As a doctor, here’s my advice on creatine supplements
Creatine may make you stronger — but only if you meet certain criteria
I think this should be an unlocked link. https://wapo.st/4nGIHSt
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Still asks for an email address, unfortunately.
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I’m cutting and pasting the body from Apple News / Washington Post:
As a doctor, here’s my advice on creatine supplements
Creatine may make you stronger — but only if you meet certain criteria
Creatine is getting a lot of attention for its supposed ability to improve strength and cognitive function. There’s some validity to the creatine stampede: Multiple randomized controlled trials have found that creatine supplementation can create small but real boosts in upper and lower body strength — but only when combined with resistance training.
Without resistance training, creatine supplementation is useless — and really, it’s the resistance training we need to do more of in the first place. This is especially true for groups like postmenopausal women, adults taking GLP-1 medications, and older adults in nursing homes, who are all at higher risk of losing muscle mass.
So my advice is: Before you consider creatine, ask yourself if you’re doing enough weekly resistance training. Federal guidelines advise doing exercises specifically designed to strengthen muscles — like sit-ups, push-ups or lifting weights — at least two times a week.
If you’re not doing that, then my guidance on creatine is a real solid “nope.”
If you’re already training, and are in those higher-risk categories or just want a small edge, then it’s reasonable to discuss creatine with your physician. Some people start at 3-5 grams a day, although for women, higher doses may be helpful. But remember: Creatine isn’t a magic bullet. The magic is lifting consistently. Master that first.
What is creatine?
Creatine is considered a nonessential nutrient because it’s produced naturally by your body. It can help form a compound called adenosine triphosphate, also known as ATP, an important source of energy for your muscles and organs.
Creatine supplements are sold as a powder, gummies or pills, but you can also get creatine in your diet from animal-derived foods, like beef or seafood. Plant-based sources don’t contain significant amounts of creatine.
What the research says about creatine
Strength
Meta-analyses of dozens of clinical trials suggest that the clearest strength and power gains show up in men and among adults below age 50. For instance, younger adults taking creatine powder while resistance training improved their bench and chest press strength by roughly 4 pounds compared with training alone. Some might feel that 4 pounds isn’t life-changing, but especially for higher risk groups, a small edge may be worth it. (One caveat: As with most research on supplements, several scientists in these studies have industry ties.)
Bone mineral density
As a physician, I’d love to see a benefit for my patients in bone mineral density, especially for postmenopausal women, and ultimately a reduction in fractures. Unfortunately, there have been no real-world studies clearly showing this is the case.
A large randomized controlled trial of postmenopausal women doing regular resistance training found that creatine did not improve bone mineral density compared to placebo over two years. The same group had previously studied creatine supplementation for one year and saw some initial improvements in bone mineral density at the femoral neck (the most common site for hip fractures), so it was disappointing that this did not appear to hold in the long term. It’s harder to remain compliant with creatine supplementation long-term, which could account for this difference.
Phil Chilibeck, a professor of kinesiology at the University of Saskatchewan and the first author of both studies, noted that even if a clear improvement in bone mineral density didn’t pan out, the two-year study still demonstrated other small but statistically meaningful benefits from creatine.
Creatine helped increase walking speed and the geometric arrangement of bone — which, although not quite the same as bone mineral density, also “theoretically leads to higher bone strength,” Chilibeck said in an email.
“Is it worth it? I would say it is relatively inexpensive and better than most of the other supplements out there for increasing muscle mass and functional performance,” he said. But, Chilibeck cautioned, “most people can expect only relatively small improvements.”
Performance
Other studies have shown increased performance during short periods among female athletes taking creatine powder, which scientists believe is because creatine can add a burst of energy that helps people work a bit harder.
And creatine powder combined with resistance training may help older adults with functional ability, such as standing up from a chair as many times as possible in 30 seconds without using your arms.
Cognitive function
The data on cognitive function is still in its infancy, and it’s mixed. For instance, a 2013 randomized double-blind placebo controlled trial of older women did not find that creatine supplementation improved cognition or depression, while a small handful of observational studies have reported a positive association with memory testing and creatine intake among older adults (including from dietary sources — and not necessarily supplementation). More research on how creatine supplementation impacts the brain is still needed.
How much creatine should you take?
Start by discussing creatine with your physician, especially if you have kidney disease, as some case studies have found an increased risk of damage among those with baseline disease.
In terms of dosage, even 3 grams of creatine powder a day has been shown to be as effective in the long-term, at least for healthy men. For women — particularly, postmenopausal women — higher doses may be helpful, and studies suggest that 5-10 grams per day is optimal.
One common approach for boosting muscle creatine stores quickly, which is used in several studies, is to take a “loading” dose of about 20 grams daily (broken up into smaller doses of 4-5 grams throughout the day) for about a week and then transition to a “maintenance” dose in the range of 3-5 grams. But in people who take 3-5 grams daily, studies have found muscle creatine stores reach similar levels after about a month.
Should I take creatine and protein powder?
Protein powders — like whey, pea or soy — are often taken to support muscle recovery after exercise, and it’s common for people to take both protein and creatine supplements. It’s worth keeping a few things in mind though:
Protein powders are composed of essential amino acids, meaning they are not made naturally by the body, and so we need to get them from our diets. Most people get enough protein from what they eat. But older adults, women and highly active people should pay closer attention.
The U.S. Food and Drug Administration does not approve or regulate dietary supplements in the same way as prescription medication, and a report from Consumer Reports released in October found that more than two-thirds of the 23 protein powders tested contained more lead in a single serving that they considered safe to ingest in a day, which they cite as no more than 0.5 micrograms. Formally, the FDA says there is no safe level of lead exposure — and of note, none of the powders tested were creatine powder specifically. But it’s worth considering whether bringing supplements into your body is truly necessary — and worth the potential risks — especially for people who are pregnant or are in other high-risk groups.
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Since I do muscle resistance workouts 
every other day… I have creatine in my morning coffee daily and in a espresso size cup of coffee just before my workout. I found it helps me easily push through.
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This is very conservative advice. Dr Rhonda Patrick has done a series of podcasts on the positive benefits of creatine in large doses for aging individuals. One of her guests noted tgat you shoukd NOT take it in coffee or anything hot. But thecreak takeaway deals with neurological benefits. But apparently you have to take 20+ grams beforevitvreaches your brain.
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Yes, you need to take creatine in a cooler liquid like an iced coffee. It’s the heat that kills the supplement.
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I understand your concern… but, my reading says coffee isn’t hot enough to degrade it… and my blood panel says I am getting ample in my blood.
No, hot coffee does not ruin creatine, but excessive heat can cause it to break down into [creatinine], a less effective compound.
Drinking creatine mixed in hot coffee is generally safe, as coffee isn’t hot enough to cause significant degradation, and the creatine remains stable for the short time it’s exposed to heat. Mixing creatine in warm liquids can actually improve its solubility.
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I’ve been taking 5g creatine as a pre exercise supplement for many years. I added 5g post exercise about six months ago. For young fit adults the benefits of this regime may be minimal.
There is some evidence that creatine offers benefits for memory and cognition in older adults at 10g / day. It’s safe, I take it with daily whey protein, “and I’m
feeling good…” Someone should make that into a song.
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Thanks @Beth for sharing the full text. But I think it’s typical media drivel, and vastly overcomplicates things.
Creatine is very well researched, and is extremely safe. I don’t think a person needs to consult a doctor before taking it. And you also don’t need to work out in order to take it. They say that like it’s gatekeeping who is allowed to take it. Cognitive/neural benefits would be independent of lifting.
I also think people massively complicate the dosing and rituals around it. Creatine builds up in the body over a long time. There’s no need to “load” 20g/d. All you do is take 3-5g per day, every day, and that’s it. Since creatine monohydrate has no flavour, and (if you buy micronised creatine) it mixes well, I just take a scoop in my protein shake in a morning. Or I just take a spoonful directly into my mouth and swallow it with water. Nothing complicated.
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Thanks for all the comments. I’ve learned more from them than from the article. 
I’d still do the loading phase if I were just starting creatine. Why wait a whole month to get the full benefits when you can be fully loaded in a few days?
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The problem with this article’s refference to the cognitive aspects of creatine supplementation being unproven is that no dosage is mentioned in those trials. New data shows that a higher dose than the 3 to 5 mg dose recommended for strength training is required to experience cognitive benefits… doses as high as 20 grams.
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An interesting topic. I took a tiny bit this morning after a pretty sleep deprived night. I was wondering if it would help with bone density but then I read this: Creatine Supplementation (3 g/d) and Bone Health in Older Women: A 2-Year, Randomized, Placebo-Controlled Trial - PubMed
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Important to note that these women were not exercising as part of the protocol. Creatine only really enhances gains and performance from exercise (and even then, only certain kinds of exercise). I wouldn’t expect it to do anything for the average sedentary person other than maybe cognitive benefits at higher doses.
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Have any of you experimented with taking the 20 grams for brain health? And if so, do you take it all at once, or divide. I would prefer never taking this much :), but if enough people feel this is a real benefit, I am all in.
Also, for those who don’t like the taste of creatine powders…
Months ago, I shared I was taking creatine in capsule form because creatine tasted like baking soda to me. I had tried the Nutricost Creapure powder.
Interestingly, I recently gave a different powder a try, and now I am fine with it. There is a chance it’s just me, but my guess is that even if it’s supposed to be the same exact product, there might be differences from brand to brand (I wish I knew!). I went to the Creapure website and found a brand they said was licensed by them. Oddly Nutricost was not on there but BPN was and that is what I’m now using.
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Because a month is nothing in the grand scheme of something you’ll take for years, decades, or a lifetime.
And because the larger doses can cause GI distress in some people. If they stop taking it, get put off, skip days etc, that is worse in the long run.
And I know creatine is super cheap, but it’s also potentially wasteful to use 20g per day
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GI distress is minimal if one simply splits up the loading dose. Getting the positive effects quicker is highly motivating towards sticking with it long-term. The rapid increase in strength and high-intensity muscular endurance is much more noticeable than a very slow, gradual effect that comes over a month. So a few extra bucks up front for loading is worth every penny, IMO.
Just remember not to get too excited and tear a muscle or a tendon.
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FWIW: creatine mono-hydrate at normal doses to 2x causes diahrea for me 1/2 hr later. I’ve found slower intake like with a drink that takes me all day is a mitigation.
Creatine HCL at its lower doses seems to not cause same problem. The higher loading doses, 2g-3g-10g I’d never be able to get to. Should you be noticing similar bowel problems.
Best of luck, curt
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You often see recommendations to check with a physician before beginning supplements. I usually ignore these, as most PCP want patients to avoid more than minimum supplements. I started taking the standard recommended dose of creatine last January. In July my blood work was off the chart in bad ways connected with potential kidney issues. Yes, I had read that although creatine supplementation could increase certain kidney-related blood markers, it was only the markers that were a problem, not the kidneys. I followed the doctor’s advice and discontinued the creatine, then retested a month later. The blood markers had considerably improved. It was now up to me to make a tough decision. I really wanted the creatine because I am starting to see some signs of sarcopenia. However, I do not want kidney failure to interrupt my plans and efforts for a long and happy healthspan and lifespan. What would you do? There are more options to help sarcopenia than to help advanced kidney disease. I chose to skip the creatine and have not regretted my decision. I suppose that indicates that I am not a gambler by nature. My suggestion to others? Start creatine supplements about 2 months prior to your next scheduled blood test, check the blood markers related to kidneys when you receive the results to be sure you are improving, not injuring, your health. I have taken other measures to treat sarcopenia.
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If you really want to improve your kidneys, you should look into an SGLT2I such as empagliflozin. I take both empagliflozin (12.5 mg) and creatine (10 g) and I have great eGFR and Cystatin-C scores.
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