Nobody Told You This About Creatine

Can you eat your way to five grams of creatine a day? To reach five grams of creatine from food alone, you would need five times your dietary intake, a steak at lunch, herring, chicken, at dinner, so you sit down to roughly 24 ounces of cooked meat and fish across three males. That's a lot, as opposed to having a single scoop of creatine. Creatine is the raw material that your muscles use to rapidly regenerate ATP. The body's immediate energy currency. Now, it doesn't build muscle by itself. It raises the ceiling on the work that you can do. Creatine is a multiplier on a training plan. Not a replacement for it. You still have to live. You still have to eat adequate protein calories. The powder does not define the effort. By the end of this episode, you will know the facts that pertain to you who should take creatine whether it's safe, the real side effects, and exactly how does it work. Now, there's two myths that deserve direct answers. First, picture this, a jar of white powder on a laboratory bench in Newmarket, England. 50 grams of creatine monohydrate sitting untouched because the biochemists who owned it didn't believe it was worth anything. 15 years earlier, in his own lab, he had tested creatine and found nothing and concluded the human body simply would not absorb it. So this one conclusion froze creatine research for over a decade. The most studied, most proven compound in the history of sports nutrition was, in fact, discovered by accident. In the mid-1980s, the British biochemist Roger Harris was studying muscle metabolism in racehorses. A supplier sent him the wrong compound. What he had actually ordered was karnasine. What arrived was creatine. Eventually, you decided, well, I guess I got to use this up. And not on a person, but on a racehorse. The protocol was simple. Dissolve the creatine in water, deliver it, draw blood over two hours and see whether anything moved. But as we all know, creatine barely dissolves in water and especially cold water. He forced 10 grams into a syringe and a clogged. So he did what any normal scientist would do. He measured a smaller dose, five grams dissolved in water, and he drank it himself. Then he drew his own blood at intervals. And this is kind of not far off from the Barry Marshall story drinking H. Pylori to prove that it caused ulcers. This kind of self-experiment, which is one that I don't necessarily recommend, became the study. The manuscript was rejected by two journals before it landed in 1992 in clinical science. Very small study, 17 subjects, five grams of creatine several times a day, muscle biopsies to measure whether the tissue retained creatine rather than the plasma. And the people who responded most were the ones who started with the least. That summer at the Barcelona Olympics, British athletes were already using it. A supplement that had been unwanted a few years earlier had made its informal debut on the world stage. Now I love this story. And I will come back to what it exposes at the end, but I know that you didn't come here for my stories or history lessons. But by the end of this episode, you will know the facts that pertain to you who should take creatine, whether it's safe, the real side effects, and exactly how does it work? First, what creatine is and what it's not. Creatine is not an anabolic steroid. It is not a stimulant, and it is not a hormone. It's a compound your body already makes from three amino acids, arginine, glycine, and methionine. And one, you already eat every time you have meat or fish. Research indicates high quality creatine monohydrate is recognized as safe by regulators and has been studied at doses well above maintenance for years at a time in populations ranging from infants to the very elderly. So we always have to ask what is the mechanism of action? Creatine is the raw material that your muscles use to rapidly regenerate ATP, the body's immediate energy currency through what is known as the phosphocreatine system. ATP powers muscle contraction, but your stores are small and can be spent within seconds during intense effort. By increasing the creatine stores, which makes a ton of sense in your muscle, supplementation expands the rapid energy reserved. So, like in my morning workout, which was brutal this morning, I can produce high force for a little bit longer before fatigue or nausea set in. Now, there's been a ton of conversation about whether men versus women, whether there are differences. So how does that translate into what I care about and hopefully you care about lean mass? Research points to two routes. The first is water inside the muscle cell. When you supplement, creatine is pulled into muscle and brings water with it. Your muscles look fuller. You might look more jacked, but ladies not that much more jacked. Your scale weight rises and the literature suggests that the cell swelling itself, which I found very interesting, may send an anabolic signal. The second route is training capacity. More phosphocreatine means your fastest energy system recovers faster. So, you can lift heavier and complete more quality reps. Now, over weeks and months, that extra volume, well, certainly adds up. Here's where it gets interesting because men and women respond differently or at least that's what's being suggested in the literature in some regard. In men, the lean masking is meaningful. There's meta-analysis that point to roughly one and a half kilograms of lean mass when creatine is paired with resistance training. Of course, men carry more baseline muscle, more storage capacity, and a hormonal profile that amplifies their response. In women, the average lean masking is smaller on the order of a third of a kilogram. In most studies, that figure is not statistically significant. That doesn't make creatine useless for women quite the contrary. I think that it is very useful. Women still see real strength gains, particularly upper body strength and grip, along with benefits for cognition, mood, and recovery. So, the difference comes down to biology and to the evidence itself, but it could just simply be that men have more muscle tissue to store creatinine. And most creatine research has been done in men. So, the data in women is still catching up, but I think that what we're ultimately going to find is that it is related to a baseline in lean mass. Some groups also respond more than others. Now, there was a period of time where I was vegan, yes, and vegetarian, and vegan vegetarians eat essentially no dietary creatin. So, their baseline muscle stores sit lower. When they supplement, they get a larger jump in muscle, phosphocreatine, and a larger jump in cognitive performance than say someone who's already eating a higher creatine diet. Older adults. Older adults show the greatest phosphocreatine responsible. Aging muscle takes up creatine readily, and when you pair it with resistance training, the literature points to meaningful effects on sarcopenia, bone density, and potential fragility. Sleep deprivation. Sleep deprived people are a newer and smaller story, but I think we're going to start to see more and more research. A single large dose in the range of.35 grams per kilogram, which for a hundred and fifty pound person is a whopping 24 grams. And that partially reversed declines in processing speed during 21 hours without sleep. Sounds like they have a newborn. And with brain energy, metabolites improving on imaging, which is pretty extraordinary. The evidence base is there, but it's still very early. What about people with depression? They might benefit from creatine as an add-on to standard SSRIs. Individual trials show large effect sizes through a meta-analysis, though found only a small to moderate benefit overall. And the evidence quality is low. So hold that up because there's an important caveat in the contraindications, which there are not many. Aging brains more broadly. Five of six studies in adults over 55 found a positive relationship between creatine and cognition, particularly in memory and attention. And now we've been using creatine in soldiers for a long time. And traumatic brain injury, creatine has shown promise in pediatric TBI outcomes and pre-clinical models that support neuroprotection across Parkinson's, Huntington's, and ALS. Now this is early and mechanistic, but I did want to flag the humility here. But the direction is certainly worth our attention. Now, and most importantly, really the safety profile, because this is where fear-mongering and misinformation lives. Now, at three to five grams a day, this is backed by hundreds of peer-reviewed publications. The record is one of the deepest in the supplement literature. The most consistent side effect, and I hear this all the time, in our clinic is waking from water retention, and friends, it's not fat, it's intracellular water, following creatine into the muscle, and there's ways to overcome that by, say, dividing the dose. First, kidneys. Creatine does not damage healthy kidneys. It nudges one of the lab values creatinine upward, because creatinine is a normal breakdown product of creatine, and I will tell you in my clinical practice, those individuals with higher muscle have higher creatinine, and we expect to find it. The research is explicit that this is a metabolic artifact, not a sign of kidney injury in healthy people. Second, I love this myth, hair loss. One study in a rugby player found DHT dihydrotestosterone rose 56% after a seven day loading phase at 25 grams a day, which then, of course, fueled fears about hair loss. No study has directly linked creatine to hair loss, and that DHT finding has never been replicated. What does not show up in control trials at all? Liver damage, dehydration, cancer, or rabdo analysis. Now, obviously, this is not medical advice, you must check with your physician, and there are real contraindications, and this is where you connect with your physician and have this conversation. Preexisting kidney disease. If you have reduced kidney function, diabetes, or hypertension, hypertension puts your kidneys at risk. Get kidney function tests checked first, and of course, doses above five grams a day either should be avoided or discussed with your physician. Now, this one I thought was very interesting, bipolar disorder. This is a caveat that I flagged earlier. Creatine augmentation has triggered hypomania and mania in case reports, and in case report is not a randomized control trial, but it is a report typically provided by physicians. And in one bipolar depression trial, two of 17 participants switched into hypomania. Now, that is a real risk, and hopefully people are screening for it. What about pregnancy and breastfeeding? Again, we don't have pregnancy and breastfeeding data. Animal data suggests there might be neuroprotective benefits, but no human trials have been completed, and regulators have excluded pregnant women from safety valuations. So no one can totally recommend it yet, but it's not because it's deemed unsafe. Children adolescents, there's also limited data here. Some evidence support safety in pediatric, traumatic brain injury, and the international society of sports nutrition considers it potentially acceptable in adolescents who are under medical supervision. But again, the default position for most people is caution. Now, here's the thing. With all this talk about supplementation, the idea is can't you just eat it? Okay, so let's start with the math. Most people on a normal omnivorous diet get about one gram of creatine a day from food. The body makes about one more on its own. To reach five grams of creatine from food alone, okay, you would need roughly five times your dietary intake. So what is that in practice? That's somewhere between two and a half to three pounds of cooked, not raw, cooked meat and fish every day. Yeah, I just want to let that sink in. Red meat runs about two to two and a half grams per pound raw. Chicken is a little bit lower, and the surprise is salmon. Salmon actually runs higher in creatine, three to four grams of creatine per pound raw. Dairy and eggs, trace amounts, and plants are the big goose egg zero. Also, cooking destroys a meaningful share of what creatine is available. So let's run a full day of a diet to support creatine. Salmon filet breakfast, a steak at lunch, herring, chicken, at dinner so you can mix those proteins. So you sit down to roughly 24 ounces of cooked meat and fish across three males. That's a lot, and I don't know about you. That's tough. As opposed to having a single scoop of creatine, a single scoop of creatine monohydrate closes that gap. So the idea of eating your way three to four pounds of a meat or fish for someone like me, I mean, that's just, it's never gonna happen. So what about the muscle-centric connection? Let's take a step back and say, well, why does this matter inside the framework of muscle-centric medicine? Creatine doesn't build muscle on its own. There is nothing in a scoop that does this. What it does do is it raises the ceiling on the work that you personally can perform, more quality reps, more force in the production, which drives better training adaptations over time. It's a multiplier on the stimulus, and the stimulus is what defend skeletal muscle. The organ of longevity, your ultimate metabolic sink, I should put that on a t-shirt somewhere. Because that tissue is what clears the bulk of glucose in your bloodstream after you eat. So defend muscle, that's the lever that pulls the whole metabolic system back toward better function. Creatine is one of those few tools with three decades of evidence behind its ability to help you train hard enough, recover well, and to hold that tissue as you age, specifically against anabolic resistance, which makes every gram harder to keep. Now back to the way-back machine, that jar in new market. Discovery is fragile, and it favors the prepared and the curious mind. The most validated compound in sports nutrition survived. Fairly, by this narrow margin, one skeptic willing to finally test his own certainty, one syringe that refused to push 10 grams, and one animal that happened to not absorb the thing being tested. Change any one of those things, and creatine may have stayed buried forever. But notice the through line, the accident got creatine discovered. Nothing about the accident gets creatine used correctly. Three decades and hundreds of trials later, the noises arguably worse than it was in 1992, that along with the food guide pyramid. But with more loading rituals, more cycling myths, and more fear about a compound with one of the cleanest safety profiles we have, discovery was luck. Using it well is discipline. They are not the same skill, and only one of them is available to you. So, the lucky accident is the story, the daily unglamorous evidence leads to the behavior that matters. Here's exactly what you need to do. If you choose to take creatine monohydrate, you don't need an exotic form. The overwhelming majority of the evidence base was built on, yes, you guessed it, boring old monohydrate. The buffered and advanced forms sold at a premium aren't solving a problem that monohydrate has. So, encourage the form, the science studied. That's my first piece of advice. Now, take a real dose, and take it every day. That can be between three to five grams daily, which saturates the muscle store. On training days and rest days alike, doesn't really matter. Larger bodies sit up at the top range. A loading phase is not necessary. It reaches the same saturation only faster. You don't need to cycle on and off it, and timing barely matters. So, no drama. We just keep the dose if muscle is the focus. And remember, what the scoop is. Creatine is a multiplier on a training plant, not a replacement for it. You still have to lift. You still have to eat adequate protein and calories. So, despite what you are hearing on the internet, and there's a ton of controversy over just about everything. Creatine monohydrate has been around for a very long time. It is safe in many populations. Three to five grams for muscle, ten plus grams for brain health. I think we still need to have humility as to the meaningful outcomes, especially as it relates to brain. But one thing for sure is that it certainly doesn't seem to be harmful in most people. And side note, it's really hard to eat your way to an optimal creatine diet. And with that, until next time, stay forever strong.