actually let's talk a little bit more about creatine um we talked about it really briefly on one of our podcasts but we we were kind of at the end so I want to kind of go back and make sure people understand that it's one of the supplements we get the most questions about it's also one of the supplements that we feel the most confident telling patients like if yeah this is a supplement worth taking it's clearly past test number one which is it safe uh and it passes test number two which is it's probably got efficacy um Washington it's God efficacy the real question is you know are you okay with a little bit of weight gain because that's you know you're going to pull more water in so um explain to people a little bit about why creatine is so important and presumably this is something that's really important in powerlifting I'm guessing going into a bodybuilding meet you probably don't want creatine for that extra weight or do you so I think it's actually great for bodybuilding okay great I want to hear about it because I assumed it would you'd have a little more water but maybe the water's all in the muscle and that's where you want it yeah so uh so creatine is a high energy phosphate donor so it in in muscle it exists is phosphocretinine and when you take supplemental creatine uh you'll it'll come into the muscle it'll get a phosphate attached to it phospher creatine and originally the the only mechanism we thought of well it's a high energy phosphate donor so people perform better but then we saw people increase their lean body mass increase their strength uh and there's even like benefits in terms of cognitive benefits appear to be pretty clear that there's some cognitive benefits as well so as you mentioned like in terms of safety and efficacy data I mean to me there's no strikes really I tell people I'm like I don't even know why we're having this conversation anymore and it's also you know it's gone up in price a little bit recently because of the supply chain stuff but it's still relatively inexpensive incredibly inexpensive for for what you're getting so you know when I see people talk about like some of these other supplements and they're not even taking creatine monohydrate and I'm like well you're you're stepping over pennies or sorry you're stepping over dollars to pick up pennies because this is just the lowest hanging fruit but are you still even at your size and even at your demand is there any benefit to taking more than about five grams a day some people have postulated there might be I haven't seen really clear evidence for it yet You could argue that there's really no downside to taking the extra that the downside might be some GI irritation for some people creatine can be a GI irritant which I think will Circle back to um but we know it can act as a high energy phosphate donor so when you are exercising or just doing anything you your energy currency of your cells ATP and in order to drive muscular contraction your ATP donates a phosphate and that liberation of that phosphate to form ADP and a free phosphate is energetically favorable and helps Drive these muscular contractions um so creatine can act or phosphocreatine can act as a high energy phosphate donor to reform uh ATP and allow you to perform better but it's also a really powerful osmolite and so it pulls water into muscle tissue which in and of itself may actually be anabolic so uh like just a muscle cell being more hydrated there's some evidence that that can actually improve the that it's more anabolic environment but regardless of the mechanism we do know that when you take creatine you see improvements in lean mass and some people will say well that's just water well but that's what muscle mostly is muscle is 70 water so whether it's and there's actually research to show that even non-contractile just water improves May improve strength and contractability so so we're not sure exactly how but it could just be like the volumization of the cell is just a benefit but it's also sort of a you could also kind of make up at least conceptually a framework that says a more hydrated cell is more able to calculate more able to carry out its function right so it's a function of a myofibril is contractile release contract release and it has more water you it sort of seems logical to me that it's going to be better at clearing metabolic waste and recruiting fuel which should at least be two things that would factor into its its ability to do that yeah I mean the other thing about it is um if you look at like anything that improves hypertrophy a big portion of it is water it's it's not just all myofibrillar so I think regardless of the mechanisms I mean it's pretty clear that this stuff works it's pretty clear it's safe I mean they've done numerous randomized control trials some of them being well over a year long yes you get an increase in creatinine which can be a marker of renal function I think although the data you know on this Lane there was a paper that just came out a couple weeks ago that we were really happy to see we've abandoned looking at uh looking at serum you know creatinine for renal function because it's just too easy to get fooled by people with varying muscle mass yeah and training volume so we've completely abandoned it so every time you order Labs on somebody and you see their creatinine it'll tell you what their estimated glomerular filtration rate is we just ignore it completely we only look at cystatin C so everything we do is based off that and there was a paper in Jama a couple of weeks ago that basically said as much which is maybe we should look more at Staten C instead of Grant and so so I would even say that you know hopefully this is a a PSA for other docs out there listening and other patients to say please look at my sister and see as a way to estimate kidney function yeah I tell people you know there's some other things that can get a little bit wonky like from lifting weights like liver enzymes and whatnot um and I tell people you have to keep in mind these are markers okay so if you have liver failure or you have kidney failure it's very very likely you will have elevated liver enzymes and elevated uh creatinine but just because you have elevated liver enzymes or elevated creatinine does not mean that you necessarily have damaged those tissues so you have to disconnect those two and I don't think that you know I feel like correlation versus causation is just not something that's taught very well in school because I even see um not really good doctors but some Physicians get so hung up on just well this is on the page and this is supposed to be in normal range and it's not it's like but just look at the person sitting in front of you who obviously works out is in good shape if you're concerned about their their kidneys then do a 24-hour urine collection or an ultrasound or whatever you have to do to verify that they're safe but yeah I mean I I just I don't worry about that kind of stuff there's also been some people um who have said well creatine can cause hair loss and you've got to be careful about that um I'm not I don't think the date on that's very compelling at all so there was a single study that showed an increase in DHT from uh supplementing with creatine one study 2009 I've never seen it replicated never seen any follow-up how much did DHT increase by I'd have to go back and look I can't remember the exact amount it was significant um but the interesting thing is we know creatine doesn't affect Androgen levels so it's kind of like where is this increase in DHT coming from right like it has to come from somewhere and we like I said there's no randomized control trials showing that creation actually causes changes to hair follicles or um actual hair loss so maybe it does but I I would think that if that data existed we probably would have seen it already do we think that there are significant benefits from from supplementation even on non-lifting days so for example on hard cardio days assuming we're not talking about Sprints so clearly there would be a benefit in sprinting because the creatine phosphate system is really lending to that ATP generation during that incredibly high intensity stuff but like if you're out there doing a VO2 max day which is that's a really hard day those are kind of three to eight minute all out intervals um which is aerobic it's Peak aerobic do you still get a benefit do you think from creatine I would guess yes um there was a recent meta-analysis that came out and looked at like different ways of taking creatine and it was useful data but it it in some ways it was kind of uh frustrating because they basically showed we take five grams a day you get increases in lean mass and strength and performance you take more than five grams a day you also get increases in lean mass and performance but it's hard to kind of compare them directly based on the way they did the meta-analysis and then they also looked at okay if we just take them on lifting days okay you get benefits if you take them on non-lifting days you also get benefits what I would say is that you probably can get away with just taking it on lifting days um but keep in mind that the benefits of creatine are an accumulation so you've really got to saturate the muscle cell that's that's that's the key because when we were kids you would load it right you would do like I feel like you did 30 grams a day for a week or something crazy yeah and then five grams thereafter and I of course this was reading bro science magazines you would then do that for a couple months and then you would come off it for a month and then you would repeat the cycle am I making that up or is that about no that was definitely a thing um so the eye I will say that the research does show if you load it you will saturate the muscle cell faster now I always try to tell people like there's no Solutions there's only trade-offs right so the trade-off with this is a lot of people will get pretty bad GI irritation with loading creatine in terms of like GI bloating nausea those sorts of things so um if you just take you're playing a long game it doesn't really matter right I mean you're talking about getting the results you want in one week as opposed to three weeks it's really not a big difference so if you just want to take five grams a day within a few weeks she'll be saturated and you'll be getting the same benefits so it's really I guess if you were somebody who'd never taken it before and you've got like a big athletic event coming up and you really want to be on it for it that could make sense but for most people I would say just take five grams a day and when people kind of say well you know what if I just take into lifting days yeah you probably could but it's also like it's pretty darn cheap yeah um so I actually think it's just easier to not forget it's easier to forget something when you only do it on certain days right sometimes it's just easier to make it a part of the routine yeah and what I would say too is people ask you about timing of creatine those sorts of things there's some really small really tenuous I really want to emphasize that evidence that perhaps after a workout might be better than before workout but I tell people just take it whenever you'll take it regularly so for me I just get up in the morning and I take it and and that's what I worry about now as far as like the cycling on and off so there's evidence that you do reduce your endogenous production of crits and when you're on it there's also evidence that the creatine receptor on the muscle cell does down regulate a little bit now the important thing to keep in mind is that doesn't mean that your intracellular levels of creatine are falling so they've actually never shown that even like far out that those phosphocreatine levels in your muscle drop so what I would say is I don't really think there's a reason to come off because they have shown that if you do come off within a month or so kind of everything goes back to normal but you lose the benefit of the supplemental creatine so I would say as long as intramuscular levels are creatine are not falling there's really no benefit to coming off I mean it used to be like I think people kind of just equated supplements with steroids and so like well you're supposed to cycle steroids so we should cycle supplements and you know creatine is not hormonal it's not the same biofeedback Loop so I would say there's probably no reason to cycle it [Music]