Mini Mikkipedia - The benefits and effects of creatine

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Hey everyone, Mikki here. You're listening to Mikkipedia, and it's a mini, cause it's Monday. This Monday, I just want to address a couple of creatine pros and cons. So we have spoken to Professor Darren Kando on the podcast before. He is one of the most prolific researchers in the creatine space, and him and his research team seem to be continuously publishing papers.

showing its effectiveness in that health and longevity space and health span space, which is really awesome. And today I want to just go over a couple of the misconceptions around creating that I get asked about a lot because people are aware that I promote it as a recommended supplement for pretty much everyone.

with a caveat and I'll discuss the caveat in a minute because there is so much research to suggest that it is beneficial for health and performance alike. But there are some considerations or some concerns that people have around taking it. So they're a little bit wary of it, particularly women, I would say. And so I did just want to go over some of the common myths that might stop you from taking creatine.

I don't know, not twist your arm, because you can take whatever you like or not. Supplements are an added cost and they are a supplement to your diet, so I would not want you to spend money on something like creatine if it means that you are taking away money from your food budget or anything. But if you were wanting to know what could be best bang for your buck from a longevity sort of health and performance perspective, I would say creatine is up there.

It is actually up there with caffeine as one of the most well-researched and well-known ergogenic aids or performance aids. Caffeine also actually has some significant health benefits as well, which we will probably address in another mini-micropedia, though it does feature today also. For reference, I would encourage listeners to go back and listen to the episode that I did with Professor Darren Kando, which was around this time last year.

So I'll pop a link to that in the show notes. But ultimately creatine is a substance that's found naturally in muscle cells and we get it from the muscle meat of animals as well. It helps our muscles produce energy during heavy lifting or high intensity exercise and it works on an antioxidant basis as well. And it's been super popular in bodybuilding and in rugby union.

you know, for 30 years and that's, that was my introduction to creatine actually. I didn't take it at the time but I had friends that took it when we were at university and they would load up their creatine monohydrate, they would do five days of about 20 grams of creatine, they would have it with 50 grams of carbohydrate and they would cycle on and offer it for its performance benefits. Now our understanding of how to use creatine has changed over time.

And with it, I think comes a better understanding of some of the drawbacks or potential drawbacks that people still hold in their heads about creatine and using it. In addition to that, it's worth mentioning that because of course creatine is found in animal protein, you're not going to find it in any vegetarian sources. And this is what makes it a super important supplement to consider if you are vegetarian.

and you don't get that animal protein that you need. The second thing to just remind you, if you're not already familiar, is that because it's found in muscle cells, women naturally have a lower level of creatine available to them, and studies have shown actually that there is an association with lower creatine levels and low mood disorder in women too. So this is one of the reasons why I really recommend it to a lot of people who ask me about it.

because of this sort of association with mood and with depression. This is interestingly not a relationship that has been seen with men, at least not yet anyway. In general though, creatine is found to be beneficial overall for the brain in addition to the body. One of the first questions I want to address with creatine is the idea around water retention for it. So there is this myth, well, not myth, because some people do

get some water retention and therefore if you are on a fat loss plan, you're probably more wary of beginning creatine because it's going to show a change in your scale weight. So this idea that creatine supplementation increases total body water is likely due to early research which showed that creatine supplementation at that loading which I mentioned before the 20 grams a day for six days was associated with water retention and that is

probably the most common adverse side effect of creatine supplementation in that early stage of using it. Studies have found that three days of creatine supplementation increases total body water and extracellular body water and intracellular water as well. And because of these short term responses, there's this notion that creatine increases water retention and it's pretty widely accepted. So the thing with creatine is that it is an osmotically active substance.

So therefore an increase in the body's creatine content could theoretically result in increased water retention. Creatine is taken up into the muscle from circulation by one of the transporters in our body, a sodium dependent creatine transporter. And because that transport involves sodium, water will also be taken up with it. But it is unlikely that this transport mechanism would result in this dramatic increase in intracellular water retention.

And there have been a number of training studies to show that there's been no increase actually in total body water. So for example, resistance trained males who received a dose of about 20 grams a day, followed by a lower dose for four weeks, so that was a seven day loading dose, then four weeks, had no significant change in either intracellular, extracellular or total body water. Similarly, another train resistance training study

found the same thing after just that loading phase for seven days, in that there was no significant increase in total body water, intracellular or extracellular water compartments. The same can be said for a study that involved both men and women who had it at a dose of about, again, that 20 grams per day for five days, followed by about five grams a day for around six weeks. No significant changes.

in total body water. And therefore, overall, when you look at the training studies that look at this question, overall there is a transient increase in total body water if you do the loading phase. However, this is not a universal side effect of creatine. And there are several studies suggesting it doesn't alter total body water relative to muscle mass over longer periods of time.

So it isn't a given that you're going to increase in scale weight. And for what it's worth, it is just scale weight. Like it doesn't mean you've had this increase in fat mass. Therefore, if this is the one reason you're not taking creatine, I would reassess or reevaluate that reason because it's not really a great meaningful reason to have. Now one thing I will, and this is the caveat that I thought I would add in here, I haven't seen any research in this.

So, but clinically speaking, some women do experience a shift in their total body water when they take creatine in their luteal phase. And some women who are experiencing perimenopausal symptoms also notice that they feel like they're retaining a lot more fluid, that their breasts are really swollen and tender, and you know, it's super uncomfortable. So in that

case, my recommendation to you would be to come off creatine for your luteal phase or shift down to a lower dose. So the dosing for creatine is typically at about 3 to 5 grams a day for at least a month to 42 days. It would take about that long to saturate yourselves with creatine, which is what you're trying to achieve. Now if you do have to cycle off creatine,

That's no problem. It just means it'll take you a little bit longer to saturate your cells. But again, I don't see that as being a super big issue. So I would definitely play around with that when it comes to your creatine dosing. And again, the studies don't really show that there's this meaningful increase in body weight, but I do wanna acknowledge that some people do experience it. So it's just.

trying to figure out a way if you're really keen on taking it and you know it is something which most people would probably recommend in my position then play around to see whether you can change the dosing or change the cycle on and off to get the benefits you want without those side effects. I will also say that nowadays it's pretty well acknowledged that there's no requirement for that sort of loading phase of 20 grams a day and that's probably where a

in addition to the idea that you don't actually need to have 50 grams of carbohydrate alongside your creatine monohydrate. And that was, you know, one of the earlier recommendations for taking it, which would have, of course, increased the body's muscle glycogen stores, or at least contributed to that. And with it would have contributed to added scale weight, because for every gram of carbohydrate that you store, you're going to store an additional three to four grams of water. So that's another

reason why some of these earlier trials with that loading phase would have shown that increased in water retention. And for what it's worth I have been taking it for two years now fairly consistently and have never really had any issues with any of that increase in water retention. And this is including sort of coming off it just because I haven't had the supplement with me when I've been away and then jumping back on when I've been back home.

Now another concern that I've had from some clients is what is the impact of creatine on the kidneys and renal dysfunction? In terms of misinformation in sports nutrition, the notion that creatine supplementation leads to kidney damage is perhaps only second to the myth that protein supplementation increases kidney damage and kidney problems. So there has been over 20 years of research demonstrating no adverse effects from recommended

creatine supplements on kidney health, but there is still this concern. And while the origin is unknown, it could well be due to just really a poor understanding of creatine and creatinine metabolism, which is the thing that is measured in your blood tests, both at that population level and in the literature. So in skeletal muscle, both creatine and phosphocreatine are degraded non-enzymatically to creatinine.

which is exported to the blood and excreted in the urine. Healthy kidneys filter creatinine, which would otherwise increase in the blood. Therefore, blood creatinine levels can be used as a proxy marker of kidney function. However, the amount of creatinine in the blood is related to muscle mass. Therefore, if you have a higher muscle mass, you're going to have a higher level of blood creatinine. And both blood and urinary creatinine

might be increased by ingestion of creatine supplementation and creatine containing foods such as meat, as I just talked about. So there does appear to be this unsubstantiated perspective that if the kidneys are forced to excrete higher than normal levels of creatine or creatinine, this must be some sort of kidney overload and this might cause kidney damage or renal dysfunction.

transient increases in blood or urinary creatine or creatinine due to creatine supplementation Unlikely to reflect a decrease in kidney function And you really just got to be cautious to sort of interpret blood creatinine readings When you're dealing with anyone who has a higher level of muscle mass, which hopefully is everyone I'm speaking to on this podcast or who has a higher protein intake and finally just

There has actually been a review looking at creating supplementation and creatinine levels for anyone who is still like mildly concerned about this. Of 12 studies, 8 did show an increase but it remained within normal range and only 2 studies showed an increase above normal limits. But in one of these studies it wasn't different from a control study. So overall we...

can pretty much say that just like higher protein intakes do not result in increased kidney dysfunction or kidney problems, neither does creatine. And blood creatinine levels that you get from the doctor is not at all really reflective of kidney problems for anyone who has a higher muscle mass or who has a higher protein intake. So you do not need to worry about creatine ruining your kidneys. Another thing which might concern

endurance athletes is this idea that creatine leads to dehydration and muscle cramping. Because there is speculation that it does in fact, and even in the early 2000s there was limited data and it was based primarily on speculation, the American College of Sports Medicine did no favors in this regard, recommended that athletes controlling their weight and exercising intensely or in hot environments should avoid the use of creatine supplementation.

So the physiological rationale suggests that creatine supplementation may cause dehydration based on a premise that creatine is, as I've said, an osmotically active substance found primarily in skeletal muscle, and it might alter whole body fluid distribution by preferentially increasing intracellular water uptake and retention, particularly over the short term, which we've already discussed.

And in situations of body water loss, such as severe sweating from exercise, you know, prolonged exercise or increased environmental temperature, the bound intracellular fluid in theory might be detrimental to thermal regulation and lead to this extracellular dehydration, electrolyte imbalance and muscle cramping or other heat related musculoskeletal issues. So this was, as I said, sort of based on incomplete data. And

That initial loading phase of creatine does typically result, as I've said, in potentially a 1-3 kg increase in body mass, mostly attributable to net body water retention in some individuals. And there was survey-based research which reported that out of 219 athletes, 90 participants reported using creatine, and 34% of them reported perceived negative effects such as cramping.

This was the basis for that American College of Sports Medicine recommendation. And there were a couple of other studies, similarly these self-reported survey data that did have a not insignificant percentage of participants say that they reported signs and symptoms of muscle cramping and dehydration. However, what is important to note is that these studies, such as the two that I've

failed to control for the use of other supplements and the dosage of creatine ingested. For example, the first study that I mentioned noted that 91% of participants who used creatine exceeded the recommended maintenance dose of 5 grams a day. Remember, creatine 3-5 grams a day is what you're shooting for. And potentially more important is that these self-report studies actually contradict experimental and clinical evidence.

So when injury rates were monitored and environmental conditions were hot and humid, participants in a clinical trial chose to receive that loading dose that we've talked about or a sports drink placebo across five days, across the whole entire football season. And across the season, creatine users had significantly less cramping.

less heat illnesses and less dehydration, muscle tightness, muscle strains and total injuries compared to non-users. So therefore this chronic use of creatine, one could argue, almost protected the users against this heat illness and dehydration and cramping. So worth noting, non-contact joint injuries and injuries, etc. were really not that different between the groups. And then if we move from the sports field to a clinical setting,

Hemodialysis patients who frequently reported muscle cramping were provided creatine, 12 grams, five minutes prior to hemodialysis, and the creatine supplementation actually reduced the frequency of symptomatic muscle cramping by 60%. So this really sort of flies in the face of that American College of Sports Medicine recommendation that we need to be mindful of creating from a cramping perspective and dehydration. And in fact,

Potentially these beneficial effects from creatine could even be explained by that fluid distribution and electrolyte imbalance as previously discussed. So in summary whilst survey analysis reports might suggest that creatine supplementation was detrimental to hydration and could potentially lead to muscle cramps, when studied in clinical and field trials this was found to not be the case. So you don't need to worry about that.

And again, the reason why I'm suggesting or even mentioning this is because these are some of the objections I get for when I talk about using creatine. And one of the last myths is, can you take creatine with caffeine? You know, are they going to cancel each other out? Do they work in opposition to each other? There is the potential actually for like, theoretically you could consider that caffeine,

Caffeine works to antagonize adenosine and it does have peripheral effects on sodium potassium pumps, metabolism, muscle function, etc. But it does lead to this performance improvement. Whereas creatine works by facilitating ATP resynthesis, helps to sort of buffer the pH, helps with anabolic signaling, etc. These are the mechanisms with which it impacts performance.

but it also creatine reduces muscle relaxation time, caffeine increases muscle relaxation time. So it seems like together, they could actually work synergistically really well, but what we do know is that if you high dose caffeine and you high dose creatine together, caffeine blunts that sort of performance benefit of that high dose creatine loading. As it stands right now, more research probably needs to be conducted in this space,

sort of thought leaders in the field tend to think that some of these earlier studies probably just used two high doses of both. And if you have a high dose of creatine and a high dose of caffeine together, you've got much more likelihood of that sort of GI distress. And anyone who's ever had any gastric issues, which let's face it, as most of us, know that you can't really perform at your sort of peak if you've got any sort of GI performance sort of problems going on.

And so the most likely explanation at this point is that the studies that showed some sort of blunting effect of the creatine probably just had too high dose of either caffeine or alongside the creatine and therefore that was going to impact on any performance outcome of that study. So for the most part now there's no real issue with that. And if you look at some of the you know pre-workouts out there like

uh, Musashi, I believe might have some creatine in it and definitely has caffeine. These are quite low doses. So the caffeine would be at a lower dose at around that three grams, three milligrams per kg body weight, rather than at the upper end. And the creatine might be about five grams. You know, it's, if you are trying to sort of load on creatine, then that's where you could get some potential issues. So, you know, long story short, I wouldn't worry about it to be honest until, until such.

that research comes out to show that is gonna be detrimental. Two things to finish up, creatine in both bone health, that is also a thing and this is another reason to take creatine and it's been found that, particularly in older adults, so this is not just for your bodybuilders and your athletes, you should get your grandma on creatine and get her in the gym because resistance training plus creatine helps protect bone and bone mass and reduce down that bone resorption.

And this is incredibly beneficial for older adults and helping optimize sort of life in the old age and independence and functionality and mobility and all of that stuff. But don't leave it until you're old, you know, do it now. And as I said, that dosing, you want three to five grams of creatine a day, potentially cycle off it for your luteal phase if required, no need to cycle off it otherwise.

A creatine monohydrate is what you want. And that is like the cheapest thing on the market. Actually, when it comes to creatine, you don't need to pay any more than, um, you know, for some, you know, other form of creatine, because the majority of the studies have been done on this real stock standard stuff. So, you know, out of all the cost-effective sort of supplements, I would say this would definitely be one of them. And I guess at the end of the day, don't even worry about.

the idea of weight gain or anything like that because it shouldn't be a concern. Creatine is super, you know, has the potential to be beneficial for bone health and brain health, largely free of side effects and healthy people other than that GI distress, which you can avoid from, you know, just doing smaller doses. And I just say, get on it basically. Anyway, that's creatine. Some myths, some things to think about. And if you're not on it, you should be.

It is Monday, hopefully you're having a great one. You can catch me over on Twitter, @mikkiwilliden, Instagram @mikkiwilliden, Facebook @mikkiwillidennutrition, or head to my website,, book a one-on-one call with me, or sign up to one of my meal plans. Oh, yeah, so I've also joined threads as well. No idea what I'm gonna do with that one, if I'm even gonna use it, but if you're on, let me know. All right guys, have a great week.