Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with creatine?

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What's the deal with creatine? · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:01
Speaker 1: Hi, Perry, Hi Emily, So I brought some props for
0:06
Speaker 1: our episode today.
0:07
Speaker 2: This will do great on an audio primarily podcast.
0:11
Speaker 1: If people are watching on YouTube, you will see that
0:15
Speaker 1: for our episode, I.
0:16
Speaker 3: Brought creating dummies.
0:18
Speaker 1: I have sour cherry, I have sour apple, and I
0:24
Speaker 1: have watermelon.
0:27
Speaker 2: Amazing. Are these your creating gummies?
0:29
Speaker 1: Okay, I'll tell you how I got these creating gummies.
0:31
Speaker 1: I mentioned Creatine on Instagram, and all of a sudden,
0:37
Speaker 1: many people wanted to send me creatine, and so a
0:40
Speaker 1: lot of Creatine has been arriving at my house because
0:43
Speaker 1: I'm an Instagram influencer.
0:45
Speaker 2: First in secret, Emily, can you mention an Nvidia RTX
0:52
Speaker 2: fifty ninety graphics card on Instagram?
0:55
Speaker 3: Everyone, Perry would love.
0:58
Speaker 1: To talk about your Nvidia blah blah.
1:02
Speaker 3: Graphics card on here. Thank you so much.
1:05
Speaker 2: It's important for all of our wellness. That's me. I'm
1:08
Speaker 2: excited to hear whether you are partaking in the creatine.
1:11
Speaker 2: But I suppose we should look at the data first.
1:14
Speaker 3: We're going to find out.
1:15
Speaker 2: Let's do it.
1:18
Speaker 1: I'm Emily Aster, I'm an economist and a data expert.
1:22
Speaker 2: And I'm Perry Wilson. I'm a medical doctor.
1:24
Speaker 1: It's Thursday, April second, twenty twenty six, and this is
1:28
Speaker 1: wellness actually.
1:30
Speaker 2: Because you're getting a staggering amount of health and wellness
1:33
Speaker 2: information nowadays from every source imaginable, and some of it
1:37
Speaker 2: is awesome.
1:38
Speaker 1: And some of it is well actually both Fortunately we
1:43
Speaker 1: are both people who know how to read studies, how
1:46
Speaker 1: to parse the data, and can tell you what's worth
1:48
Speaker 1: thinking about and what you can safely ignore.
1:51
Speaker 2: But before we dig in, a note that this podcast
1:53
Speaker 2: is for educational purposes and should not be construed as
1:56
Speaker 2: medical advice. We don't know your unique situation, so talk
1:59
Speaker 2: to your doctor for personal health decisions.
2:02
Speaker 1: This week, we're asking what's the deal with creating Perry
2:06
Speaker 1: and I will give the official smash or pass, and
2:09
Speaker 1: then we'll get to your question of the week.
2:11
Speaker 3: But first let's do the health news roundup. After the break.
2:26
Speaker 2: And we're back with the health news of the week
2:30
Speaker 2: coming up first, Emily, President Trump says quote, it's possible
2:35
Speaker 2: he will withdraw the nomination of Casey Means for Surgeon
2:39
Speaker 2: General given the lack of Republican support. You may remember
2:42
Speaker 2: we discussed the nomination of doctor Means on this podcast,
2:47
Speaker 2: and I think brought some much needed attention to the
2:52
Speaker 2: fact that she doesn't actually practice medicine and is a
2:55
Speaker 2: wellness influencer and had a confirmation hearing in which she
3:00
Speaker 2: declined to advocate for vaccination for measles. Does wellness actually
3:06
Speaker 2: have some real political clout now? That is my question?
3:10
Speaker 2: Are we what's moving Washington, DC?
3:12
Speaker 1: It is possible, but I would say unlikely. However, you
3:18
Speaker 1: never know, And I think this is not very surprising
3:22
Speaker 1: given where the conversation has landed over the past couple
3:28
Speaker 1: of months. I think the appetite for moving away from
3:33
Speaker 1: vaccines has somewhat waned. This is a little bit separate
3:36
Speaker 1: from the Casey means confirmation hearing, But I do think
3:39
Speaker 1: as we have seen more cases of measles, for example,
3:44
Speaker 1: it's become less palatable to be like, who cares about vaccines?
3:49
Speaker 1: It's like, well, actually children are dying, so maybe people
3:54
Speaker 1: should care about them. And I think we've seen increasingly
3:56
Speaker 1: inside the administration from Jay Baticharia from the Republican senators,
4:02
Speaker 1: a feeling of like, okay, you know, enough is enough,
4:04
Speaker 1: Like let's try to get back towards having more vaccines
4:08
Speaker 1: and appointing someone as surgeon general who has refused in
4:10
Speaker 1: the confirmation hearings to say that she supports vaccines is
4:14
Speaker 1: kind of part of that. So I suspect that the
4:17
Speaker 1: nomination will be withdrawn because I just don't think there's
4:19
Speaker 1: Republican support. Bill Cassidy has had enough of this. Thanks
4:25
Speaker 1: also in the camp of all the ways in which
4:28
Speaker 1: we're positively influencing the world. I noticed after last week's
4:32
Speaker 1: stem cell episode there was a BMJ article about stem
4:38
Speaker 1: cells a heart attack that was retracted.
4:41
Speaker 3: Tell me more, and what role did you specifically play
4:43
Speaker 3: in this?
4:45
Speaker 2: Yeah, I mean, once again the curse of wellness. Actually, like,
4:48
Speaker 2: woe be unto you who is mentioned on this show,
4:51
Speaker 2: because bad things will happen. The BMJ is the British
4:55
Speaker 2: Medical Journal. Actually used to be called the British Medical Journal.
4:57
Speaker 2: It is now officially just the BMJ, their hip but
5:02
Speaker 2: very well respected journal. In twenty twenty five, there was
5:05
Speaker 2: a report of in that journal of a randomized trial
5:08
Speaker 2: of people who had heart attacks and were getting a
5:11
Speaker 2: cardiac cathorization. So they you know, they put a little
5:14
Speaker 2: wire into the heart to open up the blood vessel
5:17
Speaker 2: that is blocked, and the intervention a placebo controlled intervention.
5:22
Speaker 2: Was to inject some stem cells that were isolated from
5:25
Speaker 2: Wharton's jelly, which is, for lack of a better word,
5:30
Speaker 2: the goo that's inside the umbilical cord. Okay, it's like
5:33
Speaker 2: a yeah, it does have a fair amount of mesenchymal
5:37
Speaker 2: stem cells in it. Please go back to last week's
5:40
Speaker 2: episode if you want to hear more details about that.
5:43
Speaker 2: And what this study claimed to show was that the
5:46
Speaker 2: rate of heart failure was significantly lower in the people
5:49
Speaker 2: who got this special stem cell injection. So it was
5:52
Speaker 2: sort of a thought like, oh, you're putting in these
5:54
Speaker 2: these stem cells, They're going to differentiate into heart tissue
5:57
Speaker 2: and become, you know, protect the heart in the long term.
6:01
Speaker 2: This is biologically plausible, as we often say, and it was,
6:04
Speaker 2: you know, by reports, a well done trial. Unfortunately, it
6:08
Speaker 2: turns out that there were significant data regularities that were
6:12
Speaker 2: subsequently revealed when the data was analyzed, and the full
6:16
Speaker 2: article has now been retracted. The BMJ stopped short of
6:19
Speaker 2: saying it was fraudulent, but it does just remind all
6:23
Speaker 2: of us that no one study is ever definitive because
6:26
Speaker 2: you never really know. You always need replication in this
6:29
Speaker 2: kind of thing.
6:30
Speaker 1: Yeah, and I should say that retraction of a study
6:32
Speaker 1: in a paper is actually pretty unusual, so it's not
6:36
Speaker 1: Certainly it can be retracted if it is fraudulent, but
6:39
Speaker 1: generally this means it is fraudulent or it is wrong.
6:42
Speaker 1: You know, papers are updated over time and sometimes you
6:45
Speaker 1: will look back and say, well, we weren't quite right
6:46
Speaker 1: about that.
6:47
Speaker 3: But to actually retract a paper means you.
6:48
Speaker 1: Know, the paper is not right, something was wrong, and
6:52
Speaker 1: how this was done not We have learned more later,
6:54
Speaker 1: but like the way this paper was done was not right.
6:57
Speaker 1: So it's a more extreme change than just you know,
7:00
Speaker 1: the literature has evolved.
7:02
Speaker 2: Yeah, absolutely, so wellness, Actually skepticism around stem cells is
7:06
Speaker 2: proven correct yet again. Our last news item is I
7:11
Speaker 2: think a good one for to put your economist hat on, Emily.
7:14
Speaker 2: I know we don't get to use that as often
7:16
Speaker 2: as we would like in the podcast, but a new
7:18
Speaker 2: study came out looking at childhood sugar intake and the
7:23
Speaker 2: genetic risk for obesity and how those things interact using
7:27
Speaker 2: a really cool natural experiment. So can you walk me
7:31
Speaker 2: through this new paper.
7:33
Speaker 1: Yeah, so this paper uses a technique that economists call
7:37
Speaker 1: natural experiments, where you want to think about this as
7:42
Speaker 1: the world.
7:43
Speaker 3: Has experimented for you.
7:44
Speaker 1: And so in this particular case, they're using sugar restrictions
7:48
Speaker 1: post World War two. So in the UK after World
7:52
Speaker 1: War Two, there was a long period of time in
7:53
Speaker 1: which there were restrictions on how much sugar you could
7:56
Speaker 1: buy because of worries about not having enough, and then
8:00
Speaker 1: at some point in the middle of nineteen fifty three
8:03
Speaker 1: they relax those sugar restrictions and you were allowed to
8:05
Speaker 1: buy more sugar. And the result of that was that
8:08
Speaker 1: kids ate a lot more sugar, and pregnant people ate
8:11
Speaker 1: a lot more sugar in like October nineteen fifty three
8:14
Speaker 1: than in August nineteen fifty three. And so they're using
8:17
Speaker 1: that sharp timing to look at whether being exposed to
8:21
Speaker 1: higher levels of sugar, either in utero or in early childhood,
8:26
Speaker 1: is associated with higher risks of metabolic disease later. This
8:30
Speaker 1: paper actually follows on an earlier paper where they show
8:34
Speaker 1: that kids who have higher sugar exposure in this period
8:37
Speaker 1: have higher risks of diabetes later in life. And so
8:41
Speaker 1: here they're showing higher risks of obesity and also that
8:47
Speaker 1: that interacts with your genetic predisposition to obesity.
8:51
Speaker 3: So it's really interesting paper.
8:53
Speaker 1: I think it does give a little bit of caution
8:55
Speaker 1: about very high levels of sugar exposure in early childhood.
8:59
Speaker 1: I will say, you know, parents will come to me
9:01
Speaker 1: and be like, oh my god, does this mean I
9:03
Speaker 1: can't Like I one time I gave my child a
9:05
Speaker 1: piece of cake, and like, have I ridden them forever? Like,
9:07
Speaker 1: we're talking here about a lot of sugar exposure. Clearly
9:11
Speaker 1: some is okay, but it is one of the dietary
9:14
Speaker 1: things we probably want to be a little more cautious
9:16
Speaker 1: about with kids than some others.
9:19
Speaker 2: Yeah, I think this paper also does a nice job
9:21
Speaker 2: reminding us that, like a lot of obesity is genetic,
9:25
Speaker 2: and so you know, they can look at the because
9:29
Speaker 2: this comes from the UK Biobank, which is this big
9:32
Speaker 2: amazing genetic cohort study, they can look at the genetic
9:35
Speaker 2: risk factors for obesity and they can see, you know,
9:37
Speaker 2: it's very clear that certain genes and patterns of genes
9:40
Speaker 2: increase the risk for obesity, but that lower sort of
9:43
Speaker 2: intaken childhood can kind of modify that risk, not all
9:46
Speaker 2: the way. So it wasn't even like these people who
9:49
Speaker 2: are at high risk genetically for obesity didn't become obese
9:52
Speaker 2: because they were born during the rationing period. You know,
9:56
Speaker 2: many of them still did, but the disparity in BMI
9:59
Speaker 2: was somewhat lower than would have been predicted by genetics alone.
10:02
Speaker 1: So yeah, I mean it's a very The uk Biobank
10:05
Speaker 1: is an extremely important data source because of the way
10:10
Speaker 1: I think it will continue to help us understand over
10:12
Speaker 1: time the intersection between genetics and behavior and you know,
10:16
Speaker 1: how our behaviors turn on and off genes, which is
10:19
Speaker 1: an exciting area.
10:20
Speaker 3: Of research that hopefully we'll talk about more.
10:23
Speaker 2: Absolutely, that's it for the health news of the week.
10:26
Speaker 2: When we come back. What's the deal with creatine? Okay,
10:35
Speaker 2: I want to start with an influencer telling us just
10:40
Speaker 2: how important creatine is.
10:43
Speaker 4: Creatine should be now mandatory in everybody's took it, just
10:47
Speaker 4: like brushing your teeth or exercising. I think everybody should
10:50
Speaker 4: be supplementing with creatine prior to being diagnosed with alzheim As.
10:54
Speaker 4: You've got this thirty year period of all these stages,
10:57
Speaker 4: and one of those stages is subjective cognitive impairment, which
11:01
Speaker 4: is the first stages of Alzheimer's disease. Right, Sometimes your
11:04
Speaker 4: thinking's not up to scratch, or you forgot where you
11:06
Speaker 4: put your keys, or you're getting slower reaction times. These
11:09
Speaker 4: are all cognitive functions. They start to decline, then you've
11:12
Speaker 4: got mild cognitive impairment, which is a pre dementia state,
11:15
Speaker 4: and that lasts around twenty years. So it's during these
11:18
Speaker 4: states that you need as much brain energy as you can,
11:22
Speaker 4: and we can get that from creatine.
11:24
Speaker 3: Okay, so, Perry, I like this influencer quote because I
11:29
Speaker 3: think that it illustrates what, for me is the core
11:32
Speaker 3: point that we will get to with creating as we
11:35
Speaker 3: move through this, which is this person starts with something
11:40
Speaker 3: that I think is an overstatement but is true in
11:44
Speaker 3: some sense, which is that there are some things where
11:45
Speaker 3: we see benefits of creating, and then she kind of immediately.
11:49
Speaker 1: Goes to like creatine prevents Alzheimer's, which is way on
11:52
Speaker 1: the edge of what we think. So it's such a
11:54
Speaker 1: good example of the kind of like let's take something
11:57
Speaker 1: that's real and like make it matter for for everything.
12:00
Speaker 3: So absolutely it's a good entry.
12:03
Speaker 2: This is you know, we like to give people little
12:07
Speaker 2: little hints that they are being influenced as opposed to
12:09
Speaker 2: being provided with real data, and and one of those
12:12
Speaker 2: hints is taking an extreme position. It's very engaging to
12:16
Speaker 2: be like this supplement creatine like is necessary for literally
12:21
Speaker 2: everyone and as important as brushing your teeth, and like
12:24
Speaker 2: you're you're staking out a position so extreme that you
12:28
Speaker 2: kind of have to pay attention to it. And we
12:30
Speaker 2: just need to tell everyone that's never true. There's there's
12:34
Speaker 2: literally even brushing is.
12:36
Speaker 3: As important as brushing your teeth. You should brush your teeth.
12:40
Speaker 1: But even if you don't do that, like it's rebably
12:41
Speaker 1: okay occasionally, but still you should brush your teeth.
12:44
Speaker 2: Yeah, so let's dig in. There's there's a lot here,
12:49
Speaker 2: but let's start like just at the beginning, right, Like, so,
12:52
Speaker 2: what is the what is creatine?
12:54
Speaker 5: Like?
12:54
Speaker 2: Why are people talking about creatine? I see it from
12:56
Speaker 2: a lot of bodybuilders and stuff. What's your take on creatine?
13:00
Speaker 1: I mean, I think the first thing to just tell
13:01
Speaker 1: people like literally, creatine's an amino acid. It is an
13:04
Speaker 1: amino acid that you consume in food.
13:08
Speaker 2: It's a derivative of an amino acid. I only say
13:12
Speaker 2: because we did that.
13:14
Speaker 3: Right, I'll say, doctor, I'm a real die. I went
13:17
Speaker 3: to medical school. Black blah black, Now go ahead.
13:19
Speaker 2: Please, because we said there's twenty two amino acids that
13:24
Speaker 2: you know people use in creatines. Not one of them.
13:26
Speaker 2: It's a derivative of an amino acid. But yes, by
13:28
Speaker 2: all means continue.
13:30
Speaker 1: You consume creatine in food, primarily in meat and seafood,
13:36
Speaker 1: and you store it in your muscles, and it is
13:39
Speaker 1: helpful for making the muscles work, particularly in an anaerobic way.
13:44
Speaker 1: I think the core thing that's relevant for this question
13:47
Speaker 1: of supplementation is that your muscles can generally store more
13:50
Speaker 1: creatine than most people can get indeed, and most people
13:53
Speaker 1: can get through their food. So when people supplement with creatine,
13:57
Speaker 1: it like ramps up the store of creatine and their muscles,
14:01
Speaker 1: and in principle that can then help you when you
14:06
Speaker 1: are exercising in particular ways at very high levels.
14:10
Speaker 3: That's kind of the core thing.
14:11
Speaker 1: So do you exercise to failure on a frequent basis?
14:15
Speaker 2: Perry, No, but I've done it.
14:18
Speaker 3: What does it mean to exercise to failure?
14:21
Speaker 2: Have you ever exercised?
14:22
Speaker 6: If?
14:23
Speaker 2: Have you have ever done an exercise?
14:24
Speaker 1: You feel like I exercise to failure every like the
14:26
Speaker 1: three days, But I don't.
14:27
Speaker 3: I'm not sure that I know what that means.
14:29
Speaker 2: Okay, exercising to failure literally means that you're doing an exercise,
14:35
Speaker 2: let's say push ups, and you just continue to do
14:38
Speaker 2: push ups and do push ups and do push ups
14:40
Speaker 2: until your muscles give out. They literally fail. And I
14:44
Speaker 2: think it might be worthwhile to talk about physiologically, like
14:47
Speaker 2: what is happening there, because that might be the best
14:50
Speaker 2: way to understand how creatine works. So if you do
14:54
Speaker 2: push ups and you keep going, and you don't do
14:56
Speaker 2: like I'm going to do twenty, I'm going to do thirty,
14:58
Speaker 2: you just keep going, going, going until your arms. What
15:01
Speaker 2: will happen have a pillow under your face because your
15:04
Speaker 2: arms will literally stop working and your face will smash
15:07
Speaker 2: into the ground and there's nothing you can do about this.
15:09
Speaker 2: This has happened to me, but bodybuilders will do these
15:12
Speaker 2: types of exercises to failure. What's happening in the muscle
15:16
Speaker 2: when your muscle is contracting is the muscles using energy,
15:19
Speaker 2: and the energy currency of all the cells in your
15:22
Speaker 2: body is ATP. Probably hard us mention that before, but
15:25
Speaker 2: think of it as like cash spending cash in terms
15:28
Speaker 2: of you know what cells can use for energy. There's
15:31
Speaker 2: a problem, and that's that cells can't store very much ATP.
15:35
Speaker 2: It's unstable. It's hard to keep it in its activated form.
15:39
Speaker 2: So it's like they've got some cash in their pocket,
15:42
Speaker 2: but it's not enough to you know, go on a
15:45
Speaker 2: huge spending spree. That's sort of how I think about ATP.
15:49
Speaker 2: For most cells, that's not a problem because they use
15:52
Speaker 2: a little energy to like whatever they're doing. You know,
15:55
Speaker 2: your gut sell and uses some energy to absorb some
15:57
Speaker 2: glucose or whatever, and then it's done for a while
15:59
Speaker 2: and it chills out and builds up more ATP no issues.
16:02
Speaker 2: But there's some cells in your body that use energy
16:04
Speaker 2: like a lot in over a period of time, and
16:08
Speaker 2: muscle is definitely the biggest one, and that includes your
16:11
Speaker 2: heart muscle, but you know your skeletal muscles as well.
16:14
Speaker 2: If all they had to use for that energy was ATP,
16:17
Speaker 2: then after about three seconds of muscle contraction, all the
16:21
Speaker 2: ATP and a muscle cell is gone and the muscle fails,
16:24
Speaker 2: and that means it just goes slack and your face
16:27
Speaker 2: smashes forward into the pillow that you put under you
16:30
Speaker 2: when you're doing pushups. That's not compatible with moving around
16:35
Speaker 2: or lifting up anything. You can't have only two seconds
16:37
Speaker 2: of muscle contraction, so what creatine is is a store
16:43
Speaker 2: for phosphates that can regenerate ATP. So remember you can't
16:48
Speaker 2: you can only have so much cash in your while
16:49
Speaker 2: you can't have too much ATP in a cell, but
16:51
Speaker 2: you can have lots of creatine. That's your bank account,
16:53
Speaker 2: more or less. And so as your ATP is being
16:56
Speaker 2: used up, creatine in the form of creatine phosphate is
17:00
Speaker 2: regenerating ATP. So you're taking cash out of that.
17:03
Speaker 1: But it's the ATM. It's your cells as an ATM
17:07
Speaker 1: exactly exactly.
17:09
Speaker 2: And as you pointed out, most of our muscle cells
17:11
Speaker 2: based on a typical Western diet, actually can hold more
17:15
Speaker 2: creatine than they have. And what that means is that
17:21
Speaker 2: if you build up your store of creatine by creating
17:23
Speaker 2: supplementation in theory, you have this extra amount in your
17:29
Speaker 2: ATP bank account that you can extract upon. So it's
17:33
Speaker 2: a little different. People often say creatine is like energy
17:36
Speaker 2: for your muscle. It's more like the presence of creatine
17:39
Speaker 2: allows your muscle to bank energy when it's not being
17:43
Speaker 2: used so that it can pull it out again when
17:45
Speaker 2: it is being used. It's almost acts more like a
17:47
Speaker 2: battery or like a rechargeable battery, but you still have
17:50
Speaker 2: to do the recharging. Creating does not have calories in it,
17:53
Speaker 2: creating monohydrate right, like, so it's not energetic itself, but
17:57
Speaker 2: it's a place to store energy in your muscles. There's
18:00
Speaker 2: one other set of cells that do tend to be
18:03
Speaker 2: active a lot and use a lot of ATP, which
18:06
Speaker 2: is your brain, right, that's in your brain. Yeah, so
18:09
Speaker 2: that's why you see a lot of muscle and brain
18:10
Speaker 2: talk for creating.
18:11
Speaker 1: Yeah, all right, so let's start with the muscle talk
18:14
Speaker 1: and then move to the brain talk because the muscle
18:17
Speaker 1: talk is in some ways a much easier conversation totally.
18:22
Speaker 1: So the thing we know, I think with incredibly high certainty,
18:27
Speaker 1: is that if you are doing a lot of bodybuilding
18:32
Speaker 1: related exercise, creating supplementation can improve your performance. We have
18:38
Speaker 1: hundreds and hundreds of randomized controlled trials of people doing
18:43
Speaker 1: body building activities will show that creating supplementation on average
18:50
Speaker 1: increases the time to failure, so allows you to do
18:52
Speaker 1: more of those push ups before you smash your face
18:54
Speaker 1: in the pillow.
18:56
Speaker 3: And this is this has been used by bodybuilders for
19:00
Speaker 3: are you know, decades?
19:02
Speaker 1: I mean, this is like a very standard bodybuilder activity talk.
19:07
Speaker 2: To me for a second, because this will come up again.
19:10
Speaker 2: You said randomized control trials. Why in a study that's
19:14
Speaker 2: looking at something like muscle strength, muscle performance, whatever your
19:18
Speaker 2: metric is, why is a control randomization and control like
19:22
Speaker 2: a placebo control so important Because there's plenty of studies
19:25
Speaker 2: that aren't placebo controlled, particularly when we look at the brain.
19:27
Speaker 2: So why does that matter when you're talking about things
19:29
Speaker 2: like muscle strength and function?
19:32
Speaker 1: Yeah, I mean, I think the core thing is that
19:34
Speaker 1: actually a lot of your muscle strength and function is
19:38
Speaker 1: what you think you can do, right, So if you
19:41
Speaker 1: sort of engent, like, let's let's back up. In general,
19:44
Speaker 1: we like randomized control trials because we have treat people
19:46
Speaker 1: the same and the only thing that's different is what
19:49
Speaker 1: thing we're giving them.
19:50
Speaker 3: In this case, it's actually really.
19:52
Speaker 1: Important that not only are we choosing at random who's
19:56
Speaker 1: getting the creatine, but that we are also doing something
19:59
Speaker 1: to the group that makes them think they're getting the
20:02
Speaker 1: creatine or that they might be getting the creatine. Right,
20:05
Speaker 1: Because if I tell you, hey, I gave you this
20:08
Speaker 1: like amazing substance, it's going to make you be able
20:11
Speaker 1: to do more push ups. You will be able to
20:13
Speaker 1: do more push ups, even if what I have given
20:15
Speaker 1: you is literally.
20:16
Speaker 3: Like a like flower or something, or just like nothing.
20:18
Speaker 3: I guess flower would help.
20:19
Speaker 1: But like if I just give you nothing and I
20:21
Speaker 1: tell you this helps you do push ups, you will
20:22
Speaker 1: do more push ups.
20:23
Speaker 3: Like that's how our brain is, which is cool.
20:26
Speaker 2: Yeah, it's kind of amazing. It's it's like it's like
20:29
Speaker 2: Dumbo with the feather. Remember he has the feather that
20:31
Speaker 2: can make him fly, and then at the end he
20:33
Speaker 2: loses the feather, but it turns out he could fly
20:35
Speaker 2: all along.
20:36
Speaker 1: Remember, right, I do remember it, I do remember, and
20:40
Speaker 1: that movie makes me sad and so sorry, thank you
20:42
Speaker 1: for please never bring it up again. And so yeah,
20:45
Speaker 1: so the placebo effect is like one of our best
20:47
Speaker 1: it's like one of our best effects.
20:49
Speaker 3: It really works very well.
20:51
Speaker 1: But if you want to evaluate the impact of creating
20:53
Speaker 1: on any of these things, you need to like sort
20:55
Speaker 1: of turn off the placebo effect by having a true
21:00
Speaker 1: double blind, randomized placebo control trial in which you people
21:04
Speaker 1: don't know what group they're in. And in the case
21:07
Speaker 1: of these bodybuilders, we have that.
21:08
Speaker 3: Because it's of course it's easy.
21:10
Speaker 1: We can come back to this in other settings, but
21:12
Speaker 1: it's really easy to experiment on athletes, Like, that's a
21:15
Speaker 1: great population loves environmentation. They love to first of all,
21:19
Speaker 1: they love to be in they love You tell some
21:21
Speaker 1: athlete like I had a randomized control trial something which
21:24
Speaker 1: might have proved your performance.
21:25
Speaker 3: Is like where do I sign up?
21:28
Speaker 1: And the second thing is often what you're looking at
21:31
Speaker 1: in the outcomes is really easy to define and is
21:34
Speaker 1: short term. Right, So you can run one of these
21:36
Speaker 1: studies in like like a few days, you give some
21:38
Speaker 1: people creating, You give them some people and some other powder.
21:42
Speaker 1: You ask them to do a bunch of push ups
21:43
Speaker 1: with a pillow under their face, and like then that's it.
21:45
Speaker 1: That's your paper, And that's so much easier then like
21:49
Speaker 1: I'm going to treat this and I'm going to see
21:51
Speaker 1: whether you develop dementia like fifty years from now.
21:53
Speaker 3: That's just a much harder thing to study.
21:56
Speaker 2: And that's one of the reasons we have so many studies.
21:59
Speaker 2: And you'll always hear almost every influencer I looked at
22:01
Speaker 2: talking about creatine opened with like it's the most studied
22:05
Speaker 2: supplement in the history of mankind, which I couldn't find
22:07
Speaker 2: any reference for. Like I'm not entirely I think vitamin C,
22:11
Speaker 2: and like, I think, I'm not sure if that's true,
22:13
Speaker 2: but it has been studied a lot. I'll give them that.
22:14
Speaker 1: As of two thousand and three, in some review there
22:17
Speaker 1: are like five there's like a review with five hundred papers,
22:19
Speaker 1: and that's like twenty five years ago. So I and
22:21
Speaker 1: this has only become more pop So I think this
22:23
Speaker 1: is a very highly studied I'm not sure.
22:25
Speaker 3: We don't count papers.
22:26
Speaker 1: It's not like the it's not a metric, official metric.
22:28
Speaker 1: Comedy papers have been written on something. But anyway, yeah, no,
22:32
Speaker 1: definitely not the best metric.
22:33
Speaker 2: But let's put some let's put some numbers to it,
22:36
Speaker 2: so you know, we could pick from a lot of papers.
22:38
Speaker 2: Sometimes the best thing to do when there are a
22:40
Speaker 2: lot of papers, and especially a lot of randomized controlled trials,
22:43
Speaker 2: is to look a meta analysis, which is a single
22:46
Speaker 2: paper that combines the results from multiple papers to kind
22:50
Speaker 2: of give you an average. It's sort of the idea
22:53
Speaker 2: that every paper is going to have little errors going
22:55
Speaker 2: one way or another, and you kind of average them
22:57
Speaker 2: out to get an estimate that's more more true. And
23:01
Speaker 2: so one that caught my eye because probably it speaks
23:06
Speaker 2: to my age is a recent meta analysis appearing in
23:09
Speaker 2: the journal Nutrients, looking at creatine supplementation with resistance training
23:14
Speaker 2: on muscle strength gains in adults under fifty years of age.
23:18
Speaker 2: So there's quite a lot of research in older adults
23:21
Speaker 2: for muscle function and falls and things like that, which
23:23
Speaker 2: is interesting. But you know, I'm not quite there yet,
23:27
Speaker 2: and I'm more interested, like for me personally, I want
23:31
Speaker 2: to go to the gym and like look a little
23:33
Speaker 2: better and feel a little stronger, and I'm otherwise healthy,
23:36
Speaker 2: and so I was very curious to see, like, Okay,
23:38
Speaker 2: what can I expect from creatine. So this study compared
23:41
Speaker 2: creatine supplementation and resistance training to place EBO plus resistance training,
23:47
Speaker 2: and they looked at upper and lower body strength and
23:51
Speaker 2: basically they found that the people randomized to creatine could
23:56
Speaker 2: lift an extra four point four kilograms on the bench
24:00
Speaker 2: that's what, like about ten.
24:01
Speaker 3: Extra pounds ten pounds, yeah.
24:03
Speaker 2: Yeah, ten pounds on the bench press, and thirteen kilograms
24:07
Speaker 2: on the leg press, so you know, maybe twenty five
24:10
Speaker 2: thirty pounds on the leg press. That's not nothing. I mean,
24:14
Speaker 2: you're own old all of a sudden, but that's real.
24:16
Speaker 2: What do you think?
24:17
Speaker 1: Yeah, I mean I think that seems real, and I
24:19
Speaker 1: also wouldn't There's two things I would say about that.
24:22
Speaker 1: So one is I would not dismiss the old people evidence.
24:25
Speaker 1: I actually think that's the other piece of evidence here,
24:27
Speaker 1: even though you know you're not, we're not yet older adults.
24:30
Speaker 1: But actually the other really strong piece of evidence around
24:32
Speaker 1: creatine is the benefits on falls and on mobility for
24:36
Speaker 1: older for older adults. But in both those populations and
24:41
Speaker 1: in the like the setting you're talking about, it's actually
24:43
Speaker 1: very important to be combined with resistance training. So just
24:48
Speaker 1: taking a bunch of creatine and doing nothing will not matter.
24:52
Speaker 1: The thing that creatine is helping you do is helping
24:54
Speaker 1: your muscles exercise closer to failure, which allows your muscles
24:58
Speaker 1: to break down more and then allows them to build
25:00
Speaker 1: back more. So we want to be like very clear
25:03
Speaker 1: on this, even on the well established muscle stuff, that
25:08
Speaker 1: it is not just taking the creatine. It is taking
25:10
Speaker 1: the creatine and doing some strength training at the same time.
25:13
Speaker 2: That is really important, and honestly not only doing whatever
25:19
Speaker 2: strength training you normally do. The benefit derives from the
25:22
Speaker 2: fact that you should be able to do slightly more.
25:25
Speaker 2: We don't want to interhurt themselves. We want you to
25:27
Speaker 2: ramp up slowly. And if you know you can afford
25:30
Speaker 2: like a personal trainer to even work with you to
25:32
Speaker 2: get there, that's amazing. I certainly can't. You do have
25:36
Speaker 2: to be careful, but right, creating isn't magic. It allows
25:40
Speaker 2: you to do a little more work, but you've got
25:42
Speaker 2: to do the more work if you want to see
25:44
Speaker 2: the improvement.
25:46
Speaker 3: All right, So that's on muscles.
25:48
Speaker 1: I want because it's my deep passion to say, very briefly,
25:52
Speaker 1: if you are an endurance athlete, so this is like
25:55
Speaker 1: there's also an active discussion around people who do sports
25:59
Speaker 1: that are not like bodybuilding sports, and the evidence for
26:03
Speaker 1: creating supplementation in like running and cycling is less compelling
26:10
Speaker 1: for reasons that I think makes sense with the biology.
26:13
Speaker 1: So you know, you asked about sort of exercising to failure.
26:16
Speaker 1: It is rare, even in you know, pretty intense like
26:21
Speaker 1: even in like long distance running, to exercise to the
26:23
Speaker 1: kind of failure you have described, It does happen. You
26:25
Speaker 1: will see people at the end of a marathon like
26:28
Speaker 1: unable to like control your body and like just sort
26:32
Speaker 1: of like crawling across the finish line.
26:35
Speaker 3: Like but that's not common. That's not common, and so the.
26:40
Speaker 1: Kind of thing that creating would help with is like
26:43
Speaker 1: just it's less obvious, it will be helpful.
26:45
Speaker 2: There.
26:45
Speaker 1: I will say a lot of endurance athletes do take
26:48
Speaker 1: low levels of creating because like, why the hell not
26:51
Speaker 1: just in case it might help because we're insane.
26:53
Speaker 3: But the evidence isn't as it isn't as strong.
26:56
Speaker 2: I'm so tempted to ask you if you take it.
26:58
Speaker 1: But.
27:00
Speaker 2: Oh you do, okay, I guess.
27:04
Speaker 1: Because someone once said that it might make me faster.
27:06
Speaker 1: Have we learned nothing about my psychology? Someone suggests all
27:12
Speaker 1: you need to do is say you can run faster longer,
27:14
Speaker 1: and Emily will do a little bit, a little bit
27:16
Speaker 1: faster longer. I'll do it, absolutely, yes.
27:20
Speaker 2: So let's while we're while we're sticking on effects, I mean,
27:23
Speaker 2: we've got, of course, we have to talk about like
27:25
Speaker 2: how you get creatine and stuff, but maybe let's go
27:28
Speaker 2: on to the brain, because you know, I think the
27:31
Speaker 2: data for muscle is great, but what I'm hearing from
27:33
Speaker 2: a lot of people, and especially online, even that first
27:35
Speaker 2: influencer is talking about creatine for Alzheimer's disease and things
27:40
Speaker 2: like that. We'll get to general brain effects for a second.
27:44
Speaker 2: But I'd like to play a quote from an influencer
27:48
Speaker 2: for you. You're not going to be a surprise that this,
27:51
Speaker 2: as I was.
27:53
Speaker 5: There is a supplement that reversed memory loss in people
27:57
Speaker 5: with Alzheimer's disease in a new double blind, Placibo controlled
28:01
Speaker 5: trial right here in the United States, and very few
28:04
Speaker 5: doctors are talking about it.
28:06
Speaker 6: If you are news to my channel, Hi, my name
28:08
Speaker 6: is Robert Love.
28:09
Speaker 5: I'm a neuroscientist and I have a medical clinic in
28:12
Speaker 5: Florida where we are reversing Alzheimer's in our patients. This
28:15
Speaker 5: study was released June fourth or June fifth of twenty
28:19
Speaker 5: twenty five. Kansas Medical School did a double blind, super
28:22
Speaker 5: controlled trial in adults with Alzheimer's disease. Half the adults
28:26
Speaker 5: got Creating, half the adults got at Placibo. Here's what
28:29
Speaker 5: they found. The adults who took Creating actually improved their
28:33
Speaker 5: memory in this study. Now, the thing is they give
28:36
Speaker 5: them a very large dose of creating. The dose they
28:38
Speaker 5: gave them was twenty grams a day. Most people are
28:41
Speaker 5: taking three to five grams a day, maybe ten grams
28:44
Speaker 5: a day. These people took twenty grams a day. There
28:46
Speaker 5: were no serious side effects, in fact, really no side
28:49
Speaker 5: effects at all of taking twenty grams a day, so
28:51
Speaker 5: the people did not feel.
28:52
Speaker 6: Bad and they improved their memory.
28:54
Speaker 5: Now, creating is one of the most studied supplements on
28:58
Speaker 5: the planets, lots of resource, specifically on.
29:01
Speaker 6: Athletes for muscle health. Women.
29:03
Speaker 5: This is especially important for you women, you make less
29:05
Speaker 5: creatine than men do. Creatine is evolved in the process
29:09
Speaker 5: of energy. Basically, it helps make ATP and so think
29:12
Speaker 5: about it. When you make more ATP the creatine, some
29:15
Speaker 5: of that can get into the brain and that can
29:17
Speaker 5: help your brain make more energy, and that can improve
29:20
Speaker 5: brain function.
29:21
Speaker 2: So yeah, Emily, I was doing the research for this
29:27
Speaker 2: this episode, and I was looking into the literature about
29:31
Speaker 2: creatine in the brain, and I put together all my notes,
29:34
Speaker 2: but then of course I went to the influencers. I
29:36
Speaker 2: wanted to see what people were saying. And here's someone saying, like,
29:39
Speaker 2: there's a you heard the words randomized placebo controlled trial
29:45
Speaker 2: of creating for Alzheimer's disease, and it showed that it
29:51
Speaker 2: fixed their memory problems. And I was like, huh, how
29:55
Speaker 2: did I miss that? Like that's a big deal. How
29:57
Speaker 2: did I miss that trial? And this is a this
30:00
Speaker 2: influencers like a doctor. They have a clinic down in Florida,
30:02
Speaker 2: Like it's always Florida, but you know whatever. So I
30:06
Speaker 2: did a little bit of slew thing and I actually
30:07
Speaker 2: found the study that this influencer was talking about. From
30:12
Speaker 2: the context clues, the number of patients the university was
30:15
Speaker 2: sent out of, et cetera. I found it. And it's
30:18
Speaker 2: not a randomized trial. It's there's no randomization, it's not
30:21
Speaker 2: placebo controlled. It's just twenty people with Alzheimer's who got
30:25
Speaker 2: some memory testing and then went on creatine and then
30:28
Speaker 2: got some more memory testing, and there was some modest
30:31
Speaker 2: improvement in memory from before and after. But remember we've
30:34
Speaker 2: already talked about like the importance of randomization of placebo controls.
30:38
Speaker 2: So I know how you'll feel about this, But like,
30:40
Speaker 2: I'm still having trouble with the influencer world, Like you
30:43
Speaker 2: can just say anything like is there are there no rules?
30:48
Speaker 1: What I think is interesting about this one? Yeah, of course, yes,
30:51
Speaker 1: there are no there are no rules.
30:53
Speaker 3: But what was interesting about this was it so specific.
30:56
Speaker 1: Like often in these influencer things, you'll hear, you know,
30:58
Speaker 1: there's a new exciting study that says that creating works
31:01
Speaker 1: for Alzheimer's. But to be sort of specifically wrong is
31:05
Speaker 1: actually quite dangerous because of course, like anybody who found
31:08
Speaker 1: this study would be like, oh, well, it's actually not
31:10
Speaker 1: a double blind, placy book controlled randomized trial. It's it's
31:13
Speaker 1: not a randomized trial of any sort. It's just like
31:16
Speaker 1: a study of some people. So I think it's dangerous
31:18
Speaker 1: to be too specific with your lies.
31:20
Speaker 3: In the internet.
31:21
Speaker 1: But at any rate, there is not a double blind,
31:25
Speaker 1: policy book controled randomized trial of patients with Alzheimer's that
31:27
Speaker 1: shows effects of creatine full stop.
31:30
Speaker 3: There is not.
31:31
Speaker 2: There's not. And while we're on the subject of the
31:35
Speaker 2: neurodegenerative diseases, you know, this is again a place for
31:40
Speaker 2: the reasons we talked about. Because brain cells do use
31:44
Speaker 2: atp at a rate that is faster than your typical cells,
31:48
Speaker 2: it makes sense to test these things. I'm so glad
31:50
Speaker 2: that people are evaluating, especially a relatively benign supplement like creatine,
31:55
Speaker 2: for degenerative neurologic diseases. But to give you like the
32:00
Speaker 2: data on this, there's a large randomized trial seventeen hundred
32:04
Speaker 2: people with early Parkinson's disease. They're all within five years
32:08
Speaker 2: of diagnosis. This is coming from the Journal of the
32:10
Speaker 2: American Medical Association twenty fifteen. They were given creating monohydrate
32:15
Speaker 2: ten grams a day for a minimum of five years.
32:18
Speaker 2: This is a placeable controlled randomized trial. I mean, what
32:21
Speaker 2: an amazing study, right, Yeah, and it is actually I.
32:24
Speaker 1: Mean to actually to run a set of like that
32:26
Speaker 1: is extraordinary, extraordinary, really really impressive.
32:29
Speaker 2: Yeah, kudos to the authors. The study was stopped early
32:33
Speaker 2: for futility. So when we run trials, especially trials that
32:37
Speaker 2: are expensive like this one would have been, and that
32:40
Speaker 2: go on for a long time, we'll have an independent
32:42
Speaker 2: statistical board that looks at the data at some specified
32:45
Speaker 2: time points and says, is it possible that if you
32:48
Speaker 2: continue this study you'll see a signal of benefit or
32:51
Speaker 2: at this point, based on the data we have, like,
32:55
Speaker 2: unless every single person who gets creating does amazingly, well,
32:58
Speaker 2: you're not showing benefit, so you might as well stop.
33:01
Speaker 2: Now it's no longer ethical to continue this trial. So
33:04
Speaker 2: super impressive, no effect in Parkinson's disease. And then there's
33:08
Speaker 2: another relatively large trial in this space five hundred and
33:11
Speaker 2: fifty adults with Huntington disease. They were getting creatine amountohydrate
33:15
Speaker 2: tight traded up to forty grams a day. We'll talk
33:18
Speaker 2: about the dosing, but that is an incredibly high dose,
33:23
Speaker 2: also placebo controlled, and also halted for futility.
33:28
Speaker 3: So not a pantasy, I will say.
33:30
Speaker 1: On the other side, there is a much smaller meta
33:34
Speaker 1: analysis from twenty eighteen where they put together a number
33:37
Speaker 1: of small trials. In the end totals like fewer than
33:41
Speaker 1: three hundred people, but looking at just general cognitive performance,
33:48
Speaker 1: and there, you know, maybe they get a little bit
33:51
Speaker 1: of a signal on short term memory.
33:55
Speaker 3: You know, this is not in a diagnosed population. The
33:59
Speaker 3: result else.
34:00
Speaker 1: Are pretty weak, and they only show up for a
34:03
Speaker 1: small number of outcomes, and they mostly show up for vegetarians,
34:06
Speaker 1: which you know, could be because they don't get enough meat,
34:10
Speaker 1: or could be because you're cutting the data enough to
34:12
Speaker 1: find a group where it matters for I don't really know.
34:16
Speaker 1: So putting all of this together, I would say, certainly
34:20
Speaker 1: the evidence for brain impacts is far, far, far, far
34:24
Speaker 1: far weaker than the evidence for muscle impacts.
34:29
Speaker 2: I agree. You know, in terms one of the issues
34:32
Speaker 2: with the brain, it's like muscle's pretty easy to study.
34:36
Speaker 2: You know, it's like how much can you bench? Like
34:38
Speaker 2: that's a very reasonable metric, but like how well your
34:42
Speaker 2: brain works is really hard. You know, we think about memory,
34:45
Speaker 2: but if you look at detailed neurocognitive testing that happens
34:48
Speaker 2: in a lot of these trials, it's it's memory, it's attention,
34:51
Speaker 2: it's executive function. You know, there's all these sort of components,
34:55
Speaker 2: many of which overlap with each other, some of which
34:58
Speaker 2: we don't fully understand, all of to have scores on
35:01
Speaker 2: scales that are impossible to explain to anyone, and it's
35:05
Speaker 2: very hard to say like a global estimate of like
35:08
Speaker 2: it makes your brain better. You're right. If there was
35:11
Speaker 2: one thing that keeps kind of standing out in these
35:13
Speaker 2: smaller trials of you know, older adults, it's probably memory.
35:18
Speaker 2: I mean, did you did you find that as well?
35:19
Speaker 1: Like if you're short term memory, it's kind of short
35:23
Speaker 1: term memory issues, which which is something a lot of
35:26
Speaker 1: older adults struggle with, and so that sort of comes
35:31
Speaker 1: out most consistently in these trials. It's also a relatively
35:34
Speaker 1: straightforward thing to measure, as opposed to you know, measuring
35:37
Speaker 1: someone's executive function is much harder than measuring their short
35:41
Speaker 1: term memory, which you more or less do by telling
35:43
Speaker 1: them a bunch of words and then a little later
35:45
Speaker 1: at the end of the study being like, do you
35:46
Speaker 1: remember what those words were? So there's a series of
35:49
Speaker 1: pretty standard tests for that. So I guess the other
35:52
Speaker 1: thing I would say about this is like, there's an
35:55
Speaker 1: interesting link with you know, mobility and exercise and not
36:00
Speaker 1: falling down and the brain. Right, So one one thing
36:03
Speaker 1: that could be true is like you take creatine and
36:05
Speaker 1: you do some resistance training, and so then you don't
36:07
Speaker 1: fall down, and then you you know, end up interacting
36:10
Speaker 1: more in the world.
36:11
Speaker 3: That's actually really good for your brain.
36:13
Speaker 1: So there's a whole set of interacting things when we
36:16
Speaker 1: talk about the elderly, where anything that improves your ability
36:20
Speaker 1: to do the activities of daily life is likely to
36:24
Speaker 1: improve your brain because your brain is benefiting from doing
36:27
Speaker 1: the activities of daily life absolutely.
36:30
Speaker 2: So let's talk a little bit about how people get creatine. Okay,
36:34
Speaker 2: so let's say that people say this sounds pretty good,
36:37
Speaker 2: I want to bench a little bit more. So all
36:40
Speaker 2: you have to do if you want to get creatine
36:42
Speaker 2: is post on Instagram and say, well, I like I
36:46
Speaker 2: like creatine and apparently it shows up at your house.
36:48
Speaker 2: Why doesn't this work for me?
36:49
Speaker 3: I don't know.
36:50
Speaker 2: We're going to combine people combined. Emily and I have
36:56
Speaker 2: over five hundred thousand Instagram followers.
36:59
Speaker 3: It's so so true.
37:02
Speaker 1: All right.
37:04
Speaker 2: So, creatine, as you pointed out, comes from meat. But
37:08
Speaker 2: because meat is muscle, and animals are just like us
37:11
Speaker 2: and they have they have creatine in their muscles as well,
37:15
Speaker 2: Vegetarians are people who potentially aren't ingesting creatine in that
37:20
Speaker 2: way as much, which is why some of the data
37:22
Speaker 2: restricted to vegetarians looks a little bit better for creating supplementation.
37:27
Speaker 2: I should say that creatine is not an essential nutrient.
37:31
Speaker 2: So essential nutrients are things that you must ingest or
37:34
Speaker 2: you die, right like vitamin C. If you don't, you
37:36
Speaker 2: get scurvy, you die, et cetera. Creatine is synthesized by
37:39
Speaker 2: your body. It's synthesized in the liver and the kidney,
37:42
Speaker 2: but probably not as much to sort of saturate how
37:45
Speaker 2: much your muscles can take. They really can take quite
37:47
Speaker 2: a bit of creatine, and as you pointed out, even
37:49
Speaker 2: meat eaters are probably not fully saturating their muscle with creating.
37:53
Speaker 1: Yeah, so when people talk about taking a creatine supplement
37:57
Speaker 1: just to like get to brass text.
37:58
Speaker 3: It's kind of two approaches to this.
38:01
Speaker 1: So for people who are doing who are taking this
38:05
Speaker 1: for like bodybuilding, the approach tends to.
38:08
Speaker 3: Be to take a lot for a short period of time.
38:12
Speaker 1: Like, as you know, thirty forty grams of creating a
38:16
Speaker 1: day for some period of time, and then return to
38:19
Speaker 1: a maintenance dose. For most people who would take this
38:22
Speaker 1: to kind of just generally improve their overall muscle functioning
38:27
Speaker 1: and so on, the typical dosage would be something like
38:30
Speaker 1: five grams a day, as like a regular just to
38:34
Speaker 1: take five grams a day.
38:36
Speaker 2: That's probably even a bit more than the average person needs.
38:39
Speaker 2: What will happen is that you pee out the excess,
38:42
Speaker 2: so you know you can think about whether it's worth
38:45
Speaker 2: it to you. It's not going to be harmful to
38:47
Speaker 2: take more those big, bulky loading doses. Be a little
38:51
Speaker 2: careful with if you've never done this before. There are
38:53
Speaker 2: some gi effects. You get some rumblies in your tumblies
38:58
Speaker 2: with creating, even at the I do. So if you
39:01
Speaker 2: have a sensitive stomach, be a little careful when you
39:04
Speaker 2: start out.
39:05
Speaker 1: And there's a lot of ways to get creatine. There's
39:07
Speaker 1: creating in powder, there's creatine in water, there's creating in
39:10
Speaker 1: gummy form. This creatine pills is like a lot of
39:13
Speaker 1: different a lot of different options.
39:16
Speaker 2: Most of what you'll see is creating monohydrate. All of
39:19
Speaker 2: the data that we talked about today was creating monohydrate.
39:22
Speaker 2: There is this other form of creatine out there called
39:25
Speaker 2: creatine fylester or something like that that they argue like
39:27
Speaker 2: is absorbed better. There's no data on it, and there
39:29
Speaker 2: doesn't seem to be a reason to spend extra money
39:31
Speaker 2: on that.
39:32
Speaker 1: All right, So two downside questions people often have here.
39:36
Speaker 1: One is does creatine make you retain water? So this
39:40
Speaker 1: is like I take a bunch of creatine and then
39:43
Speaker 1: I'm all of a sudden like a bloated water bag.
39:48
Speaker 3: True or false?
39:49
Speaker 2: True?
39:50
Speaker 3: True?
39:50
Speaker 2: Oh yeah, absolutely absolutely. So what creatine is getting taken
39:54
Speaker 2: up by your muscles, and water will flow from parts
40:01
Speaker 2: of your body that have less dissolved stuff in it
40:05
Speaker 2: to parts of your body that have more dissolved stuff
40:07
Speaker 2: in it. That's osmosis, and so water will move into
40:12
Speaker 2: your muscle cells when you start taking creatine as the
40:15
Speaker 2: creating concentration in your muscle cells, build up and that
40:17
Speaker 2: actually swells your muscles a little bit, Like it's not
40:20
Speaker 2: really you're not stronger, but it does kind of like
40:22
Speaker 2: maybe add a little definition. The studies show you know,
40:27
Speaker 2: you're talking about two kilograms, so four to five pounds
40:32
Speaker 2: in the first week or two of creating supplementation of
40:36
Speaker 2: water weight, so be aware of that. And it does
40:40
Speaker 2: persist as long as you supplement creatine. So like if
40:43
Speaker 2: you if you're just doing your five grams a day,
40:45
Speaker 2: like you'll you'll get that initial weight and you'll just
40:47
Speaker 2: sort of stay at that extra water weight. If you
40:50
Speaker 2: stop the creatine, then you'll have what's called diarrhsis and
40:53
Speaker 2: you'll you'll lose some of that water. So you know,
40:56
Speaker 2: don't don't freak out. You're going to gain a couple
40:58
Speaker 2: of pounds. And it's just.
41:01
Speaker 1: Second question, is it bad for my kidneys? You're a
41:03
Speaker 1: kidney doctor.
41:04
Speaker 2: Oh, I love this question. Can I tell a story?
41:07
Speaker 2: Can I tell the patient story?
41:08
Speaker 3: Do you love the kidney? So yeah, please tell.
41:11
Speaker 2: I am a fellow kidney fellow at the University of Pennsylvania,
41:16
Speaker 2: and this woman comes in and consult She's like this
41:19
Speaker 2: eighty five year old Russian grandma whatever you're picturing that
41:24
Speaker 2: is correct. That is how she looked. Okay, and she
41:27
Speaker 2: comes in and she is a creatinin value of ten. Now,
41:34
Speaker 2: creatinin is a blood test that we use to assess
41:37
Speaker 2: kidney function. Creatinin is a metabolite of creatine. So the
41:42
Speaker 2: creatine that's in your muscle breaks down and forms creatinin
41:46
Speaker 2: at sort of a steady rate. Because everything breaks down
41:48
Speaker 2: and your kidneys excrete, the creatinin fine. As your kidney
41:52
Speaker 2: function worsens because they can't excrete as much, the creatin
41:56
Speaker 2: in your blood goes up. So the higher your creatin
41:58
Speaker 2: is the worst. Normal creatin is around one. Just to
42:01
Speaker 2: keep things simple, a level of crat int of ten
42:04
Speaker 2: is like, your kidneys aren't functioning at all. You need
42:07
Speaker 2: to be on dialysis, your dad, Yeah, you need a transplant.
42:11
Speaker 2: This is terrible. So I'm waiting for her to come in.
42:15
Speaker 2: I'm ready to like have a conversation with this eighty
42:17
Speaker 2: five year old Russian grandmother. It's like, Okay, I need
42:19
Speaker 2: to admit you to the hospital today. We're going to
42:20
Speaker 2: start dialysis. We'll get you on that. She's probably too
42:23
Speaker 2: old for transplant. Like it was going to be a
42:24
Speaker 2: whole thing, and she walks in and she looks great.
42:28
Speaker 2: She's just spunky, old small lady. And I'm looking at
42:34
Speaker 2: her other laboratory parameters and like her potassium's fine, it's
42:37
Speaker 2: very unusual for some of the advanced kidney disease. The
42:39
Speaker 2: acid base balance in her blood is totally stone cold normal.
42:43
Speaker 2: Like it didn't make sense. So I'm talking to her,
42:46
Speaker 2: and it comes out eventually as I'm asking her about
42:49
Speaker 2: her diet, that she has a trick to staying healthy
42:51
Speaker 2: in life. And what she does is she takes a
42:55
Speaker 2: giant pot roast essentially at the beginning of the week
42:58
Speaker 2: and boils it and boils it and boils it and
43:01
Speaker 2: boils it until there's basically nothing left. She takes out
43:05
Speaker 2: all the like gristle and whatever is left, and then
43:07
Speaker 2: she takes that boiled stuff and she boils it and
43:11
Speaker 2: boils it and boils it until she has a thick
43:15
Speaker 2: slurry of like meat juice. Okay, And she drinks like
43:24
Speaker 2: a cup of this thick slurry of meat juice a
43:27
Speaker 2: day to stay strong and virile. And what was happening
43:33
Speaker 2: is she was ingesting just herculean amounts of probably creatine,
43:39
Speaker 2: but also creatin in because the act of cooking is
43:42
Speaker 2: going to break down the creatine from the meat into
43:45
Speaker 2: creatin in as well, So she was ingesting this huge
43:48
Speaker 2: amount of creatinin. Most people muscles produce about a gram
43:52
Speaker 2: of creatin in a day. So if so you make
43:55
Speaker 2: a gram of creatin and you pee out a gram
43:56
Speaker 2: of creatin and you stay and balance, everything's honkey dory.
43:59
Speaker 2: She was clear taking in about ten times that because
44:02
Speaker 2: her certum cretity I used to she was totally fine.
44:05
Speaker 2: She had no kidney dysfunction whatsoever. So no, there is
44:09
Speaker 2: no risk of kidney dysfunction with creatine.
44:12
Speaker 1: However, sorry, did you tell her to stop doing this
44:17
Speaker 1: or this was like totally fine?
44:18
Speaker 2: She seemed fine, but I did. I did tell her.
44:21
Speaker 2: I was like, listen, every time you get your blood tested.
44:24
Speaker 3: They're going to tell you that your kidneys are figuring.
44:28
Speaker 2: So yes, creatine supplementation will increase your creatinin in your blood,
44:34
Speaker 2: and that is our marker of kidney disease. So when
44:37
Speaker 2: you get your blood tested, if you're supplementing creatine, it
44:39
Speaker 2: will be higher. And certain doctors who are less informed
44:45
Speaker 2: might worry about that. There's no evidence that harms your
44:48
Speaker 2: kidneys directly. There is another blood test for kidney function
44:53
Speaker 2: called cistate and C which won't routinely get run, but
44:56
Speaker 2: you can ask for and that's independent of creatine and
45:00
Speaker 2: creatin and whatever. So like, if you really want to
45:02
Speaker 2: know for sure, if you're nervous and you're on creating,
45:05
Speaker 2: just ask for a size staatency. It's an approved test
45:07
Speaker 2: and you can get like a better estimate of kidney function.
45:11
Speaker 3: That's a great story.
45:12
Speaker 1: I Before we end, I want to end with the
45:16
Speaker 1: bad news for you, which is that creating, although influencers
45:22
Speaker 1: will tell you it does, creatine does actually not affect
45:24
Speaker 1: your hair loss or my hair.
45:25
Speaker 3: Growth or your hair growth.
45:28
Speaker 1: There's some discussion of both hair loss and hair growth.
45:31
Speaker 2: Talk to me about this. I mean, I'll take no
45:33
Speaker 2: effect on hair any day, although I love hair growth
45:36
Speaker 2: if you can give me some of that.
45:39
Speaker 1: There is sort of one small study that suggests that
45:43
Speaker 1: maybe creating would in testosterone and then lead to possible
45:47
Speaker 1: hair loss. But then there's many other studies which show
45:50
Speaker 1: there's no effect on any of these things and so
45:53
Speaker 1: but also no effect in the other direction.
45:57
Speaker 2: Yeah, there are some observational studies to which are interesting
46:01
Speaker 2: that correlate creatine and hair loss, and we always love
46:04
Speaker 2: to talk about confounders, which are like third variables that
46:08
Speaker 2: explain and observed association. And there are a couple of
46:13
Speaker 2: things here I can speak from personal experience. One is
46:16
Speaker 2: that as men age and start to worry about their
46:21
Speaker 2: like muscles and you know, have a little more time
46:24
Speaker 2: maybe after the kids are older, to go to the
46:26
Speaker 2: gym and start taking creating, is also the age in
46:28
Speaker 2: their life when like, the hair is not as thick
46:31
Speaker 2: as it used to be. And then in the slightly
46:33
Speaker 2: more sinister side. You know, creatine is used extensively in
46:36
Speaker 2: the bodybuilding community, and there are other substances that are
46:39
Speaker 2: used rather extensively in the bodybuilding community that certainly do
46:44
Speaker 2: result in hair loss, like the androgenic steroids. So that's
46:48
Speaker 2: another thing that is often not disclosed when taking a
46:52
Speaker 2: survey about your supplement use and your hair loss.
46:55
Speaker 1: Indeed, all right, I think that's it for creatine. Let's
47:00
Speaker 1: do the smasher pass, Perry, smash your pass on the creatine.
47:04
Speaker 2: So full disclosure, smash. I take my five grams of
47:09
Speaker 2: creatine in gummy form a day, and I'm gonna just
47:14
Speaker 2: whether it's placebo or not. I take it. I go
47:17
Speaker 2: to the gym, and I'm doing it for muscle. And
47:20
Speaker 2: if it helps my memory, that's great, but I'm not
47:23
Speaker 2: sure that it does. Emily Smasher pass smash.
47:27
Speaker 1: I also take my creatine every day. I even got
47:29
Speaker 1: my husband to take it. It's the only weird supplement
47:31
Speaker 1: thing I managed to encourage him to do. And yeah,
47:36
Speaker 1: I tend to take it in powder form, five grams
47:40
Speaker 1: a day. And I also am feeling I'm maybe relying
47:44
Speaker 1: on the placebo effect.
47:45
Speaker 3: But it's totally fine.
47:46
Speaker 2: Okay, I try powder form. How do you what? Do
47:49
Speaker 2: you put it in hot water? Just a cup of
47:52
Speaker 2: hot water? Doesn't it taste gross?
47:53
Speaker 6: No?
47:54
Speaker 1: I don't think it tastes bad. The I understand some
47:56
Speaker 1: people feel this way. I the creatine that I typically consume,
48:00
Speaker 1: which is thorn creatine.
48:02
Speaker 3: Does not taste bad. I don't think it tastes like anything.
48:04
Speaker 2: To me. It tastes super bitter. I get the whatever
48:06
Speaker 2: they sell at Costco because not an ad, by the way,
48:10
Speaker 2: but Costco. If you're listening, I love you. I get
48:14
Speaker 2: whatever they sell there, but it is very bitter. And
48:17
Speaker 2: I used to put it in my coffee and then
48:19
Speaker 2: I like missed the fact.
48:20
Speaker 3: That I enjoyed it, and it makes your coffee sad.
48:23
Speaker 2: Yeah. Yeah, And I don't like sad coffee. I like
48:24
Speaker 2: happy coffee. So I'm on gummies.
48:27
Speaker 1: I will say these Creatine, these Creatina gummies are actually
48:29
Speaker 1: really delicious. Also not an ad, but they are they
48:33
Speaker 1: are good. So if you don't like the way the
48:34
Speaker 1: powder tastes, I recommend gummies.
48:36
Speaker 2: All right, after the break, we will get to your
48:39
Speaker 2: question of the week.
48:46
Speaker 4: Hi, Emily and Perry.
48:47
Speaker 7: This is Elizabeth from Boston. So as my elder millennial
48:52
Speaker 7: heart is mourning, James Vanderbeek, I'm realizing that I should
48:57
Speaker 7: be close to scheduling my first COLONOLS could be I'm
49:00
Speaker 7: forty two. Is it time yet?
49:03
Speaker 6: Thanks?
49:04
Speaker 1: So, the recommendation is to start for somebody with sort
49:07
Speaker 1: of typical risk factors is to have a first colonoscoby
49:10
Speaker 1: or a first colon cancer screening at forty five. So
49:14
Speaker 1: that is the standard age. So if you are forty five,
49:18
Speaker 1: now is the time. If you are younger than forty
49:21
Speaker 1: five and you have significant risk factors, that could be
49:24
Speaker 1: the time, but you really do want to start this,
49:26
Speaker 1: I mean colon cancer screening is not as bad as
49:30
Speaker 1: you think. You can talk more about that if you want,
49:33
Speaker 1: but it is.
49:34
Speaker 2: It's great. I'm going to go. I'm going to go.
49:36
Speaker 3: Really I also thought it was great. Okay, I actually
49:38
Speaker 3: thought all is awe.
49:42
Speaker 1: Just to be clear, when you have a colonoscopy, like
49:45
Speaker 1: a lot of I think a lot of people find
49:47
Speaker 1: this very scary. But the procedure, the worst part of
49:51
Speaker 1: this is you drink some terrible tasting drink and then
49:54
Speaker 1: you poop for a bunch of times.
49:55
Speaker 3: You're actually totally fine.
49:57
Speaker 1: You know, you can't eat that much for a day,
49:59
Speaker 1: and then you go you take this amazing propofol like
50:02
Speaker 1: nap and it's so.
50:04
Speaker 3: Nice, and then they wake you up and you're done, and.
50:06
Speaker 1: Then you go home and take another nap and eat
50:08
Speaker 1: something and it's it's great.
50:10
Speaker 3: Yeah, right, it's great.
50:12
Speaker 2: Nothing to worry about. Forty five For people of average risk,
50:17
Speaker 2: talk to your doctor. If you're at higher risk, if
50:19
Speaker 2: you had a family member that colon cancer, you should
50:21
Speaker 2: start screening ten years before the age that they were diagnosed,
50:25
Speaker 2: or if you have other high risk factors. The recommendation
50:27
Speaker 2: is age forty. Colon cancer is occurring with increasing incidents
50:32
Speaker 2: in younger people. That is something we'll talk about in
50:35
Speaker 2: some more detail in the future, but yeah, get it done.
50:39
Speaker 1: And I will say that when you are forty five,
50:41
Speaker 1: many people face a choice about getting a colonoscopy or
50:45
Speaker 1: using coli Guard, which is a system where you poop
50:48
Speaker 1: in a box and you send it off and it
50:50
Speaker 1: tests for markers that could be associated with they could
50:53
Speaker 1: predict colon cancer. Coli Guard is very good at detecting
50:57
Speaker 1: colon cancer and advanced at Noma's kolonoscopy is better at
51:03
Speaker 1: is much better at sort of earlier stage stuff, and
51:06
Speaker 1: so it's a little bit of a trade off for people,
51:08
Speaker 1: depending on your risk factors. One thing I think many
51:11
Speaker 1: people are not aware of I will just say is
51:13
Speaker 1: if you do the colon guard and you screen positive,
51:16
Speaker 1: your insurance may actually not cover the colonoscopy afterwards.
51:20
Speaker 3: And so that is something to find out before you
51:22
Speaker 3: do this.
51:23
Speaker 1: It's like a weird thing about diagnostic versus screening, and
51:26
Speaker 1: so that is true for some insurances.
51:29
Speaker 2: Oh interesting, and cold guard you have to do every year.
51:33
Speaker 1: Color Guard you have to do every year, and colonoscopy
51:35
Speaker 1: if everything is good in principle, you could go ten
51:38
Speaker 1: years between them. All right, that's it for us today.
51:43
Speaker 1: Stick with us next week when we will ask what's
51:45
Speaker 1: the deal with protein? Wellness Actually is produced in association
51:50
Speaker 1: with iHeartMedia.
51:51
Speaker 3: Our senior producer is Tamar Avishai.
51:54
Speaker 1: Our executive producer at iHeart is Jennifer Bassett. Our theme
51:57
Speaker 1: music is by Eric Deutsch and our our content is
52:00
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52:20
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52:22
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52:24
Speaker 3: We'll let the influencers have the last word.
52:26
Speaker 8: As gues, we know we have more than twenty flavors
52:28
Speaker 8: of creatin if we don't know what flavor to pick,
52:30
Speaker 8: here are the top five flavors from the last thirty days.
52:33
Speaker 8: At number one, as usual, we have ink Lemonade. At
52:36
Speaker 8: number two, we have puckin Blures. If you like sour flavors,
52:39
Speaker 8: you are good to love this one. At number three,
52:41
Speaker 8: we have pinat Pada at number four, we have Raspberry watermelone.
52:44
Speaker 8: At number five, we have Glacier Gummy. There's a new
52:47
Speaker 8: flavor on the way which mimics the White Monster Energy drink,
52:50
Speaker 8: and I cannot wait for that one to go live.