Aidan:
Welcome to the Ideal Nutrition podcast. My name is Aidan Muir and I’m here with my co-host, Leah Higel and today we’re going to be doing episode 140 on creatine myths and misconceptions.
There’s two things that kind of inspired me to want to do this topic specifically. One was that a year or two ago, I don’t know, I read a study that was titled, I’m just scrolling down, titled Common Questions and Misconceptions about Creatine Self -Mentation. What does the scientific evidence really show by the International Society of Sports Nutrition? And I’ve been reading about creatine by like over a decade at this point when I read that study and I still learned something new. So I’m like, that’s cool. Maybe I should share some stuff.
The other thing is we’re trying to grow this podcast and we normally just choose topics based on what we think would be beneficial for people. We don’t ever look at analytics and stuff like that that much. But the most listened to podcast that we’ve ever done was episode 14 on Creatine. That’s all we titled it. It’s the most listened to podcast. it’s like, I don’t know, 100 and however many episodes later, let’s do that again.
So if you haven’t listened to that, obviously I encourage listening to that, but as a bit of a brief summary of the benefits of creatine self -plantation, the first thing 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, for example, this could help you get a few more reps out here and there. Over time creatine has been shown to increase both strength and muscle growth. So that’s why we’ll frequently recommend it to a lot of people.
Leah:
Yeah. So first thing we’re going to touch on in terms of, guess, around creatine is really around this creatine loading aspect. When going online, like when people are talking about creatine, we see so much conversation happening about creatine loading. People are like either don’t do it, waste of time, you’re just wasting your creatine, like don’t even worry about it. And then on the other side, we have people that are like, you need to load creatine. Like this is a very important part of taking creatine. So we’re kind of just going to break that down and see what the outcome of that is.
So let’s start with what creatine loading is. So loading creatine is essentially taking a higher dosage upon starting creatine monohydrate to basically build up your saturation of creatine faster than if you were just taking kind of the standard daily dose. The general recommendation for loading is 20 grams of creatine per day. Most people are going to have to split this up over around four doses across the day just to avoid any kind of gastrointestinal issues.
And then they’ll do that for five to seven days. Following that, they will then go to your regular three to five gram per day dosage and continue on with that dosage after the loading phase. If you do not load creatine when you initially start taking it, it takes around 30 days for creatine saturation to occur. And like I said, in comparison to the loading five to seven days. So the biggest difference is reaching that kind of maximal benefit of creatine faster when you load it initially as opposed to just taking your daily dose. But either way you will reach creatine saturation over a period of time whether you load or you don’t load.
So basically loading is just quicker way to reach the point of full effect of creatine monohydrate and noting that this is just when you start creatine. I definitely see a lot of people taking creatine, they’re five grams per day, and then they learn about loading like months later, and then they do their loading phase. Okay, at that point, it probably is a waste of time because you’re already, if you’ve been consistent, you’re already at the point of creatine saturation. It’s realistically when you are just starting the process of taking creatine. And if you don’t ever come off of it, there’s really no need to load once you’ve started taking it for a while.
So the breakdown on loading in general is yes, when you first start taking it, you do get the full effect of creatine faster. It’s not something that you have to do. My con is kind of like, it’s kinda annoying to take something four times a day. I’d probably just wait the extra few weeks for the full effect, but it depends on how much, I guess you want that effect and how fast.
Aidan:
Yeah, I’ve mixed views. When I was like early as a dietician, I used to just like not worry about telling people that it’d be like five grams per day, don’t need to do it. And then I met like a pretty lead athlete who’s just like can I just load? Like I’ll get that quicker. Like I actually care about those few days. And now I just like put it as like an optional thing. And even when I post about it on Instagram and I just like laid out being like optional loading phase of whatever, every now and then I do get a comment that’s like loading is a myth. You don’t need to do it. You don’t, but like you just get there quicker. Like it’s a choice.
Leah:
Yeah. Yeah. There’s definitely a benefit to doing it if you care about the speed in which you get to that saturation.
Aidan:
Yeah. The next one we’re going to talk about as a bit of a myth in a way is hair loss. So this is a complicated one. The logic largely stems from the fact that, or the logic that people go of is that creatine increases DHT production and DHT is linked with hair loss. That makes sense, but let’s dig a little bit deeper in this.
So the first part is this almost exclusively stems from a single study in 2009. We’ve added that in the show notes, so if anybody wants to check it. But it was a three week study on rugby players who were taking 25 grams of creatine per day for seven days. That’s a loading phase. The reason why it’s bigger than the standard 20 grams is because the guy is like, it scales by some size. And then they followed that up with a maintenance dose for the next 14 days for the rest of the three weeks.
In that study, levels of DHT increased by 56% after seven days of that loading phase and then they remained 40% above the baseline after 14 days of maintenance. If that was the only thing you knew, you’d kind of be a little bit concerned, but there’s a few things that we want to unpack.
First one, there are no studies on creatine and hair loss. Not a single one. If you are out there saying creatine causes hair loss, that is a very, very, very bold claim.
Leah:
It’s a big jump. Yeah.
Aidan:
And like, obviously people can like anecdotally be like, I started taking creatine and my hair started thinning. But like, there’s just so many variables going on with that. Like, was your hair going to be thinning regardless?
Leah:
Maybe you’re just a man in their 30s with genetic history.
Aidan:
Like, it makes a lot more sense to have some data on this rather than just certain anecdotal claims. I get it if you’re kind of concerned, let’s dig deeper beyond that. So there’s no direct studies on hair loss. Part two, that study that I just talked about has not been replicated. We don’t even know if creatine increases DHT levels beyond what this study found. Firstly, there’s not really a mechanism behind that. All creatine is doing is increasing ATP regeneration. What does that have to do with DHT levels? It does do some stuff with water retention and stuff like that potentially, which we’ll talk about later, but there’s not really a link with DHT levels.
To the best of my knowledge there’s not other research directly looking at that. What there is research looking at is creatine and testosterone and testosterone and DHT have quite a bit of a link. There’s at least 12 studies that I’m aware of that have looked at creatine and testosterone and as you can imagine there’s no increase in testosterone from creatine. So unlikely to really raise DHT beyond that one study we’ve seen. In that study DHT levels remained within normal levels within that study.
It’s not like they took people with normal DHT and it was a massive increase. It was always within the healthy range in that study. DHT levels typically bounce around within the healthy range as well. Sometimes they go down, sometimes they go up. Unless you read a lot of research, it may or may not be difficult to really get what I’m getting out of that. But I’m gonna use a different example. There are certain supplements that are proposed to increase testosterone.
And there’s one I’m blanking on it right now, but it has like four studies looking at it increasing testosterone. It’s a very common supplement in test boosters. And like two of the studies actually found like a decrease in testosterone.
Leah:
Yeah, interesting.
Aidan:
Don’t quote me on this because I’m doing it off the top of my head, but there is multiple studies that found a decrease in testosterone and multiple that found an increase in testosterone. Every cell phone company when they’re referencing their studies, guess which ones they’re referencing. Because testosterone also bounces around in the healthy range as well for most people as well. So like with random chance of small sample sizes, you are going to see a change.
Once again, that’s just one for the DHT. That’s just a 2009 study on rugby players, not a massive sample size. It would be a bold take to assume this increases DHT all the time. And then another thing that skews things, heavy lifting increases DHT levels on average.
Did their training change in this thing? Did any other variable change? There are a lot of variables that go into this. But I can understand if you are like super cautious about this. The main thing why I’m quite and quite busting them in is to be like, well, there’s no evidence that actually does increase hair loss. But something that takes it to another level for me personally, and I would understand if people disagree with me on this is there was only one study done in 2009 that wasn’t directly looking at hair loss and there’s been no study since.
So many people are concerned about this concern. I know so many people who don’t take creating just because they’re really clinging on to it. They’re like, I don’t want to lose my hair. I get that. I understand that.
Leah:
You have clients that are like, no, I’m worried about this.
Aidan:
Yeah, yeah. It’s actually really common. Yeah. So like I do get that. But the thing that makes me super like fine of this and being like, I just don’t think it’s an issue. Nobody studied it since. Research is hard to do. And that makes it less appealing to do. But something that I often find with lot of researchers, because it’s their job,
I want to do research that’s impactful. That’s one of the things. And I think a lot of people look at this topic, they hear the complaint and they’re like, I might look into this. And then they start looking into studying it and they’re like, nah, I just don’t think there’s a link between creatine and hair loss. I’m not gonna spend however long looking at this. That’s my actual true belief. I do understand if people disagree with that, but I would a hundred percent change my mind if we do see research coming out showing that it’s linked with Halos. We just have nothing on that at this stage. And this has been looked into like 2009 was when this process really started.
Leah:
Yeah, yeah. The next one we’ll talk about is pretty popular and that is the, I guess, myth or misconceptions around water retention.
This is a slightly harder one to unpack than the previous two things like loading and hair loss. I think we can come to some like pretty decent conclusions around this. the water retention stuff has, I guess nuance to it in that it’s pretty well accepted that creatine does increase water weight, but there’s some stuff in that to unpack here that a lot of people aren’t aware of.
So, firstly, most people are concerned that the water weight that they put on when taking creatine will make them look puffy or bloated. Or the big thing I heard growing up was like, it’s going to give you a moon face because you’re just like, bro, you started taking creatine. Like you’ve got the puffiness, but bro was just in a bulking phase anyway. So I think that’s like, that’s a huge misconception.
When realistically, when we look at the water weight from creatine, at least 50% of that does seem to be intracellular. So like inside the muscles. So if anything, this extra water weight should probably make you look a little bit more jacked than it does bloated and puffy.
Aidan:
Yeah. And like big emphasis on at least 50%. I always say at least 50% because that’s the lowest that I’ve ever seen in the research. There are other very smart evidence-based people who say it’s almost exclusively intracellular. It’s somewhere between those two things. The lowest I’ve seen is 50%. I’ve seen some like 80% intracellular. I like to put 50% as like the absolute base, but it’s not a big take to say most of it is inside your muscles.
Leah:
Yeah, I’ve said that’s probably the wording I use. say most of it’s inside your muscles. You’re to look a little bit more jacked, hopefully, especially considering how much people tend to increase their weight by if we’re thinking like, let’s say a kilo of water weight, and then half of that’s in your muscle and even like at the lower amount half that or in the higher amount half of that’s elsewhere. It shouldn’t make you look bigger. It shouldn’t make you look bloated or you’re fluffier.
So I think that is a huge misconception around creatine in general, but obviously it comes from a grain of truth in that we know that there is some water retention that does come with creatine, especially like around that loading phase if you’re doing that. So yeah, the complex thing is the water retention from creatine, it does seem to be transient. So if we look at the research, it seems like after a period at the maintenance dose, that you kind of come back to this homeostasis where you actually don’t retain that water for that kind of the whole time you’re taking creatine.
I still think there is probably some nuance around this. Maybe you retain a little bit of it. Maybe it’s not all gone, but for the most part, it does seem to be transient.
Aidan:
This is the thing that I learned in that thing, like that paper that I mentioned earlier, the creatine mis and misconceptions type thing. Cause it’s like, I’ve been reading about creatine for like 10 years or whatever never really questioned it, was just like, yeah, creatine increases water weight. And I just imagine in my head, say it increases by a kilo, that becomes your new baseline while you’re taking creatine. When you stop, after about 30 days, it goes back to the baseline, slowly over time. Whereas like, they basically put it out exactly how you had just said it, as in we can’t even really measure the difference between creatine and placebo at the 30 day and beyond time of mark. And I’m like, that’s super interesting. And I don’t say it’s non-existent or like, both of us would say we’re saying like, either it’s non-existent or it’s much smaller.
Leah:
Yeah, that’s what I’m probably more comfortable in saying.
Aidan:
Yeah, yeah, because I do still find studies where it’s like, we can still measure it. It just seems like on average, it’s either non -existent or much smaller.
Leah:
Totally, yeah. So in terms of having this water retention, I don’t think it’s a big deal, even though there is some truth to it being existing, basically.
Aidan:
And another big thing is outside of weight class sports, most people shouldn’t care about this because it’s like intracellular as we’re saying, it’s almost like being better hydrated in a way. It’s like a thing. But yeah, we’ve weight class sports. I just wouldn’t start a loading phase right before fighting for a comp. One of the reasons why this seems like we’re getting deep into theory and this doesn’t really matter.
One of reasons why I think this matters is because if I was working with a combat sports athlete who’s doing a weight cut, I no longer take creatine out. Whereas previously I thought there could be like a kilo difference or whatever. If you took it out 30 days out from a fight, we know that creatine might help with concussions, management, prevention, et cetera. In that case, I’m like, this is a huge win. It means we don’t need to worry about this. We can just keep creatine in as long as we’re not loading right before we have to weigh in.
Leah:
Yeah, absolutely. And then obviously we have so many benefits of creatine from a performance and post -concussion syndrome perspective that like that was a game changer for me. I’m like, I don’t need to take this out for these athletes. Cool.
Aidan:
Cool, now let’s go through kidney damage. So this is another complex one, unfortunately, but in muscle, both creatine and phosphocreatine are broken down into creatinine, which is sensitive to blood and excreted in urine. Since kidneys filter creatinine, this is often a marker of kidney function, but there are two things, amongst many other things, that can skew this marker a fair bit.
One is having a high creatine intake through your diet, either by supplementation or through dietary means, or having a lot of muscle mass as well. Or another thing to add in today is if you train really hard, that will also increase creatinine as well. The direct logic which is often used is that higher levels of creatinine in the blood typically means kidney function is not functioning as well.
Estimated glomerular filtration rate, which is often the one thing people will look at for kidney function just on a blood test. It’s the simplest thing to look at. It’s kind of figured out partly based on creatinine levels and it will basically like lower eGFR, which can be a bit of a worry. When we’re looking at things like chronic kidney disease, that’s partly how we define chronic kidney disease in many cases. Like if it drops below 60, we start getting concerned. That’s like stage three chronic kidney disease, for example.
That’s like the direct logic people use, indirect logic people use is it increases strain on the kidneys. That’s one that I’m less, I don’t say less understanding of because I do get the concern, but I’m like, that’s just not enough. That’s just not enough because if I go for a run, that strain on my heart. That’s not a bad thing.
Leah:
And what about other vitamins and supplements that we’re not concerned about that are also filtered through the kidneys?
Aidan:
Yeah, Sometimes people are concerned about sodium, like we said, are the kidneys filtered out or whatever, but no one’s like, nah, don’t have too much potassium through like eating like fruit and vegetables. I don’t know. like that I’m brushing it off, but it’s like late stage chronic kidney disease. We actually do start tracking these kind of things. Obviously we care more. Yeah. So it’s like starting on the kidneys do matter when the kidneys are declining in function. But if you’ve got relatively healthy kidneys at the baseline, this kind of doesn’t matter.
But big thing, important thing we have a wealth of research, including randomised control trials, showing that creatine supplementation in normal dosage does not negatively impact kidney function. You can almost in a way view this increasing creatinine levels as a bit of a red herring in a way, in that it can increase creatinine levels. You might be worried about that. Same thing is just if you did have a hard session of lifting not long before you got a blood test, that would skew this as well. But you could then be concerned about your kidney function.
But one of the issues is either it’s elevated because of lifting or creatine or whatever and you’re completely healthy and there’s no issues or maybe you do have something wrong. Yes. And the only way to find out for sure is to stop creatine for say 30 days before your next blood test and also have a deload before getting that blood test as well to be sure.
That’s only if you’re concerned about something. Another thing to touch on is there’s technically another way to measure EGFR that’s not actually using this. So that’s another thing that lot of lifters do as well. I believe it’s cysteine C or something like that, but there’s other ways to test as well.
Leah:
The next point we’ll touch on is dehydration and it does creatine create an issue with dehydration. So the logic behind this is based on creating increasing water retention and sending more water to the muscles. Honestly, like when I hear people talk about this, it doesn’t even make logistical sense to me, but I can kind of see where people are coming from. Like if we’re diverting water to a different area, really the short version is that creatine does not contribute to dehydration.
Like that’s really as like as easy as we can put it. Even logistically, it doesn’t really check out as much as we would like for something to actually like really have a solid look in there. But even from what we know, we know that it’s a non-issue really. So the long version is really just unpacking the logic around this. Firstly, obviously everybody should be well hydrated.
Whether you’re taking creatine or not, in general, let’s just drink enough water. Let’s be hydrated. But secondly, let’s say somebody has gained one kilo of water weight in a creatine loading phase over a five day period. That does sound like a lot of water, but it is split over five days. Like if we think about it as just like 200 mL per day over five days, it’s really not that much per day. So even in like the worst case scenario, it doesn’t make a whole lot of difference.
Then when you factor in changes in excretion with like reduced urination, due to a greater retention of this water occurring, then it becomes even less of an issue. So I think just to tie that up with a nice little neat bow is that creatine does not contribute to dehydration.
Aidan:
Yeah. I don’t know what it is about that that annoys me, but like I posted on creatine on TikTok the other day and somebody asked should I take creatine? Their history, et cetera. And I was like, yeah, it makes sense. And then somebody commented, make sure you drink heaps of water with it. I was like, I’m not gonna respond to this on TikTok, but like, it just annoys me a little bit. Like, cause it’s just kind of like, as you said, like everyone should be well hydrated all the time anyway. Is it really more important with creatine when you do the maths on it? Like it’s not really that much difference as you kind of said, and it’s not like it’s dangerous. It’s not any more dangerous to be dehydrated on creatine. Like I think people worry about the kidney stuff, but like it’s not more dangerous. Yeah. I just think everybody should be well hydrated at all times anyway.
Leah:
I just find it funny how things always have a flip side in that you have the camp of people that are like water retention, causes water retention. And then you have the other people like, be careful of dehydration. They’re very opposing things to worry about.
Aidan:
So the, I reckon the one we’ll wrap up on is the last one is we’ll talk about other forms of creatine. It’s super common to see marketing in a way about creatine, different, a new form of creatine being better than creatine monohydrate. So creatine monohydrate is the most studied form. has been studied very extensively since the 1990s. There’s one group that I believe has been taking it for research purposes since 1990 in, I think a dosage of 20 grams per day, and they haven’t had side effects. So it’s like, it’s one of the most studied supplements of all time in terms of safety.
No other form has been found to be superior. Like a lot of other forms will have claims like some of them will even say stuff like more effective than creatine monohydrate without the water weight or without the whatever. It’s like part of how creatine works. Even like this is off topic, but like there might even be benefits of creatine water weight as a good thing in terms of the explanation for creatine leading to improved muscle growth over time that is like the very simple base level one that largely probably explains it is an improved performance. get a few more reps out here and there. That translates to more muscle growth and more strength gain over time.
Makes sense, right? But there’s other supplements that also help with that that we don’t think of as muscle building supplements and the research doesn’t support them, that? Caffeine makes people one to three percent stronger. I don’t hear many people being like, no, that’s going to carry over to improved performance. Like apart from just like hyping you up or whatever to get more lifting done.
Obviously, I’ve seen malate, beta, alanine, maybe beetroot juice as well. All of these things, like we haven’t seen research suggesting that they improve body composition or anything like that, but they do improve performance in the gym. So if we take a second and we’re like, well, maybe the performance improvement isn’t the biggest driver, the only driver or whatever muscle growth, something else must be. One of the pieces or one of the arguments some people say is that this hydration of the muscles sensor cell signaling kind of response to build more muscle, because it’s almost like it’s more stretched or whatever.
I wouldn’t think about that too much, but it’s like it’s another potential advantage of the waterway. anyway, so other forms of creatine, no other form has been found to be superior. One thing that is not an overly uncommon concern amongst people is that creatine can sometimes cause gut upset in certain people. It’s a very common thing. I would say, one in every four clients or something like that that I see will mention something about that. The research isn’t on the same page as that kind of outcome.
When we’re looking at a three to five gram dosage, research that I’ve seen has not found any difference between gut upset between three to five grams of creatine and placebo. That means people consuming placebo are still reporting this, but the frequency is still quite low for both of them. At a 20 to 25-gram dosage, there is a bit of a gap and you actually do see more people reporting issues from creatine. So it’s like, okay, creatine does have this potential, but there’s a big difference between 20 and 25 grams and three to five grams.
One exception with the other forms of creatine that I’m far more open to is creatine hydrochloride, so HCl could potentially solve this. Not because it’s doing anything magical, just because the dosage required is lower. The maintenance dosage is about 1.5 grams, is enough to maintain optimal stores in most people. And at 1.5 grams, the dosage is so low that most people are not going to experience symptoms. So that’s another thing. It’s like, if you do get symptoms from creatine monohydrate, it could be worth trying creatine HCl.
Leah:
So a little bit of a summary of all of that realistically boils down to creatine is safe. It has really minimal downsides. And as we’ve talked about in previous episodes, it just has so many benefits for active people, people who lift weights. Realistically, I also think it has a lot of benefits in like elderly populations and combat sports. So definitely heaps of benefits from creating safe, minimal downsides. So why not take it?
Aidan:
Awesome. Well, this has been episode 140. We always like plug giving reviews on this podcast and I massively appreciate those. Fun fact, it’s been a little while since the review, so if anyone wants to leave one, we would love that too. But as a different call to action today, if anybody has enjoyed listening to this, if you could please share it on your story on Instagram or anything like that, we would massively appreciate that.