The Neuro Experience – Episode Summary

What is Creatine? Should You Be Taking This Supplement?

Host: Louisa Nicola (with guest Dr. Darren Candow)
Date: November 6, 2023

Episode Overview

In this episode, Louisa Nicola delves deep into the science and emerging uses of creatine—a well-known supplement historically associated with muscle and athletic performance, but increasingly recognized for benefits above the "neck up." Joined by renowned creatine researcher Dr. Darren Candow, they discuss creatine’s role in muscle, brain, bone, and even mood regulation, with a focus on research, dosing, myths, and its evolving role in health beyond sports. The episode has an evidence-driven but conversational tone, balancing cutting-edge science with actionable advice.

Key Discussion Points & Insights

1. Biology of Creatine: Synthesis, Storage, and Function

• Endogenous Production & Dietary Sources
  • Creatine is synthesized in both the liver and brain from three amino acids: arginine, glycine, and methionine. Most is stored in muscle (95%), the rest primarily in brain and other tissues.

    “The muscle is a vacuum. It likes to suck up as much creatine as it possibly can. ... The brain actually will create its own creatine supply.” (A, 01:50)

• Dietary Creatine
  • Highest in red meat and seafood. Vegetarians synthesize less and may benefit more from supplementation.
• Functional Role
  • Creatine donates a phosphate group to regenerate ATP during energy-intensive activities, critical for both muscle contraction and overall cellular health.

    “Creatine really sacrifices itself. It donates a part of its molecule and that allows the muscle to have a high energy status.” (A, 12:25)

2. Creatine and Brain Health

• Blood-Brain Barrier Selectivity
  • The brain is selective in allowing creatine in; only about 10% increase in brain creatine can be achieved versus up to 40% in muscle via supplementation.

    “The brain has a blood brain barrier... very selective to what gets in, and rightfully so. ... Unlike muscle... the brain is very picky.” (A, 03:44)

• Cognitive Benefits
  • Evidence for creatine aiding cognition, particularly under stress (e.g., sleep deprivation, metabolic stress, brain injury).

3. History and Reputation of Creatine

• Early Skepticism & Focus on Muscle
  • Initially studied for muscle performance; its safety and effectiveness made it "boring" until a resurgence focused on bone and brain health.

    “Creatine became boring. ... It kind of went away. And we thought we knew everything until the resurgence ... we started to look at it from the whole body.” (A, 06:05)

• Resurgence and Expanded Research
  • New research explores benefits for neurodegenerative and mood disorders, concussion, and bone health.

4. Creatine’s Protective and Therapeutic Roles

A. Concussion and Traumatic Brain Injury (TBI)

• Studies & Evidence
  • Only one major human study (in children): Children who received creatine after TBI showed better subjective health/recovery over 6 months (A, 16:05–17:06).
• Animal Models
  • Creatine pre-supplementation before induced TBI in animals showed neuroprotection.
• Practical Implications
  • “If anybody’s predisposed to head trauma… I think taking creatine before the season or during practice may be a viable tool.” (A, 18:17)

B. Stroke

• Caution due to possible differences in water retention mechanisms in the brain versus muscles—implications for post-stroke edema are not fully understood (A, 19:22).

C. Cognitive Decline & Alzheimer’s

• Early research only—preclinical evidence and some small trials, but clinical trials are still needed.

  “We have no long term clinical trials with this. ... I think the issue is that you’re going to need to randomize a few hundred people into a study.” (A, 24:00)

D. Depression and Mood Disorders

• Correlational Evidence:
  • Greater dietary creatine linked to lower depressive symptoms; possibly confounded by overall diet quality.
  • Supplementation may decrease inflammation, potentially explaining mood benefits (A, 27:39–28:12).

E. Bone Health, Especially Postmenopausal Women

• Research Findings:
  • Creatine with resistance training reduces bone mineral loss and may strengthen bone architecture (hip in particular). Effects are not seen without exercise.

    “Creatine in combination with resistance training… has been shown to reduce the rate of bone mineral density loss in the hip.” (A, 29:10)

  • Latest trial: 11g/day for 2 years improved hip bone geometry (A, 31:26).
• Key Message:
  • “Exercise needs to be there. ... without mechanical stimuli from exercise, creatine will have no bone benefits.” (A, 28:58)

F. Fertility & Pregnancy

• Preliminary findings: Creatine may support placental growth and fetal development; early days, but safety profile appears strong (A, 34:16).
  • “If you take it in at a slightly higher dose, the body recognizes and stores it. And if it doesn’t, you just pee it down the toilet.” (A, 35:16)

G. Pediatric Use and Safety

• Current evidence: Safe and well-tolerated in children at recommended doses. No adverse kidney or liver effects observed so far (A, 35:38–36:45).

5. Addressing Myths and Safety Concerns

• Kidney Disease/Failure
  • Strong research consensus: no increased kidney or liver risk in healthy populations even with long-term use (A, 36:45).
• Hair Loss
  • The “creatine causes hair loss” myth comes from one rugby player study; has not been substantiated by real-world reports or other studies (A, 38:11–39:14).

    “I’ve studied well over a thousand individuals, really high dose creatine, and not a single person has ever come to me and said, ‘my hair is falling out.’” (A, 38:47)

• Not all respond the same
  • Diet, especially high red meat/seafood intake, influences whether someone will benefit from more creatine (A, 37:10).

6. Practicalities: Dosage, Timing, and Loading Phases

Common Dosing Strategies (A, 39:31)

• Loading Phase:
  • 20g/day for 5–7 days, then maintenance (2–5g/day)
  • Rapid muscle saturation; more GI distress and water retention
• By Body Weight:
  • 0.1–0.15g/kg/day split into 2 doses (approx. 7–10g/day for avg adult)
• Minimal Effective Dose:
  • 3–5g/day continuously—saturates muscle and likely beneficial long-term for most purposes

    “3 grams a day for the rest of your life. ... Super easy.” (A, 40:37)

  • Over time, even modest doses will accumulate in the brain and bone.
• Timing:
  • Irrelevant; can be taken any time of day, with or without food or exercise (A, 41:49).
• Upper Limits:
  • Whole-body benefit (muscle, brain, bone): Averaged at about 10g/day. Brain trials often use 20g/day, bone trials 8–11g/day, muscle as low as 3–5g/day (A, 32:44).
• Absorption:
  • Cooking meat degrades creatine to creatinine, so powder forms are more efficient (A, 10:59).
• Stopping Supplementation:
  • “Once your muscles are saturated, you can stop creatine completely. ... It takes 30 days for those levels to come back to baseline.” (A, 43:14)
• Children, Pregnancy, and Elderly:
  • Evidence points toward excellent safety profile at regular doses. Special populations (e.g., with kidney issues) should still consult a physician.

Notable Quotes & Memorable Moments

• On Brain Uptake:

  “Supplementation may increase muscle creatine stores anywhere from 20 to 40%. We’re only starting to see maybe 10% max in the brain. So there’s a huge distinction.”
  — Dr. Darren Candow, (04:15)

• Creatine Safety:

  “Creatine seems to be one of the safest, most effective compounds that most people can at least consider.”
  — Dr. Darren Candow, (36:45)

• Creatine and Hair Loss:

  “I went bald before I took creatine. That’s another problem.”
  — Dr. Darren Candow, (37:08)

• On Synergy with Exercise and Nutrition:

  “I use the analogy: the big cake is resistance exercise. The icing on top is protein. ... If you put a cherry or sprinkle, that’s creatine. Creatine is not giving you the ... big effect that you think it is, but it has to be there with the others.”
  — Dr. Darren Candow, (44:17)

• Dose for Life:

  “3 grams a day for the rest of your life. ... Super easy. You can go on about your day.”
  — Dr. Darren Candow, (41:03)

Key Timestamps for Important Segments

| Timestamp | Topic/Quote | |:----:|:-------------------| | 01:17 | Creatine biology: Synthesis & storage in brain and muscle | | 03:44 | Why brain excludes most circulating creatine | | 06:05 | Creatine’s research history & expanded focus | | 10:59 | Cooking meat degrades creatine—supplement advantage | | 12:25 | ATP/energy metabolism role | | 14:42 | Creatine in TBI/concussion recovery | | 16:05 | Children’s TBI study: supplementation outcomes | | 18:17 | Proposed use for athletes in contact sports | | 22:28 | Rise in Alzheimer’s—a “lifestyle” disease context | | 24:00 | Plans for Alzheimer’s/clinical trials | | 28:42 | Bone health: postmenopausal women, hip fracture prevention | | 31:26 | Large RCT: 11g/day for 2 years, postmenopausal women | | 34:16 | Early evidence for creatine in pregnancy & fetal development | | 36:45 | Safety/myths: kidneys, children | | 38:11 | Addressing the hair loss myth | | 39:31 | Dosage/strategy breakdown | | 41:03 | Simple lifelong dose: 3g/day; timing flexibility | | 44:17 | Creatine’s place: “the cherry on top” analogy |

Summary Table: Dosage Recommendations

| Purpose | Typical Dose | Notes | |----------------------|------------------|-------------------------| | Muscle Performance | 3–5g/day | Load: 20g/day x 1 week optional | | Brain Health | 10–20g/day | 3–5g likely beneficial over time | | Bone Health | 8–11g/day | Needs weight training | | Whole Body | ~10g/day | Covers bone/brain/muscle| | Minimal Effective | 3g/day | For longevity & safety | | Pediatric/Elderly | Based on body weight (0.1–0.15g/kg) | Safe per current data |

Final Takeaways

• Creatine is more than a muscle supplement: Emerging evidence supports roles in brain health, neuroprotection, depression, bone health, and potentially fertility.
• Safety is well-established in healthy people, across ages and life stages. Myths around kidney failure and hair loss have not been borne out by research.
• Dosing need not be complicated: 3–5g daily can benefit most; higher doses may be warranted for brain/bone needs but practical, long-term consistency matters most.
• Exercise is essential for bone benefits; creatine alone is not enough for skeletal health.
• Research is ongoing: Particularly in Alzheimer’s, depression, and pediatric populations—exciting findings are expected in coming years.
• If you’re unsure: “It’s not a steroid, your body recognizes it, and unused creatine is simply excreted safely.”

Find Dr. Darren Candow:

• Instagram: @DrDarrenCandow
• Research updates and conferences announced there

For listeners: This episode is essential for anyone curious about preventing cognitive decline, optimizing bone or brain health, or simply maximizing vitality with science-backed, practical advice.