh, that has been kind of explored in science or in the real world. Uh, we know that sleep deprivation has a negative impact on the way that our, our brains function. And creatine has been shown to be a benefit in that particular situation. Uh, hypoxia. So we know that, uh, we need oxygen. uh to create some ATPs, it's a different energy system, aerobic energy system, but creatine could be a benefit when you're in a hypoxic situation. So that's a low amount when you're receiving a low amount of oxygen. We also know that there's a little bit of evidence with creatine and traumatic brain injuries. And then also mental fatigue is another way to obviously stress the brain and creatine has been shown to be a benefit in that situation as well. Okay, this is also fascinating. The hypoxia thing, was not, I don't think I had heard that one before. I've heard creatine can help with so many different things, but the hypoxia is fascinating. So could that be an athlete at an altitude training camp? Potentially, yeah. So I'm thinking like, I don't know, maybe like somebody flying a jet super fast and they're getting a low amount of oxygen or a firefighter that has to breathe with a respiratory device, you know, that could be a challenge or even clinical or chronic conditions like COPD or chronic obstructive pulmonary disease. um also, yeah, as you mentioned, maybe at altitude. Yeah, wow. going to get a little bit lower amounts of oxygen availability and creatine could be a benefit in that particular situation. Wow. Okay. So with the sleep deprivation and maybe you tell me, imagine these doses that they looked at in the studies maybe are vary what, if you recall, what doses were they using and how, particularly in the sleep deprivation, I'm curious, were they having them utilize creatine leading up to a period of sleep deprivation? So more of like a preventative or was it after the fact I woke up, I realized I only got three hours to sleep last night. Now I can take creatine and it's going to help my brain today. How did that fall? Can you break it down for us? For sure. kind of both uh kind of protocols were utilized. So there's actually a pretty cool study study that was done in rugby players where they looked at passing accuracy when they're in a rested state, when they got a good sleep versus when they got a really poor sleep. And what they found was their passing accuracy went way down when they didn't get a good sleep. So no real surprise there. But if they got a poor sleep and then they took some creatine in the morning, a couple hours before the passing accuracy test, it completely negated that sleep deprivation or that poor sleep. So that was a pretty cool study that shows, least in the sport world, that it can have an effect even after you have a bad sleep. So if you have a bad sleep, wake up, take some creatine for sure. ah Another pretty cool study that just came out, they actually took a very large dose of creatine at night. So they actually used it. It was a relative dosing protocol. So 0.35 grams of creatine per kilogram of body mass that they ingested. I don't know. That's like, yeah, you could do some math. Yeah. 0.035. So for 150 pound person, that's 23.8 grams of creatine. Does that sound right? that seems sounds sounds about right. Yeah. So yeah, you'd convert pounds into kilograms. And then yeah, multiply it by point three five. So yeah, it sounds about right. So maybe 2530 grams, depending on the weight of the individual. And then they had a night of sleep deprivation. And they showed improvements in cognitive performance. And they also measured how much creatine they got in the brain. And there was a significant increase in the brain creatine content in that study as well. So pretty cool. Yeah. And then there's been a couple other studies where they've taken creatine, for example, for a few days or a week and looked at the impacts of sleep deprivation. And again, some of the sleep deprivation negative effects were improved with the creatine condition. Cool, that's so great. And so with the 0.35 grams per kilo the night before a sleep deprivation, do you recall what kind of memory or cognitive tasks they were having them do that they improved on? did a variety of different cognitive tests on these. So they're all like computer-based cognitive tests to measure multiple cognitive domains. And in a variety of them, they showed improvements in the creatine group. Plus that study also measured brain creatine content as well. So they showed that that was also increased, which I think is again, super cool. And it was just one dose. They just ingested it one time. So again, if you know you're gonna have a... bad sleep or he needs to stay up all night to do some sort of work or maybe an ultra endurance race or something like that, then yeah, I would definitely consider taking creatine in that situation. That's really fascinating because what it makes me think of with our listeners and population is when they do have a race, oftentimes they do not sleep very good the night before the race, right? And ideally, they've done all the training things beforehand. But if we have a compromised night of sleep before the race and that when we know that's pretty common and certainly if they're going to race at altitude hypoxia, maybe there's a place for that. Do you with a dose that large? So 23 or more grams of creatine that would typically be a loading dose would would we see any negative consequences of like water retention and I guess in a weight based sport or power to weight ratio sport. Do you think there would be any cons there? I think if you're doing like an ultra race, for example, I think hydrating the muscle is important. We know that even if you consume carbohydrates, for example, that that's gonna pull some water into the muscle. So each gram of glycogen also has 2.7 grams of water as well. So people always think of that as bad, like, you're gonna have water in your muscle and like, that's gonna be really detrimental. But I'm like, well, it's kind of hydrating the muscle and we know that hydration is super important as well. There was one study that was done in runners where they showed that their performance actually got worse. So they ran slower than what they expected. And the authors suggested that it might have been associated with that increase in body mass. So of course, having too much of a big increase in body mass could could be of detriment to endurance performance. But yeah, that's one single study. It's never been replicated. Yeah, I think there could be some other great benefits to creatine that maybe could benefit endurance athletes for sure. Yeah, yeah. I ask because I get that question from my athletes all the time or the fear, right? Maybe they have a hilly race and there's lots of climbing and they want to be lighter. They have that fear of coming to the start line a little heavier and trying to move more weight. But yes, to your point, if you're more hydrated, you're going have a lower RPE. You're going to delay dehydration risk. And then better cognitive functioning, you know, you're able, I imagine like being able to quickly see a pothole you're trying to dodge or a rock or something that you're trying, you know, and you can react quickly with hopefully without crashing or flatting or something like that. So I see benefit there. Totally, yeah, I actually did uh an ultra race, but it was a part of a team. So my wife's family is a little bit crazy. And so we went on this family vacation and part of that was like, let's do this ultra race. So was a hundred mile race. And my leg of the race was 32 kilometers. So I don't know what that is, like 20 some miles. ah And it was 1400 meter elevation gain and loss. and I started at midnight and I've never ran at night before. But yeah, the cognitive demand of that particular race was like ridiculous to me. watching your steps, um going down it's super steep hills. Yeah, like any little misstep and the race could be over essentially at any point. So anything you can do to improve your cognitive performance in those situations, I think can actually play a big role. Yeah. I think are super, super important. Yeah, that is very fascinating. OK, now I have a very interesting thing. I'm sure this has not been studied yet. And I don't know if you see this. This is totally off topic, kind of. I have noticed in my years of practice, it seems like every year, like clockwork, right around this time of year. So for our listeners, end of summer, going into fall. Athletes have gone through a big season of training, racing, maybe are coming to the end of their races, whether we're talking cycling or kind of peak in the ultra and stuff like that. And it seems like I get like a good chunk of my athletes. And when I say good chunk, like five, which is five athletes all around the same time get injured by like freak accidents. Like they roll an ankle. They decide to try and do a jump on their mountain bike and crash the, you know, I had another cyclist, someone in front of her crash and she crashed and it's just, there's like, and I, I wonder, this is just me thinking out loud, but I wonder what happens with brain creatine through a race season too, for an athlete. If there's, I don't, have different theories of why I keep seeing injuries like freak injuries happen, but, I wonder if there's something going on there too, like they're dwindling or changing. just thinking out loud. Sure. There's one study that I'm thinking of right now. They actually measured in mountain bikers. Their cognitive performance with creatine. was a Brazilian researcher, uh Dr. Machado that did the research and found improvements and some, again, some computer-based cognitive testing, but in these mountain bikers. So maybe there could be a benefit to it. So yeah, I totally agree that particularly late in the season when you're tired and you have all this kind of fatigue, then that's where injuries start to occur. And maybe that's where creatine could play a role. Okay, so fascinating. So we talked about sleep deprivation and cognitive functioning. I want to dive into TBI. Yes. So share with us what we're seeing with... creatine utilization and TBI and when and how to utilize that. For sure. So this data is very limited, but there is data. It was an open labeled randomized controlled trial, so randomized controlled trials are good where you're randomized to either a placebo or a creatine group. uh But uh an open label study means that you know what supplements you're receiving. So that's kind of a limitation of that particular design. in... Research, try to blind those things usually. So you don't know if you're getting like the supplements or you're getting a placebo. But uh the only study that's been done in humans was a open label study. So they knew what they were consuming. They used a very high dose. It was actually 0.4 grams. So even a little bit higher than that sleep deprivation study per kilogram of uh body mass. And this study was also done in children and adolescents following a severe traumatic brain injury. And they showed improvements in a variety of different things. So they measured like mood, they measured hospital stay or length of stay. They measured all these things that are associated with having a TBI and looking at recovery. And a lot of them were actually improved with the creatine group. oh That's the only study that's ever been published, but it seems promising that creatine can improve several aspects associated with recovery following a TBI. Wow. And this was 0.4 grams per kilo per day, like as soon as possible since being diagnosed with a concussion or TBI Okay. my understanding from that particular study and it was actually a six month study. they gave a very high dose of creatine every single day for six months. Wow, wow. That's really helpful information. for certainly our I know our cyclists get into a lot of crashes and can hit their head runners, hopefully less so, but it does still happen. And yeah, I think that's really helpful. do you recall if they were taking that all in one dose or they split dosing that throughout the course of the day? I don't recall from that specific study, ah but yeah, so the general recommendation is to kind of is to separate it out, at least during the loading protocol for the muscle performance. um So if you do consume a ton of creatine at one time, there are some individuals that experience a little bit of GI distress. So yeah, probably separate it throughout the day if you're consuming that large of dose. Yeah. Okay. Awesome. And for our listeners, um what form of creatine should they take? Creatine monohydrate. uh I think there's over 80 alternative forms of creatine. And the most researched, uh we know it's very safe. It's effective in a variety of different situations. um The bioavailability is very good. So there's some alternative forms such as creatine HCl or hydrochloride. They suggest that it has better absorption, but it's not really the case. uh Creatine monohydrate is nearly all absorbed, so it's hard to get better than 100 % absorption. So yeah, my recommendation at this point is just stick to creatine monohydrate. Okay, and what are your thoughts on Crea Pure? So that is a trademark version of creatine monohydrate? So yeah, it's a creatine manufacturer. yeah, there's only two countries in the world that manufacture creatine monohydrate. So that's kind of mind blowing to people. So those two countries are actually Germany and China. And so Germany uh has this creatine manufacturer and they're called uh Creapure. And so a lot of brands use their particular creatine. Yeah, that's, and they've supported a lot of research. They've supported some of my research. So maybe I'm biased. But I know that that CreaPure is pure creatine monohydrate and has been very effective in the studies that I've implemented. Awesome. And for our athletes, always make sure you get a creatine that's third party tested. So NSF certified for safer sport or informed choice. Not informed choice, but NSF uh for sport and informed sport, I think are the two. Right? OK. yeah, always get them third party tested. So the creatine that I get is directly from the manufacturer grip here. So I never have to really deal with that buying supplements from the supplement store. But yeah, you need to be very cautious with the supplements that you do buy and make sure that they are independently tested. Yes, yeah. uh Okay, since we were talking about creatine supplements really quick, what are your thoughts on creatine gummies? So that's a great question. To this uh day, there's actually been no creatine gummy research study. So I'm a scientist, I love evidence and I love using that evidence to influence my decisions. ah At this point, there's no creatine gummy study. So I'm hesitant to just recommend creatine. There was one analysis where they actually did They tried to find out if those gummies actually contained creatine and uh about half the gummies that they tested failed the test miserably. So some of them had zero creatine in it. And there's also the risk is when you put it in a gummy or in a liquid, it gets converted into creatinine. So it's like a by-product of creatine. And some of those gummies, they had no creatine and they had no creatinine. as well. So it suggested that there is no creatine there to even begin with. So buyer beware with regards to uh buying creatine gummies, but there were a few creatine gummy brands that actually did contain creatine. So it does appear to be possible to put creatine in the gummies. And yeah, they're delicious. They're maybe more expensive, but if you're traveling or something like that, They're kind of nice to have great teen gummies versus carrying around some white powder. Yeah, that's good to know. It's always good to have some third party testing on actual ingredient dosing in a product. So one of the other areas that you've looked at with creatine was mental health. So depression, anxiety, PTSD. Can you share with us a little bit about what you saw in that testing and dosing duration? What did you find? For sure, so there's uh again, kind of a growing body of research in that area. There was a big uh cohort study, so they looked at about 20,000 individuals and they actually estimated how much creatine they were getting in their diet. So not even supplementing with creatine, just like how much you get in your diet. And they showed that those that consume more creatine in their diet had a lower risk of depression. Mmm. So that was pretty cool, but those types of studies don't show cause and effect. But there has been a couple of randomized control trials that have shown a benefit of creatine to reduce depression as well. But it's also important to note that this isn't just, you know, don't do any of your regular medication that's important for depression. This was an adjunct therapy in addition to that as well, but it does seem to be a promising. to actually reduce depression as well. Cool. And with dietary for our listeners, where would someone get creatine in their diet? For sure. So mainly red meats, uh but seafood is a great source of creatine as well. things like uh salmon, um but it's actually a little bit challenging to get a lot of creatine from salmon, for example. You'd have to consume about two and a half pounds or about one kilogram of salmon to get about five grams of creatine. So yeah, that's a... Maybe not recommended to do every single day, but obviously it is possible to get it from some of those food sources. ah Herring, actually the fish, has the highest amount of creatine in it. But again, you would have to consume uh over a pound of herring just to get about five grams of creatine. So there are food sources, but they're quite limited with regard to getting higher doses of creatine. Right. So are you saying herring has the most creatine per gram relative to all, like even red meat or just compared to fish? Even compared to red meat as well, yeah. Yeah. Dang. That is, yeah, well that's good to know. And is it found in any plants? No. So if you're a vegan or a vegetarian, yeah, you're not getting any dietary creatine intake. And that's why at the muscle level, we know that there's quite a big difference between vegetarians and omnivores. actually, vegetarians have lower amounts of creatine within their muscle, but the brain is actually different. So they've looked at brain creatine content between vegetarians and omnivores and they actually found no difference. Oh, interesting. do see a big difference at the muscle level, we don't see any difference at the brain level. That's fascinating. the, I mean, the body prioritizes brain creatine over muscle, maybe. I think so, yeah, I think that's the speculation and yeah, your body does a pretty good job of looking after that kind of important part of the body, the brain. Yes. Okay. So in your study, I'm not going to break down what this acronym stands for because I'm going to embarrass myself for the listeners, but GAA showed some promising potentials here in the literature. Can you share with us a little bit about GAA? What is it? Why is it something that we're starting to look into? For sure, so GAA is just a precursor to creatine. So creatine itself is derived of three amino acids, but if you put the first two amino acids together, arginine and glycine, it forms GAA. And yeah, one of my co-authors on the paper, his name is Dr. Sergey Osojic. He's probably one of the best researchers on creatine supplementation, but particularly with GAA as well. And he's showing that, yeah, if you take this supplement, you can actually get kind of bigger increases in brain creatine content compared to just creating monohydrate. So that was really, really interesting. uh Important though is the toxicity of GAA isn't well established and the safety profile is not well established. And the FDA currently does not... uh approved GAA as a supplement. So uh even though there's some promising research and maybe Dr. Osojic is onto something pretty cool. Yeah, we still don't have FDA approval to uh use GAA as a supplement. It is approved in chicken feed though. So if you're a chicken, then maybe you can take this supplement. Interesting. wonder, so does GAA increase creatine in a chicken as well, I would imagine. I have no idea but Probably, probably, yeah. that's interesting. Okay, so I want to be mindful of your time here. For our listeners, I would say the majority of our population probably lands in like 20 to maybe even 50-year-old active endurance-based athletes. If they're wanting to kind of take things to the next level, how should they... Or should they dose with creatine and if so, what should the dosing protocol be? For sure, so from the muscle level, we know as little as kind of three grams, but most people take about five grams per day. For the brain level and the cognitive benefits, I suggest around 10 grams per day. And as we've kind of discussed, there's a few situations that, and a few studies that have used even higher doses, 20 or 30 grams of creatine per day. So maybe in those crazy stressful situations, you can up your dose a little bit. But in most situations, yeah, I would just suggest either five for the muscle or 10 grams per day for the brain benefits. Awesome. And do we need to load, do a loading phase with the creatine? You do not have to load with creatine for the muscle performance benefits. It's not required. um And the brain, yeah, I think just taking 10 grams per day, you don't have to worry about the loading phase just makes it simpler. And yeah, you can get some of the benefits. Interesting. On the loading phase or even just getting creatine into the muscle, I know for the muscle for a long time they were saying you could load at 20 grams per day. Was that to fully saturate to the max capacity your muscles with phosphor creatine? Yep. So yeah, so if you did that loading phase, typically took 20 grams per day, you'd separate that into four doses throughout the day. You do that for a week, you can saturate your muscles. So you get that 20 or 30 % increase in creatine and phosphocreatine in the muscle. And then you could drop to a maintenance dose just to maintain those levels. But now we know that that's not really necessary. ah There was a uh recent study that looked that there was multiple groups, but they had two creatine monohydrate groups. One did the loading phase, one did not. They combined it with strength training and they looked at changes in muscle size and muscle strength and there was no difference between the loading group and the non-loading group. So my recommendation is usually just not to load with creatine. It's not necessary. And yeah, you can still get all the benefits. And is there a certain time of day relative to someone's training session that they should consume their creatine? So if you're just starting to take creatine, I suggest to take it close to the exercise. The exercise kind of sensitizes the creatine transporters to take up a little bit more creatine. And ah yeah, so if you're just starting to, know, fill your muscles with creatine or trying to saturate them, then uh yeah, take it close to exercise. So just, was a pretty cool study where they did unilateral cycling. So they biked with one leg. until exhaustion. So I think it was like 60 minute protocol or something like that. And then they took creatine and then they took uh they took muscle biopsies and they showed that the leg that exercised was able to take up more creatine than the non exercise leg. Wow, that's cool. em And then I have a listener question that came up. Breastfeeding moms, potentially getting sleep deprivation, is it safe for them to consume creatine in those sleep deprived states to help with cognition? ah That's a great question. So yeah, so there's a pretty cool research area that's really exploding uh and is looking at creatine during pregnancy or during breastfeeding as well. One researcher from Australia, her name is Stacey Ellery. um She published some data this year that uh looked at creatine during the third trimester. Mmm. and showed that um basically those pregnant women metabolize creatine the exact same way as a non-pregnant uh woman did. So yeah, there doesn't seem to be any real safety concerns. There is some evidence that if you supplement with creatine that you can increase the amount of creatine in breast milk. So it is going through the mom to the baby. The impact that that would have on the baby is currently unknown. So my advice right now is pretty cautious just because yeah, you don't want to do any harm to uh to a growing baby and So until we have more data, I have a feeling that it's safe. But uh yeah until we have that that scientific data Yeah, it does get to the baby and we don't know the true impact Hmm, yeah, that's fascinating. um I wonder, I mean, there's got to be maybe a little bit of naturally occurring creatine, right, coming out in breast milk em without supplementation. Absolutely, yes. So there is uh already some that's being delivered to the baby, but it's about a four-fold increase if you supplement with creatine. yeah, it is a much higher dose. And then of course the kidneys have to filter it. And if the baby's kidneys and body is developing the impact that it's having on them, we just, yeah, we don't know at this point. Okay, excellent. And I'm going to touch back a little bit to our endurance athletes. And we may have covered this a little bit, but the ultra and adventure athletes facing the sleep loss, so thinking about you and your ultra that you did through the night, um what would a race month creatine plan look like? Should they taper at all? Should they continue on with the same dosing protocol every day leading up to the race and on race morning? Should they take it during the race? What do you suggest? So once, ah basically I think you need to saturate your muscles. So again, you can do that loading protocol if you want, know, take 20 grams per day for about five to seven days or a week to saturate your muscles, or you can just have a lower uh dose of creatine, maybe three to five grams per day. That's going to take about four weeks to saturate your muscles. depending when your race is and when you want those benefits, ah yeah, you can kind of time that out accordingly, but. Yeah, I don't think it matters if you uh like which protocol you actually select. And um yeah, you can take creatine rate up to the race itself. We're actually doing I'm collaborating on a study where we're looking at the impacts of creatine 20 grams per day, one week before an ultra race. So it's a 50 mile race. So there's a researcher from Appalachian State University that I'm collaborating with. And so hopefully we can collect some data and find out if it has any impact on the ultra endurance runners. my gosh, definitely want to have you back when that's published. Yeah, that would be fascinating. Wow. So would they use it in an ultra at all during the race? Would there be any benefit to mixing creatine in their like flasks or bottles through the night? So originally I would be like, no, I don't think it actually does. because once it's saturating the muscle, it takes about four to six weeks to return back to baseline. But maybe for the cognitive uh benefits, it might. And uh yeah, that recent study with sleep deprivation where they showed a single dose can actually increase brain creatine levels. So maybe there is a strategy during the race, you know, if you can uh take some creatine. could be a benefit, but nobody has researched that so far. Yeah, that's a great question. Fascinating. And back to your rugby, I think it was rugby you said with their, it was a catching and throwing accuracy. They consumed the creatine two hours before practice, right? And what was their dose, do you recall? believe they use 20 grams of creatine. wow. Yeah, OK. Yeah, fascinating. It's so interesting. So much stuff to discover and find out. um OK, so OK, we're getting close on time here. um What's coming down the pipeline for you? What are you curious to continue testing and looking at research-wise? It doesn't have to be creatine related, but you tell me. So a lot of it is creatine related and ah obviously that ultra endurance study I'm very excited about. We're doing a muscle performance study where we're taking creatine daily versus just taking it on training days and they're training three times a week and we're gonna find out if there's a difference. So um from the muscle level, I don't think there'll be much of a difference if you take it daily versus just on training days. Maybe for the brain benefits, you need to take it a little bit more regularly. We're also doing a creatine golf study as well. And in the golf world, creatine kind of exploded last summer. Rory McElroy, he won the Masters. uh There's a video of him going around where he was talking about taking actually 20 grams of creatine per day, and that was enhancing his golf performance. uh So we'll find out if it actually has an impact on. golf, but yeah, we're doing quite a few studies at the moment. That's so cool. OK, one last question for you. em Creatine and creatinine, when people are going for their kind of maybe like annual physical and they're getting their labs tested, em is there any concern with what it would do to their blood work? Or if something is high, what would that be? And should it be of concern? Or would it be a result of creatine supplementation? oh So creatinine is a byproduct of creatine metabolism. So creatine is non-enzymatically broken. It just means that it's like broken down into this molecule. And then our kidneys need to filter that particular molecule. So in a normal situation, if it starts to rise, that would indicate that your kidneys are not filtering properly and your doctor is going to look at those values and be like, it is elevated. that's a concern to me. But if you're on creatine, that creatinine value can rise naturally just because you have more creatine in your system. So there's other markers that are really important. One is cystatin C. So it's just another marker of kidney function that's not influenced by how much muscle or creatine that you have. And, you can measure uh creatinine clearance. Mm. just in the blood, but you need to measure it in the urine. And obviously it takes a lot more time. It's a lot more uh kind of effort to get those measurements. But those are things that you'd have to do if you're on creatine supplementation. So yeah, I hear that same question a lot that, I started taking creatine, my creatinine levels are elevated. My doctor says I should stop taking creatine immediately. So I suggest measuring some other markers of kidney function. Yeah. ah Yeah, just to look at how your kidneys are actually functioning. And to follow up with that, if someone is not taking creatine, but they've done a very hard event and they got their lab work done shortly thereafter, couldn't they still have an elevation in creatine kinase because of just muscle tissue damage? Yeah, absolutely. yeah, creatine kinase is a marker of muscle damage. so if you do, if you consume a ton of protein, if you do uh strengthening exercises and create some muscle damage, if you do an ultra race, that can all influence some of the blood work. So again, you just need to be aware of those things if you're going in for blood work. And I think you need to find a good medical professional that can interpret that data appropriately. Yes, yes, very important. Okay, we are closing down on time here. So I'm gonna jump back to your two truths and a lie. You said you competed in a uh sport canoe polo and you went to the World Games that you once bowled a perfect game and that you ran a sub 33 minute 10K. I was leaning on the canoe polo thing being the lie. that accurate? Which one was it? That is not a lie. oh my gosh, wow, that's cool. I never heard that. um When was that? How long ago? That was in 2013, so quite a few years ago now, but it was in Colombia. Yeah, they have these, it's called the World Games. It's actually bigger than the Olympics and there's more participants in it. And it has everything from like bowling to tug of war, skydiving. I don't know, all these obscure sports that are not obviously at the Olympics. But yeah, so I participated in a sport called canoe polo or kayak polo. Cool. That's so neat. you're on a team like how Polo would normally operate, right? But in water on a canoe? yeah, it's played five on five. The nets are suspended in the air. So they're actually like a meter by a meter and a half. And the goalie just holds up their paddle and tries to whack the ball down. And yeah, you just paddle around, you pass the ball around and just like water polo and try to throw it in the opponent's net. So yeah, it's pretty cool. All right, so which one was the lie? I've never, I'm a horrible bowler. So there's no way I could ever bowl a perfect game. well, I did run a sub 33 minute 10 K I used to run cross country, uh, at the university level and I'm nowhere near that now, but, uh, once I used to be able to run. Yeah. that's amazing. Amazing. em Okay. Well, I got that one wrong, but now I have to look up world games and canoe polos. That's a cool thing I learned today as well. So this has been really fascinating and I very much appreciate your time, Scott. Thank you so much for joining us. Where can our listeners find you and follow you? Probably the best is on Instagram and my handle, if that's what you call it, is scott underscore forbes underscore phd. Or you can just like Google search scott Forbes greeting and yeah, you'll find a lot of information out there. Awesome. We will link your Instagram handle in the show notes and the article from today. And again, thank you so much. This has been amazing. Awesome. Thanks for having me.

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Kyla Channell, MS

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