Episode 189: All you ever wanted to now about creatine supplementation and exercise with Dr. Creatine aka Dr. Scott Forbes

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[00:00:00] Dr Mike T Nelson: .

Welcome back to the Flex Diet Podcast. I’m your host, Dr. Mike T. Nelson, and today on the podcast I’ve got my good buddy, Dr. Creatine, Dr. Scott Forbes, and as you can guess, we are talking all about creatine, the sports supplement. What are some realistic effects you can expect from. all the details about the different forms of creatine.

Basic rundown of what exactly is creatine in case you’ve been living under a rock and never heard of it before. What is the latest data say? Dr. Scott Forbes has published a lot of studies on creatine. I got to hang out with him again at the ISSN Conference this past June, which was. and you can see all your uber nerdy friends at the ISS N International Society of Sports Nutrition Conference.

Coming up again this June, I will be there again in Florida. I’ll be doing a talk for ISS N, and then I’ll also be there coming up for the neuro sports. Very soon, mid-February, so you can see me there. Also, this podcast today is brought to you by the Physiologic Flexibility Certification. It will open again in mid early March, 2023, but you can still get on the wait list for all the great information.

It’s at physiologicflexibility.com. If you’re looking for a way to be. Robust, resilient, anti-fragile, looking for true longevity gains and advanced recovery. I know it’s a mouthful. Check out the Phys Flex Cert. What we’re looking at in it is a concept called adaptive homeostasis. So these other things that you can do.

Once your exercise and nutrition is pretty good, should you be doing biohacking crazy lights or, I dunno, there’s all sorts of things you could be doing. In the cert, we divide it up into temperature. Your body has to maintain your temperature around 98.6. It’s actually 97.7, but you can do things like I just did this morning cold water immersion, or you can do sauna.

Those are both a good things for your physiology. You’re training your body to be more robust in the area of temperature. And temperature is one of those homeostatic controls that we have to hold constant. The other main areas are changes in pH. This could be from some breathing techniques high intensity interval training.

We also talk about the regulation of carbon dioxide and oxygen via exercise, training, breathing techniques. And the last component is your fuel systems. In the Flex Diet cert, we talk about metabolic flexibility, and in this cert we expanded out to extreme use of carbohydrates, what we look at for carbohydrate loading, some supplements that may help with.

and then also on the way other end of the spectrum the pros and cons of a ketogenic diet and how they might be useful. So all that is in the physiologic flexibility certification. Go to physiologicflexibility.com to get on the wait list and the newsletter. So here we go with Dr. Scott Forbes talking all about the sports supplement, creatine for health and perform.

[00:03:54] Dr Mike T Nelson: Welcome back to the Flex Diet Podcast. And I’m here with Mr. Actually, Dr. Creatine Dr. Scott Forbes. Thank you so much for being here.

[00:04:03] Dr Scott Forbes: Happy to be here. Anytime I get to talk about creatine, I get really

[00:04:07] Dr Mike T Nelson: excited. Yeah, that’s good. And you, that’s excited for a Canadian that’s saying a whole lot

[00:04:14] Dr Scott Forbes: Yeah,

[00:04:14] Dr Mike T Nelson: that’s true. That’s true. . I feel like every time I see Stu Phillips, I give him a bad time about his Canadian jokes and stuff. So

[00:04:23] Dr Scott Forbes: Yeah, they’re, it’s, they’re pretty bad and yeah I’m the same way as

[00:04:26] Dr Mike T Nelson: well. Yeah. He had something the other day about in Canada, you name your snow shovels and he had his three examples, which I thought was pretty funny.

[00:04:33] Dr Scott Forbes: Yeah. Although if you watched every Canadian watched this game last night, it was the world juniors and Canada was playing the US oh, okay. I’ll let you, I’ll let you look. I’ll let you look at the score. But yeah, it was pretty exciting.

[00:04:45] Dr Mike T Nelson: Was it? Okay. Oh, and I am even such an idiot. I have to ask what sport that’s.

It’s hockey.

[00:04:53] Dr Scott Forbes: Hockey. Oh, I didn’t know I had to, I didn’t know I had to say the

[00:04:56] Dr Mike T Nelson: sport, but, okay. Yeah, so I should have

[00:04:59] Dr Scott Forbes: guessed it was actually I’ll tell you a little bit about the game. Yeah. Like the US was actually the better team out there. But unfortunately the, they had two goals that were called back because of goalie interference.

Oh geez. One was like a legitimate probably goal that they should have called back. But the other one was like, there I didn’t think it was gonna be called back at all. And then it was, and those are pretty much the turning points in the game oh, Canada and the game? Oh yeah, it was the semi-finals at the World Juniors for hockey.

So Canada’s gonna go to the the gold medal game I guess. US will be playing for bronze, which I assume they’ll win cuz they’re super good team. But Yeah, so that was, it was pretty exciting. But I think the rafts played a major role in the out outcome of that

[00:05:45] Dr Mike T Nelson: game. Oh, that’s a bummer.

I know hockey is huge here in Minnesota and also in Canada, and my good buddy Cal Deets has helped with the women’s hockey team for quite a while and helped with some of the coaching and the Olympics this past year. So I get to expose to a fair amount of hockey training, which is always fascinating.

Yeah, absolutely. Yeah. Thank you for being on here. I really appreciate it. And how did you get interested in creatine? Most of our listeners now are familiar with the basics of creatine, which we’ll cover real briefly, but how did you end up studying creatine out of all the things to study?

[00:06:23] Dr Scott Forbes: Yeah, so I was fortunate when I was doing my master’s degree at with my supervisor. His name is Bill Chibe, and he’s a fairly big creatine researcher. In Canada at the University of Saskatchewan. And he actually had a PhD student that graduated and his name was Dr. Darren Cando. Yeah. So Dr.

Darren Cando was working at a different institution and he got funding to run a couple research sport nutrition research studies and one involved creatine. And so through his old supervisor, Phil Eck, he got introduced to me to help run some of these studies. And so that’s was my first introduction into creatine, was helping Darren Cank run some of his research and look at creatine supplementation.

And basically from there I got interested in amino acids, protein supplementation, and I did a PhD looking at L Arginine. And arginine is actually one of the amino acids involved in the building of creatine or the synthesis of creatine. So I looked at l arginine supplementation, but really creatine has been one of those supplements that has been shown to be beneficial in a variety of different situations.

And I, I think just through that, I get really excited with creatine because research we like to have significant benefits and show some positive findings. And it seems like Creatine’s just been one of those supplements that has been able

[00:07:56] Dr Mike T Nelson: to do that. And you did not find much on l Janine. And that was for listeners, that was a huge thing back, oh, maybe what, five, six years ago and it’s faded away.

It was supposed to be a nitric oxide precursor, and it’s probably been replaced with, L Citraline or Citraline malate now, which that whole research you can discuss later. It’s probably chronically underdosed, but. No, no significant findings with L Arginine or do you think it serves any role that might be beneficial?

[00:08:25] Dr Scott Forbes: Yeah, so my particular research, we found no benefit of l arginine supplementation. So we looked at markers of nitric oxide and we found that basically even a very high dose of L arginine did not increase nitric oxide in people that were trained. So if you were aerobically trained or resistance trained basically that pump that everyone thinks that they’re getting from taking those l arginine supplementation supplements is not because of the increase in nitric oxide.

It’s probably just a placebo effect and they go hard in the gym and they get increased blood flow. Vasodilation from the exercise and they think it’s because of the supplement. But the supplement actually has no benefit to enhance any kind of adaptations or increase nitric oxide.

[00:09:17] Dr Mike T Nelson: And what kind of dose did you use?

You said you used a large dose.

[00:09:20] Dr Scott Forbes: Yeah, so we started out, my first day was actually looking at a dose response study with L Arginine. So we used it based off of body weight. So we used point, the low dose was 0.075 seven five grams per kilogram of body weight per per day. And then the high dose was 0.15 grams per kilogram of body weight or body mass.

And so if you put that into absolute terms it’s basically about if you’re a hundred kilograms, then it’d be like 7.5 grams of L arginine. Yeah, cool. Or 15 grams of l arginine. Oof. And I actually tried, personally, I tr there was one study that looked at taking 20 grams of L arginine in a single setting.

So me, my supervisor and actually my wife tried to consume that dose of L arginine. And let’s just say it’s not advis, , I would not advise taking that dose of L arginine. You might have some gastrointestinal distress. So the high dose that we tried in the study was a very high dose. And we actually found taking the lower dose of creatine can increase dose of L arginine name.

[00:10:33] Dr Mike T Nelson: Say that again? You broke up a little bit. You said a lower dose of creatine can,

[00:10:37] Dr Scott Forbes: sorry. The I meant to say a lower dose of arginine. Okay. increased the amount of. Arginine within the blood to the same degree as the higher

[00:10:48] Dr Mike T Nelson: dose. Really? Huh. Interesting. Yeah. So do you think there’s some data to show that arginine, high doses by itself don’t really do a whole lot, but maybe you should add arginine to creatine?

I haven’t seen any supportive data on that, so I, that’s why I’m curious.

[00:11:08] Dr Scott Forbes: Yeah. I don’t think it’s necessary to add creatinine. Yeah, to me, arginine was not an effective supplement. But yeah, there’s there’s limited data in that area to look at that. Although we actually, we did one study, we looked at this product called En Oex Explode.

Yeah. Which is, yeah, exactly. Yeah. And we found some benefits to enhance. Upper body muscular endurance and repeated windgate performance. And we compared it to creatine alone. So perhaps combining two ingredients together might be a further benefit, but I think it’s pretty limited and yeah.

We need more research in that area for sure.

[00:11:49] Dr Mike T Nelson: And I think IO explode also has caffeine in it. So do you think the effect of caffeine by itself may account for some of those

[00:11:56] Dr Scott Forbes: changes? Yeah, absolutely. Yeah, there’s a, there’s about 20 different ingredients in the, those particular supple supplements, so it’s hard to tease out, is it a synergistic effect of all those things or which ingredients is really causing the effect.

[00:12:10] Dr Mike T Nelson: Yeah. A little tip for people looking at research, comparing pre-workouts. Like a lot of times they’ll compare it to a placebo, which maybe, or just water or nothing, and. Yeah, on one side you could argue, okay, it’s a double blind, randomized, placebo controlled trial. But, I’d like to see it compared against what we have as a known active.

So if you compare it to a standardization of say, caffeine amount and then maybe a placebo, right? So like a three arm trial, most of the pre-workout products don’t fare very well. So I think a lot of times when people are paying for research on a pre-workout, they’re like we’ll just compare it to a placebo cause that’s scientifically valid.

And it’s it is. But if you have, 350 megs of caffeine in there compared to water or just, flavored water or something like that, it’s what do you gonna happen? Yeah,

[00:13:02] Dr Scott Forbes: absolutely. And I think that’s maybe a limitation of some of the creatine research is people are gonna take a supplement and they might choose creatine or they might choose protein, for example.

And I think most of the research. With creatinine uses the placebo, maltodextrin, or sugar . But is that really a fair comparison? Most people are probably gonna take protein or they might take the combination of protein and creatin as well. So there is some research that is compared that and showing that taking creatine and protein combined is actually a further benefit compared to protein alone.

But yeah, when you look at the research, you need to think what the placebo actually is and is that a fair comparison? And yeah, that’s one thing that I think is often overlooked in the creatin research for

[00:13:49] Dr Mike T Nelson: sure. Yeah. And that’s, I wouldn’t say it’s a known issue, but even with some of the fish oil research, right?

It’s do you compare it to placebo pills? Do you compare it to the same amount of an oil? What oil do you use? Do you have olive oil, which may have other potential benefits? Do you use corn oil? Which may have potentially. Negative benefits, even though the amount you’re consuming is, super tiny.

And you look at psychedelic research, it’s like a lot of times they’ll use to naive subjects, high dose niacin, cuz they can’t sometimes maybe not tell the difference. But those two things feel dramatically different. So if you have something that does produce a different sensation, how do you sometimes account for that when you’re trying to compare it to a placebo?

So I, is there any thoughts about with creatine, would you ever do something crazy like compared to beta alanine or something, even though they’re not the same supplement, they’re both supposed to be kind a orogenic aids or things that increase performance? Or is that just a stupid design because they’re different mechanisms and they’re not even really related to each other,

[00:14:57] Dr Scott Forbes: yeah that’s a great question. And I don’t know the best answer for that. But yeah, I think something that’s similar, like maybe essential amino acids or protein and comparing it to creatine or combining creatine on top of those supplements could be, can be a great kind of placebo.

But yeah, maybe just comparing it to sugar or nothing is maybe not the best. And yeah, something that you need to be aware of definitely. When you read that research.

[00:15:25] Dr Mike T Nelson: And for people who might be new to creatine, do you wanna give us just a creatine kind of 1 0 1 in a few minutes so that the people are all up to speed?

Cuz I think there’s enough myth circulating around by creatine by now that people have heard of it, but I would be hard pressed if what they heard is actually correct, .

[00:15:46] Dr Scott Forbes: Yeah, absolutely. So creatine is actually made up. Of re amino acids, so arginine, glycine, and methyine. So your body can synthesize creatine primarily within the liver and pancreas, but it could also synthesize creatine in the brain as well, which is pretty cool.

So your body can put these three amino acids together or you can get ’em from food sources as well. So mostly red meats, so like beef or seafood as well. So things like salmon or heron have a high concentration of creatine within them. So you can get it from the diet or of course you can go to your local supplement store and buy commercially available creatine supplements as well.

And so those are the three ways that you can get creatine, either through diet, through the food, through a supplement, or your body can create creatine. And then once your body creates creatine, about 95% of it is stored within the muscle. And once it’s in the muscle, about two thirds of that gets converted into phospho, creatine and fossils.

Creatine can be broken down very rapidly into a T p, which is the energy currency within the muscle. So anytime you’re doing really intense exercise, lifting weights or running upstairs you’re gonna be utilizing that particular energy system. So one of the kind of benefits, if you supplement with creatine, you can get more creatine within your muscle.

So the average person gets about 20% increase in the amount of creatine within their muscle following supplementation, and then they can basically do a little bit more exercise so they can increase their training volume and train harder, and basically get bigger and stronger muscles over time.

[00:17:34] Dr Mike T Nelson: Awesome. And for listeners who are listening, like Creatine’s been around for quite a while. The first time I used it was God, probably back in the mid, that’s how old I am, mid nineties. I think. I was it was doing my master’s at Michigan Tech and they had a separate group there, which is interesting.

They purchased one of the rooms underneath one of the residential areas and converted it into a quote unquote private gym. So they had a club there where you could pay like $30 a quarter, you could go down to the gym and train whatever you wanted. And what they also did, which was of cool, is.

They got a hold of the distributor for a lot of supplements and said, Hey, we have a club. Do you mind if we resell your supplements? And so they got ’em directly from the distributor and they resell them for only like 10%, profit. So you got basically supplements at almost cost, which for a poor college student, it’s amazing.

Cuz when creating came out it wasn’t crazy expensive by that point, but it wasn’t dirt cheap like it is now. And so when I first started taking that, I was like, huh, this actually made a pretty big difference. But also at the time I didn’t eat any red meat. I probably didn’t have enough protein.

I was a vegan for a couple weeks and was basically a vegetarian. So I noticed that it made a pretty big difference. I think the research would support that. If you’re someone who doesn’t consume a lot of the foods that creating is found in, you would expect a greater effect in those groups such as potentially vegans or vegetarians, depending upon what diet they’re following.

Yeah,

[00:19:00] Dr Scott Forbes: absolutely. So we know that at least the muscle level vegetarians or vegans have lower amount of creatine within their muscle. At the brain level, it’s actually very, but at the muscle level, we know that vegans or vegetarians that supplement with creatine have a greater response to creatine supplementation, so they get bigger and stronger muscles compared to omnivores, those that consume meat.

And this was shown one of the studies by Dr. Darren Cando, who I mentioned earlier, and Dr. Darren Burke were the, he was the lead author on that particular study, and that was shown, I believe in 2003. So there’s definitely some benefits for vegetarians or vegans to supplement with creatine.

And again, they have greater benefits compared to those that consume red meat or

[00:19:51] Dr Mike T Nelson: seafood. Awesome. And if someone were to consume, let’s say, just to keep it simple, like lean red meat, like how much red meat would, because you hear this argument all the time oh, just eat you don’t need supplements.

They’re not really worthwhile. They don’t really do anything. And there’s some truth to that. I Depending upon what you’re looking at. But how much, like how many pounds of like lean red meat would you need per day to get five grams of creatine? Like just a ballpark, if you have any idea.

Yeah.

[00:20:21] Dr Scott Forbes: So you’d have to eat about three pounds of beef to get about five grams of creatine about two and a half pounds of salmon to get five grams or just over a pound of. Wow. Those are maybe the three best food sources out there. And obviously that’s not a sustainable or a healthy thing to do.

But yeah that’s to achieve five grams of creatine. I’m not too sure you need five grams to sour over time because your body can synthesize its own creatine as well. And there has been studies looking at just taking three grams of creatine for 28 days, and that was sufficient to saturate your muscles with creatine.

So just taking a lower dose of creatine, maybe an effective strategy at least over time to yeah, saturate your muscles. . But yeah it’s very difficult to do it with food sources alone. And I think that’s why this supplement has been shown to be so effective in so many individuals is because yeah, basically to get sufficient amount of creatine in your diet is very challenging.

[00:21:24] Dr Mike T Nelson: So is Hering like a Canadian superfood?

It sounds like it should be like the herring board should be like all over this in

[00:21:33] Dr Scott Forbes: Canada. , yeah, I’m sure in Newfoundland or Nova Scotia. I’m sure they love pickled herring. I’ve also been to to the Netherlands as well, and that was Dallas. That’s big over, yeah. Yeah. So they’re probably doing quite well simply because the creatine in their diet.

[00:21:49] Dr Mike T Nelson: Nice, nice. And you talked about dosing. So the kind of recommendation I’ve given people, just for more for the sake of simp simplicity is. And just take five grams per day. Is that, would you say accurate, useful, too much, too little? Is there any harm going over, I know you just talked about a study showing three grams per day, may, may matter.

And then the second part to that, does the body size matter? If you’ve got a smaller female athlete that’s 120 pounds versus a, strong man competitor that’s at 300, does body size make a huge difference? Because there’s obviously gonna be a significantly amount of muscle mass difference between them.

Yeah, so that’s

[00:22:30] Dr Scott Forbes: a great question. So at the muscle level I think five grams per day is sufficient. A lot of the research that we do we give it based off of body weight, so we give 0.1 grams of creatine per kilogram of body weight per. Interesting like that. If you’re a hundred kilograms, then that’d be 10 grams of creatine.

Yeah. 50 kilograms, that’d be five grams of creatine. So it’s actually like a little bit higher than just five grams per day. But in, we use that theory that yeah, if you have a lot more muscle mass, you’re probably gonna have a greater turnover of creatine within your body and you have more muscle to take up more creatine.

So maybe you should dose with a slightly higher amount of creatine. There actually hasn’t been any studies to directly compare a relative dose to an absolute dose of creatine to see if that makes a difference. I ki I doubt it would make a huge difference over time, but in theory, and if you really wanna maximize some of the benefits and you’re a really big person that has a lot of muscle mass, or maybe you’re a really small person.

And perhaps you can try that relative dosing strategy.

[00:23:43] Dr Mike T Nelson: So for bigger, larger mammals, you would say maybe 10, maybe even 15 grams per day might be appropriate.

[00:23:49] Dr Scott Forbes: Yeah. And then that’s perfectly fine and safe to do and we actually know from a bone perspective, it looks like some of the some of the higher doses and that relative dosing strategy seems to be more effective to enhance some of the bone adaptations with creatine supplementation.

[00:24:06] Dr Mike T Nelson: Yeah, I’ve always wondered about that. If. As a generalization, but supplements that generally help muscle, they seem to help sometimes soft tissue and especially bone, right? So if you look at protein, and I know it’s hard to say cuz protein does so many beneficial things, but like back in the day, even around long enough to hear all the things about, oh, too much protein it’s gonna leach all the calcium from your bones and all these horrible things that’s gonna happen.

And now we’ve seen that like high protein appears to be beneficial for bone tissue. So you think there’s any connection between what’s good for muscle is probably good for bone also?

[00:24:44] Dr Scott Forbes: Absolutely. So we know that muscle is connected to tendons and bones. So if you stress your muscles, you’re gonna stress your bones as well.

And that could lead to bone adaptations over time. So improvements in bone strength, but there’s also some pretty cool cell culture studies. Where they showed that creatin increased osteoblast activity. So osteoblast are building bone tissue. Yeah. Are the bone forming cells? So creatine can have an indirect effect by having more mass and muscle strength, which stresses the bone.

But we also know that creatine can directly influence osteoblast activity as well.

[00:25:28] Dr Mike T Nelson: That’s super cool because the lab I was in adjacent to me when I was doing my PhD at the University of Minnesota they did a lot of bone research and so they were one of the first people years ago, not just to do dxa and look at like bone mineral density or B M D, they actually started taking computer scans using like CT and looking at the changes in the shape of the bones.

And that was super interesting because for a while everyone’s oh, we just look at the density. And then what is in these olderly kind of frail people, that their bone would actually start getting bigger in diameter. But the walls were starting to get really thin. So they’re looking at different ways of trying to quantify bone health, not just from, a simple metric, which goes back to, talking about creating an even bone formation, that the body is like so complex and also redundant, but yet operates on very simple principles, right?

It’s always gonna try to find a way to survive and it’s hey, if you’re not giving me the raw materials, maybe I’ll actually change the shape of the geometry of the bone to try to, support this load on it, on top of it. So I always find those discussions fascinating. Yeah,

[00:26:42] Dr Scott Forbes: absolutely.

And again, I’ve mentioned this guy a few times, Darren Cando. He is big into that research presently. Oh, interesting. They’ve done a couple 12 month studies and they’ve just finished a two year training study with and without creatine.

[00:26:57] Dr Mike T Nelson: Oh, that was my next question, .

[00:26:59] Dr Scott Forbes: Yeah. So over they had over 260 older adults and they didn’t find any change.

So the results are not published yet. But they presented it at a conference that I saw and they found no change in bone mineral density, but they found improvements in bone strength because they looked at some bone geometry markers as well with pq C t. Yeah. So yeah, so it’s really cool and interesting research.

So I, I think bone geometry is actually more important than than bone mineral density from a bone strength perspective. So I’m glad you mentioned that.

[00:27:35] Dr Mike T Nelson: And in that study, did they compare, one group got creating and one group didn’t, and they both did their normal strength training. Is that right?

[00:27:43] Dr Scott Forbes: Yeah, so I, I believe they trained three times a week for two years and one group study, man. Yeah, I know. And one group got creatine and one group did not. And yeah. Again, yeah, 260 older adults, so a massive clinical trial. And yeah they looked at bone geometry and bone strength and bone marrow density as well.

And so a really cool study. So hopefully that gets published relatively soon.

[00:28:10] Dr Mike T Nelson: Yeah. And one more question on that, which is more of a detail of which you may not know, is, was the, did the loading end up being equivalent between the groups or did the creatine group do more loading because of the creatine allowed ’em to do a few more reps, therefore their structure actually had a little bit more physical load on it because it was able to do more

[00:28:31] Dr Scott Forbes: loading.

Yeah. So I’m not too sure. Yeah, if they found a difference in training volume, But we’ve actually done several systematic reviews in looking at the studies in older adults looking at creatine combined with resistance training. And very interesting. Even though creatine enhances muscle mass and muscle strength, very few studies actually show a difference in training volume.

Really interesting. So that’s like the main mechanism that we always talk about, that if you take creatine, you can train a little bit more and do more reps and get better adaptations. But yeah, very few studies actually show a difference in, in training volume when they try to quantify it.

[00:29:09] Dr Mike T Nelson: So is your argument then that creatine would allow you to do perhaps a little bit more higher quality of work? So if I’m normally doing the old school, say de alarm, three sets of 10 that everybody does, I take creatine, I get fully loaded on creatine. Now I can do. Three sets of 11, 12, 13 reps. Like what is in practical terms, the effect size and then does that, like you were saying, transfer to the total volume of a session being better, which sounds like it might not.

[00:29:42] Dr Scott Forbes: Yeah, so the studies quantified by multiplying reps, by sets, by weight lifted. So if you and I think that’s a good way to quantify training volume. Yeah. And they found no difference no statistical difference between the two groups. So I think creatine can work through other mechanisms as well.

So it can increase IGF one, which is an anabolic hormone. It can prevent muscle breakdown. It could reduce inflammation, oxidative. It can enhance these myogenic regulatory factors and enhance satellite cells. So there’s a variety of other mechanisms that can enhance muscle growth and muscle adaptation over time besides just increasing phosphor creatine and training volume.

So I think it’s a combination of those two things that really lead to better adaptations over time. But there’s, from my knowledge, no one’s really looked at training volume with creatine supplementation and tried to really, combine all the studies in the literature and see if creatine can actually make you train more.

Even though that’s the cited mechanism most frequently.

[00:30:52] Dr Mike T Nelson: Yeah, and that’s always argument of studies like, I know Stu Phillips gets a lot of this shit too because he is oh, you guys just did this, label muscle protein, synthetic acute tracer, you study. This doesn’t translate to anything.

And to his credit, he is done many chronic studies looking at changes there too. But on one hand it is a fair criticism because acute stuff doesn’t always translate to chronic stuff. But I also feel like most people making that argument are just trying to poo somebody’s research and just assume that the researcher never thought of that question, which if anyone’s done chronic studies, knows how big of a pain in the ass and expensive they they are to do on top of it.

So yeah, absolutely. In terms of creatine, what is the acute effect, right? So I was using my little example of a three by 10. And then I go take creatine for five to 10 grams per day, let’s say for 30 days. It should be more than enough time to saturate my dosage. It’s hard to throw out the effect of adaptation because every time you do something, you’re gonna get a little bit better.

But what is the general effect size of creatine? What sort of benefit from a pure, I’m just going to the gym and I’m gonna count reps and maybe weight and volume should someone expect from it. Yeah. So

[00:32:10] Dr Scott Forbes: it’s a smaller effect than what most people assume. They assume that, creatine a, a steroid and they’re gonna have, it’s not a steroid.

Yeah, I know. Crazy. So yeah, they’re, they assume when they take this supplement, they’re just, Balloon up and just get super jacked. And if you can see me at all, you know that even though I’m a heavy creatine user, , I’m definitely not jacked by any means. So it’s definitely has a small effect. And one way to describe it is if you’re trying to make a cake, so you need a good foundation.

So things like sufficient protein in your diet, sufficient calories you need a good resistance training program, you need good sleep. Those are the foundations. And then the icing could be like nutrient timing. And then the sprinkles on top of the cake is essentially creatine, so it can make the cake a little bit better.

But it’s definitely a small effect. So it’s not gonna have this, profound effect and you’re gonna gain tons of muscle because of. Of creatine supplementation. So I think that’s important for listeners, even though there’s lots of studies to show benefits of creatine, it’s not gonna, make you Mr.

Olympia in one or two years. And that could also depend on several factors as well. Things like your fiber type distribution or how much creatine you get in your diet, whether you’re vegan or vegetarian can influence your responsiveness as well. But overall we’ve recently done a system systematic review looking at lean tissue mask gain with creatine supplementation.

And we found that the studies that supplemented with creatine gained a one kilogram more lean tissue compared to those on placebo. . So the placebo G is just sugar. So whether that’s a fair comparison or not, but those are what the studies have done. So you gained about a kilogram more lean tissue mask on creatine.

[00:34:09] Dr Mike T Nelson: And what was the length of that study? Was that like a shorter, like a four week type study? Just like loading versus placebo then? So

[00:34:16] Dr Scott Forbes: it was a systematic review. How was a review included? Yeah. 35 different studies. Some of them included resistance training. Some of them included like high intensity interval training.

Some of them had no exercises at all. And we found on the sub-analysis that you have to combine creatine with resistance training to get bigger muscles. . Yeah. Makes sense. You’re trying to get bigger muscles. Yeah. And you’re just sitting at home listening to this podcast. You’re not gonna get bigger muscles.

Dang it. So you actually have to go the gym and train.

[00:34:45] Dr Mike T Nelson: No, that’s my problem.

So I’ve often told people that I like the analogy about the sprinkles too, that cuz everyone wants to throw out like sports supplements, oh, they’re good or they’re bad, or like I said before, you just need to eat good food. It’s yeah, of course you need to eat good nutrition. No one’s saying you, you don’t.

However, we do have some supplements like creatine, caffeine, a few other things that have been shown to be efficacious. But I think people hear that and they go, oh I’m gonna gain like five pounds this month by taking creatine or protein powder or whatever. And the reality is that’s n not true.

I would say as a, and I don’t know if you’d agree with me, the supplements, we do have data to show that they’re effective. The best case scenarios, I would say there’s still easily single digit percentage beneficial, right? So if you look at some of the stuff on caffeine, if you dose high enough, you look at acute strength, eh, maybe get two, 4%, maybe 5% on the outside that’s really pushing it.

But if you’re deadlift is say, 400 and you can do 4% more of that’s pretty damn significant. But to someone who doesn’t train 4% doesn’t mean anything. And again, if you scale up to, Olympic competitors, 0.5% is frigging massive. So I think we always want to think about what is the context of which it’s applied.

And yes, the effect size are still relatively small, but depending on the context, that might be very real world significant for you. Or it may be completely, utterly meaningless too in terms of clinical practical value. Totally.

[00:36:26] Dr Scott Forbes: Yeah, I totally agree with that. So yeah, that’s really important for people to understand.

Yeah. Gaining one an extra kilogram of muscle mass could be huge from a clinical perspective. Yeah. From a prevention of diabetes or some of the studies that have related muscle mass to health, then that could be of great benefit, particularly in, in older adults that are trying to maintain function as they age and independence and things like that.

So I think yeah, creatine can definitely be really important in those situations.

[00:36:58] Dr Mike T Nelson: In the sub-analysis, in the review. I don’t think they did this if it’s the review I’m thinking of, but the negative bros would just say, oh, that’s just all water weight. That’s not actually lean tissue because if you add more water it, it’s gonna register as lean tissue because it’s not fat.

Do we have any data to look at how much of that is potentially water and we can talk about where that water might actually be stored. Yeah. So

[00:37:24] Dr Scott Forbes: that’s a great question for sure. And there was a recent study done out of Brazil. And Brad Schoenfeld was a coulter on that study. Oh, nice. They did an eight week training study and what they did was they looked at intracellular and extracellular and total body water.

. And they also looked at skeletal muscle mass gains as well. And what they found was that after eight weeks of training, there was an increase in skeletal muscle mass with creatine. So basically creatine helped you get bigger muscles, but they showed that the ratio of intracellular water to skeletal muscle mass actually remained, was the same at the end of the study compared to at the start of the study suggesting that creatine increased intracellular water, but it was to the same ratio as an increase in muscle mass. So I think a lot of that water retention.

occurs in turn the loading phase. But that’s actually just my speculation. We don’t have really good data on that. We need to do a study to look at, each week the changes in water content within the muscle and relate that to changes in muscle

[00:38:38] Dr Mike T Nelson: size. Oh, that, that’s fascinating cuz one of the complaints I hear from females not so much anymore, but especially a lot more 10 years ago was, oh, I don’t wanna load on creatine.

I’m just going to, get all bloated and I’m just gonna gain water and look horrible. And, weather was, psychosomatic or I have this theory that maybe there’s some bad creat and on the market for a period of time. I have no data to support any of that. But I did see for a period of time, probably 8, 9, 10 years ago or longer ago, Women who did use a high dose of creatine, at least looking at their pictures and their body weight, it did seem like something funny was going on again.

Could be, placebo driven too lately. I haven’t seen that really at all. I don’t know if you have any weird thoughts on that or .

[00:39:27] Dr Scott Forbes: Yeah, so I think we need to do a lot more research looking at males and female comparisons. But in that systematic review that included 35 studies, we also did a sub-analysis with just the studies looking at females.

Oh, nice. And we found no significant difference between creatine and placebo for increasing lean tissue mass in, in females. But if you look at the size differences between those two groups, it was about they gained about a half kilogram more lean tissue mass on creatine compared to placebo.

So it still worked. In females. But it wasn’t statistically different. So we need to be very cautious with that because there is quite a bit of variability. And we also know that combining creatine with resistance training can significantly improve mu muscle strength in females. But females te tend to be less responsive to creating supplementation compared to males and potentially that could be associated with how much creatine they have in their muscles to begin with.

So there’s one study in the 1990s that directly compared males and females and has shown that females had higher intramuscular creatine stores compared to males. So that’s one of the thoughts associated with that. But again, I think more research needs to be done in that particular area.

[00:40:47] Dr Mike T Nelson: We’re coming up with all sorts of studies like your grad students or other grad students can do. And what I love about this is that the studies are not particularly hard. And I say that with the caveat is doing any human subject studies, getting i b approval, doing all that stuff, as you well know, is it’s not an easy thing, right?

It’s way harder than even simple studies are not necessarily simple or easy to do, but on the spectrum of things, I think doing a study of, muscle content of creatine and the females versus males, right? If you’ve got a lab, you can, maybe I’ll ping Andy Galpin and tell one of his grad students like, Hey, start taking biopsies, man of, cause something like that.

We would think by this point we would have more data on it. And maybe it’s because of funding, maybe it’s just no one’s asked the question, who knows? But something like that I would bin as, basic stuff. That would be good to know. . Yeah,

[00:41:38] Dr Scott Forbes: absolutely. So I think you’re also asking really good questions.

And but yeah, these are things that we’re aware of a as scientists and yeah, I think Abby Smith Ryan is another, yes. Very good researcher that looks at differences, sex-based differences. So yeah, maybe she needs to do a creatine study specifically in females and compare it to males and looking at intramuscular, creatine stores.

But Andy Galpin could obviously do that as well. He’s a muscle biopsy guy and does a lot of that research. Yeah, that’s that’s definitely a good probe for people to start to engage in this research. As much as we know about creatine, we actually still have a lot of questions that we need to answer.

[00:42:18] Dr Mike T Nelson: Yeah, and the good part is, at least in the US I know NIH has earmarked a lot of money comparing, female research versus male research, and. So hopefully there’ll be more funding available for that too, because that’s one of the questions I get a lot is, most of my clients paradox I train are females, and it’s a decent question like is there any difference between females versus male for this or for that?

And in the vacuum of a lot of data, then you get all sorts of crazy theories of either there’s no difference, so just shut up, or they’re completely different and you have to do everything completely different. And the reality is probably somewhere in between. We just don’t know . Yeah,

[00:42:56] Dr Scott Forbes: totally.

Yeah, I totally agree.

[00:43:00] Dr Mike T Nelson: Is there any, we’re talking about intracellular extracellular water. Is there any basis to the kind of the cell swelling theory that, creatine causes the muscle cells to swell and because of this kind of osmotic effect, that’s why you can lift more and do more work And this is beneficial for hypertrophy.

Like the analogy that gets thrown around all the time is, You might be stretching the fascia around the muscle and causing it to increase its size. And any thoughts about all that sort of the bro science in that area? Yeah, so

[00:43:33] Dr Scott Forbes: there’s a really good study from McMaster University, which is where Steve Phillips is at.

, it was run by Mark Tar Polsky. Yeah. And they loaded young individuals with creatine for seven days, so 20 grams per day for seven days. And they looked at a bunch of markers within the muscle that were associated with water retention and also muscle growth as well. And they showed that the cell does swell.

It does bring in water to the muscle. And that does stimulate the muscle to grow. So that was an acute study that was just like a loading phase. So that’s where I think there is some water retention that does occur, but it actually stimulates the muscle to grow. Whereas if you look at the long-term training, like eight weeks of training, it actually evens itself out.

So where as that Brad Schoenfeld study showed that the increase in intracellular water to skeletal muscle mass gains was actually, that ratio was actually the same at the end of the study compared to the start. So I think your body does adapt. It does bring in water acutely during the load phase, but over time your muscles are quite smart and it will get rid of some of that water and just it’s related to the amount of muscle mass that you actually have.

[00:44:54] Dr Mike T Nelson: Yeah. We’re back to acute versus chronic changes again, right? Because yeah, if you throw a bunch of creatine is in on the system, it sounds like, yeah, you may see some cell swelling, but. That’s not a permanent state. The muscle’s gonna stay in, right? It’s gonna figure it out over time and be like let’s adjust a few things and we’re not gonna stay in this state the whole time.

It just seems even, I’ve talked to Stu Phillips about this too, that from a muscle growth standpoint, with the exception of exogenous chemicals, your body is limited on that end. Like you can definitely make changes a hundred percent, but it’s not easy to do. Where it feels like if you change the environment drastically, like you throw someone up in microgravity pH, they like unload like crazy.

Or the bedrest studies with the, slide, head down tilt and just seems like our physiology is weirdly asymmetric where we can change a bone size, we can change soft tissue size, we can change a muscle size. But if you just think about I did this the other day. I was sitting around thinking, God, how much time have I spent in the gym?

Calories, everyone trying to gain five pounds of lean body mass, right? It just seems crazy, but you could throw me up on the moon and I could lose five pounds of lean body mass, like super fast. . Yeah. Your thoughts on that?

[00:46:18] Dr Scott Forbes: Yeah I totally agree. That it’s not, first you need to look at those acute studies versus chronic studies.

And yes, the me, the s are still being elucidated with creatine. So even though we know that it can increase phosphel creatine within the muscle, and I do a whole bunch of other things, you still need to do more kind of long-term studies and see how those factors are really playing a role in muscle growth.

And I think that’s where some of stew stew Phillips research is really powerful because he does a lot of those really cool mechanistic acute studies. But also the training studies as well. And so that’s really important. But yeah and then you talked about looking at like bedrest and going into space and things like that.

So I think creatine could be a huge benefit in those situations. Sure. And there was one study actually looking at immobilization. So this was done by Darren Cando and colleagues and Phil Chibe, and they immobilized individuals with a cast, and they took creatine and they basically showed that it prevented some of the loss of muscle mass and muscle strength in the immobilized limb when they supplement it with creatine.

So if an athlete is complete, completely immobilized injured creatine perhaps could be of benefit in those

[00:47:33] Dr Mike T Nelson: situations. Yeah, that’s definitely on my list, what I use for that. There’s some interesting data on sauna and some other mechanisms too. And what to me is fascinating about those too is that the same rate doesn’t show up when you’re active, right?

So people assume that oh, creatine, it can prevent, loss of muscle in a cast model, which is a hundred percent true and is pretty significant in terms of, statistics. But that rate is not the same rate at which you could gain lean muscle mass if you’re active, right? And again, it’s this weird asymmetrical thing where it definitely seems to halt some of the degradation to a relatively high degree, but on the other end of the spectrum, it’s still beneficial, but it’s not wildly, two x times a gain is beneficial.

Either ,

[00:48:22] Dr Scott Forbes: no, absolutely not. Like I said, like the most important things is just going to the gym resistance training. That’s probably gonna get you 90, 95% of your gains. And then all these other things that we’re trying to do to basically improve muscle adaptations is going to make, the additional 5%.

So there’s a lot of, thought that goes into that, all those nuances and training programs and supplementation and nutrient timing and caloric intake and protein intake. But the reality is that’s actually a pretty small effect. Most of our gains are just, eating anything and going to the gym and training.

So yeah, those are great questions for sure.

[00:49:04] Dr Mike T Nelson: Yeah. When I do talk some supplements, a lot of times I have what I call the, you’ve probably seen this, the squatting mouse study where they built a little harness for the guy and they have a little shocker and they shocked the mouse to get ’em to squat up and down.

They’ve done a lot of the limb loading and the unloading, models where they may even cut some stuff or they hoist their tail up so their front limbs are being used all the time. Their back limbs are not being used. And you know what, there’s some old studies, they’ve done everything to the little buggers, like they’ve castrated ’em, they’ve taken out their thyroid, they’ve put ’em on low protein diets.

They’ve done all these horrible things to little guys. And if there’s enough overload present, like you can’t take your results and gains to zero. Yes, does protein help? Yes. Does all these other things help? Does testosterone help? Yes. All those things help. But if you just kept that overloading, like no matter what they did to the little buggers, yes, it’s a mouse model.

You couldn’t drive the gains to zero. It’s almost like the body, if you apply the right stimulus, you can do a lot of other crap wrong and still see a fair amount of the benefit . Yeah, absolutely. In terms of forms of creatine, is there any like supplement companies for decades now have spent time trying to figure out, oh, this form and then, oh, look at this Ethyl Esther, creatine, and we put it in water look, it dissolves.

And then you talk to Roger Harris about this and he’s oh my God, that was almost such a disaster. Cuz according to him, if the body cleaved it at the, at a different spot, it would’ve been inherently very toxic. And so happens it cleaved it at the right spot and it got rid of the FL group and the creatine and it was fine.

But supposedly the group who put this out in the market didn’t do much of any toxicology studies at all. They just said, Hey, it’s creatine. Look at it dissolve. And any thoughts on anything that you’ve seen that is equivalent to creatine, monohydrate, and anything that is superior to it in terms of forms of creatine?

[00:51:04] Dr Scott Forbes: Yeah, so presently creatine monohydrate is. Is the best, simply because the mo, it’s the most researched and we know it’s very safe. We also know that it’s an effective form of creatine and it’s also the cheapest

[00:51:19] Dr Mike T Nelson: as well. So you can, but this is boring. I want my sexy, creatine man. You’re not helping my supplement company.

I don’t know. .

[00:51:27] Dr Scott Forbes: There, there’s been really, there’s been really good marketing Yes. For creatine hcl for example. Yeah. With regards to reduced bloating. So I think a lot of females are more keen to take creatine hcl, but the actual evidence in humans is non, it’s non-existent. So there’s no evidence that creatine HCL is superior to creatine, monohydrate, or creatine retention for creatine bioavailability.

Or performance. So I think that’s really important for people to know. And I haven’t seen any data looking at water intake with water retention within the muscle, comparing creatine hcl and creatine monohydrate. So I know there’s a lot of claims that it can actually reduce bloating and all these symptoms and but the evidence for that is, is lacking.

[00:52:17] Dr Mike T Nelson: So you would agree that there isn’t any data that you’re aware of as Dr. Creatine that says creatine monohydrate, that there’s any form that’s superior to it. If we really wanted to push hairs, maybe some might be equivalent, but even that, I don’t buy a lot of that data either. But definitely nothing that is superior to the basic old, boring, creatine monohydrate.

Yeah,

[00:52:41] Dr Scott Forbes: based off the current evidence, CRE Team Monohydrate is the best. And I know that’s boring for people to hear and maybe some of the supplement companies or you can are gonna make less money because of that. But yeah, it’s, that’s what the science would support.

[00:52:58] Dr Mike T Nelson: Is there any difference to buying creatine monohydrate from one supplement company to the next?

Correct me if I’m wrong, but I think there’s only about two or three major manufacturers of creatine monohydrate. I could be incorrect on that. Yeah, so

[00:53:14] Dr Scott Forbes: most of the creatine comes from either Germany and that company is CRE here or or China. So that’s, from my understanding, I know that crier does a lot of supports a lot of research and so a lot of the research that’s been published.

On creatine, monohydrate has used that particular product and it’s independently tested and we know that it says what it says it is. And so that’s what I use in most of my research. So that’s all I can really talk about. I haven’t done any analysis on other creatine manufacturers, but yeah from the science perspective, creatine coming from Germany as cre, we know is an effective supplement.

We know it, it is what it says it is, and that would be my recommendation. Awesome.

[00:54:06] Dr Mike T Nelson: We know that creating can cross the brain also, so is there some potential cognitive effects? We’ve had Dr. Eric on here before and did a whole episode on which will link to. On, the cognitive effects of creatine and kind of cross the blood brain barrier and how much do you need?

But I’m always curious on, on your thoughts too, from more of the neuro side with creatine.

[00:54:27] Dr Scott Forbes: Yeah. There is evidence to show that if you supplement with creatine that you can increase the amount of creatine within your brain. It’s much more challenging than at the muscle level. So it might just be a five to 10% increase in your brain versus like a 20% increase in the muscle.

[00:54:43] Dr Mike T Nelson: So it’s, yeah. And animal models with that were huge, but we can also sacrifice animals and look directly at their brain. Where , they can’t really do that in

[00:54:51] Dr Scott Forbes: humans. . Yeah, exactly. And that’s part of the problems right now is or challenges within the literature is looking. How they’re actually measuring brain creatine content within the brain, which specific regions they’re looking at might differ.

So yeah, we definitely need to do more research in that particular area, but there is some evidence that you can get more creatine in your brain and there is evidence that it can improve cognitive function as well, both animal models and human models to show that. And particularly when your brain is stressed.

So if you’re doing mentally challenging tasks like ma solving math problems if you have sleep deprivation or if you have hypoxia, those are three situations that can really stress your brain, and we know that creating the benefit in those particular

[00:55:38] Dr Mike T Nelson: situations. Oh, awesome. And based on your speculation, would you say.

The dose is the same, would you go higher if you’re really trying to use it for a neuro benefit? I’m assuming you would go a little bit higher, but any recommendations or thoughts in that area? Obviously this is definitely more on the speculation aspect of everything.

[00:56:02] Dr Scott Forbes: Yeah. So there hasn’t been a good dose response study with creatine saturation on the brain.

But because it is more challenging to get creatine into the brain, the thought is that you might need a larger amount of creatine or supply creatine for a longer period of time. So it might take more time to get some of those brain benefits. But again, that’s all speculation.

[00:56:26] Dr Mike T Nelson: Yeah, some of the athletes I’ve consulted with at a high end who I know are, let’s say in N H L N F L M A, anything where you know you’re gonna come into contact, even, kite boarding, that type of stuff.

I’ve said, we don’t know exactly, but I’d say 10 to 20 grams per day start earlier and not later. Because the downside is we’ve got pretty good data, Sean, even 20 grams per day is, there isn’t really any negative effects that we can find. I can’t really tell you that 10 grams is gonna be superior to 20 grams, but I can tell you that the downside’s pretty well known.

And even at 20 grams per day there’s not much of a downside. Any, would you agree with that or any words of wisdom

[00:57:07] Dr Scott Forbes: you would add? No I would totally agree with that. And then we also know at least some animal models that if you have creatine within your brain, that could be protective against a traumatic brain injury.

Yeah. So that’s potentially of benefit. And there’s, from my knowledge, one or two human studies that have shown improved sym improved symptoms following a concussion with creatine supplementation. So there is some evidence in that particular area, but it’s very limited in

[00:57:37] Dr Mike T Nelson: humans.

Yeah, and I’ll give a shameless plug. I did a whole program for the KE Institute on the use of ketones and potentially concussion and traumatic brain injury. So people can go to the Keurig website if they want more information on that. But yeah, ketones are interesting too because they may have potentially anti-inflammatory effects.

They can cross the blood brain barrier. They could serve as energy for when your glucose metabolism gets completely outta whack. And but again, are we ever gonna have a complete randomized, controlled trial that’s IRB approved on tbi, on ketones versus not ketones? I don’t know how that would even happen.

right? So it’s the same thing with creatine. It. It’d be great to have more information and to know more, but some of these trials just because of IRB and human ethics and technology, are just incredibly, if not impossible to actually do also.

[00:58:33] Dr Scott Forbes: Yeah, absolutely. I totally agree with that. From the keto perspective and also potentially as well, we know that as you age, your ability for your brain to metabolize glucose is reduced.

So I think both ketones and creatine could be of great benefit to provide fuels and energy for the brain and enhanced cognitive function, particularly an aging population.

[00:59:01] Dr Mike T Nelson: Yeah, no, that’s great. One thing I do for myself, which again, this is not medical advice, but when I do a lot of kite boarding in case I.

Dropped out of the sky 20 feet on my head, which hopefully doesn’t happen. I actually used high doses of creatine before fish oil. I carry keto Esther in my bag. And then I’ve also used the high dose of C B D also. There’s some interesting data around that for neuronal health. But in terms of potentially reducing risk of concussion, t b i, if you were to speculate, anything you would add to that?

Any thoughts? No,

[00:59:36] Dr Scott Forbes: I think that’s a pretty good supplement stack that you have to really benefit the brain. So yeah, I’ll Omega three s and creatine and ketones I think are definitely three potential supplements to enhance. Enhance your brain and your brain health. So if you’re a fighter, like an MMA athletes, I think creatine could be a benefit.

Not only enhance your muscle performance but it could also perhaps protect your brain as well. So yeah, we definitely need more research in that area, but I think you’re on the right track based off of all the evidence.

[01:00:09] Dr Mike T Nelson: And I also have a good buddy of mine is one of the top clinical neurologist in that area, so I have him on speed dial cuz my first thing is gonna call him be like, Hey man, what do I do

Someone else you can call is always super helpful too. Any negative effects of creatine? Anything we potentially should watch out for since it’s been so well studied at this

[01:00:28] Dr Scott Forbes: point? Yeah, so in the recommended doses it’s very safe. It does not damage your kidneys or your liver. It doesn’t oh, okay.

There’s actually a pretty cool study in Coming out of bra that came out of Brazil looking at an individual with a single kidney, and they gave them fairly high. They did a loading phase with them and gave them a fairly high amount of creatine, and they showed that his kidney continued to function perfectly normal.

Nice. Which was great. I would not want to be the one doing that study and yeah, find a negative outcome. But yeah. Yeah. So there is some evidence that even in clinical situations or individuals with impaired kidney function, that creatine is still perfectly safe, which is pretty cool. So yeah, creatine is definitely one of the safest supplements that you possibly consume.

Probably one of the only side effects is that you’re gonna get bigger muscles and you’re gonna get a little bit stronger. So if. Bad and which is not. And yeah, you might gain a little bit of water, particularly during that loading phase. But those are just, yeah, benign kind of side effects.

They’re not negative in, in any capacity and no risk

[01:01:43] Dr Mike T Nelson: of dehydration or muscle poles. I think that was one of the old myth that still I hear pops up every once in a while here and

[01:01:49] Dr Scott Forbes: there. No, absolutely not. And in fact, it does the opposite. It brings water into the body, into the muscles.

So it could be a benefit for exercising in the heat and can reduce muscle cramps and muscle injury. And Rick Kreider has done some of that research in football players and showing some benefits of creat. The complete opposite of what people declare. They say that it causes muscle cramps or dehydration, and muscle injury actually does the complete opposite.

[01:02:21] Dr Mike T Nelson: Yeah. And you’re talking about potential risks and benefits. I usually, I’m sure this has happened to you countless times, that a parent will come up and be like, oh, my 17 year old is playing football, and he just started taking creatine and that’s a steroid. And I told him, this is horrible and he should not do this.

And then you tried to explain to him that it’s not a steroid. It’s been well studied. Paradoxically, it has some, like we were talking about early preliminary data that it may actually help potentially concussion. And then they still are very mad at me. And then I politely try to point out that you’ve allowed them to play a sport where they’re running full speed into another human being.

At least of my worries would be creatine. I’m just saying, .

[01:03:03] Dr Scott Forbes: Totally, yeah. I totally agree with you a hundred percent. And. Yeah, it’s that’s, it’s hard to change people’s opinion on it, and I feel like creatine has this bad rep as this like steroid like substance that is gonna damage your kidneys.

But when you actually look at the evidence it’s a very safe supplement and it can have all these potential positive effects. So yeah, I think individuals should consider taking

[01:03:30] Dr Mike T Nelson: creatine. Yeah. And the other part I point out too is that it’s been on the market since, we could say easily mid nineties.

And you can’t even go to PubMed and find hardly any crazy case reports of bad shit happening. With the bazillions of doses of creatine that’s been out there by now, it’s if there was something really bad. With that amount of dosing and that amount of research, like we would already know about it.

Yeah. So I think you can say it’s relatively safe.

[01:03:56] Dr Scott Forbes: Yeah. The only negative side effect that I saw was if you combine creatine with cocaine and vigorous exercise, it increases your risk for compartment syndrome. Ah, , this was a case study that was actually a study. Yeah, it was a case study that was recently published.

So I’ll send you the link to that one. Yeah, that was definitely pretty interesting.

[01:04:17] Dr Mike T Nelson: Wasn’t it, I could just get this wrong, wasn’t Mauro de Pasquale was saying once that there was, this might be just complete rumor at this point, that there was a huge power lifting meet somewhere up in Canada and that the judges got all like snowed in and couldn’t get there and they decided to run the meat and they didn’t have any testing.

And supposedly all these people broke like world records and the rumor was that there was a fair amount of cocaine being used before the event. So I don’t know if any of that is even true or not, but I thought it was an interesting story, . Nice. Last question as we wrap up. What, and if you put on your prediction hat, since we’re recording this at the beginning of January, 2023, what is gonna be like the next creatine and sports supplements?

Because everyone and their brother has been looking for the next creatine, for going on decades now and. Maybe we have some stuff that’s beneficial, but I don’t think anything new, I would say, in terms of efficacy that really compares to creatine. But any thoughts about what might be coming or anything that looks kinda interesting, that has potential?

Yeah

[01:05:29] Dr Scott Forbes: that’s a great question. I think I go back to just basic physiology and like carbohydrates have such a powerful effect both on the brain and also on high intensity exercise performance. I know there’s been a push for ketones and , like low carb diets, but eventually I think it’ll start to swing back the other way and people will realize some of the benefits of carbohydrates on muscle metabolism and muscle performance.

Yeah, I’m not too sure of any supplement that’s, Coming through the woodwork, that’s gonna be showing some of these really positive effects. There are some precursors to creatine. It’s called G and Dr. Serge Ostojic. He’s yeah, done a lot of research in the creatine area, but also on this particular supplement.

And he has shown that if you take this supplement, you can get increases in increasing in the brain greater than creating a loan. . So from a brain perspective maybe that’s a supplement to watch for. But to be honest, right now, based off the available evidence, creatine is really the king of supplements.

[01:06:34] Dr Mike T Nelson: Awesome. Do you think lactate could be used as a orogenic supplement?

[01:06:39] Dr Scott Forbes: Yeah, definitely. Lactate’s just basically a half a sugar molecule, so you can convert lactate into variety of, you can convert it into glucose in your liver. You could also. Convert it into arru rebate and sent into the kreb cycle as well.

Yeah, there’s definitely some potential benefits of lactate, but there’s probably more fear of lactate than there is of I know nicotine. So trying to tell somebody, oh, you should take lactate, that they’ll be like, what? Why would I take this? It’s gonna cause muscle soreness and muscle, fatigue and all these things.

So that might be a challenge with that particular supplement.

[01:07:18] Dr Mike T Nelson: Yeah, we’ll just rename it like MYOBLAST 4 65 and we’ll be good . Exactly. Awesome. Thank you so much for all your time and I really thank you for, all the research you’ve been doing for many years, decades now. It’s, I always love reading your research.

It’s always great. I get to sit on my ass and read someone who did all the legwork, and I just get to read everything that they found, which is super cool. How do people find out more about you? I know you’ve got a lot of great stuff on your Instagram and also do you take any graduate students or people want to go to that level?

Give us the info. Yeah, so

[01:07:54] Dr Scott Forbes: probably the best way to contact me is through Instagram, so Scott underscore Forbes underscore PhD. And you can DM me or contact me through Instagram and I try to respond as, as much as possible to everyone that asks questions. Feel free to reach out. So I know some people think that researchers.

Your own world and don’t have time for anybody, but I really try to make an effort to connect with people and an answer questions. And you can also contact me through email as well. So Forbes s so there’s two S’s at Brandon u.ca. So that’s another way to contact me as well. And at my institution we actually don’t have a graduate program.

But I’m well connected with and I’m a, an adjunct professor at the University of Regina. And that’s where Dr. Darren Cando is. Yeah. And he has a really big lab, so I think currently he has seven or eight graduate students. Oh, nice. And he does a lot of creatine research and we collaborate quite frequently.

So if you’re interested in creatine supplementation, then definitely reach out to me or Dr. Darren Cando and we can. Yeah, find you a master’s program or a PhD program that

[01:09:05] Dr Mike T Nelson: would suit you. Awesome. Yeah, and I would highly recommend people to check out your Instagram. You’ve always got a lot of great information there.

And yeah, thank you so much for all your time today and I look forward to seeing you. Are you gonna be at the neuro sports conference or ISSN again? I assume you’ll be at ISSN

[01:09:20] Dr Scott Forbes: Yeah, I’m going to ISSN unfortunately I’m not going to the Neurosports this year, but I’ll definitely see you at ISS N in Fort Lauderdale.

[01:09:27] Dr Mike T Nelson: Yeah. We’ll see you there again, and I owe you a tasty adult style beverage for all your time and effort here. I really appreciate it. No problem. Cool. Thank you. Have a good day.

Bye.

[01:09:40] Dr Mike T Nelson: Thank you so much for listening to the Flexed Diet podcast today. Really appreciate it. A huge thanks to Dr. Creatine, Dr. Scott Forbes for sharing all of his amazing information on creatine. I felt like this show within about an hour, I think we hit on about the main topics of creatine. We’ll post a few studies.

There are many more. Make sure to check him out on Instagram. He provides a lot of excellent research based information, and if you find someone who has questions about creatine, please send this episode over to them. It’s a nice one-stop shop about all the pros, and if there are any cons related to the sports supplement, creatine.

Big thanks to Dr. Scott for doing. And the podcast is brought to you by the Physiologic Flexibility certification that I created, or the phys flexer. You can think of this as the level two to the Flex Diet certification. Once you’ve got your nutrition and exercise down pretty decent, what is the next level of interventions you can do to be more robust, more anti-fragile?

Speed up your recovery and provide true longevity benefits. In there. We cover everything from the use of cold water immersion saunas, actual high intensity interval training, the use of some supplements to buffer pH, what you can do for pH changes, breathing techniques, long slow distance cardio. And even talk about ketogenic diets and carbohydrate loading.

So go to physiologicflexibility.com for all the information. It will open up again this coming mid-March 2023, so make sure to get on the wait list there. Thank you as always for listening to the podcast. Really appreciate it , if you have just 30 seconds and can leave us a review, that would be epic. We really appreciate it.

Helps with the distribution of the podcast and also helps us get more guests on to bring this to you for completely free, since I’m the one who sponsors the podcast. So pass it on to anyone you think would be interested. Huge. Thanks, Dr. Scott Forbes, and that is all for this week. Thank you so much.

Talk to you all next week.