Diary Of A CEO: w/ Dr. Darren Candow on Creatine (Transcript)

But vegans and vegetarians respond literally the best on the planet because now they’re taking in a supplement to allow that in.

STEVEN BARTLETT: And is it thought that historically we would naturally have consumed more creatine?

DR. DARREN CANDOW: That’s a good point. So back, hunter and gatherer age, a lot of meat, they were consuming quite a bit through dietary products. Just say if you only wanted to get 3 grams of creatine through food, you’d have to eat quite a bit of meat to do that. And then it comes into the dilemma of, well, what if you don’t eat meat? Or you just can’t afford it, yeah.

Busting Common Myths About Creatine

STEVEN BARTLETT: Creatine has exploded over the last couple of years. I saw a stat that said, I think in women it had gone up to about 3% of women take creatine. And in men it’s slightly higher. It’s still a little bit lower in terms of consumption in women from the stats that I saw. And I think that in part is because there’s still some prevailing myths about creatine.

When I speak to some of my friends, people know that I interview a lot of health experts and scientists and PhDs that have done research on supplements. They ask me, the first question I get asked a lot is, “What other supplements should I definitely take?” And when I mention creatine, it’s always met with a certain set of rebuttals because there’s some prevailing myths. You’ve got some myths about creatine on the cards in front of you. Can you reveal one by one what they are?

# Myth #1: Creatine Damages Your Kidneys

DR. DARREN CANDOW: So this is definitely the number one myth. Creatine damages your kidneys. So when you take in creatine to the body, it gets stored as creatine. But when you metabolize it, sort of thinking leaking from the muscle, gets leaked out as creatinine. And most people watching like, oh, that was on my blood requisition form. And right below creatinine was something called eGFR. So glomerular filtration rate is an estimation of your kidney health.

So the problem is when individuals on creatine supplementation go to their doctor for their annual blood work, their creatinine might be a little bit elevated, and that’s only from the breakdown of the compound. And then unfortunately, their filtration rate is lower. So then their doctor gets really surprised and they’re like, stop taking creatine because it’s hurting your kidney. What typically happens is they go back, stop taking creatine, and then they check their kidneys again and it’s fine. So I would say 99 out of 100 times that it’s a false positive. So this is by far the biggest myth, and there’s been randomized controlled trials for several years showing that creatine causes no detrimental effects to the kidneys.

STEVEN BARTLETT: I had exactly that twice on my blood test.

DR. DARREN CANDOW: Yes. And creatinine can also be elevated if you’re on a high meat diet, a little bit dehydrated. So those that are exercising, it’s very, very elevated. So always tell your doctor you’re on creatine supplementation because your creatinine could be a little bit higher.

# Myth #2: Creatine Makes You Retain Water

DR. DARREN CANDOW: Myth number 2: Creatine makes you retain water. So this is really important. And I think this is one of the main reasons females were really hesitant to take creatine. If you take too much too soon, it can lead to an increase in water retention. So you’ve probably heard of the creatine loading phase. This is where supplement companies want you to take about 20 or 30 grams a day for about 5 or 7 days. That has been shown to increase water retention acutely. So maybe it’ll reside there for about 3 to 5 days. But after that, when you go on a maintenance phase of about 3 to 5 grams a day, that water retention goes away.

So in the initial stages, if done improperly or too much, it can cause a little bit of water retention. The good news for everybody watching is after about the first week, that water’s inside our muscle. So now we’re volumizing the size of our muscle, sort of like a balloon here is full of water. Now, after a while, the water is now going into our muscle.

STEVEN BARTLETT: It’s a lot bigger.

DR. DARREN CANDOW: Compared to a deflated balloon or muscle that didn’t have any water. So creatine is osmotic. Water likes to follow creatine. So by taking it into the muscle, it gets a lot bigger. And that’s good because a swollen muscle stimulates protein synthesis to get bigger and stronger.

STEVEN BARTLETT: Oh, really? Swollen muscle stimulates protein synthesis.

DR. DARREN CANDOW: Yeah. So when you have water coming in, that’s a really good thing. And creatine does that. And that’s one of the main mechanisms why it works.

STEVEN BARTLETT: So what does that mean? Does that mean that if I have creatine in my muscle, I’m more likely to gain muscle?

DR. DARREN CANDOW: That is potentially the factor, because when you’re having or trapping water, it turns on all these signaling pathways that are involved in protein synthesis. And one of the biggest robust evidence is that creatine increases lean tissue mass and regional muscle thickness with weight training over time.

STEVEN BARTLETT: Oh wow.

DR. DARREN CANDOW: Okay.

STEVEN BARTLETT: Yeah. Yeah. Because a lot of people are concerned that they’re going to put on lots of weight and be bloated with creatine.

DR. DARREN CANDOW: The interesting thing there is if you take smaller, more microdosing, there’s hardly any effect. And this might come surprising, but if you did a 6-week study pre and post after creatine, you only increase mass by 0.86 kilograms. And the majority of that is lean mass. So at the end of the day, a pound and a half is not a lot.

STEVEN BARTLETT: Lean mass.

DR. DARREN CANDOW: Lean mass. When we think of lean mass, most people think it is muscle, but lean mass in our body includes water, connective tissue, organs, as well as skeletal muscle. And about 50% of our lean mass is muscle.

STEVEN BARTLETT: Yeah, that’s great.

Creatine Myths Debunked

DR. DARREN CANDOW: Okay, myth number 3. Creatine is only for men. This is 100% false. When you go through the totality of all the evidence, females respond extremely robustly to creatine supplementation. They get profound benefits in strength, endurance, and performance. They lose a little bit of body fat. So there’s another idea that people thought water retention was causing an increase in fat mass. We’ve done some meta-analysis now showing that creatine reduces fat mass. Females get an increase in lean mass as well. And I’m happy this one came up because from our lab with bone health, females do respond very favorably with creatine and bone. And we can talk about that as well.

Myth number 4. Oh, I can’t believe you did this one to me. Creatine causes hair loss. So obviously looking at me, and I’m a prolific creatine researcher and taking creatine religiously for like the last 2 and a half decades. People would look at me and say, well, obviously looking at him, creatine caused this. And I was going bald before I started taking creatine. This myth came from a study in rugby players decades ago where creatine, about 20 to 25 grams a day for 7 days, increased a hormone called DHT. It’s a precursor for testosterone, which unfortunately has been linked to hair follicle loss and thinning. But the ironic thing is when creatine was given to these young males, the hormone went up, but it was still within the biological range, and no measure of hair follicle thinning or loss was done. The cool thing is, just a few years ago, they decided to put this theory to the test, and 5 grams in young males for about 6 to 8 weeks of training caused no detrimental effect from hair thinning, follicle loss. So my appearance was probably based on something else. So there’s no evidence to that as well.

Myth number 5: creatine causes muscle cramps. No, I think this is so overplayed. When creatine is taken into the body, water will follow it. Now you’re super hydrating the muscle. So one of the main issues with muscle cramps is it could be dehydration in the muscle. Some people have heard of sodium potassium. That’s why Gatorade was invented. But if anything, sodium decreases muscle cramps and it’s super hydrate. So in the hotter environments, June, July, August, creatine is going to be one of your best friends.

STEVEN BARTLETT: So those are the 5 myths we talked there about weight training. What is this very curious graph? It seems to show that creatine helped gain muscle mass through a training regime?

DR. DARREN CANDOW: Oh yes. So this is actually showing now that when you take creatine supplementation, you’re actually getting an improvement in training volume. So when you go in the weight room, you look at the load you’re lifting by the reps, by the sets, so it actually goes up. And then when you don’t, obviously it would go down over time as well. So the cool thing here is that one of the main reasons you get an enhancement in performance is that creatine seems to enhance training capacity. So a lot of people say, I’ve taken creatine, now I got an increase in the number of reps or sets that I can perform. And that probably leads to a stimulation over time.

STEVEN BARTLETT: So this is an 8-week study.

DR. DARREN CANDOW: That is an 8-week study, very short term as well. So you can see that the number of weeks came down when they weren’t taking creatine, and then when they started to take it, it went up as well. And this leads to another important point, and it’s often not talked about. When you take creatine for at least a month, people say, well, how long does it stay in my muscles if I go on vacation? What if I can’t take creatine? And in skeletal muscle, it takes about a month for those elevated levels to come back down. In the brain, we don’t have a lot of evidence, but it’s speculated it takes about anywhere between 5 weeks to about 3 months for those elevations to come back down.

STEVEN BARTLETT: And this essentially means that if I take creatine, I will be able to train harder.

DR. DARREN CANDOW: Harder or longer or more frequent. So one of the things with creatine, it allows the muscle to recover quicker. So you might be able to get back to the— if an athlete’s training twice a day. So either one of those seems to be one of the most plausible mechanisms.

STEVEN BARTLETT: And why is there a big dip in the middle of this graph?

DR. DARREN CANDOW: So that is actually showing where the individuals would train and then without creatine and then take it over time as well.

STEVEN BARTLETT: Oh, okay. So that’s, that’s—

DR. DARREN CANDOW: It’s a detraining and then taking it again. Correct.

STEVEN BARTLETT: Okay. So they start taking it.

DR. DARREN CANDOW: Taken it at week 4, and then that’s where the elevations go up. Oh yeah. So it goes to show that when you have creatine, everything is elevated. If you stop taking it, it takes about 4 weeks to come back down, but you’ll notice that it was at the same level as a placebo. And then when they take it again, they get a rebound effect. So I think this has application for people who have injured themselves and they now need to go back and start training. If you take creatine, it can accelerate the rehabilitation program.

STEVEN BARTLETT: Hmm. And it does it, I guess, because it makes your training volume increase. Correct. It makes your muscle mass gain increase.

Creatine’s Impact on Muscle Mass and Performance

DR. DARREN CANDOW: It can gain, gain increase in muscle mass. It’s not great. That’s probably going to be a bit surprising to a lot of people. A lot of people take creatine for huge increases in muscle. You get an increase in lean mass by about 1.2 kilograms. But as I said previously, remember, only half of that is skeletal muscle. So creatine, yes, can with weight training improve muscle mass, but it has more robust evidence for muscle performance.

STEVEN BARTLETT: Is there anything else we need to know about creatine’s link to muscle mass?

DR. DARREN CANDOW: I think one of the big things is that it decreases something called protein breakdown. So that might allow the muscle to maintain its integrity or recover quicker. But overall, when you combine creatine with a standard weight training program, you should expect a greater increase than weight training alone. Absolutely. And that is across all ages, which is really important.

STEVEN BARTLETT: Okay. And the studies you’ve done in your own lab, what are those? How wide varying are those? How many have you done?

DR. DARREN CANDOW: We’ve done at least 30 to 40 studies in our lab, have published over 120 papers just on creatine alone. Wow. And the interesting thing is that from young individuals to middle-aged to older adults, we see a very common theme that combined with weight training, creatine, about 5 grams or more— we use typically a little bit more— seems to have beneficial effects on muscle mass, muscle strength, as well as performance.

STEVEN BARTLETT: Absolutely. Can you show me what 5 grams looks like.

DR. DARREN CANDOW: Absolutely. So this would be a standard 5-gram dose, which is one scoop. One scoop. Now keep in mind, that can be found in meat or seafood, but you’re going to require a lot.

STEVEN BARTLETT: Yeah. Okay, so 5 grams is one scoop. One scoop. And you’re saying we don’t necessarily need to do this loading phase that bodybuilders would—

DR. DARREN CANDOW: Correct. So the loading phase is the most rapid way to saturate your muscles. Now that’s very beneficial, but that would be 4 scoops. So 4 scoops is a loading phase per day and it’s very effective. But the issue is, can it cause some adverse GI tract irritation, things like that? That’s where anecdotally people report that. But a lot of people from a muscle perspective will start with just 5 grams a day, and that’s very beneficial.

STEVEN BARTLETT: And at 5 grams a day, what benefits am I getting?

DR. DARREN CANDOW: Across from a skeletal muscle perspective, you get a whole plethora. So you definitely get an increase in lean tissue mass or muscle size. And then again, muscle performance, muscle strength, power, and endurance. And the other one that never gets a lot of press, which should, is functional ability. An older adult to sit to stand. This has applications getting off the toilet, out of the bed, out of a car. So as we get older, we’re losing muscle strength and performance as well as functionality. And creatine and weight training seems to come to the rescue there.

Who Should Take Creatine?

STEVEN BARTLETT: And is there anyone that shouldn’t take creatine?

DR. DARREN CANDOW: I can’t find anybody that can’t or shouldn’t. The safety profile is exceptional. If they have preexisting medical conditions, they definitely need to speak to their doctor. Besides that, I’m not seeing any reason a healthy individual can’t take or shouldn’t take creatine.

STEVEN BARTLETT: And pregnant women?

DR. DARREN CANDOW: So that’s an interesting— a colleague of mine, Dr. Stacy Ellery out of Australia, is now finally looking at human trials with pregnancy going into breast milk, into the fetus. So it’s still in its infancy. The jury’s still out. But as it currently stands, it seems to be relatively safe and well tolerated.

Choosing the Right Type of Creatine

STEVEN BARTLETT: Okay. So not all creatine is made the same, right? Correct. There’s lots of different types of creatine. People— some people take creatine gummies. I mean, I have some different types of creatine here. Creatine monohydrate, creatine hydrochloride. Okay. I remember looking when I was in a shelf a couple of months ago and seeing like 5 or 6 different types of creatine. What is the optimal type of creatine to take and why?

DR. DARREN CANDOW: So by far creatine monohydrate, and that goes against all the new marketing forms. So creatine monohydrate is simply creatine linked to one water molecule. When you take it into the body, the water molecule dissolves. It’s identical to what’s being produced in the liver and the brain. All the evidence that you ever hear about the safety and efficacy of creatine is based on the old boring from 1832 creatine monohydrate. There’s new market forms of creatine such as hydrochloride, which does have evidence behind it. There’s many other forms, but the only downfall with all these market forms is it’s never been shown to be safer or more effective than creatine monohydrate. The other big thing for your viewers is make sure it has CreaPure or some form of creatine monohydrate on the label. And then that is also third-party tested.

STEVEN BARTLETT: CreaPure.

DR. DARREN CANDOW: CreaPure is from Germany. It has the highest standard of qualification and scrutiny and then NSF certified or another third-party certified. So those are the three things that I personally would look for. Monohydrate, CreaPure is the type, and then NSF certified or third-party certification, which is that little logo, that little logo here at the bottom. That’s right.

STEVEN BARTLETT: What does that mean? So NSF is the National Standards Foundation.

DR. DARREN CANDOW: It’s a third-party organization that will independently take the supplement and then third-party test it, and then you get a certificate of analysis to make sure there’s no contaminants like lead or arsenic or things like that. So that’s something for the consumers watching to definitely be aware of when you go to the store.

The Dosing Dilemma

STEVEN BARTLETT: And we’ve got this thing here in front of us, right? This is the dosing dilemma, right? We talked about muscle there. Have we checked muscle off, or is there anything else to cover?

DR. DARREN CANDOW: No. So how many scoops do you think is optimal for skeletal muscle?

STEVEN BARTLETT: Oh, skeletal muscle.

DR. DARREN CANDOW: Yeah, your bicep, your tricep, you know, Arnold Schwarzenegger.

STEVEN BARTLETT: 5 grams.

DR. DARREN CANDOW: 5 grams. So that’s only going to be one little scoop.

STEVEN BARTLETT: Okay.

DR. DARREN CANDOW: Okay, that’s probably very viable, and you’re correct, across the lifespan 5 grams has been shown to be effective. But here’s a little bit of caveat: if you’re over the age of 50, maybe you want to have a little bit more, because as we get older the creatine in our lower legs is more jeopardized, and therefore you might need a bit more. Okay. So this is without the loading phase. So this is if you just want to take a little bit per day.

STEVEN BARTLETT: And you have to take it consistently.

DR. DARREN CANDOW: Good question. So ideally, yes, there is evidence that you can just take it on the training days, but we haven’t talked about the brain yet. And the reason why I think you should take it every day is it likes to go to other tissues on a daily basis.

STEVEN BARTLETT: So that’s about 7 grams.

DR. DARREN CANDOW: That’s about 7 or 8 grams. And that seems to be a very safe and viable dose to be shown to be effective for improving muscle mass. Okay.

STEVEN BARTLETT: And performance. I do have an issue sometimes when I take a little bit more creatine, which is I feel— I wouldn’t say lightheaded, but I get a little bit dizzy almost.

DR. DARREN CANDOW: 100%.

STEVEN BARTLETT: What is that?

Creatine Dosing: Muscle, Bone, and Brain

DR. DARREN CANDOW: So there is a mechanism. Creatine is the biggest methyl scavenger in the body. And without boring your viewers, methyl groups are used for everything. They’re also used to synthesize something called adrenaline, and our neurotransmitters, things that we get excited about.

So when you take in too much creatine, typically on an empty stomach or in a dehydrated state, that will spare methyl groups in the body to be used because you’re taking so much in. And then it says, where can I go? So since creatine is now being taken into a supplement, these methyl groups are available in your body to go elsewhere to do work. And they like to synthesize adrenaline. And that’s why you feel more energetic, so to speak.

STEVEN BARTLETT: When you say synthesize adrenaline, what does that mean?

DR. DARREN CANDOW: Yeah, that means you’re creating more of the hormone called epinephrine. And you hear about fight or flight, or you’re nervous, or whichever it is, it gives you a little bit more of that. So that’s why sometimes you feel a little bit jittery or things like that.

STEVEN BARTLETT: Hmm. Yeah. Sometimes I can feel a little bit sick as well if I do too much.

DR. DARREN CANDOW: Yeah. And so that’s where it’s sort of the new area of interest for me is this microdosing based on that. So we’re starting to see some evidence now that if you take smaller amounts all throughout the day, it does not have any adverse effects. If anything, it seems to be a little bit more tolerable.

So you could take a few grams in the morning, a few grams in the evening, or whichever. I think one of the best ways to take it that never gets any press is I put 5 grams in my water bottle during my workout. And so now I’m consuming a little bit of creatine as I do my weightlifting or cardio, and then I’ll consume a little bit in the morning as well. So I take about 10 grams a day at minimum on a daily basis. Other people will take more or less, but that’s just how I get it in.

STEVEN BARTLETT: Yeah, I find that if I do take a little bit in the morning and then a little bit later, it’s much better. 100%. I don’t get any weird feelings.

DR. DARREN CANDOW: That’s correct. And it seems to be more consistent and appreciated for individuals because if you do or are susceptible to any fluctuations in weight gain, water retention, or GI tract irritation, they’ll seem to definitely go away. And we’ve assessed over 1,000 individuals in my lab, and that seems to be a very viable approach. Not a lot of taste to it, is there?

STEVEN BARTLETT: It’s not the best tasting.

DR. DARREN CANDOW: No, it’s very bland, very boring. But there’s other companies trying to make it more flavorful, things like that. The cool thing is with creatine, you can put it in anything. You can put it in yogurt, a juice, whichever it is. You can now put it in coffee. There’s a little bit of controversy over the dose of caffeine. I think anywhere lower than 350 milligrams is fine, and that’s going to be most standard coffees or teas as well. So whichever allows you to become consistent is a great way to do it.

Creatine and Bone Health

STEVEN BARTLETT: Okay, so bone, tell me what I need to know about—

DR. DARREN CANDOW: Okay, so now we talked about muscle. How many do you think for the skeleton here?

STEVEN BARTLETT: That’s the same.

DR. DARREN CANDOW: Okay, 7. Unfortunately, the lowest dose ever has been shown to have bone benefits is 8 grams, all the way up to 12. So now we’re in a dosing dilemma already. We just started, we have a little bit of disconnect between muscle and bone. 3 to 5 grams seems to be really good for muscle, a little bit more is fine, but bone needs to be a little bit more.

And that’s primarily based on some of our work from our lab where we’ve shown that about 8 to 12 grams a day with exercise, and that’s crucial. If you do not exercise, there’s never been a study ever shown to have bone benefits. But if you do perform weightlifting, one of the very cool things in postmenopausal females is that creatine seemed to reduce the rate of bone mineral density loss around the hip region. So it didn’t increase bone density, but it decreased bone density loss, and it also seemed to maintain or improve the structure of the bone a little bit more.

So that has profound beneficial effects, especially as we get older. If those individuals on creatine were to fall, maybe they might not fracture their hip. And as we both know, if you fracture your hip, you’re going to be placed in long-term care, you’re going to be inactive for at least 6 months. So creatine has some bone benefits. They’re not great, they don’t improve bone density, so they’re not going to be an osteoporotic cure, but there is something there, especially if you’re prone to osteoporosis or osteopenia.

STEVEN BARTLETT: And what’s the mechanism there that’s stopping bone loss?

DR. DARREN CANDOW: Yeah, it’s very interesting. So if you understand a 24-hour cycle, creatine sort of stimulates these bone-building cells to become more energized. Think of Super Mario the original Nintendo, when he got the mushroom, he became energized. Creatine does that as well. And then on the flip side, creatine seems to decrease the osteoclasts or bone breakdown cells. So by a synergistic mechanism, it seems to cause this turnover to go a little bit better, causing the bone to maintain its structure. It’s very similar to a bisphosphonate that someone would be taking to maintain their bone health.

STEVEN BARTLETT: A bisphosphonate?

DR. DARREN CANDOW: Yeah, it’s a drug that a lot of individuals will take if they’re prone to bone loss. Obviously creatine is not a drug, but it has some of those similar properties.

STEVEN BARTLETT: So we’ve got muscle, I need to take about 7 or 8 grams to get those benefits. Yeah, with bone it’s a little bit more.

DR. DARREN CANDOW: A little bit more.

STEVEN BARTLETT: You don’t mean additionally?

DR. DARREN CANDOW: No, in total. So now this is where we get into the daily dosing dilemma. We’ve gone from 3 to 5 grams or a little bit more for muscle, bone is maybe 8 to 10 or a little bit more. So what do you think on the brain, the hottest topic?

Creatine and Brain Health: The Stressed Brain

STEVEN BARTLETT: 10.

DR. DARREN CANDOW: 10. Okay, so that would be 2 scoops.

STEVEN BARTLETT: I’m just assuming this increases.

DR. DARREN CANDOW: Yeah. So the interesting thing here is that the brain will naturally make its own creatine, very similar to the liver. So since the brain is actually making its own creatine, it may not require as much or any on a daily basis. So here’s the brain, obviously, and in different regions creatine is being synthesized and being used all throughout. So this organ is about 2 kilograms but uses 20% of our daily energy at rest. So just think about that — 20% of the amount of energy we’re consuming from food or using is being used by the brain.

But what if you’re stressed? Sleep deprivation, your dog got you up in the middle of the night to pee and you couldn’t fall back to sleep, university students cramming for a midterm, now all the countries look at the World Cup, they’re going to be up stressed, different time zones. Then all of a sudden the healthy brain becomes a metabolically stressed brain. So your guess about 10 grams on average is fine because the brain on a non-stress day is naturally making enough and it’s healthy. But now we get into a more difficult question — what about those metabolic stressors? So again, all the neurons in the brain are being used. So what about sleep deprivation?

STEVEN BARTLETT: 10 grams?

DR. DARREN CANDOW: For sleep deprived? When was the last time you slept 10 straight hours?

STEVEN BARTLETT: It’s been a while.

DR. DARREN CANDOW: It’s been a while. For even you to pause there, that’s alarming because you’re thinking, when was the last time I got a really good night’s sleep? What if you were up for 24 hours?

STEVEN BARTLETT: Gosh.

DR. DARREN CANDOW: An ER doctor traveling different time zones, all these come into play.

STEVEN BARTLETT: Yeah.

DR. DARREN CANDOW: Remember, on a healthy brain, adequate sleep, the brain is actually making enough. But when you’re stressed — night shift workers, military pilots, ER doctors, whichever it is — that’s where the brain starts to rely on supplementation. So unfortunately for the brain, creatine really struggles to get through the blood-brain barrier, but if it does, now you might need longer or higher dosages. So what about sleep deprived?

STEVEN BARTLETT: I have no idea.

DR. DARREN CANDOW: Okay, so let’s say there’s 5, there’s 10. What do you think?

STEVEN BARTLETT: It’s going to be more, isn’t it?

DR. DARREN CANDOW: It’s going to be a lot more. Here’s 15. Couple studies showed some benefits. Now let’s do 20. Remember that loading phase?

STEVEN BARTLETT: Mm-hmm.

DR. DARREN CANDOW: The best overall studies currently right now that use an MRI for the brain have showed about 20 grams seems to have some effect acutely. But the two studies last year out of Germany even showed this. There’s 25 and here’s 30. So a classic study was done last year when they gave 30 grams to a group of young individuals who volunteered to be sleep deprived for 21 hours. And that level of creatine increased creatine levels in the brain and it offset some of the negative effects. Remember, that was an acute episode of 21 hours of sleep deprivation. They’ve done a subsequent study going down to about 0.2 grams or about 14 grams. It didn’t have the same effect.

So remember, a healthy brain likely doesn’t need any creatine, but a stressed brain likely does. And the more stressed it is, the higher the dose seems to come into play. There’s a lot of nuances with the brain. Obviously we just showed different regions, which we don’t have a lot of information, but overall it seems that 20 grams seems to be the most viable dose when the brain is stressed. We basically need to start dumping out quite a bit more.

So when you get from this area on the brain healthy, it likely doesn’t benefit from any type of supplementation because it’s making its own. But in these areas, when you’re stressed, it likely does. The area of nuance, or why it’s become so popular, is I think most people fall into this stressed environment, and if they’re not getting enough creatine through their diet and/or supplementation, that’s why this big explosion on let’s take more to sort of check off all the boxes.

Finding the Right Daily Dose

DR. DARREN CANDOW: So I take 10 grams a day at minimum to check off muscle, right? That checks off bone for the most part. And I’m pretty sure over time 10 grams would do the most part for stress. Now, since I just flown different time zones today, I’m taking 20 to 25 grams based on this acutely. And then when I go back to a non-stress environment, back to Canada, I’ll go back to my regular 10.

So I look at the 10-gram dose or a little bit more as kind of being like a safety net. If you’re only taking 3 to 5, you definitely will get muscle benefits. Will you eventually get brain benefits? There’s a small chance, but taking a little bit more — and remember, the cool thing for your viewers, we’re not talking about protein. If we were talking about protein, the entire thing would be hundreds of grams. We’re only talking about maybe 20 grams, and that may only need to be done acutely, when you’re really going through metabolic stress.

Look at university students, 5 final exams, hardly any sleep for a week — this is where this would come into play. I look at flight attendants or pilots. They’ll fly from Canada to Europe and then they go back home. Their circadian rhythms are all over the place. So I think of all these scenarios.

The area that I was surprised — I watched one of the episodes of the Eras Tour and, money can’t stop circadian rhythms. So as much as Taylor Swift would have, I was marveled by 3 hours of performance in front of 90,000 to 100,000 people, all her running around. And then when you see her, they’re totally gassed. They finished the concert. They’re totally mentally exhausted. That’s a situation where this could come in to enhance performance.

Then you think of celebrities, you think of athletes, these lot of high-pressure things — like imagine being in the World Cup final, the pressure, the mental capacity. That’s where creatine seems to come into play. There’s a lot of nuances. We still don’t know a lot.

So I think the big take-home for people is that if you’re going through periods of stress, a little bit more is okay. We don’t know any adverse effects. We don’t think there are any. But again, if you’re just taking creatine for muscle, bone, and the brain, you’re likely going to be checking off all those boxes.

The Stroop Test and Brain Performance

STEVEN BARTLETT: And when we start getting the brain benefits up at this end, right, what are those brain benefits that were recorded in the studies? Is it I’m going to feel like I slept? Yeah. Or is it something more internal?

DR. DARREN CANDOW: You likely won’t feel anything.

STEVEN BARTLETT: Okay.

DR. DARREN CANDOW: However, when you get to tasks the next day, so for example, you’re up all night, you take a high dose of creatine, then you have to go write the final. Or the midterm, or you can’t remember, it’s those things when your memory and doing puzzles or basic tasks. Or what about a Stroop test?

STEVEN BARTLETT: What’s a Stroop test?

DR. DARREN CANDOW: So I’m going to get you to do this. I apologize in advance. It’s one of the most fatiguing things that you can do. And it was one of the most robust studies to show the efficacy behind creatine. So all I simply want you to do is you can see that there’s words and then corresponding letters, but you’ll notice that the color is incorrect. So up here you would see, you know, you have red, blue, green, blue, black. But the Stroop test is now looking at the bottom part.

STEVEN BARTLETT: Okay.

DR. DARREN CANDOW: So I’ve tried it. I can only get the line 2 without making a mistake.

STEVEN BARTLETT: Okay.

DR. DARREN CANDOW: Okay. So I want you to do this out loud, but as fast as possible.

STEVEN BARTLETT: And am I reading the words or the color?

DR. DARREN CANDOW: You’re reading the color.

STEVEN BARTLETT: Okay. So the first one’s green.

DR. DARREN CANDOW: Yeah. Yes.

STEVEN BARTLETT: Okay, fine. You want to do it as fast as possible?

DR. DARREN CANDOW: As fast as possible.

STEVEN BARTLETT: Okay.

DR. DARREN CANDOW: So let’s see how you do.

STEVEN BARTLETT: Gosh, this is confusing already. I hit the second one and I got it wrong in my head.

DR. DARREN CANDOW: Depends how much creatine you’re talking about.

STEVEN BARTLETT: I don’t think I’ve had creatine today. Okay. Okay. Green, red, yellow, green, blue, black, orange, red, blue, green, blue, pink, black, gray, yellow, red, blue, green. Oh, f*.

DR. DARREN CANDOW: There you go.

STEVEN BARTLETT: See?

DR. DARREN CANDOW: I failed. The study that they did, get this, they had to do this for 90 straight minutes.

STEVEN BARTLETT: Oh, wow.

DR. DARREN CANDOW: So you can imagine how fatiguing that is for someone studying for the MCATs for medical school or, you know, midterms, being sleep deprived and you’re not sleep deprived and you struggled and you got slower. Now you have to do this for 90 minutes. Wow. And in this classic study, they gave 20 grams of creatine before they did the test and then after, and it really improved their ability with speed and cognition there.

So it’s just a simple example to show, wow, our brain is seeing one thing. We gotta maintain memory and cognition, and creatine can help maintain some of those factors. So you won’t feel anything, but performance of activities like that come into play.

STEVEN BARTLETT: Do you know how much it improved the performance on the Stroop test?

DR. DARREN CANDOW: I would have to get the graph, but it did prove statistically significant. Yeah.

STEVEN BARTLETT: What else is there for me to know about the impact that creatine can have on the brain? Yeah. You know, I think as a podcaster who sometimes sits here for many, many hours interviewing people on a range of subjects, I’m always trying to find if there’s any way that I can perform better mentally.

Creatine as a Brain Safety Net

DR. DARREN CANDOW: Yeah, so it doesn’t boost the brain, it likely just brings those levels back up to normal levels before stress, and it might give you a little bit more. So there’s been populations— Alzheimer’s disease, clinical depression, concussion— when those populations are evident, one of the biggest factors is that they have reduced creatine in their brain. So maybe supplementation can get through the blood-brain barrier, the brain says I need help, and that’s why you see some improvements there as well.

So I like to think of the brain that creatine can act as a safety net, and it certainly won’t cause any detrimental effects. But it’s always good to have that because you never know when I give you a Stroop test, like I’m going to find you tomorrow and give you this and say you’re going to be practicing all night. Will you perform better? But that’s just an example of something that we go through on a daily basis.

If someone’s working on Wall Street or whichever it is, really high stress demand, you know, stuck in traffic for 2 hours, these all add up and it’s a cascade of stressors. That unfortunately most people go through. And now we have a nutrient that is being made in the brain, but during times of stress, it likely needs a little bit of help.

Creatine and Inflammation

STEVEN BARTLETT: What about inflammation? Yes, in the body. Yeah. So what is inflammation, and is there a link between creatine supplementation and inflammation?

DR. DARREN CANDOW: There is. So unfortunately, I’m 49, so at the age of 40 I have this systemic inflammation that went up. And we all know this because around the age of 30, where, you know, you can work out and nothing hurts, and all of a sudden you wake up one day when you’re in your 40s and 50s and things hurt. And so systemic inflammation is happening all the time. And unfortunately, it accelerates aging. We’re more sore more often, and it can lead to a lot of arthritis or joint pain and things like that.

Creatine does have anti-inflammatory effects, but a big distinction— creatine is not like acetaminophen or ibuprofen, which directly as a drug effect blocks that. But it has been shown to decrease markers of inflammation, specifically during long-duration exercise. So this is an important distinction. Weight training is too acute. But when you do Ironman, triathlon, things like that, those individuals who took creatine, 20 grams a day for 5 days beforehand, they had reductions in inflammation markers. So that might allow that individual to recover quicker, not get ill, and then perform more optimally. From a weight training perspective, we see that it decreases markers of muscle damage. So it has these anti-inflammatory and anti-catabolic effects as well. Interesting. Yeah.

Creatine and Neurodegenerative Disorders

STEVEN BARTLETT: And what about people that have neurodegenerative disorders?

DR. DARREN CANDOW: Yes, so Alzheimer’s is the area we’re really starting to focus on. And a couple single-arm studies came out last year by Matt Taylor and Aaron Smith showing that 20 grams a day for 8 weeks did increase brain creatine levels in Alzheimer’s patients, and it seemed to improve measures of memory and cognition there as well.

So again, using the same mechanisms, it decreases inflammation, it maintains brain bioenergetics, and it might actually have a neural protection effect as well. There’s evidence in cell cultures and in rodents that there’s some lines there, but in humans we’re still in the infancy, but if it can have any benefit to any neurological disease, it’s huge. And there’s a lot of hope, especially around Alzheimer’s.

STEVEN BARTLETT: There was an 8-week trial in Alzheimer’s patients that also showed modest muscle gains and a 1.9 kilogram increase in hand grip strength, which is a key predicator of survival in dementia patients. Correct. Which was a landmark study of 20 Alzheimer’s patients, found that taking 20 grams of creatine daily for 8 weeks increased brain creatine levels by 11% and significantly improved the cognitive test scores they showed. That’s the Journal of Psychiatry and Brain Science.

DR. DARREN CANDOW: And that one’s really exciting. And I think more future studies will come out. The limitation with those is that there was no placebo to compare to. But again, it’s just showing that, yes, creatine can be used as an effective adjunct.

Creatine and Mental Health

STEVEN BARTLETT: Yeah. And because there is impact on our brain, is there impact on our mental health with creatine?

DR. DARREN CANDOW: Excellent point. So the best lines of evidence here come from clinical depression and anxiety. The group out of Utah in the United States have clearly shown that creatine, in addition to other therapies. So this is important. Creatine by itself has never been shown to be a standalone, but with SSRIs or cognitive behavior therapy or methamphetamine use in populations under medical supervision, the addition of creatine seemed to improve symptoms.

And it’s likely going back to all the ones we’ve already talked about, where it improves bioenergetics, it improves neurotransmission or neuromodulation, but it also in animals has been shown to improve a protein called BDNF. So this protein is involved in brain plasticity. So there’s a whole bunch of emerging evidence and hope that creatine one day will be used as a treatment in the toolbox for a lot of these clinical issues. PTSD also comes to my mind.

STEVEN BARTLETT: There was a study in Gatorade Sports Science Institute, which PubMed published, that said a study of over 200,000 adults found that those who consumed the least amount of creatine in their daily diet, right, had the highest rates of depressive symptoms.

DR. DARREN CANDOW: Yes, that’s correct. And the common denominators, those with clinical depression or anxiety, when you measure their baseline creatine stores, very similar to concussion or Alzheimer’s, they’re reduced. So therefore, obviously, this condition or series of conditions is causing a disruption at the brain bioenergetic level, and creatine levels are decreasing.

STEVEN BARTLETT: And there’s another in PubMed that said, in a clinical trial of women with major depression, adding 5 grams of creatine to their daily antidepressant. Yes. Doubled their remission rate over 8 weeks.

DR. DARREN CANDOW: That’s correct. Yes. And that group is from Perry Renshaw’s group out of Utah. They do great work. Our hope— and I’m collaborating with some colleagues now to look at creatine as a standalone treatment versus placebo. Could it have some beneficial effects there? So that’s very exciting to come out.

Natural Food Sources of Creatine

STEVEN BARTLETT: If I don’t want to be supplementing with creatine, is there— what are the foods that I can eat that are high in creatine naturally?

DR. DARREN CANDOW: They’re primarily animal-based, so seafood and red meat. You know, herring is going to have one of the highest concentrations, salmon as well as beef, very small amounts in milk and dairy. So you’d have to drink all the milk in the Jersey cow to get a sufficient amount. So it definitely comes down to animal-based flesh.

STEVEN BARTLETT: Yeah, there’s some of the studies that I love that I think I’ve heard you talk about before. One of them was young athletes who took 5 grams of creatine daily, slept an average of 1 hour longer. Yes. On training days.

The Toolbox Analogy: Exercise, Creatine, and Overall Health

DR. DARREN CANDOW: Yeah. We did that study a few years ago in young biological females who were healthy, and on the days that they trained and took creatine— this is interesting because they actually slept an hour longer compared to a placebo. So this is a very interesting fact.

So creatine, we now know it has brain bioenergetics, and there’s two arguments. If it’s making the brain recover, wouldn’t you need less sleep right now? In this study, it showed that improved. So maybe these individuals trained at a higher capacity and allowed the brain to have more homeostasis to come back. So this is an area— a study that needs to be replicated in males as well to see, can creatine improve sleep quantity? And if it is, I think that’s a game changer. I think everybody on the planet would raise their hand and say, “Hey, I need more sleep.”

STEVEN BARTLETT: Is there anything else we haven’t covered as it relates to creatine?

DR. DARREN CANDOW: The expected gains versus the hype gains. I think there’s evidence there that creatine can have a— I think it’s getting overhyped, especially around the brain for what it can do. It’s one tool in the toolbox. And I think it’s one of those things that I’d like to show or talk about for sure.

STEVEN BARTLETT: Well, what do you mean by that?

DR. DARREN CANDOW: So if you think of a toolbox, when it comes to a plan, whenever you need to go fix things, you simply say, “Where’s my toolbox?” You can’t do anything without a plan. And the way I like to preface this is the most popular tool in anybody’s toolbox is the hammer. Now, from a lifestyle perspective, what do you think the hammer represents? What would you decide that the hammer represents?

STEVEN BARTLETT: As in like a—

DR. DARREN CANDOW: Is it weight training? Is it cardio? Is it creatine? Is it protein? Or is it sleep?

STEVEN BARTLETT: Sleep.

DR. DARREN CANDOW: Okay, so I say weight training is going to be the hammer.

STEVEN BARTLETT: Okay.

DR. DARREN CANDOW: Okay, now what about the screwdriver? Always need a screwdriver.

STEVEN BARTLETT: Creatine.

DR. DARREN CANDOW: No, I think aerobic training or sleep comes way before creatine.

STEVEN BARTLETT: Okay.

DR. DARREN CANDOW: But most people say, “Hey, I can fix a lot of things with that.” Now remember, we have a nice big toolbox. I like to think of creatine as the multifactorial wrench or screwdriver, because creatine has profound benefits for muscle, a little bit for bone, of course brain and other areas of the body. So you can hit something with this, you can open it up, and fix something with this. It’s heavy. You can also pull out the measuring tape. Your argument, sleep. This could be protein, whichever it is. So when you put all these things in your toolbox, you’re now having a greater comprehensive plan to improve health.

STEVEN BARTLETT: So you said weight training was the hammer.

Why Weight Training Is the Most Important Form of Exercise

DR. DARREN CANDOW: Hammer. I like to consider if you were to choose one modality of exercise, weight training is a little bit superior to cardio. You get pretty much all the same benefits of cardiovascular exercise, and then you get more with obviously an increase in lean tissue mass and performance. Weight training, if done effectively, can actually improve mitochondrial health. You can improve VO2 max if done correctly, and you don’t need a lot of it. So I think we’ve switched from just doing cardio to now incorporating weight training to be effective.

STEVEN BARTLETT: So weight training— yes, what are the sort of misconceptions about weight training, and why are you so positive about it?

DR. DARREN CANDOW: I think one of the biggest myths is that you always need to lift heavy to put on muscle mass, and world-renowned researchers in this area have clearly shown now that lighter weights performed at a lot of effort almost to fatigue, if done correctly, you can get the same increases in muscle mass as compared to lifting heavy weights. However, if your goal is just to get stronger, lifting heavy is always there.

So I think this is a cool thing for people. Some days, if you have a little bit of soreness or you don’t have a lot of energy, you can lift lighter weights, but just to fatigue. Whereas other days you come in Monday, you’ve had your coffee, whichever it is, you’re ready to go, you can lift heavy. So I think there’s not one concrete way. There’s a little bit of variety here as well.

STEVEN BARTLETT: And why are you putting it above cardiovascular work?

DR. DARREN CANDOW: I think the benefits there is that cardiovascular exercise will make you live longer and healthier, but the downfall with cardiovascular exercise is it doesn’t stimulate strength or the musculoskeletal system as much as we’d hope. So improving muscle mass is very difficult to do with cardio. Maybe sprint interval training will do that, but the cool thing with weight training is you get cardiovascular benefits, but you also get those profound musculoskeletal benefits. So if I was to tell anybody, if there’s one form of exercise to do, it’s weight training. But you’ve got to do cardio as well. So do both.

STEVEN BARTLETT: And if I just do weight training, what am I missing from not doing cardio training?

DR. DARREN CANDOW: If you do weight training improperly where you’re lifting heavy, heavy weight with low repetitions all the time, you’re likely going to jeopardize capillary density or mitochondrial health. These are things that sort of move blood flow to and from your muscles. You could decrease VO2 max, or a fitness parameter for metabolic health fitness. So at the end of the day, everybody should be doing both.

STEVEN BARTLETT: Both.

DR. DARREN CANDOW: But if you only have time to do weight training or cardio, you still benefit because the majority of the population doesn’t do any.

How Much Exercise Do You Actually Need?

STEVEN BARTLETT: And how much, how often?

DR. DARREN CANDOW: It’s amazing that it’s a small amount. So let’s just do cardio. Most countries will say 150 minutes of physical activity at a moderate level over a week. I’m okay with that. I’d like it to be higher. I’d also like the intensity to be a bit higher. So when you tell an average individual 150 minutes, a lot of people say, “Well, I’m going to do 70,” or “I’m going to do 30,” or “I’m going to hold the couch down and watch Netflix.” So we give it 150 and we say, if you can do 21 minutes or 22 minutes a day for 7 days a week, that’s going to be a brisk walk or whichever. We’d like to be at a higher intensity if possible.

Now, when it comes to weight training, this might be surprising, but 2 days a week or more is all you basically need. And you can do a whole body routine. So you don’t need to go in there and just do chest and biceps Monday and then legs Tuesday. You can, but if you say, “I want to do whole body training Monday, Wednesday, Friday,” that is great as well. So a little bit of volume or frequency goes a long way, especially as we get older. That’s the key.

STEVEN BARTLETT: Why especially as we get older?

DR. DARREN CANDOW: Well, based on this graph here, it’s clearly showing a detrimental effect. So if you can see here, you have muscle mass on the y-axis, and then you’re having all the catastrophic effects as we get older. So unfortunately, 20 and 30 looks great.

STEVEN BARTLETT: When you’re 20 or 40 years old.

DR. DARREN CANDOW: When you’re 20 and 40 years old, or all the way from 20 to 40, you can see that’s probably the area that you’re going to have the most muscle. But look what happens at age 60, 80. And if you live to be 100, it’s catastrophic. You’re losing muscle mass at an accelerated rate. On average it’s about 1% per year after the age of 40.

STEVEN BARTLETT: Even if you’re training?

DR. DARREN CANDOW: So if you’re training, you’re maintaining that. So this is the average sedentary inactive population. You lose strength at about 1 to 3%, even faster. Now, if we were to maintain resistance training, that muscle mass would plateau. So I can’t stress this enough, although we focused on creatine, if you were to choose one thing to do today, it’s exercise. And the only form of exercise that really maintains muscle is weight-bearing or resistance training. And if that’s the case, you’re going to have way more muscle later on in life so you can pick up the grandkids, you can walk those stairs, you can do more functionality things later on in life.

STEVEN BARTLETT: Can you not just, I don’t know, 60 years old, start training then?

DR. DARREN CANDOW: You can, absolutely. And you get profound benefits. You can be 80 or 100 and you still get benefits. It’s never too late to start. But one of the things we’ve already talked about is if you do weight training and add in a little bit of creatine, it gets a bit higher. If you added in protein, it gets even higher. So again, nutrition— if exercise is king, the queen is going to be nutrition. They go hand in hand all throughout lifespan. You’ve got to have both.

Protein, Creatine, and the Force Multiplier Effect

STEVEN BARTLETT: And on the subject of protein, you’re saying that when combined with creatine, it’s a force multiplier?

DR. DARREN CANDOW: It’s a force multiplier when it comes to performance and lean tissue mass. So there’s been a few studies when you combine high-quality protein with creatine, they’ve been shown to increase lean tissue mass and muscle performance a little bit more than each alone.

STEVEN BARTLETT: Does the average person get enough protein through their diet?

DR. DARREN CANDOW: I think nowadays we do, and I think this is overhyped as well. I think if you’re getting about 1.2 to 1.6 grams per kilogram— so if you’re 70 kilograms, that’s going to be on average about 84 to about 115 grams of protein. I think we’re so conscious now of the health benefits of protein that most people are. I think if you’re training really intensely, 5 or 6 days a week, and you take a gram per— that’s probably the max.

But a lot of times when you take in excess protein, it doesn’t go to your body area that you’re probably hoping. It doesn’t all go to your muscle. It’s used for other things like hormones and blood cells, things like that. But I think nowadays most people are likely getting enough protein. The question is, are they getting enough high-quality protein? So vegans and vegetarians can definitely get enough protein. They might just need to eat a little bit more to get all those essential amino acids which we need.

Creatine, Menopause, and Women’s Health

STEVEN BARTLETT: Menopause. We talked a little bit briefly about menopause, bringing both together the subjects of muscle but also of creatine. How do those two things impact a woman’s journey through menopause?

DR. DARREN CANDOW: So we know from animal cells that estrogen is highly involved in creatine metabolism. Estrogen seems to be implicated in the enzymes that are needed to make creatine, and then estrogen also has a huge impact on not only brain bioenergetics but muscle metabolism as well.

So as the female goes from a premenopausal stage to perimenopausal stage to the postmenopausal transition, if estrogen is decreasing and then independent of their diet, we think creatine has bone effects and muscle effects. And of course, we’ve talked about the cognitive effects there. So from a whole skeleton perspective, I think everybody should be. But of course, the perimenopausal postmenopausal transition is good.

And then that brings up a question about what about really young premenopausal females, optimal health. What if we built up their tissues more? Maybe that would offset the rate of this decline over time as well. So that’s what we’re hoping to get to.

STEVEN BARTLETT: Is creatine safe for kids?

Creatine Safety, Timing, and Practical Tips

DR. DARREN CANDOW: So it’s interesting you bring that up. And the current body of evidence suggests yes, at recommended dosages. Good researchers in the United States put up multiple reviews looking at creatine in adolescent children and teenagers. Improves balance, agility, body composition. If anything, they want to get at least 1 gram per day because in children they want to have an optimization for bone health as well as muscle development. But again, if any parents are watching, obviously talk to their medical practitioner, but all the current reviews currently suggest that it’s safe.

STEVEN BARTLETT: And we’re talking about— we’re not talking about babies here, we’re talking about—

DR. DARREN CANDOW: Yeah, we’re talking about adolescents all the way into teenage years. When it comes to baby or infancy, out of Australia, Stacy Aldry is starting to do that work there as well, but we don’t have a lot of data in humans yet. But that is an area to pay attention to for sure.

STEVEN BARTLETT: Yeah. What is the most important thing we haven’t talked about that we should have talked about, Dr.?

Creatine’s Safety Profile and Timing

DR. DARREN CANDOW: Yeah, I think one of the big things is the safety profile of creatine. There’s been hundreds of randomized controlled trials now on creatine. The safety profile is exceptional. Last year they put out a study looking at over 25,000 cases and creatine even over 10 grams a day for many years has been very, very safe and effective.

One area that comes up is what about the timing? Does it matter when I take it? And the cool thing is we just got a paper accepted 2 days ago putting the nail in the coffin on this, and at the end of the day, you can take creatine at any time of the day. You can take it in the morning with breakfast, you can take it right before workout. I take some during. You can take it after, go to bed. It doesn’t matter when you take it as well.

STEVEN BARTLETT: So you can take it right before sleep? You can. And it won’t impact your sleep?

DR. DARREN CANDOW: No, currently we haven’t exactly assessed the effect on sleep, but another study looked at it in the evening and it had no detrimental effect there as well.

STEVEN BARTLETT: And what else? What else is the other questions that you get messaged with or asked most often, Doctor? Yeah, can I spread out creatine all throughout the day?

DR. DARREN CANDOW: So for example, if we were to take creatine in a gummy form or a candy, you can actually have 1 or 2 of these every hour all throughout the day. You can have it periodically, so you don’t have to take creatine all at once. You can take it in smaller amounts all throughout the day. And if anything, there’s been a study a few years ago showing that 1 gram every 30 minutes up to a 20-gram dose seemed to retain more in the body, and that was beneficial as well.

Creatine Gummies and Third-Party Testing

STEVEN BARTLETT: What do you think of these gummies?

DR. DARREN CANDOW: There’s only been a few companies that have actually shown some validity and reliability. As long as they’re third-party tested, they’re very, very effective. You want to try one?

STEVEN BARTLETT: Are they third-party tested?

DR. DARREN CANDOW: The green ones? Yeah. And the bottom ones, third-party tested.

STEVEN BARTLETT: Yeah. But the stuff that makes it a gummy, is that stuff— is that stuff good for you?

DR. DARREN CANDOW: So the issue there is, does the manufacturing trying to keep the creatine together influence it? It can. And there’s only been a few companies out there. The one you’re eating is by Create from the United States. They have had multiple trials. They’re the first company to actually look at a randomized control trial to show improvements in volleyball players with the gummies. Children love them. Older adults— this has become an area of interest where chewing ability or taste sensation has gone down. They seem to be very convenient and effective. You can have these at your desk, whichever. You don’t need the white powder to mix. So the companies are coming up with more viable ways to get creatine in there. But to your point, you always want to make sure the company’s third-party tested.

STEVEN BARTLETT: It.

DR. DARREN CANDOW: It uses a high-quality creatine, and it actually has a source of creatine in there as well.

STEVEN BARTLETT: Because I remember watching a YouTube video by a guy called James Smith, who’s been on the show before, and he did some testing on the off-the-shelf creatine and found that a lot of them didn’t contain any creatine.

DR. DARREN CANDOW: 90%, and there was only a few. And the one that you did consume, it did. Yeah, 1.5.

STEVEN BARTLETT: Isn’t that crazy that you can go buy creatine and it has no creatine?

DR. DARREN CANDOW: So that’s why I think for the consumers watching, you got to do a little bit of homework and look at those 3 things. Make sure third-party tested, it has a logo clearly on the packaging. If it doesn’t, I would strongly advise you not to consume it.

Landmark Studies on Creatine

STEVEN BARTLETT: Of all the studies that you’ve encountered on all the subjects we’ve talked about— muscle protein, creatine— are there studies that were pivotal in how you think about these subjects?

DR. DARREN CANDOW: Yeah, there was. So the landmark study came out in 1992, and it clearly showed that 5 grams elevated creatine in the blood. But if you took multiple 5-gram dosages, it maintained that throughout the day. So this is where the dose of 5 grams seems to be very, very viable.

And the other one showed that, hey, I don’t want to take 5, what if I only want to take 3 grams? So 3 grams seems to be the lowest, most effective dose, and you just need to take that for 1 month and you’ll saturate your muscles. So again, you have options to take as little amount or a high amount as you want over time.

But I think one of the biggest studies is that we did was a 2-year trial in postmenopausal women where we gave 0.14 grams of creatine, and it really seemed to improve or have an effect on bone preservation as well as muscle performance. So these are the studies that seem to come to my mind. We’ve done quite a few, but they seem to be the landmark ones.

Dr. Candow’s Personal Supplement Stack

STEVEN BARTLETT: Yeah. And what are the supplements that you take outside of creatine?

DR. DARREN CANDOW: Yes, for sure. So on a daily basis, it’s a probiotic with food in the morning and evening. And that’s something I just recently learned. I was taking it on an empty stomach, but probiotic. I take two forms of magnesium, one before bed and then one in the day, 3 and 8, for cognition and function. I take 2,000 international units of vitamin D. I always take protein on a sufficient basis as well. And then I take about 4 grams of omega-3 fatty acids, and I always take one of the omega-3 fatty acids post-exercise because that seems to be the best time to take it.

STEVEN BARTLETT: So omega-3, magnesium, vitamin D, probiotics, of course creatine and protein.

DR. DARREN CANDOW: I take powder and/or through dietary food every now and then. I don’t eat a lot of red meat, so I’ll take iron, but not on a consistent basis. And I’m hoping the new one is— this is an area of controversy— NAD+. This is a precursor for a main enzyme that’s highly involved in metabolism. There’s been evidence to suggest it goes down with aging. So my eye is closely on that to see if that’s going to be something to come up into play. And a multivitamin— started with Flintstone Vitamins as a kid, and I take a multivitamin a day as a safety net.

Creatine’s Growing Appeal Among Older Adults

STEVEN BARTLETT: I noticed that when I looked at your video in the interview you did with Dr. Rhonda Patrick, a lot of the comments were from people in their 60s, 70s, and 80s. And I wondered why that was. I was just looking at the top 3 or 4 comments, and it’s a 71-year-old, it’s an 82-year-old, it’s a 53-year-old who’s contending with Alzheimer’s, right? Why is that?

DR. DARREN CANDOW: Yeah, I think it’s the awareness and education now, and social media has really helped with this, getting our evidence-based research out to the public and the awareness that creatine is just not for young males to get bigger, stronger, faster. If anything, when you go to an aging body and they’re predisposed to age-related muscle loss, strength functionality, bone loss, and atrophy in the brain, creatine has been shown to have effects there as well.

So I think a lot of older individual populations are becoming more aware of the effects of creatine. And of course, as we produce more research, it gets out to the public more often. So I’m really excited and encouraged that creatine has sort of taken on a life of its own in the last decade.

STEVEN BARTLETT: And are there direct weight benefits if I’m trying to cut fat by taking creatine? Or is it indirect?

DR. DARREN CANDOW: It’s indirect. So it seems that if you increase lean mass, it might stimulate energy expenditure or a turnover. And then in animal models, it has been shown to have some beneficial effects from a cellular perspective on fat. But at the end of the day, if you are seeing a reduction in fat, it’s likely that you’re improving your metabolic health with lean tissue mass.

Building Consistency with Creatine

STEVEN BARTLETT: Do you think much about how to get these habits to stick? Because I imagine there’s lots of people that are aware by now that creatine is a useful thing to take, but for whatever reason they still don’t take it.

DR. DARREN CANDOW: Exactly. And I think that’s one of the biggest reasons people don’t. So we got to come up with ways to maintain consistency. And I think whatever vehicle you want to choose to maintain that in the run of a day is the best. So if it’s putting it in your coffee in the morning, because you won’t forget it, great. If it’s putting a little bit in Greek yogurt, if it’s using the gummies, whichever it is, as long as it’s a viable source of creatine that makes it very practical and consistent for you, that’s the best way.

STEVEN BARTLETT: Yeah. I found that having it en route to where I’m going is being really, really important.

DR. DARREN CANDOW: Yeah.

STEVEN BARTLETT: So when I come to my office in the morning, it’s all on my desk. So I have the supplements just on my desk. And actually, even before I walked into the studio today, in the green room that I have, it’s on the green room, right? When I’m at home, it is where the coffee machine is. And that has radically helped me. Otherwise, if it wasn’t within my routine, it wouldn’t happen.

DR. DARREN CANDOW: We have a jug on the counter with all our other supplements. It’s in the pantry, it’s close by, because if it’s in the garage, you’re like, I forgot about it.

STEVEN BARTLETT: I think the other thing is with some things like creatine, it’s hard to really notice the difference sometimes.

DR. DARREN CANDOW: Ah, excellent point. Yeah, this is not like caffeine, you know, it’s an immediate effect. So unlike caffeine, creatine takes a while to notice the effects, and they come in direct. You don’t immediately notice a massive increase in energy or alertness. It’s like after a week of weight training, or even two, you’re like, wow, I did more repetitions, I could do more weight, I recover quickly, is one that we hear quite often.

You’ll never notice with your bone, but we have heard anecdotally with cognition, especially sleep deprivation supplementation. People do notice the effects. And I’m a man of one, but I notice jet lag goes down quite a bit when I take a high dose of creatine.

When Will You Notice the Effects?

STEVEN BARTLETT: And when you start taking it— if you start taking it today— if I start taking, say, 3 to 5 grams of creatine today, am I going to notice the differences today?

DR. DARREN CANDOW: No, it’ll— with 3 to 5 grams, you’ll probably notice it in a few weeks, if not to a month, from a muscle perspective. From a brain perspective, that low, you’re likely not going to notice any effect because the brain is probably making enough. But if you’re really metabolically stressed, then you might notice some memory or cognitive benefits after a few days. But at such a low dose, you need to be a little bit patient. But again, 3 grams could saturate your skeletal muscle in 30 days, so it’s not that long of a wait.

STEVEN BARTLETT: And on the cognitive side— the cognitive benefits that were observed when doing these Stroop tests, had they been taking it previously, or was it just administered on that particular day when the test happened?

DR. DARREN CANDOW: Yeah, so that one was in a week in advance with the loading phase, so they really saturated the body to try to get the effects.

STEVEN BARTLETT: Okay, so they were taking it for some time.

Creatine, Sleep Deprivation, and High Doses

DR. DARREN CANDOW: Yeah, but on the sleep deprivation study from Germany, they just gave it one bolus megadose for 21 hours of sleep deprivation, and those individuals did perform better from a number of tests like this the next day. So if you’re like, wow, I got something coming up Friday, unfortunately I’m not going to get any sleep, at best 1 or 2 hours, then a high dose might come into play, and then you can go back to your more consistent routine.

I think what happened, or is happening, is a lot of individuals are now thinking, I need to take 20 or 30 grams on a daily basis based on those studies. And I’m like, wait a minute. Are you getting enough sleep the next day? Because at that dose, we don’t know if the neuron will swell with water. And if that’s the case, is that potentially causing any detrimental effects in the long term? So again, I would not recommend taking a mega dose consistently over time. Could that downregulate your natural synthesis? These are all questions that we need to look at.

Dr. Candow’s Personal Health Routine

STEVEN BARTLETT: Yeah. So outside of the realm of creatine, outside of the realm of muscle, outside of the realm of nutrition generally, what are you doing to keep yourself healthy? What is your routine?

DR. DARREN CANDOW: Yeah, so I’m religious with exercise. So I try to exercise at least 3 to 4 days a week with weight training, and add in at least 20 to 30 minutes of either moderate intensity cardio or a spin class. I personally like to do alternating days. So I’ll do weight training like maybe Monday, Wednesday, Friday, and then cardio Tuesday, Thursday, and then on the weekends hiking, things like that.

Pretty religious with nutrients as well, try to eat a really balanced diet. And my God, my failure is getting enough sleep. So I’ve had to cut caffeine out quite a bit by past noon to allow me — I’m probably a slower metabolizer with caffeine. So I try to really optimize evidence-based research, take it into my daily life and try to promote it that way. Yeah.

Exciting Frontiers: Brain Health, Concussion, and Alzheimer’s

STEVEN BARTLETT: And is there anything you’re particularly excited about in the work and research?

DR. DARREN CANDOW: I’m super fascinated with the movement from the neck up. I think we know a lot about the neck down with creatine and exercise, or other nutrients. I’m fascinated with the ability — what about concussion? Can the UFC fighter take creatine before they get hit? Could that decrease CTE or concussion or brain trauma later on in life? I think of boxing, Muhammad Ali, things like that.

So there’s evidence in rodents that if you take creatine before head trauma, it really speeds up concussion recovery. So I’m fascinated with that as well, like almost a prophylactic. Anybody involved in head trauma, I think you should definitely look at creatine as something to be taking just in case you get hit. And then of course everything with Alzheimer’s or other areas of depression. So I’m fascinated that this nutrient, which was discovered in 1832, boring for the longest time because we thought we knew everything, and now it’s taken a life of its own and it’s having these profound benefits we never even thought would happen yet.

Will Dr. Candow Ever Stop Researching Creatine?

STEVEN BARTLETT: A lot of people consider you to be the sort of leading expert on this subject for many reasons. Do you think there’ll be a time where you stop researching creatine and you move on to something else?

DR. DARREN CANDOW: I would have said yes about 5 years ago, but now, no, there’s too much to do. Even with skeletal muscle, if you were to say, what’s the best dose, Darren, to take? I say, I have no clue. Every creatine researcher said, I don’t know. We still don’t know the best dose that every person can take that will check off all the boxes, especially in the brain. We’re just giving an estimate that I take 10, maybe you take 12, someone might take 15. But at the end of the day, we still don’t know the best supplementation protocol, the best dose. So there’s so many areas. So for the next 20 years, I bet y’all still be focusing on creatine with other things as well.

Is the Optimal Dose Different for Different People?

STEVEN BARTLETT: Yeah. And on that, doses, is that different for different people?

DR. DARREN CANDOW: Excellent question. So the thought was that the larger you are, you have more storing capacity in your muscle for creatine. So it makes sense if you’re 50 kilograms and 150 kilograms, you’re going to have a greater storing capacity. So the dose on a relative basis is likely higher there as well. The more stressed the person is, it’s likely they’re going to require more because their natural machinery in the brain can’t keep up. So it is very individualistic. I think we give out general recommendations to make it easy, but again, some people can take it very scientifically and base it on body weight, and you can’t go wrong with both of them.

Making the Case for Creatine to Your Loved Ones

STEVEN BARTLETT: I bet there’s a lot of people that are this far into the conversation and their central question is, right, I’ve got loved ones that I really, really want to start considering creatine supplementation for whatever reason. It could be cognitive benefits, muscular benefits, whatever, all the things we’ve talked about. They might end up sending this conversation to their loved ones. Something that I do sometimes when I have episodes that are particularly moving for me. If their loved ones are now listening, and you had to make a case to their loved ones about why they should take creatine, what would you say?

DR. DARREN CANDOW: I would say creatine is one tool in that health promotion toolbox that might help you live longer and better and allow you to maintain activities later on in life, which you wouldn’t have been able to do. And unfortunately, that leads to accelerated aging and a poor way to go. It’s like saying I’m going to save everything for retirement. My question is why? You might not make it to retirement. So that’s one of the things.

STEVEN BARTLETT: Yeah.

DR. DARREN CANDOW: Aging.

Defining Aging

STEVEN BARTLETT: Yes. What is aging in your definition of the word?

DR. DARREN CANDOW: It’s catastrophic. Unfortunately, I’m going through it. I’ve noticed ever since I hit the fourth decade, things hurt a lot more and muscle mass to retain, it’s a little bit harder. So unfortunately, think of the body’s ability to withstand stress is not as high. And things start to break down quite fast. So we all know things hurt more, we’ve lost muscle mass, I can’t run as fast. So biological aging is kind of the deterioration of the human body. We need to, with this conversation and others, come up with ways to stop the deterioration and if anything, come up with ways to maintain that ability to live longer free of disease.

What Is Reality? The Closing Tradition

STEVEN BARTLETT: Yeah, we have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they’re leaving it for. This one’s quite a tricky question.

DR. DARREN CANDOW: Okay.

STEVEN BARTLETT: What is reality? What do you think all of this is? All this stuff that we can see and all we experience, what do you think it is? Do you think it’s a simulation? Do you think it’s —

DR. DARREN CANDOW: This is all real for sure because I think we can feel it. It’s not a Big Brother or anything that’s a game show. We all go through different emotions and things like that. So I think you can feel it.

STEVEN BARTLETT: Are you religious?

DR. DARREN CANDOW: Yes. Catholic. Roman Catholic.

STEVEN BARTLETT: Yeah. And you’re a family man. You’ve got some —

DR. DARREN CANDOW: French bulldog and a cat as we talked about and wife at home. Yeah. And really close to my family. And stuff like that.

STEVEN BARTLETT: And what is your goal if we get to the end of your career and this was your last day and you had been successful?

DR. DARREN CANDOW: I think it would be a lasting impression on my students that, wow, he changed my life in some way. And if I can make one person live longer, free of disease, and happier, I’m all for it. You know, when you start to see the human body as people get older, you’re like, oh, that person used to be young and vibrant. And then when you hear other people that can’t do activities they love, or they can’t travel, or they’re afraid to, I’m like, you need to embrace today.

I love that quote from Morgan Freeman, Shawshank, “get busy living or get busy dying.” Because honestly, we have the ability with lifestyle choices to improve optimization. And I want to see people live to be 120, 130, still active, still going. And I think we’re on the cusp with technology. And I think awareness around nutrition, exercise, sleep, laughter — oh geez, if I could ask anybody to do one more thing, it’d be just laugh more often. For me to be just a small piece of the puzzle promoting it, I think it’s, if anything, it’s just beyond my belief. Yeah.

The Fear of Death That Drives the Research

STEVEN BARTLETT: Why did this pull you in? I ask that in part because it tends to be the case that the things that draw us in or pull on our — make us curious, there tends to always be a bit of a personal reason.

DR. DARREN CANDOW: Right.

STEVEN BARTLETT: Yeah.

DR. DARREN CANDOW: It was more that, am I scared to death? 100%. Yeah. Really? I can’t think of it. Yeah.

STEVEN BARTLETT: Why?

DR. DARREN CANDOW: Yeah. I just think it’s weird for me. I get to a point maybe being religious, and then you think about it, and then my brain stops. I can’t think about it. Really? Yeah. And it becomes almost like I want to live forever. And if I can think of ways to make me live and partially get there, obviously it’s not reality. But yeah, I’m scared to death of dying.

STEVEN BARTLETT: Yeah. Have you always been?

DR. DARREN CANDOW: Yep. 100%. Scared to death of heights. And I can’t even talk about the death experience. Yeah. Because I think it sort of brings into perspective things that you just don’t know.

STEVEN BARTLETT: Did you ever lose anybody?

DR. DARREN CANDOW: Just friends and things like that, but nothing specific like parents or anything like that yet. But it’s always been there. I don’t know if it’s the Roman Catholic in me or not, but it’s like, whoa, I don’t want that at all. Yeah.

STEVEN BARTLETT: You can’t even talk about it.

DR. DARREN CANDOW: Can’t even talk about it. No. No.

STEVEN BARTLETT: Yeah.

DR. DARREN CANDOW: Really? Yeah. It’s kind of like I can talk about it in a sense. I understand it and it’s realistic, but it’s more that for some reason I don’t even want to think about it because I have so much passion for life that I don’t even want to think about, oh sh, this could happen. Yeah.

STEVEN BARTLETT: And you believe you go somewhere after death?

DR. DARREN CANDOW: Oh, for sure. Heaven. Yeah, yeah, yeah. Okay. Yeah, yeah.

STEVEN BARTLETT: But if you do believe you’re going to heaven, that sounds like a good place, no?

DR. DARREN CANDOW: Great place. Yeah. I just want to spend more time here. There’s still a lot of things to do. Yeah, for sure.

Closing Remarks

STEVEN BARTLETT: Makes sense. Yeah. Well, thank you.

DR. DARREN CANDOW: Thank you for taking the time. Thank you so much. This was great. Thank you.

STEVEN BARTLETT: Yes. You’ve done so much research on this subject that so many of my previous guests cite and talk about. And so it’s great to have the source here himself. And I applaud you for the work you’ve done. Thank you so much. I think a lot of people do want to extend their health span, which is to live healthier for longer. There’s a real sort of epidemic of people having short health spans, being medicated from the age of 40, 50 years old, and then having that sort of last couple of decades of our life being incapable of doing the things we care about.

DR. DARREN CANDOW: 100%, yeah.

STEVEN BARTLETT: And I think a lot of this research gives us an option if we choose to take it to live a better life.

DR. DARREN CANDOW: Thank you so much. Yeah, it was great.

STEVEN BARTLETT: Thank you so much.

DR. DARREN CANDOW: Thank you.

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