Podcast #1,024: The Safe, Effective Supplement That Can Improve Your Body and Brain

• AoM Article: Creatine — A Primer on Its Benefits and Use
• AoM Article: A Primer On Muscle-Building Supplements — Which Work and Which Don’t?
• AoM Podcast #878: The Fitness Supplements That Actually Work
• AoM Podcast #585: Inflammation, Saunas, and the New Science of Depression
• AoM Podcast #852: The Brain Energy Theory of Mental Illness
• Darren’s studies

Connect With Darren Candow

• Darren’s faculty page
• Darren on IG

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Read the Transcript

Brett McKay: Brett McKay here and welcome to another edition of the Art of Manliness podcast. What if there was a supplement that could build muscle, maintain bone health, fortify the brain against cognitive decline due to age and stress and alleviate depression. Has been proven safe and comes with almost no side effects. Well, there is such a supplement, it’s been around for a long time and it’s not even expensive, it’s creatine. Here to unpack the myths, benefits and recommended ways to use creatine with Darren Candow, professor of Exercise Physiology Nutrition who supervises the Aging Muscle and Bone Health Laboratory at the University of Regina. Darren specializes in studying creatine and has published over 70 papers on the subject. Today, on the show, Darren explains how a supplement often associated with bodybuilders may actually be beneficial for just about everyone, athletes and non-athletes and the young and older alike. He unpacks what creatine does in the body and how its benefits extend beyond the body and into the brain. He offers recommendations on the formulation of creatine to use, suggested dosage and whether it should increase with age and how to avoid the bloating effect. He also shares what we know about creatine safety, including its effect on the kidneys and whether it can cause hair loss. After the show’s over, check our show notes at aom.is/creatine.

All right, Darren Candow, welcome to the show.

Darren Candow: Thanks for having me. Really excited to be here.

Brett McKay: So you research a supplement that I’m sure a lot of our listeners have taken or have probably heard of, and that is creatine and we’re gonna do a deep dive into creatine today. I think there’s a lot of misconceptions about it. So start off with just basic questions. What is creatine?

Darren Candow: Yeah, actually creatine is very similar to a protein. It’s naturally found in our diet. If you eat red meat or seafood, you’re getting about one to three grams a day. But a lot of people don’t know. We actually naturally produce this in our body, primarily in the liver and brain. So those are the two main areas and of course that leads into the third, probably the global area, which is creatine supplementation. So again, it’s in our diet. We naturally produce it in our body and it’s probably why it has an exceptionally high safety profile.

Brett McKay: Alright, so creatine. Our body makes it, we get it from food. What does it do? We’ll talk about specific effects creatine has on our physiology, but in general, what does creatine do in our body, like why does our body make it and why do we need it from food?

Darren Candow: Yeah. Basically why we make it and or get it from food is because it helps maintain the energy currency of all our cells. So a lot of your listeners are familiar with adenosine triphosphate or ATP, but we need ATP to do any activities of daily living and keep our body moving. So carrying groceries, lifting weights, running your muscles primarily are using ATP to maintain the movement and creatine in the form of phosphocreatine just comes to the rescue. It’s kind of like Batman and Robin. A Batman is ATP or energy, and Robin is the sidekick that helps maintain those energy currency of our cells. So that probably why a lot of people who take creatine or increase it through their diet, they can exercise longer, more intensely. They can recover better. In other words, athletes usually get bigger, stronger, faster.

Brett McKay: Okay, so creatine, we use it for metabolism.

Darren Candow: That is correct.

Brett McKay: Okay. And then, I mean, kind of sort of recap of metabolism. We’ve talked about this on the podcast before. There’s different levels of metabolism. There’s oxidative metabolism, that’s where your body’s primarily using fat and oxygen to create ATP. Is that right? Did I get that right?

Darren Candow: That is correct. Yeah. Think of when you’re walking.

Brett McKay: Yeah. Okay. And that form of metabolism, it creates a lot of energy, but it takes a long time to produce that energy.

Darren Candow: Yeah. That is correct. It’s a very slow process to break down body fat, as we all know. It’s step by step by step process and it does take a long period of time.

Brett McKay: Yeah. And then after that, if you increase the intensity of your movement, of your activity, that’s when you use anaerobic metabolism and you’re using carbohydrates or glucose to create ATP.

Darren Candow: That is 100% correct from the muscle or the liver? That’s correct.

Brett McKay: Okay. And that’s, so you’re using anaerobic and like you’re not using oxygen in that form metabolism, is that right?

Darren Candow: Yeah. If it’s 100% pure anaerobic, very little oxygen is actually incorporated or utilized. So anything maybe over 30 seconds of intense exercise, that’s only when oxidative phosphorylation or capacity really kicks in or predominates. But if you were watching the Olympics and a hundred meter sprint is less than 10 seconds. These individuals are actually not breathing when they’re running, which might be a little counterintuitive to a lot of people listening. They hold their breath, they use something called myoglobin, which is an oxygen storage form in the muscle. But they’re also highly relying on creatine. Creatine is an anaerobic compound that really comes into aid during really explosive high intensity movements, sprinting, weightlifting comes to mind, intermittent sports. But once you’re finished the event, that’s when the mitochondria or oxidative capacity comes in to replenish those creatine stores. So the interesting thing is, a lot of people taking creatine have done it during weight training. They do a set, they rest for a couple minutes, they do another set. Where we see the big bang for its dollar is when creatine is coming to the aid in sets two, three, and four, they can perform more weight or more repetitions ’cause they had higher amounts in the body. And that’s really where it became famous.

Brett McKay: Right. And so what creatine does, it takes a phosphate molecule and kind of adds it to the whole metabolic system to create more ATP.

Darren Candow: Yeah. So when we can produce creatine, just say in the liver or we eat it, just say if you had a salmon steak, it takes about an hour to sort of peak in the blood and then it goes through a specific doorway into our muscle primarily. And when it’s in there, you’re right, it’s linked to a phosphate bond and then it becomes too large to just disassociate and leave the muscle so it becomes trapped. But when it does get metabolized with exercise, whichever it’s broken down into something called creatinine. So when creatine leaves the cell, it’s in the form of creatinine. But when it’s in the cell, it’s linked to phosphate and that’s when it becomes phosphocreatine, which gives all the magic with it.

Brett McKay: Okay. So overall creatine plays a role in metabolism. It helps create ATP, which allows us to do move like sprint, run, lift weights, do a heavy deadlift, everything. I think most people when they talk about creatine or think about creatine, they associate it with muscles. So let’s talk about that specifically. What are the benefits of creatine when it comes to muscle mass and strength? Why are bodybuilders taking creatine?

Darren Candow: Yeah, the benefits are enormous and really elegant. So there’s probably over a thousand peer referee studies now showing that creatine improves lean mass, some areas of pure regional muscle mass, strength, endurance, power, and also muscle recovery. So when you have more creatine in the muscle, it increases the capacity to do work. So this is really important. Creatine without exercise will give very minimal effects. You can get some acute effects, maybe an improvement in strength or endurance with a really, really high load without exercise. But exercise unlocks all the magical benefits from a muscle biology perspective with creatine. So there’s really good established mechanisms for that. But in summary, when individuals take creatine through supplementation or the diet, their muscle has a greater ability to perform more work that either is more reps, more sets, and potentially more frequent training sessions. So usually training volume will go up and that probably explains why a lot of people either get an improvement in strength, lean tissue mass or endurance.

Brett McKay: Okay. So that’s a good point. The creatine itself doesn’t increase muscle mass or strength, it just allows the muscle to train harder for longer, which will give you more stimulus to drive hypertrophy and strength.

Darren Candow: Yeah, all the good mechanisms that get turned on, like things like satellite cells and insulin-like growth factor and things like that that we could probably talk about. From a pure mechanistic standpoint, they have been shown to be increased primarily in young adults with creatine supplementation in combination with resistance training. Very minimal research suggests that these pathways get turned on in a meaningful way. They might get turned on in from a biological way, but from a meaningful human way without exercise.

Brett McKay: Okay. So if someone’s doing, I mean you would see the effect of creatine if you’re… So let’s talk about, use weightlifting as an example. If you’re on set two, if you didn’t supplement with creatine, you’d probably feel, Ah, I’m kind of depleted. I can still do it, but it’s pretty tough. If you have supplemented with creatine, your muscle had been saturated with creatine, like your muscles have something to fall back onto to create the ATP it needs to go really hard in that second set.

Darren Candow: 100%. So even if you didn’t change the weight, let’s say for set one, the group that was on creatine did a hundred pounds on the bench press. The group that was on placebo also did a hundred pounds. The first set maybe there, each group did about 8-9 repetitions. No difference. Now when it comes to sets two, three, and four, the creatine group still with a hundred pounds can definitely do more repetitions in sets two, three, and four. So when you add up the total amount of repetitions over those sets, the creatine group in theory did more. And if you do that over weeks and months, that’s probably why an individual will put on lean tissue mass and indefinitely improve muscle performance.

Brett McKay: Does creatine have any effect on the neuromuscular aspect of strength? Like does it help you contract your muscles harder and things like that?

Darren Candow: Oh, it does. It really reduces relaxation time. So the muscle can contract more often. And the other theory is there was hope for multiple sclerosis where the axon going to all our… Or the power cord if you will, going to all our muscles was frayed. There was some hope there with multiple sclerosis, but we didn’t really see a lot of promise in that disease state clinical population. But creatine now has been shown to act as a neurotransmitter. Picture caffeine, something like that. But creatine, there’s a little bit of evidence to suggest that acts as a neurotransmitter, which kind of makes sense because now you may be able to recruit more muscle fibers, primarily those type two muscle fibers. And that may be why some of the best evidence suggests that creatine improves maximal strength and measures a muscle power. So that has huge applications for athletes.

Brett McKay: Yeah. So allow you to lift a one rep max that’s heavier.

Darren Candow: Yeah, I would say the one rep max is probably the most established benefit from creatine supplementation over time. Next to it would be probably more repetitions, perform to evolutional fatigue or indices of muscle power. But by far, if you had to ask me what’s the best reason to take creatine, I would probably say overall it’s the improvement in muscle strength.

Brett McKay: Okay. Alright. So creatine can increase muscle strength, can increase muscle mass because it allows you to do more volume, which gives your muscles more stimulus to drive muscle protein synthesis. But creatine isn’t just about muscles. In fact, creatine helps a whole bunch of other stuff. And this is what a lot of your research is showing. And one thing I was surprised about is that creatine can help with our bone health. So how does creatine help with our bone health?

Darren Candow: Yeah, it’s taken on almost a new life of its own. It’s pretty much for anybody across the lifespan. And a study done in 2003 out of Switzerland when they put bone building cells, if you go all the way back to biology, if you put bone building cells in the presence of creatine in a Petri dish, these cells became energized. And so the theory was, Wow, if these bone building cells have more energy, maybe they can potentially in a human, start laying down more calcium and phosphate salts and maybe the skeleton can get stronger. And of course, that would have enormous application for males and females to primarily biological females prone to osteopenia and osteoporosis. And there was a couple of pioneering rodent studies done at McMaster University in Ontario showing that rodents improved bone mineral density when creatine was added to their food. And then, of course, as a segue of you mentioned, we’ve done a number of clinical trials now looking at long-term creatine supplementation and exercise. Bone tissue takes a long time to turn over, so you probably need at least six months of exercise. And we’ve shown from anywhere 0.1 gram to 0.14 grams per kilogram.

So that’s about 8-12 grams for the average person. If you take that per day in combination with exercise, primarily weight training, you can preserve some aspects of bone health primarily around the hip region. This is primarily shown in post-menopausal females, but we’ve also shown some benefits in healthy males. Now, I will preface that we did not increase bone mineral density at best we preserved bone mineral density in some of those regions and simply showed that there’s improvement in bone geometry. But there’s only been about four studies to show that the vast majority do not show these effects. So we need a lot more clinical research, especially in disease state populations. But there is some evidence to suggest it has some bone beneficial effects.

Brett McKay: Okay. And you have to do it in combination with exercise. It’s not just like you take creatine and you’re gonna maintain bone mineral density.

Darren Candow: Yeah, so this is crucial. There is some studies regarding skeletal muscle that without exercise creatine can have some very small, very small favorable effects, but we don’t see any benefits without exercise on bone. So you need that mechanical stimuli from brisk walking or more importantly weight training that cause the muscle to pull on the bone all throughout the day to cause bone to improve. So there’s been studies in Brazil, worldwide not showing any benefits from creatine without exercise and a little bit different than skeletal muscle. The lowest dose ever been shown to have any bone benefits is 8 grams a day. Whereas skeletal muscle, the lowest dose has been about 2-3 grams a day. So there is a difference from a tissue perspective.

Brett McKay: Okay. So this is interesting research. If you have an older parent or maybe a wife going through menopause, this would be useful to know, take some creatine and exercise, it can help maintain that bone mineral density. Do we have any research on whether creatine helps connective tissues like tendons and ligaments?

Darren Candow: We don’t. And I’ve asked a few colleagues, I think now with the big push on collagen, where collagen is kind of not really that great for muscle protein synthesis, but I thought, Wow, what if we could combine creatine and collagen protein into a research study? I think it would have some potential benefits there, especially for people prone to osteoarthritis, osteopenia, or osteoporosis. I think those two synergistic compounds might play a role. But again, we need the research to do that. But as creatine by itself, nothing on tendon bone or cartilage per se.

Brett McKay: Okay. So creatine can help increase muscle mass and strength, it can help potentially stave off osteoporosis. You mentioned creatine supplementation can help endurance athletes. Walk us through that ’cause typically when I think of creatine, I think of it as far as for sprinters or power lifters, how can creatine help someone running a 5K or a marathon?

Darren Candow: Yeah, that area’s really come into its own in the last five or six years. And you’re right, creatine was just for anaerobic athletes get bigger, stronger, faster. And then we started to look at research in soccer players, long distance running. Some of the best studies show that creatine really speeds up recovery in post Ironman and post long marathon training. But it has improvements in agility and balance and recovery in swimming, soccer. So it’s not just for the weight room, it seems to be a metabolite that can really have some promise for endurance type athletes as well.

Brett McKay: And I think it’s important to note even if you’re taking part in an endurance activity, like you’re not just in that oxidative metabolism state where you’re using fat. Like when people think about metabolism, they often think of it as sort of these like very discreet things. Like you’re either in fat-burning zone or either in carbon… Like it’s like a spectrum. It’s all going on at the same time. It’s very dynamic. And so in any endurance event, I’ve run a few 5Ks. I know at the end you do that kick, you’re going as hard as you can, you’re basically doing a sprint. I imagine an athlete who’s got a good store of creatine in their muscles, they’re probably gonna do better at that point in the race than someone who doesn’t.

Darren Candow: Yeah. And you’re right, all three energy systems are turned on simultaneously no matter what you’re doing. It just depends on the activity, which would dictate predomination. And so, if you’re on a treadmill or as you said, you’re doing the marathon and then you sprint, you don’t have time to wait for your anaerobic, a lactic system to kick in. It’s already kicked in at the beginning, it’s just which one predominates. And you’re right, the more creatine that’s in the muscle, that can actually delay glycogen depletion. A lot of people don’t realize this, but if you utilize creatine, more anaerobically, that’ll offset the reliance on glycogen, which we only have a little bit amount in our liver and skeletal muscle. And then that’ll further delay oxidative phosphorylation. So that’s probably why individuals, when they do take creatine, they can sort of exercise at a higher capacity, really train that anaerobic system and that’ll delay the reliance on a really slow producing energy system such as fat burning.

Brett McKay: Okay. So marathon runners can benefit from creatine supplementation or just increasing their creatine levels. Some other exciting researches coming out about creatine. Creatine doesn’t just affect your athletic performance. It can also influence or affect our brain health. So tell us about the research about creatine and brain health.

Darren Candow: Yeah, this is so exciting. So, this is probably the big focal point for the next 20 or 30 years, and creatine can get into the brain, but it’s really difficult. So as we all know, the brain has the blood brain barrier, that little force field that prevents toxin particles from getting into our precious tissue. A creatine can accumulate into the brain, but it’s at a slower rate. So our skeletal muscle acts as a vacuum. It sucks up all the creatine from our blood, but the brain is resistant to that. So when it does get in, it takes a long time. And also that’s different. Our brain does make its own creatine. So the brain might say, Hey, we don’t really need a lot from supplementation, only during times of metabolic stress. Creatine supplementation can accumulate in the brain, which is fantastic. And it’s now been shown to have some cognitive memory benefits for older adults. And what’s really coming to the forefront is during times of metabolic stress in the brain, such as sleep deprivation. So I don’t know anybody that’s not sleep deprived or sometime I would consider jet lag up there as well.

The mechanism seems to be very similar to recovery of the muscle. The brain does rely on creatine just like bone and muscle, and so when the brain is stressed it needs help, even though it makes its own, it may need help from circulation. So I think when the brain is stressed, students staying up all night, if you’re flying to Europe and you’re susceptible to jet lag, sleep deprivation, whatever it is, that’s when you would probably notice the benefits from creatine if you are not metabolically stressed, you get adequate sleep. Everything’s good, you’re probably not gonna notice those beneficial effects.

Brett McKay: Okay, so creatine can help your brain during times of stress, so sleep derivation. How are you gonna notice it? So let’s say you don’t supplement with creatine and you are sleep-deprived, everyone knows that you feel just groggy and tired and cranky. How would you feel if you take supplement with the creatine?

Darren Candow: Yeah, I’ll put it from an experimental perspective, and I’ll tell you what happens in me specifically. So from an experimental perspective, it’s very easy that when we have people volunteer overnight to be sleep-deprived, they’re able to do sort of puzzles and sort of like a task on a computer, more steady compared to those on a placebo, so maybe performing tasks of daily living the next day is easier. I sure notice my fogginess goes away, I’ve had covid now three times, and I’ve had sort of the brain fog twice, but when I go fly to Europe or other parts of the world, I find creatine really decreases the fogginess and allows me, to sort of get back to feeling normal on the next couple of days, and I have increased my creatine a little bit more when I am flying overseas just for the hope that it can have some beneficial effects.

Brett McKay: And then you also talk about… You just mentioned that it can help with age-related mental deterioration, tell us about that research…

Darren Candow: Yeah. So there’s been a couple of meta-analysis showing that in healthy adults, these are individuals without dementia or Alzheimer’s or related, they’ve been able to have an improvement in memory and some cognitive function, and that might make sense as the brain, just like any other organ starts to deteriorate as we get older, so we are starting to look at some areas maybe dementia and Alzheimer’s, which would have massive implications moving forward, but overall, we’re not seeing any huge benefits in Parkinson’s Huntington’s, there’s been no research that’s been published on Alzheimer’s, but stay tuned for that, I know those studies are in the works. There’s a great group out of Utah, a group of psychiatrists which have clearly shown huge benefits, primarily in females with clinical depression. Creatine when added to their medication program seems to alleviate symptoms of depression, anxiety and PTSD. So some more randomized control trials will be coming up there, and one of all the main mechanisms with all this seems that it decreases inflammation in the brain or oxidative stress, we need a lot more evidence to look at other mechanistic actions that seems to be the theory.

Brett McKay: Yeah, that’s interesting, creatine’s connection to mental illness and inflammation. We’ve had a few podcasts guests, psychiatrists and psychologists who have explored inflammation’s connection to mental illness, particularly depression, like there’s a guy, I forget his name, but he studies sauna use, and how it alleviates depression and some types of depression. The theory is there, is that depression is an inflammatory or a type of depression can be an inflammatory response, and so by adding the sauna, you acutely increase inflammation and your body can better handle inflammation and reduce this information overall, and then there’s another guy had a book out, I forgot again, I can’t remember off the top of my head, but basically the argument he made a lot of the mental illnesses that we have they’re metabolism problems in our brain…

Darren Candow: Right. Yeah, yeah, there’s so much out there now. An important distinction is that some of these studies that show brain benefits have been without structured exercise. So now this is important because the question came up, should I just take creatine on the days I work out, I now tell people take it every day, just in hope that some of that creatine will be trickling into the brain on a daily basis and eventually accumulate. It takes a long time to accumulate in the brain, and if you’re taking a low dose of creatine, it could take several months if you’re taking a super high dose, a little bit less, but now that’s why it’s recommended to probably take creatine on a daily basis. Either from one of those potential mechanistic standpoints, but we’re actually seeing some benefits without structured exercise, so to that question, should everybody on the planet consider creatine? I can’t say yes or no, but there’s evidence to suggest it has some potential to have some beneficial effects.

Brett McKay: We’re gonna take a quick break for words from our sponsors. And now back to the show. Okay, so we talked about the many benefits of creatine. It helps build muscle strength and mass, can help with endurance, maintains bone health, it can improve cognitive function when you’re sleep-deprived or jet lag, and also maybe help cognitive function as you age. Might help with depression. Are there any other benefits of creatine we haven’t talked about that you’re excited about?

Darren Candow: Yeah, I think the big one is that we’re starting to see some promise from pregnancy all the way across the life span, especially in females, and we’d like to really start looking at young bone and children and adolescents, can that improve a coordination development, things like that. So there’s a lot coming down the pipeline, it’s starting to have some potential beneficial effects on cardiovascular health, so it’s sort of gone from athletes to pretty much anybody on the planet may or may not get a potential benefit just depending on their situation.

Brett McKay: Alright, so we talk about the benefits. A lot of benefits to creatine. Let’s talk about supplementing with creatine. First question is, is supplementation even needed? Or Can you get enough creatine from your diet?

Darren Candow: So the correct answer is no, you definitely do not need to supplement with creatine, unless you’re born with a creatine deficiency. And the validity to that is vegans, vegetarians have healthy muscle cells and they’re only relying on what they’re naturally producing, however, when you do take a little bit more, you can get substantial beneficial effects. So the technical answer is no, but there are other individuals that would probably argue that it’s conditionally essential, but I fall in the other category to be an essential nutrient, like an essential amino acid, if you don’t consume it, you would die, we’re actually producing enough to get by so, it’s a tough one to answer.

Brett McKay: So if you’re looking for optimization, you’d probably wanna… It’d be easier just to supplement.

Darren Candow: Yeah, and you don’t need a lot. Like most people take creatine for muscle benefits, you could probably take as little as three grams a day, that’s a quarter of a teaspoon, and that will accumulate in your muscles in about 30 days, but of course, if you’re looking for bone and or brain benefits, you may need a bit more.

Brett McKay: Okay, let’s talk about dosing if you’re gonna supplement with creatine. I think the typical dose when you buy creatine is they recommend, I think it’s five grams a day.

Darren Candow: Yeah, it depends. So a lot of the companies will say, “Hey, we want you to load creatine,” which is primarily just for athletes that’s 20 grams a day for five to seven days. It’s an extremely reliable, fast, rapid strategy to saturate your muscle to get the best benefits out of it. The only problem, and why I’m really hesitant on recommending the loading phase is that creatine is an osmotic compound, so it drags water with it, and so when you’re taking in that much creatine, you’re gonna take a lot of water inside the cell. And a lot of people say, “Oh, I gained weight during the first week, or I had some bloating or GI tract irritation,” that kind of logically makes sense, but you can take as little as three grams a day.

You can probably move it up to a really effective dose of five grams a day. Five grams a day, your muscles should be saturated in about 15 to 20 days, we don’t know if you can saturate the bone or brain, but again, once your muscles are saturated, any access would go down the toilet, or hopefully it’s going into other demanding tissues. In our lab, we use a relative dose based on the size of the person, about 0.1 grams per kilogram, so if you’re 70 kilograms, you get seven grams a day, if you’re a 100 kilogram, you get 10 grams a day, and you can divide that up into multiple smaller dosages. So for example, if you do wanna take five grams a day, you can take two and a half in the morning, two and a half in the evening, the timing is essentially irrelevant, and it’s really up to you.

I would not recommend going anything less than one gram per serving. A classic study showed that one gram just wasn’t enough to accumulate in the blood and eventually get into the tissue.

Brett McKay: How much creatine do you take a day?

Darren Candow: I personally take… I take 10 grams a day now for probably the last decade, based on a whole body perspective, not only muscle and bone, but now the brain. So muscles just say is about three grams, bone anywhere between eight to 10 and the brain, the best study showed 20 grams, so I just simply divided all those dosages by 3, and I get about 10 grams and I take five grams in the morning, and then I actually mix the other five grams in a water bottle and I drink it during my work out. And that seems to really be an easy, consistent way for me to get it in.

Brett McKay: Okay. And can you take creatine every day?

Darren Candow: Yes, you can, yeah. And I think I’ve changed my opinion on this, primarily due to the brain that, you know, take it every day, ’cause you want some hopefully trickling into the brain after the muscles is full.

Brett McKay: Let’s talk about the type of creatine to take. There are different formulations out there on the market. Which do you recommend?

Darren Candow: I only recommend mono hydrate, so I know it’s the boring original, but it’s the one that’s been shown in all the studies to be effective and safe. All these other marketed forms of creatine. First, they have to be creatine when it gets through your small intestine, if it’s not the creatine molecule, your cells will not allow it in so then it’s useless. And all these other things linked to it, to me are irrelevant. The bioavailability of pure creatine is near 100%. So if someone wants to spend way more money on a fancy bottle, go ahead, but at the end of it, it has to be the creatine molecule, and I only recommend and talk about monohydrates.

Brett McKay: Okay. And it’s pretty affordable. I think it’s gotten more expensive, I’ve seen the price go up a little bit, but overall, creatine’s pretty affordable.

Darren Candow: It is, and we’re not talking like protein where you need hundreds of grams if you wanna start with three grams a day, that’s great, you’re probably gonna get some benefits down the road.

Brett McKay: Another question I have about taking creatine. I remember when I was a teenager, I read in the Muscle Mags, if you wanna get better absorption of your creatine, you need to take it with a quick absorbing carbohydrate like orange juice. Is there anything to that?

Darren Candow: Yeah, there’s a lot of good research or the UK validating that the only problem is that the dose of carbohydrate or high glycemic sugars is so high that most people nowadays won’t even go near 50 to 100 grams of sugar. And luckily for everybody listening, if you’re not a big fan of simple carbohydrates, exercise muscle contractions will stimulate creatine up taken to the muscle really well, and that’s probably why a lot of people take creatine in close proximity to their workouts. Take it before, during or after. Blood flow is upregulated and these doorways that allow creatine are stimulated, so it’s a great time to take creatine.

Brett McKay: Continue on, just dosage. Does your creatine supplementation need to increase as you get older?

Darren Candow: That’s an excellent question. I’m in the opinion, yes, it’s very similar to the blunted response to protein. We’ve done a meta-analysis showing that our creatine stores are sort of negatively affected in the lower limbs as we get older, so my thought is that we need more as we get older to offset some of those age-related declines.

Brett McKay: Okay. So let’s say you take five grams a day as a 30-year-old guy, maybe when you get to your 60s, are you taking 10 grams a day?

Darren Candow: And there’s been some studies all the way up the 30 grams, showing some beneficial effects. That’s quite high, but for me, I think 10 grams is more than enough on a daily basis, unless you had some metabolic disease or other conditions such as Cachexia or maybe cancer where it was really inflammatory, I just don’t see why you would need more than that on a daily basis.

Brett McKay: Do we know how early we can start taking creatine?

Darren Candow: So this is an area of controversy for sure, and I gotta be careful how I preface this, but there’s some really good potential during fetal development and during pregnancy, and most people will shake their head and say, “What did he just say?” But yes, there’s good research outta Australia now, again, they’re using the rodent model, but they have been showing some benefits that creatine during pregnancy for the mother and the fetus has some substantial benefits again decreasing inflammation and oxidative stress. Good researchers in the United States, Andrew Jagim and Chad Kerksick is clearly shown now that creatine is beneficial for children and adolescents at the recommended dosage is no adverse effects. We’re still waiting on the blood biomarkers, but I’d be very shocked if there was any adverse effects there so it sort of transcended and now seems to be something that anybody on the planet can consider, and one of the main reasons is again, we’re naturally producing this. Right? Our body recognizes it, and if we don’t like it, we excrete down the toilet, so we need a lot more research in those younger years, but the current body of research suggests it is safe and potentially effective.

Brett McKay: So if you’ve got a teenage kid who’s an athlete and they’re like, “I wanna take creatine,” it’d be okay to do that. No safety problems there that we know of.

Darren Candow: 100%, and if I had a child that young, they be taking creatine for sure.

Brett McKay: Okay, does creatine supplementation… Should it differ whether you’re a man or a woman?

Darren Candow: No, there’s no big sex differences when it comes to creatine. I think I saw something the other day, creatine was marketed for females, which is just quackery. The only thought was that biological females may have smaller muscle, so their creatine stores may be at rest, or already higher. So they may not respond as well. And there’s been a few studies to suggest that females may not improve lean tissue mass at the same rate as males, and from a mechanistic standpoint, we think for some reason, maybe estrogen is involved, that females don’t experience a decrease in protein breakdown at the same level as males, and the only logical reason there is maybe estrogen is involved, but we just don’t know.

Brett McKay: Okay, so I think a lot of people… There’s a lot of people out there might be wary of taking creatine ’cause they may have heard some things. I remember when I first started taking creatine in high school, this was in the 90s, this was when the home run race between Mark McGwire and Sammy Sosa was going on. And then Mark McGwire said, “Oh yeah, I just take creatine.” He’s actually taking steroids, and I remember my mom or my dad, and one of the parents heard, he’s like, “You shouldn’t take this, it’s like steroids, and it’s you’re gonna mess up your liver and your kidney,” walk us through, is creating safe? I think we kind of mentioned it throughout this conversation, and the research says it’s pretty much safe, but is there any… Can creatine damage our kidneys, liver, etcetera?

Darren Candow: Yeah, so we can go through a many miss so for one creatine is not a steroid. There’s been study after study, and we’ve done a two year study in post-menopausal females looking at long-term high dose creatine on kidney and liver health, and there’s been no greater adverse effects, and that’s been replicated around the world, so in summary, creatine has no adverse effects on liver, kidney or even cardiovascular function. It does not lead to muscle cramping, and if anything, it actually decreases it because it’s super hydrates the muscle, and that was another big myth. So it does not increase fat mass, as we’ve shown a few times that it decreases fat mass. I think the blowing just do not do the loading phase and start with a really small dose, but the big safety profile of creatine has been well established. It’s probably the safest, most effective dietary compound, even above caffeine, have recommended dosages that a human can take.

Brett McKay: And it’s the most studied, like you said, there’s over 1000 peer-reviewed studies on creatine. Let’s dig deeper into the kidney thing, because you mentioned earlier that one of the by-products of creatine is creatinine. So this is a marker that your doctors look at to check your kidney function, whether your kidneys are working the way they’re supposed to do, and elevated creatinine levels is a sign like, “Oh, something’s wrong with your kidney we need to look into this.” When you take creatine, your creatinine levels are gonna go up ’cause you have more creatine, so you have more by product. So how does this not mean your kidneys are messed up?

Darren Candow: Yeah, it’s a false positive of almost 99 out of 100 times, so when you take supplementation, as you mentioned, it goes into your demanding cells and when it gets utilized, it leaves the cell in the form of a metabolic by-product called creatinine. It’s measured on all blood requisition forms, the doctor will check off something called creatinine and right below it, it has eGFR, so that’s estimated glomerular filtration rate. They use this to assess the health of the kidney. And so think of the kidney as a filter, like a brita or a water filter. It’s filtering things in the blood and what it doesn’t like, they leave the body, so it should be filtering creatinine therefore, creatinine levels should not change. However, when you take supplementation, creatinine levels go up, the kidney is still fine, it’s just those levels went up, and when you happen to go to your doctor, when they measure it, they’re like, “Woah, why is your creatinine so high and your eGFR’s so high, that means… Sorry of your EGFR is lower. That means you’re not having a filtration through that.” So one of the biggest things I tell people is that if you’re taking creatine supplementation, please tell your nephrologist or GP that you’re on it.

Typically, your creatinine levels in the blood are elevated, that does not necessarily mean you have any kidney issues.

Brett McKay: Yeah, and the other issue too, if you take creatine, you’re also probably lifting weights and strenuous exercise can also raise creatinine levels, which can…

Darren Candow: And dietary protein, 100%.

Brett McKay: Yeah dietary protein. And then also something else I’ve learned, if you reduce body fat, if you’re like have more lean mass, your creatinine levels are gonna be higher.

Darren Candow: That’s right. On a relative position that’s correct. On a relative basis.

Brett McKay: Is there another test you can take, let’s say your doctor freaks out, ’cause I’ve had this happen a few times. Your general practitioners are typically not… They got so much going on, they don’t have enough time to stay on top of the research on nutrition and physiology, so they see this elevated creatinine level and you’re like, “I’m fine,” they’re like, “No, we gotta send you to a nephrologist,” is there another test you can take to show that your kidney function is okay, and it takes an account that you’re supplementing with creatine?

Darren Candow: Yeah, and there is one I believe I’m pronouncing it right it’s cystatin C, it’s a new type of test that a lot of individuals can ask your doctor to get and usually when that’s done, it doesn’t consider the estimated error of measurement in the filtration rate or the amount of creatinine being filtered.

Brett McKay: Gotcha. And then again, to the liver, nothing shows that creatine negatively impacts liver function.

Darren Candow: No only at super physiological doses in the rodent model, have we seen this but in humans no.

Brett McKay: Okay. Alright, so overall, creatine seems to be safe it’s not gonna damage your kidneys. I have heard that if you have some kidney issues, maybe you gotta talk to your doctor, and nephrologist before you start supplementing with creatine.

Darren Candow: Yeah, 100%, since those organs are involved in the synthesis and or metabolism, creatine, we always recommend that they consult their doctor before they’re taken. Not only creatine, but any other dietary supplement. Absolutely.

Brett McKay: Right. And then bloating, if you wanna manage that, just don’t do the loading phase, does your body adapt if you take the lower dose every day, does your body eventually just adapt and you get back to normally not gonna experience any of that water retention?

Darren Candow: Yeah, and that actually happens after the loading phase as well, our body does adapt, and the funny thing is when we measure someone’s weight before the study and after, usually it’s unchanged. Maybe muscle mass went up and fat mass came down, so typically it does subside after about seven to 10 days.

Brett McKay: Okay. Another thing people might have heard, and I’ve seen this on the internet, is that creatine can increase DHT levels, which increased DHT levels can cause hair loss. So for those who aren’t familiar, what is DHT in its connection to hair loss, and where did this idea that creatine plays a role in that come from?

Darren Candow: Yeah, it’s mind-boggling that does one study in South African rugby players, and DHT is dihydrotestosterone as derivative of testosterone linked to hair thinning or hair follicle loss, but this study simply looked at the loading phase for seven days in rugby players, and the hormone did go up compared to placebo, but it was still within the physiological range. Like when you go to a doctor and measure your blood glucose, there’s a low end and a high end and this hormone did improve or increase in response to creatine, but again, it was in the physiological range. They did not measure hair thinning, hair follicle loss, no study has. I believe there is one study now being done in the South Pacific, starting to look at hair cross-sectional area, but at the end of the day, there’s no evidence to suggest that creatine has been linked directly to hair thinning or hair follicle loss. I’ve assessed over a thousand people, and not one time, has someone came to me and said, “Hey, Darren, whatever you’re giving me is causing my hair to fall out,” that’s a subjective answer, but again, we have no empirical evidence to suggest that it increases hair follicle loss, or thinning.

Brett McKay: Okay. So it sounds like creatine pretty dang safe from what we know so far.

Darren Candow: Absolutely, and we’ve looked at some studies two to five years in duration at higher dosages, and we’re just not seeing any evidence that has greater adverse effects than placebo.

Brett McKay: That’s good it’s five, that’s a long-term study. So that’s…

Darren Candow: Yes, it is. Yeah, they’re hard to do, but we did a two-year one which took almost a decade to finish, so kudos to those researchers who can do these really long-term study, especially in humans who have a lot of things going on in their life to stay in the study.

Brett McKay: Alright. And so we’ve covered a lot of great stuff. So I think you’ve been interested about Creatine supplementation, gave you some things to check out the dosage. Creatine monohydrate, and you’re gonna be good, and you’ve mentioned that where research is going now is what creatine can do for young people, right. Is that where you’re kinda…

Darren Candow: Yeah. Almost about anybody across their lifespan where… Just think of females, we’d love to know the effects during the pre-menopausal stages during the perimenopausal stages, we just don’t know much there. Then of course, post-menopausal stages, and then look at young males as we’re going through the peak testosterone ages during the pre-andropause and then we get into old age. What about frailty and your grandparents and that, so I think it’s something in combination, again, with exercise. I use this analogy, but exercise is the cake, protein is the nice icing and creatine might be the sprinkles on top that allow you to eat it a little bit better, but at the end of it, supplements give a small effect, exercise has to be the driving force behind anything from a healthy longevity perspective.

Brett McKay: Fantastic. Well, Darren, this has been a great conversation where can people go to learn more about your work?

Darren Candow: Yeah, I think nowadays on Instagram @dr.darrencandow, I try to produce and promote a lot of things, not only creatine related, but exercise and health related, so… @dr.darrencandow on Instagram.

Brett McKay: Fantastic well Darren Candow. Thanks for your time it’s been a pleasure.

Darren Candow: Right, thank you so much for having me.

Brett McKay: My guest today was Darren Candow, he’s an expert on creatine, you can find him on Instagram @dr.darrencandow, also check out our show notes at aom.is/creatine where you find links to resources we delve deeper into this topic. Well, that wraps up another edition of The AOM podcast, make sure check on our website at artofmanliness.com or find our podcast archives as well as thousands of articles that we’ve written over the years about pretty much anything you think of. And if you haven’t done so already, I’d appreciate you to take one minute to [0:42:50.4] ____ podcast or Spotify, it helps out a lot. And if you’ve done that already, thank you, please consider sharing the show with a friend or family member who you think will get something out of it. As always, thank you for the continued support until next time is Brett McKay [0:43:00.5] ____ on podcast, but put what you’ve heard into action.