Episode Transcript
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Welcome Back to part two of my interview with Dr. Darren Kandel. In part two, Dr. Kandel discusses the power, how creatine helps brain and bone function and if you're new here and you like our interviews, press like subscribe, share and hit the bell. Also, please leave comments. Be sure to watch our full length documentary Open your eyes on Amazon Prime, Apple TV, iTunes, Google Play and YouTube movies and shows. And chia seeds, you know, some people say it's a nutrient. Where do you fall on that?
[00:01:53] Speaker A: Oh, those are all to me beneficial. If you look at the Mediterranean diet, the phytochemicals, so many antioxidants, all those, you know, hemp flax is a big one. Chia seeds, if you could and you had a whole buffet, you go to that first, you stay away from the fast fried things and put that in. And those are all beneficial from an antioxidant fiber perspective. Yeah.
[00:02:16] Speaker B: So if you can review for weightlifting muscle, what are the all what are the benefits of creatine for exercise?
[00:02:25] Speaker A: Yeah, it comes very multifactorial. So for those who currently lift weights, you should expect a number of things. If you add creatine to that, the first one is you're going to get an increase in lean body mass and we think about half of that is muscle. So that's super important.
The second and likely the most important and robust amount of evidence comes from muscle performance.
You should expect an increase in strength, endurance and power.
And then finally you'll also get an increase in functionality. Now, the young adult getting off the toilet, out of bed, out of a chair is easy, but as you get older, those things get a little bit more difficult. So those are the three caveats where we think you get from a muscle perspective, let alone the bone and brain health benefits. Yeah.
[00:03:07] Speaker B: And there's an improvement in agility. Could you talk about.
[00:03:10] Speaker A: There is.
[00:03:11] Speaker B: And why does that happen?
[00:03:13] Speaker A: Yeah. So agility or agility, balance, coordination, those have been shown now not only in children, but in older adults on creatine. There we don't know very much on the motor unit recruitment patterns or the neuromuscular system per se with creatine. But we think if the muscle is getting larger, stronger, you're having more neural drive. So that might help maintain an increase in some of those parameters, especially around geology imbalance. Is creatine improving tendon and ligament strength and endurance? We don't have any data on that as well. And that's why there's a big theory about creatine and collagen. Could those two be combined to consider some of the benefits for arthritis and things over time? So we still have a long way to go. But regarding the agility imbalance, we think it may be from an enhancement in other muscle function and or stability or neural drive.
[00:04:03] Speaker B: And creatine has been considered a neurotransmitter. And why is that?
[00:04:08] Speaker A: It's only been recently promoted, obviously in the rodent model and from a cellular perspective. But the thought is it can stimulate the release of a neurotransmitter called acetylcholine. If you go all the way back to university biology, that's the main neurotransmitter that activates our skeletal muscle. And I think creatine has the potential to release acetylcholine across the neuromuscular junction. It's in its infancy, has never been shown in humans. But there's a thought there as well also that gets more press now on depression and anxiety. So creatine is now thought to be acting sort of as a dopamine antagonist, kind of like caffeine does to adenosine. So maybe creatine can help maintain some of those effects from a neuromodulation perspective.
[00:04:53] Speaker B: And adenosine helps people with sleep. And there's been search to show that creatine people who take creatine actually will sleep an hour longer. Can you talk about that study?
[00:05:03] Speaker A: Yeah. So that study we published last year and it was interesting. We didn't measure the mechanisms, but the females who worked out on the days they trained, they actually got about an hour greater increase in sleep than the females on placebo. So the duration was greater. We did not use sleep lab technology, REM, non REM, things like that, or EEGs.
But the thought is maybe it has something to do with adenosine or does it have something else to do with one of the magical areas of the brain? So it's a preliminary study. It has a lot of potential. You piggyback that off about five or six really good studies that show that creatine decreases symptoms of sleep deprivation. And so you combine those two and maybe those that are really impaired by sleep, jet lag, mental stress, fatigue. It's something to at least consider. Yeah. The brain uses creatine just like our muscle for energetics. So maybe if there's more creatine in circulation, the brain will eventually tap into it when need be, during times of metabolic stress, and that might help cause that organ to recover quicker and maybe allow it to function better.
[00:06:08] Speaker B: And we're going to talk about brain in a little bit, but you need a bigger dose to get through the blood brain barriers.
[00:06:14] Speaker A: Yeah. So the blood brain barrier is there for a specific reason. And one of the issues with the blood brain barrier is we have a cell called astrocytes. It's kind of like the main, a sort of a glue glial cell that allows things to move from the endothelial cells into our cells or part of our muscle tissue as well, and brain.
But the doorway or transporter for creatine to get taken in is lacking in those astrocytes. So creatine through circulation, getting into the brain is really blunted. And then you combine that with the brain actually makes its own creatine.
The theory is that the brain only relies on supplementation or dietary creatine when it's needed. And during times of metabolic stress, it might signal, hey, we need help. And that's why it can accumulate slowly. But we think unlike muscle, you need a higher dose or longer period of time.
[00:07:08] Speaker B: How about creatine's effect? Does it affect testosterone at all?
[00:07:13] Speaker A: We're not really seeing any effect. A recent paper just came out the last month. I think it was on creatine and baldness. One of the biggest myths. And it didn't have any effect on bound testosterone, free testosterone. So without having an effect on free testosterone, if it's not getting through the plasma membrane and affecting DNA, we're not seeing any effects there from a Hormonal perspective, very rare. Does creatine affect hormones? It's been shown to increase growth factors, insulin, like growth factor 1 or myostatin, but it really doesn't have much effect on testosterone, growth hormone, things like that.
[00:07:48] Speaker B: Well, you and me both take creatine. I don't know if that has.
[00:07:50] Speaker A: I know exactly, exactly. I was going bald way before I started anyway, so.
[00:07:56] Speaker B: So it does, it does increase dihydrotestosterone.
[00:07:59] Speaker A: It does, yeah.
[00:08:01] Speaker B: So that's where the baldness thing probably came.
[00:08:03] Speaker A: And this is an important distinction. The study that showed it did took 20 grams a day. The latest study where they only gave 5 grams had no effect on DHT. So now we're starting to do another study coming up and dosing, maybe the high dose was too high to cause that or a lower dose might not have any effect. So that's an interesting comparison.
[00:08:23] Speaker B: And talking about dosing, let's, let's talk about that. I know like the standard dose is around 5 milligrams, but tell me about different ways of dosing, loading dose, if you like, of your. If you're a big believer in loading those.
[00:08:37] Speaker A: Yeah.
[00:08:38] Speaker B: And different ways to do it with. With athletes.
[00:08:40] Speaker A: Yep.
[00:08:41] Speaker B: Or so I think if you're the gym a regular.
[00:08:43] Speaker A: Yeah. So I think if you're an athlete, you know, training for something that's upcoming really demanding and you're looking for a really rapid boost. The most effective way to saturate your skeletal muscle is this loading phase and that's 20 grams a day for about five to seven days. That has been shown clearly to saturate your muscle. Once you've done that, you can reduce the daily dose all the way down to about 2 to 3 grams a day.
Now the issue with that is it can cause with acute weight gain and water retention, which a lot of people don't like. It can also cause a little bit of GI tract irritation because you're taking in so much creatine. Creatine is osmotic. It likes to take water with it so as it moves throughout the body. That's why a lot of people might get about a 1-3 kg increase in water retention with the loading phase. You do not need the loading phase for it to be effective. For those listening to this and say, okay, I'm a little tempted to try creatine supplementation. I think if you're just taking it from a muscle perspective, start as little as 3 grams a day. That'll take about a month to saturate your body. You'll get accustomed to it, you'll know if it's for you. You should not have any adverse effects. No weight gain there as well. That's about a serving in one salmon steak. So it should be very, very fine. You can slightly progress up there after 3 grams for the first month. Move it maybe up to five, which is the traditional daily dose. We think that's a very viable amount for skeletal muscle.
The issue comes in, what about all those other systems of the body?
So from my bone perspective, the lowest dose that have shown to be any bone benefits. They're minimal benefits, but they are benefits is about 8 grams in combination with weight training and then from the neck up. We're still in its infancy. We still don't know the optimal recommendation. The vast majority of the studies look at 20 grams a day for about seven days. Now that is the loading phase. Or you can take a lower dose, but you need to take it for months, likely because that blood brain barrier thing we talked about. So when I've done the math, it averages out about 10 grams a day. From a muscle, bone and brain health perspective, is 10 the best? We have no idea. That's personally what I take.
And I think a little bit more is fine. We're not seeing any safety or adverse effects there as well. But for those listening, just wanting to try it, I think start as little as 3 grams a day, see how you do. You can take it in the morning with food, whichever you like.
[00:11:02] Speaker B: Back in the 90s, the Harris Protocol I remember we used that started with a loading dose of about 20 milligrams a day, I think for about seven days and then, then drop down.
[00:11:13] Speaker A: Yeah, it's supposed 20 grams, not 20 milligrams, 20 grams a day. And in his paper, actually after two days, you, you were excreting the majority of the third day onward down the toilet. So the recommendation is maybe you only need the loading phase for two or three days and then you can substantially reduce it. So the cool thing with that series of study with Harris and Holtman, they looked at the loading phase, which was fantastic. They also looked at that 3 grams a day and it took 30 days to saturate skeletal muscle. And then you could reduce it down to 3 grams or even a little bit. Sorry. Down to 2 grams and maintain that as well. So you don't need a lot. This is not talking about protein where it's hundreds of grams. It's a small amount.
[00:11:50] Speaker B: Let's talk about bone health.
[00:11:52] Speaker A: Yes.
[00:11:53] Speaker B: What are some of the new research that you found on Boat health or other researchers. And you mentioned you had to use, you have to use 8 grams instead of 5 grams for bone health. But still, you know, as people, we're worried about as people get older, becoming sarcophenic or, you know, become catabolic and so talk a little bit about that.
[00:12:15] Speaker A: Yeah. My colleague Dr. Phil Chilibeck and I, we've published quite a few in that area. And great colleagues in Brazil, Doctors Bruno Gualiano and Hamilton Rochelle have looked at creatine and bone in that part of the world as well. And it's really come to the forefront. So the effects are very, very small.
But there's a couple key things here.
So the Brazilian group has looked at 1 in 3 grams of creatine a day without exercise for all the way up to two years and found absolutely no benefits.
So the key here is that exercise is likely the driving force.
One or three grams is not going to do it.
Secondly, we've shown in combination with weight training, primarily one year, all the way up to two years seems to have a more favorable effect on bone mineral density and bone preservation. It was primarily in postmenopausal females because that population is really important with the cessation of estrogen. But about 8 to 12 grams a day for all the way up to two years did a few things. It maintained bone strength. It actually had a few bone preservation effects there as well.
And then if you reduce the dose down to one year, we actually saw an increase in tibial and lower bone, our lower leg bone area and geometry. So at the end of the day, the effects are small, but they are there. So what we recommend is take creatine. If you are susceptible to aging, which we all are, and have any bone related issues, it might cause a small beneficial effect.
The key one is that the females who took creatine for a year reduce bone mineral density loss in the hip. So I think that's a really important factor because if you fall and suffer hip fracture, it usually leads to replacement. We did not see an increase in bone mineral density. So I think this is important. We're not saying that creatine increases bone mineral density. At best it seems to have these anti catabolic, it's like a bisphosphonate. It seems to preserve the bone that you have, which might lead to a little bit more safety or preservation effects over time.
[00:14:19] Speaker B: But doesn't creatine increase osteoblasts?
[00:14:22] Speaker A: Yes.
[00:14:23] Speaker B: Which create bone cells, which bisphosphonates?
[00:14:27] Speaker A: Yeah. In vitro work has showed that osteoblast activity is increased and the best lines of evidence show that it decreases markers of osteoclast activity or bone breakdown. So if it decreases breakdown or decreases breakdown and it might increase synthesis when you do that turnover cycle, that might help preserve or potentially have favorable effects on bone geometry or streng over time. The issue with bone is it takes so long to really occur. That means you need to do these longitudinal studies maybe three or five years before you notice any meaningful or big effects.
[00:15:02] Speaker B: And with bisphosphonates, the side effects, you know, there's the jaw, there's the bone fractures.
Are those side effects going to happen with creatine?
[00:15:12] Speaker A: Yeah, we've looked at it for up to two years and an additional year of falls and we're not seeing any adverse effects there to the bone whatsoever.
[00:15:19] Speaker B: Because the biphosphonates really work on osteoclasts bone breakdown. The bone doesn't break down, but it could be thinner and thinner.
You could get some fractures.
[00:15:34] Speaker A: Yeah. One of the big issues with the bisphosphonates is that it might lead to fragility fractures later on because the bone hasn't turned over and gotten stronger. And we just have no data on long term effects of creatine on bone there as well to see the effects.
[00:15:48] Speaker B: And creatine could have an anti inflammatory effect.
[00:15:52] Speaker A: Yeah, that's a sort of a new area. It seems to reduce something called reactive oxidative species or enhance the mitochondria as we get older. And there's been a good lines of evidence of the rodent model primarily in mice and rats. And then we've looked at some evidence in humans that it reduces cytokines after long duration exercise. So marathon or triathlon, it seems to reduce these things called cytokines that are indications of inflammation. And so maybe the athlete can recover quicker to get back on the field or start training more often. So creatine has more anti catabolic and it also has anti inflammatory effects there as well. So that might explain why a lot of individuals who take creatine can recover quicker to allow them to maintain the frequency of training.
[00:16:33] Speaker B: And when you're training, sometimes in between sets, some people are waiting 2, 3, 4 minutes in between sets. Creatine seems to help with the, with the amount of time in between sets. Because of what, how it helps the mitochondria. Yeah, that a little bit.
[00:16:49] Speaker A: Yeah, exactly. So the, if you totally wipe out your creatine stores with a really, really long duration heavy leg press or chest press, it takes about five minutes on average, for those levels to come back up the baseline. And nowadays everybody's in a time constraint. They don't have five minutes to wait between each set. Creatine substantially increases the ability or rest time between sets. So it augments recovery after muscle contraction and in between. So maybe now you only need to rest maybe one, two and a half, three minutes at most to resynthesize the muscle. So that's where creatine seems to come into aid. It sets 2, 3 and 4 to speed up recovery. It seems to stimulate the mitochondria to release more creatine through the cytosol, so it can be bound with phosphate to allow this energy transduction to occur quicker.
[00:17:37] Speaker B: If you could explain what catabolic is, it has an anti catabolic effect. Why that's important where people get older and want to try to prevent sarcopenia.
Explain it if you could.
[00:17:49] Speaker A: Yeah. So the easiest way is to think of anabolic or anabolic steroids making things big. And of course we all want to have an increase in lean mass, muscle and strength. But as we get older, starting probably in the fourth decade, we go through periods of heightened catabolism or catabolic. That means we're breaking things down.
So think of long term bed rest. You've broken your arm, put a cast on it. When you take the cast off, the muscle and bone was catabolic. So again, it's getting smaller. That's a bad thing from a human physiology perspective. So creatine does have anti catabolic effects we've shown now in young individuals volunteering to put a plaster cast on during rehabilitation. So the good thing here is that if creatine has anticata catabolic effects and you combine that with the anabolic effects, it could be a synergistic property that will allow the body to not only stay the way it is, but heighten or improve it over time.
[00:18:41] Speaker B: Now, if you're sprinting, I assume that it's very helpful. How about a marathon runner?
[00:18:47] Speaker A: Yeah. So the, the evidence for the anti catabolic effects, the best lines of evidence come from marathon and triathlon. And, and this small group did 20 grams of creatine for five days before the race, but when they finished, and I believe the shortest duration was 40km when they finished the race, these cytokines or markers of inflammation were attenuated compared to those on placebo. So what that really says is yes, inflammation is beneficial acutely, but that reduction might allow the body to come back to homeostasis, allowing that athlete to maybe recover quicker and get back to training more, more quickly.
[00:19:25] Speaker B: We talked about the anti inflammatory effect a few minutes ago. What do you think about combining with curcumin?
[00:19:31] Speaker A: It's a potential there as well. The thought is also with collagen or what about NSAIDs, even you know, Advil or Tylenol, especially with aging because there's been beneficial effects there. Todd Trappy's group has shown that numerous times. Anything that has heightened anti inflammatory effects could be beneficial. I look at the Omega 3s, could those combination there have a really beneficial effect? And there's so many studies we'd love to do and hopeful in the Future, the next 20 or 30 years we'll be focused on the health aspects of it. Yeah, if you can.
[00:20:01] Speaker B: You mentioned collagen. The difference collagen and creatine, other than they both start with C. Yeah, yeah.
[00:20:08] Speaker A: So the thought there is, you know there's a big raging in collagen and I think it's well established now that collagen doesn't even come close to a complete protein source regarding protein synthesis. But a lot of people will take collagen for skin health or pain or anti inflammation or anything around cartilage. So ACL issues ligament and tendon and so the thought there's collagen can cause some beneficial effects in certain aspects. But I was more thinking of creating a collagen from a bone or connective tissue perspective in those with osteoarthritis or osteoporosis.
Hopefully someone's going to be thinking of doing the study. But it'd be interesting to see could the addition of collagen and or creatine each other be more effective than the other and that would be an interesting supplement or an area to go forward.
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[00:21:11] Speaker B: Embrace the science since there's not enough studies but just thinking about it from a practical point of view. What do you think about adding collagen into the shake with the cream?
[00:21:23] Speaker A: No detrimental effects there. If anything you'll get some small, very small beneficial effects. I usually will put a bit of collagen in my Greek yogurt with whey protein and creatine there as well. Although it's a combination of three different amino acids over time it kind of gives you some of the skin or anti aging effects. That seems to be the greatest promise.
[00:21:43] Speaker B: Yeah, you know this may be out of your area but if you know anything about like Adding carotenoids with creatine, plant pigments for the nutrition part of it.
[00:21:54] Speaker A: Yeah, I don't know much about that specifically, but obviously from an organ health perspective that would be an interesting way to go as well there. But yeah, I can't really make a lot of comments on that. We haven't done anything there yet.
[00:22:06] Speaker B: So let's talk about cognition we mentioned before.
So with cognition you mentioned 20 milligrams. We could support memory, sleep, stress, even talk about that. This is a fascinating area where creatine can help us and it makes sense. Creatines in the brain, I mean we need it.
[00:22:26] Speaker A: Yeah, it's interesting. So it seems that the more metabolically stressed the brain is, that's where creatine supplementation may help come to the rescue. And it comes from two specific areas. So sleep deprivation. Individuals who have volunteered to be sleep deprived for about 21 to all the way up to 36 hours when you take a variety of doses of creatine and they're quite higher. It seemed to offset the effects of sleep deprivation primarily by improving memory and cognition.
Excuse me. The next day, the biggest dose was just done in Europe. One dose, 0.35 grams. So a very, very high dose there.
All that simply says is that a large dose can get into the brain. I don't know if that dose is very viable on a daily basis. So we don't know the mechanisms to thought also comes from animal models. It could decrease inflammation, improve mitochondrial efficiency or brain bioenergetics. So that might allow the brain either to recover more, decrease hydrogen ion accumulation just like in skeletal muscle. So it could cause that organ to function at a higher amount. There's been good evidence coming out of Utah, it's great psychiatry group there showing that in combination with medication that creatine added to antidepressant or anti anxiety medications, cognitive behavior therapy as well, it seemed to have some improvements in self efficacy. And the only study in children during concussion was in children in Scotland. And those children unfortunately suffered head trauma taking 0.4 grams per kilogram. So about 20 grams for up to six months really improved symptoms of recovery or concussion. Recovery, sleep, self efficacy, sleep improvements, headaches went down. So there's something there that when the brain is traumatized or stressed, creatine seems to have some potential there to improve.
The other cool thing is there's only been a few studies that measure brain content after supplementation. You usually need basically an MRI for the brain. And it's been shown that creatine can accumulate into the Brain, it takes a little bit longer. So I would say the next 20 or 30 years will be the predominance of research focusing on the neck up.
[00:24:35] Speaker B: And the German study that you referred to, did it help improve memory and cognition?
[00:24:41] Speaker A: It did after 21 hours of sleep deprivation and that has been shown in a few studies now. So it's probably dose dependent and the longer they'll sleep deprived. But if it does hold water, what about, you know, people jet lag, working overnight, ER doctors up for, you know, extensive periods anytime someone's stressed. I always think of university students cramming the night before for a big exam.
Maybe creatine could allow the brain to be a bit healthier or function better the next day. And, and I'll be really interested in the practical applications just because it enhances memory and cognition. Sleep deprivation, does that translate into improvements in, in activities of daily living or functionality? That's somewhere. That's the area we should be going next. Yeah.
[00:25:21] Speaker B: And, but this is high doses, 20 grams divided doses.
[00:25:27] Speaker A: Yeah. They're usually dosed over five gram intervals. But there's been a few studies. One study showed that 4 grams for up to 6 months and people belong I did accumulate in the brain. So I think if someone's taking, you know, 4 to 5 grams a day, it'll eventually saturate your muscle and then hopefully it will accumulate into the brain. The question comes what happens if you only take 5 grams a day? You're not active, but your brain is really active. Does that go to the brain before muscle? We don't know that. So we still have a long way to go. Yeah.
[00:25:58] Speaker B: And did it help people with long.
[00:26:00] Speaker A: Covid it did it really reduced a lot of the symptoms. Brain fogginess again. Serge Osteoc in Norway has shown this.
It also decreased their incidence of headaches in those individuals. So it was an interesting population to look at with symptoms of long covet.
[00:26:15] Speaker B: Now and how about theoretically in something like muscular dystrophy?
[00:26:21] Speaker A: So the two that that actually population has been shown to have some really good beneficial effects. Mark Tarnopolski in Ontario has shown in young boys with Duchenne and Becker's muscular dystrophy that creatine improved bone mineral density and measures of muscle performance. So that could be something to consider if you know of a young boy with Becker's or Duchenne muscular dystrophy.
[00:26:45] Speaker B: And how about theoretically to me it would seem that would help musculoskeletal problems like tunnel tendinitis, rotator cuff problems, maybe even Herniated disc on that.
[00:27:00] Speaker A: Nothing on any of those. Surprisingly, the the closest comes to a few studies on osteoarthritis and is very mixed. One study showed a benefit, another didn't.
Nothing on osteopenia or osteoporosis specifically.
And again, so when it comes to the neurological diseases, Parkinson's, Huntington's, multiple sclerosis, not showing great promise yet, certainly not causing any detrimental effects. But we have a long way to go. I think the issue when it comes to the disease is that you need such a large sample size to cause a significant treatment effect that are very difficult to do. Yeah.
[00:27:35] Speaker B: You know, a lot of older people, especially people that are in memory care or living or long term care, they really have trouble sleeping.
[00:27:46] Speaker A: Yes.
[00:27:47] Speaker B: Kind of dosage would you have them try?
You know, speak to your doctor, but it was your parent and you had an 85, 90 year old parent.
A lot of these people can't sleep. What dose would you have them try?
[00:28:01] Speaker A: Yeah, since we don't really know why it's influencing sleep, I think the easiest would be to take it in the morning because a lot of times people will drink a little bit more water with creatine, which is usually recommended. It's not essential, but recommended. And that might cause a person to get up more frequently throughout the night because they need to urinate.
So that could disrupt sleep. And I often hear that a lot of people, they'll say they took creatine late in the night, they were up all night, almost insomnia. So I think take it early in the morning, see how you do. And then does it cause any benefits to sleep? If you notice it's not really affecting it adversely, then start to take it a little bit later on in the evening, maybe with supper time. So more almost like a case study, trial and error there. I like to take it in the evening, especially on the days I'm really mentally tired. I will usually put it in a little bit of Greek yogurt a little bit later on or some snack late at night if I'm watching TV before bed, I haven't noticed any detrimental effects of anything. I feel more cognitively awake the next day.
[00:28:56] Speaker B: And how many milligrams would. I mean, milligrams, how many grams would you recommend?
[00:29:00] Speaker A: I keep saying, yeah, so usually in the Evening it's about a 5 grams. Yeah. I'll either have the gummies or a package.
[00:29:05] Speaker B: And in the morning for the elderly, 5 grams also if it was a pair.
[00:29:09] Speaker A: Yeah, I think, I think, you know, I think Older adults do need more than a younger individual based on a meta analysis we published. But I think if they're just thinking of starting it, start with 3 grams, see how you do, and then work your way up that way. Yeah.
[00:29:22] Speaker B: And how about kids like my son who's 15, or these very competitive athletes, whether it's baseball, lacrosse, football, what, what age can they start taking it? And how much would you start and how much would you go up to in grams?
[00:29:37] Speaker A: Right, yeah. The, the best lines of evidence come from review articles of my good colleagues Chad Gersik and Adrian Yagam in the United States. And they've shown that with the current body of evidence, there is no age, maximum or minimum, since they're producing it as well. And they recommend, you know, either 0.1 grams per kilogram because they're a lot smaller, or I would use three grams. You can spread that out as well. Maybe 1.5 with breakfast, 1.5 later.
There's, there's currently no detrimental effects with creatine. So I know we put out a big paper last year, I know some states were trying to ban creatine, but when you look at the evidence based research, we're currently not seeing any reason why a child can't consume creatine, likely because they're already producing it.
Based on the totality of evidence, it seems to have a lot of beneficial effects based on the current body of research.
[00:30:27] Speaker B: You know, kids that take lutein, zeaxanthin, Meso Zeaxanthin is a product called Maca Health that has all of them in that and we've seen their baseball improve less speaking out. They, you know, it helps visual processing. I'd love to see a study done with like baseball players before and after creatine if that may help their, their hitting or the power of their hitting of what they would be able to hit harder and hit the ball faster.
[00:30:56] Speaker A: Yeah, it's, it is something that is interesting from all, not only, you know, professional athletes, but to amateur athletes as well growing up and put this compound in combination with their whole battery of treatments. You know, Roy McElroy has clearly come out and said he takes 20 grams of creed. Did that allow him to finally make that putt at the masters when he was so stressed. We'll have no idea. I'm sure if it did have any role. It played a very, very minor role. But at the end of the day it seems to be more important than Caitlin Clark came out. She's at a creatine now to her offseason program. So it's something that has been around since 1832. Lyford Christie won the gold medal in 92 and he was asked what he was taking and one of the things was creatine. He might have been taking other things, we don't know.
And it's really exploded to not just exercise, but more a lot of these health benefits. And that's why I think it's exploded from a worldwide perspective. The thought is 35 million people take creatine currently the goal would be about 350 million based on evidence based research in 10 years. So it'll be very interesting to see if I come back in 10 years and talk about it where we're at. It'll be interesting. Yeah.
[00:32:03] Speaker B: It's funny. Rory and my son have the same barber.
[00:32:06] Speaker A: Okay, there you go. Yeah.
[00:32:08] Speaker B: Area of Florida.
[00:32:09] Speaker A: Yeah.
[00:32:10] Speaker B: How about fertility? Has there been anything on fertility, males or females?
[00:32:15] Speaker A: Yeah, it's. This is out of my wheelhouse. But again, Serge Ostiac is shown that it improved. And we put this out in part two of our misconception paper. The thought is where the flagellum will use creatine, almost like energy for the motor. Could the sperm get benefits, not impairments? The thought was originally that creatine might downregulate sperm motility and regulation and surge has shown now many times that it actually improves vitality of the sperm. So that might have an application for male fertility issues. Again, obviously anybody with these issues, male or females, please talk to their medical practitioner. But the current body of evidence is not seeing any impairments yet.
[00:32:55] Speaker B: Anything with cancer, any anti cancer, decreased risk of cancer.
[00:32:59] Speaker A: Yeah, yeah. This is probably one of the biggest areas next to the brain.
So in part two of this paper, again, Mark Tarnopolski from McMaster's an MD, PhD, one of the world's biggest and best creatine researchers. He was touted with this section and when he looked at the totality of evidence, creatine seemed to have some anti cancer properties of recommended dosages. There's been a few studies in Rhodes a super physiological dosages that cause some escalation properties of cancer. But we're not seeing anything in humans. And if anything from those who have had cancer, you'll notice you're usually catabolic, you're losing substantial strength, bone mass and muscle. So from a rehabilitation perspective, creatine in combination with exercise could be beneficial. And I'm happy to say that Karen Fairman in University of South Carolina collaborating with him, we're looking at a few studies in breast cancer as well as prostate cancer survivors. So we're now seeing anti cancer properties from creatine, likely because of the anti catabolic or anti inflammatory properties.
[00:34:00] Speaker B: And let's turn our attention to vascular health.
[00:34:02] Speaker A: Yes.
[00:34:04] Speaker B: Tell us what's new in vascular health.
Homocysteine.
[00:34:07] Speaker A: Yeah.
[00:34:08] Speaker B: Does it affect methylation, endothelial dysfunction, triglycerides.
[00:34:13] Speaker A: Yeah.
[00:34:15] Speaker B: The cholesterol, et cetera?
[00:34:17] Speaker A: Yeah. There's been a handful of studies looking at the cardiovascular system in general, but it was interesting. Two studies this year by Mike Ormsby and Eric Rawson was a co author on another one. They looked at endothelial function in older adults. And creatine did seem to improve dilation or blood flow mediation. In a few of those studies there not a lot or big effect, but it was a potential. We actually showed in a group of stroke survivors that creatine improved gait speed. We did not look at any mechanisms, but the people who had stroke unfortunately did have impairments in gait or walking velocity. And creatine helped there as well.
And then when it gets to home assisting, you would think if you go back to the way creatine is made through arginine, glycine and methionine, by taking the methyl group from methionine, that would eventually decrease homocysteine accumulation. Homocysteine is a big precursor for cardiovascular disease and susceptibility of stroke. And ironically, the research is mixed.
Half the studies show that homocysteine is unaffected, others show that homocysteine decreases. And there's been a few showing that homocysteine increase. So the evidence is very mixed and we can't really conclude there as well.
[00:35:26] Speaker B: Interesting. And ileal dysfunction, that's, you know, we can see that in the eye.
[00:35:31] Speaker A: Yeah.
[00:35:33] Speaker B: Dysfunction studies on that.
[00:35:35] Speaker A: The only study, not endothelial function, but gyroid atrophy was the longest term study ever done and they looked at it for up to five years at a high dose there. And improved type 2 fiber in those people with gyroid atrophy. So that had some application there. But I don't believe in that study they looked at any end of field blood flow or flow mediation. No.
[00:35:53] Speaker B: And how about decreasing body fat? I've seen about 1%.
[00:35:57] Speaker A: Yeah. One of the biggest misses that creatine increases fat mass and we actually see the opposite. So for adults 18 and above, in combination with weight training, you see a very, very small decrease in body fat, about 0.5 kg or about a 1% reduction in body fat percentage. So at the end of the day. For those consuming creatine, it's not going to increase body fat. It'll decrease it. If lean body mass goes up, maybe the number on the scale is not really affected. So I think those are really cautious areas because a lot of people are very hesitant to take creatine because they think the weight gain is body fat. We actually see the opposite decrease.
[00:36:35] Speaker B: Has anyone ever tried using creatine IV or sub Q injections?
[00:36:42] Speaker A: One study has looked at intravenous creatine just to see the effect in transport throughout the body. But no other research study has looked at that from a practical standpoint. Yeah.
[00:36:52] Speaker B: And you mentioned Creapure as a brand from Germany. What other brands do you like besides Korea Pure? I know you could buy Korea Pure online.
I'm not sure if they sell it at any stores or. But you can buy it online. Is there any other. Is there any other. There are the other brands that you like.
[00:37:11] Speaker A: Yeah. So I think the basis is just focus on creatine monohydrate. So Creapure is just a form of creatine monohydrate, but it is really scrutinized, safe and it's found in a lot of products.
I know there's a big hesitancy on any of the products coming from Asia just based on the lack of third party testing. So I can't comment on the purity, but I do know for sure that grass status has been linked to creatine monohydrate with Creapure. So I think if the individual is especially for their children or someone like that, look for a product that has Creapure also that is third party tested and therefore you can be very confident that the product is very pure and safe.
[00:37:48] Speaker B: And how about other supplements that increase ATP besides creatine? Are you a fan of D Ribose Coenzyme Q10? I know you mentioned magnesium.
[00:37:58] Speaker A: Yeah.
[00:37:58] Speaker B: What else do you like? Nad.
Carnitine.
[00:38:03] Speaker A: Of those, I think the big one, I. I definitely have my eye on nad. So I know the vast majority has been in the animal model and a paper just came out two weeks ago showing that just because NAD is, is reduced in older adults, it didn't compromise muscle function. But when you look at NAD through the derivative of niacin, if it is reduced with aging, you would really look at the electron transport chain and even glycolysis. So that's the one I'm having my eye on. I'd love to see a lot more randomized control trials in humans. Magnesium is getting a big push. Not Only for sleep and recovery, but of course linked to ATP when it's being produced as a cofactor. So magnesium and NAD are the ones I'm keeping my eye on for sure.
[00:38:43] Speaker B: But magnesium, what, what kind of magnesium? You know, I usually tell people, stay away from oxide.
[00:38:48] Speaker A: Yeah.
[00:38:49] Speaker B: You know, but what kind of magnesium do you.
[00:38:53] Speaker A: My understanding is the glycinate is the one that seems to have. From a recovery and a sleep aid. But I know others take.
I think it's called magnesium threonate or something very similar to pronouncing that but under if you're not getting it from food sources and rely on supplementation. I do know pillar performance in Australia has a combination of a magnesium product that has all three. So it's something that we'll look at which one is better for which. I know there's about six different variations, I believe. Yeah.
[00:39:21] Speaker B: You know, and I was excited to see that there's some research in an eye for glaucoma.
[00:39:26] Speaker A: Yeah.
[00:39:27] Speaker B: That it might protect the retinal ganglion cells and maybe at some point helpful in glaucoma. You know, I, I know more studies have to be done.
[00:39:35] Speaker A: Yeah.
[00:39:35] Speaker B: And comment on that.
[00:39:37] Speaker A: Yeah. And. And I love this because when they're like, oh, let's do a supplement, I was like, wait a minute. Magnesium was found in legumes and nuts and spinach and those are the big staples of the Mediterranean diet. And you know, if you look at dietary food first, which we should be focusing on, a lot of these things we've talked about are naturally found in food and you get great bioavailability and phytochemicals and, and things like that. But it's interesting. We'll go to a supplement. But when you're like, wow, I'm getting a lot of that through your diet, or maybe I'm not, and that's why supplements are, are so convenient. But it is interesting when you look at a food first approach. Yeah.
[00:40:08] Speaker B: Is there anything that I didn't mention that you'd like to talk about with creatine or anything else?
[00:40:14] Speaker A: Yeah, I think, you know, the interesting thing is creatine was just thought of for young males. That's where the majority of research is there. But from a female health perspective, the totality of accumulating research is quite phenomenal. I can't really speak too much to pregnancy, but Stacey Ellery in Australia has shown now that for the mother and during fetal development, creatine is improving brain or bioenergetics there, but females should expect an increase in Lean body mass, muscle performance. We've talked about bone density there as well. So I know there's a huge push for female health and creatine might be one of the components in your whole program to consider.
[00:40:51] Speaker B: And is she recommending it for pregnancy?
[00:40:53] Speaker A: She's recommending it based on the totality of available evidence. We're not seeing any big safety effects. She started a clinical trial in females now, which is great to see.
So based on the the body of evidence, we're not seeing any detrimental effects yet. But obviously for anybody listening that is thinking of becoming pregnant is please talk to your medical practitioner to make sure creatine is right for you.
[00:41:16] Speaker B: Yes, absolutely. You got to talk to your doctor. You know, some great information for people to think about.
[00:41:22] Speaker A: Yep, exactly.
[00:41:23] Speaker B: To your doctor.
[00:41:24] Speaker A: Right.
[00:41:24] Speaker B: Dr. Kandel, I want to thank you for joining me today. You're amazing. Such a wealth of knowledge. It's great to be able to talk to somebody into the same things that I'm into into the exercise. I can see how what kind of great shape you're in. And I really appreciate you joining me.
[00:41:39] Speaker A: Thank you so much for having me. I had a pleasure. Thank you.
[00:41:41] Speaker B: And if people want to find out more about you, how could they do it and you work?
[00:41:44] Speaker A: I think Instagram is the easiest. At Dr. Darren Candle is probably the best way to disseminate all the things coming out. So at Dr. Darren Kando on Instagram. Yeah. Thank you.
[00:41:53] Speaker B: Well, thank you. I really appreciate it.
[00:41:54] Speaker A: Thank you for joining. Yeah. Thank you so much.
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