Coffee and Creatine, Part 2

There are 2 main reasons to consider taking creatine monohydrate as a nutritional supplement: improved exercise performance and improved brain function. 

For active muscle

Athletes have used creatine since 1992 when they wanted an edge in explosive action sports: powerlifting, sprinting, football, baseball, and boxing. By the time of the 1996 Olympics in Atlanta, 80% of athletes were using creatine supplements, just 3 years after it became commercially available. 

More recently, it’s been used by athletes in endurance sports, particularly those with high-intensity efforts. 

The short version of how it works: at the cellular level, creatine enables greater bursts of high-intensity effort, reduces muscle damage and time to recover, assists in increasing muscle mass, and makes it possible to train with more repetitions and higher loads.

So, for people like me interested in 

• Combatting sarcopenia, the muscle loss associated with aging
• Lifting heavier or longer in the gym
• Improving their power output in sports like BJJ that require brief, high-intensity bursts of activity

… creatine may be worth a look.

For the brain

Studies have found positive effects on brain function within the past 25 years—and mostly within the past 5. Since I have no aspirations to a Captain America bod, I found the benefits in these areas more interesting:

• Memory
• Processing speed
• Protection from traumatic brain injury
• Performance when sleep-deprived or otherwise brain-stressed
• Possible mild benefits in neurodegenerative disease
• Depression, anxiety, and PTSD

The main mechanism is similar to that seen in muscle: creatine improves energy creation in brain tissue, the most energy-demanding tissue in the body. And certain brain pathologies share a problem with brain cell energy production, which can lead to neurologic dysfunction or cell death.

(If you are interested in articles on the Substack platform, ​this post​ by Liz Baker Prosser cites several additional benefits for women, including improvements in bone density, post-menopausal memory and brain fog performance, and enhanced effectiveness of the antidepressant medication.)

Also, for aging

In addition, this ​review article​ lists many potential benefits for problems associated with aging:

• Lowering cholesterol and triglyceride levels
• Reducing fatty liver
• Improving blood sugar control
• Reducing oxidation
• Reduces cortisol stress responses
• Increasing muscle size and mass
• Reducing bone loss
• Improving function in patients with knee arthritis and fibromyalgia 
• Improved cognition and depression/anxiety symptoms

It seems like the number of people who would NOT benefit from creatine supplementation may be pretty small.

How safe is it?

If numbers mean anything, very:

More than a thousand studies have been performed, with billions of doses consumed. The higher quality studies were characterized by the following long but nicely specific quote from the ​International Society of Sports Nutrition (ISSN) last month​: 

Over 680 peer-reviewed clinical trials have been conducted on creatine supplementation (95% as creatine monohydrate) since the 1970s, involving over 12,800 study participants administered creatine supplements in dosages up to 30 grams per day for 14 years in populations ranging from infants to very elderly individuals in both healthy and clinical populations. No clinical adverse events were reported in any clinical trial study, and the minor side effects reported were infrequent and not significantly different from over 13,500 participants consuming placebos in these studies. This includes a comparison of studies conducted on children and adolescents (< 18 years), young adults (19 – 45 years), middle-aged adults (46 – 65 years), and older adults (>65 years). Moreover, an analysis of over 28.4 million adverse event reports in the United States, Canada, Australia, and Europe, using SIDER 4.1 over the last 50 years, reveals that creatine has rarely been mentioned (about 0.0007%) despite billions of doses taken worldwide over the past 30 years. While adverse event reports do not imply causality, the lack of reports worldwide supports findings from clinical trials that creatine is safe for individuals of all ages.

Additionally,

High-quality creatine monohydrate is Generally Recognized as Safe (GRAS) by the Food and Drug Administration 13and is considered safe for human consumption in dietary supplements in the United States, Canada, Europe, Australia, South Korea, Japan, and China. Efforts are underway to fortify creatine in food and to position it as a conditionally essential nutrient.

What about kidney safety?

The level of a naturally occurring substance in the blood, serum creatinine, is commonly used as a gauge of kidney function. A high serum creatinine (Cr) often means kidney damage: when the kidneys malfunction, they can’t filter out Cr from the blood, and Cr levels rise.

But creatine monohydrate is partially converted to Cr in the bloodstream. Cr levels rise, not because the kidneys aren’t getting rid of it, but because there’s more Cr being made.

Translation: Cr levels can rise when taking creatine, but this does not reflect kidney damage.

How I take it

First, if you are not a patient of mine, please consult your physician. This newsletter post is for educational purposes and cannot replace a discussion of your personal situation. 

My personal research has led me to take 5 grams daily, which is a standard dose. I use the creatine monohydrate from Momentous, which is 3rd party tested and NSF (National Sanitation Foundation) certified for sport (for freedom from contaminants, absence of substances banned by major sports organizations, and ingredient/potency confirmation). I have no financial relationship with this company.

5 grams is equivalent to one small scoop of the white powder, which dissolves with no flavor in water, a smoothie, or most often, my morning coffee.

Studies have been done using a higher daily loading dose for a week, followed by reducing the dose to 5 grams daily. But taking 5 grams daily for about 3–4 weeks reportedly saturates the creatine levels in muscle tissue, and because I was in no rush, I kept it simple to 1 scoop of 5 grams daily.

Action Item: think about self-monitoring anything you take

I recommend thinking about why you’re taking any supplements. 

Ideally, you’d want to see a benefit: no benefit, and you’d stop taking it. Creatine falls into this category: you should see a pretty clear improvement in lifting or athletic performance, mental clarity, and energy levels.

Less compelling but still justifiable is taking something supposedly beneficial but that you can’t really feel. Taking blood pressure or cholesterol medication falls into this category since I don’t know anyone who can feel their LDL level.

Least compelling of all is taking something on pure faith. You can’t feel a difference, and there’s someone of a not-very-scientific or evidence-based background saying it’s good for you.