June 9, 2025 • 33 mins
Creatine is often associated with athletic performance, but growing evidence points to its broader benefits for brain health, aging, and overall muscle preservation. This episode breaks down what pharmacists need to know about creatine’s evidence-based uses, safety considerations, and counseling opportunities. Tune in to strengthen your knowledge and help ensure patients receive accurate, evidence-based information about this widely used supplement.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Mark Smith, PharmD, CDCES, AFAA-CGFI
Pharmacist
UAB Medicine
Ian Haywood, PharmD, BCPS, CDCES
Clinical Pharmacist
Baptist Memorial Hospital
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the evidence-based uses of creatine beyond athletic performance, including its potential benefits for brain health and aging.
2. Identify key counseling points for pharmacists when discussing creatine supplementation with patients.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-200-H01-P
Initial release date: 6/9/2025
Expiration date: 6/9/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:11):
Hey, CE Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, Josh Kinsay, andas always, I'm excited about
our conversation today.
Creatine is often thought of asjust a sports supplement, but
emerging research shows it mayhave far-reaching benefits for
brain health, aging and overallmuscle preservation.
(00:31):
In today's episode, we'lldiscuss what pharmacists need to
know about creatine'sevidence-based uses, safety
considerations and how to guidepatients with accurate,
meaningful information.
And because this is a topic ofinterest that I know nothing
about, I have got two expertwitnesses today, two experts to
(00:51):
kind of share some details withus today.
So super excited to have bothof you with us, Mark Smith and
Ian Haywood.
And, if you guys don't mind, goahead and take a couple minutes
to introduce yourselves to ourlearners and tell us a little
bit about your practice site andyour passion for the profession
.
And again, we're just we'regrateful to have both of you
joining us today.
Speaker 2 (01:10):
So 1000%, josh again.
Thank you again so much forhaving us.
First and foremost, it's trulyan honor to be back here a
second time on such a greatplatform, so thank you for the
invite as well.
Absolutely, my name is MarkSmith.
I'm a pharmacist currently atUAB Hospital in Birmingham,
alabama, where I practice on theinpatient setting and see
(01:34):
patients in our orthopedicssurgery department.
As well to being a pharmacistand in the hospital setting, I'm
also a group fitness instructorhave been for over three years
now and so fitness and pharmacysort of have this positive
relationship in my life rightnow, in addition to being a
(01:56):
certified diabetes care andeducation specialist, which I
have been for about five years.
So diabetes education, fitnessand pharmacy has been a crucial
part of my career thus far.
Speaker 1 (02:08):
Awesome, awesome.
Thanks, mark.
All right, ian.
Speaker 3 (02:11):
Hey there.
Thanks again, josh, for havingme again.
I really appreciate it.
We had a great time last time Iwas on here and I'm pretty sure
we're going to have anothergreat time this episode as well.
My name is Ian Haywood.
I'm actually the qualitycoordinator at Baptist Memorial
Hospital for the DiabetesSelf-Management Education and
Support Program here.
(02:31):
This program actually is alsoan elective rotation for the
PGY1 residents that come toBaptist Memorial Hospital here
in Memphis, tennessee.
So I guess you could say I'm abig educator and that's what I
really enjoy.
Also, in my free time I do alot of physical activity,
(02:54):
exercise, working out, running.
So that's always been a part ofmy life, so that, along with my
passion for diabetes care,that's kind of they all kind of
align and work together to kindof promote fitness and promote,
you know, better health for ourdiabetes patients.
So that's a little bit aboutwhat I do and I'm looking
(03:16):
forward to talking to you guysabout creatine.
Speaker 1 (03:20):
Yeah, awesome.
Thank you so much.
Thanks again for taking timeout of your busy schedules I
know it takes a lot and remindme the episode you all it was
when Jen was still hosting.
So remind me what episode thatwas Was it on diabetes?
Was it the?
Speaker 2 (03:34):
topic yeah, it was on diabetes.
It was the high intensityinterval training with CGM.
Speaker 1 (03:42):
Oh great, yeah, yeah, awesome, yeah, awesome, awesome
.
And then you both alsoparticipated in one of our
courses, in the um cgm course.
Speaker 3 (03:50):
Uh, right, that's right, that's right, yeah, yeah
great, yeah, so we've.
Speaker 1 (03:54):
We've um, partnered with you all several times and
super excited to have you againtoday.
So, um, again, it sounds like,with your background, you're
very poised to give us greatinformation on this topic today.
So I'm really excited to hearwhat you guys have to say.
So let's jump into the content.
So let's just kind of set thefoundation, remind us exactly
(04:15):
what creatine is.
How does it work in the body?
It's generally associated withathletic performance, those that
are heavily involved in the gym.
So just kind of give us afoundation review of that, if
you don't mind.
Speaker 2 (04:28):
Yeah, sure, you're 1000% right about that with the
fitness aspect of it.
So creatine, another from.
Verbiage like creatine versuscreatinine can often be
confusing at times.
So making sure that we saycreatine for the sake of our
discussion today, and I'll trymy best to keep it on the
(04:50):
straight and narrow as well.
But creatine essentially is anaturally occurring substance
that is synthesized in the liver, pancreas and kidneys from
specific amino acids and it'sone of the precursors that lead
to the production of ATPessentially, and so it's
predominantly stored in ourskeletal muscle about 95% and
(05:11):
then the other remainingpercentages is restored in some
body tissues as well as thebrain as well.
But the biggest thing withcreatine is how it's
phosphorylated and how it'sactivated under high, intense
energy demands.
So that's the popularity whenit comes to fitness, in that not
(05:34):
only do people that takecreatine on a regular basis
experience an increase in leanmuscle mass, they also
experience increases in energyand short bursts due to the
production of creatine duringthose moments.
So this is a this is asubstance that has been around
for a long time.
It's been extensively studiedand it's exciting to see its its
(05:58):
sort of reemergence in intopics that are in addition to
fitness in topics that are inaddition to fitness, such as
major depressive disorders, someneurodegenerative disorders,
and as well as some of thebenefits in our aging patient
population, as well as aprecursor to energy metabolism,
taking that ADP and convertingit to ATP, which, as we know
(06:19):
from one of our basic scienceclasses, the ATP, is the energy
powerhouse of the cell andresponsible for many, many
functions from an energystandpoint in our body, great,
great.
Speaker 1 (06:31):
That's a great foundational review.
I feel like I just had a goodlittle cliff notes.
Speaker 2 (06:35):
That's awesome.
Speaker 1 (06:36):
Some of that, you know, it's been many, many years
since I was in school, so someof that is just, you know, gone.
But thanks again, that's reallyhelpful.
I have to admit I forgot thatit was a naturally occurring
substance in our body.
So you know, I think thatthat's just again just a great
reminder and making sure thateverybody's on the same page as
(06:56):
we talk about it here.
So, you mentioned some of thoseexpanded roles beyond the
athletic performance perspective.
So let's go ahead and dig justa little bit into those.
We can continue to talk aboutthem as we go through.
But I heard you mentionsomething about neurological
disorders, aging what else?
Have we kind of seen an uptickwith creatine use in recent
(07:19):
years?
Speaker 2 (07:20):
Absolutely so.
In addition to the skeletal,muscle and fitness aspect that
we all know about, there's fourkey components.
I'll discuss too, and Ian willnicely do, the other two as well
, the first one being cognitivehealth.
And by cognitive health, whatstudies have shown over the
years is that there have beenimprovements in memory in
(07:42):
patients that take creatineproducts.
There's been improvements inattention time as well as
processing speed.
So basically, an improvement incognition in patients that are,
in individuals that utilizecreatine within their regimen
and from a mental healthstandpoint.
(08:04):
So we've talked about cognition.
From a mental health standpoint, we're getting into conditions
such as major depressivedisorder.
Studies, which is one of theprimary studies that led to our
(08:29):
conversation, was the use ofcreatine in patients that have
major depressive disorder, andso studies have shown that there
has been a improvement inpatients with major depressive
disorder that have creatine.
One of the biggest studies thatwe saw was cognitive behavioral
therapy, or CBT, combined withcreatine therapy was successful
in reducing major depressivedisorder in those patients,
versus CBT and the placebo byitself.
(08:52):
So we're starting to see, inaddition to the muscle component
, we're also seeing cognitionand mental health, and there are
several others as well, right,ian?
Speaker 3 (09:01):
Yeah, there's also a lot of research and evidence
going into showing that creatinehas like a neuroprotective
properties and improvements incognitive performance,
especially during stress orsleep deprivation, especially
with the older population.
A couple research articlesactually come to mind.
(09:23):
A couple research articlesactually come to mind One by Ray
Etel in about 2003.
He found improved workingmemory and intelligent task
performance in weeks two withfive grams of creatine in
patients that were vegetarians.
That was super interesting,actually.
And again there was anotherarticle from Avgarinos Etal in
(09:48):
2018.
He did like a meta analysisthat showed that significant
cognitive benefits, particularlyin short term memory and
reasoning, was found in thecreatine group as well.
So it's just been reallyinteresting to see we're so used
to seeing creatine just havingto deal with athletes being this
(10:09):
wave of research going in adifferent direction, other than
what we're most commonly see.
Speaker 1 (10:17):
When we're talking about supplementing for these
patients in some of thosestudies, because what I envision
or what I've seen creatine usedbefore, it's usually a powder
and it's mixed into it like adrink, right, like a
supplemental drink or whatever.
Is that the same format inwhich these patients were
receiving it or is it adifferent modality that they're
getting it?
Speaker 2 (10:36):
There's several studies that we saw.
We've seen the use of thepowder form.
We've also seen the use ofcreatine capsules as well.
Those have been the predominantforms and it's interesting that
you mentioned that and thatkind of, in case anyone asks.
You would rarely see creatinein a liquid form that you can
(10:58):
buy from the store.
That's because if it's left inthe water for an extended period
of time, it gets converted tocreatinine which is so that
interaction or that reactiontakes place, and so that's why,
like it comes in that powder orcapsule form, so that when it is
(11:18):
formulated it has to beingested, almost you know pretty
quickly, okay, okay,interesting.
Speaker 1 (11:26):
And I'm interested in the fact that there are
capsules because I'm a textureperson and I hate the grittiness
of I hate all of the powder.
I just I can't do it.
Everybody's always like justslam it and it just oh, can't,
can't do it.
Speaker 3 (11:40):
There are different formulations, though there's
some gummies.
Speaker 1 (11:43):
Okay interesting.
Capsules powder.
Yeah, okay, so it doesn't haveto be the chalky aftertaste.
Speaker 2 (11:51):
No, you definitely don't have to go to the extent
of.
We were listening to thispodcast on some medical
providers talking about creatineand they had like a round table
question.
It's like, how do you take yourcreatine?
And one of the providers saidhe just dry powders it, which
means that he just takes noabsolutely by itself.
Speaker 1 (12:12):
So phone mouth exactly yeah, I imagine like
those.
You remember those pixie stickswhen you were kids and you tear
yeah, I sticker, I bet.
Yet I just I can't imagine thattakes good potential marketing
idea actually.
Yeah, maybe, yeah, rip off thecreatine stick.
So yeah, okay, interesting, andit's really interesting that
(12:34):
we're seeing kind of a go in adifferent direction as far as
what it can be used for.
Obviously, our podcast here isfor pharmacists, so what's the
pharmacist's role in this?
What should we be doing?
Should we be ready to answerquestions about it?
Is there certain education weshould be providing?
Should we be pointing tocertain versions of the
(12:55):
supplement as opposed to others?
Just what are some of thethings that pharmacists can do
in this space that can reallymake sure that, I guess, the
awareness is there and alsoproper education and use?
Speaker 2 (13:08):
Sure, I think one of the most important things is
that pharmacists, as youmentioned, being on the front
lines for the majority of thetime.
It's important that we bridgethe gap that exists between the
research and the real-worldimplementation.
So being that connector isgoing to be extremely crucial,
and that's partly done byeducating the patient on these
(13:29):
type of products and so gettingthe most recent evidence, and
one of the things that standsout the most is identifying the
appropriate candidates, and sothat's pharmacists can play a
huge role in that.
Some examples just include theolder population that are at
risk of fall and have a lot ofthat dietary creatine that you
(13:50):
would otherwise miss as avegetarian when missing out on
(14:11):
those types of products, andthen also individuals with
cognitive impairment.
We've mentioned that creatinehas been studied in cognitive
impairment, but there justhasn't been much funding behind
studies that can say, hey,creatine really, really works.
And the reason that it hasn'tbeen much funding is because
(14:33):
it's been around for so longthat, you know, no one is like
really rushing to like fund astudy that that can lead or draw
those conclusions.
Not a new or novel product.
Not a new or novel product,exactly.
So to kind of say that I thinkthat we can play a huge role as
(14:54):
pharmacists in sort ofidentifying patients that might
be a potential candidate forcreatine therapy.
Speaker 1 (15:00):
Yeah, and Mark, I really love the connection you
made there and you alluded to itearlier and I didn't make the
full connection until youreiterated it but with the
reason for its use in vegetarian, because you mentioned that
that was part of the study andso now that makes sense because
you're right.
Either they're missing out onsome of those building blocks of
(15:21):
the protein components and sopotentially less muscle mass and
whatnot.
So that's interesting to me forsure.
But as far as like dosing goes,do we see each of those things?
Are they the same similar usualsupplemental dose?
Or is it in order to getcognitive behavioral changes you
have to be like five times whatthe bottle recommends?
(15:42):
Or whatever Like are we?
Does that make?
Speaker 3 (15:44):
sense.
So, to be honest, the dosesthat were researched and that's
what we kind of need more of.
We need the more research withthe higher doses.
Right now, the doses that havebeen commonly researched are the
three to five grams, orpotentially even up to 10 grams,
or they may have even given theloading dose of, you know, 20
(16:07):
grams for the first five toseven days and then dropping it
down to the maintenance dose,which is about five grams for
the duration of the trial.
So technically, there has beenstudies where if the dose is
increased, it has shown toactually have more creatinine
that's actually crossed theblood-brain barrier and that is
(16:31):
actually shown to have an effecton the results of a study in
terms of depression.
But again, this is all still newto us and there still hasn't
been a lot of enough studies forthese dosings to kind of be
Fleshed out completely.
Yeah, completely that's a goodquestion you ask and that's kind
(16:51):
of what we've noticed with theresearch.
There's just kind of been alittle bit of variation, but
they stay.
Nobody's really pushed out tothe extreme of when beyond like
20 grams of no, and majority ofthem have just been about five
or five and so okay, um, justbecause I think maybe even the
safety too there's.
Speaker 1 (17:11):
You know, still like you know, that's what I was
gonna ask, yeah, like around thesafety, because you think about
, you know, like some of yourvitamins that are wasted in in
the urine and it's like youcan't really overdose on some of
those.
But then you have thefat-soluble ones.
You know A, d, e and K that youcan.
So, like, where does creatinefall in that?
Like, is it one of those thingswhere you can get too much, or
(17:31):
is it one of those things whereit's like, eh, it'll just waste
away if you don't use it, it'sfine.
Speaker 2 (17:36):
So one thing that we know for and we might end up
addressing this again later onin the podcast, but one thing we
know for sure is that inhealthy individuals by healthy I
mean patients that do not haveestablished CKD or chronic
kidney disease creatine isrelatively safe.
(17:57):
Creatine is very, very safe andso, in terms of just
elimination, there's nopotential risk for an otherwise
healthy individual to go up tothat, like Ian mentioned, 20
gram amount without beingworried about oh my God,
something's bad going to happento me.
Speaker 1 (18:14):
Right, my kidneys are going to shut down.
I can't filter it, right.
Speaker 2 (18:18):
Outside of that increased serum creatinine that
will likely reflect on your labsor something like that, but it
won't be clinically significantin an otherwise healthy patient
because if they stop taking itit's going to go back down to
that baseline level.
The example that it was like0.9 starting out and then you go
(18:40):
on creatine therapy for acouple of months or so and then
you go get labs drawn again andit's like 1.1.
You can dc that creatine andyou'll notice that it'll go back
down.
So it's not that.
So that increase doesn't relateor correlate to being
clinically significant in termsof a person needing to be
worried about CKD.
(19:01):
Or it's not damaging the kidneysto where you're leading.
It's not damaging, or anythinglike that.
Now, on the other hand, there'sthe other side of that, in that
individuals that do haveestablished CKD.
Everything that we've comeacross so far is talk to your
nephrologist.
Sure, sure, find out what.
Find out what your nephrologistsays, because there hasn't been
(19:23):
there hasn't been much push inadvocating for the use of
creatine in patients that dohave established CKD
no-transcript makes sense, okay.
Speaker 3 (19:45):
And then, josh, the dehydration aspect too.
Right, because what you knowcreatinine really does, it's
actually pushing all your fluidinto your cells.
So as it's pushing all yourfluid into your cells, your
body's actually can becomedehydrated, so that with
somebody having CKD and alreadyyou're having an imbalance and
them having to balance fluidsand waste and everything, and
(20:09):
then becoming super dehydrated,it could lead to possible issues
.
So that's kind of where I wouldjust be kind of cautious for
patients that have any AKI orCKD issues or anything like that
.
Speaker 1 (20:21):
Okay, yeah, that's great to know when we're talking
about using it in theneurological for patients that
have any AKI or CKD issues oranything like that.
Okay, yeah, that's great toknow.
When we're talking about usingit in the neurological sense or
for athletic performance andthen also aging and whatnot.
Are there any othercontraindications considerations
?
Does it interact withprescription medications that
patients might be on?
Is there something thatpharmacists?
Obviously that's one of the keythings that we do as
(20:43):
pharmacists, so is thatsomething we should be looking
out for as well?
Speaker 2 (20:48):
Yeah, the biggest thing that we came across with
regards to medication inconjunction with creatine are
NSAIDs, and so the thing thatwe've come across is that you
know so.
Ibuprofen the thing that we'vecome across is that you know so.
(21:08):
Ibuprofen, naproxen, aleveanything that's considered an
NSAID.
Didn't really see about liketopical NSAIDs so that I can't
make a statement on that, but atleast we know for sure oral
NSAIDs is going to be like oneof those things that you want to
watch out for in terms of drugtherapy in combined with
creatine, because of the waythat the NSAIDs are metabolized.
They're.
Speaker 1 (21:30):
Yeah, that makes sense, and so I'm assuming it
would be constant use, everydayuse of NSAIDs as opposed to.
I have a headache and I'mtaking two ibuprofen kind of
thing.
Speaker 3 (21:41):
And other like net for toxic agents, sure, sure.
Speaker 1 (21:45):
Right, right, which that just makes logical sense if
you think about it.
So yeah, okay, that's yeah.
So we've talked a little bitabout the broader use of it, the
benefits of it beyond justsports performance.
I guess one thing I want totouch on, and maybe we haven't
touched on it enough, but I,when we say it's for our aging
patients, are we talking aboutthat just in general of the
(22:07):
neurological benefits, or arethere other benefits that it's
doing?
Actually, you did mention thatit's increasing muscle mass,
because a lot of those patientswe see that dwindle or maybe
they're not as active and sotherefore that's kind of going
down.
So is there any other benefitsfor the aging population that we
can kind of highlight?
Speaker 3 (22:24):
Well, there's been some growing interest in a lot
of the research in terms of thepotential for creatine to have
some anti-inflammatory andosteoprotective effects.
So they think there was a trialwith creatine, with or without
resistance training, and thatkind of led to an increase in
lean mass, an increase in musclestrength and also reduce the
(22:48):
risk of falls in older adults.
And so this kind of isimportant because if you're
hopefully I won't have thisissue, but I'm pretty sure, like
a lot of grandparents andgrandmothers, it's very
difficult for them to just comeout, just to get off the toilet,
sure, just to get up out of thechair.
So there's actually been like atrial.
(23:09):
There was a trial back in 2017by Chilibe Etal.
He did like a meta-analysisshowing that creatine and
resistance training improvedlean body mass and significantly
increased leg muscle strengthin older adults.
And this is huge because thisactually can help directly
correlate to fall riskmitigation, and so there's huge
(23:34):
benefits just on taking creatineas you get older, especially if
somebody is going to continueto do some resistance training,
which kind of leads me me beinga diabetes educator.
I'm always promoting that for mypatient.
It's not just you doing cardioIf I have a 65-year-old,
67-year-old patient in here.
I'm always telling them to dosome resistance training with
(23:58):
resistance bands or using theirown body weight and stuff like
that.
And so me now like, after kindof doing a little bit more
research about creatine, this issomething that kind of makes me
want to.
You know, you know, tell themto potentially.
Speaker 1 (24:13):
Yeah, that's great, I've got just a few minutes left
.
So one of the things I wantedto be sure I touched on and I'll
admit to our listeners that Ihad shared some of the public
misconceptions and our littletalk before we actually got on
to record because I feel like Ihave for some reason thought
that it was one of those bannedsubstances.
You know, like you can't takeit at the Olympics or it's, it's
(24:33):
.
You know it's a faux pas if yousee someone using creatine in
the gym or whatever.
So clearly that's not the case.
But you all had someinteresting information to share
with me in the beginning.
Um, so if you want to just kindof talk to that a little bit
too, let's clear up themisconceptions that creatine as
a supplement is a bad thing, orit's only used by gym nerds and
(24:54):
it can be overused and whatever.
So if you want to kind of justtalk to that misconception
really quick, yeah, I canmention a couple of things.
Speaker 2 (25:01):
I think it kind of ties back into the going back to
the kidneys again if I could.
I think it kind of ties backinto the going back to the
kidneys again if I could.
The misconception one of thebiggest misconceptions is that a
person starts taking creatine.
It's going to potentially ruinmy kidneys and in an otherwise
healthy individual that is notthe case.
It is not going to cause anydamage to your kidneys.
(25:21):
Again, however, a person thathas established CKD, that type
of dialogue, that type ofinteraction, conversation needs
to be had with the nephrologist.
Another thing too is and thiskind of talks about the
underutilization of creatine inpractice.
So we have studies that haveshown, as Ian mentioned, about
(25:46):
the benefits of creatine in theelderly population that do have
the lean muscle mass, and theevidence is solid, like the
evidence is solid with the agingpopulation with lean muscle
mass.
It's solid in the area of TBIor traumatic brain injury and
concussion, and it's becomingmore and more solid with major
(26:10):
depressive disorder.
But what hasn't happened as aresult of that is the increased
use of that by providers, and wecan go back and forth as to why
that is, but one of the.
I think we kind of hit the headon one of them being like since
it's not funded, it's itdoesn't get a lot of spotlight,
(26:30):
so it doesn't get a lot ofattention, and so we don't see
that, we don't see the researchthat that shows benefits, great
benefits and a great productthat's been around for a long
time and it's relativelyinexpensive.
We don't see that equality ofuse in those patients as a
result of that.
So I mean, those are two bigmisconceptions that stood out to
(26:52):
me with regards to that.
Speaker 1 (26:53):
Yeah, and then Ian, you had touched on earlier
because I'd said, you know, isit one of those banned
substances or is it, you know,the performance enhancer, like
it's not in the same categorysteroid?
But you had mentioned howsometimes where the confusion
comes in is that creatine ispossibly found in some of those
banned products, faux products,and so that maybe is where some
(27:16):
of the misconception lies, isthat while it's an ingredient in
there, it is not the culprit,like it's correct, and the
product is banned.
Speaker 3 (27:24):
so yeah, and you can just get it by yourself, right?
You can just get actuallycreatine just all culprit, like
it's not the reason the productis banned.
So yeah, and you can just getit by yourself, right, you can
just get actually creating justall by itself in its pure form,
right?
Speaker 1 (27:32):
and that is completely acceptable.
There's no, you know, no one'sgonna look at you odd in the gym
if you have that or if you'reusing that for something in your
house or anything.
It's so cool.
And also I mentioned earlier Iused the term gym nerds and I
mean that with full love andsupport.
I don't mean that as a negativething.
Speaker 3 (27:51):
We're going to fly you down here for a quick gym
action one day, absolutely.
Speaker 1 (27:58):
Well, we are out of time.
So I think we've had a greatdiscussion on just the fact that
this should be, and is,somewhat being brought back into
the forefront and making surethat we're aware, as pharmacists
, that we may have patientsasking about it and maybe it's
something that we think aboutfor those individuals that are
vegetarians or low muscle massor aging population that do have
(28:21):
difficulties with quickmovement and whatnot because of
low muscle mass or because ofosteoporosis or whatnot.
So we see where we can bemaking some recommendations to
our patients, and that's great.
One thing I always like to kindof summarize at the end is what
do you think are the gamechangers here?
So what exactly?
What's our take-home point forour listeners from today's
(28:42):
episode?
Speaker 3 (28:49):
point for our listeners.
From today's episode, One ofthe take home points is
basically that well, one thing Iwant to kind of sneak in here
really quick is that I thinkright now in our society there's
a big push on GLPs, and one ofthe big things with GLPs is that
you can lose up to about 30 to40% of your lean muscle, and so
having a natural substance thatwe already have in our body that
(29:12):
creatine itself shown studiesthat can actually increase lean
muscle mass, increase yourmuscle strength when you're
taking these GLPs, that can besomething that people maybe we
should kind of look into alittle bit more and maybe get
some more research with thatcombination.
I think it just makes sense,but that's just kind of like
(29:37):
another podcast for another day,kind of.
Speaker 1 (29:40):
Yeah, no, I'm glad you threw that in because I
mean're right.
We have so many patients um areon glps and we've had so many
sessions and podcasts anddiscussions and and ces on it
and you know, it just is, Idon't see it going away anytime
soon, and so I feel like thatthat's something that we're
going to continue to be facedwith as pharmacists is making
(30:00):
sure that those patients aresupported properly, and I I love
this idea.
Maybe there's somebody outthere who is is gonna fund the
research for you, ian, and canget that off the ground, so yeah
.
Speaker 3 (30:11):
But a clinical pearl for me would be just, if you
guys do decide to get oncreatine, to make sure you
hydrate yourself, stay hydrated.
Creatine, remember it's takinga lot of your fluid and pushing
it into your muscle cells so bythat sense you can become very
dehydrated.
So make sure you're hydrated.
And if you have any GIdiscomfort with the creatine,
(30:37):
try the micronized version ofcreatine monohydrate it's called
micronized and that should helpalleviate some of the GI
symptoms.
If you do have some with Lortecand creatine Awesome.
Speaker 1 (30:49):
Another great tip for pharmacists as they're talking
with patients.
Mark, what's your summary?
Speaker 2 (30:54):
Yeah, my biggest call to action, in addition to
everything that we've talkedabout today and the information
that we've kind of shared andexchanged, is for our
pharmacists.
That are, whether you're inretail and the retail community
setting, or if you're aninpatient, see if you can
identify a patient or two, youknow, every once in a while it
(31:15):
doesn't have to be like aproactive type thing, like you
don't have to go and say, hey,I'm going to go and put on my
pharmacist cape and I'm going toput everybody on creatine and
see if they meet the criteria.
This is one of these things thatcan kind of happen organically
and I feel like, because it'sbeen established for so long and
it's been around for so long,the safety net that you have as
a practitioner can lead to moreconfidence.
(31:37):
Because who's to say that?
An elderly patient that's inhis or her 60s or 70s, that
otherwise hasn't been familiarwith creatine, and you just so
happen to see that they don'thave CKD and that you've noticed
that they've lost some musclemass recently, like it's just
like little small things likethat, and you say, hey, mr and
Mrs, so-and-so, I think thatmaybe you could look into this
(32:00):
over-the-counter product thatyou don't have to have a
prescription for, that isrelatively inexpensive.
Maybe you might want to trylooking into this right here or
at least see what your primarycare provider says about this.
And if they want to have aconversation, I'll be more than
willing to have thatconversation with them.
That's how we get that, that'show we bridge the gap.
That's how we bridge the gap,and so that will be my call to
(32:21):
action for the pharmacists thatare either in the community
setting or in the hospitalsetting, or whichever setting
you're in.
Speaker 1 (32:27):
Yeah, I love that.
I love the fact of you know it'snot a mission to put everybody
on creatine, or to find everysingle patient that's eligible
or whatever, but but yeah, Ithink you know, just being more
aware that this is an option,that this is not a faux pas,
it's not a negative thing, it isrelatively safe and effective
and as long as you're utilizingit appropriately, then I think
(32:50):
it can really benefit patients.
So, yeah, this has been supergreat.
Thank you so much, mark and IanReally appreciate you giving of
your time again and sharingyour expertise and, being gym
nerds, we appreciate that.
Speaker 3 (33:03):
As always.
Thank you, josh, I appreciateyou.
Speaker 1 (33:07):
Thanks, josh, thanks.
So if you're a CE plansubscriber, be sure to claim
your CE credit for this episodeof Game Changers by logging in
at CEimpactcom.
You.
Hey, CE Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, Josh Kinsay, andas always, I'm excited about
our conversation today.
Creatine is often thought of asjust a sports supplement, but
emerging research shows it mayhave far-reaching benefits for
brain health, aging and overallmuscle preservation.
(00:31):
In today's episode, we'lldiscuss what pharmacists need to
know about creatine'sevidence-based uses, safety
considerations and how to guidepatients with accurate,
meaningful information.
And because this is a topic ofinterest that I know nothing
about, I have got two expertwitnesses today, two experts to
(00:51):
kind of share some details withus today.
So super excited to have bothof you with us, Mark Smith and
Ian Haywood.
And, if you guys don't mind, goahead and take a couple minutes
to introduce yourselves to ourlearners and tell us a little
bit about your practice site andyour passion for the profession
.
And again, we're just we'regrateful to have both of you
joining us today.
Speaker 2 (01:10):
So 1000%, josh again.
Thank you again so much forhaving us.
First and foremost, it's trulyan honor to be back here a
second time on such a greatplatform, so thank you for the
invite as well.
Absolutely, my name is MarkSmith.
I'm a pharmacist currently atUAB Hospital in Birmingham,
alabama, where I practice on theinpatient setting and see
(01:34):
patients in our orthopedicssurgery department.
As well to being a pharmacistand in the hospital setting, I'm
also a group fitness instructorhave been for over three years
now and so fitness and pharmacysort of have this positive
relationship in my life rightnow, in addition to being a
(01:56):
certified diabetes care andeducation specialist, which I
have been for about five years.
So diabetes education, fitnessand pharmacy has been a crucial
part of my career thus far.
Speaker 1 (02:08):
Awesome, awesome.
Thanks, mark.
All right, ian.
Speaker 3 (02:11):
Hey there.
Thanks again, josh, for havingme again.
I really appreciate it.
We had a great time last time Iwas on here and I'm pretty sure
we're going to have anothergreat time this episode as well.
My name is Ian Haywood.
I'm actually the qualitycoordinator at Baptist Memorial
Hospital for the DiabetesSelf-Management Education and
Support Program here.
(02:31):
This program actually is alsoan elective rotation for the
PGY1 residents that come toBaptist Memorial Hospital here
in Memphis, tennessee.
So I guess you could say I'm abig educator and that's what I
really enjoy.
Also, in my free time I do alot of physical activity,
(02:54):
exercise, working out, running.
So that's always been a part ofmy life, so that, along with my
passion for diabetes care,that's kind of they all kind of
align and work together to kindof promote fitness and promote,
you know, better health for ourdiabetes patients.
So that's a little bit aboutwhat I do and I'm looking
(03:16):
forward to talking to you guysabout creatine.
Speaker 1 (03:20):
Yeah, awesome.
Thank you so much.
Thanks again for taking timeout of your busy schedules I
know it takes a lot and remindme the episode you all it was
when Jen was still hosting.
So remind me what episode thatwas Was it on diabetes?
Was it the?
Speaker 2 (03:34):
topic yeah, it was on diabetes.
It was the high intensityinterval training with CGM.
Speaker 1 (03:42):
Oh great, yeah, yeah, awesome, yeah, awesome, awesome
.
And then you both alsoparticipated in one of our
courses, in the um cgm course.
Speaker 3 (03:50):
Uh, right, that's right, that's right, yeah, yeah
great, yeah, so we've.
Speaker 1 (03:54):
We've um, partnered with you all several times and
super excited to have you againtoday.
So, um, again, it sounds like,with your background, you're
very poised to give us greatinformation on this topic today.
So I'm really excited to hearwhat you guys have to say.
So let's jump into the content.
So let's just kind of set thefoundation, remind us exactly
(04:15):
what creatine is.
How does it work in the body?
It's generally associated withathletic performance, those that
are heavily involved in the gym.
So just kind of give us afoundation review of that, if
you don't mind.
Speaker 2 (04:28):
Yeah, sure, you're 1000% right about that with the
fitness aspect of it.
So creatine, another from.
Verbiage like creatine versuscreatinine can often be
confusing at times.
So making sure that we saycreatine for the sake of our
discussion today, and I'll trymy best to keep it on the
(04:50):
straight and narrow as well.
But creatine essentially is anaturally occurring substance
that is synthesized in the liver, pancreas and kidneys from
specific amino acids and it'sone of the precursors that lead
to the production of ATPessentially, and so it's
predominantly stored in ourskeletal muscle about 95% and
(05:11):
then the other remainingpercentages is restored in some
body tissues as well as thebrain as well.
But the biggest thing withcreatine is how it's
phosphorylated and how it'sactivated under high, intense
energy demands.
So that's the popularity whenit comes to fitness, in that not
(05:34):
only do people that takecreatine on a regular basis
experience an increase in leanmuscle mass, they also
experience increases in energyand short bursts due to the
production of creatine duringthose moments.
So this is a this is asubstance that has been around
for a long time.
It's been extensively studiedand it's exciting to see its its
(05:58):
sort of reemergence in intopics that are in addition to
fitness in topics that are inaddition to fitness, such as
major depressive disorders, someneurodegenerative disorders,
and as well as some of thebenefits in our aging patient
population, as well as aprecursor to energy metabolism,
taking that ADP and convertingit to ATP, which, as we know
(06:19):
from one of our basic scienceclasses, the ATP, is the energy
powerhouse of the cell andresponsible for many, many
functions from an energystandpoint in our body, great,
great.
Speaker 1 (06:31):
That's a great foundational review.
I feel like I just had a goodlittle cliff notes.
Speaker 2 (06:35):
That's awesome.
Speaker 1 (06:36):
Some of that, you know, it's been many, many years
since I was in school, so someof that is just, you know, gone.
But thanks again, that's reallyhelpful.
I have to admit I forgot thatit was a naturally occurring
substance in our body.
So you know, I think thatthat's just again just a great
reminder and making sure thateverybody's on the same page as
(06:56):
we talk about it here.
So, you mentioned some of thoseexpanded roles beyond the
athletic performance perspective.
So let's go ahead and dig justa little bit into those.
We can continue to talk aboutthem as we go through.
But I heard you mentionsomething about neurological
disorders, aging what else?
Have we kind of seen an uptickwith creatine use in recent
(07:19):
years?
Speaker 2 (07:20):
Absolutely so.
In addition to the skeletal,muscle and fitness aspect that
we all know about, there's fourkey components.
I'll discuss too, and Ian willnicely do, the other two as well
, the first one being cognitivehealth.
And by cognitive health, whatstudies have shown over the
years is that there have beenimprovements in memory in
(07:42):
patients that take creatineproducts.
There's been improvements inattention time as well as
processing speed.
So basically, an improvement incognition in patients that are,
in individuals that utilizecreatine within their regimen
and from a mental healthstandpoint.
(08:04):
So we've talked about cognition.
From a mental health standpoint, we're getting into conditions
such as major depressivedisorder.
Studies, which is one of theprimary studies that led to our
(08:29):
conversation, was the use ofcreatine in patients that have
major depressive disorder, andso studies have shown that there
has been a improvement inpatients with major depressive
disorder that have creatine.
One of the biggest studies thatwe saw was cognitive behavioral
therapy, or CBT, combined withcreatine therapy was successful
in reducing major depressivedisorder in those patients,
versus CBT and the placebo byitself.
(08:52):
So we're starting to see, inaddition to the muscle component
, we're also seeing cognitionand mental health, and there are
several others as well, right,ian?
Speaker 3 (09:01):
Yeah, there's also a lot of research and evidence
going into showing that creatinehas like a neuroprotective
properties and improvements incognitive performance,
especially during stress orsleep deprivation, especially
with the older population.
A couple research articlesactually come to mind.
(09:23):
A couple research articlesactually come to mind One by Ray
Etel in about 2003.
He found improved workingmemory and intelligent task
performance in weeks two withfive grams of creatine in
patients that were vegetarians.
That was super interesting,actually.
And again there was anotherarticle from Avgarinos Etal in
(09:48):
2018.
He did like a meta analysisthat showed that significant
cognitive benefits, particularlyin short term memory and
reasoning, was found in thecreatine group as well.
So it's just been reallyinteresting to see we're so used
to seeing creatine just havingto deal with athletes being this
(10:09):
wave of research going in adifferent direction, other than
what we're most commonly see.
Speaker 1 (10:17):
When we're talking about supplementing for these
patients in some of thosestudies, because what I envision
or what I've seen creatine usedbefore, it's usually a powder
and it's mixed into it like adrink, right, like a
supplemental drink or whatever.
Is that the same format inwhich these patients were
receiving it or is it adifferent modality that they're
getting it?
Speaker 2 (10:36):
There's several studies that we saw.
We've seen the use of thepowder form.
We've also seen the use ofcreatine capsules as well.
Those have been the predominantforms and it's interesting that
you mentioned that and thatkind of, in case anyone asks.
You would rarely see creatinein a liquid form that you can
(10:58):
buy from the store.
That's because if it's left inthe water for an extended period
of time, it gets converted tocreatinine which is so that
interaction or that reactiontakes place, and so that's why,
like it comes in that powder orcapsule form, so that when it is
(11:18):
formulated it has to beingested, almost you know pretty
quickly, okay, okay,interesting.
Speaker 1 (11:26):
And I'm interested in the fact that there are
capsules because I'm a textureperson and I hate the grittiness
of I hate all of the powder.
I just I can't do it.
Everybody's always like justslam it and it just oh, can't,
can't do it.
Speaker 3 (11:40):
There are different formulations, though there's
some gummies.
Speaker 1 (11:43):
Okay interesting.
Capsules powder.
Yeah, okay, so it doesn't haveto be the chalky aftertaste.
Speaker 2 (11:51):
No, you definitely don't have to go to the extent
of.
We were listening to thispodcast on some medical
providers talking about creatineand they had like a round table
question.
It's like, how do you take yourcreatine?
And one of the providers saidhe just dry powders it, which
means that he just takes noabsolutely by itself.
Speaker 1 (12:12):
So phone mouth exactly yeah, I imagine like
those.
You remember those pixie stickswhen you were kids and you tear
yeah, I sticker, I bet.
Yet I just I can't imagine thattakes good potential marketing
idea actually.
Yeah, maybe, yeah, rip off thecreatine stick.
So yeah, okay, interesting, andit's really interesting that
(12:34):
we're seeing kind of a go in adifferent direction as far as
what it can be used for.
Obviously, our podcast here isfor pharmacists, so what's the
pharmacist's role in this?
What should we be doing?
Should we be ready to answerquestions about it?
Is there certain education weshould be providing?
Should we be pointing tocertain versions of the
(12:55):
supplement as opposed to others?
Just what are some of thethings that pharmacists can do
in this space that can reallymake sure that, I guess, the
awareness is there and alsoproper education and use?
Speaker 2 (13:08):
Sure, I think one of the most important things is
that pharmacists, as youmentioned, being on the front
lines for the majority of thetime.
It's important that we bridgethe gap that exists between the
research and the real-worldimplementation.
So being that connector isgoing to be extremely crucial,
and that's partly done byeducating the patient on these
(13:29):
type of products and so gettingthe most recent evidence, and
one of the things that standsout the most is identifying the
appropriate candidates, and sothat's pharmacists can play a
huge role in that.
Some examples just include theolder population that are at
risk of fall and have a lot ofthat dietary creatine that you
(13:50):
would otherwise miss as avegetarian when missing out on
(14:11):
those types of products, andthen also individuals with
cognitive impairment.
We've mentioned that creatinehas been studied in cognitive
impairment, but there justhasn't been much funding behind
studies that can say, hey,creatine really, really works.
And the reason that it hasn'tbeen much funding is because
(14:33):
it's been around for so longthat, you know, no one is like
really rushing to like fund astudy that that can lead or draw
those conclusions.
Not a new or novel product.
Not a new or novel product,exactly.
So to kind of say that I thinkthat we can play a huge role as
(14:54):
pharmacists in sort ofidentifying patients that might
be a potential candidate forcreatine therapy.
Speaker 1 (15:00):
Yeah, and Mark, I really love the connection you
made there and you alluded to itearlier and I didn't make the
full connection until youreiterated it but with the
reason for its use in vegetarian, because you mentioned that
that was part of the study andso now that makes sense because
you're right.
Either they're missing out onsome of those building blocks of
(15:21):
the protein components and sopotentially less muscle mass and
whatnot.
So that's interesting to me forsure.
But as far as like dosing goes,do we see each of those things?
Are they the same similar usualsupplemental dose?
Or is it in order to getcognitive behavioral changes you
have to be like five times whatthe bottle recommends?
(15:42):
Or whatever Like are we?
Does that make?
Speaker 3 (15:44):
sense.
So, to be honest, the dosesthat were researched and that's
what we kind of need more of.
We need the more research withthe higher doses.
Right now, the doses that havebeen commonly researched are the
three to five grams, orpotentially even up to 10 grams,
or they may have even given theloading dose of, you know, 20
(16:07):
grams for the first five toseven days and then dropping it
down to the maintenance dose,which is about five grams for
the duration of the trial.
So technically, there has beenstudies where if the dose is
increased, it has shown toactually have more creatinine
that's actually crossed theblood-brain barrier and that is
(16:31):
actually shown to have an effecton the results of a study in
terms of depression.
But again, this is all still newto us and there still hasn't
been a lot of enough studies forthese dosings to kind of be
Fleshed out completely.
Yeah, completely that's a goodquestion you ask and that's kind
(16:51):
of what we've noticed with theresearch.
There's just kind of been alittle bit of variation, but
they stay.
Nobody's really pushed out tothe extreme of when beyond like
20 grams of no, and majority ofthem have just been about five
or five and so okay, um, justbecause I think maybe even the
safety too there's.
Speaker 1 (17:11):
You know, still like you know, that's what I was
gonna ask, yeah, like around thesafety, because you think about
, you know, like some of yourvitamins that are wasted in in
the urine and it's like youcan't really overdose on some of
those.
But then you have thefat-soluble ones.
You know A, d, e and K that youcan.
So, like, where does creatinefall in that?
Like, is it one of those thingswhere you can get too much, or
(17:31):
is it one of those things whereit's like, eh, it'll just waste
away if you don't use it, it'sfine.
Speaker 2 (17:36):
So one thing that we know for and we might end up
addressing this again later onin the podcast, but one thing we
know for sure is that inhealthy individuals by healthy I
mean patients that do not haveestablished CKD or chronic
kidney disease creatine isrelatively safe.
(17:57):
Creatine is very, very safe andso, in terms of just
elimination, there's nopotential risk for an otherwise
healthy individual to go up tothat, like Ian mentioned, 20
gram amount without beingworried about oh my God,
something's bad going to happento me.
Speaker 1 (18:14):
Right, my kidneys are going to shut down.
I can't filter it, right.
Speaker 2 (18:18):
Outside of that increased serum creatinine that
will likely reflect on your labsor something like that, but it
won't be clinically significantin an otherwise healthy patient
because if they stop taking itit's going to go back down to
that baseline level.
The example that it was like0.9 starting out and then you go
(18:40):
on creatine therapy for acouple of months or so and then
you go get labs drawn again andit's like 1.1.
You can dc that creatine andyou'll notice that it'll go back
down.
So it's not that.
So that increase doesn't relateor correlate to being
clinically significant in termsof a person needing to be
worried about CKD.
(19:01):
Or it's not damaging the kidneysto where you're leading.
It's not damaging, or anythinglike that.
Now, on the other hand, there'sthe other side of that, in that
individuals that do haveestablished CKD.
Everything that we've comeacross so far is talk to your
nephrologist.
Sure, sure, find out what.
Find out what your nephrologistsays, because there hasn't been
(19:23):
there hasn't been much push inadvocating for the use of
creatine in patients that dohave established CKD
no-transcript makes sense, okay.
Speaker 3 (19:45):
And then, josh, the dehydration aspect too.
Right, because what you knowcreatinine really does, it's
actually pushing all your fluidinto your cells.
So as it's pushing all yourfluid into your cells, your
body's actually can becomedehydrated, so that with
somebody having CKD and alreadyyou're having an imbalance and
them having to balance fluidsand waste and everything, and
(20:09):
then becoming super dehydrated,it could lead to possible issues
.
So that's kind of where I wouldjust be kind of cautious for
patients that have any AKI orCKD issues or anything like that
.
Speaker 1 (20:21):
Okay, yeah, that's great to know when we're talking
about using it in theneurological for patients that
have any AKI or CKD issues oranything like that.
Okay, yeah, that's great toknow.
When we're talking about usingit in the neurological sense or
for athletic performance andthen also aging and whatnot.
Are there any othercontraindications considerations
?
Does it interact withprescription medications that
patients might be on?
Is there something thatpharmacists?
Obviously that's one of the keythings that we do as
(20:43):
pharmacists, so is thatsomething we should be looking
out for as well?
Speaker 2 (20:48):
Yeah, the biggest thing that we came across with
regards to medication inconjunction with creatine are
NSAIDs, and so the thing thatwe've come across is that you
know so.
Ibuprofen the thing that we'vecome across is that you know so.
(21:08):
Ibuprofen, naproxen, aleveanything that's considered an
NSAID.
Didn't really see about liketopical NSAIDs so that I can't
make a statement on that, but atleast we know for sure oral
NSAIDs is going to be like oneof those things that you want to
watch out for in terms of drugtherapy in combined with
creatine, because of the waythat the NSAIDs are metabolized.
They're.
Speaker 1 (21:30):
Yeah, that makes sense, and so I'm assuming it
would be constant use, everydayuse of NSAIDs as opposed to.
I have a headache and I'mtaking two ibuprofen kind of
thing.
Speaker 3 (21:41):
And other like net for toxic agents, sure, sure.
Speaker 1 (21:45):
Right, right, which that just makes logical sense if
you think about it.
So yeah, okay, that's yeah.
So we've talked a little bitabout the broader use of it, the
benefits of it beyond justsports performance.
I guess one thing I want totouch on, and maybe we haven't
touched on it enough, but I,when we say it's for our aging
patients, are we talking aboutthat just in general of the
(22:07):
neurological benefits, or arethere other benefits that it's
doing?
Actually, you did mention thatit's increasing muscle mass,
because a lot of those patientswe see that dwindle or maybe
they're not as active and sotherefore that's kind of going
down.
So is there any other benefitsfor the aging population that we
can kind of highlight?
Speaker 3 (22:24):
Well, there's been some growing interest in a lot
of the research in terms of thepotential for creatine to have
some anti-inflammatory andosteoprotective effects.
So they think there was a trialwith creatine, with or without
resistance training, and thatkind of led to an increase in
lean mass, an increase in musclestrength and also reduce the
(22:48):
risk of falls in older adults.
And so this kind of isimportant because if you're
hopefully I won't have thisissue, but I'm pretty sure, like
a lot of grandparents andgrandmothers, it's very
difficult for them to just comeout, just to get off the toilet,
sure, just to get up out of thechair.
So there's actually been like atrial.
(23:09):
There was a trial back in 2017by Chilibe Etal.
He did like a meta-analysisshowing that creatine and
resistance training improvedlean body mass and significantly
increased leg muscle strengthin older adults.
And this is huge because thisactually can help directly
correlate to fall riskmitigation, and so there's huge
(23:34):
benefits just on taking creatineas you get older, especially if
somebody is going to continueto do some resistance training,
which kind of leads me me beinga diabetes educator.
I'm always promoting that for mypatient.
It's not just you doing cardioIf I have a 65-year-old,
67-year-old patient in here.
I'm always telling them to dosome resistance training with
(23:58):
resistance bands or using theirown body weight and stuff like
that.
And so me now like, after kindof doing a little bit more
research about creatine, this issomething that kind of makes me
want to.
You know, you know, tell themto potentially.
Speaker 1 (24:13):
Yeah, that's great, I've got just a few minutes left
.
So one of the things I wantedto be sure I touched on and I'll
admit to our listeners that Ihad shared some of the public
misconceptions and our littletalk before we actually got on
to record because I feel like Ihave for some reason thought
that it was one of those bannedsubstances.
You know, like you can't takeit at the Olympics or it's, it's
(24:33):
.
You know it's a faux pas if yousee someone using creatine in
the gym or whatever.
So clearly that's not the case.
But you all had someinteresting information to share
with me in the beginning.
Um, so if you want to just kindof talk to that a little bit
too, let's clear up themisconceptions that creatine as
a supplement is a bad thing, orit's only used by gym nerds and
(24:54):
it can be overused and whatever.
So if you want to kind of justtalk to that misconception
really quick, yeah, I canmention a couple of things.
Speaker 2 (25:01):
I think it kind of ties back into the going back to
the kidneys again if I could.
I think it kind of ties backinto the going back to the
kidneys again if I could.
The misconception one of thebiggest misconceptions is that a
person starts taking creatine.
It's going to potentially ruinmy kidneys and in an otherwise
healthy individual that is notthe case.
It is not going to cause anydamage to your kidneys.
(25:21):
Again, however, a person thathas established CKD, that type
of dialogue, that type ofinteraction, conversation needs
to be had with the nephrologist.
Another thing too is and thiskind of talks about the
underutilization of creatine inpractice.
So we have studies that haveshown, as Ian mentioned, about
(25:46):
the benefits of creatine in theelderly population that do have
the lean muscle mass, and theevidence is solid, like the
evidence is solid with the agingpopulation with lean muscle
mass.
It's solid in the area of TBIor traumatic brain injury and
concussion, and it's becomingmore and more solid with major
(26:10):
depressive disorder.
But what hasn't happened as aresult of that is the increased
use of that by providers, and wecan go back and forth as to why
that is, but one of the.
I think we kind of hit the headon one of them being like since
it's not funded, it's itdoesn't get a lot of spotlight,
(26:30):
so it doesn't get a lot ofattention, and so we don't see
that, we don't see the researchthat that shows benefits, great
benefits and a great productthat's been around for a long
time and it's relativelyinexpensive.
We don't see that equality ofuse in those patients as a
result of that.
So I mean, those are two bigmisconceptions that stood out to
(26:52):
me with regards to that.
Speaker 1 (26:53):
Yeah, and then Ian, you had touched on earlier
because I'd said, you know, isit one of those banned
substances or is it, you know,the performance enhancer, like
it's not in the same categorysteroid?
But you had mentioned howsometimes where the confusion
comes in is that creatine ispossibly found in some of those
banned products, faux products,and so that maybe is where some
(27:16):
of the misconception lies, isthat while it's an ingredient in
there, it is not the culprit,like it's correct, and the
product is banned.
Speaker 3 (27:24):
so yeah, and you can just get it by yourself, right?
You can just get actuallycreatine just all culprit, like
it's not the reason the productis banned.
So yeah, and you can just getit by yourself, right, you can
just get actually creating justall by itself in its pure form,
right?
Speaker 1 (27:32):
and that is completely acceptable.
There's no, you know, no one'sgonna look at you odd in the gym
if you have that or if you'reusing that for something in your
house or anything.
It's so cool.
And also I mentioned earlier Iused the term gym nerds and I
mean that with full love andsupport.
I don't mean that as a negativething.
Speaker 3 (27:51):
We're going to fly you down here for a quick gym
action one day, absolutely.
Speaker 1 (27:58):
Well, we are out of time.
So I think we've had a greatdiscussion on just the fact that
this should be, and is,somewhat being brought back into
the forefront and making surethat we're aware, as pharmacists
, that we may have patientsasking about it and maybe it's
something that we think aboutfor those individuals that are
vegetarians or low muscle massor aging population that do have
(28:21):
difficulties with quickmovement and whatnot because of
low muscle mass or because ofosteoporosis or whatnot.
So we see where we can bemaking some recommendations to
our patients, and that's great.
One thing I always like to kindof summarize at the end is what
do you think are the gamechangers here?
So what exactly?
What's our take-home point forour listeners from today's
(28:42):
episode?
Speaker 3 (28:49):
point for our listeners.
From today's episode, One ofthe take home points is
basically that well, one thing Iwant to kind of sneak in here
really quick is that I thinkright now in our society there's
a big push on GLPs, and one ofthe big things with GLPs is that
you can lose up to about 30 to40% of your lean muscle, and so
having a natural substance thatwe already have in our body that
(29:12):
creatine itself shown studiesthat can actually increase lean
muscle mass, increase yourmuscle strength when you're
taking these GLPs, that can besomething that people maybe we
should kind of look into alittle bit more and maybe get
some more research with thatcombination.
I think it just makes sense,but that's just kind of like
(29:37):
another podcast for another day,kind of.
Speaker 1 (29:40):
Yeah, no, I'm glad you threw that in because I
mean're right.
We have so many patients um areon glps and we've had so many
sessions and podcasts anddiscussions and and ces on it
and you know, it just is, Idon't see it going away anytime
soon, and so I feel like thatthat's something that we're
going to continue to be facedwith as pharmacists is making
(30:00):
sure that those patients aresupported properly, and I I love
this idea.
Maybe there's somebody outthere who is is gonna fund the
research for you, ian, and canget that off the ground, so yeah
.
Speaker 3 (30:11):
But a clinical pearl for me would be just, if you
guys do decide to get oncreatine, to make sure you
hydrate yourself, stay hydrated.
Creatine, remember it's takinga lot of your fluid and pushing
it into your muscle cells so bythat sense you can become very
dehydrated.
So make sure you're hydrated.
And if you have any GIdiscomfort with the creatine,
(30:37):
try the micronized version ofcreatine monohydrate it's called
micronized and that should helpalleviate some of the GI
symptoms.
If you do have some with Lortecand creatine Awesome.
Speaker 1 (30:49):
Another great tip for pharmacists as they're talking
with patients.
Mark, what's your summary?
Speaker 2 (30:54):
Yeah, my biggest call to action, in addition to
everything that we've talkedabout today and the information
that we've kind of shared andexchanged, is for our
pharmacists.
That are, whether you're inretail and the retail community
setting, or if you're aninpatient, see if you can
identify a patient or two, youknow, every once in a while it
(31:15):
doesn't have to be like aproactive type thing, like you
don't have to go and say, hey,I'm going to go and put on my
pharmacist cape and I'm going toput everybody on creatine and
see if they meet the criteria.
This is one of these things thatcan kind of happen organically
and I feel like, because it'sbeen established for so long and
it's been around for so long,the safety net that you have as
a practitioner can lead to moreconfidence.
(31:37):
Because who's to say that?
An elderly patient that's inhis or her 60s or 70s, that
otherwise hasn't been familiarwith creatine, and you just so
happen to see that they don'thave CKD and that you've noticed
that they've lost some musclemass recently, like it's just
like little small things likethat, and you say, hey, mr and
Mrs, so-and-so, I think thatmaybe you could look into this
(32:00):
over-the-counter product thatyou don't have to have a
prescription for, that isrelatively inexpensive.
Maybe you might want to trylooking into this right here or
at least see what your primarycare provider says about this.
And if they want to have aconversation, I'll be more than
willing to have thatconversation with them.
That's how we get that, that'show we bridge the gap.
That's how we bridge the gap,and so that will be my call to
(32:21):
action for the pharmacists thatare either in the community
setting or in the hospitalsetting, or whichever setting
you're in.
Speaker 1 (32:27):
Yeah, I love that.
I love the fact of you know it'snot a mission to put everybody
on creatine, or to find everysingle patient that's eligible
or whatever, but but yeah, Ithink you know, just being more
aware that this is an option,that this is not a faux pas,
it's not a negative thing, it isrelatively safe and effective
and as long as you're utilizingit appropriately, then I think
(32:50):
it can really benefit patients.
So, yeah, this has been supergreat.
Thank you so much, mark and IanReally appreciate you giving of
your time again and sharingyour expertise and, being gym
nerds, we appreciate that.
Speaker 3 (33:03):
As always.
Thank you, josh, I appreciateyou.
Speaker 1 (33:07):
Thanks, josh, thanks.
So if you're a CE plansubscriber, be sure to claim
your CE credit for this episodeof Game Changers by logging in
at CEimpactcom.
You.
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.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.