Ep. 340 AMA: Creatine’s Impact on Metabolic Health and Wellness with Dr. Darren Candow
- March 2, 2024
- No Responses
Today, I am delighted to reconnect with two previous guests, Dr. Darren Candow.
Dr. Candow is a distinguished professor and an internationally renowned researcher on creatine monohydrate, nutrition, and physical activity who joined me before on Episode 301, where we spoke about creatine.
We are doing an AMA session today, delving into various themes surrounding creatine, from debunking outdated RDA recommendations to exploring the synergies between strength training and creatine efficacy. We look into the cognitive benefits of creatine, exploring how it interacts with caffeine and its implications for bone health, hydration, anabolic resistance, and metabolic health.
I trust you will find today’s AMA session as enlightening and enriching as I did while recording it.
“You can put your creatine in Greek yogurt after a workout and get all the benefits.”
– Dr. Darren Candow
IN THIS EPISODE YOU WILL LEARN
- The safety and efficacy of creatine as a supplement
- How creatine increases muscle mass and reduces protein catabolism
- The benefits of combining creatine with protein
- Is it better to take creatine before or after a workout?
- How creatine supplementation may improve brain performance and mental clarity
- Why exercise is essential for those who want to experience the benefits of creatine for maintaining their bone health
- The benefits of resistance-band workouts for post-menopausal women
- Are there any age-related limits for creatine supplementation?
Bio: Dr. Darren Candow
Dr. Darren Candow, PhD, CSEP-CEP, is Professor and Director of the Aging Muscle and Bone Health Laboratory in the Faculty of Kinesiology and Health Studies at the University of Regina, Canada. The overall objectives of Dr. Candow’s research program are to develop effective lifestyle interventions involving nutrition (primarily creatine monohydrate) and physical activity (resistance training), which have practical and clinical relevance for improving musculoskeletal aging and reducing the risk of falls and fractures. Dr. Candow has published over 120 peer-refereed journal manuscripts, supervised over 20 MSc and PhD students, and received research funding from the Canadian Institutes of Health Research, Canada Foundation for Innovation, the Saskatchewan Health Research Foundation, the National Institute of Health, and the Nutricia Research Foundation. In addition, Dr. Candow serves on the editorial review boards for the Journal of the International Society of Sports Nutrition, Nutrients, and Frontiers.
Connect with Cynthia Thurlow
- Check out Cynthia’s website
- Submit your questions to support@cynthiathurlow.com
Connect with Dr. Darren Candow
Previous Episode Mentioned:
Transcript
Cynthia Thurlow: [00:00:03] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of reconnecting with two previous guests, Dr. Darren Candow, who joined me on Podcast Episode 301, Diving Deep into Creatine, he is a distinguished professor and internationally renowned researcher on creatine monohydrate, nutrition and physical activity. I am also joined again by Chris Irvin, who has been a twice previous guest on Episode 175 and Episode 219, which was the number one most downloaded podcast of 2022.
[00:01:01] Today, we did an AMA format diving into creatine themes including supplementation, the outdated RDA, the role of strength training, how to potentiate the effects of creatine monohydrate, brain benefits, the interactions between caffeine and creatine, bone and exercise, hydration, anabolic resistance, and metabolic health. I hope you will enjoy this AMA format as much as I did recording it.
[00:01:33] Welcome back.
Dr. Darren Candow and Chris Irvin: [00:01:34] Thank you for having me. [laughs]
Cynthia Thurlow: [00:01:36] Chris Irvin is back on the podcast. It’s great to have you both. I thought this would be fun to do an AMA episode talking about one of my favorite subjects, which is creatine monohydrate. And for listeners, again, got hundreds of questions. And from the hundreds of questions, I tried to synthesize themes so that we could stay really nicely organized, curious. How does creatine differ from essential amino acids? Is it necessary to take both? I got this question multiple times. There’s a lot of confusion about how they are different mechanistically, are they both necessary? Do you have any thoughts on this?
Dr. Darren Candow: [00:02:13] Yeah, there’s a big difference. Without essential amino acids, you die. Without creatine, we can still survive because we can make them. So, essential amino acids are found from food products or supplements because we can’t produce those in near the quantity that were needed to basically keep our body alive. Enzymes, hormones, bone, muscle, everything we need. So, protein is an essential macronutrient.
[00:02:33] Some people like to call creatine conditionally essential. But keep in mind, creatine is basically formed from indispensable or essential amino acids and nonessential, so we’re naturally producing it in the body like a lot of our proteins. However, unlike essential amino acids, which are required to keep you alive, essentially, I think the little bit we produce in our brain and kidneys can keep most people very healthy and functionally as well, so that’s an excellent question. I’m glad it was essential amino acids versus individual amino acids, there’s a huge difference. Essential amino acids are very important. They can improve a lot of beneficial things with muscle growth, whereas the branched chain may be a little limiting, at least with the essential. And I know there’s a big EAA-9 new template coming out which is great for individuals to look at food products that have a lot of these essential amino acids. So, there’s a huge difference between a creatine and the critically important essential amino acids.
Cynthia Thurlow: [00:03:29] Thank you for that, because I feel like that question in light of branched chain amino acids, the essential amino acids and trying to make sense of what supplementation is really most important. I think that’s the crux of the conversation, is that a lot of people feel a sense of overwhelm and they’re hearing different information from different individuals and they’re trying to determine what for me is most important. And it was interesting, I was reading a tweet from Dr. Don Layman, and someone was asking him about essential amino acids and his answer was, “If you are getting in at least 100 g of protein a day, I think it’s probably not necessary.” And I thought that was a very thoughtful answer. This is obviously the predecessor to Dr. Gabrielle Lyon, the person that’s influenced so much of her work, the work around mTOR. And I don’t know if you feel any similarities to his response was or if you have an opinion about that. Is it essential to necessarily purchase, taking essential amino acids as opposed to just getting them from food sources if you’re getting in adequate amounts of protein.
Dr. Darren Candow: [00:04:31] Yeah, the RDA, I think most of us would agree it’s outdated and so let’s do a quick math, if you’re 70 kg and you take 1.2 g/kg that’s only 84 g. So, Don is obviously one of the world’s best. Bob Wolf, Stu Phillips, the list goes on and on and they all come to the same agreement, that if you’re getting 100 g of protein or more for the average person, not the offensive lineman in the NFL and things like that, but for the average person, that’s around 1.4 g/kg, 1.6 g/kg certainly shown to be exceptionally beneficial and probably the maximal amount we can utilize for muscle protein synthesis and benefits.
[00:05:10] And the other nice thing is we’ve gone, 10 years ago, the timing of protein seems to be kind of interesting, then we got to the source, but they all conclude one thing. If you get your total daily amount, you’re checking off all those boxes. So, for example, if you’re getting over 100 g of protein, there’s a good chance they’re high-quality proteins. They have all the essential amino acids. You’re hitting the leucine threshold, which is probably easy to do. You’re having protein distribution, so you feel fuller throughout the day that may help increase fat loss or satiety over time, and the total daily amount seems to be now the most important. And I think if you’re getting 100 or 150 g of protein, all those other small trivial things are checked off. So, if you say, I take a whey protein supplement, I have tofu, Greek yogurt, salmon. You know what? I would agree supplementation is not needed, but I tell my students it’s a sure convenient way to get that total daily amount. It tastes good. The food labels are typically good where you know exactly what you’re getting. And I use a whey protein supplement and I mix it with my Greek yogurt. And I try to get about 40 or 50 g of protein in the morning and definitely at lunch or supper as well. That middle meal may not be the most important. I think you turn on the process in the morning and then again later on in the evening. And then I add in a few other meals a day.
[00:06:23] So, in Canada, I try to get a gram per pound. I’m about 190 pounds, and that’s way too much, but it snowed last night, the environmental conditions are coming, and protein is used for your immune system and hormones and enzymes, and I think we take protein for muscle, but God, it does a lot of other benefits. And I love the satiety of a protein dense meal. I don’t know what Greek yogurt is made from, but it’s sure thick and it fills me up most of the morning, so I agree. I think if you’re hitting that much protein, you’re probably doing very well and way better than most of society.
Cynthia Thurlow: [00:06:56] Yeah, I think the average that I see with most women is they’re probably doing a total of 50 or maybe 60 g of protein a day, and that’s just not enough to offset the sarcopenic loss that is occurring north of 40. Chris, what are your thoughts? I know that you are very conscientious about your nutrition as well.
Chris Irvin: [00:07:14] Yeah, actually, I kind of had a question while we’re on the topic of the whole foods. I know we’re talking a little bit more about essential amino acids, but as it relates to creatine, I was kind of drawing a blank on the exact numbers, but I was doing a calculation the other day, because I take somewhere between like 5 and 10 g of supplemental creatine a day. And I think when I did the breakdown of how many ounces of beef I would have to eat to get that amount, it was like somewhere between 38 and 76 ounces to get to that, which is pretty crazy. And I’m happy to answer that one too, Cynthia, but while we’re on that topic, I’d love to get your take on how that relates to creatine If you feel like– Is there a realistic threshold where maybe is 5 to 10 g too much and we don’t need that because it’s maybe more than we would get from whole foods realistically? Or is creatine one of those amino acids where we should supplement because we can get that maybe super physiological dose that we can’t get from whole foods?
Dr. Darren Candow: [00:08:02] Yeah, it’s a tough one. So, I personally take 10 grams or more a day, and I’ve been doing this along, for the last few years when the bone and brain formation started to come into play, and we can talk about different tissues. But you’re absolutely right to get even 3 g of creatine through your food, you’re eating one to two servings of red meat or seafood or pork. Again, what happens to vegans, vegetarians, plant-based diets, people who can’t afford that super expensive food nowadays, their allergies, or the ethical treatment of animals, there’s a number of factors. Unfortunately, plant-based products have no creatine. I think we all know William Walsh, he put out 250 kg cranberries just to get a small dose.
[00:08:42] And again, that small dose is in addition to what we’re making and offsetting what we’re excreting down in our urine just to potentially accumulate in the body. And I think that’s a little bit different. Creatine is probably easier to go from a supplementation standpoint. But if you’re eating two or three or four servings of steak and seafood a day, my argument is you’re totally full in the body at least by the muscle creatine. We don’t know the effect in the brain, but my guess is it would probably be accumulating over time. So, anybody on a carnivore diet probably won’t respond really noticeably to the supplement. But then I argue, we’ve done studies in vegans so holy cow, they really improve exercise performance, reps to fatigue, lean tissue mass because they’re doubling this energy currency of the cell. So, it’s something to consider and we can talk more about that today, but I kind of look at supplementation and diet differently. I try to eat a lot of seafood because you get the omega-3’s and the essential fatty acids, but I add creatine on top of that to just have the extra benefit. If some is being converted to creatine, that’s fine, but we have trickle amounts going to our bone and brain, and I think that’s an area that’s often overlooked. And so having a bit more might be advantageous from a whole-body perspective.
Chris Irvin: [00:09:56] Yeah, I think that’s fascinating, because even I’m somebody that eats more closely to a carnivore diet, probably 80% of my diet coming from meat. And when I cut out supplementation, like if I’m on a trip or something for a few days and I don’t bring creatine supplement with, I notice it so much more than really any other supplement that I’ve ever taken, so that’s why I was so curious about it, because I’m definitely always in the camp of like I would like to get everything I can from whole foods. I’d like to try to cut out as much supplementation as possible. But that one seems like the one where if performance goals are kind of up there on your hierarchy of goals, it just makes a lot of sense to add it in it seems like.
Dr. Darren Candow: [00:10:30] Yeah, absolutely.
Chris Irvin: [00:10:31] Yeah.
Cynthia Thurlow: [00:10:32] Another common question was, it made me laugh, not because there weren’t many people that asked this question, but I was like, it’s consistent with other things that we talk about in the body. Since our body naturally makes creatine, will taking exogenous creatine halt my body’s own production of it? Might seem silly, and this was Tracy’s question.
Dr. Darren Candow: [00:10:48] Oh, certainly not silly. That was the biggest thing when EAS, the pioneering supplement company came out. The theory was that, well, if we naturally produce it, just like, take for example, insulin, if you synthetically inject insulin when your pancreas doesn’t need it, there is some theory that it could downregulate that and that was happening in professional bodybuilders. So, the theory was, well, if you’re taking a supplement, you’re naturally producing maybe the body says, “Whoa, I’m going to rest and take it in.”
[00:11:14] There was a single study done in mice, it was actually a rodent model, and it was shown to downregulate its natural production, but as soon as they stopped taking the super physiological dose, it came back. We’re not aware of any good evidence in humans. I guess the theory would be the liver is going to be making it, the brain is going to be making it. Anything additional, which is nice for the human body will accumulate in the tissues. We now know it’s not just muscle, and any extra could be dumped down the toilet in the form of creatinine. So, we’re not aware of any good data in humans that it does downregulate the natural production.
Cynthia Thurlow: [00:11:46] It’s really interesting because I know even with the use of melatonin it could be controversial, people say, well, “You make less of it north of 40, but if you take some of it as you’re making less of it, is that problematic?” So, I think that’s certainly a reasonable question. Does creatine lead to an increase in body fat? This was Kelly’s question again, a question that was asked many many times.
Dr. Darren Candow: [00:12:09] Yeah, so we just published the second meta-analysis last week looking at adults 49 and younger. So, if you look at adults 18 to above, when they combine it with resistance training, we saw no increase in body fat across any population. We actually saw a small decrease in percent body fat. It was significant, but it was less than about 1%. So collectively, you should probably conclude that creatine does not increase fat mass. It’s probably going to have a minimal, trivial effect if you’re really going through the weeds.
[00:12:38] The whole theory here is that if you take creatine where it is osmotic, some individuals experience acute water retention or maybe the number on the scale may go up, but probably based on the dose and the length of time you’re taking it, and if it is a water fluctuation or distribution, a lot of people feel like, “Hey, I’m a little bit heavier or a little bit more bloated,” maybe on the loading phase, but we’re not seeing any evidence it increases fat mass. If anything, it may have a beneficial effect whole body energy expenditure.
Cynthia Thurlow: [00:13:07] Yeah, it’s interesting. Both my teenagers take creatine and my youngest son, who’s put on quite a bit of muscle in the past year. I mean, he is so conscientious and he actually listened to the podcast we did together and now he is taking 10 g a day, because for him, he was like, “I like this brain element. I like knowing that a little more will cross the blood-brain barrier.” And he attends a pretty intense school, so for him, he’s like, “It’s helping my brain and my muscles.” And so, for him that is definitely something that he thinks about quite a bit. How about, I know that we had talked last time that creatine and caffeinated beverages don’t meld well together. Is there anything that we should not take creatine with at the same time? I know caffeinated beverages. Is there anything else, any other liquids or foods that you should not take it concurrently with that may impact or lessen its ability to be as efficacious?
Dr. Darren Candow: [00:13:58] Yeah, it’s a hot topic. So, let’s start with the first one to sort of clarify. I think even for some of your viewers around the caffeine, because a lot of people immediately say, coffee, caffeine, it’s the same, and not really. So, the studies that have looked at the interference with caffeine have typically done pills or powders, and some have done solution. However, the dose is usually around at least 250
. So, if you think of a normal cup of coffee is about 80, that’s about three cups, okay, and that’s usually done with a higher dose of creatine. So, there’s only been about seven studies and good mechanistic data to suggest that those two metabolites sort of interfere with one another. But if you were to put your creatine acutely in a cup of coffee and drink it really quickly, I highly doubt the acidity of the caffeine is going totally degrade the bioavailability of creatine. But if you do this over time, it could.
[00:14:49] So, I think maybe pre-exercise is caffeine, post exercise or throughout the day is creatine. But temperature will actually improve the solubility of creatine within a safe realm. If you were to boil it would degrade it quicker to creatinine, and I don’t think I’ve heard of anybody actually boiling something and putting their creatine in for a long period of time. So, a really long answer to a simple question. There’s probably really nothing that interferes with creatine. It could be taken in a gel, a lozenge, you can get it through your diet and meat. At the end of the day, it might delay the absorption or getting into the bloodstream. Solution is superior to meat, lozenge, candy, whatever, that will peak in the blood the quickest. I think that’s why a lot of people will just put their creatine in water or fruit juice, whichever. But the only thing we see an interference effect is high dose caffeine for longer periods of time.
Chris Irvin: [00:15:38] That’s funny, I’m sure you talked about this on the last podcast, but every single pre workout is like 250 plus. That is like the number too is 200 to 300 mg of caffeine, so I’m sure [crosstalk] of it.
Dr. Darren Candow: [00:15:49] May be there isn’t an interference effect. I got a lot of questions today, and I said, if it’s working for you just keep it. There’s cellular data to suggest they oppose one another. But the other thing, to your point about those pre workouts, there’s usually creatine and caffeine, and then there’s nine other things beetroot juice, leucine, beta alanine, sodium bicarb, so you never know what’s working. But at the end of the day, I tell people, “If you feel like it’s working, then why stop, really, unless it’s going to hurt you.”
Cynthia Thurlow: [00:16:16] I was laughing and saying one of the big takeaways from our last conversation was everyone was then paranoid to put the creatine in their coffee, and now, reassuringly, knowing that one cup of coffee is not going to offset the benefits, but if you’re having 20 ounces of coffee at one point all at once, then that might be the case. How about, do you feel that there’s certain amount of water that needs to be consumed while taking creatine? One listener said, I heard that it was a gallon or more a day in order to ensure that you stay hydrated while taking creatine, this is Paige’s question.
Dr. Darren Candow: [00:16:48] Yes. So, theory here is we don’t know the exact amount, but it’s certainly advantageous to consume more water, ideally to help maintain the plasma or decrease the viscosity of the blood. So, if the blood gets thicker, it has more hematocrit or cells in it, so it sort of could potentially fluctuate blood pressure or heart rate, but I always recommend to drink about two or three more glasses of water a day, that helps maintain the hydration not only of the muscle, but also the plasma or bloodstream, because hopefully, if individuals are taking creatine, they’re exercising and therefore sweat rate would go up, and you don’t want to have metabolic dehydration, so there’s not a fixed number. But in our research studies, we usually recommend to people to drink more water. Now, that could be an increase in fruits and vegetables, whatever vehicle they want to get, but water is just easy. And logically, if you have more water, it could allow a vehicle to get into the muscle cell a little bit quicker.
Cynthia Thurlow: [00:17:37] Makes a lot of sense. And that was, again, one of those questions that I got over and over and over again. Any specific contraindications or safety concerns about creatine? And I got questions about hematologic issues. We just talked about the hydration and viscosity specific to Factor V Leiden. So, people that are prone to clotting, is there anything to support that there’s a contraindication to using creatine?
Dr. Darren Candow: [00:18:04] Yeah, not that I’m aware of, it can– We’ve looked at blood cell count and function in those long-term studies, especially in the postmenopausal study for two years and found no adverse effects. And so, in theory I guess if the individual is dehydrated, that could cause some other abnormalities. But there’s no mechanistic reason why creatine itself, it’s an organic acid, would lead to blood clots. Now, it could influence blood pressure acutely if the individual is consuming too much fluid or not enough, where it will take some of the water from the blood into the cell. But all the studies and review papers I’ve read on cardiovascular health and function, there’s no adverse effects, if anything, there’s potential beneficial effects. So, specifically for blood clotting, thrombosis, there’s nothing that I’m aware of, no.
Cynthia Thurlow: [00:18:48] That’s certainly reassuring because there must have been multiple people who have some hematologic issues who were concerned and wanted to know if there’s any research suggestive of that.
Dr. Darren Candow: [00:18:58] I think, though, if they’re prone to hypertension which usually leads to potential risk for stroke and things like that, obviously medical clearance is going to be huge because they could be on a statin or any other type of medication that doesn’t normally interfere with bioavailability of creatine or vice versa, but we always like to have medical clearance for sure when they have a preexisting condition.
Cynthia Thurlow: [00:19:18] No. And what’s interesting is you had a really nice segue into a question someone asked, “Does supplementation with creatine lead to hypertension or lead to high blood pressure?” And I think a very reassuring message we want to make sure we send, “If you have chronic health conditions, if you have a specific concern, please talk to your healthcare provider, your prescribing provider to make sure this is the right decision for you.” For most other individuals, it sounds like it’s very, very safe. I know that we addressed this in our last conversation, but again, lots of questions about safety and efficacy with teenagers. Obviously, my teenagers take it and do really well with it, but any specific research about teenagers, young adults, in terms of efficacy?
Dr. Darren Candow: [00:19:55] Yeah, it seems to be the small body of research. It’s very effective for performing agility and performance measures, which we’re very accustomed to with creatine. No adverse effects from a subjective standpoint, such as doesn’t lead to an increase in GI tract irritation, cramping, nausea, things like that. Two good colleagues in the United States I mentioned last podcast, they are finally looking at blood biomarkers to look at these individuals who are younger in stature and age, to see is creatine at recommended dose just have any adverse effects on the development of the kidneys or liver or any other areas that we just don’t see in adults or even older adults. My guess is a small dose will certainly be tolerated. Again, it’s just three amino acids that our body recognizes. If it doesn’t recognize something, we always excrete it. And I think it’s no different than protein. It’s not going to have any detrimental effects. And I guess, why would creatine.
[00:20:46] A lot of people think it has steroid-like principles because it works. But when you look at the molecular structure, it’s identifiable by the body. It’s a bunch of carbons and nitrogen, hydrogen, and very similar to a protein. It’s made of three amino acids, unlike 20, and comes into our vital organs. And when the renal and lymphatic system, liver and kidneys, say, “Hey, I don’t need you anymore, you go to the bathroom.” And that’s kind of what happens. So, I don’t expect to see any detrimental effects, but it’ll be very interesting to get that data out there.
Cynthia Thurlow: [00:21:14] Absolutely. Chris, from a Sports Medicine perspective, any additional questions that you want to make sure we respond to on the podcast?
Chris Irvin: [00:21:22] Yeah, so I actually had it funny when you brought up the steroid one. Maybe I told the story, Cynthia, but I remember being in high school and there was a football player at a school like the town over, and everybody was– And he was a big strong guy, and everybody’s talking about how he’s taking some steroid that pulls water into your– It makes your muscles inflated with water. [Darren laughs] And everybody thought it was crazy. So, I always laugh when I think back on that. But I have a question related to when you were talking about the hydration and drinking a lot of water with the creatine. Is there any evidence that that would actually help with the improvements in body composition and specifically muscle mass? Kind of thinking about, if I’m not mistaken, I think that if we pull more water into the muscle and we can kind of swell those cells up, I think the mechanism is maybe through satellite cells, but that’s an opportunity maybe to stimulate more muscle growth. Do we have any evidence of that that more water with creatine would stimulate more muscle growth?
Dr. Darren Candow: [00:22:12] Yeah, that’s actually the whole premise of how creatine works.
Chris Irvin: [00:22:14] Okay. Yeah.
Dr. Darren Candow: [00:22:15] So, a theory here and this has been around since the late 1990s as well, that if you swell the cell, it sends a whole bunch of signals to turn on process involved in protein synthesis. So, you’re right, it increases transcription factors. It’s potentially proposed to increase satellite cells. And if satellite cells migrate around the muscle fiber and donate its nucleus, it has a greater capacity for protein synthesis. It’s also been proposed to increase insulin like growth factor, maybe decrease myostatin. So, there’s a plethora of mechanisms that have been shown to increase with creatine or decrease, and it was primarily based on the cell swelling. If you put water into the cell, it turns on, and so by hydrating the muscle, it gets larger and that might turn on the cascade of events.
[00:23:01] It doesn’t directly increase muscle protein synthesis at the ribosome level, but it sort of turns on all the other things involved. And kinase is in the mTOR pathway. And so, this cell swelling is probably the overarching idea of how this works of why people who say, “I’m a responder, I felt an increase in maybe body weight,” They’re going to respond more often than not. And it also has those anticatabolic effects. So if you swell the cell, that might help explain a decrease in protein catabolism or the anti-inflammatory effects. You’re correct, it’s kind of the area what pose is when the cell is swollen, these genes are expressed from DNA to RNA to a protein, and there’s a lot of things in those intermediate steps that get turned on.
Chris Irvin: [00:23:41] Nice. No, that’s great. Yeah. I’ve always kind of wondered if there was a– Because I think every time you read with the back of a supplement, there’ll be kind of the general recommendation of how much water to drink, but it seems like it’s going to be whole, whole day water intake that’s probably going to matter there.
[00:23:55] Another question that I had was we talked about things that could interfere with creatine’s effectiveness. Is there anything that can potentiate it? And maybe kind of two questions with that. One we talked about, like essential amino acids. One of the things that I always wonder is whenever we isolate something comes from a whole food are we missing out on any benefit of what would have been being consumed with it in its whole food form? So maybe in the terms of what you could get naturally in a food, is there anything that potentiates it? And then aside from that, is there any other ingredients that you could take? Whether it’s another– Something you’d find in a pre-workout or something you could take alongside of it that would potentiate it.
Dr. Darren Candow: [00:24:29] Yeah, it’s an excellent two-part question. Let’s start with the individual ingredients because it’s pretty clear. So, there’s two things that really seem to augment or increase some of the effectiveness of creatine, at least getting into the muscle, let’s focus on muscle, one by far is insulin or carbohydrate. So, I know that’s a faux paw for pretty much anybody on the planet when you say carbohydrates, we merely think of sugar. And I say, “Well, wait, what about fruits and vegetables and other things that we don’t really classify.” But high-glycemic carbohydrates, simple sugars will spike insulin, and that has been shown time after time to increase the amount of creatine getting into the cell.
[00:25:05] The downfall is a lot of the high-glycemic carbohydrates are really unhealthy and/or the amount you would need to consume is considered super physiological. So, a lot of people say, “I don’t like simple sugars, we know of toxicity, and it’s just a bad habit to get into. Is there anything else that you can take?” And I say, “Yes, there is, luckily there, it’s called protein.” And primarily, whey, which is very insulinogenic and gluconeogenic [unintelligible 00:25:29]. So, if you were to combine creatine with a protein, I would have guessed casein and other ones like that would do it, that will stimulate insulin and allow maybe creatine to get into the cell as well. And plus, you get the plethora of benefits by taking in protein, so that’s what I would recommend from a food ingredient.
[00:25:44] We’ll come back to probably the better one at the very end it has nothing to do with food. But from a food product, I totally agree, always emphasize food first. So let’s take, for example, I’m going to take away whey protein and creatine, great. But I’m like, “What if you chose the salmon steak?” You got omega-3s, calcium, vitamin D, some minor carbohydrates, you get all the potential vitamins and minerals, really high-quality protein and creatine, and you got to enjoy eating. You got to enjoy it with friends and family, and you kind of embrace what humans were kind of meant to do. So, food first, because you’re also probably going to have a salad and other things with the meal, which could provide that food matrix.
[00:26:26] Relying always on supplements can be difficult. They’re very convenient, but in today’s society, it might be a little bit easier to get it through your food. So that’s sort of where I look at it, food first, but if you’re looking at a quick shake or something after a workout, that’s easy to do. And then of course, you can put your creatine and Greek yogurt and you get all the benefits.
[00:26:45] But the other big one that a lot of people don’t realize is that exercise will stimulate your muscles to sort of open these doorways to allow creatine in. So, if you were to take creatine post exercise, that’s a really viable strategy that can be probably shown to increase creatine uptake into the body. The timing of creatine is probably irrelevant, but it’s been shown many times that if you exercise, then take creatine either before or after you work out, those transport kinetics seem to be turned on. So going back to the creatine-caffeine dilemma, I think most of us take caffeine before we work out to wake up, well, that’s great. Now you can take your creatine later on at supper whenever you want. They don’t necessarily have to be taken together if you don’t want. So, I think there’s some very viable, easy ways to do that.
[00:27:30] And the other alternative is maybe you don’t like taking creatine as a supplement, but you’re going to have supper later on, you’re going to respond three, four hours later, maybe chicken, seafood, whatever it is. Now, if you’re a vegan, it gets a little bit more tricky where you might have to consider a supplement.
Chris Irvin: [00:27:44] Another little question on that too. You bring up like the combining it with protein. So, you may have answered part of that, but I do want to maybe dig in a little bit more. If we’re thinking about pre versus post workout, I think that there’s several different goals, maybe for creatine, as it relates to performance, or maybe body composition. So, thinking about performance specifically, is there a benefit to maybe having that protein, creatine combo before the workout to try to drive that– And water as well to try to drive the creatine into the cells to improve that short-term performance? And depending on your answer there, would you say that one is better than the other pre or post workout?
Dr. Darren Candow: [00:28:21] Yeah, it’s an excellent question. So, if you take it before, let’s say people work out in the morning or in the afternoon, they say, “I just can’t work out faster on an empty stomach.” I’d say, “You’re going to experience a whole bunch of benefits by consuming food beforehand. First, you’re going to be having high satiety. You’re not going to be hangry during the workout. You’re going to have more potential energy.” And keep in mind, the blood that’s moving to your muscles acts as a vehicle to bring the amino acids and creatine and whatever else is in there through the capillaries into your cells. So, you’re basically refueling your muscles as they’re working. And if you did this strategy over time, it’s a great way to fuel the body before you go and do a workout.
[00:28:56] And again, you might say, “Okay, now let’s refuel the body again,” having a post exercise. I don’t think one is necessarily better than the other. I think they’re both viable, but I think in my opinion, I would probably emphasize more post workout because it’s a reward of all the effort you did in the gym. A lot of people say, “I can barely have a small snack. I get GI tract irritation if I have a large meal. But I’m going to work extra hard because I want to have that nice, enjoyable meal with my family, whichever it is.” So, it’s kind of a cool way to reward yourself and refuel it. But that’s kind of the way it is. If you woke up 05:00 in the morning, maybe some people say, “I’d like working out fasted.” I’m like, “All I care about is that you’re working out. All professionals, what’s the best exercise? It’s the one you’re going to do. What’s the best time to eat? It’s when you’re going to eat things like that. I think as long as you maintain consistency, that’s the cool thing. Protein will accumulate. Creatine needs time to accumulate. Caffeine will spike a bit quicker and I think we can get really stressed with all the timing and mixing and think in today’s society, post Covid has taught us that the brain is really important to take care of and if we can make just life a little bit easier to cause you to go walk a bit more or work when you’re not feeling up to it, I think that’s the biggest crux.
[00:30:10] I always tell people, if any benefit from creatine, 99% is what you do in the gym, that 1%, 2% maybe is going to be from that supplement. You got to put the effort in to get the benefits, that’s from the muscle. We can talk about the brain, which seems to be a bit unique and different.
Chris Irvin: [00:30:24] Yeah, that’s– Maybe one more Cynthia and I’ll turn it back over, but I think that’s a good segue into– So, I think the brain benefits of it is something that’s been really interesting to me. It’s not the reason why I ever started taking it, but it’s been a reason why I’ve continued to take it. But I wonder, we know that obviously the nervous system is so important for performance, so do you think that there’s any of the benefits related to the brain? Do you think that that is also going to be conducive of those performance benefits that you can experience on creatine?
Dr. Darren Candow: [00:30:51] Yeah, I totally believe that. If you ask anybody after they went for a run or sorry before they go, “I’m tired, but I know I should work out.” And if you immediately catch them as soon as they’re done, they’re sweating and they’re out of breath and they’re laughing or whatever. How is your workout? “Fantastic. I feel amazing.” And then I say, “Okay, let’s measure this.” And people say it’s like the Mastercard commercial, “It’s priceless.” We can’t really measure the endorphins or how that made you feel, and I totally agree. If we can improve anything from the neck up, focus, clarity, your work on life, how you’re going to tackle the day, it’s why I love working out first thing in the morning, the day just seems to get better. I think the neck up translates to the neck down. And if you’re exhausted, sleep deprivation, metabolically stressed, it doesn’t matter how much stimulants and supplements you’re taking, the workout might not be there. Most people say, “I’m too tired to work out. I’m too stressed,” I totally agree. It’s a new emerging area that these nootropics from the neck up probably will be the focal point for the next 20 years, and I’m very excited that creatine could be one of those that has some good potential.
Chris Irvin: [00:31:54] Yeah, for sure. I mean, that’s just something I’ve noticed. Like when I was younger and working out, it was always about the stimulants and the things that would– You generally consider like a pre workout supplement, but now I’ve noticed it’s more of the things that the nootropics and the things that impact my brain that I feel like get me a much better workout because it puts you in that mood, you’re happy while you’re doing it, and better connection with your muscles as you’re working out all of that so, yeah, that’s fascinating.
Cynthia Thurlow: [00:32:16] Yeah that concept of mental clarity, I think is really important. And I talked about this on our last podcast, that being able to cut through jet lag, for me, having just come back from Europe is huge, realizing that doubling up on my creatine dosing, because at that 10-g mark, that’s where you get this crossing over to the blood-brain barrier. And for me, it was like life changing. I kept thinking, “Wow.” I like creatine, but now I like it even more. But I think mental clarity for so many of us is something that we’re always endeavoring to work towards. And certainly, my demographic, we’re always looking to ensure that we remain mentally sharp and astute. We can stay on top of our– Now, my teenagers who like to pull things over on me left and right, this is like the new normal for me at this stage of life.
Dr. Darren Candow: [00:33:01] It’s true. It’s like I’m going to Italy in a couple of weeks to present, so I’ll take probably about 10 to 15 g before. And the cool thing is, this is something that most people don’t know, but if your muscle is saturated, it takes at least 30 days for those levels to come back. So, hey, people, go travel, enjoy food. If you get a chance to go to Europe, I love Europe. Cynthia, you were just there. They’re so great, food is amazing, enjoy it. And don’t worry about taking the big bag of powder, things like that, it’s still going to stay. And there’s indirect evidence once the brain– stores the creatine and it takes about five weeks to come back. So again, you got lots of time. Go lay on the beach in Mexico, just enjoy life and don’t stress too much.
[00:33:41] Exercise will help maintain those stores. So, if you could be active on your vacation, even walking can potentially help maintain some of those. But you’re right, sleep deprivation, I look at university students as midterm week again and studying, staying up all night, cramming, is their diet the best? Probably not, lack of sleep, can creatine provide any potential benefits? Well, when it comes to sleep deprivation, that’s probably the area that has the more solid type of evidence compared to a healthy person who says, “I feel fine,” you’re probably not going to notice the biggest effects.
Cynthia Thurlow: [00:34:09] Yeah, it’s really interesting. And let’s pivot a little bit, because I know on our last conversation, we talked about the interrelationship between perimenopause, menopause, and bone health. And for so many people, we got a lot of questions. People who can’t take hormone replacement therapy, they’re doing all the right things. How do you help them understand is it probably taking 10 g or more daily, long term, it’s not like a short-term fix because if you’re already in a low estradiol state, you are more a catabolic state where your bone is breaking down as opposed to building up. In terms of timing and dosing for bone health, does it matter if it’s around exercise or not? Because I know that was something you really emphasized, that when you’re taking creatine, it’s creatine and exercise or creatine and strength training, it’s not in lieu of either of those activities.
Dr. Darren Candow: [00:34:58] Right. God, I wish we had more data on this area. And so, the dose in this case does seem to influence the response, but nothing will come close to exercise. So, let’s preface this. To have any of the potential bone benefits from an evidence-based research perspective, exercise has to be there, primarily focus on resistance training. And then the dose that we’ve shown to be effective or somewhat effective, the minimal dose is about 8 grams, all the way up to about 12.
[00:35:24] Now, how am I going to get that much creatine in my diet per day? And if I don’t want to take supplement, that’s going to be extremely difficult. Even with supplementation, that’s a little tricky. We haven’t done a dosing study, but my hope is that if individuals will take red meat, seafood, whatever it is, or small amount of commercial creatine, eventually from a lifelong journey perspective, it will start to cause some of those beneficial effects even longer than a few years. So, sadly we need more cellular biology. So, the timing doesn’t matter. But if you’re taking a dose, maybe just say 10 g. I would probably recommend from a consistency, maybe you put a little bit in each meal or you could take it as a bolus, but that might cause a little bit of GI tract irritation. I’ve taken 10 g, 15 g, one shot, no problem with me. Other people say, “Oh, I’m kind of sensitive.” I think the lowest– I wouldn’t go any lower than 1 g. I think the lower lowest amount may be 2 to 3 g for multiple servings. If that’s not feasible for you, two 5-g dosages or whichever.
[00:36:25] But if you say, “You know what, I’m just going to take 3 g, I’ll get muscle benefits. Hopefully that translates potentially into bone.” I’m like, “That’s fantastic, you’re going to get some benefits and if you take it for 10 years.” My guess is more muscle pulling on the bone probably going to cause an increase in bone maintenance, at least for some population. So, the nice thing is you can split up creatine however you like, but whatever’s convenient and maybe consistent for you is ideal.
[00:36:48] I have to take mine with breakfast and then I drink it. So, I’ll put it in a water bowl and I drink it during my sets because that’s a very easy way for me to get it into the body. That’s when I take it. Others might break it up throughout the day, it’s really up to them.
Cynthia Thurlow: [00:37:01] Well, and I think you really bring up a good point. It’s whatever is feasible. There’s not this kind of strict mindset around this. You know for many, whether it’s medications or certain types of lifestyle measures, it has to be very strict. And from what I’m hearing it’s, do the types of exercise you can fit into your lifestyle, take creatine when you can remember to take it, make sure your nutrition is on point, I think that’s all very important. Now just a quick question about strength training. A couple of questions came in about low-level home resistance band workouts. Do those count as strength training or is that not strenuous enough to get the benefits?
Dr. Darren Candow: [00:37:36] Those people probably broke into my office because we’re the first to look at a series of studies upcoming. We have two actually PhD students and this will be their dissertation. Because during COVID the government said stay home and everybody was scared. And numbers here in Canada are going back up. I’m not sure what’s going on in the US, but we’re like, “Oh God, not again.” And then all of a sudden people said, “I had to be a shut in, I was watching a lot of TV, and I had nowhere to exercise and the detrimental effects, inactivity is catastrophic.”
[00:38:06] So, these resistance bands have been shown now in multiple studies to be just as effective from an older population as dumbbells and barbells. They improve strength, which is the number one cause or implicator for sarcopenia and functionality. So, we’re actually going to be looking at the effects of creatine with and without protein with resistance band training.
[00:38:22] I use resistance bands after every single set. So, I perform dumbbells or machines and then I finish the set with resistance bands which give a great pump. It kind of mimics this low load, high volume training that cause a transient hypertrophy. We’re looking at that on bone as well. Could the increase in blood flow cause bone to grow potentially in postmenopausal females? So, I don’t know who asked that, but they probably broke in and stole some documents. But those are planned actually for the new year, we’re going to look at creatine with people at home working out in the comfort of their own home.
[00:38:54] And that brings in shut ins, people in long-term care facilities, retirees, which is a huge population that we never get access to. And we give them TheraBands, we give them the supplement, we do Zoom monitoring, and it’s a good way to encourage them in the safety of their own home. But resistance bands are really great for traveling. I take them everywhere I go. Sometimes the gym is not the best. You can do it in your hotel room or whatever, and they’re space efficient. And I swear by these and I’ve broken one. I think I was pulling on a sharp object. But you can do some pretty cool exercises with these in addition to exercise like dumbbells and barbells. Or you’re like, “Hey, I don’t have time to work out today.” And I’m like, “Yes, you do. I just need 3 minutes of your time.” And you can do some pretty effective exercises to at least maintain circulation and some of the benefits you know.
Cynthia Thurlow: [00:39:36] Very reassuring. And I think for the individual, it was Caitlin who actually asked that question. Bravo to Caitlin.
Dr. Darren Candow: [00:39:43] Okay, I’ll check to see if there’s Caitlin outside or something. That’s funny. Good question. Really good, yeah.
Cynthia Thurlow: [00:39:48] Next is kind of focused on my niche, perimenopause and menopause. And so, lots of questions again about bone health. This is from Suzanne. She said, I have osteoporosis. I’m doing all the right things strength training, heavy walking, good nutrition, bioidenticals, calcium, I want to avoid biphosphates. Can creatine help with bone health? I think the answer is yes. Has there been any research comparing creatine to some of the pharmaceutical agents?
Dr. Darren Candow: [00:40:13] No, there hasn’t. We had some individuals with low bone mass in our long-term study, but to be diagnosed with osteoporosis or God forbid severe osteoporosis and frailty, we did not, and that’s kind of where we’re hoping to go next in some of these institutionalized individuals. It was shown to preserve the skeleton in what we consider healthy postmenopausal females. We don’t know the effect it would have on osteoporotic females. Our hope is maybe it would have some if it does great beneficial effect, it won’t compare to a bisphosphonate or any pharmacological intervention. So, although creatine preserves some measures in the skeleton, bisphosphonates are pharmacological intervention. Please don’t stop taking those, they’re medically prescribed. Creatine might just be a small adjunct to exercise.
Cynthia Thurlow: [00:41:00] Yeah, the unfortunate thing and whether or not listeners know this, that there’s some potentially really severe side effects from taking those drugs, they don’t actually produce strong bone. And the mandibular necrosis is the thing that so many of us as clinicians are genuinely concerned about it. But again, don’t stop any medications. Talk to your healthcare practitioner about that.
Dr. Darren Candow: [00:41:20] Certainly, not making any suggestions to stop any medication from a medical– because we don’t know what other conditions– They might have osteosarcopenia, diabetes, high blood pressure. So, for those watching, if the doctor’s prescribed you something, please take it, but maybe you might ask them about proper nutrition or exercise or sleep, things like that that can help.
[00:41:41] Again, a supplement is designed to usually overcome a deficiency, but there’s some compounds that can actually augment some things in the body, and creatine is like one of five that seems to be beneficial over time.
Cynthia Thurlow: [00:41:53] That’s interesting, because what I’m starting to see, at least clinically, is the women that are on estradiol and testosterone and progesterone are the ones that tend to– Even if they have some degree of osteopenia. And really, when you’re comparing a 20-year-old’s bone to a 50-year-old’s bone of course you’re going to have less bone mass less than a 20-year-old. But for many individuals, being on HRT seems to be one of the biggest predictors of healthier bone mass.
Dr. Darren Candow: [00:42:14] Right.
Cynthia Thurlow: [00:42:15] Now, when we’re looking at women in middle age versus women in the peak cycling year, so 35 and under.
Dr. Darren Candow: [00:42:23] Okay.
Cynthia Thurlow: [00:42:26] Any recommendations? Do you feel like younger women can get away with? I would imagine they eat a lot less protein to trigger muscle protein synthesis versus older women who are going to need more protein for that same threshold. Does the same thing apply to creatine? Are there differences in terms of a younger woman’s needs versus an older woman’s needs?
Dr. Darren Candow: [00:42:43] Yeah, that’s an excellent question. And so, if we start with the protein, there’s theory of this anabolic resistance. So, Chris would be the youngest here on the screen I’m assuming, and he’s going to need a lot smaller dose of protein compared to me to get the same response. So, he might respond 20, 25 g. I’m 46 years of age, I’d probably need about 40 to 45 to get the same relative effect. So, he’s high five’ing himself, he’s like, “Jeez, I just don’t need as much protein. I don’t need to spend as much money.”
[00:43:12] When it comes to creatine, we have proposed this idea on the last long-term study in postmenopausal women. That’s why we gave 0.14 g. We didn’t see previously an increase in muscle mass or even an increase in strength. So logically, we thought, “Wow, if there’s anabolic resistance to protein, maybe there’s anabolic resistance to creatine.” And there’s been a few studies to suggest that creatine kinetics in the aging population is impaired primarily in the lower body. So, if creatine kinetics is impaired or the ability to take creatine and sort of utilize it for high energy phosphate kinetics, maybe they need more. And lo and behold, when we gave that higher dose in postmenopausal females, it did improve lean tissue mass, whereas in our previous study, at 0.1 g it did not, so indirectly suggesting a little bit more might have been needed.
[00:43:59] Now, we also did an additional year of weight training. So, what has to happen is we now need to compare younger females versus middle age to older individuals, different dosages of creatine that would probably take about four to six different studies. It’s been in the back of my mind for a long period of time. I would speculate if we’re anabolic resistant to protein, we’re probably anabolic resistant to creatine, and that’s maybe why older individuals respond so well when they take a supplement in addition to their diet, they seem to respond favorably. So that’s an excellent question. Still needs to be done. But my speculation is there’s some level of validity to that, yeah.
Cynthia Thurlow: [00:44:39] Yeah, definitely makes sense. And then there were a lot of questions that came about, is there an age limit to supplementation with creatine? And this is specific to probably parents in my age range, my parents who are in their 70s and 80s– I’m assuming if we’re dealing with anabolic resistance to creatine, I mean, all these things, sarcopenia, etc., that it’s probably safe again in the context of broad generalizations, if you are on medications or you need to check with your doctor or your nurse practitioner, please do. But in terms of age are there any age-related limits that you’ve discovered or researched?
Dr. Darren Candow: [00:45:14] No, we’ve had people in their 70s and 80s. I guess you could also argue it’s probably more important in the seventh, eight, and ninth decade, when the muscle is being atrophied, bone is being decreased, this is where creatine can maybe even help even more in combination with exercise. So that’s kind of the populations we need to look at. Those with [unintelligible 00:45:32] or frailty or assisted devices for walking, that’s the area we think would be more clinically important. We’ve done some rehabilitation work with stroke victims, very small sample size, but it did improve their ability to walk compared to placebo, so that has a huge rehabilitation perspective. But I think as we get older, eighth decade, ninth, centurions, these are the individuals where we think you might even get any beneficial effect. And again, it’s never too late to start exercising, it’s never too late to eat properly. And if we can get it through diet, great. But as we get older, impairments in chewing and taste, and financially to export all these expensive foods, there’s a lot of issues we have to look at, but there’s no reason to suggest someone who’s 100 can’t take creatine and maybe get a little bit beneficial effect.
Chris Irvin: [00:46:14] Is there any risk about? What about like somebody who has cardiovascular disease? I’ve always wondered about if the heart being a muscle and pulling water into muscles. So, if you’re talking somebody that’s maybe in their 70s, 80s, 90s and they’ve had a history of cardiovascular disease, any concerns there with creatine?
Dr. Darren Candow: [00:46:31] There’s always potential concerns, especially if they’ve had an infarction or any type of– But if they’re in a cardiac rehab program and their doctor clears it, it’s something to consider. They probably would want to, as you mentioned, food matrix first, but there’s a lot of good, excellent reviews. Colleagues in the US that have looked at the effects of creatine on all aspects of cardiovascular health and they’re showing some improvements and no detrimental effects at a recommended lower dosage. So, we’re not really seeing any adverse effects in any population that would be at a heightened risk. Again, if it’s done educated, professionally and medically supervised, it should be fine.
Chris Irvin: [00:47:02] That was one I had on my list to ask you. My grandfather, he’s 87 years old and he came to me about a week ago and he was asking me, “I need to put some muscle on, I feel like I’m getting a little bit weak, I hear this creatine stuff good, should I take it?” And I was like, “I’m going to ask first because I want to make sure.”
Dr. Darren Candow: [00:47:19] Yeah. Go work out first and then we’ll talk about eating well after. That’s right, yeah.
Chris Irvin: [00:47:21] Right, right.
Cynthia Thurlow: [00:47:24] Well, I just find it so interesting that maybe it’s through Dr. Gabrielle Lyon’s work. She’s made me much more aware of this issue surrounding frailty and sarcopenia. And now when I’m in Pilates class or I’m just out observing, I love to observe people, I’m kind of the person that puts the sunglasses on and I just like to watch people. Just the lack of awareness, we don’t talk enough about this issue surrounding frailty. And I look at my parents who are now in their 70s. My dad, I think, just turned 80 this past year, and so looking at them, and they’re starting to get a little bit of– Sorry, mom, if you’re listening to this, a little bit of the dwindles, they’re getting smaller and more sarcopenic and just look a little weaker, they don’t walk as fast as they once did. And hoping that our generation is going to ensure that there’s much greater awareness around peak bone and muscle mass and how important some of these ergogenic aids can be for preserving metabolic health, bone health, brain health.
Dr. Darren Candow: [00:48:19] Yeah, I think that’s critical, because if you look at a master athlete, 70, 80, running, walking, living life, they’ve been exercising their whole life. And I think we lied to people for so many decades and say “As a child you shouldn’t work out, it’s going to stunt your growth.” And yet you look at all these young children who have amazing agility, coordination by playing sports or moving, and that translates into the middle years and into old age. And I don’t know if we did a bad job promoting physical activity or proper nutrition, but I just wish we would get the young generation to eat properly, exercise and move often, and that’s going to maybe offset frailty later on in life. And maybe proper nutrition, emphasizing high quality proteins, low glycemic sugars, emphasize those essential fats, and move and walking, jogging, weight training, whatever it is, these TheraBand’s, there’s a lot of easy ways we can get children and pretty much anybody on the planet to move effectively. And it’s so correlated that if you’re improving physical activity, improving proper nutrition, you’re probably going to live longer free of disease and that’s kind of the goal for most individuals, yeah.
Cynthia Thurlow: [00:49:23] Absolutely. Well, Dr. Darren Candow and Chris, it’s been a pleasure to connect with you. I know that team and I had to go through hundreds of questions to try to pull out some common themes, things that people were really interested in. One last question that came from M. Gibson, she didn’t give her first name. Wondering about future studies Dr. Candow is doing and how he recruits participants, I’m a middle-aged woman, by the way.
Dr. Darren Candow: [00:49:23] Yeah, we have about seven, so middle aged, we’ll probably be looking at that, home-based exercise training and creatine supplementation and typically very similar to most universities, once you get ethics approval, you’re allowed to recruit on social media and/or email and just stay tuned. If they want to follow me on social media, it’s probably the best way. Ethics usually takes a while to get approved and rightfully so. But once that’s approved, we just try to recruit as many people who are eligible to participate.
Cynthia Thurlow: [00:50:11] Sounds great. Thank you again for your time.
Dr. Darren Candow: [00:50:12] Thank you so much for having me. Yeah.
Cynthia Thurlow: [00:50:19] If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.
