Episode 1788 - Do you REALLY need creatine?

Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall discusses what creatine is, how we get it, and the concept that not everyone may need to supplement creatine Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION ALAN FREDENDALLDo we really need creatine? If not, who does? Let's start today by talking about what is creatine? How do we get it? Where does it come from? What does it do from a performance perspective? And then let's finish about talking about potentially who may and who may not need to take creatine. WHAT IS CREATINE? So starting from the top, what is creatine? You've probably heard about it. You've probably taken it at this point and how do we get it? We're going to reference a lot the International Society of Sports Nutrition position papers which come from the International Society of Sports Nutrition. They publish their own journal and more importantly they publish these position papers on a frequent basis that cover a wide variety of of supplement diet and nutrition topics. They are incredibly comprehensive. They cover the thousands and thousands and thousands of supplements that are up there as well as all of the articles, the other thousands and thousands of articles that have research about those supplements that come out on an annual basis. And so these position papers are great because they do such a great job of summarizing all of the research in this area. And so asking the question, what is creatine? Where does it come from? 95% of the chemical known as creatine is found in our skeletal muscles, so our working muscle. And then about 5% is in our brain. We do have a little bit in our liver, but primarily, creatine is stored in our muscle. We have to get it somehow externally. We do not make it on our own. We usually get it between one to five grams a day. is what we're looking for. And that primarily comes from eating red meat such as beef or coming from fish, approximately 16 ounces about a pound per day. And so if you think that you are not eating that much red meat or fish or eating that at all, and you know that for sure, maybe you follow a vegan or vegetarian based diet, then the recommendation for many, many years has been supplementation, typically as five grams of creatine monohydrate per day. If you've ever taken this or you've known somebody who's taken this, it kind of just comes in a big tub like protein powder. It is a tasteless, odorless white powder that you can certainly do what we would call a dry scoop with some water. You can mix it with water or juice. It does not have a taste at all and so it does not really need to be mixed. It can be taken at any time of the day. And over the years, there have been different research papers on the concept of preloading creatine, taking a large dose to kind of bump up levels in our system and then tapering off to the maintenance dose. And what really decades of research at this time point have shown is that just taking five grams a day has the same effect as any sort of preloading, deloading effect. Just taking that five grams every day gets you to the levels where it's found to be optimal. WHAT DOES CREATINE DO? So that's what it is and how we get it. What does it do in our body? Why is it so talked about? Creatine has a number of great effects that have been shown in the research and have been shown and reinforced and validated over again many, many, many years of research. In general, typical results of having enough creatine in your system whether that comes from eating more of the food sources that creatine is found in, or by supplementing, that we can increase our lean muscle mass by approximately five pounds, we can increase our muscular strength, we can reduce our blood glucose levels, we can improve our anaerobic power output, and we can also see improvements in brain function, which is an interesting new area of research for creatine that we'll talk about in a few minutes. Creatine allows for more creation and storage of the chemical known as ATP. We learned about that back in high school. That is the chemical that powers cellular work inside of our body. It also improves muscular hydration and it improves the rate of protein synthesis. So all good things that we would like to have as much of going on as possible, right? With creatine, there's a lot of myths about what it does. What does it not do? It does not increase water retention or bloating, even in some papers having people take four times the dose, taking 20 grams a day. Creatine is not an anabolic steroid. You cannot get in trouble for taking it. It is completely legal to take it. Anabolic steroids, by nature, are some sort of form of testosterone or some chemical, some sort of what we might call a precursor chemical, that results in increased levels of testosterone in the body. Creatine does not do that. It is not an anabolic steroid. Creatine does not cause kidney damage. Again, in studies following folks taking really high volume doses, 20 grams plus a day, no effect on the kidney, and certainly all of the research on five grams a day, no effect on the kidney. Creatine is safe for adolescents and kids. Remember, we primarily get this from our food, and so you can't, if you're somebody that eats red meat, if you're somebody that eats fish, you can't not eat creatine, right? You're getting it every time you have a serving of red meat or a serving of fish. And so no matter what, even if they don't supplement, kids are getting it every day. Kids tend to eat a lot of food, especially teenagers. And so arguably they're probably getting the same amount that an adult might supplement with anyways. And so just know that it's unavoidable and because they're already getting it and they have no adverse reactions. Also, it's naturally found in our muscles that it is completely safe for adolescents and kids to take. When we talk about what types of creatine are out there, what is the most effective? There is zero peer reviewed evidence that creatine sources found in energy drinks, meal replacement bars, you've probably seen them if you've had an energy drink in recent years. It's all over the top. I've got I've got an energy drink can right here. It's four in the morning, what's right across the top. Pure creatine is advertised right on the energy drink can. Meal replacement bars, pre-workout powders, all that sort of thing. Is that as effective or maybe more effective than taking that creatine monohydrate, that five gram scoop from that big jug? Overwhelming evidence would say no. That over time, all of these studies, regardless of dosage, regardless of other creatine type that is not creatine monohydrate, creatine monohydrate consistently outperforms all of the other chemical derivatives that are out there. So, if you are somebody that needs to supplement, just know that just because your energy drink can or your protein bar says it has creatine, it's probably not a biologically available source that's actually going to result in you getting the effective creatine that you want. When in doubt, go with that scoop of creatine monohydrate. Okay, our most important point, who needs it? Looking at research and that sort of thing, who needs it? If it's not everyone, who is it? INTERLUDE And before we get to that point, I just want to take a break and introduce myself. My name is Alan. I'm the chief operating officer here at ice. This is the PT on ice daily show, a daily physical therapy podcast talking about all things related to rehab and fitness across the spectrum. Today is Fitness Athlete Friday. We talk about all things helping the functional fitness athlete, the CrossFitter, the Orange Spheres, the bootcamp. We also talk about supporting our endurance athletes, runners, bikers, swimmers, that sort of thing. So if you are working with that population, you want to get better at working with that population, Fridays on the podcast are for you. I teach a course called Clinical Management Fitness Athlete. We have a three course series here at ICE, two online courses, level one and level two, and a live course. Our level one course just started this past Monday, and our level two course will begin on September 1st in just a couple weeks. You need to have taken the level one online course to take the level two course. And then our live course, where we get you moving barbells, We have you learn how to max out, practice maxing out, a lot of different concepts found in the fitness space that are going to be important for you if you want to work with this population. You can catch us out on the road. Our friend Zach Long will be in Austin, Texas, September 7th and 8th. Joe Hanesko, another one of our instructors, will be in Longmont, Colorado, September 14th to 15th. and Mitch Babcock will be in Houston, Texas, September 28th to 29th. Just want to pause and say congratulations to Mitch. Mitch is my business partner here in Michigan at our clinic. We coach CrossFit together, we teach these courses together. Mitch is a great friend and him and his wife just had a beautiful baby boy on Wednesday night and so they're at the hospital this morning loving on that baby. So if you follow Mitch, go give him a like, go give him a positive comment. I know he'd appreciate that. DO YOU REALLY NEED CREATINE? So do we need creatine supplementation? A really cool article came out towards the end of last year from Moriarty and colleagues in the journal Brain Science, a journal looking at the emerging area of research of creatine supplementation on cognitive performance, specifically in older adults. But what I like about this study is they did a really good job of breaking the population of study subjects into different subgroups, right? And essentially we had four subgroups. Not unlike anything else we are tending to find about the human race as a whole, humans tend to categorize into subpopulations whether involuntarily from things like genetics or voluntarily, right? And so this study did a good job of breaking out younger individuals from older individuals and also those consuming a meat-based diet or a vegetarian or vegan-based diet. And so they essentially found that there are four subgroups here. These subgroups all had the same experimental effect, which was they're taking creatine and they're having some different stuff measured. And what is great about this study is while the aim was to look at cognitive effects, it really kind of let us know, based on what people eat in their age, who might be the person that will benefit the most, and maybe who is a person that, especially if they're hyper fixated on getting their creatine dose in, maybe they don't need to worry as much. And so finding younger individuals aged 11 to 31 that consumed a meat-based diet saw minimal to no improvement in this study with creatine supplementation. Younger individuals, again, aged 11-31, consuming a vegetarian or vegan-based diet saw more improvement, right? And that makes sense given that we talked about you primarily get this from food sources being red meat and fish. And so that if you don't eat those, you have sort of a deficit that you need to shore up. A third subpopulation, now older adults, the other side of the age spectrum, older adults, age 66 to 76, consuming a meat-based diet with no diagnosed cognitive impairment, saw minimal to no improvement. So, young or old, eating meat, no cognitive impairment, minimal effect from creatine supplementation. The final subgroup, older adults age 66 to 76 consuming a vegetarian or vegan-based diet with diagnosed cognitive impairments, saw the largest improvement in the study group. Why? Again, we've talked about it. Folks eating meat on a regular basis are getting that one to five grams of creatine that we need to eat per day. And so for those folks, even regardless of age, it seems like additional supplementation is unnecessary. And so who needs it at the end of the day? Or we should say who needs it the most? It seems to be that older folks who maybe are beginning to show signs of mild cognitive impairment, or definitely who have a diagnosed cognitive impairment, and especially who consume no red meat or no fish or very small amounts, less than 16 ounces per day combined, have the most to benefit from creatine supplementation, especially in regard to improving cognitive performance. But also that in general, the second group right underneath that was even in a younger population, 11 to 31, those folks, again, based on their dietary choices, no red meat or fish or a smaller amount, those folks also saw an improvement from creatine supplementation. So it seems to come down to lifestyle, right? If you are eating red meat, if you're eating fish on a regular basis, especially if you're getting close to 16 ounces, right? Eight ounces of ground beef and rice for lunch, eight ounces of fish and veggies or whatever for dinner, you are checking the box on getting that creatine from your diet. And so that is not to say you should not take creatine and see what happens, but just that if you take it and you're diligent about taking it, and you're consistent with taking it, and you don't see those improvements that we talked about earlier, those improvements in lean body muscle mass, muscular strength, anaerobic power, that is to be totally expected if you don't see those improvements. At the end of the day, should you use it? I would always say with a supplement like creatine, try it. It has almost no risks as we talked about. It is incredibly cheap, literally a couple cents per serving. A giant tub of creatine is like 20 bucks and you get like 500 servings out of it. And so at the end of the day, if you've never supplemented with it, even if you think you're getting enough from your diet, just try a cycle, right? Try taking it for a couple of months, be diligent about it, take it every day like you're supposed to take that five gram dose. But also don't be upset at yourself. If you don't see these massive improvements, likely from your diet, when you begin exercising regularly, possibly many, many years ago, you saw those gains that you would have seen with creatine supplementation. because you were already getting enough creatine from your diet. So you already got the benefit, don't be upset that you're missing out. SUMMARY So creatine, what is it? Where's it come from? Should you take it? creatine is a chemical we have to eat, we use it to power muscular energy functions and other functions throughout our body, and especially our brain. And that new lines of research, especially investigating the effects on the cognitive system, have shown that there seems to be groups of people who benefit the most, and the groups of people who benefit the least. Primarily, those eating a small amount or no red meat or fish who do have a mild cognitive impairment, a diagnosed cognitive impairment, will benefit the most. And even in younger folks with no concerns about cognitive impairment, if they are following that diet with a small or no amount of red meat or fish, they will also benefit. On the opposite side of that, young or old, without any diagnosed cognitive impairment, eating a meat based diet, Those folks seem to have the least to gain from creatine, but again, like we said, all that being equal, try it out if you haven't and see if you like the results or not. So, that's creatine. We hope you have a fantastic Friday. Have an awesome weekend. We'll see you next week. Bye, everybody. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.