Hey folks, Dr. Mike here for RP Strength and today we're going to talk about a new study that came out that shows that creatine is not effective when combined with weight training to actually get you more jacked and that all of the quote unquote muscle or lean body mass that you gain from creatine seems to come only from the water that creatine brings in with it into the cell. Uh-oh. Is creatine in trouble? Well, let's find out. Let's talk about the study, break it down, figure out the methods, the results, talk about what the conclusions are, and then compare it to the other studies that have been done about the subject to see where the truth really lies. So, new study came out about creatine. People, males and females, trained for 12 weeks, took 5 g of creatine daily. This was a great study. Measured muscle size pre and post. I'll link the study in the description and a bunch of references as well too if you want to read up to some of the other studies we'll be talking about today. And this is a really good study. So we're not dogging on the studies is seriously good work by the researchers mostly from um University of New South Wales in Sydney, Australia. OM word to say that starts with a C and ends with a n that they say in Australia YouTube will kabash us for that one. great study design, very robust internal validity and has important insights. So let's take a look at the uh basic design and findings before digging a little bit further. So the purpose of the study, the express purpose was to examine whether creatine monohydrate, which is the most common and the most effective form of creatine alone or combined with resistance training increases lean body mass beyond just water retention. The participants were 63 healthy adults, 34 females, 29 males with an average age of 31 years. Very applicable. I mean, this is a big study. In exercise science and sport science, 63 healthy adults is one hell of a sample size. We're going to be able to conclude a lot of really good stuff from such a massive sample size. The clarity with which we can see the world with 63 participants is very, very high. It was a randomized control trial, which is probably the most rigorous kind of study that there is. They compared five grams of creatine supplementation per day with no supplementation over 13 total weeks. That means each group got fake creatine or real creatine did a week of consuming the fake creatine 5 g per day or real creatine for 5 g per day. 12 weeks of training and got their lean body mass measured at the beginning after one week after the creatine loading phase was concluded and at the end of that 12week phase. So the measurement method to figure out how much muscle they were gaining was via DEXA which is really really really uh insightful method and also by um well no I guess yep just dexa. Yeah, at baseline after the washin period, which is a week of taking creatine or fake creatine, and after that 12 weeks of resistance training, which is 13 weeks total, the first week is just to get the creatine going. They found that the immediate effects after 7 days of of consuming creatine was that the people that consumed creatine on average gained about a pound more muscle, quote unquote, than the control group that didn't have creatine. And that mainly indicates water related changes because creatine does not grow a pound of muscle if you just start taking it. That's creatine bringing water into your cells. So far so good. Very, very expected. What we would expect next if creatine really is effective at helping you build muscle is the group that weight trained with creatine would gain more muscle between week one and week 12 versus between week zero and week 12 than the group that weight trained but didn't have any creatine. the resistance training phase occurred. Both the uh groups, the creatine and non-creatine group gained roughly 4 lbs of lean mass, which is pretty dope for 12 weeks of training. And there was no significant difference between groups. Uh-oh. That means that the group that took creatine and trained didn't gain any more muscle than the group that didn't take creatine and trained. That is curious. If creatine actually affected muscle growth, you would think it would boost training results, but in this study, it did not. Females had a little bit of a bigger lean mass increase from the creatine washin. A lot of times, females actually respond a little bit better to creatine because females typically tend to undereat u protein and undereat meat compared to males. Sometimes they have a bigger response in some studies to creatine. such a small amount that I wouldn't say this is something to run home to, but um neither sex showed significant lean mass gains over the course of the 12 weeks of training if they took creatine versus if they didn't. Not great. So, the conclusion of the study by the study authors was that creatine's initial lean mass increase is almost certainly likely due to water retention. That's not contentious. And that creatine in this study did not enhance muscle gain beyond its initial water bloating effect. So that the people who used creatine to help them lift weights didn't get any more jacked taking in 5 g of creatine per day, which is the standard dose is the dose I take, than the folks that didn't. And the author's implication here was that maybe a higher creatine maintenance dose that during the 12 weeks, more than 5 grams a day might be necessary for creatine to show additional true hypertrophy. But this is kind of an interesting conclusion to me. Most studies show that five grams is more than good enough. Many studies show that two to three grams of creatine can detectably enhance muscle hypertrophy. So what the hell is going on here, right? Um so we have to be open-minded and think, okay, maybe the muscle quote unquote that people gain on creatine when they think they're gaining is really just body water. And some of it definitely is. But this study just by itself concludes that all of it is. And for this study, that's definitely true. That's what seemed to have been happening. But before we conclude this video and say, hey, listen, creatine has been refuted. I'm sure you've seen a bunch of memes and infographics by now that no creatine doesn't work. Science works never, ever, ever one study at a time. Science builds its understanding of the world by taking lots and lots of studies and putting them together, zooming out and seeing, you know, what is the overall message we're getting from these studies. Let me give you an example in the real world with almost no science whatsoever. Let's say you have a friend that you think is super funny and super cool and you have another friend that you think is super awkward and kind of weird. You love him, but it's not for public consumption. Maybe you are biased. You're just vibing weird. Maybe you're the weird one. And the friend that you think is cool and funny really isn't. And the friend that you think is awkward and strange really isn't. And they're roughly kind of the same effect on people that they meet. If I gave you a situation where we had both friends separately meet with a person who never saw them before and then afterwards we asked the person, hey, which one was funny/cool and which one was kind of weird? Whatever that one person says, how much faith do we put in to their answer being like the actual truth that pretty much everyone will agree with? Come on, one person. I mean, the person you pick could just be a wacky, strange, no offense, Dungeons and Dragons playing Asmouth. And then they'll be like, "I really like the weird friend. He was the cool one to me." And you're like, "Oh, that's not true. That's wrong." What if you had someone who's a real bro and real like vibes person? They like the chill cool guy and they hate the real nerd guy, but maybe that's not representative. Not everyone's a bro. So, how do you really parse that problem? That right there is one study at a time. How do you really solve that problem over time? You have 100 people, at least 10 people, for the love of God meet your two friends and tell you afterwards, hey, which one was cool and which one was weird? Look, if you meet a hundred people and most of them say you're chill and funny, you're probably chill and funny. If you meet a 100 people and most of them say you're kind of weird, you're probably kind of weird. But it's those multiple interactions that really build a big picture. One examination at a time could just be chance. It could be mismeasurement. It could be that the person you're asking, hey, how was my friend? They're actually thinking about their exam they have later that day and they're like, "Uh, yeah, that one was chill. He was funny. It was cool. Yeah, I got to go." and you're like, "Okay, I guess that's what it is." It's like, "They didn't even think it through. That's just error." So that's how science works. So if you see anyone study at a time, we can't be too sure that they really discover the truth or that it was just strange finding. Statistical error is 100% possible. Our understanding our visibility to reality is fuzzy. But if we do it over and over and over and over, then after a while we're like, "Yeah, man. That really is a thing." Another quick analogy is one of sports. You have two people who play basketball. How do you find out who's better at basketball? Do you have them play one game? Um, I mean, people get lucky. The guy can sprain his ankle. A guy can have an off day. One game doesn't tell you a lot. But if you have people play 10 games against each other, 10 games to seven points or something like that, and one guy wins eight games and loses two, he's probably the better basketball player. So, what we're going to do now is we're going to look at a huge body of evidence, kind of a total body of the evidence we've collected over literally decades about about creatine to ask two questions about creatine to see if they agree or disagree with this study. Here are two questions. Does creatine cause actual muscle gain and not just lean, not just uh body water gain? We test this. We do after wash out period. So they have people train with weights and either take creatine or not. And then they don't test their lean muscle after the study. They test it a week later when they're no longer taking creatine. So they lose all the creatine bloat. And if that group still has more muscle gain than the group that didn't take creatine, well, it must have been something the creatine did cuz that was the only different variable. And the body water isn't even around anymore. So then creatine really actually caused muscle gain. The second thing we're going to look at is whether creatine enhances that weight training induced muscle growth in a way that's independent of water retention, which is really kind of the same thing, but we need to see does the wash out period account for that? And then later, okay, now we have the wash out period, it really works. Does the creatine enhance weight training performance and muscle growth in a way that is reliable and happens with or without the creatine present? So, took a look at a bunch of studies. I've summarized or I've linked some of them for you in the description of this video if you want to take a look couple of findings that are very very apparent through these studies. First, creatine alone with no resistance training, if you take it, it primarily increases your lean mass due to intracellular water retention. And typically you get like basically two pounds of rapid lean muscle, lean body gains within about a week of taking creatine at even 5 grams a day. And that's very little if not zero actual muscle growth. It's just body water. So that's true bloat. Which also means that if you take creatine all the time and you don't lift weights, which would be strange to do, you're not going to get jacked. Now that's not the case for all supplements and drugs. If you take anabolic steroids and you don't lift weights, you actually just grow muscle. Even without weightlifting, which is triple, but with creatine, that doesn't seem to happen. But it does cause a body water increase. You take creatine for a week, your body mass goes up, lean body mass, your muscles look more swole, literally in the mirror. And you don't take creatine for the week and it goes right back down. Make sense? Now, creatine, so that's answering our first question. There is absolutely this effect. Creatine combined with resistance training, does it actually gain you muscle? Aside from body water? A lot of findings here. First, we find in multiple studies that creatine consistently enhances true muscle hypertrophy beyond water. Typically, the group that used creatine versus the one that didn't adds about 2 to four pounds of muscle more than the group that doesn't, which is really, really dope. Over the course of about 8 to 12 weeks, by the way. So, roughly 10 weeks of weight training and taking creatine, you can expect maybe about three extra pounds of muscle gain. That's the first time you try creatine. It levels off after that, but that's pretty impressive. And you see greater increases in muscle fiber cross-sectional area confirmed via muscle biopsies, confirmed by MRI and ultrasound. And some of these methods do account for body water, which is really, really dope. We've had creatine studies that have looked at fiber specific hypertrophy. We find that type one fibers and type two fibers, type two fibers a little bit more, are are experiencing muscle hypertrophy increase, which is really awesome. We can also examine regional hypertrophy. Creatine isn't just a whole body effect. Some studies assess the muscles that were trained versus just a random muscles in the body. So you you have a person who's lifting for just their arms and their arms while taking creatine grow way way more uh in this case 7.1% gain in muscle cross-sectional area versus 1.6% gain without creatine. That is very impressive. Very impressive. and not accounted for by body water. So this indicates true hypertrophy is linked directly to exercise stimulus in addition to taking creatine. And another study or group of studies finds that older adults also experience meaningful hypertrophy. And so that starts to say that not only are they experiencing meaningful hypertrophy, but there are functional improvements associated with creatine muscle gain. What does that mean? That means in most of the studies that test not just your muscle gain from creatine, which could be body water, but they test your strength as well. And in almost every study, when you gain muscle from creatine, you also get stronger. Just adding body water to a muscle bloat it up, it gives you a pump, doesn't make you stronger. only adding actual physical muscle like the the myosin and actin machinery in the sarcimeirs that makes your muscles contract to do the thing. That's the only thing that's going to make you stronger outside of neural changes. And remember the groups that don't use creatine, they get the same neural changes cuz they're doing the exercises. So the nervous system gets the same workout either way. The creatine group, not only do they get bigger, they get stronger, too. Now, that shows us that man, there's something happening here that is not accounted for by body water alone. And a couple of studies, actually multiple studies, focused on the idea of like, well, what if we're just not washing out properly? An example here is one specific study, canow at all, which should be linked in the description, I sure hope. Um they did a wash out period where they gained they so they basically did some training with creatine. Then they did a bunch of training without creatine and their gains from the creatine training phase still held in place weeks after the creatine was no longer around. And that confirms that the hypertrophy or very highly suggests that the muscle growth folks got from creatine really was actual muscle because the body water is gone but you're still more jacked kind of by definition means it can't be body water. Now a similar study that was just done which is the study we're reviewing this Hagstrom paper it showed that well actually after wash out period we don't have any sort of uh effect there. the washin period uh accounted for that. And so we basically saying here that well it was really only body water. Now it could be true except we have one study that shows creatine only results in body water gain which is this one. And there's a few more out there floating around and then literally dozens of studies just as well controlled that show that creatine enhances actual muscularity in addition to bringing in body water. one study at a time when it is an aberrant conclusion that doesn't align with most of the other studies is very interesting. But if you look at most of the studies at the same time, which is what science is all about, it's starting to show us that creatine probably actually makes you jacked. Every now and again, some studies get wacky and they find no effect. But I'll get to why they're doing that in just a little bit. So, for now, our confidence in creatine is starting to rise significantly more than when I first started this video and told you, "Hey, mate, creatine, this new study found, doesn't really do anything." Here's another interesting line of evidence that shows us creatine probably gains muscle. I mean, the best evidence is directly shown to gain muscle uh irrespective of body water gain. That's the most direct, but it's really cool to also have indirect evidence to support that position. So, we have a bunch of it. First, creatine usually enhances the performance. You get more reps per set or able to do a little bit more weight per set. And it enhances your ability to do multiple sets productively for higher reps every time. And it enhances your relative effort. It enhances, sorry, it enhances the result of your relative effort, the performance in each set, and it enhances how much volume, how many sets you can do productively before you get so weak that you can't really train anymore. that we know getting more reps per set and we know that doing more sets productively robustly predictably causes muscle gain because creatine is allowing us to do that. We're saying well there's this mechanism by which we know weight training re leads to more muscle and creatine is clearly doing it. Okay, that's pretty cool but wait there's more. In multiple studies, cell swelling, especially certain kinds of cell swelling, triggers anabolic signaling. A swollen cell becomes more likely to grow muscle, and the initial water-driven intracellular expansion of creatine seems to cause muscle protein synthesis pathways to activate. This has been confirmed in numerous studies. Cell hydration, especially if you're dehydrated cells, is a known anabolic stimulus. Is it really reliable? Is it really dependable? Does it really cause a lot of growth? No. Do nitric oxide supplements help you get a pump? Yeah, but that's actually your blood vessels expanding and not your muscles expanding. So, unfortunately, taking nitric oxide pump supplements gives you cooler pumps, but it's mostly a blood flow thing and not an intramuscular selling cell swelling thing. But if your cells swell from either resistance training, maybe even from creatine consumption and definitely from shooting exogenous insulin and growth hormone, but I get ahead of myself there. Don't do that at home. It's probably causing at least a mild mechanistic increase in muscle growth. Okay, another indirect data point that's very good. Here's where the real is hitting. Multiple studies confirmed, including randomized control trials, that creatine significantly increases muscle fiber nuclei number. That means that satellite cells donate their nuclei to the main cells. And that is one of the most powerful and predictive mechanisms of boosting hypertrophy. It's a different thing if you take creatine and dot dot dot something happens and then maybe you look bigger versus if you take creatine and instrumentation confirms that it's activating the most powerful growth pathways that the body has. That means it's probably growing some muscle. Now some things activate pathways but the pathways end up getting muted later or deactivate some and on the net balance it doesn't grow any muscle. But remember from earlier, from most of the studies, we already know creatine grows muscle. From some of those studies, we know that creatine grows muscle even if we account for the body water effect. From other studies, we know that it boosts the ability of training to drive a stimulus. That's really good. And now we're seeing that well, it activates satellite cells more and brings in more myionuclei, which is a known from 50 other different kinds of studies way to get you more jacked. Here's the last one for this part. Creatine reduces myostatin expression. Myostatin muscle stopper is a protein everyone makes in their skeletal muscles that reduces how much muscle growth you have. It's a cap on your growth. If you make less myostatin, it frees your muscles up to grow more. You guys ever see those pictures? Scott, can we insert a picture of one of those greyhounds or cows or some like that that has broken myostatin? Yes. Those animals just have a completely non-functional skeletal muscle meostatin gene, which means they grow muscle doing nothing all the time and they grow maximum muscle all the time. This is way more powerful than steroids. Creatine just by a little bit has been shown in the scientific literature to decrease the expression of myostatin, which means that protein that blocks growth, creatine lowers it. It frees up more growth. Now man, this is starting to look like we have evidence of creatine gaining muscle. We have evidence of that in the absence of body water or controlling for body water changes. We have performance enhancements we know also cause hypertrophy. Creatine does those. And we have satellite cells and myostatin activity being modulated, both of which are really linked to growth. It's kind of starting to look like something's happening. You know, it's like you see a guy in an expensive car and you're like, is he really rich? He shows you his bank account. You're like, "Okay, that's a lot of money, but is it fake?" He shows you his portfolio of companies and you're like, "Okay, these clearly make money." And then you're like, "Well, maybe it's all fake." You talk to the customers and they're like, "These are great products and I pay money for them all the time and they really work." And you're like, "Yeah, guess this guy really does make money. Holy crap." Multiple a consilience of evidence from multiple perspectives shows you, yeah, this thing is probably really happening. So, what are the conclusions from this overarching body of evidence? Creatine reliably augments, improves real muscle hypertrophy with resistance training. These effects extend beyond acute fluid shifts and they are sustained after supplementation. The muscle you build on creatine, most of it you keep afterwards. That's cool. And maybe a higher initial loading phase or more sustained high dose clearly enhances hypertrophy. But we know for many of these studies that even lower doses do this in most of the studies. Some of the studies that show creatine doesn't work. And this study we reviewed today is not one of them are too short-term just a few weeks or too low dose one to two grams. They show that creatine doesn't build muscle. But that's really like you know asking someone like hey um interact with my friend to see if he's funny. They're like okay. They sit across the table. They're like, "So, what's up?" And the friend's like, "So, anyway," and they're like, "Okay, that's it. What do you think? What is he funny?" Like, "But I didn't even hear him saying I I don't know. His face looked I don't know. Not enough. Not enough time, not enough friend." You get the idea. Overall practical takeaway from this whole body of literature is that creatine results in actual muscle gains, function to make you bigger and stronger, are really supported by mechanisms, and are irrespective of body water. though it does also help with the body water thing. It's not just transient body weight like this study found. And in fact, creatine is one of the few genuinely hypertrophic supplements robustly backed by randomized control trials. There are not a lot of other supplements that have the effect creatine does. Creatine is the number one non-drug muscle building supplement, period. Especially if you're consuming enough protein in your diet. So, what does this mean about our new study? Here's the thing. Like I said earlier, one study at a time means very little, if not nothing at all in the grand scheme. Imagine you're trying to figure out, Scott, we go through this all the time, right? When we're collabing with people and we start talking about other influencers with them and we're asking them like, "Hey, is XYZ person cool and they either say yes or no, how much stock do we put into one person's opinion?" Yeah. Very little. You got to pull some more. You got to pull some more, man. You don't know. They just didn't vibe right or something like that. One study at a time just says almost nothing. Which you guys can take into the real world. If you follow Instagram, some of these science pages, you go on the news or your aunt at Thanksgiving tells you, well, I heard a study says a study is a hint. It's a hint. The rest of it is like all the studies combined. That's how you really find out. So far, creatine is one of the most well- vetted supplements and actually builds muscle for multiple multiple studies, not just water weight. But here's the thing, creatine does not build a ton of muscle. It is not like weight training. It is not like steroids, and it's not like eating a good diet high in protein, getting lots of sleep. It's a much smaller effect than that. And it takes months to pack on enough muscle for you to really notice. So some studies because of this very low effect magnitude of creatine just by chance through statistical noise even though creatine is under the hood actually effective some studies will find that it's not effective simply because it has such a small effect. If your friend is the funniest person of all time a 5minute conversation with most people revealed to them that okay at least he's really funny. If your friend is really low-key funny, Scott, you ever have people be like, "My friend is hilarious." And then you meet them once and you're like, "H, yeah, all the time." And all the time. And then you but you hang out with him a few more times and you're like, I I get it. I get it. But you have to like know who Jim is. You know, he's subtly funny in his own way. You know what I'm talking about? Absolutely. But it's nothing you would immediately like just see. And so only with tombs can we see immediately that the person is not like the other, right? So basically, if your friend is low-key funny, a lot of people interacting once won't pick up on that and be like, "This that's not funny." But you're like, "Trust me, you get to know him. He's really funny." Well, that's multiple samples. So every now and again, a study about creatine will conclude that it doesn't do anything simply because it just doesn't do a whole lot. If creatine did a ton, almost every study would find something, but creatine doesn't do a ton. And a good way to illustrate this is that the effect of creatine is on on lean muscle gain is sometimes like comparable or even smaller than the error in measurement. For example, in this study, the you know the one pound of body water and muscle um that the folks gained in the washin period, if you read the actual study, the variance plus minus on average was uh three pounds. The noise is three times bigger than the signal. Are there ways to parse that over long enough durations? Yes. But is there a probability you'll miss the whole thing? Yeah. Hell yeah, there is. So, here's the kind of end-of-the-line recommendation I have. Yes, creatine still works. Yes, you should still be taking it. On the other hand, you should always be on the lookout for new research that will finally tune exactly how strong creatine is because it could be like over in the next several years we find that you know what creatine is actually underrated and if you take it like this or combine it with this kind of training is actually more powerful than we thought. We might find that creatine is accurately rated or we might find that actually creatine a little bit overrated. It does grow some muscle but not as much as we used to think before because there was kind of a file drawer effect of selection bias in the studies. The more studies we get, the more unbiased they are, the more that creatine sees. It does have an effect, but a very small one. Um, and one of the reasons I'm telling you guys this is creatine doesn't have these crazy transformative effects. It works. It helps, but it's not this steroid like effect. So, don't plan on when you start taking creatine to be like, "Dude, taking creatine now. Don't with me. I'm going to be huge." If you're looking for steroid effects from creatine, you're almost always going to be disappointed. Another thing is there's a variance within individuals of how they respond to creatine. Some people hardly respond at all or not at all. Some people respond a ton. Some people who have very fast twitch muscle fibers and a lot of them, you know, have undereaten meat significantly which has its own little creatine in it. They'll get huge gains. Some people like after 3 months of training gain 7 lbs of muscle from creatine addition. Very rare but possible. I knew at least one person that did that reliably. The thing is this study they could have just accidentally recruited mostly creatine low or non-responders and that's why they found the situation they did. But for almost everyone taking creatine, don't expect for the steroid like effects and at worst you'll be pleasantly surprised. Uh at best you'll be pleasantly surprised. At worst you'll be like I gained a little bit and that's cool. That's exactly what I was expecting. All right folks, that's all I have for today. Hopefully that makes sense. got some references in there for you to read up if you're a super nerd and in the description and I will see you next time. [Music] [Applause]