Darren Candow Creatine

Darren Candow
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Kelly: [0:00:04] Hey everyone, I’m Dr. Kelly Starrett.

Juliet: [0:00:06] And I’m Juliet Starrett.

Kelly: [0:00:08] And you’re listening to The Ready State Podcast.


Juliet: [00:00:16] This episode of The Ready State Podcast is brought to you by our friends at LMNT.

Kelly: [00:00:21] When we’re talking LMNT, I want to talk about one of the things that it does is allows me to solve a problem.

Juliet: [00:00:26] What problem is that, Kelly?

Kelly: [00:00:26] We’ve learned from some of our uber sports nutrition friends, like people who work in Tour de France-

Juliet: [00:00:34] That you should drink some water?

Kelly: [00:00:35] Well, there is that too. But that we should separate our nutrition from our hydration. And I think a lot of times we’re all trying to drink everything down and it’s like a turkey meal, whole Thanksgiving meal in a bottle. And one of the things that we have discovered is that we take a little snack on our long rides, we actually eat a food, but then our water is really about hydration and electrolyte replacement. And we have been running LMNT exclusively in our bottles for a long time.

Juliet: [00:01:04] A long time.

Kelly: [00:01:05] And it is amazing, A, how effective it is, but how tasty it is. I’m actually getting enough electrolytes. I’m a big human, I don’t know if you know this. And one of the things that happens is that-

Juliet: [00:01:15] You’re a little bit big.

Kelly: [00:01:16] Oh, thank you. One pack of LMNT in my bike bottle turns out to be a perfect recipe for electrolyte supplementation and hydration and then separating out my nutrition. And I think that I just can’t recommend that strategy enough unless of course you’re going so hard you can’t eat.

Juliet: [00:01:38] Well, and for me, while I’m training, I really crave salt and in fact-

Kelly: [00:01:44] You are so salty.

Juliet: [00:01:45] I have trouble getting down anything that tastes too sweet when I’m-

Kelly: [00:01:48] It’s true.

Juliet: [00:01:49] In sessions-

Kelly: [00:01:52] You want like a Sriracha walnut flavor.

Juliet: [00:01:55] Something like that. But I don’t care for really sweet bars or goos or any really sweet drinks while I’m training. So that’s another one of the reasons that I love LMNT in my bottle, especially while I’m mountain biking because it tastes good to me and feels like what my body needs.

Kelly: [00:02:12] It tastes good and that is really the thing. When you’re redlining and it’s hot out, it’s got to taste good. It can’t be gross and sweet. LMNT strikes the perfect balance of hitting all those things and allows you to separate your nutrition out.

Juliet: [00:02:25] Right now if you order through our link, you get a free sample pack with all of LMNT’s flavors. Go to drinklmnt.com/trs.

Juliet: [00:02:34] On this episode of The Ready State Podcast, we are very excited to welcome Dr. Darren Candow. Dr. Candow is a professor and director of the Aging Muscle and Bone Health Laboratory in the faculty of kinesiology and health studies at the University of Regina Canada. The overall objectives of Dr. Candow’s internationally renowned research program are to develop effective lifestyle interventions involving nutrition, primarily creatine monohydrate and physical activity, aka resistance training, which have practical and clinical relevance for improving musculoskeletal aging and reducing the risk of falls and fractures. Dr. Candow has published 188 peer refereed journal manuscripts, supervised over 20 MSC and PhD students, and received research funding from the Canadian Institutes of Health Research, Canada Foundation for Innovation, the Saskatchewan Health Research Foundation and the Nutricia Research Foundation. In addition, Dr. Candow serves on the editorial review boards for The Journal of the Journal of International Society of Sports Nutrition, Nutrients, and Frontiers.

Kelly: [00:03:46] Are you prepared to have your mind blown by this conversation?

Juliet: [00:03:50] This is one of the coolest podcast episodes I think we’ve done in recent memory, mostly because you and I have been so interested in supplements generally and trying to figure out which ones actually work, but in creatine in particular.

Kelly: [00:04:04] One of the four.

Juliet: [00:04:05] One of the four that actually work and in creatine in particular.

Kelly: [00:04:09] I feel like I became creatine aware in high school. But really, that was the first time I felt like that was like a moonshot. But I remember being in college, first discovering creatine and realizing then that, man, it really allowed me to perform better.  How we were using it, loading it, crazy now in retrospect. Gross. Basically, had to drink it with massive amounts of fruit punch. But we found that it made a difference when we were racing fulltime and we were using it at that point. Here we are all these years later, we had no idea that it wasn’t just about performance. It could be really about brain health, bone health, muscle health. It’s amazing.

Juliet: [00:04:44] Yeah, and one of the things I loved about this conversation is that Dr. Candow debunks some of the commonly held myths about creatine supplementation, gives us some really good information about who should be taking it, how much, dosing information, when people should consider taking it.

Kelly: [00:05:01] Basically, let me just summarize it for everyone so you don’t have to listen to it: You should take creatine.  And if you have babies, you should figure out how to get your babies on creatine.

Juliet: [00:05:09] Yeah, so this whole conversation is so filled with practical information and advice and all things creatine and I think you all are really going to enjoy it.

Kelly: [00:05:17] Hold onto your creatine butts.

Juliet: [00:05:20] Dr. Candow, welcome to The Ready State Podcast. Let’s go. We are very excited to talk to you.

Darren Candow: [00:05:25] Absolutely. Can’t wait. Let’s go.

Kelly: [00:05:28] Set up where your current work/life balance is. Where are you talking to us from, where are you headquartered?

Darren Candow: [00:05:35] Yeah, I’m actually talking to you from Invermere, British Columbia, which is the farthest western province in Canada. But I actually work at the University of Regina. That’s in Saskatchewan, Canada, about three provinces over. So a little bit diverse in Western Canada.

Juliet: [00:05:48] Western Canada. Okay, so we are going to dive in all things creatine today, as that is one of your areas of expertise. But before we do that, how does one become an expert on creatine? Can you give us just a little bit of the Dr. Candow backstory before we get into the details here.

Kelly: [00:06:05] And let’s be honest, I was born in the ’70s, which means I came of age during EAS, I gave myself diabetes trying to load creatine back in the day. Everyone who’s over 40 will understand that. But I’m like am I an expert in creatine.

Juliet: [00:06:21] Well, I think that’s the other thing that’s funny, is I feel like it’s this new thing people have been talking about in our industry for the last five years. But Kelly and I, we were both athletes in the ’90s, I mean I’ve been hit or miss taking it for a lot of time in my life, but we were taking it in the ’90s. And then it kind of went out of fashion.

Kelly: [00:06:38] I know what I know but I am so excited to understand my blind spots and to change all of the things that I think I’ve gotten wrong.

Juliet: [00:06:47] Anyway, we don’t even know what question was in there. But I’m sure there’s something you can respond to.

Kelly: [00:06:49] How did you stumble into this hotbed topic?

Darren Candow: [00:06:55] Yeah, I got insanely lucky. So this is interesting when you brought up fashion, so creatine was discovered in the late 1800s by mistake and then you never heard anything until Linford Christie won the gold medal in ‘96 I believe in Atlanta and they asked him what he was taking for training and he said creatine supplementation. And then if you go look at the research, in the late ’90s, two landmark researchers who are the most popular in the world, Roger Harris and Eric Hultman, simply did a study where they took 20 grams a day of creatine, which is very typical for the athlete to load, and it really maximized the amount in a muscle. And Dr. Hultman even showed that three grams a day was just as effective. It just took about a month, a little bit later on. and that’s probably where a lot of our dosing strategies come from. But I did my master’s degree with Dr. Phil Chilibeck who, Phil’s not on social media a lot but he’s probably, or actually easily one of the best clinical researchers in the world. And he actually was the first author on our big post menopausal study. And I was doing amino acid research. And we were interested in glutamine. I hate to quash everybody’s interest on glutamine, but it’s probably in my opinion the most worthless supplement that a healthy individual can take because it’s the most abundant nonessential amino acid. You can dump it all in and unless you have sepsis or cancer it won’t do anything. So we showed it didn’t do anything for someone healthy. 

Right about that time, creatine was getting a lot of momentum. And I worked with Dr. Darren Burke and Phil Chilibeck and Darren got a lot of industry funding from MuscleTech at the time, which is now currently owned by Iovate. And we did a lot of creatine research with muscle biopsies and vegetarians. And my career was by chance. I was around two phenomenal individuals at the right time, and shockingly, I’ve been doing this for over two decades. And it went in a lull, we got very lazy, we just simply said take it, take it, take it. And then I said, wait a minute, people are getting bigger, stronger, faster. Are you trying to tell me that someone can take three grams a day and they weigh 300 pounds and they’re going to get the same results as a 100 pound individual? So we have seven studies currently planned and there’s a lot more. So something that was sort of complacent has taken on its new life.

Juliet: [00:09:09] So I have heard that creatine might be the most studied supplement on Earth. Do you agree?

Darren Candow: [00:09:17] Yeah. It’s probably neck and neck with caffeine but I will say creatine in my opinion is the safest, most effective dietary supplement on the planet. High dose caffeine can cause some adverse effects and there’s over 1,300 peer refereed publications now on creatine. So it probably is number one, yeah.

Kelly: [00:09:37] Back up a second.

Juliet: [00:09:38] Are you going to tell him the story about your caffeine?

Kelly: [00:09:41] No one needs to know that. Ended in diarrhea. That’s fine. What I want to know is will you explain to those folks who’ve heard what creatine is, their children, I’m thinking of all of the parents who’ve said, hey, my son wants to take it, my daughter, should my daughter take creatine, could you tell us what creatine is, why it’s useful in the body? Just give people a little background and history. I remember all my physiology, but I’m trying to repress it. So just lay the table for everyone so that we can have the next conversation.

Darren Candow: [00:10:12] Yeah. Creatine is a very simple compound that we naturally produce in reactions in the kidney and liver. It’s very similar to a protein molecule. It’s just made of three amino acids we get through our diet, and those amino acids are arginine, glycine and methionine. So plant based proteins or animal based, primarily. But it’s also synthesized and made in the brain, which is sort of an emerging area. And we simply create this product to provide energy to all our cells in the body and this compound about 95 percent is stored in our muscles and the remaining five percent is stored in our bone and brain. We simply use it to maintain our energy currency of the so called adenosine triphosphate. And so if you have more of this energy currency, the theory is someone could exercise in the weightroom or around the track a little bit longer or faster and that could lead to greater adaptations.

Kelly: [00:11:00] You just hinted at some of the effects. I know we’ll get into it. But it seems like what we’re starting to understand is maybe it’s not just about more powerful muscles. In fact, for someone who’s over 50 now or almost there—Juliet’s over 50—the question is what are the other uses in the body and if I’m not interested in power development for a last rep of a max squat or a 100 meter sprint, does it still benefit me taking it?

Darren Candow: [00:11:27] Yeah, it’s a whole body supplement now. It used to be isolated, as you just mentioned, the power or athletes. But anybody looking to improve muscle mass. There’s massive implications for glucose disposal for someone with Type 2 diabetes. The more muscle you have, the more glucose can be disposed. Muscle is hugely important for people susceptible to sarcopenia or age-related diseases. We’re now actually coming in with a paper showing that creatine actually has a small beneficial effect on fat loss. Through a lot of misconceptions people thought creatine, because it increased water retention, but we’re actually now showing a small decrease in fat mass. So that could have implications for obesity. 

From the neck up we’re now seeing huge implications for pulse concussion syndrome, individuals with muscular dystrophy. Has huge implications maybe for sleep deprivation. And from a bone health perspective, any females susceptible primarily to osteoporosis, we’re actually seeing an increase in bone geometry. So I always say there’s not a person on the planet, and if you include the fetus with that, that’s included, that would not benefit from creatine. And we know this because people who are born with creatine synthesis deficiencies where they can’t create it, they get huge beneficial effects from speech pathology to cognitive affection. So I really struggle to find anybody on the planet that can’t benefit from creatine. And again, it is the safest. And we can talk about that long-term study we looked at a little bit later on. Because I think that’s a lot of hesitation with parents and children, they’re like is it safe. And I’m like, well, you’re naturally producing it, why wouldn’t it be safe if you’re taking it at a recommended dosage.

Kelly: [00:13:00] I know you have a real question but I’m just wondering how I get it into my fetus. I mean is there… I feel like fetal supplements are the next level. 

Juliet: [00:13:08] The next thing. Okay, so can we play a little game here and I’m going to hit you with some commonly talked about on the internet myths or facts about creatine and then maybe you can say if it’s a myth or a fact and then maybe you could go through each and then talk a little bit more about the why behind it. So this is my game. Does creatine cause weight gain?

Darren Candow: [00:13:26] It can, yes.

Juliet: [00:13:27] Does creatine cause hair loss?

Darren Candow: [00:13:30] No. I’m a bad example. But there’s no evidence to suggest it does.

Juliet: [00:13:34] Well, Kelly’s right there with you. Does creatine cause GI issues?

Darren Candow: [00:13:39] It can at the loading phase. So that’s why we typically don’t do that. We can talk about why that is, yeah. 

Juliet: [00:13:44] And then the only other one I’ve heard of on the internet is that creatine dehydrates your muscles.

Darren Candow: [00:13:50] Complete opposite. It super hydrates the muscles so it will decrease muscle cramps, especially for those athletes exercising in hot environments such as July and August. It super hydrates the muscles, so that’s complete opposite.

Juliet: [00:14:01] So let’s go back to the weight gain because if I’m not mistaken, the weight gain caused by creatine is from that water retention.

Darren Candow: [00:14:09] Yeah.

Kelly: [00:14:10] Is retention even the right word?

Juliet: [00:14:13] Is that even the right word? And then is it really just that it could have all these other beneficial effects but because people focus on the plus two pounds on the scale and feel very bothered by that-

Kelly: [00:14:24] Well, I don’t even know it’s five pounds.

Juliet: [00:14:25] What is it, plus five pounds? I’m just throwing that out there. Can you tell us a little bit about this whole weight gain thing and the concern around it?

Darren Candow: [00:14:34] Yeah. So creatine is osmotic. That means it drags water from your blood into the muscle primarily. So it kind of adds on overall mass in the first week. Now the issue that I think a lot of users, especially young females, they’re so underrepresented in creatine research, and it’s very tough to get them to stay in a study when you do the creatine loading phase because on average, you can increase body mass from one to three kilograms, depending on the genetics of the person. So what we do is we do a different dosing protocol. But yes, it does cause intracellular water retention and it can cause net body accumulation. So people say they feel very bloated or they increase body mass on the scale in the first week. That tells me you’re a responder to creatine. That actually is a good thing if you actually have a little bit of patience. That water retention will subside after a little bit of while. But we could talk about great strategies, especially for females, if you don’t want that rapid weight gain, we’ve done many things in our lab to show that we can get the same beneficial effects but hardly getting any weight gain over time. 

Kelly: [00:15:38] Hang on a second.

Juliet: [00:15:40] Oh, oh, so many questions. We’re dying.

Kelly: [00:15:41] You are saying that that could be a potentially net negative to step on the scale and be heavier. I think of, oh, I don’t know, half the population that would step on the scale and be like, dude, I’m up three pounds? Two, three kilos, I think… Okay go ahead. I’m just saying that that is not necessarily a net negative, J.

Juliet: [00:15:56] So tell me what does it mean to be a creatine responder? How would someone know if they are? And then two, for women listening to this who might be worried about the weight gain or anyone who might be worried about the weight gain, what would be the dosing protocol that you recommend to get someone up to an appropriate dose that they could keep taking forever?

Darren Candow: [00:16:16] Those are excellent questions. So the number one thing that determines everybody’s individual responsiveness to creatine is the amount you already have in your muscles. So in theory, a vegan who gets no creatine from their diet will respond the best. An individual eating a little bit of red meat or seafood, which are the food products that have the highest amounts of creatine, will respond in the middle. But someone on a carnivore diet will probably not respond hardly at all from an additional muscle perspective. We don’t know if that’s the same from our brain perspective. And more times than not, that’s how we determine responsiveness. There’s other things that can influence it such as sex, the age of the individual, but diet or individual amounts in the muscle seem to be the number one factor.

 So again, as a vegetarian or an individual who is emphasizing a plant-based diet, they should expect some really great gains from a creatine perspective. But for those who say I don’t want the water retention, I want to take creatine for the clinical and health aspects, I say there’s many strategies you can do. But if you’re looking at it from the muscle, activities of daily living perspective, you can take three grams a day, not twenty grams, three grams a day, and it’ll probably saturate your muscles in 30 days. Now, another cool strategy is that you can divide up the three grams individual one gram dosages: breakfast, lunch, dinner. You will not get any water retention whatsoever.

Kelly: [00:17:42] And like a teaspoon is about five grams, is that right?

Darren Candow: [00:17:45] Five grams. So you can divide it up. 

Kelly: [00:17:48] That’s a tiny amount.

Darren Candow: [00:17:49] We use something very novel in our lab because we use it based on the size of the individual. So we use 0.1 gram per kilogram. So if you’re 70 kilograms, you’re taking seven grams a day; if you’re 100 kilograms, you get 10 grams a day. The theory there is that the larger you are you have more of these transporters that allow creatine into the cells so that makes sense. It’s no different than having a small coffee versus a large coffee for a linebacker versus a child. It’s going to be relatively the same.

Kelly: [00:18:16] My child’s titrated up to a large coffee already, that’s right. 

Darren Candow: [00:18:20] And we’ve shown this dosage is very safe and effective, and also, you can break it up. So a really cool thing with creatine is you don’t always have to take it as a bolus. You can divide it up in smaller, more frequent dosages through the day. I like to put about five grams in my breakfast. I drink five grams during my workout. We’ve also shown that’s a novel way. And now since there’s new research suggesting… I take at least 10 grams if not more. I’ll take a little bit more later on in the day. We’ll talk about the timing, if you can mix it with coffee, things like that. But those are all things that I think the viewers would be very interested in. Yeah.

Kelly: [00:18:55] You hinted at some of the effects of I can work a little bit harder in training and theoretically that allows me to handle higher work volume. That sort of is magical. I can get more work done. And that means I can have a better adaptation response, theoretically. You also mentioned some hydration benefits, that if it’s really hot, then maybe I can prevent some of this deep dehydration, hypohydration. What other ways might someone feel if they were taking this at an appropriate level? What other benefits might I see? Because sometimes would I expect to feel something right away? And the reasons I’m mentioning this is I want people to understand like all whole food supplement based things, we’re trying to augment what the human physiology does. This is not a shortcut towards better function. But what might someone experience and how was it being used clinically? You hinted at some of these other things. But can you expand besides just that power idea or work idea?

Darren Candow: [00:19:56] Yeah, I think a lot of people take creatine for the promotion, the enhancement and strength, the power and all that, and muscle mass. But just as clear evidence is suggesting, think of the word recovery. We’re now seeing an accelerated rate of post exercise recovery. It really strengthens the immune system and we’re seeing really good evidence post long endurance exercise such as triathlon, certain proteins that are elevated go down. And that seems to increase preservation such as muscle tissue and potentially what they call an anticatabolic effect. So two lines of thought. It improves your ability to do more work or training volume. We’re actually seeing now an improvement in recovery, allowing that athlete to exercise maybe twice a day, almost on a daily basis. And they’re not susceptible to the overtraining syndrome. So the elite athlete can exercise more frequent, longer, and it doesn’t interfere with training frequency or programming. So not only is it potentially an anabolic or promotion product, but we’re starting to really see the recovery aspect come into play now. So it really seems to be this overall product that can be considered.

Juliet: [00:21:02] So before we get too far down a different path, can you talk about the hair loss myth and the possible GI issues that I know some people do experience? And then we can move on from the myths and facts.

Darren Candow: [00:21:15] So this myth comes from the hormone DHT that’s a precursor from testosterone that’s been linked to hair follicle loss. And the only study that was ever done is on rugby players. And they gave 20 grams a day for seven days, so the typical loading phase. They did an elegant design where they had a group of these young individuals do a crossover so they got placebo for seven days and they also got creatine. And when they measured simply this hormone, it did go up when they were on creatine but it was in the normal physiological range. So next time you go to your doctor and they measure blood and urine, they’re going to measure your cholesterol and they’re going to say, hey, it’s a little bit elevated, but you’re still within a normal range. So that’s exactly what happened. 

And for the viewers, please note, just because a hormone goes up, if it doesn’t translate into an actual phenotypical change… So for example, just because DHT, which is a precursor for hair loss went up, they never measured hair follicle cross sectional area or loss. And so you can’t conclude or there’s no evidence to suggest it causes baldness. And I always like to finish that question I get all the time off, I’ve assessed over 1,000 individuals, males and females. Not a single one has come to me and said, “My hair’s thinning.” And we’ve given 10 grams a day for two straight years. And I think if someone’s hair started to fall out, that’s the first thing they would come and say to me. All of this is genetic. Creatine, there’s no evidence to suggest it does. And so it is a myth as it stands right now. Oh, and then the GI tract, the other big thing. We always see the GI tract issues with high, high dosages.

Kelly: [00:22:53] What’s a high dosage?

Darren Candow: [00:22:55] Probably over 10 grams a day. So usually, we only hear about this during the loading phase. That’s 20 grams a day for the first seven days. And some of the causes of GI tract irritation where it is osmotic, it pulls water from the blood, depending on your habitual diet, some people may not be taking in enough water or it can cause some GI tract irritation there. To get rid of any of those issues, just take smaller, more frequent dosages.

Kelly: [00:23:18] Hold up. You’re saying I’m supposed to drink water every day?

Juliet: [00:23:22] Kelly just started drinking water last week so he’s feeling pretty-

Kelly: [00:23:25] It’s pretty amazing. 

Juliet: [00:23:26] So I’m hoping to be able to ask this question in a way that it can be clipped out for the internet so that Kelly and I can just point people to this video. Is creatine safe to be given to kids and teenagers and do you recommend they take it?

Darren Candow: [00:23:43] One hundred percent. There’s great research in the United States that have looked at all of the studies that have looked at in children and it is safe. And you look at the doses, you can base it on body weight or a small dose. And the theory here is we got cautious because not a lot of research was happening. And so I say, well, geez, if you’re a little cautious of creatine you must be cautious of giving your children a hamburger or chicken sandwich or a glass of milk. Because that’s a protein, we naturally create that in the body. Since creatine is naturally produced, I struggle to say why couldn’t a child take it, why couldn’t your grandfather take it. I just don’t see any evidence to say why not. And all the reviews suggest that it’s very effective. It’s really been shown to be effective in pulse concussion syndrome in children and the safety profile is excellent. Now here’s where a bit of caution comes into play: There’s been no research in children to look at blood biomarkers and what creatine is doing such as liver and kidney enzymes. But from a health perspective, there’s no evidence to suggest it causes any adverse effects.

Kelly: [00:24:46] I want to circle back for a second, talking about post concussive phenomenon. Right now, we are in what I feel like is either anecdotally or experientially a high watermark of concussions. Either kids are bigger and faster or they’re less prepared or there’s some aspect, but we seem to be much more aware or at least are testing and we’re seeing a lot more concussions. Definitely I was concussed as a kid, not identified, never pulled to the side, eyes cross eyed, that wasn’t great. But we’re starting to identify it now. So even if it was just a misrepresentation, we’re starting to be aware that kids are getting concussions a lot more. And it really feels like we’re in the dark ages helping families come up with interventions. I mean it was in the last year and a half where people were like, oh, there are lymph nodes in your neck and head and we can actually decongest the brain the same way that we decongest the knee just through muscle contraction alone. So it feels like we’re just starting to realize that there’s a lot that we can do. Can you speak to how this works or help us understand why this might make the case for that because it seems like a really safe, really powerful intervention. Even if it’s the belief effects of, hey, here’s something that we know can support the organism, I’ll take that.

Juliet: [00:26:03] And then just before you answer that question, this was actually also not just for kids but adults as well. This was a question submitted in my Instagram post from my dear friend and many time mountain bike champion Rebecca Rusch, who suffered a really bad concussion from a mountain biking accident. So she also wanted to get your take on the role of creatine in concussion recovery. So if you could cover both those things.

Darren Candow: [00:26:26] So just like the research in children, it’s in its infancy, but nothing is saying there’s any detrimental effects from the neck up. We have a huge paper coming out in a prestigious journal soon looking at all the data. So this is where it gets very interesting. The brain is very unique. It makes creatine. The muscle doesn’t. So that’s why the brain is so unique that it’s very resistant and we can talk about dosing a little bit later. But right now, all three of our brains are making creatine. It’s very resistant to what’s coming in so it kind of has this blood brain barrier that’s specific. But when you look at all these conditions, concussion, Parkinson’s, Huntington’s, any type of myopathies, we start to see a really common denominator that their brain creatine content is significantly reduced. 

So this is interesting. If you suffer a concussion, it drastically reduces the amount of creatine in the brain and just like our muscle, our brain uses creatine for energy and healthy tissue. So sleep deprivation is probably one of the most popular things from a worldwide perspective and when the brain is stressed from a memory sleep deprivation hypoxic concussion, creatine has promise to improve not only creatine content in the brain, but some of the recovery prospectives. So I love your analogy with concussion. The two studies that have been done ironically have been in children. Not in NFL pro athletes, things like that. They were in children. When the child suffered head trauma, they were immediately put on creatine for up to three or four months at a pretty high dose, 0.4 grams per kilogram. And when they looked at all the post recovery measures—cognition, speech, self-care—they were substantially improved for the children on creatine versus placebo. So at least two studies show a promise. A child when the brain is still developing can recover quicker in the presence of creatine compared to children who didn’t. 

So the thought was how are we ever going to do a study in the NFL or NCAA because the only way to legitimately do it is when they get a concussion, immediately put them on creatine. One of the big issues that I just mentioned is the brain is very resilient. By the time the creatine gets into the brain, it might be too late. So the other thought is why don’t we just put all the athletes in the NCAA on creatine now, measure them at baseline and God forbid, hope they get a concussion. At least we could do it that way. So at the end of the day, it’s in its infancy. We need to have randomized controlled trials. But again, I’m not seeing any data to suggest it’s not favorable to be on creatine from a brain health perspective.

Juliet: [00:29:04] That is really fascinating. I have to go back to this kid thing again one more time. You said very clearly that it’s safe and that there’s no reason why kids and teenagers shouldn’t or couldn’t be taking it. Could you just list out, what would be the benefits for kids or teenagers taking it?

Kelly: [00:29:22] Let me take a swing at this first. Kids don’t eat food. They eat processed food, starting, right?

Juliet: [00:29:26] Yeah. Right. How can it help kids and teenagers? Because I think of the parents in my neighborhood, they’d be like, okay, great, well, this guy’s saying it’s safe, that’s fine. But why should they take it? What would be the reason that it would improve their athletic performance or their academic performance or you name it? How would it help them?

Kelly: [00:29:39] By the way, that’s doctor guy.

Juliet: [00:29:41] Doctor guy.

Darren Candow: [00:29:43] Again, for clarity, from a physiological perspective, we’re not seeing any reasons why a child would not benefit and performance goes up. We need to do a lot more blood bile markers to see the long-term health effects if they’re doing it at safe dosages. But as a child is developing, all their systems are developing, brain, health, muscle, bone health. So creatine is highly involved in all those energy systems. So if you just focus on muscle, bone, and brain. If a young female has greater bone accrual as they’re growing older and when they hit puberty, they may offset osteoporosis. When an individual’s getting healthier, stronger muscles, that might keep them more active. Could that decrease childhood obesity and some of the adverse effects we’re having now to keep the, running longer, less fatigue? From a brain perspective, children are very prone to sleep deprivation, screentime can have some effect. So the effects would be no different on an adult. And I think we’re actually hesitant with giving a supplement to a child. But I would say great, just emphasize maybe more salmon or more poultry or red meat if you can. Now if they’re a vegetarian, that’s going to be a little bit different. But I can totally understand the caution for parents especially because creatine seems to be too good to be true and that’s why we need to have a lot more data in children especially. And it’s an area that we’re starting to see. And a good colleague of mine, we’re presenting at the American College of Sports Medicine Conference in a couple weeks in Denver, and his whole talk is on the safety and efficacy of creatine in children. And all his review papers which I can send out if anybody wants those-

Kelly: [00:31:19] We’d love to have those.

Darren Candow: [00:31:22] It’s effective, we need to do a lot more work, but we’re not seeing any reason why a child can’t.

Juliet: [00:31:28] Hey Ready State listeners, if you like what you’re hearing, please subscribe and leave a review on iTunes to help others find our show. 

Juliet: [00:31:35] This episode of The Ready State Podcast is brought to you by Momentous, and for obvious reasons, we’re going to be talking today about how much we like Momentous Creatine. 

Kelly: [00:31:44] Couple things. One is that Momentous Creatine is third party validated so you’re going to get it and it’s not contaminated and you’re not going to send off any positive drug tests to WADA because I know who you are out there. Second is that the creatine that Momentous uses is the Creapure, which is the brand or the style of creatine that Dr. Candow talks about in his study.

Juliet: [00:32:08] Research. Yeah.

Kelly: [00:32:09] That’s the kind that he uses. We have been using creatine in our family for a long time. We were stoked to have these big bags of creatine from Momentous lying around. I put it in the girls’ Emergen-C. I mix it into their shakes. I started adding another scoop so I’ve been doing 10 grams for a while now, maybe a year. And I suddenly am like maybe I need to take more.

Juliet: [00:32:30] One of the things we learned too from Dr. Candow is that anyone who takes creatine only needs to take creatine monohydrate, noting else.

Kelly: [00:32:39] That’s right. 

Juliet: [00:32:40] And that’s exactly what the Momentous Creatine brand is, is just creatine monohydrate, nothing else in it, five milligrams, five grams.

Kelly: [00:32:45] If you’re a little gun shy about the whole supplement world, and I think it’s reasonable to be so because of them have different effects, he talks about the few supplements that are actually validated, and turns out creatine is one of the handful of things.

Juliet: [00:33:00] And it is one of the most studied supplements on earth.

Kelly: [00:33:04] Also, very inexpensive, relatively inexpensive to add this into your diet. We’re now thinking less about performance and we’re starting to think about how do I keep myself intact as I age. Creatine is part of that solution.

Juliet: [00:33:17] Go get yourself some creatine at livemomentous.com/trs and use code TRS for 20 percent off your first purchase. 

Kelly: [00:33:27] Do you feel better now that I’ve been spiking our kids’ food for years with creatine?

Juliet: [00:33:30] Yeah, exactly. Okay, let’s talk about dosing because I think you mention this, .1 gram per kilogram is pretty universally good for people. And then obviously this higher amount if someone is post concussion?

Darren Candow: [00:33:43] Yeah. 

Juliet: [00:33:43] But yeah, how much should people be taking? Does it vary by age, by activity level? Let us know more about dose.

Darren Candow: [00:33:50] So right now, there’s three common strategies. So whoever’s listening can fall into one of these strategies. Let’s take the loading phase as the most popular. These would be for people who need a really quick fix. World championship coming up, powerlifting event. This is the typical 20 grams a day for seven days. If you think 20 grams of creatine maybe four times a day, five grams each for seven days, that’ll fully saturate your muscle and that will provide numerous benefits from a muscle performance perspective. 

For those who say I financially can’t afford that much creatine, I don’t want to risk water retention, I’m taking it every day for the health aspects, from a muscle perspective you can take three grams a day every day until the day you die. That’s been shown to replenish what we are naturally excreting when we go to the bathroom. And adults, we use in between 0.1 gram per kilogram, that’s on average about seven to ten grams a day. It’s very effective. I will say in the paper that we just came out that the longest term study ever, we gave 0.14 grams in older females because they go through something called anabolic resistance. After the age of 50 males and females have a blunted response not only to protein, exercise, but we think creatine. And that’s why we gave them a little bit higher. Across the entire aboard, there’s no adverse effects on the kidney, liver, cardiovascular system. So again, you can choose whichever you like. I think if you’re doing the loading phase, you can easily drop it down to three grams a day from a muscle perspective thereafter. I should point out though if you’re looking at it from a bone health perspective, there’s never been a single study showing bone benefits less than eight grams a day. And the branding is over 20.

Juliet: [00:35:36] The brand’s over 20. So you’ve mentioned a few times this postmenopausal study, which I took a particular interest in since I am 100 years old now and definitely a lot older than Kelly. But I would love to hear about the study and what you learned and what the takeaways are for normal people.

Darren Candow: [00:35:55] Yeah, we did a few preliminary studies in advance and we came across bone health by mistake actually when we were looking at muscle. But this is the longest term study ever to look at exercise and creatine supplementation in an adequately powered study. So we had over 200 postmenopausal females. They had to have their last menstrual cycle 24 months post or after the study. So everybody was falling into that. They did three days a week of supervised weight training and six days a week of walking. So a very common strategy which we’re trying to promote to get over 150 minutes of physical activity in per week. Again, so one sex, postmenopausal female, over 100 individuals in each group. And we gave them 0.14 gram per day. So keep in mind that was over 10 grams of creatine a day for two straight years. They took it on their off days every day. 

There was no increase in bone mineral density around the hip which was a bit surprising because our previous study showed it did have some favorable effects. But when it did show is it increased bone strength. So I don’t know if you can see this. If I take my hand and try to break your bone, the individuals on creatine was more bendable. That means they probably will have less fracture later on in life. And the fracture of the hip and the upper leg is one of the biggest causes of hip replacement surgery, not only in Canada but I’m sure in the United States as well. But it increased bone strength, it increased bone width so it might be able to withstand those falls that you might incur in icy roads or around the house. It improved walking speed. So it allows these individuals to move faster. And then it also increased lean tissue mass. And as I mentioned earlier, lean tissue mass is a surrogate for blood glucose disposal, which could decrease the incidence for diabetes. You add in all these good things.

 And then when we looked at two years of kidney, liver, blood cell count, creatine at that high dosage caused no greater adverse effects than placebo. At the end of the day, I’m thinking individuals post menopause or even before should consider exercise first and maybe creatine is going to be the sprinkling on the cake to just make it taste a little bit better. Please note we did not have a nonexercised group. We don’t think creatine is going to do anything from a bone health perspective unless those individuals exercise. So the biggest take home is you need to exercise. Weight training is really favorable. Walking is extremely beneficial from an overall health. And creatine will potentially give you a small greater effect.

Juliet: [00:38:29] And greater effect in terms of bone health and muscle mass, if I could just reduce it to third grade language.

Darren Candow: [00:38:37] And walking for mobility. Yes. 

Juliet: [00:38:38] And by the way, thank you for helping us be evangelists for walking, because we’re obsessed with walking and we talk about it all the time. So thank you for being on that train. 

Kelly: [00:38:46] You hinted at that vegans can struggle to get enough creatine. Is dietary protein intake a consideration? If I am hitting say .7 to 1 grams, do you feel like… I mean you talked about the effect. There’s potentially no negative downside. But I’m just wondering because we have plenty of vegetarian and vegan friends and we’re trying to come up with better solutions for them. Now we have these incredible vegetarian proteins that allows them to supplement their diet. We’re looking at some of these other things that they can put in, essential aminos that they can take to supplement. Am I hearing that if I, for whatever reason am a vegetarian and shoot to be a vegan and an athlete or a person, that I might really benefit from creatine supplementation?

Darren Candow: [00:39:34] Yeah, easily the best people on the planet. So for example, ironically, most commercial creatine is vegan based but it’s only primarily found in red meat and seafood. So depending on the individual in a plant based diet, vegetarian or pure vegan, they’re not getting any dietary creatine, they are only synthesizing from these plant based proteins probably half the amount of an omnivore, someone who eats all different food groups. So when we’ve done these studies in 2003 with muscle biopsies and when you take a vegetarian or vegan and put them on a normal dose of creatine supplementation, they double the amount of creatine in the muscle. Just think about doubling the work the muscle can do. They can do more repetition, they can do more HIIT classes, spin classes, run faster, they can recover better, and male or female, that can really improve body composition. 

And that’s independent of the neck up. The cool thing with the brain and this is interesting, is that it’s not the same with muscle when it comes to diet. So let’s get a little bit of clarity. Your skeletomuscle if you’re a vegetarian has half the amount of creatine in general compared to someone on an omnivore or high meat diet but that’s not the same in the brain. The vegan brain or the omnivore brain seems to have the same level of creatine content. So that’s why we think you need a lot higher dosage for brain health compared to muscle. You know a vegetarian or vegan or someone on a plant-based diet and they say, “Hey, do you think it’d be good idea to take creatine supplementation,” and at first you say, “Why?” you’re like well, I want to improve overall health, I heard it’s potentially good for muscle, bone health and brain, absolutely. They should respond really, really well.

Kelly: [00:41:16] That’s great.

Juliet: [00:41:18] So tell me what creatine cycling is? Is it a thing?

Kelly: [00:41:22] Do we need to cycle creatine?

Juliet: [00:41:22] Do we need to do it or think about it?

Darren Candow: [00:41:24] Over the thousands and thousands of studies, no study’s ever actually determined this. So there’s no evidence to suggest you need to cycle it. And I think our study we just talked about giving creatine for two years clearly shows you do not.

Kelly: [00:41:38] That’s a pretty big macrocycle. It’s almost an Olympic cycle.

Darren Candow: [00:41:42] But for the viewers who want to, maybe financially, they’re traveling, they don’t want to take the powder across the border, whichever it is, it stays elevated in  your muscles for about 30 days and it stays elevated in your brain for about 90 days. So I think if you’re taking creatine for four to six weeks and you say you injured yourself or whatever it is and you just say I want to take some time off, keep in mind the elevated amounts in the tissue can stay from anywhere from a month to three months.

Juliet: [00:42:09] Oh, that’s so interesting. So let’s talk a little bit about this whole thing of types of creatine. So I think I actually only know about creatine monohydrate but I know there are other kinds. So what are they? And I’m pretty sure your recommendation is to not take any of those and focus on creatine monohydrate. But could you talk a little bit about this whole type of creatine thing? I think there’s a lot of marketing behind some other types. 

Darren Candow: [00:42:33] Yeah, it’s because creatine got boring. When we say creatine, we talk about monohydrate. And they’re a simple thing. When you take creatine monohydrate, meaning creatine linked to one water molecule, when it goes through your GI tract and goes through your small intestine it’s identical to what the liver’s producing. So that’s why creatine monohydrate works. It’s identical to what’s released from our liver, identical to what’s synthesized in the brain. So our muscles say, hey, we know you, we can let you in really quickly. And then it got boring. Creatine monohydrate, we’ve got to come up with some flashy things. And then all of a sudden, people said what about creatine hydrochloride, create citrate, creatine pyruvate? At the end of the day, and this is really critical for your viewers especially, it’s only going to work if it’s creatine. And it might be linked to pyruvate or an estrobon. But when it goes through the GI tract, it has to raise your blood creatine levels. And we’re actually seeing a lot of these marketing gimmicks do not raise your blood creatine levels. And if it doesn’t, it’s complete quackery. And my argument is why spend way more money on these fancy designers when monohydrate has been tried and tested and it’s the only one that works. We use Creapure, 100 percent monohydrate in our clinical trials. But I just think, hey, it’s been around for so long we’ve got to change it up, people have got to be susceptible to marketing.

Kelly: [00:43:53] But my creatine goes to 11.

Juliet: [00:43:54] My creatine goes to 11.

Kelly: [00:43:58] Have you found that there are things to take with creatine? When people do ask us about supplementation, we’re always like whole foods first, period. Let’s get a blood panel and see if you have genetics that could benefit from other supplementation. I feel like creatine is almost one of those food like things where we’re just like hey, I don’t really need to understand because it is so inexpensive. It really is relatively inexpensive and so safe. But have you found… Turmeric and black pepper turns out to be great bedfellows. Is there something that makes creatine more effective in the system, eating with food?

Juliet: [00:44:37] You mean like collagen and vitamin C, that connection?

Kelly: [00:44:39] Yeah. We use to bolus the crap out of creatine with massive amounts of sugar and that didn’t help anyone, obviously.

Juliet: [00:44:46] Or if you put it in your coffee, does it kill the creatine? Give us all those scenarios about how to take it. 

Kelly: [00:44:53] Creatine killer.

Darren Candow: [00:44:53] So this is really cool. One of the best ways to get creatine into the tissues you want is prior exercise. So this is an interesting thing with the timing of creatine. If you simply move and increase blood flow, creatine will get accelerated into your tissues. So exercise is my first go to. If you want to get greater amounts of creatine in the body, exercise. Secondly, carbohydrate has been shown numerous times through insulin to cause a greater increase in creatine outtake. But the dose is so high, nowadays with the toxicity of sugar, most people say I don’t want to be taking any of these additive sugars. Well, the good news is you can take a protein source, and the majority of protein is glycemic. So 18 of the amino acids and a protein primarily can cause an insulin spike. Whey protein is very popular. If you combine creatine with whey protein, we showed it really increased more so than protein alone. 

So carbohydrate and protein seemed to be some of the greater stimuli if you will. There’s other growth factors. But exercise is first, diet is second. But hey, if you just want to take creatine and water, it will still get into the muscles over time. It accumulates, unlike caffeine where it peaks really quickly. Those are the two areas that seem to be the effectiveness. I would always emphasize protein way more than simple, unrefined carbohydrates. But if you want to put it in your yogurt or in a meal, that’s going to be an advantageous effect as well.

Kelly: [00:46:20] There are 10 million bros out there that you are like, what, put it in my shake after exercise, it’s all fine. Confirmation bias, thank you.

Juliet: [00:46:31] How much do you take and when do you take it and then what do you put it in?

Darren Candow: [00:46:37] Yeah. So in the morning I typically have Greek yogurt, whey protein, and berries. So I’ll put a teaspoon in there. That’s five grams. I have two Pelotons in my house so if I’m doing a HIIT workout or weightlifting, I actually put five grams in my water, just like a water bottle. And we’ve shown, it’s the only study to ever show this, you can drink a small amount, very similar to people drinking branched chain after a set, that’s a very viable weight increase strength, and then later on in the day, if I’m sleep deprived, very stressed, I’ll take another five. So I get at least 10 grams, if not more times metabolic stress, I’m writing grants, boring papers, things like that, I will take about 15 grams a day. But 10 on average pretty much as long as I can remember. 

Timing does not matter. You can take it at any time of the day. However, if you can take it in close proximity to exercise, either before, during, or after, that’s a really cool area to recharge and refuel the body as well. And now your question with coffee, this is a big one, if you were to just do a single dose of caffeine and coffee one time for two days, it may not impose one another, but we’re seeing really excellent cellular data. Go to Europe and we did a study where they did caffeine powder and creatine together, they did oppose one another. So my personal recommendation based off cellular data, take your caffeine before you work out and creatine after.

Kelly: [00:48:02] And that’s a great talk, everyone. We’re just going to lace that last sentence. That’s hugely important.

Juliet: [00:48:08] Thank you because that’s exactly what I do. So everybody likes hearing what they’re doing is the right thing.

Darren Candow: [00:48:12] Preworkouts have a whole bunch of stuff in there. You don’t know what’s causing it.

Kelly: [00:48:18] Let me ask you this. Who would benefit? What we’re going to get is every edge case in the comments of all time. I only have one kidney. I took this and I had elevated creatine in my blood and my doctor said stop taking creatine. Can you talk about some of those edge cases?

Juliet: [00:48:36] Yeah, the outliers. Who really shouldn’t be taking it?

Darren Candow: [00:48:39] Anybody with a preexisting medical condition. Kidney, dialysis, a heart condition. They always need to get medical advice. I’m a fake doctor and I’m going to put on a real doctor’s head here. So if you take creatine and it gets into the muscle, we all have a diffusing from the muscle in this thing that we’re all scared of called creatinine. When you go to the doctor you have to tell them you’re on creatine supplementation because it’s nonsensical that your creatinine levels are not elevated. And we use this thing called the estimated glomerular filtration rate, EGFR, and people say oh my God, your EGFR is really, really low and it has to be because you’re on creatine supplementation. That’s an estimate.

 So for those going to see their doctor, and I just had to correct an Instagram poster, about 20 females who were getting very worried. I said that makes sense, you’re taking creatine, that’s going to elevate creatinine, therefore there’s more things in the blood. It’s like mixing Kool-Aid, the more sugar you mix into it, it gets darker and darker and darker, it’s going to cause the filtration to be a little bit lower. And we know it’s not causing any harm because when they come off creatine, the kidney goes back to normal. If it was disease, the kidney would still be impaired. So it’s just filtering more things in the blood. It’s no different than alcohol. Alcohol’s going to dehydrate the blood, the blood pressure’s going to go up. It’s a common analogy. So don’t get too scared when your creatinine levels go up. That is a very common thing with creatine supplementation.

Juliet: [00:50:06] So we have a ton of questions that were submitted in advance by people on Instagram, which we’re excited to get to. But before we do that, there had been some talk of, and I know it is extremely preliminary, of possibly a benefit to people who are taking SSRIs and also taking creatine. And I will preface this by saying that if anything, maybe it’s promising. But could you just tell us where we are with the data on that particular issue/question and what about that are they researching?

Darren Candow: [00:50:37] Do you mean from a depressive standpoint?

Kelly: [00:50:40] Are you even aware? Is this-

Juliet: [00:50:44] Is this a thing? Are researchers looking at this to see whether creatine increases the effectiveness of SSRIs? We’ve heard that somewhere.

Darren Candow: [00:50:52] Not really. We’re more looking at some of the data, looking at creatine and depressive symptoms. But those individuals have been on medication. We haven’t looked at creatine by itself. So to look at any hormonal regulations or even, God, we could even talk about estrogen receptors, if there is data, it is probably in its infancy. So that’s something that we can’t really comment on in the sense there’s not a lot of data on that.

Kelly: [00:51:18] If someone is taking creatine, and I say this because for all of the athletes that we work with who are blood tested, we want to make sure that they’re on NSF, safe sport, informed sport tested supplements. For the average person, should they be taking supplements that are third party validated, in your opinion?

Darren Candow: [00:51:39] Well, I have to say 100 percent yes. We all use third part tested from an independent lab in our clinical trials. And when you go to buy… Because again, I love your idea with food first, because you can get creatine naturally through red meat or seafood. Now again, that limits some populations and the ethical use of animals and whichever. But please note there’s many different companies now—TrueSafe, Certified Sport—but they should be third party tested. And I always like to encourage people, choose a product that has one ingredient. If you go and get Joe Blow’s Mega Mass 9,000 and they have 60 ingredients in it, you don’t really know what’s happening. So people say what creatine products should I go and get. I say I can only tell you creatine monohydrate and when you flip around the label it should say creatine monohydrate. If you’ve got 15 different things like beetroot juice and some of these growth factors, we don’t know the safety of it. So again, that’s something to be really aware of and do a little bit of research before you go to the vitamin shops and GNCs. They look very flashy. Do you really need this explode product that’s going to cause an NFL player to maybe run a little bit faster? What if you just want to from a health perspective, again, you can get a lot of things through food. I would say 99 percent of supplements are useless. There’s only a handful that are effective. And the IOC says five.

Kelly: [00:53:03] Amazing.

Juliet: [00:53:03] Well, I don’t want to go off from this topic, but what are those five, just for my own curiosity?

Darren Candow: [00:53:09] Yeah, so caffeine, creatine, beta-Alanine, sodium bicarbonate, beetroot juice, and of course, we always put protein in there from a recovery. But from an enhancement perspective, there’s five. There’s a few others that have some evidence. But the five big ones are pretty standard.

Kelly: [00:53:25] And I just want to go on record as saying I appreciate you telling and saving everyone from having to go on Weight Gainer 900.

Juliet: [00:53:31] We were the same person.

Kelly: [00:53:32] I took in high school Weight Gainer 900 and I managed to pack on 10 pounds on my unsuspecting father.

Juliet: [00:53:37] I thought it was Weight Gainer 9,000.

Kelly: [00:53:39] No, that’s what he said.

Juliet: [00:53:40] 900. Yeah. So we laughed. That’s why we both laughed because we’ve laughing about Kelly’s Weight Gainer 900 for 10 years, 20 years.

Darren Candow: [00:53:46] It’s true, yeah.

Juliet: [00:53:49] Okay, if we could come in hot with some questions from the people. These first two questions I think are sort of related because they’re related to hydration. Yeah, we hit a lot of these already. But this person wants to know if they’re mixing it with an electrolyte, does it disrupt hydration in some way. And then someone wants to know if your daily water intake should change if you’re taking creatine.

Darren Candow: [00:54:09] Yeah, so totally fine to mix with electrolytes. And if anything, I would recommend to drink a bit more water because it does pull water from the plasma or the bloodstream into the surrounding cells. Especially in hotter environments, try to increase a little bit more water as well. 

Juliet: [00:54:22] I like this one. Is it safe to take creatine while breastfeeding or pregnant?

Darren Candow: [00:54:28] Yeah, so I talked to Stacey Ellery who’s probably the world’s leading researcher on creatine and pregnancy umbrella and we recently talked about this. Creatine can get degraded into creatinine as we all know and breast milk as well. So we’re not 100 percent sure. And of course, this is the area where safety becomes unprecedent where medical intervention and community should be there as well. So we don’t know if it gets translated. A lot more data has to be there. But you definitely want to take precautions here. It definitely is shown to have promise for improving fetal development, decreasing inborn deficiencies with the child, and the mother can actually benefit from an energy status there as well. 

Kelly: [00:55:08] So total tongue in cheek here but you’re saying it’s much better for me to load it in my baby’s milk than to give it to the mother and have it passed to the breast, is that right? I’m just kidding. Do not answer that.

Juliet: [00:55:19] Does creatine cause sleep disturbances or insomnia, even if taken early in the day?

Darren Candow: [00:55:24] Yeah, we don’t have any research to support that, but that’s a very common myth. And my only thought is the individual may be exercising at a higher intensity. They could be slightly dehydrated. They might be taking more caffeine. So directly, there’s no evidence to suggest it does or it doesn’t. Sometimes I hear it improves their sleep. Sometimes I hear they feel some disruptions. But there’s no evidence to suggest why that would be. Yeah.

Juliet: [00:55:52] Since creatine has anticatabolic properties, is it a good idea to increase intake on a calorie deficit?

Darren Candow: [00:55:58] Yeah, 100 percent, yes. This is a big one. Just like protein, if you’re having a reduced calorie diet, you want to maintain energy status and creatine can help maintain frequency there as well. Absolutely.

Kelly: [00:56:10] That actually has interesting implications for surgery and post surgery, people trying to maintain lean muscle mass. I really appreciate that.

Juliet: [00:56:18] So we also got a question about should cyclists be taking creatine and I know that endurance athletes in particular would maybe be a population that would maybe be concerned in particular about the water retention feature. So is there any different recommendation of any kind related to endurance specific athletes like cyclists?

Darren Candow: [00:56:35] We just published a huge review on creatine and endurance just two weeks ago and it came out and the answer is yes, it has massive implications. Now there’s a little bit of a caveat. If your sport is very sensitive to weight gain, you may not want to take the loading phase, but you can take the smaller dosages.

Kelly: [00:56:53] Three grams.

Darren Candow: [00:56:53] Exactly. So three grams all the way up to about five or six or even more, however you want to do it. It definitely helps with hydration. And it really has been shown, in those studies we talked about the anti-inflammatory effects. It was in post marathon and triathlon, it decreased the inflammation response. So if you know someone saying hey, I’ve got a 40K marathon coming up, taking creatine for weeks before the race will help increase the recovery afterwards and I think accelerate your recovery there. So it can be very advantageous.

Juliet: [00:57:24] I actually take thyroid medication so I’m going to ask this one. Is there any concern in taking creatine when on thyroid medication?

Darren Candow: [00:57:31] We don’t know the interaction or bioavailability of effecting T3 or T4 or if you’re taking thyroid stimulating hormone. If anything, creatine may increase overall metabolism but there’s no evidence that I’m aware of that it interferes with any of those medications. 

Juliet: [00:57:47] So this one’s kind of special. But someone is getting their annual DEXA scan in July to assess their muscle mass. Do you recommend that this person stop taking creatine before their DEXA scan especially given that this person hasn’t been taking it prior to their previous DEXA scans? So how should someone manage this as testing themselves around DEXA scans?

Darren Candow: [00:58:08] He or she should have a little bit of caution when they get their DEXA scan because it’s only measuring the lean mass. That takes into consideration blood, organs and all that. It’s not measuring muscle mass. So hydration can overestimate the amount of lean mass that you have if you’re dehydrated the other way. So again, if they’re just getting it once, they can choose however they want to do it, but I’m assuming they want to get a DEXA now and then down the road. They should have the same procedures. They need to void their bladder, make sure their hydration is coming in. So yes, we have specific protocols before coming to the DEXA scan. But you always want to measure pre, post. Getting it once is just going to give you numbers and you’re like, well, what does that mean, I don’t really know.

Kelly: [00:58:52] We work with a company called Momentous that uses Creapure. We talked about making sure that supplements are third party validated. We’ve got a couple questions of people talking about gas and creatine. Is that common? Is that more common with a certain kind of creatine? If I’m on a vegan or vegetarian based in your experience? And what might someone try to alleviate that? 

Darren Candow: [00:59:16] Yeah. It’s not a common effect. It is more common on a really high protein diet. So when you start to take creatine, most people say, hey, I’m getting a gram per pound or 2.2 grams per kilogram. Just say that’s 200 grams of protein. So obviously protein is nitrogenous. It can create a lot of gas or bloating. But when they’re on a lower protein, we don’t see that. But it’s very rare. And my only analogy is probably based on a protein amount and methane gas from different protein sources that they’re doing.

Kelly: [00:59:45] Interesting.

Juliet: [00:59:46] What if someone wants to know if they miss a day of their creatine supplementation do they just keep going on the next day as normal? I’m assuming yes.

Darren Candow: [00:59:54] Yes, 100 percent. Yep. And if they’ve been taken it for more than 30 days, again, remember, you’ve got that month before it comes back to baseline. You can miss a day, you can miss a week. You don’t have to freak out. Again, that’s the luxury of this. And I think if they eat seafood or meat maybe for supper, just choose that and that can be your source of creatine. There’s about two to three grams of creatine in a salmon filet. Herring and mackerel’s very high. Or if you eat red meat, you’re going to get about three to five grams per steak. 

Kelly: [01:00:25] I feel like you do not know my family. We are not eating mackerel. It’s powder for the girls. So you have blown our minds, made the case, I feel like put a lot of uncertainty to bed. Where are you most interested in where your current research is going and where’s your current hypothesis around usage or special test cases, edge cases, in the use for creatine.

Darren Candow: [01:00:52] We’re really interested on individuals that are diagnosed with sarcopenia. So the loss of strength and functionality. And we want to take a population of long-term care facilities, retirement facilities who may not have access to fitness centers, and look at homebased exercises with creatine. And God forbid another pandemic comes, we can actually provide evidence for people who stay at their home. And then individuals with osteoporosis, cancer, and frailty. So more of a clinical population, we start to see some really good effects there. And then the big one is the neck up. We’re really starting to get interested in depression, anxiety, cognition, self-esteem for a lot of individuals. Host exercise is interesting when you’re really fatigued in the fourth quarter, can creatine help maintain clarity to make that pass or allow you to still exercise or go to work. And then sleep deprivation is a big one, not only for students but I think everybody worldwide. I think everybody’s sleep deprived. And you can’t do anything without a good night’s sleep. No supplement, doesn’t matter how much coffee you’re going to take, if you’re getting three or four hours a night of sleep, eventually it’s going to catch up to you. And we think since sleep deprivation reduces creatine content in the brain and causes an impaired cognition effect, can that have some effect. So we’ve sort of got away from athletes and we’re now looking at a lot of clinical populations.

Juliet: [01:02:12] So that brings up a couple questions for me. I guess I have heard of people being diagnosed with sarcopenia but I think of sarcopenia as a thing that’s happening to everybody and wouldn’t we all… But you know what I mean. It’s sort of understood at 40, 50 and then especially starting at 60, everybody’s experiencing some kind of sarcopenia. If someone is diagnosed with sarcopenia, do they have an extreme amount of muscle loss above what would be normal? Is that what differentiates that?

Darren Candow: [01:02:42] Yes. So the definition of sarcopenia has completely flipped. We used to think muscle mass was number one, then strength, the functionality like climbing stairs and carrying groceries. Now strength is number one, functionality is maybe two, and maybe muscle mass is three because there’s good evidence to suggest doesn’t matter how much muscle you have, you could be stronger or weaker. So the diagnosis of sarcopenia is very clinical. You come into a lab and you’re diagnosed with a lot of things. So yes, we’re losing muscle mass, we lose strength, and we lose functionality later on in life. Those are the three big categories. And if you’re diagnosed with sarcopenia, that’s very detrimental. But if you maintain exercise your whole life, aerobic or weight training, you may never develop severe or even heightened levels of sarcopenia until the day you die. So I can’t stress enough lifelong physical activity is the key and I think it’s the fountain of youth. Yes.

Juliet: [01:03:33] So you probably know we just published a book called Built to Move so we’re obviously obsessed with movement. Seems like almost all these studies have been done with creatine plus some kind of movement. And there seems to be a hypothesis in advance that those two things need to go together, which I understand. Is there research being done on just using creatine in a couch potato population? Can it happen if it’s for people who don’t now or never going to really move their bodies? Can it be beneficial in those populations?

Darren Candow: [01:04:04] Yeah, it’s an excellent question. So yes, 99 percent of the studies have some type of exercise modality and that seems to unlock the magic of creatine. But there’s been a few studies in older populations and in clinical populations just giving creatine without exercise has improved measures of strength and functionality. And in young boys with muscular dystrophy, it really had beneficial effects on functionality and even on bone health. We’re looking at mobilization. What about those older adults placed in long-term care facilities that are unable to move? Could that have some ability to decrease muscle loss? And the reason we say that is we did a study in young, healthy individuals who volunteered to put a plaster cast on their arm and when they took creatine, they reduced the rate of muscle loss. So that is huge implication for athletes that have suffered some type of fracture. And the other big area is the brain health seems to be a bit independent of exercise. We’ve actually seen some improvements in cognition, pulse concussion syndrome without exercise. So yes, the vast majority says you need an exercise component, but we are starting to see some beneficial effects without exercise.

Kelly: [01:05:10] Is it too soon to start an Instagram fan account for creatine? I feel like we should put your face… Really, it’s so-

Juliet: [01:05:20] Fans of creatine.

Kelly: [01:05:21] Yeah, I am so grateful for Forrest in high school who was like, “Bro, you’ve got to start getting on creatine right now.” I think I was 16 the first time I became creatine aware.

Darren Candow: [01:05:31] The big thing is too everybody, all of us researchers have conflict of interest. But all what we’re talking about today has been in peer refereed journals which go through a rigorous process of science. It’s not my opinion. I’m giving you all the data that’s out there, freely accessible for anybody to research. So a lot of things that are coming out on the market have never been researched or shown to be safe. And I think the biggest thing is don’t put something in your body unless you’re confident that the majority of research, if not all, says it’s safe. And then is it effective for what you’re trying to do. And I use the analogy, creatine is just the sprinkle or the cherry on top of the cake. The cake is exercise. You can take every supplement you want but you have to move. And I think if the population moved, all our chronic diseases would go down quite substantially. And I think that’s something we’ve got to get going. Yes, Netflix and Prime, they’re all fascinating, but you’ve got to try to move 20 minutes a day. Just do it. You’re going to live longer free of disease. I think that’s a huge thing. 

Kelly: [01:06:30] Can you just say that all again?

Juliet: [01:06:30] Built to Move. Could you just say we’re all built to move?

Kelly: [01:06:33] Dr. Candow, where might people follow your research? Are you on the socials? Can we follow along?

Juliet: [01:06:43] Well, I know you’re on Instagram, so as new research is coming out, are you posting about it there because I feel like that’s where most people are going to find you, honestly. And where else?

Darren Candow: [01:06:51] It’s funny, in academia we’ll publish a journal and we put it in the medical diagonals and no one reads it. And then all of a sudden, Instagram came out, or Twitter, and it’s geez, why not just start posting it there. So my handle is I post all our research on Instagram primarily, academia and more nerdy stuff is on Twitter. But Instagram is probably the best. And it’s just @dr.darrencandow. I try and put little videos of different podcasts and things like that just to get awareness out to people and I’m more than happy to answer a lot of questions. So yeah, this is fantastic.

Juliet: [01:07:22] Thank you so much, Dr. Candow. This was so awesome and informative.

Kelly: [01:07:24] Thank you so much. 

Darren Candow: [01:07:26] I loved it. Yeah.


Kelly: [01:07:32] Thank you for listening to The Ready State Podcast. If you like what you’re hearing, check out all our episodes here or at thereadystate.com. And be sure to subscribe or leave a review on iTunes to help others find our show. 

Juliet: [01:07:44] Check us out and follow us on Facebook, Instagram, and Twitter @thereadystate.

Kelly: [01:07:48] Until next time, cheers everyone. 



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