Creatine

Scott: It's actually very challenging to get a high amount of creatine from food sources alone. For example, salmon is a great source of creatine and also has protein and omega fatty acids. I love salmon, but you would have to consume about 2.5 pounds of salmon per day to get five grams of creatine.

Brent: Welcome to Death Clock. I'm your host, Brent Franson. Today we speak with Doctor Scott Forbes about creatine. Doctor Forbes has basically devoted his career to understanding, creating, and promoting the benefits of creatine. As you'll hear in the episode, I grew up thinking about creatine as something only weightlifters take, but I've been recently convinced that it has a whole bunch of other benefits.

Brent: So I was excited to chat with Doctor Forbes and learn more. He's a really great resource on the topic. We try to cover all the basics, so if you've heard that creatine might be something you want to take, this episode is going to have all of the answers that you need.

Brent: It's not just for people who are trying to build muscle. It's really good for mostly everybody and has very few side effects. So I highly recommend getting educated on creatine and figuring out whether or not it makes sense for you. Hope you enjoy.

Brent: Doctor Scott Forbes, welcome to the show.

Scott: Thank you for having me. I'm happy to be here.

Brent: You are an expert on creatine. I've been really looking forward to this conversation because I grew up thinking about creatine as the thing you did just to look strong. My impression of it has been changing over time to something that's beneficial outside of high school kids.

Brent: You can tell me if that's right or wrong, but I'm excited to learn. I've been taking creatine every morning, convinced of it, and there don't seem to be any side effects. It will be interesting to see if I'm still taking it after this episode. Before we get into that, can you give us a sense of your background and how you came to creatine?

Scott: For sure. I'm currently an associate professor at Brandon University in Canada in the Department of Physical Education. As a graduate student involved in research, I got connected with Doctor Darren Candow. Our supervisor at the time was studying creatine, so I got involved with some of that research.

Scott: Basically since that time, we've conducted quite a few studies and published quite a few papers together. Creatine seems to be one of the few supplements that shows a clear benefit.

Brent: Awesome. First, when we talk about creatine, are we talking about creatine monohydrate, and what is that? What is the substance of creatine? When we say creatine, what specifically are we referring to?

Scott: There are different alternative forms of creatine, such as creatine monohydrate or creatine HCl. There are buffered forms of creatine. But once creatine gets into the bloodstream, it gets broken down into just creatine. That gets taken up into the muscle, and two thirds of that actually gets converted into a molecule called phosphocreatine.

Scott: That can be used to create energy very quickly, which is why that particular energy system is quite useful. Creatine itself is made up of three amino acids: arginine, glycine, and methionine. Your body can synthesize creatine by putting those three amino acids together, or you can get creatine as a supplement as well.

Brent: When we use the word creatine, we're typically talking about it in the context of a white powder put in water and consumed. That's how it's typically consumed. Or do people consume it in other ways?

Scott: That's typically how you'd consume it. You get creatine monohydrate, which is a water molecule attached to creatine. You can dissolve that in water, which is a great way to take your creatine, but it's not strictly necessary to mix it in water. It just makes it a little bit easier to ingest than dry scooping creatine.

Brent: So you could dry scoop the creatine into your mouth and it would be fine. What I do is take it with a glass of water. Let's talk about why it's beneficial, but first, what are the side effects? Personally, I take it on an empty stomach or after my morning meal and it doesn't bother me. What are the negative side effects?

Brent: It doesn't give me a stomach ache. What are the negative side effects?

Scott: That's one of the best parts of creatine: it's probably one of the safest supplements on the market. There have been hundreds, if not thousands, of creatine supplementation studies, showing very few side effects. A few people experience GI distress, but that's less than 5% of the population.

Typically that's during the loading phase. People will take 20g per day for 5 to 7 days to saturate their muscles with creatine. That's when we typically see some GI distress, even though it's relatively rare. Other studies show that taking a lower dose of creatine will minimize those side effects.

Scott: You can still get very similar benefits.

Brent: When you say GI distress, you mean a stomach ache?

Scott: Exactly. You might feel a little discomfort in the stomach.

Brent: Even in those cases, you're not worried about real long-term harm. It's just uncomfortable.

Scott: Absolutely not. There is no real negative side effect associated with creatine. There is an idea that it creates more stress on the kidneys, but in recommended doses, there's zero evidence showing it induces stress on the kidneys. There are a couple of case studies where people consumed massive amounts of creatine—over 200g per day—which is huge.

Scott: They had some kidney dysfunction, but in recommended doses, it's very safe.

Brent: And what are the recommended doses?

Scott: People might take 20g per day separated into four doses throughout the day: five grams in the morning, five at lunch, five at dinner, and five before bed. You do that for about a week to saturate your muscles with creatine, and then move to a maintenance dose, typically between 3 to 5g per day.

Scott: You can continue that long-term or cycle on and off. We also know that taking a lower dose, as low as three grams per day, will eventually saturate your muscles, though it takes longer than a week.

Scott: It might take about four weeks to saturate your muscles.

Brent: I'm taking around five grams in the morning using a small scoop. How might you contextualize five grams for someone who isn't familiar with measuring in grams?

Brent: How would you describe five grams for someone unfamiliar?

Scott: A level teaspoon is equivalent to five grams. A heaping teaspoon would be around 6 or 7g.

Brent: It's also worth noting there is virtually no taste to it. It's not extremely bitter or difficult to swallow; I put it in water and drink it easily.

Brent: It doesn't taste bad or awful.

Scott: No, it has virtually no taste. Other supplements, like beetroot juice, improve performance but taste terrible, which keeps them from going mainstream. Creatine has no real taste.

Brent: No negative taste and very few side effects outside of incredibly high doses. Regarding the loading versus maintenance phase, is loading necessary for general health, or is it mostly relevant for weightlifters?

Brent: Yeah.

Scott: The main difference is how rapidly it saturates your muscles. Someone wanting benefits quickly can do a loading phase, but for 99.9% of the population, it's just about filling your muscles over time to support training adaptations.

Scott: It's not necessary to get it in as quickly as possible. For most people, I suggest 3 to 5 grams daily. Five grams is common because creatine can leave residue in the glass, so five grams ensures you meet at least the three-gram target.

Scott: Okay.

Brent: So the loading phase would be 20g a day for seven days, split into four five-gram doses, followed by 3 to 5g daily for maintenance long-term. I take mine with water in the morning after eating, but does timing or consuming it with food matter?

Brent: Is that typically how it's ingested?

Scott: That's typical. We conducted studies looking at the best time of day to consume creatine and found it doesn't matter whether it's taken before exercise, after exercise, or before sleep. Maintaining muscle saturation is the key factor.

Scott: Timing isn't critical. Mixing about a teaspoon with water and drinking it is completely effective.

Brent: Another common association with creatine is that you need to drink a lot of water. Do you really need to significantly increase water intake to get full benefits?

Brent: Why would someone need to drink more water?

Scott: It's partially true. When you start taking creatine and it enters the muscle, it draws some water into the muscle cells. However, muscles regulate water well, so you won't have waterlogged muscles indefinitely.

Scott: Studies show that after eight weeks, muscle water levels reset. Muscle is naturally about 75% water anyway. You draw a bit of extra water initially, but that's about it.

Scott: It isn't necessary to consume excessive amounts of extra water alongside creatine.

Brent: So that's mostly a myth. You don't need to drastically increase water intake to get benefits.

Brent: That's fine.

Scott: Yeah. Absolutely.

Brent: Is it also a myth that taking creatine makes you look stronger simply because your muscles hold extra water weight and look bulkier?

Brent: Is that also mostly myth?

Scott: That's mostly a myth. Combined with resistance training, creatine helps build muscle size and strength. We recently conducted a review to quantify how much muscle growth occurs.

Scott: We examined ultrasound studies measuring bicep thickness—from the bone to the subcutaneous fat layer.

Scott: Comparing creatine against placebo groups over a training program, creatine increased muscle thickness by about one millimeter. That quantifies the direct effect.

Scott: It won't turn you into Mr. Olympia overnight, but it is effective, even if the individual effect size is modest.

Brent: Is that increase due to stored water, or because creatine makes muscle function more efficiently, allowing you to lift more and grow muscle faster?

Scott: Initial water influx into the muscle cell over the first 1 to 3 weeks actually triggers cellular pathways for muscle growth. A study in Brazil evaluated water content versus solid muscle tissue mass.

Scott: After eight weeks, the water-to-protein ratio remained normal while total muscle mass grew. So over time, it fosters true tissue growth, not just temporary water retention.

Brent: Why is creatine so heavily linked specifically to strength training in popular culture? People often connect it directly with bench pressing and heavy lifting.

Brent: Where does that strong association originate?

Scott: It stems from how creatine functions. Converting to phosphocreatine fuels short, high-intensity, explosive bursts of exercise lasting under 15 seconds.

Scott: Resistance training relies heavily on that energy system. Supplementing expands that capacity, helping you perform better in the gym to build strength and muscle mass.

Brent: What types of exercise or athletes should avoid creatine? Should a marathon runner take it, or are there drawbacks for endurance sports?

Scott: You gain a small amount of body mass. Our systematic review showed an average increase of about 0.86 kg (roughly 2 lbs) of body mass, which can affect performance in weight-sensitive sports.

Scott: Marathoners might avoid extra mass, but it can still benefit endurance athletes like cyclists during surges, pace changes, or sprint finishes where high-intensity energy systems are critical.

Scott: There is less research on endurance performance, but there is a solid rationale for certain endurance applications.

Brent: So the main potential downside for athletic performance is simply gaining around two pounds of mass.

Scott: That is the main consistent side effect. However, that mass gain represents lean muscle tissue, and emerging evidence suggests creatine may even assist with slight fat mass loss.

Scott: It improves overall body composition, so even if weight increases slightly, gaining muscle while losing fat mass is a positive outcome.

Brent: Muscle stores glucose and supports metabolic health in several ways. The weight gain is actual muscle tissue rather than just water weight.

Scott: Muscle tissue naturally contains around 75% water, but you gain functional muscle mass, which provides real benefits.

Scott: Strong data demonstrates increased muscular force and strength. Fluid retention alone cannot generate contractile force—that requires functional muscle protein.

Brent: I exercise regularly for long-term health. What are the broader benefits of creatine for general wellness, such as cognitive or brain health?

Brent: What are some less understood benefits supported by research?

Scott: Emerging data suggests nootropic benefits for brain function. While muscles rely on external intake or liver synthesis, the brain synthesizes some of its own creatine.

Scott: Supplementation can increase brain creatine levels, supplying rapid energy during cognitive stress. The brain consumes roughly 20% of daily energy despite accounting for only 2% of body mass.

Scott: It's a very energy-demanding tissue. While social media hype sometimes overstates brain effects for young healthy adults, specific populations show real cognitive benefits.

Scott: In older adults, sleep-deprived individuals, or under conditions of mental fatigue or hypoxia, creatine helps preserve memory and cognitive performance.

Brent: Are there other health benefits, such as reducing diabetes or cardiovascular risk?

Brent: Are there ancillary medical benefits?

Scott: Skeletal muscle clears most blood glucose. Creatine upregulates GLUT4 glucose transporters in muscle cells based on animal research.

Scott: This may improve insulin sensitivity and lower diabetes risk. Preliminary research also investigates vascular health, bone density, and neuroprotection.

Scott: Combining creatine with strength training enhances bone mineral density more than strength training alone.

Brent: Who should avoid creatine? Would you recommend it to teenagers, older adults, or specific groups?

Brent: Who should avoid taking creatine?

Scott: Studies show safety in adolescents, but I generally advise against pushing supplements on kids under 15 or 16. It's better to prioritize whole foods, sleep, and consistent training habits.

Scott: For elite competitive adolescent athletes doing everything else right, low-dose creatine can be considered.

Scott: I do not recommend creatine during pregnancy or breastfeeding due to a lack of robust safety data. Creatine supplementation elevates breast milk levels, but long-term impacts on infant development remain unstudied.

Scott: Until thorough clinical trial data exists, caution is warranted for pregnant and nursing mothers.

Scott: As more safety data emerges in coming years, clinical guidelines may update.

Brent: So the caution for teens and pregnancy stems from a lack of research rather than direct proof of harm.

Brent: It's about taking a prudent, responsible approach.

Scott: Exactly. Individuals with chronic kidney disease should also avoid it due to missing safety protocols. Patients on dialysis lose significant muscle and endogenously stored creatine.

Scott: While they might theoretically benefit, we advise against use without clear clinical trial validation.

Brent: What about age and gender differences? Should a 70-year-old woman take it, and how do benefits vary between men and women?

Scott: Creatine benefits individuals across the lifespan. In older adults, it preserves muscle mass, strength, and functional capability, such as sit-to-stand movements, reducing fall risks.

Scott: Females naturally maintain slightly higher baseline intramuscular creatine stores than males, making them slightly less responsive in total hypertrophy gains.

Scott: However, women gain full strength benefits without substantial, unwanted bulky muscle gain.

Brent: Is that difference absolute or proportional to average baseline body size differences between men and women?

Scott: Our reviews indicate clear absolute differences in muscle mass accumulation, but on a relative percentage basis, response rates appear quite similar.

Scott: Relative percentage gains between sexes are comparable when accounting for overall body size.

Brent: So the primary difference comes down to baseline muscle building, rather than a unique reaction to creatine itself.

Scott: That is correct.

Brent: If a skeptic argued against creatine, what would their main critique be?

Brent: What is the strongest counterargument?

Scott: They might argue that you should rely strictly on whole food sources or that social media overhypes the magnitude of benefits. I agree social media inflates claims, but getting optimal creatine from diet alone is extremely difficult.

Scott: For instance, salmon contains creatine, protein, and omega-3s, but you would need to eat 2.5 pounds of salmon daily to obtain five grams of creatine. Supplementation fills muscle stores efficiently in ways whole food diets struggle to reach.

Brent: There isn't a strong counterargument based on harm. Critics mainly point out exaggerated online claims and urge prioritizing sleep, nutrition, and exercise.

Brent: Outside of youth, pregnancy, or kidney disease, research supports its efficacy across all adult age groups.

Brent: While fundamental lifestyle habits remain primary, diet alone can't fully replicate supplemental creatine dosage.

Scott: I agree that basic habits come first. Everyone should exercise, resistance train, eat whole foods, and sleep well. Most fitness results stem from consistent effort over time.

Scott: People often overcomplicate minor variables like protein timing or exact set counts, whereas 90% to 95% of progress comes simply from showing up and training hard consistently.

Brent: Once lifestyle fundamentals are nailed down, adding easy, proven habits makes sense. Creatine is simple to mix with morning water, has no side effects, and provides clear biological benefits hard to match through diet.

Brent: I take basic supplements alongside my morning water, so adding creatine is effortless.

Brent: Since diet alone won't provide five grams, adding creatine feels like a simple decision.

Brent: It feels like a straightforward addition to a wellness routine.

Scott: It is one of the easiest, safest supplements available, with strong scientific backing explaining exactly how it provides energy to muscle and brain cells.

Scott: Unlike supplements with questionable mechanisms—like l-carnitine, which fails to increase mitochondrial transporters—creatine consistently elevates tissue phosphocreatine levels.

Scott: Solid scientific evidence confirms that supplementation increases muscular creatine stores.

Scott: Having more phosphocreatine provides extra cellular energy, helping you train harder to build strength and muscle over time.

Brent: When shopping for creatine, what specific type or quality markers should buyers look for?

Scott: Stick to creatine monohydrate. Companies advertise alternative forms claiming better solubility or lower GI distress, but no scientific evidence proves superior efficacy over monohydrate.

Scott: Creatine monohydrate is the most effective and affordable form. Most global raw creatine monohydrate is manufactured in either Germany or China.

Scott: Much research utilizes Creapure, manufactured in Germany, known for high purity and rigorous quality control standards.

Brent: Why is manufacturing limited primarily to Germany and China? Is it difficult to produce?

Scott: Specialized manufacturing facilities require significant capital investment. Creapure in Germany maintains a well-established, clean manufacturing facility.

Brent: Look for Creapure creatine monohydrate when purchasing.

Scott: Many brands formulate using Creapure, displaying its seal on the label. Furthermore, select products verified by third-party testing organizations.

Scott: Look for certifications from independent testing bodies like NSF, Informed Choice, or Informed Sport to confirm label accuracy and purity.

Brent: Where can listeners follow your work online?

Scott: Instagram is best: @scott_forbes_phd. I share research updates and answer questions about creatine there.

Brent: How dare you!

Scott: I regularly post scientific information on creatine, so that's the best place to connect with me.

Brent: Thank you, Doctor Scott Forbes. I am officially a creatine devotee and look forward to sharing this valuable information.

Scott: It was a pleasure to be here. I'm glad we could discuss the benefits of creatine.

Brent: Death Clock with Brent Franson is produced by Patrick Gudino, music by Patrick Lee, and hosted by Brent Franson, founder and CEO of Death Clock.