#100 The Optimal Creatine Protocol for Strength, Brain, and Longevity | Darren Candow, PhD

Bone health requires 8g/day minimum: 3-5g won't cut it

Standard creatine doses (3-5g) benefit muscle but fall short for bone protection. At least 8g daily is needed to increase osteoblast activity and reduce bone resorption.

"Yeah, there's actually a neurophysiological recruitment. So now creatine has been touted as a new neurotransmitter. So this is quite interesting. It actually seems to release a lot of things from a neuromuscular perspective. But the biggest thing is the ability to recruit not only type 1, but these type 2 muscle fibers as well. And then of course, if we're having greater muscle or motor unit recruitment, we can potentially lift longer, heavier, and over time get sort of an increase in strength. The other big thing from a cellular perspective is that creatine causes calcium to come back in a little vesicle in our muscles. If you've taken high school biology or university, this will be your nightmare, but I remember everybody talking about the sarcoplasma reticulum. And it's an area that just releases calcium to allow our muscles to contract. And creatine speeds up the uptake of calcium. So some of the evidence out of Europe has shown that it increases relaxation time or the ability of the proteins in your muscle to grab hold of each other to contract. So there's a cellular aspect there explaining why we think we get an increase in muscle performance. I say strength, but endurance and power are all lumped in there as well. So endurance is the ability to perform repetitions to fatigue or power, move an object as fast as you can. They're all vitally important. But we think strength is overall from a global perspective, number one, it's probably the main reason a lot of older adults are placed in long-term care facilities. If they have a reduction in strength, they can't live independently. So that's why, again, resistance training or weight-bearing exercise, as you mentioned, CrossFit, whichever it is, foundational. I'm from Canada, so shoveling the driveway in the winter counts because anything that's a load against you is really beneficial to the body. I think people underestimate the benefits of moving. And then if anything can be taken in in this form, creatine, it'd be very, very beneficial. You mentioned some of the anti-inflammatory effects of creatine, particularly in the context of more endurance type of training. People that are perhaps running marathons or just clocking in a lot of hours of running or cycling per week. Is that, so I think that that goes to some respect in the recovery sort of bin, right? And I'm wondering if that also plays a role in recovering from doing your resistance training, strength training, like on a recovery day. So, I mean, do you think it plays a role just broadly in recovery? Yeah, it does. Now, this is interesting, and I probably would have been the most surprised when we wrote the paper on this, that we don't think traditional weight training, where you're doing a set, you're resting maybe a minute to two, it seems like it's not catabolic or intense enough. Now, most people will say, shake their heads, say, hey, when I'm in the gym, I'm really putting a lot of effort in. I think from a mechanistic standpoint, when you're doing running or long distance, continuous muscle contractions, it causes this large catabolic effect to the body. So that really heightens the inflammatory response. Weight training is acute. 10 seconds of work, three minutes of rest, 10 seconds of work, three minutes of rest for whichever it is. And we just don't see creatine having a lot of superior effects from a resistance training recovery aspect. Probably because the rest intervals for the average person are there. But from a long-distance event, you're running hours. You're swimming, whichever it is. The best lines of defense come from triathlon and marathon running, where the increase in these markers called cytokines were elevated, the creatine sort of attenuated that rise, could allow the individual to recover and get back on the track or whichever it is quicker. But I've talked to some good colleagues in Canada, and it just seems like weight training is too intermittent. Now, when you mentioned CrossFit, that's different. I'm thinking of the three sets of 10, you move from machine to machine, you rest, you have CrossFit or something that's really continuous would probably fall in line here of the necessity for creatine. So that would be a very good study to look at the effects of creatine on the recovery aspects of something like high-intensity interval training or CrossFit, for example. Our military type of training that's really endurance and resistance training. So you just gave me another idea to run with, but it's logical. The more intense, the more demanding, I think that's where creatine's anti-inflammatory properties would come into play. So when people hear catabolic or, you know, they'll think of muscle breakdown, right? And certainly, you know, there's a big component to sarcopenia, inflammation in sarcopenia, which is age-related muscle breakdown. Is there a role for creatine in preventing the breakdown of muscle? There is. It's very mixed. So, we don't have a lot of data. First off, creatine doesn't directly increase protein synthesis, which might be a surprise for a lot of reviewers. It sort of works in a magical other way, which we can talk about. But from a muscle breakdown perspective, it seems to reduce something called leucine oxidation primarily in young males. And that's an indicator of whole body breakdown. We've also shown in our lab, it reduces 3-methylhistamine, which is another indicator of whole body breakdown, but nothing is directly shown in the muscle itself. And for some reason, females don't experience this. We've looked at it in young and older females. We don't see the same effect. The only logical explanation is it could have something to do with progesterone or estrogen. We just't know that um and from an anti-catabolic effect uh decreasing some of these tissue repair mechanisms there's not a lot of research out there but unfortunately we're not seeing any evidence that creatine increases protein synthesis so unlike protein which it does creatine seems to help increase muscle size in other ways uh satellite cells growth growth factors, things like that. But it does decrease protein breakdown primarily, though, in males. And we still don't know exactly why, but we think estrogen or the other sex hormones might be involved. Does creatine have a general anti-inflammatory effect in both males and females? It does in young and older individuals. But here's an important distinction. The more stressed the body is, it seems to come to the rescue more. So if you're a young individual, adequate sleep, proper nutrition, you're probably not going to notice any anti-inflammatory effects. It's when the body is under times of extensive exercise or trauma, hypoxia. I'm sure we'll talk about the brain and sleep deprivation. So whenever the body is more stressed or under more attack, that's when creatine seems to come to the rescue. And getting, circling back to, you know, people that are supplementing with creatine and it improves their training volume, improves their strength. Why do people have to supplement with creatine? Well, they don't actually. So a little bit of clarity. So we naturally are producing creatine in two main areas, in the liver and in the brain. And on average, we're producing about one to two grams. Then we're also consuming in the diet anywhere between one to three grams or none. So a vegan is not getting any dietary creatine. Those that are on a carnivore diet might be all the way up to about three grams. And we excrete through the urine a product called creatinine at about two. So when you do the math, we're in a net surplus anywhere between one to two grams a day. And we know it's not essential because vegans can live a long, healthy, successful life. But we consider it conditionally essential because when we see all the evidence, I think there's over a thousand peer-reviewed papers, when we take in a little bit more, there is some substantial beneficial effects across the whole board, not just muscle. We're now looking at bone, brain, and the immune system. So from a perspective of a vegan who is not getting any almost amount of dietary creatine. They're relying on their liver to make it. What's going on in their brain? You mentioned the brain makes creatine. Yeah, it's very interesting. So on average, vegans have substantially less muscle creatine compared to an omnivore or carnivore diet. But an elegant study out of Brazil about four years ago, they used sort of an MRI for the brain. And they showed that vegans and omnivores had the same amount of brain creatine stores. So that's really substantiating that the brain makes its own creatine. It probably makes enough for the non-stressed individual. But during times of metabolic stress, the question is, will vegans or omnivores need more? And it's likely that that's true, yeah. During development, is the developing brain making its own creatine? It is, yeah. Just like our liver is making its own creatine, and it's probably at an accelerated rate for brain development, cognitive development. Again, our brain is small, but it uses 20% of our daily energy. And, of course, during development, that's when it's very, very precious as well. Yeah. So creatine is mostly found in animal foods, meats, poultry, fish. Yes. None in plants at all. Trace amounts. You'd have to eat the entire orchard of whatever plant you're thinking. And same with milk. You'd have to drink all the milk from a Jersey cow to get any significant amount. So that's why it's unrealistic. So if we're producing between, you know, one to two grams? At best. At best, yeah. Just in our liver. Correct, yeah. And that presumably then is being transported to muscle? That's the whole 95%. We can't forget about the bone and brain are the main areas, yeah. Okay. And then if, let's say, let's say you're getting, I think I was reading some NHANES study where on average people get younger adults, not older adults get anywhere between one to two grams a day from their diet. Right. But older adults are getting on that lower end, even not even necessarily at, even at one gram. So, so older adults are getting even, even less. Yes. But then, you less. But then, you know, is there more to be consumed by the muscle or does it get spread around? Yeah, that's an excellent question. So the thought is as we get older, we have reduced fossil creatine stores in our body, so they might need more. And the hope is about 95% is housed in our skeletal muscle. But now with the emergence of research, the rest is in bone and brain specifically. So the hope is if we take in more, our muscles will be full, which is great. But now hopefully we're going to have some trickling into our bone, which is even just as important. And I think most people would argue from the neck up, that's really important from a global perspective with all the neurological diseases, depression, anxiety. So I'm one of the big proponents of taking a lot more than probably what's recommended based on the evidence-based research to sort of disperse throughout the whole body, not just skeletal muscle. Well, let's talk a little bit about that. So in some of these, let's, you know, the strength training, resistance training studies, what's the common dose that's taken? And maybe we can talk a little bit about, I mean, there's the loading phase, which I've never done. So I actually take five grams a day. And although I might start taking more after this podcast. So I'd love to know, like, what is the average dose that's taken to improve, you know, your strength training, your resistance training, your training volume? And then we can go from there. Yeah. So, I mean, in 1992, Roger Harris came out with a seminal protocol where, as you just mentioned, this loading phase, it's the most viable, rapid way to really saturate your skeletal muscle. This has nothing to do with the bone or the brain. And so that's 20 grams a day for about seven days is usually what's recommended. A bit of new information, you only need to do that for two days and then your muscles are saturated. So the loading phase was designed for athletes to really rapidly sort of fill up the room, if you will, from a skeletal muscle perspective. After that, you can reduce it as little as two grams a day. So again, that's a half a salmon steak, that would be a half a chicken breast or whichever. So it's very viable. They call that the maintenance phase. The only problem with the loading phase is it's so rapid, it does cause water to enter a lot of our cells. And a lot of individuals do not like this potential net water retention or GI tract irritation. We don't usually use that in our labs for that reason. But for the athletes, World Championship coming up, the loading phase followed by a maintenance phase is a very viable rapid way. Young females hate it because of that water retention and weight gain. The good news is you can take as little as two to three grams a day, no loading phase, and take that on a daily basis, probably for the rest of your life. And that will definitely accumulate and fill up your muscles in about 30 days. We don't know if that low dose will get into the bone or brain on a long period of time. What we've done is look at a relative dose. So that means everybody has a certain weight, we put them on scale, and we use 0.1 gram all the way up to 0.14 grams per kilogram um so for example if you're 70 kilograms you're taking seven grams a day all the way up to about nine grams a day you can take that in one bolus dose or split it up into smaller dosages throughout the day i wouldn't go any less than one gram one gram doesn't seem to get in the blood as rapidly as we need um so that's something for your viewers if they're microdosing, no less than one gram. But you can split it up two and a half grams, five grams, whichever you want. I take a lot more than that based on our new clinical data. I'm 48 years of age. I know the effects of aging and from a bone and brain perspective. But really all this dosing came from muscle and we have all these new areas. That's why I think the emergence of new dosing strategies has really come to light. I definitely want to get into some of these potentially negative effects of the high, high dose. Right, right. But let's talk a little bit about your new emerging data on bone health. So you're talking about, so I mentioned five grams a day. And well, maybe before we get to that, how long does, if I'm taking, like if someone's taking five grams a day and how long does it take to get your muscle stores saturated? And then let's say your resistance training, right? So you're working, let's say your resistance training and endurance training. I mean, you're working out five to six hours a week. I'm just talking about my schedule here. And then, and I'm doing five grams a day, right? Am I just constantly saturating my stores, even though I'm, you know, pulling down from them as I'm working out? Or how does that work? Because five is the average global recommendation. And that's a fantastic dose, overall, we think to start, especially from a a muscle perspective so it'll take you 21 days to fully saturate your skeletal muscles so after that you're going to have some being excreted in your urine or let's pray here hopefully some is now being up taken into your bone because the muscle is pulling on bone your bone is a very metabolically active tissue which no one actually sees in mirror. And then hopefully some is trickling more into your brain. So the thought is, okay, 5 grams is very viable. Easily 21 days, your muscles will be full. Taking 5 grams a day thereafter, some would probably go in the form of creatinine. But hopefully, and we don't know this, maybe some is going into your bone, being used by your immune system, your GI tract, your gut health, and your brain. So five is a great dose. I'd like it to be higher just because of some of the new data to suggest every day we get out of bed, we're a day older. There's some good evidence to suggest bone needs a bit more. And of course, the brain, we still don't know. But I have some lines of thinking about when we're really metabolically stressed, how much to take. But if you're taking five, rest assured, you're doing exceptionally well. Well, let's talk about bone. So one of the best things you can do for bone health is weight-bearing exercise. These compound lifts, the things that we were talking about with improving your explosive power and your strength, right? Right. How is creatine adding to that? By two ways, a direct and indirect. So let's go with the boring direct. It sort of increases osteoblast cells. These are the cells that sort of create or the formation of our bone cells. So in rodents, osteoblast cells have been energized in the presence of creatine. So it was logical to think in humans, maybe our osteoblast cells, the cells that are responsible for increasing bone size and strength, might have more fuel. And these cells do use creatine just like our muscles do for fuel and potentially increase bone density. And if that's true, we've just cured osteoporosis, basically. The other line of thinking, which is surprising, going back to this anti-catabolic phenomenon, is the best lines of evidence with bone are from an anti-catabolic perspective. It seems to resemble a bisphosphonate. So a lot of viewers are maybe taking a bisphosphonate. It sort of preserves your skeleton. I know my mom is taking that as well. So creatine reduces something called the osteoclast activity or bone resorption. So for some reason, it really inhibits these osteoclasts from sort of chopping down our bone and increasing blood calcium levels when not needed. And then of course, if it's sort of increases osteoblast potential, maybe the recycling of bone gets stronger. It's kind of like laying a foundation of a house. The bricks are stronger. You're sort of putting the bricks together a little bit faster and then inclement weather is not chopping away the bricks or the cement. So that's how we theorize it was working. And there's been about 15 studies now showing that it has a lot of anti-resorptive effects. So think of anti-catabolic to the bone. We have not shown in a single study an increased bone mineral density."

Creatine mechanism: enhanced motor unit recruitment and calcium cycling in muscle

Creatine improves type 1 and 2 fiber recruitment and speeds calcium uptake in the sarcoplasmic reticulum, boosting strength.

"Welcome back to the podcast. Today, we're doing a deep dive into one of the most well-researched and widely used supplements, creatine. And joining me is Dr. Darren Kandau, one of the world's leading experts on creatine, muscle physiology, and aging. Dr. Kandau is a professor and director of the Aging, Muscle, and Bone Health Laboratory at the University of Regina in Canada. He's also the director of research for the Athlete Health and Performance Initiative and has published over 140 peer-reviewed papers on how nutrition, particularly creatine, and resistance training impact muscle, bone, and brain health. Most people associate creatine with strength and power, but its effects extend far beyond that. In fact, in this episode, Darren and I discuss how research now suggests creatine supplementation may play a role in cognitive function, particularly under stress or sleep deprivation, muscle and bone health, especially in aging populations, endurance performance, and HIIT adaptations. It reduces inflammation and improves recovery. We talk about metabolic and cardiovascular health with potential benefits for cholesterol, triglycerides, and even vascular function. We even discuss mental health conditions like depression. We also get into a lot of specifics regarding creatine supplementation, including how creatine supplementation works, the best ways to take creatine should you cycle it, is timing important, does it work better if you take carbohydrates? We talk about dosing strategies. Standard recommendations are three to five grams per day, but the question is, should some people take higher doses? We discuss creatine and whether or not we need a loading phase for it, or if you can just start with a daily dose. We also talk about different forms of creatine. Monohydrate is the gold standard, but what about HCL or other formulations? And we also discuss a lot of different common concerns. Does creatine cause bloating, GI distress? Does it interact with caffeine? Does it cause baldness? Is it bad for the kidneys? And many other concerns. We also dive deep into the emerging research on creatine and sleep, including whether creatine actually improves sleep or if it's just helping the negative effects Thank you. If you haven't yet downloaded our free guide, How to Train According to the Experts, you can get it at howtotrainguide.com. We just uploaded it to include new creatine protocols. This guide distills insights from top experts featured on the podcast into one actionable resource. It covers protocols to build muscle mass and strength efficiently, training strategies to improve cardiorespiratory fitness, which is a key biomarker for longevity, evidence-based approaches for enhancing metabolic and brain health, and also options tailored for highly time-constrained individuals. Again, it's completely free and available at howtotrainguide.com. If you're interested in exploring creatine even further, we've compiled a comprehensive set of resources for you. Head over to foundmyfitness.com forward slash topics, where you'll find a deep dive into all the current evidence-based research on creatine. Just scroll through the alphabetical listing until you'll find the letter C. It's also a part of my mission and sincere commitment to deliver high quality evidence-based science and practical health tools to everyone entirely free without advertisements. To make that possible, we rely directly on support from you, our listeners. If you appreciate the depth, the rigor, the objectivity we bring to every episode, please consider becoming a Found My Fitness premium member. Premium membership is the best way to directly support our work, and it also grants you access to exclusive perks like the Aliquot, which is our members-only podcast, monthly live Q&As with me, and our curated Science Digest. Your support directly enables us to continue providing trustworthy, actionable information on health, fitness, and aging. You can sign up for that at foundmyfitness.com forward slash premium. Again, that's foundmyfitness.com forward slash premium. And now on to the podcast with Dr. Darren Kandow on all things creatine. Darren, I'm super excited to have you here today, to have this conversation with you, to go deep into the science of creatine. Yeah. No, thanks for having me. I'm really excited as well. Absolutely. I've read several of your studies. I'm a huge fan. A lot of really important and interesting research to talk about. Maybe we can start where it's most popular. I mean, a lot of people think about creatine in its role in exercise performance. However, there's been a lot of emerging research in other areas. Maybe you could give people just a quick snapshot. Yeah, like it's really evolved over the last 40 years. It's gone from athletes getting bigger, stronger, faster. Now we're looking at potential benefits on bone health, brain health, cardiovascular health, even in children and during pregnancy. So it's evolved from just the young male athlete to pretty much anybody on the planet is now considering creatine either in their diet or supplementation. So for the next few hours, super excited to talk about all aspects of creatine and the evidence-based research behind it. Well, let's talk about the resistance training and improving performance, muscle health. I mean, why are people, why is it so popular? Well, because it works from a muscle performance perspective. So, really, it basically increases the ability to produce ATP or maintain it during an exercise session. So, for example, when you're doing, you know, squat or leg press or even running, you're doing muscle contractions and phosphocreatine, which is what we're going to be talking about today from creatine supplementation. It really maintains ATP or adenosine di-triphosphate. So if you have more ATP longer, you can exercise at a higher capacity, a higher intensity, and that delays the utilization of other energy systems that might be a bit slower. So anybody involved in high explosive anaerobic type of sports, weightlifting, high intensity interval training, for example, probably would experience some benefits from creatine supplementation. And how is it going to benefit you? Is it going to improve your training volume? Is it going to make you stronger? All the above. So it definitely seems to increase training volume. So that's either the load by the reps by the set or exercise capacity from a cardiovascular perspective. It definitely, if you were to choose one thing why creatine has been so effective, it's improving muscle strength. You could also encompass that with endurance and power. It also improves lean body mass. So here's a big discrepancy that a lot of the viewers might not know. When we measure lean body mass in the labs, we're technically measuring blood, connective tissue, soft tissue. So we're not directly measuring muscle mass. We need to do a lot more research on that. But in general, about 50% of the value of lean body mass, we consider muscle. So it has some small favorable effects. There's been some studies with QCT as well as ultrasound, but you can get an increase in lean body mass, regional muscle thickness, muscle performance, but probably the area that most people don't realize is the recovery aspects. It really seems to have some anti-catabolic effects, potentially anti-inflammatory effects. And that's interesting because it's from the aerobic community. For the longest time, we never thought creatine was for endurance or aerobic type athletes. And the best lines of evidence from a recovery aspect come from long duration aerobic exercise, a marathon, ultramarathon, a triathlon. It seems to reduce cytokines. So those are markers of inflammation. So there's a whole gamut of mechanisms. There's about 10 what we consider anabolic factors, and then there's probably just as many as an anti-catabolic effect. So it has a plethora of benefits, which I'm sure we'll talk more about in detail today. Yeah. So you, okay, to go back, you just gave it total information dump, which was just awesome let's go back first to the explosive power you were talking about it seems to really help benefit in that explosive power like you're talking about doing doing a squat yes or i don't know maybe the first few seconds of a interval um something where you're going you know using all that power yeah um is is it Is creatine benefiting, is that how it's benefiting increasing the training volume? Or is there something else that's happening? Yeah, in two ways. So it really seems to maximize either the recruitment or the ability of type 2 muscle fibers. And when we talk about aging, unfortunately, those are the ones we're losing as we get older. But it really seems to work in the second, third, and fourth set. So for example, if you were to do four sets of leg press, compared to placebo, you may not notice any difference in the first set because we think we have enough ATP or fossil creatine stores in our muscle. But when it comes to set two, three, and four, that's where creatine really comes to the rescue. The individual or group can do more repetitions, and then over time, they can actually do a greater volume. We think with weeks of training, if you're doing more volume, you can actually get greater physiological adaptations. So when we look at all the meta-analysis, when you compare creatine and weight training to creatine placebo and weight training, there is a greater increase in lean body mass, muscle size, as well as muscle performance. So creatine, there is something there from a mechanistic standpoint to allow that. And we think muscle fiber recruitment, primarily type two muscle fibers is one of the main reasons. Does it affect the recovery time in between sets? Excellent question. It does. It really speeds it up. So on average, if you were to totally wipe out your normal creatine stores, it takes about three to five minutes for your mitochondria to recover that. However, creatine really, really speeds up that recovery, which is great for the average person. They don't have a lot of time to work out. They can't wait around for three to five minutes in between a really intense set. So it really speeds up the recovery. Not only does it speed up the recovery after every set, but in between contractions as well. So over time, the individual could probably have a really intense, great workout in less time total and get actually more favorable effects. And I think what this is really important, we're talking about here, I mean, we were talking about squats, you know, these explosive types of power, types of training. And this is a really important field because, you know, you often hear about people talking about the loss of muscle mass as we age. You talked about losing type 2 types of muscle fibers more readily than the type 1. So, these are the types of muscle fibers involved in that explosive type of power type, you know, exercise."

Creatine as a neurotransmitter: speeds calcium uptake for faster muscle contraction

Creatine enhances motor unit recruitment, speeds calcium reuptake in the sarcoplasmic reticulum, and improves strength, endurance, and power output.

"Welcome back to the podcast. Today, we're doing a deep dive into one of the most well-researched and widely used supplements, creatine. And joining me is Dr. Darren Kandau, one of the world's leading experts on creatine, muscle physiology, and aging. Dr. Kandau is a professor and director of the Aging, Muscle, and Bone Health Laboratory at the University of Regina in Canada. He's also the director of research for the Athlete Health and Performance Initiative and has published over 140 peer-reviewed papers on how nutrition, particularly creatine, and resistance training impact muscle, bone, and brain health. Most people associate creatine with strength and power, but its effects extend far beyond that. In fact, in this episode, Darren and I discuss how research now suggests creatine supplementation may play a role in cognitive function, particularly under stress or sleep deprivation, muscle and bone health, especially in aging populations, endurance performance, and HIIT adaptations. It reduces inflammation and improves recovery. We talk about metabolic and cardiovascular health with potential benefits for cholesterol, triglycerides, and even vascular function. We even discuss mental health conditions like depression. We also get into a lot of specifics regarding creatine supplementation, including how creatine supplementation works, the best ways to take creatine should you cycle it, is timing important, does it work better if you take carbohydrates? We talk about dosing strategies. Standard recommendations are three to five grams per day, but the question is, should some people take higher doses? We discuss creatine and whether or not we need a loading phase for it, or if you can just start with a daily dose. We also talk about different forms of creatine. Monohydrate is the gold standard, but what about HCL or other formulations? And we also discuss a lot of different common concerns. Does creatine cause bloating, GI distress? Does it interact with caffeine? Does it cause baldness? Is it bad for the kidneys? And many other concerns. We also dive deep into the emerging research on creatine and sleep, including whether creatine actually improves sleep or if it's just helping the negative effects Thank you. If you haven't yet downloaded our free guide, How to Train According to the Experts, you can get it at howtotrainguide.com. We just uploaded it to include new creatine protocols. This guide distills insights from top experts featured on the podcast into one actionable resource. It covers protocols to build muscle mass and strength efficiently, training strategies to improve cardiorespiratory fitness, which is a key biomarker for longevity, evidence-based approaches for enhancing metabolic and brain health, and also options tailored for highly time-constrained individuals. Again, it's completely free and available at howtotrainguide.com. If you're interested in exploring creatine even further, we've compiled a comprehensive set of resources for you. Head over to foundmyfitness.com forward slash topics, where you'll find a deep dive into all the current evidence-based research on creatine. Just scroll through the alphabetical listing until you'll find the letter C. It's also a part of my mission and sincere commitment to deliver high quality evidence-based science and practical health tools to everyone entirely free without advertisements. To make that possible, we rely directly on support from you, our listeners. If you appreciate the depth, the rigor, the objectivity we bring to every episode, please consider becoming a Found My Fitness premium member. Premium membership is the best way to directly support our work, and it also grants you access to exclusive perks like the Aliquot, which is our members-only podcast, monthly live Q&As with me, and our curated Science Digest. Your support directly enables us to continue providing trustworthy, actionable information on health, fitness, and aging. You can sign up for that at foundmyfitness.com forward slash premium. Again, that's foundmyfitness.com forward slash premium. And now on to the podcast with Dr. Darren Kandow on all things creatine. Darren, I'm super excited to have you here today, to have this conversation with you, to go deep into the science of creatine. Yeah. No, thanks for having me. I'm really excited as well. Absolutely. I've read several of your studies. I'm a huge fan. A lot of really important and interesting research to talk about. Maybe we can start where it's most popular. I mean, a lot of people think about creatine in its role in exercise performance. However, there's been a lot of emerging research in other areas. Maybe you could give people just a quick snapshot. Yeah, like it's really evolved over the last 40 years. It's gone from athletes getting bigger, stronger, faster. Now we're looking at potential benefits on bone health, brain health, cardiovascular health, even in children and during pregnancy. So it's evolved from just the young male athlete to pretty much anybody on the planet is now considering creatine either in their diet or supplementation. So for the next few hours, super excited to talk about all aspects of creatine and the evidence-based research behind it. Well, let's talk about the resistance training and improving performance, muscle health. I mean, why are people, why is it so popular? Well, because it works from a muscle performance perspective. So, really, it basically increases the ability to produce ATP or maintain it during an exercise session. So, for example, when you're doing, you know, squat or leg press or even running, you're doing muscle contractions and phosphocreatine, which is what we're going to be talking about today from creatine supplementation. It really maintains ATP or adenosine di-triphosphate. So if you have more ATP longer, you can exercise at a higher capacity, a higher intensity, and that delays the utilization of other energy systems that might be a bit slower. So anybody involved in high explosive anaerobic type of sports, weightlifting, high intensity interval training, for example, probably would experience some benefits from creatine supplementation. And how is it going to benefit you? Is it going to improve your training volume? Is it going to make you stronger? All the above. So it definitely seems to increase training volume. So that's either the load by the reps by the set or exercise capacity from a cardiovascular perspective. It definitely, if you were to choose one thing why creatine has been so effective, it's improving muscle strength. You could also encompass that with endurance and power. It also improves lean body mass. So here's a big discrepancy that a lot of the viewers might not know. When we measure lean body mass in the labs, we're technically measuring blood, connective tissue, soft tissue. So we're not directly measuring muscle mass. We need to do a lot more research on that. But in general, about 50% of the value of lean body mass, we consider muscle. So it has some small favorable effects. There's been some studies with QCT as well as ultrasound, but you can get an increase in lean body mass, regional muscle thickness, muscle performance, but probably the area that most people don't realize is the recovery aspects. It really seems to have some anti-catabolic effects, potentially anti-inflammatory effects. And that's interesting because it's from the aerobic community. For the longest time, we never thought creatine was for endurance or aerobic type athletes. And the best lines of evidence from a recovery aspect come from long duration aerobic exercise, a marathon, ultramarathon, a triathlon. It seems to reduce cytokines. So those are markers of inflammation. So there's a whole gamut of mechanisms. There's about 10 what we consider anabolic factors, and then there's probably just as many as an anti-catabolic effect. So it has a plethora of benefits, which I'm sure we'll talk more about in detail today. Yeah. So you, okay, to go back, you just gave it total information dump, which was just awesome let's go back first to the explosive power you were talking about it seems to really help benefit in that explosive power like you're talking about doing doing a squat yes or i don't know maybe the first few seconds of a interval um something where you're going you know using all that power yeah um is is it Is creatine benefiting, is that how it's benefiting increasing the training volume? Or is there something else that's happening? Yeah, in two ways. So it really seems to maximize either the recruitment or the ability of type 2 muscle fibers. And when we talk about aging, unfortunately, those are the ones we're losing as we get older. But it really seems to work in the second, third, and fourth set. So for example, if you were to do four sets of leg press, compared to placebo, you may not notice any difference in the first set because we think we have enough ATP or fossil creatine stores in our muscle. But when it comes to set two, three, and four, that's where creatine really comes to the rescue. The individual or group can do more repetitions, and then over time, they can actually do a greater volume. We think with weeks of training, if you're doing more volume, you can actually get greater physiological adaptations. So when we look at all the meta-analysis, when you compare creatine and weight training to creatine placebo and weight training, there is a greater increase in lean body mass, muscle size, as well as muscle performance. So creatine, there is something there from a mechanistic standpoint to allow that. And we think muscle fiber recruitment, primarily type two muscle fibers is one of the main reasons. Does it affect the recovery time in between sets? Excellent question. It does. It really speeds it up. So on average, if you were to totally wipe out your normal creatine stores, it takes about three to five minutes for your mitochondria to recover that. However, creatine really, really speeds up that recovery, which is great for the average person. They don't have a lot of time to work out. They can't wait around for three to five minutes in between a really intense set. So it really speeds up the recovery. Not only does it speed up the recovery after every set, but in between contractions as well. So over time, the individual could probably have a really intense, great workout in less time total and get actually more favorable effects. And I think what this is really important, we're talking about here, I mean, we were talking about squats, you know, these explosive types of power, types of training. And this is a really important field because, you know, you often hear about people talking about the loss of muscle mass as we age. You talked about losing type 2 types of muscle fibers more readily than the type 1. So, these are the types of muscle fibers involved in that explosive type of power type, you know, exercise."

10g/day doubles brain creatine; 5g may not be enough for cognitive benefits

A German MRS study showed 10g/day doubled brain creatine content vs. lower doses. Under metabolic stress, the brain actively pulls in more creatine.

"So again, the 5% that's remaining throughout the body is in your testes, heart, bone, and brain. So for me, as a biological male, it's going to different areas compared to you as a biological female. But my hope is, wait a minute, let's go a bit higher so we're sort of checking off all the boxes. My guess is 5 grams, you'd have a small increase in brain creatine content. but if you have a really non-stressful life the brain says no, go to the bone or we'll excrete it down the toilet. But if you're metabolically stressed, it's begging for more. I'd like you to be probably higher than five, but I think it'd be interesting to look at some pre-post-MRS scans and it's viable. It could be there. The study that did four grams was in long COVID. These individuals, brain fog, fatigue, headaches, things like that. So the brain was really begging for recovery. Okay. So you just mentioned the best studies showing any improvement in, and when we're talking about improvement, we're talking about cognition. We're talking about like memory, memory. Okay. You said 20 grams, right? Which is definitely what I don't want, the swelling part of that, which happens around 20 grams. Yes. So have there been studies looking at 10 grams? Is that like a sweet spot? The seminal study was out of Germany, and they did two versus four versus 10. And this is where I personally take at least 10. And they use MRS studies, and they showed that about 10, double the percent increase in brain creatine content. But they also measured it in the gray matter, the white matter, and I believe the thalamus. And it all improved by about 10%. Now, it was a small sample size because the run on MRS is super expensive. So statistically, it wasn't there, but the percent improvements were a lot higher. And when you look at all the other data, 10 grams seems to be a very viable dose to not only check off the box, definitely for muscle. We're now checking off the box for bone, and then we're also checking off the box for brain as well. So I personally take about 10 grams a day on average. But during times of metabolic stress, sleep deprivation, or jet lag, I'll increase it to 20. So today, I will take 20 grams because I flew down from Canada. I'll take 20 grams again tomorrow. But when I get back home, I'll decrease it back down to 10. If any is being excreted down the toilet, I'm totally fine with that. Creatine is very cost effective, but I want to make sure I'm maximizing all my abilities. And the immune system, especially in Canadian winters, is really heightened and activated. And I really have found in the last few years, I'm not getting flu-like symptoms. Hopefully, that's from exercise or diet. But who knows? Maybe creatine is helping because there is some anti-inflammatory effects. um you went to another area that i definitely want to talk about but like before that so 20 grams then you're saying acutely when you're in this sleep deprived state jet lag you know let's say fill in the blank type of you know extreme stress right um is that immediate so let's say like you you miss you're like up late you had you're up late one night and you have something to do the next morning or the next day you have to be like on your game if you take that 20 grams either at night would you take it at night like before you go to sleep or in the morning or does it matter and will it have an effect immediately yeah and i love learning and this is just so 20 grams might be too low it's surprisingly your viewers so another study came out of germany they did is very elegant design it was a crossover and they gave 0.35 grams per kilogram so even if you're only 70 kilograms that's 25 grams in a bolus dose and they measured it for 21 hours of sleep deprivation and it really improved memory cognition and it increased brain creatine content so that high a dose not only does it get into your plasma or blood really probably in about three hours it's peaking. When your brain is stressed, it's being taken in quite readily. So during times of metabolic stress, it seems to work. Now, the argument is, how do I know I'm going to be stressed tomorrow? How do I know I'm going to have a bad night's sleep? You don't. So that's why I think taking a higher daily dose might be a safety. But the days you're like, oh, I didn't sleep at all. And I have a big presentation later of me as a professor teaching four classes a term. I've really increased the amount. I would say I might be the most saturated person on the planet because I've been taking creatine for decades. There's no reason to stop. We can talk about cycling or continuous. But I'm even taking more in hope that it's getting into my brain. Again, 20 years ago, it was just muscle. Then we've evolved into the bone, and now we're getting into the brain. And I think a university student's midterm week, final exam, staying up all night, cramming. Maybe creatine could really improve their ability to score better on tests. And when you look at the mental fatiguing studies, that's when creatine seems to work. After you've done a whole bunch of fatiguing exercises, or sorry, taking creatine before, it really speeds up your ability to maintain memory and cognition. And we can talk about neurofilament things in the brain or BDNF, and that's some of the mechanisms primarily in rodent. So there is some mechanisms showing that creatine is decreasing oxidative stress or really having some potential for neuronal health, which now you think of Alzheimer's, dementia, neurodegenerative diseases. So I'm super excited to see where this is going for the next 20 or 30 years. I wonder if there's any effect just because it was sort of a triaging of like it's helping with the energy. And so it's like freeing up other energy, you know, for like other, you know, taking care of oxidation. And that's probably the best overall segue. So it increases brain bioenergetics. And if it can, one of the common numbers with depression or concussion is that they have reduced brain creatine stores and bioenergetics compared to a healthy control on average. And so maybe creatine is bringing those values up or even slightly more and now the brain has more energy capacity to do and deal with all the daily stressors of society yeah absolutely so tbi i mean traumatic brain injury it i i the way i think of it is like real-time brain aging yes it's just it's like all of a sudden you just get a knock to your head and it's like accelerated aging so what would be a protocol for someone that you know let's say they take a blow to the head or they get hit with a ball a soccer ball or you know whatever the football whatever sport that they're doing um would it be like they should be taking high dose immediately yes oh i'm now in the camp and i think a lot of other researchers and a lot of the work coming from here in the United States. But if you're in contact sports, creatine should be taken on a daily basis because unfortunately, if you do get hit in the rodent model when, because you can't do this in humans, but when they've actually forced concussion in rodents taking creatine beforehand, the recovery symptoms are really accelerated. And in the only single human study was in children. As soon as these people in Scotland got head trauma, they put them on 0.4 grams of creatine per kilogram. So about 20 grams, these are just children immediately. And over six months, these children that were taking creatine had substantial improvements in self-care and efficacy. No blood biomarkers were taken, but at least it showed the improvement in recovery recovery so instead of waiting till you get hit why not take the preventative role and that's why again i think for me and again it's it's opinion but we've seen some data to suggest that 10 grams might be a good viable dose more or even a little bit less depending on why you're taking it but i personally take it from a whole body perspective i I don't play any contact sports now, but who knows? I could go and skate and fall and hit my head or skiing or whichever, and maybe that would help accelerate recovery. I'm taking it just for any chance to have some potential brain benefits. But the big area is it does increase the recovery aspects of concussion. So NFL, NCAA, especially down here in the United States, trillion-dollar industry. I got to believe these players are taking creatine in anticipation. I know the quarterback for the Dolphins, I think he's had three concussions this year. So his brain is so compromised right now, massive inflammation. Hopefully his medical team is at least considering high-dose with his other there. So, yeah. And they shouldn't be taking it for the benefits on muscle, you know, and explosive power, those, you know, high intensity moments. You mentioned earlier about 0.1 grams per kilogram body weight. So how would you adjust, let's say, you know, you're taking 10 grams of creatine per day and you're wanting the effects, the benefits of muscle, bone, brain, as do I. However, I do not weigh as much as you. So would you, is there a scalable amount per kilogram body weight you think would be something that, or is it hard? That's an excellent question. And the answer would probably be no, because when we go on on the scale we don't consider the head even when we do dexa scans as headless so you know if i'm 80 kilograms i'm taking about there's the the sweet spot about you know nine to ten grams a day uh taking it from a weight perspective to the correlate to the brain it is almost impossible because we need to measure the weight and where it's a hard tissue it's little bit soft, but it's usually hard tissue. I think overall body weight, very similar to how people do protein based on lean mass or a total body structure. So you can take creatine based on lean body mass, but it's very difficult. You would have to have some type of imaging apparatus. So we just usually recommend it on body mass. They hit all the aspects. That makes sense. And it really does seem like there's this sort of triaging where it's like, okay, the muscle's consuming it. It's like the greedy one. And then whatever's left over, maybe the bone. But if the brain's stressed, well, maybe, you know, it's funny how the body can figure that out. Like, no, the brain needs it. So, you know, there was another, there's some interesting research that you also published kind of in the brain area is sleep, right? And I'd love for you to talk about that study. I thought it was so interesting, these resistance training females, and you gave them creatine, and it really seemed to help improve their sleep on training days. Yeah, it was colleagues at the University of Idaho, Ann Brown and CJ Prush, and they looked at looked at young healthy uh individuals biological females and we gave a pretty high dose here five grams plus we added five grams of placebo so 10 grams a day versus a 10 gram placebo and this was done for six weeks and they resistance train um with a tonal home gym for um two days a week and the interesting thing is total sleep duration on the days they trained was substantially higher. I think it was about almost an hour compared to placebo. And again, these are young university-age students that were taking creatine, about five grams a day. The nice thing is it also improved strength. There was no big fluctuations in weight gain, which was very, very interesting. No adverse effects. Now, there was no mechanisms assessed, but the logic was that on the days these individuals are training, maybe they put in more effort. So creatine helped recover the body a little bit more, allowed that body to be in repair mechanism a little bit more, and they slept more for about an hour on average more. We still don't know the exact reason, but it is interesting that it improves sleep duration. And it's almost kind of the opposite of what we were just talking about. We were talking about if you're in this context where you're jet lagged, you're sleep deprived, and you take the creatine and it kind of helps you get over that brain fog that like, you know, you're not quite on your game. Yeah, it goes against most of the comments I get where when people take high-dose creatine, some people say they feel like insomnia or intermittent sleep. And the theory there from a rodent model out of Belgium is that maybe the brain is recovering quicker, that it doesn't need to sleep as long. So we still need a lot of work to do. We need to look at different stages of sleep. I'd really like to look at some blood biomarkers, indication of what's happening from an inflammation perspective."

Creatine + resistance training reduces body fat ~1% and benefits bone and brain

Creatine combined with resistance training yields a small but reliable fat loss (~0.5 kg).

"I put creatine in my coffee. I put everything in my coffee because it just masks everything. I just didn't do it in one. I've never really had any GI problems with creatine supplementation myself. But I'm not sure that I'm supposed to be doing that. Yes, I'm one of the rare people and most people argue against me. I don't do it either. Um, so there's two ways to look at this. The pharmacokinetics of creatine and, uh, caffeine do not oppose each other, but from a cellular perspective, they certainly do. So remember when I talked about the sarcoplasm reticulum, caffeine likes to release calcium, but creatine likes to take it in. And some really good research out of Europe have shown that the two molecules oppose each other from a muscle relaxation time. But the dose of caffeine seems to be the most important factor. If the dose is over 250 milligrams or even higher, that's when it seems to have the interference effect. If the dose is lower, it doesn't seem to have an interference effect. So the average large black coffee from Starbucks might be 300, 400 milligrams of caffeine. So if you were to put your scoop of creatine in there and sip on it for hours, you probably won't notice an interference effect in a few times. But if you did that every day for months, you might notice a blunting effect. If you did it a one-time shot, you know, you were doing an experimental trial, you might not notice it. So I never combine the two. I always have coffee early in the morning. I love coffee. And then I wait at least two hours before I take my first thing at creatine in anticipation of those cellular interference. But other people, other big-time creatine researchers say, no, I take it together. If it works for you, great. But there's something there that makes me a little cautious. And we've done the only training study. It was underpowered, but they did interfere with each other. Yeah. Okay. Is creatine heat sensitive? It is. It denatures a little bit. So if you warm up the solution, some people don't like the grittiness. So when the temperature rises, it will decrease the or increase the solubility, if you will. It will not degrade at the creatinine unless it's super heated for a long period of time. So if you are putting it in your coffee... The heat is not the act. It seems like the caffeine molecule might be the one that might interfere with it. Okay, so you don't have to worry so much about it being in like a hot liquid, like tea or... But if you had like a normal K-cup is 80 milligrams, there should be no interference effect. You could have two of those. But if you get up to like a large coffee, so a normal cup of coffee here in the United States, maybe 80 to 100 milligrams should be totally fine. Yeah. Yeah. Okay. Well, this is all really good information. I think addressing some of these, the myths and, you know, questions, the misconceptions, I mean, all those things, because you've published a couple of meta analysis or review articles, I guess, or review articles on this. And so you talked about, let's talk about the fat gain, right? So that was kind of when you touched on a little bit. I mean, especially women, women, is it really just because of the lean mass increase? Yeah, we there has been some cellular and our animal data to show the increases thermogenesis. But overall, the decrease in body fat is there, but it's very low. So don't run out and buy creatine and think you're going to lose 20 or 30 pounds. We're seeing at best about a 1% decrease in body fat and about 0.5 kilogram reduction over time in combination with weight training. Now, that could have implications for obesity, type 2 diabetes, or chronic diseases down the road. But the nice thing is a lot of people had a myth that creatine increased body fat. We don't see any evidence to that. Okay, so it's doing the opposite. The hydration myth. So what about you hear? I've heard some people talk about cramps, causing cramps or dehydration. It's opposite. It super hydrates the muscle. So it could be from the sodium potassium pump or disruption from dehydration. But if you're metabolically dehydrated, creatine is not the cause. If anything, creatine is trapping water into the cell. It also has been shown to increase extracellular water and total body water in some studies. So from a cramping or dehydration perspective, it's actually opposite. So for those exercising upcoming summer months, NFL football players, two-day practices in July, creatine might actually help hydrate the muscle and decrease the chance of muscle cramping or dehydration. Oh, that's super important. Interesting. Has anyone directly looked at that? I think Rick Crider's done some studies with that when he looked at NCAA players, but a lot of people don't take it because the myth was that it was dehydrating and we just don't see that. Where did that myth come from? I think what happened was in the inception of creating research, a lot of people don't take the myth was that it was dehydrating and we just don't see. Where did that myth come from? I think what happened was in the inception of creatine research, a lot of people were not drinking water or going through some practices like wrestling, wearing rubber suits, extreme hydration. They happen to be taking creatine and then they said, well, I'm on creatine since it traps water. Therefore, my cells must be exploding or muscles and therefore was causing cramping. And we just don't see any evidence behind that. Okay, so it was like a correlation thing. Yeah, unfortunately, it was the opposite. And then it sort of went with you. Okay, we've talked a lot about the kidneys. And you're talking about creatinine. And I'd love to talk about that. That's one that I hear a lot, that it's bad for the kidneys. It's bad for the liver. Can you address that? It's probably the biggest concern. So we've looked at study after study and rest assured from a clinical perspective, creatine does not adversely affect renal liver or cardiovascular cells. And we've given 11 grams a day in postmenopausal females to a population where their organs are under a little bit more stress and no adverse effects. The theory here was that when creatine enters your muscle, when it gets metabolized, it's non-enzymatically metabolized as something called creatinine. And those watching say, oh, wait a minute, I just saw that my doctor checked that off. And the reason they do that is creatinine is a byproduct. It's supposed to be filtered by the kidneys. So if you have high blood creatinine, that means your filtration rate in the kidneys is not working properly. Think of your Brita water filter. It's clogged up. So unfortunately, when a lot of people go to their doctor, they don't say, hey, to the nephrologist or GP, I'm on creatine supplements. Because it's logical that if you're taking creatine, your creatinine might be acutely raised, and then that causes a false pause. And if your estimated filtration rate is low, so your doctor says, whatever you're taking, stop, it's killing your kidneys. We know that's not the case because when they do stop, their kidney function just comes back. So it's just the metabolism of the molecule. Okay, well, this is really important. I've had a few people reach out to me and tell me that their creatinine was elevated, and I don't think they told their GP that they were taking creatine. And so the idea here is that it's the metabolism of the creatine to creatinine that's being excreted through urine. That's right. So creatine and fossil creatine don't leave the muscle. It gets left in the muscle as creatinine. Creatinine can also be raised with a very, very high protein diet, excessive exercise or dehydration. But make sure if you're on creatine supplementation, tell your doctor because it's logical that your creatinine in the blood will be elevated. That's just from the metabolism of the supplement. Now, if your liver enzymes are through the roof, that could be an infection. So again, make sure you go and get medical screening and guidance. But every time we hear this, it's usually a false positive. I see. False positive. Okay. So it's really good to talk to your physician about that. Baldness. That's one. That's one. It was that rugby. Was it rugby players? Yeah, yeah, yeah. I was going bald way before I started taking creatine. So a lot of people say, oh, well, obviously. And it's interesting. It was a great study in a sense that they looked at a novel concept. So they had elite rugby players do a crossover design and a crossover design is really powerful. That means the group gets both placebo and creatine. So it really controls for diet, genetics, hormones, things like that. And when they took 20 grams a day, it might've been even 25 grams a day for seven days during the creatine supplementation phase, they increased the hormone dihydroxy, testosterone, or DHT. And most people say, oh, I think I've seen commercials about this."