Your Lifestyle Is Your Medicine
“Your Life Style Is Your Medicine” is a podcast that focuses on how a person's lifestyle can be the key to health and happiness. Routed in the principles of lifestyle medicine, Ed Paget, osteopath, and exercise scientist, interviews area-specific experts on how lifestyle impacts well-being, focusing on purpose, physical activity, nutrition, sleep, and stress, which could lead to a longer, happier life. Edward now runs immersive lifestyle medicine retreats, with the purpose of helping others take back control of their lives to live longer and healthier.
Your Lifestyle Is Your Medicine
Episode 37: Is Creatine only beneficial for Bodybuilders? with Darren Candow, Ph.D.
Ever wondered how something as simple as a supplement could potentially transform your brain's recovery from injury or even aid in the combat against long COVID-19’s after-effects? In today’s episode, Dr. Candow offers compelling insights into the research backing creatine's ability to support cognitive function during physically demanding activities and its promising anti-inflammatory properties.
Dr. Candow is the Professor and Director of the Aging Muscle and Bone Health Laboratory in the Faculty of Kinesiology and Health Studies at the University of Regina, Canada. His work focuses primarily on developing effective lifestyle interventions involving nutrition (primarily creatine monohydrate) and physical activity (resistance training). With an internationally renowned research program and over 125 peer-reviewed journal manuscripts, you’ll want to hear what he has to say.
But how safe is creatine, really? We tackle the myths and truths head-on, dispelling fears and affirming its safety profile with evidence-based confidence. Postmenopausal women take note – Dr. Candow shares groundbreaking findings on how combining creatine with exercise might just be the key to preserving muscle mass and bone density. For our aging listeners or those on plant-based diets, discover how the strategic pairing of creatine and protein might revolutionize your approach to maintaining strength and vitality.
This episode promises an enlightening journey through the storied history and multifaceted benefits of creatine monohydrate, the star player in cellular energy. Tune in to understand why this supplement might just be the unsung hero of your wellness routine.
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Watch the video of this episode on YouTube
Welcome to the your Lifestyle is your Medicine podcast, where we do deep dives and topics of mind, body and spirit. Through these conversations you'll hear practical advice and effective strategies to improve your health and ultimately add health span to your lifespan. I'm Ed Padgett. I'm an osteopath and exercise physiologist with a special interest in longevity.
Speaker 1:Today's guest is Professor Darren Koundler, one of the world's leading authorities on creatine. He is the director of the Aging and Bone Health Laboratory in the Faculty of Canadian Knowledge and Health Sciences at the University of Regina, which is in Canada, and the overall objectives of Dr Koundler's research is to develop effective lifestyle interventions that involve nutrition, which is primarily creatine in his case, and physical activity, which is primarily resistance, training or moving weights, and he wants to create practical and clinically relevant strategies for helping reduce the risk of falls and fractures and increasing muscle as people age. So he's produced about 130 peer-reviewed studies and his work has been cited by literally thousands of different people all over the world. So in other words, he knows a thing or two about the science and the evidence base behind supplementation. So, darren, welcome to the show, thank you so much for having me excited to be here.
Speaker 1:Well, I'm excited for you to be here as well, because from my research, there is nothing you don't know about creatine. So you're the guy and I'm really, I'm really excited to be here on the show to help me understand creatine better and also to help my audience understand creatine better. So let's start by framing this with what is creatine and where does it come from in our natural environment?
Speaker 2:Yeah, well, first off, creatine was discovered way back in 1832. But I think when people hear the word creatine they think of a supplement like a powder or a candy. But a lot of people don't know we naturally produce this every day in our body, primarily in reactions, in the kidneys and liver, and we also produce it in the brain. So we're producing about one to three grams a day. But we also can't consume this compound. It's an organic acid. It's really made up of three amino acids that we get from all types of protein food sources and that's why it's found in higher concentrations in animal based protein, such as red meat, seafood or poultry.
Speaker 2:And, of course, I think most of us are very familiar with the dietary supplement creatine. Those are the three areas and essentially it just aids in maintaining energy within ourselves. So when we're performing weight training, shoveling the driveway, you know, cycling, atp or adenosine triphosphate is our energy in ourselves that prevent us from getting tired, and creatine sort of helps maintain or extends our energy capacity of our cell. So oftentimes you'll hear a lot of athletes who take creatine say they can exercise a little bit more intensely, a little bit longer, and now we're starting to see an increase in recovery, and then that's primarily where creatine got its momentum. But now we'll talk about probably over the next hour about the health benefits where it's really sort of pivoted from athletes to pretty much anybody on the planet now.
Speaker 1:Exactly. Yeah, I first heard about creatine back in the 90s when I was interested in sort of bulking up a little bit and I remember me and my buddy were sort of taking creatine and thinking we were almost taking up performance enhancing drugs. We didn't really know what it was Right, so that was. I think back then it was creatine monohydrate. It's still. That's still the one that's recommended. Is that correct?
Speaker 2:It is. It's monohydrate is basically creatine linked to water and when you digest it, the water molecule, as we all know, will just dissolve in the stomach and then that creatine molecule is identical to what's being produced naturally. So that's why creatine safety is so high and its efficacy or effectiveness, but monohydrate is the one that's the most safest and most effective. There's other forms of marketed and I use that term marketed First off, it has to be creatine, but at the end of the day, all these derivatives have never been shown to be better. So I think, if someone is considering creatine, always think of monohydrate, and that's probably one of the most important things to consider.
Speaker 1:It occurs naturally in our bodies. It's made within our bodies. We can get it from a food source. So how is it made and put into a bottle where people would buy that in a store?
Speaker 2:Yeah, interestingly it's a multi-factorial process. Creatine is actually not even involved in the creation of the molecule that you get as a powder or whichever. But Germany is the leaders in the world that have an amazing production plant in Lausland, Germany, and other areas that sort of create the product called CREA-P here. So it's been third-party tested. It has high purity. So it's an interesting chemical process, just like anything else that's process. But most of the CREA-Team-based products that you find are vegan-based. They're based on reactions from those amino acids in our body, but the processing actually doesn't usually use creatine as a reagent.
Speaker 1:So this is okay for vegans to take a creatine monohydrate because it's not source from animal products.
Speaker 2:Yeah, if you're a vegan or vegetarian or even emphasizing a plant-based diet, most reputable companies will actually have that right on the label. Of course, just as important, you need to make sure it's third-party tested or certified safe, especially for athletes. You know the Olympics are coming up in Paris. You don't want to be taking a compound that may have an illicit or banned substance, but for the most part it's all vegan-based. There's no animal-based products or processes involved in the higher quality. Now, if the product doesn't list that, I'd be very suspect. I think you can just do a little bit more work, and monohydrate is well established around the world. A lot of different companies will do that, just primarily based on the evidence suggesting that it's extremely safe and effective for certain recommendations and populations.
Speaker 1:And if someone has bought a product that's not creatine monohydrate, does that work differently? Are all creatine products equal or is there a difference?
Speaker 2:In theory they shouldn't be equal if the molecule is different. But at the end of the day, our doorways to our muscle and brain and bone are very specific to creatine. It's a specific transporter or doorway. So if the creatine molecule looks different, there's high probability it will not get taken into the cells that you're hoping for and if anything, it may just be degraded down the toilet when you urinate. So at the end of the day, whatever marketing form of creatine you're taking, it has to get taken into the body as creatine and that's why we only focus on monohydrate.
Speaker 1:Okay, I understand. So, going back to something you said earlier, it actually helps with the energy production within the cell that will be in the mitochondria, I'm guessing.
Speaker 2:It actually helps in the cytosol or the watery meeting of the cell, but it also can enhance the shuttling of ATP that's being produced in the mitochondria to the cytosol, where all those precious proteins such as actin and myosin are involved, the sarcoplasm in particular for calcium. So anywhere the cell needs energy, also known as ATP, creatine is in high proximity to basically help say, hey, I'm going to donate a phosphate group to maintain ATP during muscle contraction. So there's a lot of areas of that cell that are highly involved during sprinting, weight training, and creatine just basically enhances the energy capacity. So a lot of times people say I could do a few more repetitions, I can exercise at a higher VO2 max, I can. Whatever it is, they just seem to have an improvement in performance. And if you do that weeks on end, that's usually where we start to get a network of parents on either body composition or how you're feeling, or strength and things like that.
Speaker 1:Okay. So this is interesting Because I think some people are under the impression that creatine somehow produces more muscle. They don't do that right. It only does that if you stimulate the muscle and it allows you to stimulate the muscle more.
Speaker 2:Yeah, so this is a perfect segue. So there's been a handful of studies that have just given creatine to people who don't exercise and this is primarily in older adults because, you could argue, maybe they don't have enough creatine in their diet, maybe they're losing muscle fibers. But there's been a handful of studies to suggest that older adults, about 50 and above, who take creatine by itself will have some improvements in muscle performance. You definitely get that in young adults as well, when you primarily don't do exercise. From a muscle performance perspective, creatine has never been shown to increase the rates of protein synthesis, and you need protein synthesis to put on muscle mass. But there's about 10 other purportive mechanisms that sort of come together. It's kind of like pieces of the puzzle which probably explain why people often do get an increase in muscle mass with creatine. But to your point, it's highly likely it has to be in combination with weight training, so it kind of allows the person to do more work to build bigger muscles.
Speaker 1:Okay, can you tell us then a little bit more about those studies with a slightly older population where they didn't do exercise? You said there was a performance gain in the muscles. What does that mean?
Speaker 2:Yes. So when individuals typically either took a high dose of creatine or a lower dose for longer periods of time, they would measure strength, endurance and power and agility. And more studies than not have shown that when individuals will take creatine without an exercise regimen, in the study there's been some evidence to suggest it has improvements from a muscle strength endurance perspective. Unfortunately, there's never been a study showing that creatine by itself has improved aspects of bone health, but there have been a few studies to show creatine by itself have been able to improve aspects of brain health.
Speaker 1:Now is there a study that shows where a person is using their brain. Let's say they're learning a language, learning an instrument, something like that, and supplementing with creatine so it enhances cognitive effects the same way it would do with the muscles?
Speaker 2:Yeah, that's an excellent segue. So it's changed within the last probably a year, with new studies coming out. So let's start with the population that's not stressed. If you have a young, healthy individual, adequate sleep, excellent diet, and if you're taking creatine for the cognitive effects, expect nothing, because your brain is healthy. It already has enough creatine. Remember, the brain, unlike muscle, will make its own creatine and it also has to protect the blood-brain barrier, so it really is picky to what lets it in. So if the brain is not metabolically stressed, it already has enough.
Speaker 2:However, sleep deprivation, long flights to Europe, jet lag, hypoxia or aging, those have a common denominator that the brain is metabolically stressed. The brain uses ATP or energy, just like our muscle. So that's why the best small body of evidence is suggesting that creatine has some favorable effects when the brain is stressed. So it has been shown to improve memory and cognition in older adults. It's been shown decreased symptoms of sleep deprivation in younger adults. It even has improvements in concussion in children, although that's in its infancy. So at the end of the day, I think if the brain is metabolically stressed, that's where creatine can be considered to sort of overcompensate for those decrements.
Speaker 1:Let's talk a little bit more about the concussions. We had a podcast my last one with Dr Perry Maynard. He's a chiropractic neurologist. He mentioned a study where the amount of creatine in a person's brain decreases through a season of football, depending on how many concussion or head trauma as they have, how many concussions they've had. So at the beginning there's lots of creatine and at the end there's less creatine. The conclusions that they were talking about is that maybe young athletes should supplement with creatine because it's something to do with concussions, but they don't know what. Is there more to it than that?
Speaker 2:Well, that's 100% sound theory. So the idea is that you know our brain is. It takes about 2% of our body weight but it uses 25 or 20 to 25% of our energy. So athletes with head trauma common denominator, just like clinical depression or neurological diseases they have a reduction in brain creatine. So that's why we think when the brain is compromised and we have a paper coming out on long COVID, the same theory there is that they respond very well because the brain is almost begging, saying we're not producing enough, we need more. So that's why those clinical populations that have a reduction in brain creatine, from impaired brain creatine bio-energetics will probably respond better.
Speaker 2:So immediately we always think of concussion. As soon as you get head trauma and repeated concussions, the brain has tons of inflammation and oxidative stress and that's why the theory is that creatine may be a strategy not to prevent concussion but maybe speed up aspects of recovery. And that has been clearly shown in children. It hasn't been shown in adults, it's definitely been shown in rodents. But here's the big issue To totally conclude that creatine is effective, you would have to randomize probably 200 individuals before the season, half with the creatine, half placebo, and then, ironically, you have to wait around and hope they get a concussion with ethically is gonna be an issue at research institutes, so that's kind of why the study has never been done.
Speaker 2:It might have to be a multi-country, multi-institution event to try to get enough people to show. Can it improve symptoms of recovery in adults or individuals involved in head trauma? At the end of the day, we're not seeing any reason why they can't and, based on the potential, it may be a good idea if you're involved in football, hockey, soccer, where head trauma or concussion is there, to take creatine beforehand. God forbid. If you do get a head trauma, it may speed up your ability to recover.
Speaker 1:We interviewed Dr Tommy Woodshews Do you know, tommy Wood? And he talked about potentially the general population supplementing with creatine, because you don't know if and when you're gonna get a concussion, slip on ice, being a car crash and so on, and the athletes who are more likely to get a concussion should definitely supplement with the creatine.
Speaker 2:Yeah, and that's my personal philosophy. I take probably a higher dose than what most people do, based on the muscle, bone and brain and all three of those. As you get older you start to lose the functionality and the amount of tissue you have and creatine has been shown to sort of have some anti-catabolic effects and it has some beneficial effects. So if you look at all three areas of the body and the other one never gets talked about is the immune system the anti-inflammatory responses from creatine are really emerging and I can attest to this at 47. So after the fourth decade there's a lot more inflammation. I can't do as heavy weight as I used to. I definitely don't recover as much.
Speaker 2:And when you look at the circle painting of research, one of the main causes of muscle loss or inflammation or decreases with age is this low grade inflammation we have in our system and we don't wanna be taking, you know, advol and Tylenol and NSAIDs a lot. Could creatine have some many inflammatory effects? It has a lot of promise shown in rodents and some preliminary data in humans. But it definitely has been shown to decrease inflammation post-long duration or roving exercise and we always thought, hey, why would cardio or endurance athletes take creatine. It now seems to have some recovery aspects, which is kind of an emerging and exciting area.
Speaker 1:This is exciting, exciting for me, because I do supplement with creatine and this weekend I've got an ultramarathon. It's my first one. Yes, up and down, some crazy volcanoes here and I'll be yeah, so okay. Well, this is a little personal for me, but it's very different sort of cycling programs Someone would use if they're going into an endurance event and afterwards.
Speaker 2:Yeah, so the studies that have shown exactly in your area Ironman or Ultramarathon they gave the loading phase five days before the race. Now the potential issue here is, when you do the loading phase, it's 20 grams a day. For about five to seven days you can put on weight and that's net water retention, which is great for you because it's going to decrease the chance of dehydration and muscle cramping. But you don't want to have a huge increase in weight because you got to carry that frame a little bit longer. But at the end of the day, maybe if it's one or two pounds or even a little bit more, that's going to be okay, especially with the high sweat rate. But when you're finished the race, you should expect from the evidence that's out there is that you have a decrease in inflammation compared to if you didn't take creatine. So what that means is maybe you're going to recover a few days quicker after the marathon or long duration race and then get back to training a little bit quicker, and that's been shown in a few studies. Okay, interesting.
Speaker 2:And the other big thing that we haven't tested is I am not a runner but I got to imagine you're mentally fatigued near the end of a race or going up a hill. What about the cognitive effects of creatine? And that's why I think that's an area that I think will explode with the upcoming Olympics and down the road, not only from a muscle perspective, but can it allow the athlete to really focus when there's five minutes left in the World Cup? If it's five minutes left in the Stanley Cup final, whatever it is, can they have a greater mental acuity? And I've recently got asked by professional hockey teams in the NHL creatine for performance, but what about the mental aspect and, of course, concussion in the NHL? So that's why there's a huge boom on creatine interest. We're not seeing any downward effects and if there's any potential, I think that's why people are interested in it.
Speaker 1:Well, let's just talk about any potential negative effects, if that's okay. Like you've mentioned that, it's been around for a long time. It's thoroughly studied by you and many people around the world. What are the any negative consequences of taking creatine?
Speaker 2:Yeah, so again, it's the most studied or regenerated, even more than caffeine. There's over a thousand publications on creatine and there's probably two potential negative or adverse things to consider, and it's only every year during the loading phase. So this is 20 grams a day for five to seven days and creatine is osmotic. So what I mean by that is it'll sort of take blood or water from the bloodstream into your cells, which a lot of people like they feel a little bit bigger or stronger, but by doing so you may need to drink a little bit more water to maintain hydration in the blood. That's something called hematocrit. You don't want it to get a little bit higher. So when you do that, sometimes weight will increase. So, depending on your sport or preference, sometimes weight will increase and that only usually lasts about 10 days to maybe two weeks. Every time you do a study from pre to post, usually weight doesn't change at all. So maybe weight gain is gonna be something to consider just during the initial phases and sometimes with a loading phase, you can get GI tract irritation. A lot of people may have some like incidences of diarrhea or stomach cramping because you're taking such a high volume.
Speaker 2:I have some strategies to get around that. I don't know if you need the loading phase for the average person. In fact, we don't recommend that. We talk about a lower dose that I think you can take on a daily basis. And the other thing is maybe split up that dose into more smaller, frequent dosages throughout the day. We've often heard it's a little bit easier on the body. And the third is consume it with food. So if you have yogurt in the morning for breakfast, put a little bit in there. If you have a salad, it's creatine doesn't taste, you can put it in there. Or if you want to drink it. So there's some strategies if you wanna talk about ways to alleviate some of these side effects.
Speaker 1:But at the end of the day, that's it.
Speaker 2:There's no adverse effects on your liver, kidney, cardiovascular system. We don't see any abnormalities or diseases go up, so that's why the safety profile is exceptional.
Speaker 1:And it's produced inside your body anyway, so it's not a that's right. Yeah, you're not introducing something that's not natural.
Speaker 2:And the other big one. I think for a lot of people it does not increase fat mass. We've actually shown it decreases body fat a little bit. But for those that are going to get annual blood work, this is the area of scare tactic. When you take creatine into the muscle or other areas of the body, when it gets broken down and it doesn't get broken down as creatine, it gets broken down to something called creatinine. And for those who are like, oh, I just saw that on my blood requisition form, so you need to tell your doctor that hey, I'm taking creatine, expect that my creatinine levels will be higher. That means your EGIFR will be higher. That does not necessarily mean I've killed my kidneys. All that means is you have more creatinine in the blood from the supplement. It's not indicating that the kidneys are not filtering it correctly. On a PhD, I'm not a medical doctor, but that usually is what happens. But again, if anybody has preexisting kidney or liver abnormalities, it's always warranted to talk to their medical practitioner.
Speaker 1:So it's not stressing the kidneys by having more creatinine in the blood. It's just that there's just more for it to process. Is that right?
Speaker 2:That's correct. Think of it like a brick of filter for water. It's just filtering it out a little bit more. Some people often speculate when they drink a lot more water on creatine, they're urinating more and that makes sense, you're taking in more volume. But actually we've seen people with kidney issues take creatine and their kidneys improve, because actually creatine is an energetic metabolite for the nephron and things like that of the kidneys as well. So we've done a two-year study with a really high dose of creatine in postmenopausal females and found no greater adverse effects on the kidney or liver compared to placebo. So we're very confident, based on the totality of all the studies, that creatine is probably one of the most safest in effect, the vergaetgenic aids.
Speaker 1:Do you do studies on children ethically? Can you do that and are there studies?
Speaker 2:Yeah, so in Canada we can't do anything less than the age of 18 unless you do a special exemption. So we've only ever done 18 years and above and good colleagues in the United States who have clearly been able to do that. And based on the small body of research, creatine at recommended dosages, either 0.1 gram per kilogram or roughly three to five grams a day that's going to be the amount in a salmon steak or a red meat steak it's been shown to be very health or safe and healthy and effective from a sport and health performance. The one thing when I say safe it's subjective. How they're feeling in GI tract irritation. They're currently looking at blood right now to look at liver and kidney, which is crucial. So when I preface it safe, it's safe from a subjective standpoint. I would highly be surprised if they're gonna come back with any side effects because, to your point, we naturally produce it. They're naturally consuming it. That's why it's so safe.
Speaker 2:But I think if anybody's considering the use of creatine in children, I would start as little as three grams a day and I would even divide that up into two 1.5 dosages, one in the morning, one in the evening and see how they react. Again, with a child. It's always good to talk to your medical practitioner with that as well. The dose really doesn't change as we progress in the teenage years and then young adulthood. You can go one of three ways. We've already talked about the loading phase. I think that's just really for the athletes the world champion athletes coming up. I don't really know if anybody, the average individual, needs that. Again, you can take three to five grams a day for the rest of your life and it's gonna be very effective.
Speaker 2:We do a little bit different in our lab. We kind of base it more on the relative dose of the person, because we theorize that the larger the person is, they have a greater capacity to store and have a greater creatine update. So we do typically 0.1 grams of creatine per kilogram. So if you're 70 kilograms you get seven grams a day. If you're 100 kilograms you get 10 grams a day. We have given that in one bowl of stoves, but you could probably give that up in a multiple smaller dose each.
Speaker 2:And then we look at the aging population and we've actually now shown that a little bit more 0.14 grams per kilogram, or about 10 grams a day on a daily basis has been shown to have some beneficial effects on muscle and bone. So collectively you're not gonna be able to take a separate dose for muscle, a separate dose for bone and of course you can't take a separate dose for brain. At the end of the day, if you're accustomed to creatine and there's no adverse effects, you could probably work your way up to about 10 grams a day. But starting out I think three grams a day is great for a few weeks. See how you feel, work your way up, maybe to five, slowly, work your way up to eight and so on. But taking 15, 20 grams a day for a long period of time I don't think is necessary, even if you're metabolically stressed. So has there been a dosing study to say, hey, my dose is way better than a lower one? No, but we're currently looking at those in our lab.
Speaker 1:Upcoming All right. So going back to the kids, let's say some of my daughters, 13 years old she's. The sleep is changing a little bit as she's getting to her teenage years. The work she's doing at school is getting harder, physically pushing herself a little bit. What benefits would creatine supplementation have on a person like that, on a child like that?
Speaker 2:Yeah, so definitely for agility, balance and things like that coordination. It's basically what enhanced her energy capacity of all the cells. And I love your input about studying metabolically stressed, staying up late at night, university students staying up all night that's when the brain is really stressed. Could creatine enhance that? And we have a study that we're gonna be doing in Iowa looking at potential effects of creatine after a really stressful incident and we think of that's like a university student scrambling for an exam getting ready, or individual studying for the MCAT or wherever it is.
Speaker 2:So in your daughter's case or any other child's case, not only would it have potential benefits on cognition or focus and muscle, but the big area that never gets talked about it is what if we were to able improve bone strength and integrity during the pre-adolescent years? That's been hugely correlated to fracture later on in life, just like muscle and fall. So maybe the female or male may have stronger bone and then when they do go through the cessation of estrogen, for the female maybe they might not have a decrement. And that's an area we'd love to do. It's a very expensive study and it's a longitudinal epidemiological study, but that's our new area of interest. What about pre-menopausal females, perimenopause during the transition, compared to post and collaborating or talking about some college in the US on that as well.
Speaker 1:Well, let's go there. I mean that's a great place to go to. So I always look at bone density as a bank. You're putting it in as a child and then postmenopausal, you're kind of taking it out, and how fast you take it out depends on your lifestyle, right? So can creating help with that?
Speaker 2:Yeah. So there's been a few studies, elegantly designed and I'll sort of talk about too. We've done a few and we've clearly shown now that in different populations of postmenopausal females so this was 12 months since the cessation of estrogen or their metrolocytic or longer creatine about eight to 10 grams or eight to 11 grams for up to two years has been shown to preserve aspects of the skeleton, primarily around the hip. So we've shown that individuals on creatine in combination with exercise, they got a reduction in bone mineral loss. Compared to placebo. They also got an improvement in bone strength around the hip region as well. It did also improve lean tissue mass and walking speed. But at the end of the day all we could conclude is that exercise plus creatine sort of preserve the skeleton.
Speaker 2:Now, as to your point, we're losing as we get older. I think it's very important from a clinical perspective to maintain and we even showed a little bit of improvement. But you've got to have exercise there, and the reason I say that is close colleagues of mine who are some of the best researchers in the world in Brazil looked at the effects of one to three grams of creatine a day for up to two years as well, but no exercise and they had no effect on the bone whatsoever. So in conclusion, for anybody that's watching, exercise is going to be the foundation for pretty much anything we know. Supplements can give a little bit extra benefit, but depending on your population and lifestyle, they may get greater improvements depending on that as well. So I always look at vegans and vegetarians. They're not getting any dietary creatine and that's why they respond so well. And can you have a female vegan who is more susceptible to osteoporosis later on in life? That's probably a population where creatine and exercise would be something to at least consider.
Speaker 1:Okay so that's bone, potentially enhancing the effects of exercise. What else would be beneficial for a postmenopausal lady with supplementing creatine?
Speaker 2:So in one of our studies we also measure the incidence of fracture or sorry falls for a year later and there was no difference between placebo or creatine. So you can't say, hey, one improved agility, because it depends. In Canada, with icy roads and things like that, it doesn't matter how much ability. But what we need to do now is sort of go back to this population and look at did this decrease the incidence or rate of fracture? And that's the area that we sort of need to look at. We've now have this population and maybe we touch base in five or 10 years and say, hey, those who took creatine, did that reduce the incidence of fracture? And that's a huge public health concern when it comes to our global healthcare system, because once you get a fracture you're immobilized in activity and that leads to other chronic diseases and, unfortunately, premature mortality.
Speaker 1:Someone described to me sort of mortality is essentially a series of injuries and steps like here's your, here's your vitality and health, and then you sprain ankle, then you hurt your hip and so on, and then the older you get, the more, the quicker, the quicker the demise happens.
Speaker 2:Yeah. So let's start at the most popular sarcopenia, or the age-related reduction in strength, muscle mass and functionality. You know the ability to perform activities, a daily living, and I think that's where creatine has the most evidence. So when creatine is in combination with exercise, it's been clearly shown to improve aspects of muscle mass, lean tissue mass, strength and functionality. So it has an anti-ageing potential for that area. We've just talked about the bone benefits as well, but now we get into other aspects. And it's been shown to improve cognition and memory. In older adults.
Speaker 2:It has been shown to decrease symptoms of depression and anxiety in clinical populations on medication. So I need to make sure people are aware of what I'm saying. I'm never going to show up say, take off your medication if you have clinical depression or anxiety, but in those individuals that just added creatine to their medication or therapy or regiment, it did seem to improve some of the symptoms. So now there's going to be more research. The pioneers in Utah are actually looking at the psychiatry aspects of creatine there. So from the neck up it's becoming very, very popular. I think.
Speaker 2:One of the other areas that never gets a lot of press because it's hard to measure, but we often ask people after they finish the study how do they feel and they say, wow, I can do things around the house a lot easier, carrying groceries, shoveling the driveway. It's hard to put that in a statistical model, to say, hey, creatine, improve your way of life, but you'll often hear people from a self-efficacy or self-esteem aspect go up as well. Again, we're naturally consuming it in the diet or producing it in the body. Exercise has to be foundational. For those who can't exercise bed rest, disuse, atrophy there's been a few studies to show that creatine will maintain strength, so I think it has a lot of promise. If you fracture the limb, if you're an older individual going into a long-term care facility, protein is crucial and creatine is something to consider as well.
Speaker 1:What about special populations? Are there studies with diabetics or autoimmune disease, that kind of thing?
Speaker 2:Yes, so collectively. There's been a few studies in type 2 diabetes and it has been shown to improve glucose disposal. So there's a group now looking at the beneficial effects of creatine, with exercise potentially decreasing symptoms of type 2 diabetes. From a neurophysiological perspective, we had a lot of hope in this area but it really hasn't panned out. There is one study currently going to be going on with Alzheimer's which is massively important. This might be the most important aspect of creatine research in the history of it. That's going to be currently done in the United States. There's not a lot of promise with Parkinson's or Huntington's. Some studies have shown some benefits. But the problem with these studies you need such a large sample size to come up with adequate effect size or statistical significance that sometimes these small studies don't pan out. They're not showing any benefit with multiple sclerosis, but young boys with muscular dystrophy they have. So from a neurophysiological or muscular perspective, there's minimal benefit for the majority. We're not seeing enough evidence in those areas right now.
Speaker 1:What about pregnant ladies? Can they take creatine?
Speaker 2:Yes, it's really a popular emerging area. So before I give an answer, obviously during pregnancy make sure you talk to your medical practitioner. But Stacey Allery in Australia is leading the charge here and it's quite fascinating. It's something we never considered. But when you look at the physiology of fetal development, brain bioenergetics during fetal development and during pregnancy for the female they all seem to be elevated in the presence of energy.
Speaker 2:And creatine has been shown primarily in the animal model. Mice is the most popular model, but there's been a few clinical trials in humans showing that creatine actually has been shown to decrease oxidative stress and inflammation, enhance brain bioenergetics from ischemia and sort of improve the aspects or potential I got to underline word potential for more healthy improvements during birth. So again, we need a lot of studies, a lot of clinical and medical guidance, but there is some potential there. But Stacey Allery, you can Google her name and you'll see all her papers. And, for those interested, we don't know if creatine is transferred to breast milk but there's a theory that it's not. But there's an area of interest anyway. So that's probably just like incontinent or brain, the area around pregnancy and healthy field development or improved birth will be an area of interest for sure.
Speaker 1:So, talking of special populations, can you tell us whether it's been proved to be beneficial with people who have long COVID?
Speaker 2:Yeah. So a good colleague of mine, one of the world's best surgeons in Norway, has a magnet. It's like an MRI for the brain. He's one of the few that do that.
Speaker 2:He's put out a few studies now showing an interesting idea from the brain a healthy brain before we get the long COVID. The most common dose was about 20 grams a day for at least a week, or five grams a day for about several months. And he showed just recently that if you take four grams of creatine for up to six months, not only did it improve muscle in individuals with long COVID but it also did accumulate in the brain and they actually had improvements in sort of cognition, a decrease in headaches and the fogginess. And the theory is that maybe COVID caused the brain, just like depression, to be very sensitive to additional creatine to start the repair process. So God forbid if we ever get another pandemic. But I'm also on another paper with him on the long COVID and we're starting to see a nice collection or emergence that when the brain is compromised and COVID would fall into there, especially long COVID there seems to be some aspects of creating decreasing inflammation by accumulating in the brain.
Speaker 1:What about your other research? So you're, you know, director of the anti sorry, the aging, muscle and bone health faculty. Are you looking at combining creatine with any other supplementation or any other modalities?
Speaker 2:Yeah, so we're we're really focused on does the timing of creatine ingestion matter? And we have a few studies in younger adults are really sort of answer this question. We don't think the timing of creatine really matters. You can take it at any time of the day. But the other area where we're focusing on now is creatine or creatine in combination with weight protein. Could that have some synergistic effects for older adults? The importance of protein in older adults is on parallel, it could a small edition of creatine have effects.
Speaker 2:But the nice thing is, after COVID and the government said, hey, stay home and be inactive, we've come up with a strategy to get people to work at home with supplementation. So now people say you know it's, it's icy roads, I don't have enough financial freedom to buy gym memberships. We're going to provide like exercise kits and supplementation and maybe in the convenience of your own home, in between commercials on TV or whatever. They can still get the benefits. And that's what we're trying to focus on to make exercise nutrition convenient and that. Well, and that's where adherence would go up and maybe that's some of the beneficial ideas. So that's. We have six studies in our lab plan. We're also looking at aspects on brain health as well as bone in the United States.
Speaker 1:And with that supplementation with with way, with the protein. You mentioned how protein is very important as we as we age. Can you talk a little bit more about that, because I think this is a commonly misunderstood area as well, especially with more and more people in the developed world anyway going to more plant based diets and not necessarily understanding their protein requirements. Can you tell us a little bit about that?
Speaker 2:Yeah. So the RDA recommended dietary allowance still 0.8 grams per kilogram a day. That basically means that 98% of the world's population would not suffer a metabolic or chronic health condition. But if you do the quick math, if you're 70 kilograms that's only 56 grams of protein a day. But research study after research, study after research study has clearly shown that as you get older you can utilize more protein because we have sort of a blunt response or ability to take that protein in so many researchers in Canada, europe, united States, worldwide have clearly shown now that more protein, ideally in combination with exercise, has beneficial effects on muscle mass, strength and endurance.
Speaker 2:I would venture. I guess if you're 15 above, the lowest amount you want to be taking is 1.2 gram per kilogram. Ideally, 1.6 seems to be the favorable amount. So that's twice as much as what the governments are recommending. And then when you ask why hasn't it been updated? Well, you need companies to go to the government to pay for them to review the change the label on other products. So at the end of the day, I think doubling the RDA is good. Young individuals can go well past 1.6 grams per kilogram, maybe up to a gram per pound. Will that really translate into more muscle mass? Probably not. The protein is used for pretty much everything in our body, so, embarrassingly, the 0.8 grams is way too low. There's actually some studies to suggest that an older adult is only consuming that. They can develop sarcopenia, which leads into frailty and caxia.
Speaker 1:And what about the nutritional sources of protein? Does that matter?
Speaker 2:It does. Now, animal-based protein dairy or animal has a higher concentration of the essential amino acids and primarily leucine, so that's a very viable and adequate source. Plant-based proteins are excellent as well, but sometimes they lack the amount of essential amino acids that sort of need to be put together and some proteins will lack an amount needed to be almost considered satisfactory. So you can definitely get anabolic effects from plant-based proteins. You just might need to eat a little bit more. So essential amino acids there's nine.
Speaker 2:We just don't produce those in our body, so we require them from the diet. The other 11 are non-essential and we can produce those in our body. So at the end of the day, you need all 20 to come together like Lego blocks to make functional proteins. If you're missing one or two, they're going to be impaired and they'll get degraded. And at the end of the day, for anybody watching that's eating dairy or animal-based proteins, you're getting sufficient essential amino acids. For those that are vegan or plant-based, there's high probability you're getting a lot. You just may need to eat a little bit more to make sure those levels are coming up to adequate levels.
Speaker 1:Is there a common group of those essential amino acids that plant-based people eat? Plant-based proteins? Thank you.
Speaker 2:Usually you have to combine legumes and corn or peas to get the amount of lysine. That's limited, but a lot of times now people that are on a vegan or vegetarian based diet. It's so easy to go online or meet with individuals and combine a bunch of food products. It's high probability to be deficient in those essential amino acids. That would usually be a specific case. So at the end of the day, all someone on a vegan or plant based diet may need to do is just eat a little bit more protein.
Speaker 1:What are the common myths, and can you bust them for us?
Speaker 2:Yeah, there's a lot and we put it a paper a few years ago and we're actually working on part two of this. So the biggest one we I'm looking at you, you're looking at me as baldness that's got originated from South Africa. When we're looking at athletes, let's put them in that category. And when they took a high dose creatine they improved a hormone called DHT, which is a precursor from testosterone, which has been linked, correlated to hair follicle loss. But in that study the range of DHT went up and no measure of hair follicle loss or thinning occurred. So I get this question almost on a daily basis and I always say that there's no direct evidence that creatine causes hair loss.
Speaker 2:The second one does create an increased fat mass. No, it does not. We've shown now that it actually will decrease body fat percentage by a very small amount, but we conclude it has no effect. I think people feel that because if they do the loading phase, the weight will go up on the scale and we're not seeing that. The third is it does not have any detrimental effects on kidney or liver failure or function. We've shown that many, many times over time. The best form of creatine. Nothing has been shown to be better. So again, all these market forms of creatine are not better than monohydrate and it can be pretty much used for any biological sex males or female males, at any age group. It's not a steroid and it's not banned by the ILC. In fact, the ILC list, creatine is one of five with good, safe and effective evidence.
Speaker 1:What's next? What's in the next? You mentioned a couple of studies that are coming from the US, and so on. What are you guys working on in your lab? What's exciting and on the horizon for you?
Speaker 2:Yes, specifically, we're looking at the effects. Can creatine enhance or cognitive ability post stressful incidences? We're also looking at the effects. What about taking creatine on days you don't work out compared to creatine on the days you do work out? And that'll finally answer the question does the timing of creatine really matter? And, as I already talked about the at home exercise in older adults, so we have about six or seven studies currently planned. But from a long term perspective, we're really starting to become interested on the neck up bone health and young females and then the collective body of evidence looking at the effects and circle PNIC adults, those that are predisposed to long term care facility. Can we stop that and rescue the effects?
Speaker 1:Exactly, can we stop them from going into that long?
Speaker 2:term care facility Exactly.
Speaker 1:What about injury, recovery or burns? Has that been looked at at all?
Speaker 2:Yeah, it has some anti-inflammatory or anti-catabolic effects. So from injury, it has some minimal promise for those going into surgery, such as ACL or arthritis. But there's also equivocal evidence to suggest creatine really didn't have the effect there. But there's some minimal benefit from a skin perspective. We don't really see any research in that area of trauma, but that's an area that it could have some potential.
Speaker 1:And gut health with the single cell gut lining.
Speaker 2:Yeah, so that's a. I would say that's a very popular and emerging area. Creatine can get through the GI tract through certain transporters as well, just like probiotics and prebiotics. Them cells and bacteria can use creatine as fuel. So that will be an area. It can't creatine actually improve gut health where a lot of people taking the lowly face say, well, there's something going on there, maybe it's causing a disruption, and that's something that will be coming in the future, I'm sure.
Speaker 2:Yeah, I think for those listening, the question often says do am I absolutely required to take creatine? And of course the answer is no. Unless you're born with a deficiency, you can produce it in the body. You can get it through the diet. If that's challenging, you can consider supplementation. But I think if you have any preexisting medical issues, please talk to your doctor and make sure creatine is right for you.
Speaker 2:Who funds your research? So ideally it's the Canadian government, but it's becoming extremely difficult to get funding. So for the most part we can sort of ask for creatine to be donated, but we're always asking for money. So a lot of our creatine studies you can go unfunded, but that one I talked about for two years it's usually from Canadian governmental agencies that provide funding, very similar in the United States, like the NIH rate in Europe. Funding has gone down quite a bit. It's very difficult and competitive. We submitted a really good application what I thought in the fall but it didn't get funded. So it takes a lot of perseverance, just like going through an undergrad degree or a graduate degree takes a lot of perseverance, but we're very passionate about it, trying to improve the health for individuals, primarily older adults, and we'll keep trying.
Speaker 1:Yes, so I want to ask this you don't have to answer, but let's say someone's listening and they want to help your research what would it cost roughly to fund a study where you can do a double not double blind necessarily, but a good, high quality study that you need to either prove or disprove something to do with creatine?
Speaker 2:Yeah, luckily with the Canadian dollar it's pretty low. I would say you could do a really good study for $20,000. You can do an exceptional one for $50,000. If you go above that, then you're looking at long-term clinical measures and things like that. So sometimes our studies don't cost hardly anything. But I will say the two-year one we did with post-planopausal females cost $600,000. So it really depends on the measures you're looking at. But you can do really low and still be very effective. It's about the quality of the research.
Speaker 1:Excellent. Thank you very much, darren. Thank you, if people want to find out more about you, where would they go and where would they read about your work?
Speaker 2:Yeah, I think the easiest is Instagram. At Dr Darren Candle I try to post about all our research and others, as well as some fascinating things from other researchers as well, and I think it's just a popular area to go through and Twitter as well, but at Dr Darren Candle for both.
Speaker 1:Perfect. Thank you very much for being on the show. Great Thank you. Thank you for joining me in my conversation with Dr Darren. If you've enjoyed listening to and learning from this podcast, please leave a comment and leave a suggestion for a future podcast guest that you would like us to feature at some point in the future. Now, if you're on Apple, you can leave us with a comment and up to a five-star review if you're so inclined. But remember, if you want my direct help, send me an email at edpagetcom or visit my website, edpagetcom, where you can learn a little bit more about how I can help you make your lifestyle your medicine.