April 2, 2026 • 53 mins
This week, Emily and Perry tackle creatine, a beloved amino acid derivative with surprisingly robust health properties. What is it actually doing to our muscles, and our brain? Pop a gummy, or stir in some powder, and find out.
Plus: Casey Means might be out for Surgeon General, stem cells don't help heart attacks, and just how much sugar intake affects your kids.
Submit a question for our weekly mailbag at wellnessactually.fm.
See omnystudio.com/listener for privacy information.
Listen
Watch
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hi, Perry, Hi Emily, So I brought some props for
our episode today.
Speaker 2 (00:07):
This will do great on an audio primarily podcast.
Speaker 1 (00:11):
If people are watching on YouTube, you will see that
for our episode, I.
Speaker 3 (00:16):
Brought creating dummies.
Speaker 1 (00:18):
I have sour cherry, I have sour apple, and I
have watermelon.
Speaker 2 (00:27):
Amazing. Are these your creating gummies?
Speaker 1 (00:29):
Okay, I'll tell you how I got these creating gummies.
I mentioned Creatine on Instagram, and all of a sudden,
many people wanted to send me creatine, and so a
lot of Creatine has been arriving at my house because
I'm an Instagram influencer.
Speaker 2 (00:45):
First in secret, Emily, can you mention an Nvidia RTX
fifty ninety graphics card on Instagram?
Speaker 3 (00:55):
Everyone, Perry would love.
Speaker 1 (00:58):
To talk about your Nvidia blah blah.
Speaker 3 (01:02):
Graphics card on here. Thank you so much.
Speaker 2 (01:05):
It's important for all of our wellness. That's me. I'm
excited to hear whether you are partaking in the creatine.
But I suppose we should look at the data first.
Speaker 3 (01:14):
We're going to find out.
Speaker 2 (01:15):
Let's do it.
Speaker 1 (01:18):
I'm Emily Aster, I'm an economist and a data expert.
Speaker 2 (01:22):
And I'm Perry Wilson. I'm a medical doctor.
Speaker 1 (01:24):
It's Thursday, April second, twenty twenty six, and this is
wellness actually.
Speaker 2 (01:30):
Because you're getting a staggering amount of health and wellness
information nowadays from every source imaginable, and some of it
is awesome.
Speaker 1 (01:38):
And some of it is well actually both Fortunately we
are both people who know how to read studies, how
to parse the data, and can tell you what's worth
thinking about and what you can safely ignore.
Speaker 2 (01:51):
But before we dig in, a note that this podcast
is for educational purposes and should not be construed as
medical advice. We don't know your unique situation, so talk
to your doctor for personal health decisions.
Speaker 1 (02:02):
This week, we're asking what's the deal with creating Perry
and I will give the official smash or pass, and
then we'll get to your question of the week.
Speaker 3 (02:11):
But first let's do the health news roundup. After the break.
Speaker 2 (02:26):
And we're back with the health news of the week
coming up first, Emily, President Trump says quote, it's possible
he will withdraw the nomination of Casey Means for Surgeon
General given the lack of Republican support. You may remember
we discussed the nomination of doctor Means on this podcast,
(02:47):
and I think brought some much needed attention to the
fact that she doesn't actually practice medicine and is a
wellness influencer and had a confirmation hearing in which she
declined to advocate for vaccination for measles. Does wellness actually
have some real political clout now? That is my question?
(03:10):
Are we what's moving Washington, DC?
Speaker 1 (03:12):
It is possible, but I would say unlikely. However, you
never know, And I think this is not very surprising
given where the conversation has landed over the past couple
of months. I think the appetite for moving away from
(03:33):
vaccines has somewhat waned. This is a little bit separate
from the Casey means confirmation hearing, But I do think
as we have seen more cases of measles, for example,
it's become less palatable to be like, who cares about vaccines?
It's like, well, actually children are dying, so maybe people
(03:54):
should care about them. And I think we've seen increasingly
inside the administration from Jay Baticharia from the Republican senators,
a feeling of like, okay, you know, enough is enough,
Like let's try to get back towards having more vaccines
and appointing someone as surgeon general who has refused in
the confirmation hearings to say that she supports vaccines is
(04:14):
kind of part of that. So I suspect that the
nomination will be withdrawn because I just don't think there's
Republican support. Bill Cassidy has had enough of this. Thanks
also in the camp of all the ways in which
we're positively influencing the world. I noticed after last week's
stem cell episode there was a BMJ article about stem
(04:38):
cells a heart attack that was retracted.
Speaker 3 (04:41):
Tell me more, and what role did you specifically play
in this?
Speaker 2 (04:45):
Yeah, I mean, once again the curse of wellness. Actually, like,
woe be unto you who is mentioned on this show,
because bad things will happen. The BMJ is the British
Medical Journal. Actually used to be called the British Medical Journal.
It is now officially just the BMJ, their hip but
very well respected journal. In twenty twenty five, there was
(05:05):
a report of in that journal of a randomized trial
of people who had heart attacks and were getting a
cardiac cathorization. So they you know, they put a little
wire into the heart to open up the blood vessel
that is blocked, and the intervention a placebo controlled intervention.
Was to inject some stem cells that were isolated from
(05:25):
Wharton's jelly, which is, for lack of a better word,
the goo that's inside the umbilical cord. Okay, it's like
a yeah, it does have a fair amount of mesenchymal
stem cells in it. Please go back to last week's
episode if you want to hear more details about that.
And what this study claimed to show was that the
(05:46):
rate of heart failure was significantly lower in the people
who got this special stem cell injection. So it was
sort of a thought like, oh, you're putting in these
these stem cells, They're going to differentiate into heart tissue
and become, you know, protect the heart in the long term.
This is biologically plausible, as we often say, and it was,
you know, by reports, a well done trial. Unfortunately, it
(06:08):
turns out that there were significant data regularities that were
subsequently revealed when the data was analyzed, and the full
article has now been retracted. The BMJ stopped short of
saying it was fraudulent, but it does just remind all
of us that no one study is ever definitive because
you never really know. You always need replication in this
(06:29):
kind of thing.
Speaker 1 (06:30):
Yeah, and I should say that retraction of a study
in a paper is actually pretty unusual, so it's not
Certainly it can be retracted if it is fraudulent, but
generally this means it is fraudulent or it is wrong.
You know, papers are updated over time and sometimes you
will look back and say, well, we weren't quite right
about that.
Speaker 3 (06:47):
But to actually retract a paper means you.
Speaker 1 (06:48):
Know, the paper is not right, something was wrong, and
how this was done not We have learned more later,
but like the way this paper was done was not right.
So it's a more extreme change than just you know,
the literature has evolved.
Speaker 2 (07:02):
Yeah, absolutely, so wellness, Actually skepticism around stem cells is
proven correct yet again. Our last news item is I
think a good one for to put your economist hat on, Emily.
I know we don't get to use that as often
as we would like in the podcast, but a new
study came out looking at childhood sugar intake and the
(07:23):
genetic risk for obesity and how those things interact using
a really cool natural experiment. So can you walk me
through this new paper.
Speaker 1 (07:33):
Yeah, so this paper uses a technique that economists call
natural experiments, where you want to think about this as
the world.
Speaker 3 (07:43):
Has experimented for you.
Speaker 1 (07:44):
And so in this particular case, they're using sugar restrictions
post World War two. So in the UK after World
War Two, there was a long period of time in
which there were restrictions on how much sugar you could
buy because of worries about not having enough, and then
at some point in the middle of nineteen fifty three
they relax those sugar restrictions and you were allowed to
(08:05):
buy more sugar. And the result of that was that
kids ate a lot more sugar, and pregnant people ate
a lot more sugar in like October nineteen fifty three
than in August nineteen fifty three. And so they're using
that sharp timing to look at whether being exposed to
higher levels of sugar, either in utero or in early childhood,
(08:26):
is associated with higher risks of metabolic disease later. This
paper actually follows on an earlier paper where they show
that kids who have higher sugar exposure in this period
have higher risks of diabetes later in life. And so
here they're showing higher risks of obesity and also that
(08:47):
that interacts with your genetic predisposition to obesity.
Speaker 3 (08:51):
So it's really interesting paper.
Speaker 1 (08:53):
I think it does give a little bit of caution
about very high levels of sugar exposure in early childhood.
I will say, you know, parents will come to me
and be like, oh my god, does this mean I
can't Like I one time I gave my child a
piece of cake, and like, have I ridden them forever? Like,
we're talking here about a lot of sugar exposure. Clearly
some is okay, but it is one of the dietary
(09:14):
things we probably want to be a little more cautious
about with kids than some others.
Speaker 2 (09:19):
Yeah, I think this paper also does a nice job
reminding us that, like a lot of obesity is genetic,
and so you know, they can look at the because
this comes from the UK Biobank, which is this big
amazing genetic cohort study, they can look at the genetic
risk factors for obesity and they can see, you know,
it's very clear that certain genes and patterns of genes
(09:40):
increase the risk for obesity, but that lower sort of
intaken childhood can kind of modify that risk, not all
the way. So it wasn't even like these people who
are at high risk genetically for obesity didn't become obese
because they were born during the rationing period. You know,
many of them still did, but the disparity in BMI
was somewhat lower than would have been predicted by genetics alone.
Speaker 1 (10:02):
So yeah, I mean it's a very The uk Biobank
is an extremely important data source because of the way
I think it will continue to help us understand over
time the intersection between genetics and behavior and you know,
how our behaviors turn on and off genes, which is
an exciting area.
Speaker 3 (10:20):
Of research that hopefully we'll talk about more.
Speaker 2 (10:23):
Absolutely, that's it for the health news of the week.
When we come back. What's the deal with creatine? Okay,
I want to start with an influencer telling us just
how important creatine is.
Speaker 4 (10:43):
Creatine should be now mandatory in everybody's took it, just
like brushing your teeth or exercising. I think everybody should
be supplementing with creatine prior to being diagnosed with alzheim As.
You've got this thirty year period of all these stages,
and one of those stages is subjective cognitive impairment, which
is the first stages of Alzheimer's disease. Right, Sometimes your
(11:04):
thinking's not up to scratch, or you forgot where you
put your keys, or you're getting slower reaction times. These
are all cognitive functions. They start to decline, then you've
got mild cognitive impairment, which is a pre dementia state,
and that lasts around twenty years. So it's during these
states that you need as much brain energy as you can,
and we can get that from creatine.
Speaker 3 (11:24):
Okay, so, Perry, I like this influencer quote because I
think that it illustrates what, for me is the core
point that we will get to with creating as we
move through this, which is this person starts with something
that I think is an overstatement but is true in
some sense, which is that there are some things where
(11:45):
we see benefits of creating, and then she kind of immediately.
Speaker 1 (11:49):
Goes to like creatine prevents Alzheimer's, which is way on
the edge of what we think. So it's such a
good example of the kind of like let's take something
that's real and like make it matter for for everything.
Speaker 3 (12:00):
So absolutely it's a good entry.
Speaker 2 (12:03):
This is you know, we like to give people little
little hints that they are being influenced as opposed to
being provided with real data, and and one of those
hints is taking an extreme position. It's very engaging to
be like this supplement creatine like is necessary for literally
everyone and as important as brushing your teeth, and like
(12:24):
you're you're staking out a position so extreme that you
kind of have to pay attention to it. And we
just need to tell everyone that's never true. There's there's
literally even brushing is.
Speaker 3 (12:36):
As important as brushing your teeth. You should brush your teeth.
Speaker 1 (12:40):
But even if you don't do that, like it's rebably
okay occasionally, but still you should brush your teeth.
Speaker 2 (12:44):
Yeah, so let's dig in. There's there's a lot here,
but let's start like just at the beginning, right, Like, so,
what is the what is creatine?
Speaker 5 (12:54):
Like?
Speaker 2 (12:54):
Why are people talking about creatine? I see it from
a lot of bodybuilders and stuff. What's your take on creatine?
Speaker 1 (13:00):
I mean, I think the first thing to just tell
people like literally, creatine's an amino acid. It is an
amino acid that you consume in food.
Speaker 2 (13:08):
It's a derivative of an amino acid. I only say
because we did that.
Speaker 3 (13:14):
Right, I'll say, doctor, I'm a real die. I went
to medical school. Black blah black, Now go ahead.
Speaker 2 (13:19):
Please, because we said there's twenty two amino acids that
you know people use in creatines. Not one of them.
It's a derivative of an amino acid. But yes, by
all means continue.
Speaker 1 (13:30):
You consume creatine in food, primarily in meat and seafood,
and you store it in your muscles, and it is
helpful for making the muscles work, particularly in an anaerobic way.
I think the core thing that's relevant for this question
of supplementation is that your muscles can generally store more
creatine than most people can get indeed, and most people
(13:53):
can get through their food. So when people supplement with creatine,
it like ramps up the store of creatine and their muscles,
and in principle that can then help you when you
are exercising in particular ways at very high levels.
Speaker 3 (14:10):
That's kind of the core thing.
Speaker 1 (14:11):
So do you exercise to failure on a frequent basis?
Speaker 2 (14:15):
Perry, No, but I've done it.
Speaker 3 (14:18):
What does it mean to exercise to failure?
Speaker 2 (14:21):
Have you ever exercised?
Speaker 6 (14:22):
If?
Speaker 2 (14:23):
Have you have ever done an exercise?
Speaker 1 (14:24):
You feel like I exercise to failure every like the
three days, But I don't.
Speaker 3 (14:27):
I'm not sure that I know what that means.
Speaker 2 (14:29):
Okay, exercising to failure literally means that you're doing an exercise,
let's say push ups, and you just continue to do
push ups and do push ups and do push ups
until your muscles give out. They literally fail. And I
think it might be worthwhile to talk about physiologically, like
what is happening there, because that might be the best
(14:50):
way to understand how creatine works. So if you do
push ups and you keep going, and you don't do
like I'm going to do twenty, I'm going to do thirty,
you just keep going, going, going until your arms. What
will happen have a pillow under your face because your
arms will literally stop working and your face will smash
into the ground and there's nothing you can do about this.
This has happened to me, but bodybuilders will do these
(15:12):
types of exercises to failure. What's happening in the muscle
when your muscle is contracting is the muscles using energy,
and the energy currency of all the cells in your
body is ATP. Probably hard us mention that before, but
think of it as like cash spending cash in terms
of you know what cells can use for energy. There's
a problem, and that's that cells can't store very much ATP.
(15:35):
It's unstable. It's hard to keep it in its activated form.
So it's like they've got some cash in their pocket,
but it's not enough to you know, go on a
huge spending spree. That's sort of how I think about ATP.
For most cells, that's not a problem because they use
a little energy to like whatever they're doing. You know,
(15:55):
your gut sell and uses some energy to absorb some
glucose or whatever, and then it's done for a while
and it chills out and builds up more ATP no issues.
But there's some cells in your body that use energy
like a lot in over a period of time, and
muscle is definitely the biggest one, and that includes your
heart muscle, but you know your skeletal muscles as well.
If all they had to use for that energy was ATP,
(16:17):
then after about three seconds of muscle contraction, all the
ATP and a muscle cell is gone and the muscle fails,
and that means it just goes slack and your face
smashes forward into the pillow that you put under you
when you're doing pushups. That's not compatible with moving around
or lifting up anything. You can't have only two seconds
(16:37):
of muscle contraction, so what creatine is is a store
for phosphates that can regenerate ATP. So remember you can't
you can only have so much cash in your while
you can't have too much ATP in a cell, but
you can have lots of creatine. That's your bank account,
more or less. And so as your ATP is being
used up, creatine in the form of creatine phosphate is
(17:00):
regenerating ATP. So you're taking cash out of that.
Speaker 1 (17:03):
But it's the ATM. It's your cells as an ATM
exactly exactly.
Speaker 2 (17:09):
And as you pointed out, most of our muscle cells
based on a typical Western diet, actually can hold more
creatine than they have. And what that means is that
if you build up your store of creatine by creating
supplementation in theory, you have this extra amount in your
ATP bank account that you can extract upon. So it's
(17:33):
a little different. People often say creatine is like energy
for your muscle. It's more like the presence of creatine
allows your muscle to bank energy when it's not being
used so that it can pull it out again when
it is being used. It's almost acts more like a
battery or like a rechargeable battery, but you still have
to do the recharging. Creating does not have calories in it,
(17:53):
creating monohydrate right, like, so it's not energetic itself, but
it's a place to store energy in your muscles. There's
one other set of cells that do tend to be
active a lot and use a lot of ATP, which
is your brain, right, that's in your brain. Yeah, so
that's why you see a lot of muscle and brain
talk for creating.
Speaker 1 (18:11):
Yeah, all right, so let's start with the muscle talk
and then move to the brain talk because the muscle
talk is in some ways a much easier conversation totally.
So the thing we know, I think with incredibly high certainty,
is that if you are doing a lot of bodybuilding
(18:32):
related exercise, creating supplementation can improve your performance. We have
hundreds and hundreds of randomized controlled trials of people doing
body building activities will show that creating supplementation on average
increases the time to failure, so allows you to do
(18:52):
more of those push ups before you smash your face
in the pillow.
Speaker 3 (18:56):
And this is this has been used by bodybuilders for
are you know, decades?
Speaker 1 (19:02):
I mean, this is like a very standard bodybuilder activity talk.
Speaker 2 (19:07):
To me for a second, because this will come up again.
You said randomized control trials. Why in a study that's
looking at something like muscle strength, muscle performance, whatever your
metric is, why is a control randomization and control like
a placebo control so important Because there's plenty of studies
that aren't placebo controlled, particularly when we look at the brain.
So why does that matter when you're talking about things
(19:29):
like muscle strength and function?
Speaker 1 (19:32):
Yeah, I mean, I think the core thing is that
actually a lot of your muscle strength and function is
what you think you can do, right, So if you
sort of engent, like, let's let's back up. In general,
we like randomized control trials because we have treat people
the same and the only thing that's different is what
thing we're giving them.
Speaker 3 (19:50):
In this case, it's actually really.
Speaker 1 (19:52):
Important that not only are we choosing at random who's
getting the creatine, but that we are also doing something
to the group that makes them think they're getting the
creatine or that they might be getting the creatine. Right,
Because if I tell you, hey, I gave you this
like amazing substance, it's going to make you be able
to do more push ups. You will be able to
(20:13):
do more push ups, even if what I have given
you is literally.
Speaker 3 (20:16):
Like a like flower or something, or just like nothing.
I guess flower would help.
Speaker 1 (20:19):
But like if I just give you nothing and I
tell you this helps you do push ups, you will
do more push ups.
Speaker 3 (20:23):
Like that's how our brain is, which is cool.
Speaker 2 (20:26):
Yeah, it's kind of amazing. It's it's like it's like
Dumbo with the feather. Remember he has the feather that
can make him fly, and then at the end he
loses the feather, but it turns out he could fly
all along.
Speaker 1 (20:36):
Remember, right, I do remember it, I do remember, and
that movie makes me sad and so sorry, thank you
for please never bring it up again. And so yeah,
so the placebo effect is like one of our best
it's like one of our best effects.
Speaker 3 (20:49):
It really works very well.
Speaker 1 (20:51):
But if you want to evaluate the impact of creating
on any of these things, you need to like sort
of turn off the placebo effect by having a true
double blind, randomized placebo control trial in which you people
don't know what group they're in. And in the case
of these bodybuilders, we have that.
Speaker 3 (21:08):
Because it's of course it's easy.
Speaker 1 (21:10):
We can come back to this in other settings, but
it's really easy to experiment on athletes, Like, that's a
great population loves environmentation. They love to first of all,
they love to be in they love You tell some
athlete like I had a randomized control trial something which
might have proved your performance.
Speaker 3 (21:25):
Is like where do I sign up?
Speaker 1 (21:28):
And the second thing is often what you're looking at
in the outcomes is really easy to define and is
short term. Right, So you can run one of these
studies in like like a few days, you give some
people creating, You give them some people and some other powder.
You ask them to do a bunch of push ups
with a pillow under their face, and like then that's it.
That's your paper, And that's so much easier then like
(21:49):
I'm going to treat this and I'm going to see
whether you develop dementia like fifty years from now.
Speaker 3 (21:53):
That's just a much harder thing to study.
Speaker 2 (21:56):
And that's one of the reasons we have so many studies.
And you'll always hear almost every influencer I looked at
talking about creatine opened with like it's the most studied
supplement in the history of mankind, which I couldn't find
any reference for. Like I'm not entirely I think vitamin C,
and like, I think, I'm not sure if that's true,
but it has been studied a lot. I'll give them that.
Speaker 1 (22:14):
As of two thousand and three, in some review there
are like five there's like a review with five hundred papers,
and that's like twenty five years ago. So I and
this has only become more pop So I think this
is a very highly studied I'm not sure.
Speaker 3 (22:25):
We don't count papers.
Speaker 1 (22:26):
It's not like the it's not a metric, official metric.
Comedy papers have been written on something. But anyway, yeah, no,
definitely not the best metric.
Speaker 2 (22:33):
But let's put some let's put some numbers to it,
so you know, we could pick from a lot of papers.
Sometimes the best thing to do when there are a
lot of papers, and especially a lot of randomized controlled trials,
is to look a meta analysis, which is a single
paper that combines the results from multiple papers to kind
of give you an average. It's sort of the idea
that every paper is going to have little errors going
(22:55):
one way or another, and you kind of average them
out to get an estimate that's more more true. And
so one that caught my eye because probably it speaks
to my age is a recent meta analysis appearing in
the journal Nutrients, looking at creatine supplementation with resistance training
on muscle strength gains in adults under fifty years of age.
(23:18):
So there's quite a lot of research in older adults
for muscle function and falls and things like that, which
is interesting. But you know, I'm not quite there yet,
and I'm more interested, like for me personally, I want
to go to the gym and like look a little
better and feel a little stronger, and I'm otherwise healthy,
and so I was very curious to see, like, Okay,
what can I expect from creatine. So this study compared
(23:41):
creatine supplementation and resistance training to place EBO plus resistance training,
and they looked at upper and lower body strength and
basically they found that the people randomized to creatine could
lift an extra four point four kilograms on the bench
that's what, like about ten.
Speaker 3 (24:01):
Extra pounds ten pounds, yeah.
Speaker 2 (24:03):
Yeah, ten pounds on the bench press, and thirteen kilograms
on the leg press, so you know, maybe twenty five
thirty pounds on the leg press. That's not nothing. I mean,
you're own old all of a sudden, but that's real.
What do you think?
Speaker 1 (24:17):
Yeah, I mean I think that seems real, and I
also wouldn't There's two things I would say about that.
So one is I would not dismiss the old people evidence.
I actually think that's the other piece of evidence here,
even though you know you're not, we're not yet older adults.
But actually the other really strong piece of evidence around
creatine is the benefits on falls and on mobility for
older for older adults. But in both those populations and
(24:41):
in the like the setting you're talking about, it's actually
very important to be combined with resistance training. So just
taking a bunch of creatine and doing nothing will not matter.
The thing that creatine is helping you do is helping
your muscles exercise closer to failure, which allows your muscles
to break down more and then allows them to build
back more. So we want to be like very clear
(25:03):
on this, even on the well established muscle stuff, that
it is not just taking the creatine. It is taking
the creatine and doing some strength training at the same time.
Speaker 2 (25:13):
That is really important, and honestly not only doing whatever
strength training you normally do. The benefit derives from the
fact that you should be able to do slightly more.
We don't want to interhurt themselves. We want you to
ramp up slowly. And if you know you can afford
like a personal trainer to even work with you to
get there, that's amazing. I certainly can't. You do have
(25:36):
to be careful, but right, creating isn't magic. It allows
you to do a little more work, but you've got
to do the more work if you want to see
the improvement.
Speaker 3 (25:46):
All right, So that's on muscles.
Speaker 1 (25:48):
I want because it's my deep passion to say, very briefly,
if you are an endurance athlete, so this is like
there's also an active discussion around people who do sports
that are not like bodybuilding sports, and the evidence for
creating supplementation in like running and cycling is less compelling
(26:10):
for reasons that I think makes sense with the biology.
So you know, you asked about sort of exercising to failure.
It is rare, even in you know, pretty intense like
even in like long distance running, to exercise to the
kind of failure you have described, It does happen. You
will see people at the end of a marathon like
unable to like control your body and like just sort
(26:32):
of like crawling across the finish line.
Speaker 3 (26:35):
Like but that's not common. That's not common, and so the.
Speaker 1 (26:40):
Kind of thing that creating would help with is like
just it's less obvious, it will be helpful.
Speaker 2 (26:45):
There.
Speaker 1 (26:45):
I will say a lot of endurance athletes do take
low levels of creating because like, why the hell not
just in case it might help because we're insane.
Speaker 3 (26:53):
But the evidence isn't as it isn't as strong.
Speaker 2 (26:56):
I'm so tempted to ask you if you take it.
Speaker 1 (26:58):
But.
Speaker 2 (27:00):
Oh you do, okay, I guess.
Speaker 1 (27:04):
Because someone once said that it might make me faster.
Have we learned nothing about my psychology? Someone suggests all
you need to do is say you can run faster longer,
and Emily will do a little bit, a little bit
faster longer. I'll do it, absolutely, yes.
Speaker 2 (27:20):
So let's while we're while we're sticking on effects, I mean,
we've got, of course, we have to talk about like
how you get creatine and stuff, but maybe let's go
on to the brain, because you know, I think the
data for muscle is great, but what I'm hearing from
a lot of people, and especially online, even that first
influencer is talking about creatine for Alzheimer's disease and things
like that. We'll get to general brain effects for a second.
(27:44):
But I'd like to play a quote from an influencer
for you. You're not going to be a surprise that this,
as I was.
Speaker 5 (27:53):
There is a supplement that reversed memory loss in people
with Alzheimer's disease in a new double blind, Placibo controlled
trial right here in the United States, and very few
doctors are talking about it.
Speaker 6 (28:06):
If you are news to my channel, Hi, my name
is Robert Love.
Speaker 5 (28:09):
I'm a neuroscientist and I have a medical clinic in
Florida where we are reversing Alzheimer's in our patients. This
study was released June fourth or June fifth of twenty
twenty five. Kansas Medical School did a double blind, super
controlled trial in adults with Alzheimer's disease. Half the adults
got Creating, half the adults got at Placibo. Here's what
(28:29):
they found. The adults who took Creating actually improved their
memory in this study. Now, the thing is they give
them a very large dose of creating. The dose they
gave them was twenty grams a day. Most people are
taking three to five grams a day, maybe ten grams
a day. These people took twenty grams a day. There
were no serious side effects, in fact, really no side
effects at all of taking twenty grams a day, so
(28:51):
the people did not feel.
Speaker 6 (28:52):
Bad and they improved their memory.
Speaker 5 (28:54):
Now, creating is one of the most studied supplements on
the planets, lots of resource, specifically on.
Speaker 6 (29:01):
Athletes for muscle health. Women.
Speaker 5 (29:03):
This is especially important for you women, you make less
creatine than men do. Creatine is evolved in the process
of energy. Basically, it helps make ATP and so think
about it. When you make more ATP the creatine, some
of that can get into the brain and that can
help your brain make more energy, and that can improve
brain function.
Speaker 2 (29:21):
So yeah, Emily, I was doing the research for this
this episode, and I was looking into the literature about
creatine in the brain, and I put together all my notes,
but then of course I went to the influencers. I
wanted to see what people were saying. And here's someone saying, like,
there's a you heard the words randomized placebo controlled trial
(29:45):
of creating for Alzheimer's disease, and it showed that it
fixed their memory problems. And I was like, huh, how
did I miss that? Like that's a big deal. How
did I miss that trial? And this is a this
influencers like a doctor. They have a clinic down in Florida,
Like it's always Florida, but you know whatever. So I
(30:06):
did a little bit of slew thing and I actually
found the study that this influencer was talking about. From
the context clues, the number of patients the university was
sent out of, et cetera. I found it. And it's
not a randomized trial. It's there's no randomization, it's not
placebo controlled. It's just twenty people with Alzheimer's who got
some memory testing and then went on creatine and then
(30:28):
got some more memory testing, and there was some modest
improvement in memory from before and after. But remember we've
already talked about like the importance of randomization of placebo controls.
So I know how you'll feel about this, But like,
I'm still having trouble with the influencer world, Like you
can just say anything like is there are there no rules?
Speaker 1 (30:48):
What I think is interesting about this one? Yeah, of course, yes,
there are no there are no rules.
Speaker 3 (30:53):
But what was interesting about this was it so specific.
Speaker 1 (30:56):
Like often in these influencer things, you'll hear, you know,
there's a new exciting study that says that creating works
for Alzheimer's. But to be sort of specifically wrong is
actually quite dangerous because of course, like anybody who found
this study would be like, oh, well, it's actually not
a double blind, placy book controlled randomized trial. It's it's
not a randomized trial of any sort. It's just like
(31:16):
a study of some people. So I think it's dangerous
to be too specific with your lies.
Speaker 3 (31:20):
In the internet.
Speaker 1 (31:21):
But at any rate, there is not a double blind,
policy book controled randomized trial of patients with Alzheimer's that
shows effects of creatine full stop.
Speaker 3 (31:30):
There is not.
Speaker 2 (31:31):
There's not. And while we're on the subject of the
neurodegenerative diseases, you know, this is again a place for
the reasons we talked about. Because brain cells do use
atp at a rate that is faster than your typical cells,
it makes sense to test these things. I'm so glad
that people are evaluating, especially a relatively benign supplement like creatine,
(31:55):
for degenerative neurologic diseases. But to give you like the
data on this, there's a large randomized trial seventeen hundred
people with early Parkinson's disease. They're all within five years
of diagnosis. This is coming from the Journal of the
American Medical Association twenty fifteen. They were given creating monohydrate
ten grams a day for a minimum of five years.
(32:18):
This is a placeable controlled randomized trial. I mean, what
an amazing study, right, Yeah, and it is actually I.
Speaker 1 (32:24):
Mean to actually to run a set of like that
is extraordinary, extraordinary, really really impressive.
Speaker 2 (32:29):
Yeah, kudos to the authors. The study was stopped early
for futility. So when we run trials, especially trials that
are expensive like this one would have been, and that
go on for a long time, we'll have an independent
statistical board that looks at the data at some specified
time points and says, is it possible that if you
continue this study you'll see a signal of benefit or
(32:51):
at this point, based on the data we have, like,
unless every single person who gets creating does amazingly, well,
you're not showing benefit, so you might as well stop.
Now it's no longer ethical to continue this trial. So
super impressive, no effect in Parkinson's disease. And then there's
another relatively large trial in this space five hundred and
fifty adults with Huntington disease. They were getting creatine amountohydrate
(33:15):
tight traded up to forty grams a day. We'll talk
about the dosing, but that is an incredibly high dose,
also placebo controlled, and also halted for futility.
Speaker 3 (33:28):
So not a pantasy, I will say.
Speaker 1 (33:30):
On the other side, there is a much smaller meta
analysis from twenty eighteen where they put together a number
of small trials. In the end totals like fewer than
three hundred people, but looking at just general cognitive performance,
and there, you know, maybe they get a little bit
(33:51):
of a signal on short term memory.
Speaker 3 (33:55):
You know, this is not in a diagnosed population. The
result else.
Speaker 1 (34:00):
Are pretty weak, and they only show up for a
small number of outcomes, and they mostly show up for vegetarians,
which you know, could be because they don't get enough meat,
or could be because you're cutting the data enough to
find a group where it matters for I don't really know.
So putting all of this together, I would say, certainly
the evidence for brain impacts is far, far, far, far
(34:24):
far weaker than the evidence for muscle impacts.
Speaker 2 (34:29):
I agree. You know, in terms one of the issues
with the brain, it's like muscle's pretty easy to study.
You know, it's like how much can you bench? Like
that's a very reasonable metric, but like how well your
brain works is really hard. You know, we think about memory,
but if you look at detailed neurocognitive testing that happens
in a lot of these trials, it's it's memory, it's attention,
(34:51):
it's executive function. You know, there's all these sort of components,
many of which overlap with each other, some of which
we don't fully understand, all of to have scores on
scales that are impossible to explain to anyone, and it's
very hard to say like a global estimate of like
it makes your brain better. You're right. If there was
one thing that keeps kind of standing out in these
(35:13):
smaller trials of you know, older adults, it's probably memory.
I mean, did you did you find that as well?
Speaker 1 (35:19):
Like if you're short term memory, it's kind of short
term memory issues, which which is something a lot of
older adults struggle with, and so that sort of comes
out most consistently in these trials. It's also a relatively
straightforward thing to measure, as opposed to you know, measuring
someone's executive function is much harder than measuring their short
(35:41):
term memory, which you more or less do by telling
them a bunch of words and then a little later
at the end of the study being like, do you
remember what those words were? So there's a series of
pretty standard tests for that. So I guess the other
thing I would say about this is like, there's an
interesting link with you know, mobility and exercise and not
falling down and the brain. Right, So one one thing
(36:03):
that could be true is like you take creatine and
you do some resistance training, and so then you don't
fall down, and then you you know, end up interacting
more in the world.
Speaker 3 (36:11):
That's actually really good for your brain.
Speaker 1 (36:13):
So there's a whole set of interacting things when we
talk about the elderly, where anything that improves your ability
to do the activities of daily life is likely to
improve your brain because your brain is benefiting from doing
the activities of daily life absolutely.
Speaker 2 (36:30):
So let's talk a little bit about how people get creatine. Okay,
so let's say that people say this sounds pretty good,
I want to bench a little bit more. So all
you have to do if you want to get creatine
is post on Instagram and say, well, I like I
like creatine and apparently it shows up at your house.
Why doesn't this work for me?
Speaker 3 (36:49):
I don't know.
Speaker 2 (36:50):
We're going to combine people combined. Emily and I have
over five hundred thousand Instagram followers.
Speaker 3 (36:59):
It's so so true.
Speaker 1 (37:02):
All right.
Speaker 2 (37:04):
So, creatine, as you pointed out, comes from meat. But
because meat is muscle, and animals are just like us
and they have they have creatine in their muscles as well,
Vegetarians are people who potentially aren't ingesting creatine in that
way as much, which is why some of the data
restricted to vegetarians looks a little bit better for creating supplementation.
(37:27):
I should say that creatine is not an essential nutrient.
So essential nutrients are things that you must ingest or
you die, right like vitamin C. If you don't, you
get scurvy, you die, et cetera. Creatine is synthesized by
your body. It's synthesized in the liver and the kidney,
but probably not as much to sort of saturate how
much your muscles can take. They really can take quite
(37:47):
a bit of creatine, and as you pointed out, even
meat eaters are probably not fully saturating their muscle with creating.
Speaker 1 (37:53):
Yeah, so when people talk about taking a creatine supplement
just to like get to brass text.
Speaker 3 (37:58):
It's kind of two approaches to this.
Speaker 1 (38:01):
So for people who are doing who are taking this
for like bodybuilding, the approach tends to.
Speaker 3 (38:08):
Be to take a lot for a short period of time.
Speaker 1 (38:12):
Like, as you know, thirty forty grams of creating a
day for some period of time, and then return to
a maintenance dose. For most people who would take this
to kind of just generally improve their overall muscle functioning
and so on, the typical dosage would be something like
five grams a day, as like a regular just to
(38:34):
take five grams a day.
Speaker 2 (38:36):
That's probably even a bit more than the average person needs.
What will happen is that you pee out the excess,
so you know you can think about whether it's worth
it to you. It's not going to be harmful to
take more those big, bulky loading doses. Be a little
careful with if you've never done this before. There are
some gi effects. You get some rumblies in your tumblies
(38:58):
with creating, even at the I do. So if you
have a sensitive stomach, be a little careful when you
start out.
Speaker 1 (39:05):
And there's a lot of ways to get creatine. There's
creating in powder, there's creatine in water, there's creating in
gummy form. This creatine pills is like a lot of
different a lot of different options.
Speaker 2 (39:16):
Most of what you'll see is creating monohydrate. All of
the data that we talked about today was creating monohydrate.
There is this other form of creatine out there called
creatine fylester or something like that that they argue like
is absorbed better. There's no data on it, and there
doesn't seem to be a reason to spend extra money
on that.
Speaker 1 (39:32):
All right, So two downside questions people often have here.
One is does creatine make you retain water? So this
is like I take a bunch of creatine and then
I'm all of a sudden like a bloated water bag.
Speaker 3 (39:48):
True or false?
Speaker 2 (39:49):
True?
Speaker 3 (39:50):
True?
Speaker 2 (39:50):
Oh yeah, absolutely absolutely. So what creatine is getting taken
up by your muscles, and water will flow from parts
of your body that have less dissolved stuff in it
to parts of your body that have more dissolved stuff
in it. That's osmosis, and so water will move into
(40:12):
your muscle cells when you start taking creatine as the
creating concentration in your muscle cells, build up and that
actually swells your muscles a little bit, Like it's not
really you're not stronger, but it does kind of like
maybe add a little definition. The studies show you know,
you're talking about two kilograms, so four to five pounds
(40:32):
in the first week or two of creating supplementation of
water weight, so be aware of that. And it does
persist as long as you supplement creatine. So like if
you if you're just doing your five grams a day,
like you'll you'll get that initial weight and you'll just
sort of stay at that extra water weight. If you
stop the creatine, then you'll have what's called diarrhsis and
(40:53):
you'll you'll lose some of that water. So you know,
don't don't freak out. You're going to gain a couple
of pounds. And it's just.
Speaker 1 (41:01):
Second question, is it bad for my kidneys? You're a
kidney doctor.
Speaker 2 (41:04):
Oh, I love this question. Can I tell a story?
Can I tell the patient story?
Speaker 3 (41:08):
Do you love the kidney? So yeah, please tell.
Speaker 2 (41:11):
I am a fellow kidney fellow at the University of Pennsylvania,
and this woman comes in and consult She's like this
eighty five year old Russian grandma whatever you're picturing that
is correct. That is how she looked. Okay, and she
comes in and she is a creatinin value of ten. Now,
(41:34):
creatinin is a blood test that we use to assess
kidney function. Creatinin is a metabolite of creatine. So the
creatine that's in your muscle breaks down and forms creatinin
at sort of a steady rate. Because everything breaks down
and your kidneys excrete, the creatinin fine. As your kidney
function worsens because they can't excrete as much, the creatin
(41:56):
in your blood goes up. So the higher your creatin
is the worst. Normal creatin is around one. Just to
keep things simple, a level of crat int of ten
is like, your kidneys aren't functioning at all. You need
to be on dialysis, your dad, Yeah, you need a transplant.
This is terrible. So I'm waiting for her to come in.
I'm ready to like have a conversation with this eighty
(42:17):
five year old Russian grandmother. It's like, Okay, I need
to admit you to the hospital today. We're going to
start dialysis. We'll get you on that. She's probably too
old for transplant. Like it was going to be a
whole thing, and she walks in and she looks great.
She's just spunky, old small lady. And I'm looking at
her other laboratory parameters and like her potassium's fine, it's
(42:37):
very unusual for some of the advanced kidney disease. The
acid base balance in her blood is totally stone cold normal.
Like it didn't make sense. So I'm talking to her,
and it comes out eventually as I'm asking her about
her diet, that she has a trick to staying healthy
in life. And what she does is she takes a
giant pot roast essentially at the beginning of the week
(42:58):
and boils it and boils it and boils it and
boils it until there's basically nothing left. She takes out
all the like gristle and whatever is left, and then
she takes that boiled stuff and she boils it and
boils it and boils it until she has a thick
slurry of like meat juice. Okay, And she drinks like
(43:24):
a cup of this thick slurry of meat juice a
day to stay strong and virile. And what was happening
is she was ingesting just herculean amounts of probably creatine,
but also creatin in because the act of cooking is
going to break down the creatine from the meat into
(43:45):
creatin in as well, So she was ingesting this huge
amount of creatinin. Most people muscles produce about a gram
of creatin in a day. So if so you make
a gram of creatin and you pee out a gram
of creatin and you stay and balance, everything's honkey dory.
She was clear taking in about ten times that because
her certum cretity I used to she was totally fine.
(44:05):
She had no kidney dysfunction whatsoever. So no, there is
no risk of kidney dysfunction with creatine.
Speaker 1 (44:12):
However, sorry, did you tell her to stop doing this
or this was like totally fine?
Speaker 2 (44:18):
She seemed fine, but I did. I did tell her.
I was like, listen, every time you get your blood tested.
Speaker 3 (44:24):
They're going to tell you that your kidneys are figuring.
Speaker 2 (44:28):
So yes, creatine supplementation will increase your creatinin in your blood,
and that is our marker of kidney disease. So when
you get your blood tested, if you're supplementing creatine, it
will be higher. And certain doctors who are less informed
might worry about that. There's no evidence that harms your
(44:48):
kidneys directly. There is another blood test for kidney function
called cistate and C which won't routinely get run, but
you can ask for and that's independent of creatine and
creatin and whatever. So like, if you really want to
know for sure, if you're nervous and you're on creating,
just ask for a size staatency. It's an approved test
and you can get like a better estimate of kidney function.
Speaker 3 (45:11):
That's a great story.
Speaker 1 (45:12):
I Before we end, I want to end with the
bad news for you, which is that creating, although influencers
will tell you it does, creatine does actually not affect
your hair loss or my hair.
Speaker 3 (45:25):
Growth or your hair growth.
Speaker 1 (45:28):
There's some discussion of both hair loss and hair growth.
Speaker 2 (45:31):
Talk to me about this. I mean, I'll take no
effect on hair any day, although I love hair growth
if you can give me some of that.
Speaker 1 (45:39):
There is sort of one small study that suggests that
maybe creating would in testosterone and then lead to possible
hair loss. But then there's many other studies which show
there's no effect on any of these things and so
but also no effect in the other direction.
Speaker 2 (45:57):
Yeah, there are some observational studies to which are interesting
that correlate creatine and hair loss, and we always love
to talk about confounders, which are like third variables that
explain and observed association. And there are a couple of
things here I can speak from personal experience. One is
that as men age and start to worry about their
(46:21):
like muscles and you know, have a little more time
maybe after the kids are older, to go to the
gym and start taking creating, is also the age in
their life when like, the hair is not as thick
as it used to be. And then in the slightly
more sinister side. You know, creatine is used extensively in
the bodybuilding community, and there are other substances that are
used rather extensively in the bodybuilding community that certainly do
(46:44):
result in hair loss, like the androgenic steroids. So that's
another thing that is often not disclosed when taking a
survey about your supplement use and your hair loss.
Speaker 1 (46:55):
Indeed, all right, I think that's it for creatine. Let's
do the smasher pass, Perry, smash your pass on the creatine.
Speaker 2 (47:04):
So full disclosure, smash. I take my five grams of
creatine in gummy form a day, and I'm gonna just
whether it's placebo or not. I take it. I go
to the gym, and I'm doing it for muscle. And
if it helps my memory, that's great, but I'm not
sure that it does. Emily Smasher pass smash.
Speaker 1 (47:27):
I also take my creatine every day. I even got
my husband to take it. It's the only weird supplement
thing I managed to encourage him to do. And yeah,
I tend to take it in powder form, five grams
a day. And I also am feeling I'm maybe relying
on the placebo effect.
Speaker 3 (47:45):
But it's totally fine.
Speaker 2 (47:46):
Okay, I try powder form. How do you what? Do
you put it in hot water? Just a cup of
hot water? Doesn't it taste gross?
Speaker 6 (47:53):
No?
Speaker 1 (47:54):
I don't think it tastes bad. The I understand some
people feel this way. I the creatine that I typically consume,
which is thorn creatine.
Speaker 3 (48:02):
Does not taste bad. I don't think it tastes like anything.
Speaker 2 (48:04):
To me. It tastes super bitter. I get the whatever
they sell at Costco because not an ad, by the way,
but Costco. If you're listening, I love you. I get
whatever they sell there, but it is very bitter. And
I used to put it in my coffee and then
I like missed the fact.
Speaker 3 (48:20):
That I enjoyed it, and it makes your coffee sad.
Speaker 2 (48:23):
Yeah. Yeah, And I don't like sad coffee. I like
happy coffee. So I'm on gummies.
Speaker 1 (48:27):
I will say these Creatine, these Creatina gummies are actually
really delicious. Also not an ad, but they are they
are good. So if you don't like the way the
powder tastes, I recommend gummies.
Speaker 2 (48:36):
All right, after the break, we will get to your
question of the week.
Speaker 4 (48:46):
Hi, Emily and Perry.
Speaker 7 (48:47):
This is Elizabeth from Boston. So as my elder millennial
heart is mourning, James Vanderbeek, I'm realizing that I should
be close to scheduling my first COLONOLS could be I'm
forty two. Is it time yet?
Speaker 6 (49:03):
Thanks?
Speaker 1 (49:04):
So, the recommendation is to start for somebody with sort
of typical risk factors is to have a first colonoscoby
or a first colon cancer screening at forty five. So
that is the standard age. So if you are forty five,
now is the time. If you are younger than forty
five and you have significant risk factors, that could be
the time, but you really do want to start this,
(49:26):
I mean colon cancer screening is not as bad as
you think. You can talk more about that if you want,
but it is.
Speaker 2 (49:34):
It's great. I'm going to go. I'm going to go.
Speaker 3 (49:36):
Really I also thought it was great. Okay, I actually
thought all is awe.
Speaker 1 (49:42):
Just to be clear, when you have a colonoscopy, like
a lot of I think a lot of people find
this very scary. But the procedure, the worst part of
this is you drink some terrible tasting drink and then
you poop for a bunch of times.
Speaker 3 (49:55):
You're actually totally fine.
Speaker 1 (49:57):
You know, you can't eat that much for a day,
and then you go you take this amazing propofol like
nap and it's so.
Speaker 3 (50:04):
Nice, and then they wake you up and you're done, and.
Speaker 1 (50:06):
Then you go home and take another nap and eat
something and it's it's great.
Speaker 3 (50:10):
Yeah, right, it's great.
Speaker 2 (50:12):
Nothing to worry about. Forty five For people of average risk,
talk to your doctor. If you're at higher risk, if
you had a family member that colon cancer, you should
start screening ten years before the age that they were diagnosed,
or if you have other high risk factors. The recommendation
is age forty. Colon cancer is occurring with increasing incidents
in younger people. That is something we'll talk about in
(50:35):
some more detail in the future, but yeah, get it done.
Speaker 1 (50:39):
And I will say that when you are forty five,
many people face a choice about getting a colonoscopy or
using coli Guard, which is a system where you poop
in a box and you send it off and it
tests for markers that could be associated with they could
predict colon cancer. Coli Guard is very good at detecting
colon cancer and advanced at Noma's kolonoscopy is better at
(51:03):
is much better at sort of earlier stage stuff, and
so it's a little bit of a trade off for people,
depending on your risk factors. One thing I think many
people are not aware of I will just say is
if you do the colon guard and you screen positive,
your insurance may actually not cover the colonoscopy afterwards.
Speaker 3 (51:20):
And so that is something to find out before you
do this.
Speaker 1 (51:23):
It's like a weird thing about diagnostic versus screening, and
so that is true for some insurances.
Speaker 2 (51:29):
Oh interesting, and cold guard you have to do every year.
Speaker 1 (51:33):
Color Guard you have to do every year, and colonoscopy
if everything is good in principle, you could go ten
years between them. All right, that's it for us today.
Stick with us next week when we will ask what's
the deal with protein? Wellness Actually is produced in association
with iHeartMedia.
Speaker 3 (51:51):
Our senior producer is Tamar Avishai.
Speaker 1 (51:54):
Our executive producer at iHeart is Jennifer Bassett. Our theme
music is by Eric Deutsch and our our content is
for educational purposes only.
Speaker 2 (52:02):
If you like the show, help other people find us.
Leave a rating and review on Apple Podcasts or your
podcatcher of choice and help us spread the word about
the show. You can follow us on Instagram at Wellness
Actually pod and don't forget We want to hear from you.
Head over to Wellness Actually dot fm and leave us
a question for our mailbag or suggest a topic for
(52:22):
a future show.
Speaker 3 (52:24):
We'll let the influencers have the last word.
Speaker 8 (52:26):
As gues, we know we have more than twenty flavors
of creatin if we don't know what flavor to pick,
here are the top five flavors from the last thirty days.
At number one, as usual, we have ink Lemonade. At
number two, we have puckin Blures. If you like sour flavors,
you are good to love this one. At number three,
we have pinat Pada at number four, we have Raspberry watermelone.
At number five, we have Glacier Gummy. There's a new
(52:47):
flavor on the way which mimics the White Monster Energy drink,
and I cannot wait for that one to go live.
Hi, Perry, Hi Emily, So I brought some props for
our episode today.
Speaker 2 (00:07):
This will do great on an audio primarily podcast.
Speaker 1 (00:11):
If people are watching on YouTube, you will see that
for our episode, I.
Speaker 3 (00:16):
Brought creating dummies.
Speaker 1 (00:18):
I have sour cherry, I have sour apple, and I
have watermelon.
Speaker 2 (00:27):
Amazing. Are these your creating gummies?
Speaker 1 (00:29):
Okay, I'll tell you how I got these creating gummies.
I mentioned Creatine on Instagram, and all of a sudden,
many people wanted to send me creatine, and so a
lot of Creatine has been arriving at my house because
I'm an Instagram influencer.
Speaker 2 (00:45):
First in secret, Emily, can you mention an Nvidia RTX
fifty ninety graphics card on Instagram?
Speaker 3 (00:55):
Everyone, Perry would love.
Speaker 1 (00:58):
To talk about your Nvidia blah blah.
Speaker 3 (01:02):
Graphics card on here. Thank you so much.
Speaker 2 (01:05):
It's important for all of our wellness. That's me. I'm
excited to hear whether you are partaking in the creatine.
But I suppose we should look at the data first.
Speaker 3 (01:14):
We're going to find out.
Speaker 2 (01:15):
Let's do it.
Speaker 1 (01:18):
I'm Emily Aster, I'm an economist and a data expert.
Speaker 2 (01:22):
And I'm Perry Wilson. I'm a medical doctor.
Speaker 1 (01:24):
It's Thursday, April second, twenty twenty six, and this is
wellness actually.
Speaker 2 (01:30):
Because you're getting a staggering amount of health and wellness
information nowadays from every source imaginable, and some of it
is awesome.
Speaker 1 (01:38):
And some of it is well actually both Fortunately we
are both people who know how to read studies, how
to parse the data, and can tell you what's worth
thinking about and what you can safely ignore.
Speaker 2 (01:51):
But before we dig in, a note that this podcast
is for educational purposes and should not be construed as
medical advice. We don't know your unique situation, so talk
to your doctor for personal health decisions.
Speaker 1 (02:02):
This week, we're asking what's the deal with creating Perry
and I will give the official smash or pass, and
then we'll get to your question of the week.
Speaker 3 (02:11):
But first let's do the health news roundup. After the break.
Speaker 2 (02:26):
And we're back with the health news of the week
coming up first, Emily, President Trump says quote, it's possible
he will withdraw the nomination of Casey Means for Surgeon
General given the lack of Republican support. You may remember
we discussed the nomination of doctor Means on this podcast,
(02:47):
and I think brought some much needed attention to the
fact that she doesn't actually practice medicine and is a
wellness influencer and had a confirmation hearing in which she
declined to advocate for vaccination for measles. Does wellness actually
have some real political clout now? That is my question?
(03:10):
Are we what's moving Washington, DC?
Speaker 1 (03:12):
It is possible, but I would say unlikely. However, you
never know, And I think this is not very surprising
given where the conversation has landed over the past couple
of months. I think the appetite for moving away from
(03:33):
vaccines has somewhat waned. This is a little bit separate
from the Casey means confirmation hearing, But I do think
as we have seen more cases of measles, for example,
it's become less palatable to be like, who cares about vaccines?
It's like, well, actually children are dying, so maybe people
(03:54):
should care about them. And I think we've seen increasingly
inside the administration from Jay Baticharia from the Republican senators,
a feeling of like, okay, you know, enough is enough,
Like let's try to get back towards having more vaccines
and appointing someone as surgeon general who has refused in
the confirmation hearings to say that she supports vaccines is
(04:14):
kind of part of that. So I suspect that the
nomination will be withdrawn because I just don't think there's
Republican support. Bill Cassidy has had enough of this. Thanks
also in the camp of all the ways in which
we're positively influencing the world. I noticed after last week's
stem cell episode there was a BMJ article about stem
(04:38):
cells a heart attack that was retracted.
Speaker 3 (04:41):
Tell me more, and what role did you specifically play
in this?
Speaker 2 (04:45):
Yeah, I mean, once again the curse of wellness. Actually, like,
woe be unto you who is mentioned on this show,
because bad things will happen. The BMJ is the British
Medical Journal. Actually used to be called the British Medical Journal.
It is now officially just the BMJ, their hip but
very well respected journal. In twenty twenty five, there was
(05:05):
a report of in that journal of a randomized trial
of people who had heart attacks and were getting a
cardiac cathorization. So they you know, they put a little
wire into the heart to open up the blood vessel
that is blocked, and the intervention a placebo controlled intervention.
Was to inject some stem cells that were isolated from
(05:25):
Wharton's jelly, which is, for lack of a better word,
the goo that's inside the umbilical cord. Okay, it's like
a yeah, it does have a fair amount of mesenchymal
stem cells in it. Please go back to last week's
episode if you want to hear more details about that.
And what this study claimed to show was that the
(05:46):
rate of heart failure was significantly lower in the people
who got this special stem cell injection. So it was
sort of a thought like, oh, you're putting in these
these stem cells, They're going to differentiate into heart tissue
and become, you know, protect the heart in the long term.
This is biologically plausible, as we often say, and it was,
you know, by reports, a well done trial. Unfortunately, it
(06:08):
turns out that there were significant data regularities that were
subsequently revealed when the data was analyzed, and the full
article has now been retracted. The BMJ stopped short of
saying it was fraudulent, but it does just remind all
of us that no one study is ever definitive because
you never really know. You always need replication in this
(06:29):
kind of thing.
Speaker 1 (06:30):
Yeah, and I should say that retraction of a study
in a paper is actually pretty unusual, so it's not
Certainly it can be retracted if it is fraudulent, but
generally this means it is fraudulent or it is wrong.
You know, papers are updated over time and sometimes you
will look back and say, well, we weren't quite right
about that.
Speaker 3 (06:47):
But to actually retract a paper means you.
Speaker 1 (06:48):
Know, the paper is not right, something was wrong, and
how this was done not We have learned more later,
but like the way this paper was done was not right.
So it's a more extreme change than just you know,
the literature has evolved.
Speaker 2 (07:02):
Yeah, absolutely, so wellness, Actually skepticism around stem cells is
proven correct yet again. Our last news item is I
think a good one for to put your economist hat on, Emily.
I know we don't get to use that as often
as we would like in the podcast, but a new
study came out looking at childhood sugar intake and the
(07:23):
genetic risk for obesity and how those things interact using
a really cool natural experiment. So can you walk me
through this new paper.
Speaker 1 (07:33):
Yeah, so this paper uses a technique that economists call
natural experiments, where you want to think about this as
the world.
Speaker 3 (07:43):
Has experimented for you.
Speaker 1 (07:44):
And so in this particular case, they're using sugar restrictions
post World War two. So in the UK after World
War Two, there was a long period of time in
which there were restrictions on how much sugar you could
buy because of worries about not having enough, and then
at some point in the middle of nineteen fifty three
they relax those sugar restrictions and you were allowed to
(08:05):
buy more sugar. And the result of that was that
kids ate a lot more sugar, and pregnant people ate
a lot more sugar in like October nineteen fifty three
than in August nineteen fifty three. And so they're using
that sharp timing to look at whether being exposed to
higher levels of sugar, either in utero or in early childhood,
(08:26):
is associated with higher risks of metabolic disease later. This
paper actually follows on an earlier paper where they show
that kids who have higher sugar exposure in this period
have higher risks of diabetes later in life. And so
here they're showing higher risks of obesity and also that
(08:47):
that interacts with your genetic predisposition to obesity.
Speaker 3 (08:51):
So it's really interesting paper.
Speaker 1 (08:53):
I think it does give a little bit of caution
about very high levels of sugar exposure in early childhood.
I will say, you know, parents will come to me
and be like, oh my god, does this mean I
can't Like I one time I gave my child a
piece of cake, and like, have I ridden them forever? Like,
we're talking here about a lot of sugar exposure. Clearly
some is okay, but it is one of the dietary
(09:14):
things we probably want to be a little more cautious
about with kids than some others.
Speaker 2 (09:19):
Yeah, I think this paper also does a nice job
reminding us that, like a lot of obesity is genetic,
and so you know, they can look at the because
this comes from the UK Biobank, which is this big
amazing genetic cohort study, they can look at the genetic
risk factors for obesity and they can see, you know,
it's very clear that certain genes and patterns of genes
(09:40):
increase the risk for obesity, but that lower sort of
intaken childhood can kind of modify that risk, not all
the way. So it wasn't even like these people who
are at high risk genetically for obesity didn't become obese
because they were born during the rationing period. You know,
many of them still did, but the disparity in BMI
was somewhat lower than would have been predicted by genetics alone.
Speaker 1 (10:02):
So yeah, I mean it's a very The uk Biobank
is an extremely important data source because of the way
I think it will continue to help us understand over
time the intersection between genetics and behavior and you know,
how our behaviors turn on and off genes, which is
an exciting area.
Speaker 3 (10:20):
Of research that hopefully we'll talk about more.
Speaker 2 (10:23):
Absolutely, that's it for the health news of the week.
When we come back. What's the deal with creatine? Okay,
I want to start with an influencer telling us just
how important creatine is.
Speaker 4 (10:43):
Creatine should be now mandatory in everybody's took it, just
like brushing your teeth or exercising. I think everybody should
be supplementing with creatine prior to being diagnosed with alzheim As.
You've got this thirty year period of all these stages,
and one of those stages is subjective cognitive impairment, which
is the first stages of Alzheimer's disease. Right, Sometimes your
(11:04):
thinking's not up to scratch, or you forgot where you
put your keys, or you're getting slower reaction times. These
are all cognitive functions. They start to decline, then you've
got mild cognitive impairment, which is a pre dementia state,
and that lasts around twenty years. So it's during these
states that you need as much brain energy as you can,
and we can get that from creatine.
Speaker 3 (11:24):
Okay, so, Perry, I like this influencer quote because I
think that it illustrates what, for me is the core
point that we will get to with creating as we
move through this, which is this person starts with something
that I think is an overstatement but is true in
some sense, which is that there are some things where
(11:45):
we see benefits of creating, and then she kind of immediately.
Speaker 1 (11:49):
Goes to like creatine prevents Alzheimer's, which is way on
the edge of what we think. So it's such a
good example of the kind of like let's take something
that's real and like make it matter for for everything.
Speaker 3 (12:00):
So absolutely it's a good entry.
Speaker 2 (12:03):
This is you know, we like to give people little
little hints that they are being influenced as opposed to
being provided with real data, and and one of those
hints is taking an extreme position. It's very engaging to
be like this supplement creatine like is necessary for literally
everyone and as important as brushing your teeth, and like
(12:24):
you're you're staking out a position so extreme that you
kind of have to pay attention to it. And we
just need to tell everyone that's never true. There's there's
literally even brushing is.
Speaker 3 (12:36):
As important as brushing your teeth. You should brush your teeth.
Speaker 1 (12:40):
But even if you don't do that, like it's rebably
okay occasionally, but still you should brush your teeth.
Speaker 2 (12:44):
Yeah, so let's dig in. There's there's a lot here,
but let's start like just at the beginning, right, Like, so,
what is the what is creatine?
Speaker 5 (12:54):
Like?
Speaker 2 (12:54):
Why are people talking about creatine? I see it from
a lot of bodybuilders and stuff. What's your take on creatine?
Speaker 1 (13:00):
I mean, I think the first thing to just tell
people like literally, creatine's an amino acid. It is an
amino acid that you consume in food.
Speaker 2 (13:08):
It's a derivative of an amino acid. I only say
because we did that.
Speaker 3 (13:14):
Right, I'll say, doctor, I'm a real die. I went
to medical school. Black blah black, Now go ahead.
Speaker 2 (13:19):
Please, because we said there's twenty two amino acids that
you know people use in creatines. Not one of them.
It's a derivative of an amino acid. But yes, by
all means continue.
Speaker 1 (13:30):
You consume creatine in food, primarily in meat and seafood,
and you store it in your muscles, and it is
helpful for making the muscles work, particularly in an anaerobic way.
I think the core thing that's relevant for this question
of supplementation is that your muscles can generally store more
creatine than most people can get indeed, and most people
(13:53):
can get through their food. So when people supplement with creatine,
it like ramps up the store of creatine and their muscles,
and in principle that can then help you when you
are exercising in particular ways at very high levels.
Speaker 3 (14:10):
That's kind of the core thing.
Speaker 1 (14:11):
So do you exercise to failure on a frequent basis?
Speaker 2 (14:15):
Perry, No, but I've done it.
Speaker 3 (14:18):
What does it mean to exercise to failure?
Speaker 2 (14:21):
Have you ever exercised?
Speaker 6 (14:22):
If?
Speaker 2 (14:23):
Have you have ever done an exercise?
Speaker 1 (14:24):
You feel like I exercise to failure every like the
three days, But I don't.
Speaker 3 (14:27):
I'm not sure that I know what that means.
Speaker 2 (14:29):
Okay, exercising to failure literally means that you're doing an exercise,
let's say push ups, and you just continue to do
push ups and do push ups and do push ups
until your muscles give out. They literally fail. And I
think it might be worthwhile to talk about physiologically, like
what is happening there, because that might be the best
(14:50):
way to understand how creatine works. So if you do
push ups and you keep going, and you don't do
like I'm going to do twenty, I'm going to do thirty,
you just keep going, going, going until your arms. What
will happen have a pillow under your face because your
arms will literally stop working and your face will smash
into the ground and there's nothing you can do about this.
This has happened to me, but bodybuilders will do these
(15:12):
types of exercises to failure. What's happening in the muscle
when your muscle is contracting is the muscles using energy,
and the energy currency of all the cells in your
body is ATP. Probably hard us mention that before, but
think of it as like cash spending cash in terms
of you know what cells can use for energy. There's
a problem, and that's that cells can't store very much ATP.
(15:35):
It's unstable. It's hard to keep it in its activated form.
So it's like they've got some cash in their pocket,
but it's not enough to you know, go on a
huge spending spree. That's sort of how I think about ATP.
For most cells, that's not a problem because they use
a little energy to like whatever they're doing. You know,
(15:55):
your gut sell and uses some energy to absorb some
glucose or whatever, and then it's done for a while
and it chills out and builds up more ATP no issues.
But there's some cells in your body that use energy
like a lot in over a period of time, and
muscle is definitely the biggest one, and that includes your
heart muscle, but you know your skeletal muscles as well.
If all they had to use for that energy was ATP,
(16:17):
then after about three seconds of muscle contraction, all the
ATP and a muscle cell is gone and the muscle fails,
and that means it just goes slack and your face
smashes forward into the pillow that you put under you
when you're doing pushups. That's not compatible with moving around
or lifting up anything. You can't have only two seconds
(16:37):
of muscle contraction, so what creatine is is a store
for phosphates that can regenerate ATP. So remember you can't
you can only have so much cash in your while
you can't have too much ATP in a cell, but
you can have lots of creatine. That's your bank account,
more or less. And so as your ATP is being
used up, creatine in the form of creatine phosphate is
(17:00):
regenerating ATP. So you're taking cash out of that.
Speaker 1 (17:03):
But it's the ATM. It's your cells as an ATM
exactly exactly.
Speaker 2 (17:09):
And as you pointed out, most of our muscle cells
based on a typical Western diet, actually can hold more
creatine than they have. And what that means is that
if you build up your store of creatine by creating
supplementation in theory, you have this extra amount in your
ATP bank account that you can extract upon. So it's
(17:33):
a little different. People often say creatine is like energy
for your muscle. It's more like the presence of creatine
allows your muscle to bank energy when it's not being
used so that it can pull it out again when
it is being used. It's almost acts more like a
battery or like a rechargeable battery, but you still have
to do the recharging. Creating does not have calories in it,
(17:53):
creating monohydrate right, like, so it's not energetic itself, but
it's a place to store energy in your muscles. There's
one other set of cells that do tend to be
active a lot and use a lot of ATP, which
is your brain, right, that's in your brain. Yeah, so
that's why you see a lot of muscle and brain
talk for creating.
Speaker 1 (18:11):
Yeah, all right, so let's start with the muscle talk
and then move to the brain talk because the muscle
talk is in some ways a much easier conversation totally.
So the thing we know, I think with incredibly high certainty,
is that if you are doing a lot of bodybuilding
(18:32):
related exercise, creating supplementation can improve your performance. We have
hundreds and hundreds of randomized controlled trials of people doing
body building activities will show that creating supplementation on average
increases the time to failure, so allows you to do
(18:52):
more of those push ups before you smash your face
in the pillow.
Speaker 3 (18:56):
And this is this has been used by bodybuilders for
are you know, decades?
Speaker 1 (19:02):
I mean, this is like a very standard bodybuilder activity talk.
Speaker 2 (19:07):
To me for a second, because this will come up again.
You said randomized control trials. Why in a study that's
looking at something like muscle strength, muscle performance, whatever your
metric is, why is a control randomization and control like
a placebo control so important Because there's plenty of studies
that aren't placebo controlled, particularly when we look at the brain.
So why does that matter when you're talking about things
(19:29):
like muscle strength and function?
Speaker 1 (19:32):
Yeah, I mean, I think the core thing is that
actually a lot of your muscle strength and function is
what you think you can do, right, So if you
sort of engent, like, let's let's back up. In general,
we like randomized control trials because we have treat people
the same and the only thing that's different is what
thing we're giving them.
Speaker 3 (19:50):
In this case, it's actually really.
Speaker 1 (19:52):
Important that not only are we choosing at random who's
getting the creatine, but that we are also doing something
to the group that makes them think they're getting the
creatine or that they might be getting the creatine. Right,
Because if I tell you, hey, I gave you this
like amazing substance, it's going to make you be able
to do more push ups. You will be able to
(20:13):
do more push ups, even if what I have given
you is literally.
Speaker 3 (20:16):
Like a like flower or something, or just like nothing.
I guess flower would help.
Speaker 1 (20:19):
But like if I just give you nothing and I
tell you this helps you do push ups, you will
do more push ups.
Speaker 3 (20:23):
Like that's how our brain is, which is cool.
Speaker 2 (20:26):
Yeah, it's kind of amazing. It's it's like it's like
Dumbo with the feather. Remember he has the feather that
can make him fly, and then at the end he
loses the feather, but it turns out he could fly
all along.
Speaker 1 (20:36):
Remember, right, I do remember it, I do remember, and
that movie makes me sad and so sorry, thank you
for please never bring it up again. And so yeah,
so the placebo effect is like one of our best
it's like one of our best effects.
Speaker 3 (20:49):
It really works very well.
Speaker 1 (20:51):
But if you want to evaluate the impact of creating
on any of these things, you need to like sort
of turn off the placebo effect by having a true
double blind, randomized placebo control trial in which you people
don't know what group they're in. And in the case
of these bodybuilders, we have that.
Speaker 3 (21:08):
Because it's of course it's easy.
Speaker 1 (21:10):
We can come back to this in other settings, but
it's really easy to experiment on athletes, Like, that's a
great population loves environmentation. They love to first of all,
they love to be in they love You tell some
athlete like I had a randomized control trial something which
might have proved your performance.
Speaker 3 (21:25):
Is like where do I sign up?
Speaker 1 (21:28):
And the second thing is often what you're looking at
in the outcomes is really easy to define and is
short term. Right, So you can run one of these
studies in like like a few days, you give some
people creating, You give them some people and some other powder.
You ask them to do a bunch of push ups
with a pillow under their face, and like then that's it.
That's your paper, And that's so much easier then like
(21:49):
I'm going to treat this and I'm going to see
whether you develop dementia like fifty years from now.
Speaker 3 (21:53):
That's just a much harder thing to study.
Speaker 2 (21:56):
And that's one of the reasons we have so many studies.
And you'll always hear almost every influencer I looked at
talking about creatine opened with like it's the most studied
supplement in the history of mankind, which I couldn't find
any reference for. Like I'm not entirely I think vitamin C,
and like, I think, I'm not sure if that's true,
but it has been studied a lot. I'll give them that.
Speaker 1 (22:14):
As of two thousand and three, in some review there
are like five there's like a review with five hundred papers,
and that's like twenty five years ago. So I and
this has only become more pop So I think this
is a very highly studied I'm not sure.
Speaker 3 (22:25):
We don't count papers.
Speaker 1 (22:26):
It's not like the it's not a metric, official metric.
Comedy papers have been written on something. But anyway, yeah, no,
definitely not the best metric.
Speaker 2 (22:33):
But let's put some let's put some numbers to it,
so you know, we could pick from a lot of papers.
Sometimes the best thing to do when there are a
lot of papers, and especially a lot of randomized controlled trials,
is to look a meta analysis, which is a single
paper that combines the results from multiple papers to kind
of give you an average. It's sort of the idea
that every paper is going to have little errors going
(22:55):
one way or another, and you kind of average them
out to get an estimate that's more more true. And
so one that caught my eye because probably it speaks
to my age is a recent meta analysis appearing in
the journal Nutrients, looking at creatine supplementation with resistance training
on muscle strength gains in adults under fifty years of age.
(23:18):
So there's quite a lot of research in older adults
for muscle function and falls and things like that, which
is interesting. But you know, I'm not quite there yet,
and I'm more interested, like for me personally, I want
to go to the gym and like look a little
better and feel a little stronger, and I'm otherwise healthy,
and so I was very curious to see, like, Okay,
what can I expect from creatine. So this study compared
(23:41):
creatine supplementation and resistance training to place EBO plus resistance training,
and they looked at upper and lower body strength and
basically they found that the people randomized to creatine could
lift an extra four point four kilograms on the bench
that's what, like about ten.
Speaker 3 (24:01):
Extra pounds ten pounds, yeah.
Speaker 2 (24:03):
Yeah, ten pounds on the bench press, and thirteen kilograms
on the leg press, so you know, maybe twenty five
thirty pounds on the leg press. That's not nothing. I mean,
you're own old all of a sudden, but that's real.
What do you think?
Speaker 1 (24:17):
Yeah, I mean I think that seems real, and I
also wouldn't There's two things I would say about that.
So one is I would not dismiss the old people evidence.
I actually think that's the other piece of evidence here,
even though you know you're not, we're not yet older adults.
But actually the other really strong piece of evidence around
creatine is the benefits on falls and on mobility for
older for older adults. But in both those populations and
(24:41):
in the like the setting you're talking about, it's actually
very important to be combined with resistance training. So just
taking a bunch of creatine and doing nothing will not matter.
The thing that creatine is helping you do is helping
your muscles exercise closer to failure, which allows your muscles
to break down more and then allows them to build
back more. So we want to be like very clear
(25:03):
on this, even on the well established muscle stuff, that
it is not just taking the creatine. It is taking
the creatine and doing some strength training at the same time.
Speaker 2 (25:13):
That is really important, and honestly not only doing whatever
strength training you normally do. The benefit derives from the
fact that you should be able to do slightly more.
We don't want to interhurt themselves. We want you to
ramp up slowly. And if you know you can afford
like a personal trainer to even work with you to
get there, that's amazing. I certainly can't. You do have
(25:36):
to be careful, but right, creating isn't magic. It allows
you to do a little more work, but you've got
to do the more work if you want to see
the improvement.
Speaker 3 (25:46):
All right, So that's on muscles.
Speaker 1 (25:48):
I want because it's my deep passion to say, very briefly,
if you are an endurance athlete, so this is like
there's also an active discussion around people who do sports
that are not like bodybuilding sports, and the evidence for
creating supplementation in like running and cycling is less compelling
(26:10):
for reasons that I think makes sense with the biology.
So you know, you asked about sort of exercising to failure.
It is rare, even in you know, pretty intense like
even in like long distance running, to exercise to the
kind of failure you have described, It does happen. You
will see people at the end of a marathon like
unable to like control your body and like just sort
(26:32):
of like crawling across the finish line.
Speaker 3 (26:35):
Like but that's not common. That's not common, and so the.
Speaker 1 (26:40):
Kind of thing that creating would help with is like
just it's less obvious, it will be helpful.
Speaker 2 (26:45):
There.
Speaker 1 (26:45):
I will say a lot of endurance athletes do take
low levels of creating because like, why the hell not
just in case it might help because we're insane.
Speaker 3 (26:53):
But the evidence isn't as it isn't as strong.
Speaker 2 (26:56):
I'm so tempted to ask you if you take it.
Speaker 1 (26:58):
But.
Speaker 2 (27:00):
Oh you do, okay, I guess.
Speaker 1 (27:04):
Because someone once said that it might make me faster.
Have we learned nothing about my psychology? Someone suggests all
you need to do is say you can run faster longer,
and Emily will do a little bit, a little bit
faster longer. I'll do it, absolutely, yes.
Speaker 2 (27:20):
So let's while we're while we're sticking on effects, I mean,
we've got, of course, we have to talk about like
how you get creatine and stuff, but maybe let's go
on to the brain, because you know, I think the
data for muscle is great, but what I'm hearing from
a lot of people, and especially online, even that first
influencer is talking about creatine for Alzheimer's disease and things
like that. We'll get to general brain effects for a second.
(27:44):
But I'd like to play a quote from an influencer
for you. You're not going to be a surprise that this,
as I was.
Speaker 5 (27:53):
There is a supplement that reversed memory loss in people
with Alzheimer's disease in a new double blind, Placibo controlled
trial right here in the United States, and very few
doctors are talking about it.
Speaker 6 (28:06):
If you are news to my channel, Hi, my name
is Robert Love.
Speaker 5 (28:09):
I'm a neuroscientist and I have a medical clinic in
Florida where we are reversing Alzheimer's in our patients. This
study was released June fourth or June fifth of twenty
twenty five. Kansas Medical School did a double blind, super
controlled trial in adults with Alzheimer's disease. Half the adults
got Creating, half the adults got at Placibo. Here's what
(28:29):
they found. The adults who took Creating actually improved their
memory in this study. Now, the thing is they give
them a very large dose of creating. The dose they
gave them was twenty grams a day. Most people are
taking three to five grams a day, maybe ten grams
a day. These people took twenty grams a day. There
were no serious side effects, in fact, really no side
effects at all of taking twenty grams a day, so
(28:51):
the people did not feel.
Speaker 6 (28:52):
Bad and they improved their memory.
Speaker 5 (28:54):
Now, creating is one of the most studied supplements on
the planets, lots of resource, specifically on.
Speaker 6 (29:01):
Athletes for muscle health. Women.
Speaker 5 (29:03):
This is especially important for you women, you make less
creatine than men do. Creatine is evolved in the process
of energy. Basically, it helps make ATP and so think
about it. When you make more ATP the creatine, some
of that can get into the brain and that can
help your brain make more energy, and that can improve
brain function.
Speaker 2 (29:21):
So yeah, Emily, I was doing the research for this
this episode, and I was looking into the literature about
creatine in the brain, and I put together all my notes,
but then of course I went to the influencers. I
wanted to see what people were saying. And here's someone saying, like,
there's a you heard the words randomized placebo controlled trial
(29:45):
of creating for Alzheimer's disease, and it showed that it
fixed their memory problems. And I was like, huh, how
did I miss that? Like that's a big deal. How
did I miss that trial? And this is a this
influencers like a doctor. They have a clinic down in Florida,
Like it's always Florida, but you know whatever. So I
(30:06):
did a little bit of slew thing and I actually
found the study that this influencer was talking about. From
the context clues, the number of patients the university was
sent out of, et cetera. I found it. And it's
not a randomized trial. It's there's no randomization, it's not
placebo controlled. It's just twenty people with Alzheimer's who got
some memory testing and then went on creatine and then
(30:28):
got some more memory testing, and there was some modest
improvement in memory from before and after. But remember we've
already talked about like the importance of randomization of placebo controls.
So I know how you'll feel about this, But like,
I'm still having trouble with the influencer world, Like you
can just say anything like is there are there no rules?
Speaker 1 (30:48):
What I think is interesting about this one? Yeah, of course, yes,
there are no there are no rules.
Speaker 3 (30:53):
But what was interesting about this was it so specific.
Speaker 1 (30:56):
Like often in these influencer things, you'll hear, you know,
there's a new exciting study that says that creating works
for Alzheimer's. But to be sort of specifically wrong is
actually quite dangerous because of course, like anybody who found
this study would be like, oh, well, it's actually not
a double blind, placy book controlled randomized trial. It's it's
not a randomized trial of any sort. It's just like
(31:16):
a study of some people. So I think it's dangerous
to be too specific with your lies.
Speaker 3 (31:20):
In the internet.
Speaker 1 (31:21):
But at any rate, there is not a double blind,
policy book controled randomized trial of patients with Alzheimer's that
shows effects of creatine full stop.
Speaker 3 (31:30):
There is not.
Speaker 2 (31:31):
There's not. And while we're on the subject of the
neurodegenerative diseases, you know, this is again a place for
the reasons we talked about. Because brain cells do use
atp at a rate that is faster than your typical cells,
it makes sense to test these things. I'm so glad
that people are evaluating, especially a relatively benign supplement like creatine,
(31:55):
for degenerative neurologic diseases. But to give you like the
data on this, there's a large randomized trial seventeen hundred
people with early Parkinson's disease. They're all within five years
of diagnosis. This is coming from the Journal of the
American Medical Association twenty fifteen. They were given creating monohydrate
ten grams a day for a minimum of five years.
(32:18):
This is a placeable controlled randomized trial. I mean, what
an amazing study, right, Yeah, and it is actually I.
Speaker 1 (32:24):
Mean to actually to run a set of like that
is extraordinary, extraordinary, really really impressive.
Speaker 2 (32:29):
Yeah, kudos to the authors. The study was stopped early
for futility. So when we run trials, especially trials that
are expensive like this one would have been, and that
go on for a long time, we'll have an independent
statistical board that looks at the data at some specified
time points and says, is it possible that if you
continue this study you'll see a signal of benefit or
(32:51):
at this point, based on the data we have, like,
unless every single person who gets creating does amazingly, well,
you're not showing benefit, so you might as well stop.
Now it's no longer ethical to continue this trial. So
super impressive, no effect in Parkinson's disease. And then there's
another relatively large trial in this space five hundred and
fifty adults with Huntington disease. They were getting creatine amountohydrate
(33:15):
tight traded up to forty grams a day. We'll talk
about the dosing, but that is an incredibly high dose,
also placebo controlled, and also halted for futility.
Speaker 3 (33:28):
So not a pantasy, I will say.
Speaker 1 (33:30):
On the other side, there is a much smaller meta
analysis from twenty eighteen where they put together a number
of small trials. In the end totals like fewer than
three hundred people, but looking at just general cognitive performance,
and there, you know, maybe they get a little bit
(33:51):
of a signal on short term memory.
Speaker 3 (33:55):
You know, this is not in a diagnosed population. The
result else.
Speaker 1 (34:00):
Are pretty weak, and they only show up for a
small number of outcomes, and they mostly show up for vegetarians,
which you know, could be because they don't get enough meat,
or could be because you're cutting the data enough to
find a group where it matters for I don't really know.
So putting all of this together, I would say, certainly
the evidence for brain impacts is far, far, far, far
(34:24):
far weaker than the evidence for muscle impacts.
Speaker 2 (34:29):
I agree. You know, in terms one of the issues
with the brain, it's like muscle's pretty easy to study.
You know, it's like how much can you bench? Like
that's a very reasonable metric, but like how well your
brain works is really hard. You know, we think about memory,
but if you look at detailed neurocognitive testing that happens
in a lot of these trials, it's it's memory, it's attention,
(34:51):
it's executive function. You know, there's all these sort of components,
many of which overlap with each other, some of which
we don't fully understand, all of to have scores on
scales that are impossible to explain to anyone, and it's
very hard to say like a global estimate of like
it makes your brain better. You're right. If there was
one thing that keeps kind of standing out in these
(35:13):
smaller trials of you know, older adults, it's probably memory.
I mean, did you did you find that as well?
Speaker 1 (35:19):
Like if you're short term memory, it's kind of short
term memory issues, which which is something a lot of
older adults struggle with, and so that sort of comes
out most consistently in these trials. It's also a relatively
straightforward thing to measure, as opposed to you know, measuring
someone's executive function is much harder than measuring their short
(35:41):
term memory, which you more or less do by telling
them a bunch of words and then a little later
at the end of the study being like, do you
remember what those words were? So there's a series of
pretty standard tests for that. So I guess the other
thing I would say about this is like, there's an
interesting link with you know, mobility and exercise and not
falling down and the brain. Right, So one one thing
(36:03):
that could be true is like you take creatine and
you do some resistance training, and so then you don't
fall down, and then you you know, end up interacting
more in the world.
Speaker 3 (36:11):
That's actually really good for your brain.
Speaker 1 (36:13):
So there's a whole set of interacting things when we
talk about the elderly, where anything that improves your ability
to do the activities of daily life is likely to
improve your brain because your brain is benefiting from doing
the activities of daily life absolutely.
Speaker 2 (36:30):
So let's talk a little bit about how people get creatine. Okay,
so let's say that people say this sounds pretty good,
I want to bench a little bit more. So all
you have to do if you want to get creatine
is post on Instagram and say, well, I like I
like creatine and apparently it shows up at your house.
Why doesn't this work for me?
Speaker 3 (36:49):
I don't know.
Speaker 2 (36:50):
We're going to combine people combined. Emily and I have
over five hundred thousand Instagram followers.
Speaker 3 (36:59):
It's so so true.
Speaker 1 (37:02):
All right.
Speaker 2 (37:04):
So, creatine, as you pointed out, comes from meat. But
because meat is muscle, and animals are just like us
and they have they have creatine in their muscles as well,
Vegetarians are people who potentially aren't ingesting creatine in that
way as much, which is why some of the data
restricted to vegetarians looks a little bit better for creating supplementation.
(37:27):
I should say that creatine is not an essential nutrient.
So essential nutrients are things that you must ingest or
you die, right like vitamin C. If you don't, you
get scurvy, you die, et cetera. Creatine is synthesized by
your body. It's synthesized in the liver and the kidney,
but probably not as much to sort of saturate how
much your muscles can take. They really can take quite
(37:47):
a bit of creatine, and as you pointed out, even
meat eaters are probably not fully saturating their muscle with creating.
Speaker 1 (37:53):
Yeah, so when people talk about taking a creatine supplement
just to like get to brass text.
Speaker 3 (37:58):
It's kind of two approaches to this.
Speaker 1 (38:01):
So for people who are doing who are taking this
for like bodybuilding, the approach tends to.
Speaker 3 (38:08):
Be to take a lot for a short period of time.
Speaker 1 (38:12):
Like, as you know, thirty forty grams of creating a
day for some period of time, and then return to
a maintenance dose. For most people who would take this
to kind of just generally improve their overall muscle functioning
and so on, the typical dosage would be something like
five grams a day, as like a regular just to
(38:34):
take five grams a day.
Speaker 2 (38:36):
That's probably even a bit more than the average person needs.
What will happen is that you pee out the excess,
so you know you can think about whether it's worth
it to you. It's not going to be harmful to
take more those big, bulky loading doses. Be a little
careful with if you've never done this before. There are
some gi effects. You get some rumblies in your tumblies
(38:58):
with creating, even at the I do. So if you
have a sensitive stomach, be a little careful when you
start out.
Speaker 1 (39:05):
And there's a lot of ways to get creatine. There's
creating in powder, there's creatine in water, there's creating in
gummy form. This creatine pills is like a lot of
different a lot of different options.
Speaker 2 (39:16):
Most of what you'll see is creating monohydrate. All of
the data that we talked about today was creating monohydrate.
There is this other form of creatine out there called
creatine fylester or something like that that they argue like
is absorbed better. There's no data on it, and there
doesn't seem to be a reason to spend extra money
on that.
Speaker 1 (39:32):
All right, So two downside questions people often have here.
One is does creatine make you retain water? So this
is like I take a bunch of creatine and then
I'm all of a sudden like a bloated water bag.
Speaker 3 (39:48):
True or false?
Speaker 2 (39:49):
True?
Speaker 3 (39:50):
True?
Speaker 2 (39:50):
Oh yeah, absolutely absolutely. So what creatine is getting taken
up by your muscles, and water will flow from parts
of your body that have less dissolved stuff in it
to parts of your body that have more dissolved stuff
in it. That's osmosis, and so water will move into
(40:12):
your muscle cells when you start taking creatine as the
creating concentration in your muscle cells, build up and that
actually swells your muscles a little bit, Like it's not
really you're not stronger, but it does kind of like
maybe add a little definition. The studies show you know,
you're talking about two kilograms, so four to five pounds
(40:32):
in the first week or two of creating supplementation of
water weight, so be aware of that. And it does
persist as long as you supplement creatine. So like if
you if you're just doing your five grams a day,
like you'll you'll get that initial weight and you'll just
sort of stay at that extra water weight. If you
stop the creatine, then you'll have what's called diarrhsis and
(40:53):
you'll you'll lose some of that water. So you know,
don't don't freak out. You're going to gain a couple
of pounds. And it's just.
Speaker 1 (41:01):
Second question, is it bad for my kidneys? You're a
kidney doctor.
Speaker 2 (41:04):
Oh, I love this question. Can I tell a story?
Can I tell the patient story?
Speaker 3 (41:08):
Do you love the kidney? So yeah, please tell.
Speaker 2 (41:11):
I am a fellow kidney fellow at the University of Pennsylvania,
and this woman comes in and consult She's like this
eighty five year old Russian grandma whatever you're picturing that
is correct. That is how she looked. Okay, and she
comes in and she is a creatinin value of ten. Now,
(41:34):
creatinin is a blood test that we use to assess
kidney function. Creatinin is a metabolite of creatine. So the
creatine that's in your muscle breaks down and forms creatinin
at sort of a steady rate. Because everything breaks down
and your kidneys excrete, the creatinin fine. As your kidney
function worsens because they can't excrete as much, the creatin
(41:56):
in your blood goes up. So the higher your creatin
is the worst. Normal creatin is around one. Just to
keep things simple, a level of crat int of ten
is like, your kidneys aren't functioning at all. You need
to be on dialysis, your dad, Yeah, you need a transplant.
This is terrible. So I'm waiting for her to come in.
I'm ready to like have a conversation with this eighty
(42:17):
five year old Russian grandmother. It's like, Okay, I need
to admit you to the hospital today. We're going to
start dialysis. We'll get you on that. She's probably too
old for transplant. Like it was going to be a
whole thing, and she walks in and she looks great.
She's just spunky, old small lady. And I'm looking at
her other laboratory parameters and like her potassium's fine, it's
(42:37):
very unusual for some of the advanced kidney disease. The
acid base balance in her blood is totally stone cold normal.
Like it didn't make sense. So I'm talking to her,
and it comes out eventually as I'm asking her about
her diet, that she has a trick to staying healthy
in life. And what she does is she takes a
giant pot roast essentially at the beginning of the week
(42:58):
and boils it and boils it and boils it and
boils it until there's basically nothing left. She takes out
all the like gristle and whatever is left, and then
she takes that boiled stuff and she boils it and
boils it and boils it until she has a thick
slurry of like meat juice. Okay, And she drinks like
(43:24):
a cup of this thick slurry of meat juice a
day to stay strong and virile. And what was happening
is she was ingesting just herculean amounts of probably creatine,
but also creatin in because the act of cooking is
going to break down the creatine from the meat into
(43:45):
creatin in as well, So she was ingesting this huge
amount of creatinin. Most people muscles produce about a gram
of creatin in a day. So if so you make
a gram of creatin and you pee out a gram
of creatin and you stay and balance, everything's honkey dory.
She was clear taking in about ten times that because
her certum cretity I used to she was totally fine.
(44:05):
She had no kidney dysfunction whatsoever. So no, there is
no risk of kidney dysfunction with creatine.
Speaker 1 (44:12):
However, sorry, did you tell her to stop doing this
or this was like totally fine?
Speaker 2 (44:18):
She seemed fine, but I did. I did tell her.
I was like, listen, every time you get your blood tested.
Speaker 3 (44:24):
They're going to tell you that your kidneys are figuring.
Speaker 2 (44:28):
So yes, creatine supplementation will increase your creatinin in your blood,
and that is our marker of kidney disease. So when
you get your blood tested, if you're supplementing creatine, it
will be higher. And certain doctors who are less informed
might worry about that. There's no evidence that harms your
(44:48):
kidneys directly. There is another blood test for kidney function
called cistate and C which won't routinely get run, but
you can ask for and that's independent of creatine and
creatin and whatever. So like, if you really want to
know for sure, if you're nervous and you're on creating,
just ask for a size staatency. It's an approved test
and you can get like a better estimate of kidney function.
Speaker 3 (45:11):
That's a great story.
Speaker 1 (45:12):
I Before we end, I want to end with the
bad news for you, which is that creating, although influencers
will tell you it does, creatine does actually not affect
your hair loss or my hair.
Speaker 3 (45:25):
Growth or your hair growth.
Speaker 1 (45:28):
There's some discussion of both hair loss and hair growth.
Speaker 2 (45:31):
Talk to me about this. I mean, I'll take no
effect on hair any day, although I love hair growth
if you can give me some of that.
Speaker 1 (45:39):
There is sort of one small study that suggests that
maybe creating would in testosterone and then lead to possible
hair loss. But then there's many other studies which show
there's no effect on any of these things and so
but also no effect in the other direction.
Speaker 2 (45:57):
Yeah, there are some observational studies to which are interesting
that correlate creatine and hair loss, and we always love
to talk about confounders, which are like third variables that
explain and observed association. And there are a couple of
things here I can speak from personal experience. One is
that as men age and start to worry about their
(46:21):
like muscles and you know, have a little more time
maybe after the kids are older, to go to the
gym and start taking creating, is also the age in
their life when like, the hair is not as thick
as it used to be. And then in the slightly
more sinister side. You know, creatine is used extensively in
the bodybuilding community, and there are other substances that are
used rather extensively in the bodybuilding community that certainly do
(46:44):
result in hair loss, like the androgenic steroids. So that's
another thing that is often not disclosed when taking a
survey about your supplement use and your hair loss.
Speaker 1 (46:55):
Indeed, all right, I think that's it for creatine. Let's
do the smasher pass, Perry, smash your pass on the creatine.
Speaker 2 (47:04):
So full disclosure, smash. I take my five grams of
creatine in gummy form a day, and I'm gonna just
whether it's placebo or not. I take it. I go
to the gym, and I'm doing it for muscle. And
if it helps my memory, that's great, but I'm not
sure that it does. Emily Smasher pass smash.
Speaker 1 (47:27):
I also take my creatine every day. I even got
my husband to take it. It's the only weird supplement
thing I managed to encourage him to do. And yeah,
I tend to take it in powder form, five grams
a day. And I also am feeling I'm maybe relying
on the placebo effect.
Speaker 3 (47:45):
But it's totally fine.
Speaker 2 (47:46):
Okay, I try powder form. How do you what? Do
you put it in hot water? Just a cup of
hot water? Doesn't it taste gross?
Speaker 6 (47:53):
No?
Speaker 1 (47:54):
I don't think it tastes bad. The I understand some
people feel this way. I the creatine that I typically consume,
which is thorn creatine.
Speaker 3 (48:02):
Does not taste bad. I don't think it tastes like anything.
Speaker 2 (48:04):
To me. It tastes super bitter. I get the whatever
they sell at Costco because not an ad, by the way,
but Costco. If you're listening, I love you. I get
whatever they sell there, but it is very bitter. And
I used to put it in my coffee and then
I like missed the fact.
Speaker 3 (48:20):
That I enjoyed it, and it makes your coffee sad.
Speaker 2 (48:23):
Yeah. Yeah, And I don't like sad coffee. I like
happy coffee. So I'm on gummies.
Speaker 1 (48:27):
I will say these Creatine, these Creatina gummies are actually
really delicious. Also not an ad, but they are they
are good. So if you don't like the way the
powder tastes, I recommend gummies.
Speaker 2 (48:36):
All right, after the break, we will get to your
question of the week.
Speaker 4 (48:46):
Hi, Emily and Perry.
Speaker 7 (48:47):
This is Elizabeth from Boston. So as my elder millennial
heart is mourning, James Vanderbeek, I'm realizing that I should
be close to scheduling my first COLONOLS could be I'm
forty two. Is it time yet?
Speaker 6 (49:03):
Thanks?
Speaker 1 (49:04):
So, the recommendation is to start for somebody with sort
of typical risk factors is to have a first colonoscoby
or a first colon cancer screening at forty five. So
that is the standard age. So if you are forty five,
now is the time. If you are younger than forty
five and you have significant risk factors, that could be
the time, but you really do want to start this,
(49:26):
I mean colon cancer screening is not as bad as
you think. You can talk more about that if you want,
but it is.
Speaker 2 (49:34):
It's great. I'm going to go. I'm going to go.
Speaker 3 (49:36):
Really I also thought it was great. Okay, I actually
thought all is awe.
Speaker 1 (49:42):
Just to be clear, when you have a colonoscopy, like
a lot of I think a lot of people find
this very scary. But the procedure, the worst part of
this is you drink some terrible tasting drink and then
you poop for a bunch of times.
Speaker 3 (49:55):
You're actually totally fine.
Speaker 1 (49:57):
You know, you can't eat that much for a day,
and then you go you take this amazing propofol like
nap and it's so.
Speaker 3 (50:04):
Nice, and then they wake you up and you're done, and.
Speaker 1 (50:06):
Then you go home and take another nap and eat
something and it's it's great.
Speaker 3 (50:10):
Yeah, right, it's great.
Speaker 2 (50:12):
Nothing to worry about. Forty five For people of average risk,
talk to your doctor. If you're at higher risk, if
you had a family member that colon cancer, you should
start screening ten years before the age that they were diagnosed,
or if you have other high risk factors. The recommendation
is age forty. Colon cancer is occurring with increasing incidents
in younger people. That is something we'll talk about in
(50:35):
some more detail in the future, but yeah, get it done.
Speaker 1 (50:39):
And I will say that when you are forty five,
many people face a choice about getting a colonoscopy or
using coli Guard, which is a system where you poop
in a box and you send it off and it
tests for markers that could be associated with they could
predict colon cancer. Coli Guard is very good at detecting
colon cancer and advanced at Noma's kolonoscopy is better at
(51:03):
is much better at sort of earlier stage stuff, and
so it's a little bit of a trade off for people,
depending on your risk factors. One thing I think many
people are not aware of I will just say is
if you do the colon guard and you screen positive,
your insurance may actually not cover the colonoscopy afterwards.
Speaker 3 (51:20):
And so that is something to find out before you
do this.
Speaker 1 (51:23):
It's like a weird thing about diagnostic versus screening, and
so that is true for some insurances.
Speaker 2 (51:29):
Oh interesting, and cold guard you have to do every year.
Speaker 1 (51:33):
Color Guard you have to do every year, and colonoscopy
if everything is good in principle, you could go ten
years between them. All right, that's it for us today.
Stick with us next week when we will ask what's
the deal with protein? Wellness Actually is produced in association
with iHeartMedia.
Speaker 3 (51:51):
Our senior producer is Tamar Avishai.
Speaker 1 (51:54):
Our executive producer at iHeart is Jennifer Bassett. Our theme
music is by Eric Deutsch and our our content is
for educational purposes only.
Speaker 2 (52:02):
If you like the show, help other people find us.
Leave a rating and review on Apple Podcasts or your
podcatcher of choice and help us spread the word about
the show. You can follow us on Instagram at Wellness
Actually pod and don't forget We want to hear from you.
Head over to Wellness Actually dot fm and leave us
a question for our mailbag or suggest a topic for
(52:22):
a future show.
Speaker 3 (52:24):
We'll let the influencers have the last word.
Speaker 8 (52:26):
As gues, we know we have more than twenty flavors
of creatin if we don't know what flavor to pick,
here are the top five flavors from the last thirty days.
At number one, as usual, we have ink Lemonade. At
number two, we have puckin Blures. If you like sour flavors,
you are good to love this one. At number three,
we have pinat Pada at number four, we have Raspberry watermelone.
At number five, we have Glacier Gummy. There's a new
(52:47):
flavor on the way which mimics the White Monster Energy drink,
and I cannot wait for that one to go live.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Kingdom of Fraud
It’s the unlikeliest of criminal partnerships: a devout polygamist from an insular Utah sect joining forces with a shadowy Armenian tycoon from LA. The result - a billion dollar fraud conspiracy. In Kingdom of Fraud, investigative reporter Michele McPhee traces the origins of the extraordinary alliance between Jacob Kingston and Levon Termendzhyan. Together, the two men trigger the largest tax investigation in American history and weave around themselves a web of dirty cops, influential political relationships and transnational money laundering. All this is set against the backdrop of Jacob Kingston’s clan – The Order. A powerful and secretive polygamist organization in Salt Lake City. To whom Jacob is desperate to prove his worth. Kingdom of Fraud is produced by Novel for iHeart Podcasts. For more from Novel, visit https://novel.audio/. You can listen to new episodes of Kingdom of Fraud completely ad-free and 1 week early with an iHeart True Crime+ subscription, available exclusively on Apple Podcasts. Open your Apple Podcasts app, search for “iHeart True Crime+, and subscribe today!