Episode 140 – Creatine Myths and Misconceptions

Key Topics Covered

Protein and creatine on floor with weights.

A brief summary of the benefits of creatine supplementation is that it:

  • Increases ATP regeneration.
  • ATP is a form of energy that is typically useful for the first 10 seconds of activity. 
  • If you lift weights, this allows you to get a few more reps out here and there.
  • Creatine has been shown to contribute to both strength gain and muscle gain. 

Episode 14 was a full podcast on Creatine, so if you want to learn more about the research and benefits we encourage you to listen to that episode.

Creatine Loading

  • Many people make it seem like you either NEED to load creatine OR that it is a waste of time/money/effort. 
  • Creatine Loading Protocol: 20g per day, split over 4 dosages, for 5-7 days. Normal amounts are 3-5g per day.
  • If you don’t load, it takes ~30 days for creatine saturation to occur on your regular daily 3-5g dose BUT If you load, it takes 5-7 days.
  • Essentially, creatine loading makes it quicker to reach a point of saturating your creatine stores and therefore seeing the full effect of supplementation.
  • However, when you consider that you don’t need to stop taking creatine once you commence (outside of exceptions), you can argue that there is no need to load.
  • Pros: You get the maximum effect of creatine quicker.
  • Cons: Inconvenient.

Hair Loss

Man looking at mirror with thinning hair.

  • The logic is that creatine increases DHT production and DHT is linked with hair loss. 
  • This largely stems from a 2009 study (listed below). It was a 3-week study on Rugby Players taking 25g creatine daily for 7 days, followed by a maintenance dose.
  • Levels of DHT increased by 56% after 7 days of creatine loading and remained 40% above baseline after 14 days of maintenance.
  • There are a few things here:
  1. This study hasn’t been replicated. So we don’t even know if creatine increases DHT levels, beyond what this study found.
  2. There has never been a study looking at creatine and hair loss.
  3. DHT levels remained within normal levels in that study.
  4. At least 12 studies have looked at creatine and testosterone, with the consensus being that it doesn’t change testosterone. Testosterone and DHT have a pretty big link. 
  5. DHT levels typically bounce around within the healthy range, which could be a factor, particularly with small sample sizes. 
  6. Heavy lifting increases DHT levels on average. So that’s another variable.

The biggest thing for me personally is that no researcher has done a study looking at hair loss, even though this initial study came out in 2009. Research is hard to do. But this may imply that most researchers in this space don’t think it has a link with hair loss.

Water Retention

creatine pouring into water.

This is probably the most difficult one to unpack. It’s pretty well accepted that creatine increases water weight. But there’s some information around this that most people may not be aware of.

  • Firstly, many people are concerned that the water weight will make them look puffy or bloated. But that’s not the case. The increase in water weight is at LEAST 50% intracellular aka inside the muscles.
    • Some research has found it more skewed towards a higher percentage being inside the muscle. This would make it look like you are a bit more muscular if anything. 
    • It’s also worth noting that this intracellular water is normally something that is a bit of a signal for increasing muscle growth. So this is sometimes thought of as another potential benefit of creatine.
  • But the complex aspect is whether this water retention is even an ongoing thing.
    • We clearly see an increase in water weight vs placebo in studies looking at the loading phase. 
    • But AFTER a period of time at a maintenance dosage, this difference is either non-existent or much smaller in research. 
    • Subsequently, outside of the loading phase, most people shouldn’t be concerned about water retention. And even in the loading phase, it’s arguably a good thing, like being better hydrated, unless you are about to compete in a weight-class sport. 

Kidney Damage

Kidney inlammation.
  • In muscle, both creatine and PCr are broken down into creatinine, which is sent to the blood and then excreted in urine.
  • Since kidneys filter creatinine, this measure is often used as a marker of kidney function.
  • This marker can be skewed by either having a lot of muscle mass or by having a high intake of creatine.
  • The direct logic people use is that the higher creatinine levels of a blood test (or lower eGFR) means the kidneys are not functioning well.
  • Other indirect logic some people use is that it increases “strain on the kidneys” by making it filter more products.
  • Fortunately, we have a wealth of research, including randomized controlled trials, showing that creatine supplementation in normal dosages does not negatively impact kidney function.

Dehydration

  • The logic behind this is based on creatine increasing water retention and sending more water to the muscles.
    • This also doesn’t make much logistical sense anyway as this is just additional water retention.
  • The short version is that creatine does not contribute to dehydration.
  • The long version is just unpacking that logic.
  • Let’s say somebody gained 1kg of water weight in the loading phase, over 5 days.
  • Over 5 days that’s only 200ml difference per day. So even with the worst-case scenario like that, it doesn’t seem like a big difference.
  • Then when you also factor in changes in excretion e.g. reduced urination due to greater retention, then it becomes even less of an issue.

Other Forms of Creatine

Other forms of creatine supplements.

  • Creatine monohydrate is the most studied form and has been extensively researched since the early 1990s. 
  • No other form has been shown to be superior. And even if another was just as good, it makes sense to stick with monohydrate just because of how well-researched it is.
  • Some people experience gut upset from creatine. This is trickier than you’d expect to interpret since people also report this from placebo.
  • At a 3-5g dosage, reports of gut upset are similar to placebo. At a 20-25g dosage though, symptoms are more common from creatine.
  • One exception worth considering though is that creatine HcL could solve this. The maintenance dosage of 1.5g is enough to maintain optimal stores. At 1.5g, it would be rare for symptoms to occur since it is such a small amount.

Summary

There are many myths out there, however when you look at the research it is clear that creatine is safe, has minimal downside and can also benefit many people, particularly those who lift weights.

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