[Angela Foster] (0:12 - 5:22)
Our energy depends on our mitochondria, and they're also a key influence in how we age, but as the years pass, mitochondrial efficiency naturally declines, and this is especially prevalent in our perimenopausal years. And looking after our mitochondria is super important if we want to have high energy and thrive. Exercise and nutrition are both important, but there is also a powerful postbiotic that affects your mitochondria that is nearly impossible to get from your diet alone, and that is Urolithin A.

The global leader in Urolithin A research is Timeline, a Swiss-based life science company, and they spent 10 years doing research to bring their product Mitopure to market. I first came across Timeline at the Health Optimisation Summit, and since taking it, I've noticed improvements in my strength, more energy, and faster recovery after my workouts. Mitopure is clinically shown to give our cellular energy generators new power by triggering the body's natural process for removing and rebuilding damaged mitochondria, called mitophagy.

One way to think of Mitopure is that they're kind of like these little Pac-Men in your cells, chomping up the damaged mitochondria that makes you feel old and tired, and recycling it into new, healthy ones. And they have two products designed to fit your needs. They've got a berry powder, which is great to mix into yoghurt, or what I do is add it to my daily smoothie.

Or, if you're on the run and want something convenient as a grab-and-go option, you can just use two of their soft gels. And their results show that after four months of taking Mitopure, you'll feel yourself getting stronger, recovering faster after workouts, and experience less inflammation. All important if, like me, you want to slow ageing.

And Timeline is offering 10% off your first order of Mitopure. Go to Timeline.com forward slash Angela. That's Timeline.com forward slash Angela. Hey, it's Angela, and welcome back to High Performance Health. I'm so thrilled you're here because today's episode is one I've been waiting to record for a long time. And I promise you it's going to change the way you think about one of the most misunderstood supplements in women's health.

And just by pressing play today, you've already done something really powerful for your future self. So let's celebrate that. Now, full honesty, I didn't always like creatine.

The first time I tried it, I felt bloated, uncomfortable, and I assumed that it just wasn't for women like me. But that was back in the day when we were told we had to do a loading phase of 20 grammes a day. And no wonder it felt like too much.

Fast forward to today, and I take it every single day. Not for bulking, but for clarity, recovery, bone health, brain energy, body composition, and yes, even sleep. So if you've ever thought creatine was just for guys at the gym, today's conversation will blow that belief out of the water.

If you're a woman in your 40s or 50s navigating hormone shifts, brain fog, sleep issues, or stubborn body changes, this episode is for you because creatine isn't just about performance. It helps preserve bone density. It supports your nervous system under stress.

It improves brain energetics and mood stability. And at the right dose, it can even help to reduce body fat. We'll also talk about how it can support teenagers, pregnancy, cognitive load during exams, recovery for busy professionals, and yes, even help with sleep deprivation and burnout.

And if someone sent you this episode, they know how much you care about how you want to feel your best, supported, and strong. And to walk us through the science, I'm joined by the global authority on creatine. Dr. Darren Kandow is a professor and the director of the Ageing Muscle and Bone Health Laboratory at the University of Regina in Canada. He's also director of research for the Athlete Health and Performance Initiative and former associate dean of graduate studies and research. Dr. Darren Kandow has published more than 150 peer-reviewed studies, secured over $2 million in research funding, and his work focusses on how nutrition, particularly creatine and resistance training, can improve muscle, bone, and brain health across our lifespan. He also sits on multiple editorial boards.

He's a fellow of the International Society of Sports Nutrition and serves as scientific advisor for companies like CREATE and ALSCHEM. Simply put, this is the man that the researchers go to for the truth about creatine. And as you're listening, if something comes to mind, maybe a friend who's constantly tired, struggling with body changes, or just wants to feel sharper and stronger, send them this episode because this might be the one supplement and the one conversation that helps them feel like themselves again.

This is your deep dive masterclass on creatine, why it's so much more than just a gym supplement, and how it could be one of the most powerful tools for women's longevity, resilience, and brain health. So let's get into it with Dr. Darren Kandow. Darren, I am super excited to have you here today.

I've been looking forward to this for some time. You've already seen me post a number of times, I'd say, on my Instagram all about creatine. I'm a big lover of it.

It's made a huge, huge difference to me on many levels. I'm really excited to dive into the science. So thank you for joining us today.

[Dr Darren Candow] (5:22 - 5:25)
Yeah, no, thanks for having me. I'm excited to talk to you about creatine for sure.

[Angela Foster] (5:26 - 6:08)
Yeah, amazing, amazing. We are like the world expert on creatine. So it's great to have you here.

So many places that we could start. Let's start with the traditional kind of narrative around creatine, which is how it helps to support muscle strength and power performance in exercise. I think a lot of women, first up, do still worry about the fact that they're going to get puffy and bloated.

That used to worry me, actually, because in all honesty, when I first took it, that was my experience with it. It's not my experience having used it now for a long time. Should we start there?

What are the benefits from an exercise physiology perspective? What can it give us?

[Dr Darren Candow] (6:09 - 7:12)
Yeah, so the benefits stem to what it is. It's nitrogen containing compound, and it's actually produced naturally in our body. So a lot of people think it only comes from supplementation, but rest assured it's produced in the liver and kidneys.

You also can consume it through red meat or seafood. But the idea is that creatine or another compound called fossil creatine, it helps maintain the energy currency of our cell called ATP. So when you're exercising, when you're doing activities of daily living, this compound really helps to improve those lifestyle interventions or activities.

So typically, primarily in young males, they usually got bigger, stronger, faster. And that was in the late 1990s. And all of a sudden, it's exploded into females and pretty much anybody across the lifespan.

And it sort of gives the cell more energy to do more work. So there are some mechanisms I'm sure we'll talk about. But at the end of the day, the main reason people probably think creatine supplementation is to improve probably exercise performance, which obviously leads to adaptations to the body.

[Angela Foster] (7:12 - 7:43)
Yeah, for sure. And so when we're looking at exercise performance, I think many of my a lot of my audience will be aware, particularly if they're going through kind of their 40s, there's hormone changes that they need to start resistance training that they need, you know, Stacey Sims has been on the show a few times, she's talked about the importance for women to do some of that top end work and that high intensity, which I think creating can also help with what are the kind of performance benefits that we can see? And then we can look at dosages later.

[Dr Darren Candow] (7:43 - 9:19)
Yeah. So across both biological sexes, it's pretty even, but let's focus on females. The first thing that you'll probably notice the most robust evidence is an improvement in muscle performance.

So females get stronger, they have greater endurance and or muscle power. So that's huge applications for living functional independence later on in life. They also improve lean body mass.

Now, lean body mass doesn't necessarily constituent muscle, but we think about 50% of lean body mass is muscle. So that is very favourable, obviously, when we talk about sarcopenia or getting older. But the one that a lot of females especially don't realise is that creatine has been shown to decrease body fat.

I didn't make a mistake there, it actually decreases body fat. So to your first point where some people experience water retention or the number going up on the scale, that's likely due to taking a little bit too much creatine in the initial stages or creatine is osmotic. And what that means is it likes to take sodium and water with it.

So typically in the first maybe seven to 10 days, some people may experience a one or two, three pound increase in body mass. But please be rest assured that's just water retention. Over time, creatine will increase lean mass, decrease fat mass only by a small amount, but it is still a decrease.

And therefore you get better body composition parameters. So in summary, it improves muscle, body composition, and then we can obviously talk about the bone benefits primarily for biological females a little bit later on. And so it's not just for males, it's for everybody on the planet essentially, yeah.

[Angela Foster] (9:20 - 9:43)
And when we're looking at that water that's kind of coming in, you know, one of the things we can look at is we do something like an in-body scan or something like that. We can see that intracellular and extracellular water. I think women often struggle a little bit more with excess extracellular water in comparison to men and what we want is that water in the cell.

How can we improve that and how does creatine affect that?

[Dr Darren Candow] (9:43 - 10:52)
Yeah, so you're totally right by increasing water retention extracellular or inside the cell that causes the, unlocks the magic of creatine from a mechanistic perspective. So there is, it's a myth to drink more water with creatine. It's not absolutely essential, but it is advised because hopefully you're taking creatine and exercising.

So obviously that's a beneficial effect there. But one way to sort of offset the net water retention that some people don't like is I think a lot of people make an error in taking too much. So for example, the loading phase is very common.

It's 20 grammes a day for about five to seven days. That's typically only where we see this water retention or some adverse small effects. We recommend to take a lot lower dose and maybe divide that up into more frequent dosages throughout the day.

So for example, if someone says I just want to start with three to five grammes a day, that's totally great for muscle. I would advise you can take it all at once or divide that up into two smaller dosages in the morning and afternoon. And that really seems to decrease any of the chances of the adverse chance of water retention.

But again, the idea with creatine is it likes to trap water and that actually seems to be a signal to some of the benefits to the cell.

[Angela Foster] (10:53 - 11:07)
Right. Okay. Which actually, I mean, in terms of like when you're looking at aesthetics, that's actually going to improve the look, right?

Particularly with ageing, because if you're filling out a little bit of water and you don't want like wrinkles and things like that, it's actually going to make you look better. Yeah.

[Dr Darren Candow] (11:07 - 11:39)
And think of this as if we're putting more water in our muscle, which is primarily a muscle, a love or a water loving tissue, the muscles will swell and that turns on a whole bunch of beneficial signalling pathways and proteins and growth factor. You don't want your muscles to be dehydrated because of that decreases the metabolic efficiency. So when you're taking creatine and exercising, think of if you do experience a little bit of water retention, it's primarily inside the muscle, which is fantastic.

And that's why bodybuilders can take creatine before going on stage. They seem more vascular.

[Angela Foster] (11:39 - 11:48)
Okay. Got you. And what about when we look at like high intensity in terms of how it's helping us get to that top end and recover faster in between sprints?

[Dr Darren Candow] (11:48 - 12:37)
Yeah. So it's interesting. It helps recover in between sets and or sprints as you would just allude to.

And it also helps recover in between exercise training sessions. So for example, if you were to do three sets of squat, it helps to recover ATP after every muscle contraction during each set and in the rest period between each set. And that's typically why sets two and three when you're on creatine, you can do more work compared to placebo.

So therefore in each session, the individual can typically do more work. That's either lift more, do more reps or whichever. And then it allows the muscle to recover quicker to get you back in the gym or on the track, whichever it is more frequently.

So that may allow an twice a day that might allow them to train every day. So it really seems to be a recovery agent in addition to something, what we call an anabolic agent.

[Angela Foster] (12:38 - 12:49)
Really interesting. Cause I would say that's something I have noticed. I've been able to really increase volume both in terms of the number of sets, but also the amount of times I can train.

[Dr Darren Candow] (12:49 - 12:49)
Right.

[Angela Foster] (12:50 - 12:50)
Yeah.

[Dr Darren Candow] (12:50 - 13:17)
And another big thing is people who are lifting heavy, heavy weight, they're usually advised to wait about three to five minutes between sets to fully recover your creatine stores. And a lot of people are time constraints. They don't have the luxury of waiting three to five minutes between sets creating speeds up that recovery process, still allowing you to have benefits.

So that may allow an individual who's very busy to get a really good workout in, in a shorter period of time and still get the benefits of that session.

[Angela Foster] (13:17 - 13:24)
So you can actually shorten those rest periods, which I've heard that women actually can recover faster. Is there truth to that than men?

[Dr Darren Candow] (13:24 - 13:59)
It's in theory, it comes down to some of the, that's more of a fat premise from an aerobic type of perspective, but when it comes to creatine kinetics, there's not really a big sex difference with the kinetics. The only thing we see a difference is with ageing. I think older adults have reduced creatine stores in the larger muscles of the body.

So therefore older adults might need more. And I'm sure today we'll talk about the differences in dosages for bone and brain, and it is evolved. It's, it's not one dose fits all per se, it has evolved.

And, and I sort of look at the different tissues of the body while the individual is taking it.

[Angela Foster] (13:59 - 14:34)
What about, because I think this will be true for many people listening. So my son, he's 16 years old. He's really trying to get some, some size on.

He's a big fan of creatine. He's been taking it. My understanding from reading the research is it's safe in under 18s.

What would be, I was chatting to him and he was, he's kind of read about the dose of 0.1 grammes per kilo of body weight. Is that for exercise performance or for other benefits? What would you say to, you know, any of our members listening to this who are audience who basically have teenagers who are looking at taking it?

What are the guidelines for that?

[Dr Darren Candow] (14:34 - 15:39)
Yeah. So the start with the relative dosage, our lab is the one that came up with that based on the size of the individual. So we usually use 0.1 all the way up to 0.14 or five grammes per kilogramme. So that's on average, if you're 70 kilogrammes, that's anywhere between seven to 10 grammes a day. You can take that all at once or divide it up into smaller dosages. So that's a lot higher than most people would hear about the three to five grammes a day.

Regarding children, great research in the United States have clearly shown that creatine is very safe. It has a lot of potential improvements for agility, body composition, muscle performance. They have not looked at any blood biomarkers of the kidney or liver.

But I would be shocked that creatine at that age range has any adverse effects. Going back to what I initially said, they're naturally producing it. And if the body doesn't like it, it simply excretes it down the toilet.

So I argue I struggle to find anybody on the planet at any age that why they can't take creatine because they're already producing it. It's kind of like saying someone can't consume protein. They're consuming it at all ages.

So it's the exact same principle to that now.

[Angela Foster] (15:39 - 15:46)
Because the question I've had a lot on is like, what's what about women who are pregnant? Can they can they take it?

[Dr Darren Candow] (15:46 - 16:51)
Yeah. So a caution obviously goes out to any medical condition. I think that's the big thing.

Make sure you talk to your general practitioner. But just last month, I came back from Munich and Stacey Ellery at Australia is the world's leader on creatine and pregnancy and foetal growth. And she's shown in the animal model.

And now she actually has human models working with this from a pregnancy standpoint. And it seems to have a lot of profound benefits. And Stacey will be the first to tell you, you know, anybody who's pregnant or thinking of becoming pregnant, make sure they talk to their medical practitioner before they take it.

But the dosages don't change. There's no adverse effects right now. If anything, it has potential benefits to improve bioenergetics, not only for the mother, but for the foetus and the placenta.

So there's a lot of hope here and a lot of potential. But again, I'm not a medical doctor. If someone is pregnant or thinking of it, make sure you talk to your medical practitioner.

Just make sure creatine is right for you. But the current body of evidence suggests that it is and there's no safety adverse effects. But of course, we do need long term trials with that before we can have a unanimous consensus.

[Angela Foster] (16:52 - 17:33)
Yeah. Okay, great. Thank you.

What about the recovery piece? You were mentioning there that maybe you can train a couple of times a day. I always find that for me, there's, I think, as someone as well, who's really struggled with sort of depression and bipolar, exercise, particularly resistance training and high intensity.

Both of those and I know about like the myokines that release things like this, the hope molecules, they give me a really stable mood. But the thing I have to be difficult or tricky with, I guess, is I'm always walking the tightrope of not over training and overstimulating my nervous system, which would bring my mood down and trying to get that balance right. How can something like creatine help us with that recovery?

[Dr Darren Candow] (17:34 - 18:50)
Yeah, it serves as a great adjunct to exercise. I think everybody would agree, nothing's going to replace exercise, the profound benefits you get from a cognitive perspective, muscles are unbelievable. But the interesting thing is when you combine creatine with exercise, not only do you get the beneficial effects moving forward, but it argues that it's an anti-catabolic or anti-inflammatory agent.

So it speeds up recovery. You mentioned depression and anxiety, some phenomenal researcher coming out of Utah showing that individuals with clinical depression, when they add a creatine, they got substantial benefits. And when you look at all these mechanisms, it seems to decrease inflammation or oxidative stress in ourselves, especially as we get older.

So it has an ability to recover the cell better. And then when you look at exercise, some excellent work using long duration aerobic exercise like Ironman and triathlon has clearly showed that creatine reduces proteins involved in inflammation. So it'll allow that body to sort of recover quicker to get back to excessive volumes of training.

So creatine is not just for weightlifting anymore. It seems to have application for aerobic and cardiovascular exercise as well. But to your point, it seems to have that anti-inflammatory mechanism which seems to recover our cells and or our body to allow us to get back to exercise quicker.

[Angela Foster] (18:52 - 19:24)
Interesting. And so I guess there's obviously injury risk with too much in exercise, but also looking at kind of the nervous system and monitoring HIV, you obviously have like so much knowledge in terms of exercise physiology. What would you say when someone's looking at their recovery rates in terms of them tracking whether that volume is becoming too much, because we've got to look at all the life stress as well.

I know that you see like a short term dip in HIV, but hopefully the long term trajectory always fighting ageing, but is is that there's an upward trend? Yeah. What do you look for in terms of that?

[Dr Darren Candow] (19:24 - 20:05)
And what's acceptable in terms of dipping down and how much someone Yeah, that's a phenomenal question, because we have so much data on weight training, you know, you can easily measure that by getting stronger, more repetitions and, and adaptations in the gym. Regarding cardiovascular effects, we don't have hardly any data looking at heart rate variability. There's been a few studies looking at endothelial function in older adults, but that's more from a rehabilitation perspective.

But to your question about can you exercise too much and creatine comes to the rescue, it's likely it can help, but I don't know if it would overcome the overtraining syndrome. So I think it's subjective to each person. But we don't have a lot of data in that.

And that's a very interesting question.

[Angela Foster] (20:06 - 21:27)
I want to take a quick break to share something that's made a noticeable difference to my focus recovery and overall energy. You've heard me talk about creatine on the show, and you'll know I take it daily for my brain, my workouts and the way it helps me feel mentally sharp and physically strong. And the one I recommend is called create create provides career pure creatine monohydrate renowned for its purity and quality.

Their products come in convenient forms like gummies and single serve powders, making it super easy to incorporate into your busy lifestyle without the mess or guesswork. And what I love about create is their commitment to clean ingredients, no unnecessary additives, vegan friendly and non GMO. Plus their products are designed to support not just physical performance, but also mental clarity and recovery from workouts.

So you can feel more energised, focused and resilient every single day. And as a high performance health listener, you can get 20% off your first order. Just head to try create.co forward slash Angela 20 and use the code Angela 20 at checkout. That's try create.co forward slash Angela 20 and code Angela 20 to save 20%. Your brain and body will thank you. What about for people using like obviously we make it ourselves.

So it's kind of almost like a conditional amino acid. What about vegetarians and vegans any reason that they should take more?

[Dr Darren Candow] (21:28 - 22:36)
Yeah, yeah, the some of the best lines of evidence support vegans, vegetarians and those on a plant based diet. So as I initially mentioned, you can get a small amount of dietary creatine, but it only comes in red meat and excuse me, seafood. So about one to three grammes at most I think if you're on a carnivore diet, you're getting about three grammes, but everybody will raise their hand and say I'm a vegan.

They're not getting any habitual dietary creatine. At most their body is only synthesising maybe one to two grammes. So in those populations, the evidence based research clearly shows a superior effect.

When you get vegans and vegetarians who consume creatine in combination with exercise, they almost double the amount of creatine that was already in their muscle. They have about half the amount of an omnivore. So therefore you're doubling the amount and almost their muscle becomes so energised they can do more repetitions, heavier weight and get those physiological adaptations.

We don't have any evidence on vegans in bone with creatine, but we do have really good evidence on vegans from a muscle perspective and actually from a brain health perspective. Vegetarians do respond very well to creatine from a cognitive and memory perspective.

[Angela Foster] (22:36 - 22:39)
It's really exciting. It really is super exciting.

[Dr Darren Candow] (22:39 - 22:55)
I think the NECOP pregnancy and anti-cancer are the three big areas you'll start to see emerging. Our focus is on healthy ageing, but now it seems to have a lot of global benefits to a lot of different populations that we didn't actually think creatine had relevance for.

[Angela Foster] (22:55 - 22:59)
When you say anti-cancer, as in it may be protective against you ever getting cancer?

[Dr Darren Candow] (23:00 - 23:29)
Potentially. From cellular data, it looks like it has where it's an anti-inflammatory or anti-catabolic agent. It seems to reduce the chance of malignancy growth and or where it's an anti-inflammatory and might have benefits for those with cancer and rehabilitation to maybe help maintain lean tissue mass or functionality.

It's in preliminary stages, but there's some good cellular data showing that it has anti-cancer properties on certain cells. I'm really excited with the potential of this coming out down the road for sure.

[Angela Foster] (23:29 - 23:37)
Yes, super exciting. Is that research, is it looking at it in and of itself? Because often people who take creatine are exercising, which is also protective against cancer.

[Dr Darren Candow] (23:37 - 23:44)
Yes. In the cellular data, obviously those studies are easy to do just with creatine, but from a practical standpoint in humans, it's usually combining with exercise.

[Angela Foster] (23:45 - 24:00)
Yes, okay. Let's switch to bone then next because I think this is also really important and particularly for peri and postmenopausal women. How can creatine help us with bone health?

[Dr Darren Candow] (24:00 - 25:06)
There's been about 15 studies in total. Some are equivocal, others support it, some don't, but the best lines of evidence suggest that in combination with exercise, and I can't stress that enough because there's never been a study where creatine was taken by itself that had bone benefits. For those listening, make sure exercise is first.

Then when you add creatine, about eight grammes seems to be the minimum, so quite a bit higher than what's needed for muscle. Eight grammes all the way up to about 12 grammes has been shown to decrease bone mineral density loss in the hip, and that was in postmenopausal females. Then in older females as well as males, it seemed to improve bone area and strength.

We don't have hardly any data on perimenopausal, premenopausal females, which is substantially lacking, but in the postmenopausal phases and older adults and primarily males, it does have some bone benefits. Collectively though, when you look at all the studies, we can now conclude creatine does not increase bone mineral density. At best, it has a bone preserving effect.

[Angela Foster] (25:07 - 25:17)
Okay, okay, which is dropping. It's interesting then if we did have research around perimenopausal women to kind of get in before you see that drop and that loss.

[Dr Darren Candow] (25:17 - 26:18)
I think one of the best lines is if we take a young group of primarily biological females, like early premenopausal, measure their bone, then measure them again during the perimenopausal stage and then postmenopausal, like a longitudinal study, that would see the effects of ageing hormones as well as can creatine have a benefit. But to your point, we've done an awful job looking at the age of 40 to 49. We've really looked at older adults and we'd love to look at young females, 18 to 39, and then another cohort of the perimenopausal transition.

That oestrogen hormone and progesterone seems to influence creatine a little bit. Ironically, females don't experience the rates of muscle protein breakdown nearly as well as males. And we don't know why that is.

It's the only logical reason is maybe oestrogen is having an influence there. But I think from a biological sex perspective, we have a lot of data on males, but we don't have a lot on females. And I'm really excited to see that area emerging.

And I think it's a main focal point now.

[Angela Foster] (26:19 - 26:22)
How do you mean that you don't have the same benefits of muscle protein breakdown?

[Dr Darren Candow] (26:23 - 27:08)
Yeah, so males seem to decrease protein breakdown way more than females. And what I mean by that is when males take creatine, they sort of decrease protein breakdown, almost creating a more favourable environment for muscle growth. That's in older males and younger males.

Females don't experience that breakdown, and we don't really know why. Is it oestrogen? Is it other female sex hormones?

We just don't know that. And that's an area of future research. So males might respond a bit better than females, but not by a lot.

And one of the reasons there we think maybe oestrogen fluctuations are playing a role. Abby Smith-Ryan doesn't really see big fluctuations with the menstrual cycle, but maybe hormones might play a role there.

[Angela Foster] (27:09 - 27:29)
Okay, so because some of the stuff that I'd heard about and looked into and like when I interviewed Dr. Stacey Sims is that women are more catabolic and that they shouldn't train in a fasted state. They're more prone to breaking down muscle. And so actually having some protein before, but are you saying that they don't break it down quite as much?

[Dr Darren Candow] (27:29 - 27:54)
Well, actually females oxidise more body fat. Males oxidise more muscle protein. So in a fasted state, the female is going to be oxidising more triglycerides or fat.

Unfortunately for males, they have more protein. They oxidise a greater amount. So females will obviously, when it comes to training, they can train fasted.

They don't experience the decrease in protein breakdown on creatine like males do. So they're- Oh, I see what you're saying.

[Angela Foster] (27:54 - 28:05)
Okay. So creatine doesn't have the same benefits for women. Yeah.

I've got you as in- From a protein breakdown perspective, yes. Against breakdown, but maybe they're not having as much breakdown in the first place.

[Dr Darren Candow] (28:05 - 28:36)
Right. And the other thing is, although both sexes increase lean body mass, males increase a little bit more. Now, the caveat with lean body mass is there's a lot of other tissues, not just muscles.

So is it more water retention in males? They might have larger muscle to start with. Is it more fluctuations in blood?

So those are areas where when we measure lean body mass, take it with a grain of salt, we need to do a lot more new studies on 3D imaging, MRI, D3, creating a look at muscle. And there's only a few studies that have looked at muscle biopsies yet.

[Angela Foster] (28:37 - 28:47)
And when we're looking at measuring bone, is DEXA a good way of estimating how good your bone density is?

[Dr Darren Candow] (28:47 - 29:40)
Yeah. The majority of studies use DEXA. Now, DEXA is great.

The only issue with DEXA is that the standard error measurements are about one to 3%. The problem with bone is though it does turn over, it takes a very long time. So that's why a lot of bone research is scarce.

It's very expensive and takes a long period of time. And to get a one or 2% increase in any of our bodies from a DEXA measurement could take years of training. So the caveat is that some of our studies are underpowered because if there's about a one to 3% error in the machine, you need at least that and more to get a treatment effect.

So that's why a lot of studies are underpowered, or we usually have a lot of caution saying it showed benefit, it did not overcome the error, maybe longer term studies are needed there. So that's the problem with bone, whereas in muscle, you can do a six week study and see noticeable effects.

[Angela Foster] (29:40 - 30:00)
Okay, got you. It's interesting, because I guess for people listening, like, I always thought the more that I can build that and the stronger I can be going into perimenopause, the better. And actually, in terms of the bone, when I looked at DEXA two years ago, it was above the level, which is quite nice.

I don't know, I'm interested to go back and see what's happened now.

[Dr Darren Candow] (30:01 - 30:46)
Yeah, I agree. It's massively important and start as early as you can. So if there's any females watching and they're 1516 or younger, please start lifting weights or doing weight bearing exercise, try to build up muscle and or bone as much as you can, because when the body starts to deteriorate, you're going to have a lot more.

So therefore you can offset the rate of muscle decline, strength loss and osteoporosis and osteopenia. So it's never too early to start, try to get in there and lift things as much as possible. Take the stairs, don't take the elevator, carry the groceries, you know, all these little things add up, the more things that pull on muscle will pull on the bone throughout the day.

And so there's a big area called the muscle bone crosstalk. We see muscle or body in the mirror. We never see our bone.

But keep in mind, it's a really important tissue that we need to favour and pay attention to.

[Angela Foster] (30:46 - 30:51)
And do we need to do any kind of plyometric stuff for that or is just the resistance itself enough?

[Dr Darren Candow] (30:51 - 31:14)
Resistance is great. Plyometrics is great as well. The more variety the muscle will respond, but the bone actually responds quite well to load and variety of vectors.

So anytime you can do something that's weight bearing to the body, great, like running on a treadmill will look better than cycling because obviously the ground force is there. So anything that's weight bearing is going to be beneficial not only to muscle, but obviously bone tissue as well.

[Angela Foster] (31:14 - 31:25)
It's interesting, isn't it? Because I think of my daughter, she's 13 and she's like hugely into gymnastics, seven hours of gymnastics a week. And I think she must be building good muscle and bone.

[Dr Darren Candow] (31:25 - 31:40)
They have some of the best bone mineral densities across the lifespan and muscle mass. And obviously because they're always putting weight on the body, holding poses, ground forces. So if you look at bone mineral density and muscle mass in gymnasts, it's very, very high, if not some of the highest.

[Angela Foster] (31:41 - 31:47)
Interesting. And what about when we get to the point of like, is there a point that we get to where we're now just defending what we have?

[Dr Darren Candow] (31:48 - 32:46)
Yeah, unfortunately, around the 40th birthday, that's where the body says, okay, let's sort of change a bit. It really accelerates after the fifth decade, but the biological process of ageing, there's clear evidence that sarcopenia, I think a lot of viewers have probably heard that, that's the age-related reduction in muscle mass strength and functionality coincides with bone-related diseases and frailty. So the 40th birthday onwards is where the body starts to deteriorate a little bit.

It does accelerate after the fifth decade. And of course, when we get 60, 70, and 80, we don't want that. We want to come up with interventions, ideally non-pharmacological, to make us live longer, free of disease.

Exercise has to be number one. You could argue exercise has to be number one, two, and three. Right after that though, adequate protein.

I think still today, a lot of people are not consuming enough quality protein. And then consider creatine, if you can, to give you that synergistic effect of those two interventions. Yeah.

[Angela Foster] (32:47 - 32:52)
Okay, great. Thank you. And do you think things like red light therapy can make a difference to bone?

[Dr Darren Candow] (32:52 - 33:13)
Not. The evidence of all those things seems to be a little questionable until I see randomised control trials. I don't know much about that.

So I can't really comment on that per se. I know a lot of people will do it to wake up or for skin health. It's kind of like collagen, but I haven't seen anything on that and bone health, especially.

[Angela Foster] (33:13 - 33:33)
Okay, interesting. You mentioned there for bone health, eight grammes to 12 grammes. I'm thinking like the typical, very typical postmenopausal women is somewhere in the region of 60 kilos.

If we went on that 0.1 gramme per kilo, that would only be six grammes. So you're saying they can actually go above that if they're trying to protect bone health?

[Dr Darren Candow] (33:34 - 35:06)
Our best study was two years and we gave postmenopausal females 0.14 grammes. So that equated to about 11 to 12 grammes a day for two straight years. No adverse effects on the kidney or liver, and it had improvements on improving lean body mass, preserved bone and increased bone strength.

Now people say, wow, that's a lot higher than I've ever heard. And keep in mind our knowledge has evolved from the three to five grammes for just muscle. Now we're talking about bone.

And of course, brain is a different story altogether. But if you are taking a higher amount than five, please note, it's likely you can divide that up into smaller dosages. So I personally take about 10 grammes a day at least.

And I put five in my breakfast. I usually have Greek yoghurt and whey protein. And then I'll put five in a water bottle and drink that when I'm working out.

So there's an easy way to get 10 grammes in the day. And I don't notice any adverse effects like GI tract or things like that. Could I take 10 at once?

100%. You could take 20 or 30 if you want. But just do what's consistent for you.

I think if a listener is saying, OK, I'm interested in starting creatine, I wouldn't recommend to start maybe at 10. Maybe start with three to five grammes. See how you do.

Tolerate it. You could divide that up into maybe two and a half grammes in the morning, two and a half grammes later. Come up with a nice, slow, progressive strategy to make it more consistent.

And hopefully they're considering it, taking it on a daily basis for the benefits, not only for exercise, but health benefits there as well.

[Angela Foster] (35:07 - 35:26)
When you're talking there about tolerating it, that's interesting to me because we talk a lot about creatine monohydrate. And then you can spend a few more pounds or dollars to get CreaPure, which I've heard is like water wash, but certainly it seems gentler on the stomach and the other ones in some kind of acid. I don't really understand that.

Can you explain for our listeners?

[Dr Darren Candow] (35:26 - 36:24)
Yeah. So CreaPure is the world's leading type of creatine monohydrate. It has grass status.

That means it's generally recognised as safe by the FDA. It's third-party tested. The purity is almost a hundred percent.

If not, it is a hundred percent. So it's the highest quality creatine monohydrate. Alls Chem also has another product called CreaVialis, where it's really micronised.

It's very fluffy. So when you mix it in water, it almost dissolves completely, whereas CreaPure will have a little bit of grittiness if you were to drink it in water. If you put it in food, you don't notice any of the differences.

And again, that's a really important point that I didn't disclose. I serve on the advisory board for Alls Chem. But when I talk about creatine, I'm only talking about monohydrate.

All those other forms out there that people hear of, they're more expensive and they've never been shown to be better. And the safety is the most important. The safety of creatine monohydrate is exceptional.

We do not know the safety of all those other marketed forms out there.

[Angela Foster] (36:25 - 36:58)
Yeah. I wanted to talk to you a little bit about those because there's some other forms. Like for example, I've heard that, I can't even pronounce it.

Grinidone Acetic Acid, GAA, is a direct precursor. And that has been shown to increase musculoskeletal creatine, I think by 16.9% versus 2% for monohydrate. And then we're going to come onto the brain later, but 3.9 times higher in grey and white matter is that. And it seems to be used synergistically alongside CreaPure to increase it even more. I was curious as to what you thought about that.

[Dr Darren Candow] (36:59 - 37:43)
Yeah. So GAA is guanidinoacetoacetate. It's the precursor in our natural synthesis of creatine from the kidney and liver.

So that's why it is a very viable surrogate. And when you combine creatine with GAA and or GAA itself, it has beneficial effects in getting creatine into the muscle and or brain. And my colleague, Serge Austiak in Norway is the leader in GAA research.

And that is a good surrogate of creatine there. It's really beneficial for those children born with creatine synthesis deficiencies where they may be lacking this enzyme. So that's why GAA can be beneficial.

But pay attention to that one coming up soon, especially for brain, trying to get more creatine into the muscle and or brain more specifically. GAA will be a hot topic area coming out for sure. Yes.

[Angela Foster] (37:44 - 38:17)
Yeah. Do you know, it's really interesting because I've been testing it. I know Kyle, the founder of Level Up Health, and he makes peptides, and he's put together this amazing creatine stack.

And I used to take like basic creatine monohydrate. Then I went to Creapure, got better. But I would still get sometimes, particularly if I was a bit sleep deprived, I'd feel like I wasn't quite giving me enough.

And we can talk about sleep in a moment and the dosages and brain. But then I moved on to his one with the GAA. And I have to say, like, the brain benefits that I'm experiencing are really markedly different.

[Dr Darren Candow] (38:18 - 38:19)
Interesting. Yeah, yeah.

[Angela Foster] (38:19 - 38:22)
I can really, really feel it. And it's like, it's my go to now in the morning.

[Dr Darren Candow] (38:23 - 38:50)
Yeah, the physiology is there. And then, of course, we need the evidence to suggest is GAA and creatine together better than creatine alone or GAA. There's some preliminary data to assist.

GAA really helps get it in. There's like, it's like carbohydrates, the skeletal muscle. Then the question is, is it actually better or worth adding it in?

But if you've experienced in that, I have heard that before from other people. So I think pay attention to GAA. It's an interesting compound for sure.

[Angela Foster] (38:50 - 39:11)
Yeah, really interesting. And then the other ones, I think the other thing to mention here for people that are looking at GAA with it is my understanding is to make sure that it has trimethylglycine or something like that, because you need to support the methylation pathway with creatine takes the methylation from homocysteine natural synthesis.

[Dr Darren Candow] (39:12 - 39:26)
When you're adding in GAA, which is a natural precursor in the process, there might be some other things to consider. Again, Serge would be the best person to talk more about GAA on that. And he'd be great to bring on your show and talk about the benefits of that molecule for sure.

[Angela Foster] (39:26 - 39:38)
Amazing. Maybe you can give me the details. And then there's some other forms like creatine, HCL, creatine, magnesium, chelate.

What are those?

[Dr Darren Candow] (39:39 - 40:12)
I would really caution your viewers to consider those. They've never been shown to be safe and more effective than monohydrate. And I think, you know, if someone's considering putting a supplement in their body, I know creatine monohydrate has been around since 1832.

It's a little boring. It's that white powder. And we're always looking for something new.

But I'm a strong proponent against all those other market forms that just don't hold the weight from a scientific perspective. So monohydrate is the only one we would consider from an evidence based perspective. Yeah.

[Angela Foster] (40:12 - 40:21)
Yeah. And then thinking about this precursor. Yes, exactly.

With the safety, it's not that you have particular concerns. It's just that it's not been proven over a long period, right?

[Dr Darren Candow] (40:22 - 40:23)
From a GAA perspective?

[Angela Foster] (40:24 - 40:30)
No, from things like the creatine, magnesium, chelate or the creatine, HCL.

[Dr Darren Candow] (40:30 - 41:07)
Yeah, the issue is if the body's going to like it, it has to be creatine for sure. So can those new types get through the GI tract, remain intact? And when it gets into the blood, can it get into our cells?

Creatine is very specific. It has a doorway, a creatine transporter, SLC 6A8, that only will allow GAA and or creatine. So that's my first question of these new types that are out there.

Did it get into the cell? And if it did, is it better than monohydrate from a cost perspective or safety? So the safety profile of monohydrate is exceptional.

We have no clue about the safety of all these other types.

[Angela Foster] (41:08 - 41:27)
Okay, interesting. So let's, I think it's a good time to switch gear into the brain because I saw the extra brain benefits with GAA. Yeah.

And I think let's start with, first of all, just how can creatine cross the blood brain barrier and actually help with cognitive health? Yeah.

[Dr Darren Candow] (41:27 - 44:13)
So the brain makes its own creatine. The muscle doesn't. So the muscle acts as a vacuum.

It basically sucks in all the creatine from the blood. The brain says, hang on, we make our own. We don't need what's in the blood.

So one of the big issues with supplementation that we've found out is that creatine can get through the blood brain barrier, but it's really slow. It's like the blood brain barrier is there for a reason. It doesn't like it.

It can take it in, but it's really slow compared to muscle. If anything, it's half. But eventually creatine will accumulate very slow, very slow.

It can get in through the blood brain barrier. And then when it gets into our neurones or other cells of the central nervous system, it has been shown to increase brain creatine levels. Now, the interesting thing with the brain is only about two kilogrammes or 2% of our weight, but it uses 20% of our daily energy.

And that's on a good day. Now think of when you're sleep deprived, jet lag, kids woke you up, dog had to get up in the middle of the night. You've got to work 16 hours.

You're an ER doctor, shift worker. Everybody I know in the world is stressed. Everybody could use more sleep.

The brain seems to use creatine supplementation almost from a rescue or safety perspective. So I think this is really important for your viewers. If you're a young, healthy individual, adequate sleep, great diet, and you take creatine, you're likely not going to notice any benefits because the brain is already making enough.

But if you're sleep deprived, jet lag, stress, night worker, your job is super intense, you're relying on too much caffeine, whatever it is, that's where the brain says, you know what, I could use a little bit of help here. And one of the common denominators is that in the studies, the best lines of evidence with creatine is when you do a mentally fatiguing task, or you keep people up for 21 hours with no sleep, it seems to improve memory and cognition when the brain is stressed. So this is important.

When you're going through metabolic stressors, creatine seems to come to the rescue. It has been shown even when the brain is not metabolically stressed to have some minimal memory benefits for older adults. But at the end of the day, if someone says, I want to take creatine to improve memory cognition, when you're stressed, that's when it seems to come to the rescue.

So before we went on camera here, I talked about his final exam now in universities, students are staying up all night studying, could creatine be something that they consume to improve better on their final exams? We don't know, but the logic is there when they're metabolically stressed. So it does improve tasks of cognition and memory after sleep deprivation.

I use it when I'm jet lagged. So if I have to fly to Europe, and you know, I typically get jet lag, I actually take a 20 gramme dose to offset those effects.

[Angela Foster] (44:14 - 44:15)
For how long would you do that?

[Dr Darren Candow] (44:16 - 45:49)
I would take the week before and then of course the week after. So that begs the question, what about the dose for the brain? And this gets a little tricky.

So there hasn't been a lot of great studies, but a common denominator with clinical depression, anxiety, and other neurological diseases is that their population, people who have these conditions, they're arresting creating stores in the brain are lower than a healthy control. So maybe supplementation is bringing those levels up or potentially even higher. And the best lines of evidence come from the rodent model.

Then of course we're having some preliminary data now in humans. When you use an MRI for the brain, it's called an MRS. There's only a few labs that will look at that. When a human will take about 20 grammes a day for seven days, that really increases brain creating levels.

The problem is that's the loading phase I initially talked about when we started this podcast saying, hey, that's a great dose for rapidly saturating the body, but it might cause a little bit of adverse effects. So I've done the math. And when you look at muscle, bone, and brain, that's where that 10 grammes a day seems to be a very viable daily dose.

I'm super confident that if you were taking 10 grammes or slightly more, your muscle will be full. That checks the box for bone. And it also likely checks the box for brain because there was a good study showing that 10 grammes doubled the amount of brain creating content compared to two and four grammes a day.

So I think you need a little bit more. Some will eventually get into the brain, and when the brain is stressed, that's where it really seems to come into action.

[Angela Foster] (45:52 - 48:16)
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It does.

[Dr Darren Candow] (48:16 - 49:27)
Yeah, no research in autism, unfortunately. There has been good research, and it is emerging with depression and anxiety. Please note, though, that creatine was added to their standard treatment.

Creatine alone has not been looked at. Not a lot of big problems in Parkinson's, Huntington's, nothing in Lou Gehrig's or ALS, probably because you need long-term clinical trials to be equivocal. Muscular dystrophy, young boys with muscular dystrophy do benefit there.

And then, unfortunately, with multiple sclerosis, we're not seeing any benefits yet. But I'm happy and encouraged to know that there is finally a study looking at creatine in Alzheimer's patients, and we're hoping to start one with clinical dementia starting in 2026 as well. So it is emerging.

I think it's the area to focus on for maybe the next 20 or 30 years because we're so fascinated. And the big area we haven't talked about is head trauma, concussion for athletes, or traumatic stress syndrome for individuals. That's the area I think there's going to be a lot of hope there.

The mechanism is all consistent. It seems to be a neurotransmitter, and it also seems to decrease inflammation in the brain, just like our muscle when the brain is stressed.

[Angela Foster] (49:27 - 49:57)
It's very interesting. I mean, I tell you, so my son, my eldest son, he's 17 coming on 18. He's on the autism spectrum, very high functioning, very intelligent, but struggles a bit with anxiety.

And he was taking, it was one actually that was sent to me, a creatine-taurine blend. And that works really well. He feels a little bit calm, I think, from the taurine, and he has that energy and focus.

And that was going to be my question, are there any other things that are kind of synergistic like taurine?

[Dr Darren Candow] (49:57 - 51:12)
Yeah, there hasn't been any RCTs on creatine-taurine, but the mechanisms are there. For example, taurine obviously being an amino acid compound in theory has some anti-inflammatory properties as well combined with creatine. So no issues with taurine, but I need to see the evidence comparing creatine by itself with creatine and taurine.

The best lines of evidence are creatine combined with protein actually. So you get the beneficial effects of protein, and they seem to be synergistic with creatine. So there's been a few studies when you combine creatine and protein, you get greater improvements in lean body mass and muscle performance.

Nothing's been looked at now on bone or brain, but that's for future research designs. For the elite athletes watching, creatine and beta-alanine or sodium bicarbonate have been shown to have a more buffering effect. But that's about it, really.

We sort of tried to do a study with creatine and CLA derivative of omega-6. It had a little bit of potential, but getting the omega-3 oil with creatine is very tough to do from an experimental perspective. But there's been some ideas with creatine and collagen coming up for bone health or arthritis and things like that.

So I think it's an area of interest for a lot of research labs to look at creatine in combination with other things.

[Angela Foster] (51:12 - 51:44)
I mean, that's really interesting, isn't it? Creatine with collagen, because also there's some research I've seen around collagen with protein, and you were saying creatine with protein as well. And then there's also collagen with protein and how that supports the body and the connective tissues in addition.

When you're saying creatine, I mean, creatine with protein makes sense, right? Because creatine is found in protein-rich foods. But when you're saying creatine with protein, are you saying like if someone's preparing a shake, say a whey isolate or maybe a plant-based shake, adding some creatine into that shake, that's when I do it.

Is that a good idea?

[Dr Darren Candow] (51:44 - 51:58)
That's 100% correct. Yeah. So I throw in about five grammes and a big bowl of Greek yoghurt and whey protein for breakfast.

But in the studies that I've looked at, it's the two powders coming together. Same principle as if you were to put it in yoghurt or whichever it is, it's the same principle. Yeah.

[Angela Foster] (51:58 - 52:02)
And how much protein do you need to match that five grammes in terms of...

[Dr Darren Candow] (52:02 - 52:31)
Yeah. Interesting though, the studies that have shown some effects, it was small dose with 25 to 30 grammes in one setting. So not a lot.

That would be your typical shake, if you will, you know, a scoop of whey protein or whichever it was. Both studies were whey protein-based. But if you were to put creatine in a bowl of Greek yoghurt, it's the same amount there as well.

Now, keep in mind that the dose of protein does depend on the age. I think if you're under 40, 20, 25 grammes is plenty. If you're over 40, you might need about 40 or so due to that ageing anabolic resistance.

[Angela Foster] (52:32 - 53:24)
Yeah. You know, what's really interesting to me, and also I'm not a scientist, so you might just absolutely laugh at this, but when you were looking at creatine in the brain and how it could improve, right, if someone was taking enough creatine and the studies that were being done around kind of mood stability and things like that, what's interesting is when you look at serotonin and experts that I've had on in relation to gut health and neuroscientists, because 90% of the serotonin is made in the gut, but that's not getting across the blood-brain barrier. However, through the vagus nerve, when the gut feels happy and there's sufficient serotonin, which also helps with motility, it seems like that then communicates for the brain.

If it has enough tryptophan and stuff and the right, you know, steps to convert it, it will then make its own serotonin. And I was just curious, do you think there's maybe a link there coming through in terms of what the brain's doing in response?

[Dr Darren Candow] (53:24 - 54:25)
I'm aware of one paper looking at creatine potentially improving gut health. It's a very interesting idea there. And one of the most fascinating, probably in the last two years, is that creatine is now acting not only as a neurotransmitter, but a neuromodulator.

And it's seeming to have an interaction with dopamine and serotonin. And that's why we think it might have huge applications for clinical depression. That's the idea or premise is that, unlike SSRIs, it can actually sort of modulate or sort of kind of be like caffeine is an adenosine antagonist to the brain.

It'll make you alert. It seems to cause more of a stimulating or pleasurable effect. And when you talk to people with clinical depression in the papers, it seems to improve their mood symptoms.

They don't need to rely on so much drug dependency or medication. So their self-efficacy goes up, self-esteem. So super fascinating.

And I think that'll be a huge area of research. I do know there's a group out of Utah, a psychiatry group that has been looking at creatine. And there's a lot of excellent data coming out of there as well, especially with clinical depression.

[Angela Foster] (54:26 - 54:50)
Really, really interesting. But you're saying in terms of like dosaging it to help with the brain at the moment, the preliminary research seems to be that you would stagger that across the day. So like if someone, I mean, you make a good point with exams, right?

Both my boys are taking their end exams, which are really important. Would they, and they may not be getting enough sleep. Someone who's working hard, jet lagged, would they be better off splitting that across the day?

[Dr Darren Candow] (54:50 - 55:58)
Yeah. So just recently, a great study out of Germany showed that a massive bolus dose, I think it was about 30 grammes can be consumed one setting and have some brain beneficial effects on memory and cognition post sleep deprivation. But I don't know if 30 grammes is viable in a single dose.

I think that's a very log for people. I see no reason why you can't take smaller, more frequent dosages because unlike caffeine, creatine does need to accumulate in the tissues. And if you have a more steady state throughout the day, I think you'll get beneficial effects.

And I think if you're looking at those higher dosages, more frequent, smaller dosages is more plausible for people. And in the studies that showed those beneficial effects, 20 grammes a day for about seven days was the minimum. There's only been one study in people with long COVID at four grammes a day.

It did accumulate in the brain after three months. So I think if you're taking smaller dosages, that's fine. Just be a lot more patient.

I think a little bit, we'll get into the brain when you need it. If you take a bit higher dose that might get in there a little bit more. And that's personally why I've doubled my dose, at least 10 grammes a day.

I'm now trying to hit the whole body, not just a muscle squiggle.

[Angela Foster] (55:58 - 56:21)
So if you, if you've got somebody who's training like Michael Middleton, he basically, he likes to do his revision and then he'll go work out in the gym and do resistance training. You could argue that the muscles are going to like, like rub a little bit more of that creatine, right? Because they need them.

And so maybe there's an argument for an increased dose. If you've got exam revision, the brain's using a load and then the muscles are using a load as well.

[Dr Darren Candow] (56:21 - 56:46)
A hundred percent. I'd almost double it. There's no reason why there's no adverse effects.

We're not seeing anything. A massive paper just came out on the safety. I think the average dose was 12 grammes, no greater effects.

So if your son happens to be taking three to five grammes a day and he's maybe 70 or 80 kilogrammes or whatever he is, I see no reason why you can't increase it. We have so many studies out there now showing no adverse effects, superior benefits with higher dosages.

[Angela Foster] (56:46 - 56:59)
Up to 10 or 12. And what about any argument that we talk about the fact that it can help with sleep deficits? If you're staggering that dose, would there be any benefit to taking it before sleep?

Could it improve sleep outcomes?

[Dr Darren Candow] (56:59 - 57:29)
Yeah, we just published a paper last year in biological females who were exercising and when they took five grammes a day for six weeks, on the days they trained with weights, it was two days a week, they actually improved sleep duration by an extra hour. And it was statistically significant. So we think it has some benefits to exercising and maybe causing the body to sleep a little bit more for extra recovery, getting you ready for the next thing.

So not only does it decrease sleep deprivation, there's some evidence to suggest it improves greater sleep quantity.

[Angela Foster] (57:30 - 57:33)
Interesting. Do you think it would improve the quality in addition to the quantity?

[Dr Darren Candow] (57:34 - 58:04)
We didn't show that and we definitely need to look at sex differences there as well because the question is, you might sleep longer, but if you're tossing and turning, okay, what was being measured? They did the Oura Ring in this case, but it'd be great to go into a sleep lab and see the stages of non-REM and REM sleep and deep quality sleep. And I think now with that paper coming out last year, I think some sleep lab researchers will be sort of looking at this to see, can it have, and if it does, why?

We don't know why it does, we did not measure any mechanisms.

[Angela Foster] (58:05 - 58:15)
Yeah, that would be super interesting because you think like a busy mum like myself, I probably don't have much room to improve sleep duration because there isn't that time available at this point, but sleep quality would be a big thing.

[Dr Darren Candow] (58:16 - 58:19)
I would pay anything for greater sleep quality, I would do it, yeah.

[Angela Foster] (58:21 - 58:22)
Magic, isn't it?

[Dr Darren Candow] (58:22 - 58:22)
Yes.

[Angela Foster] (58:22 - 58:31)
And if you're taking it then at night, I don't know what the study did, but again, would it be better then to take it with the evening meal because you're having it with food as opposed to a bedtime drink?

[Dr Darren Candow] (58:31 - 59:09)
Yeah, so there wasn't a time perspective, but yeah, if you were to take it in the evening, you can take it with food. I like taking it like later on in the evening, shortly before going to bed when I need that extra boost, so jet lag and things like that. So again, the timing is irrelevant per se, but I do suggest on the days you work out, try to take it in close proximity to exercise.

So that means maybe an hour before, you can take it during your workout or after. Muscle contractions really seem to increase the uptake there and I think that's a very consistent, think of creatine as a recovery or reward for you exercising. It really will help you allow you get back to the gym or whatever it is, yeah.

[Angela Foster] (59:09 - 59:13)
Okay, interesting. So either before, during, or post-training is a good time to take it.

[Dr Darren Candow] (59:13 - 59:17)
And again, you can take it at any time, but I like taking it in close proximity to exercise.

[Angela Foster] (59:18 - 59:47)
Yeah, I take it straight after actually. That's interesting. Menopausal women, perimenopausal women, we talked, I mean, it seems to be coming through, I mean, so many benefits, right?

We see that they have higher rates of inflammation, you're saying it reduces inflammation. They get brain fog frequently, the brain energetics we've talked about, there's improvements there, they can get increased anxiety, low mood with loss of eating, it seems like that could also help to support that. The bone stuff, is there anything else that we're missing for the perimenopausal women?

[Dr Darren Candow] (59:47 - 1:00:32)
I think the big one is the decrease in body fat. I think there's a transitional thing when, so that's a huge one. I think a lot of people, especially females say, oh, the number on the scale went up, please notice water.

And over time with exercise, body fat might come down and those are the big things. The area we're really curious of is if we did look at perimenopausal transition, imagine if it had applications for decreasing falls and fractures later on in life when the bone is really under attack with the cessation of oestrogen. And those are clinical population areas we're interested in, but I would love to do a lot more research in that perimenopausal transition to see really what's going on.

And exercise is foundational. Can a nutrient cause some beneficial effects? That would be great to test.

[Angela Foster] (1:00:32 - 1:01:16)
That's really interesting. I think that would make a lot of people happy that it reduces body fat. I mean, what's really interesting is I've noticed is we always associate this sort of move in the deposition of fat.

It's not so much that there's so much overall gain, but the deposition changes. And I take creatine daily because I swear by it. And my visceral fat rating is the lowest.

It's on a one. And I'm curious, which is great, right? Because it's such a very common that women would accumulate that.

And definitely, if you say, is it genetic and family history? I have a strong family history. I'm half Lebanese.

They generally, that area of the world tends to get more abdominal fat. So actually, it's really interesting. Do we think that the creatine in addition to reducing overall body fat could also play a part in reduction of visceral fat?

[Dr Darren Candow] (1:01:17 - 1:02:03)
Yeah, I wish we had that data. It was just sort of looking at overall distribution. In the rodent model, creatine has been shown to increase thermogenesis.

So there might be some mechanism of why it could lead to a decrease. Again, the decreases are small, but they are still a decrease. So we don't necessarily think it's just improving lean mass, which increases your energy metabolism or expenditure.

We do see some evidence in animal models that there's a thermogenic effect there. But we need to do obviously measuring subcutaneous versus visceral fat. We also need to look at intramuscular fats to see if it's being metabolised higher in trained people.

So there's a lot of work in that area. Not a lot of labs are really looking at this, but maybe this might spark some interest in individuals to look at the mechanisms.

[Angela Foster] (1:02:04 - 1:02:21)
Yeah, really interesting. Okay, and then should we just get rid of the two things that need to be debunked? Because everyone will want me to ask, even I think lots of people know this.

So you've talked about the safety, it does not cause kidney problems, and it does not cause No, so actually, great timing.

[Dr Darren Candow] (1:02:22 - 1:03:36)
I mean, people can see me and I was going bald before I started taking creatine. But first off, there's no renal or kidney issues, even at higher recommended dosages. Safety papers just came out, and a paper that just got accepted regarding they finally actually measured hair loss.

This myth goes all the way back to a hormone from rugby players about 30 years ago, and it had no validity to hair thinning or loss. And I know there's a study that has just been accepted, and it's coming out, where they actually measured hair follicle number, size, and cross-sectoral area. I don't know the results, but that should be out in the press any day now.

But to be honest, there's no evidence, there's no reason why creatine would cause hair loss. Independent of looking at me, I've assessed over 1000 people and not a single person has ever come to me and said, whatever you're giving me has caused my hair to thin. But I hear this on Instagram on a daily basis, multiple times a day.

So it is a huge concern, and I can't wait for this paper to come out. It'll probably be the paper of the year just because it will address. Now, if it turns out creatine did cause hair thinning and loss, well, then there's a lot of validity to this myth.

But my guess is based on the evidence. I can't see it. And if it does, I'll be super shocked.

[Angela Foster] (1:03:37 - 1:04:05)
Yeah. Yeah. That's good to know, isn't it?

Because I think, as you say, I see it on Instagram all the time. I guess the reason I ask is because for some women who maybe haven't been taking creatine and are in perimenopause and are experiencing a drop in oestrogen and therefore their hair is thinning and maybe even the drop in progesterone is reducing their iron levels, which is also thinning their hair. They could incorrectly associate the hair loss with the creatine that's just come in new.

Do you know what I mean?

[Dr Darren Candow] (1:04:06 - 1:04:27)
Yeah, a hundred percent. It's like when people say I'm suffering muscle cramping from creatine. I'm like, well, actually, it super hydrates the muscle.

And then when you find out more, they're like, oh, I'm exercising now an extra hour a day, not drinking as much water. I'm not taking as many electrolytes. So there's so many correlations.

But creatine always gets blamed for pretty much any adverse thing that a person's going through. Yeah.

[Angela Foster] (1:04:27 - 1:04:28)
So many things.

[Dr Darren Candow] (1:04:28 - 1:04:28)
Yeah.

[Angela Foster] (1:04:28 - 1:04:33)
Some rapid fire questions then. So what can we do with it? Can we eat it?

Can we put it in coffee? Is there a problem with that?

[Dr Darren Candow] (1:04:33 - 1:04:55)
Yes. So you can put in everything, but a little caution here with coffee. So some really good evidence suggests that the dose of caffeine might interfere, not coffee, caffeine.

So if your coffee contains any more than 250 milligrammes of caffeine on the long term, they might interfere with one another. But the average small, medium and even large coffee is well under that. So it should be fine.

[Angela Foster] (1:04:56 - 1:05:00)
Okay. But it's not the overall consumption of caffeine across the day that could interfere?

[Dr Darren Candow] (1:05:00 - 1:05:03)
No, it seems to be the extreme dosage. That's correct. Yeah.

[Angela Foster] (1:05:03 - 1:05:30)
Oh, okay. Okay. Got you.

And then it makes as well in water, in yoghurt. We've talked about splitting the dosages across the day for brain health, for sleep health. People can experiment with that going up to kind of 10, 11, 12 grammes for bone health and brain health.

And then GAA looks like this exciting new thing that I'm definitely seeing the benefits. Is there anything I'm looking at my notes because I have so many. Is there anything I haven't asked you that you think I should have asked you that way?

[Dr Darren Candow] (1:05:30 - 1:06:10)
No, we hit pretty much everything. Fat mass, bone, brain, it's applications for anybody. And I think in addition to exercise.

So one thing is creatine is not a magic cure. It really responds in combination with exercise. But it is something that seems to have a totality of beneficial effects.

Do you need the supplement? The answer is no. But the evidence suggests that to get the amount we're talking about is very difficult to do from your diet.

So you may need to get a bit more. But please, if you are considering supplementation, make sure it's third party tested, and make sure the compound that you're consuming is safe and a valid source of creatine.

[Angela Foster] (1:06:10 - 1:06:27)
When you say the complementary benefits of exercise, right, it's not kind of a magic bullet on its own. So you know, I have clients, for example, who, for whatever reason, medical reasons, they're not able to do so much of the resistance work at this point, they might be doing brisk walking, for example, will it complement something like that as well?

[Dr Darren Candow] (1:06:27 - 1:07:01)
Yeah, there's probably about 10% of studies out there that have looked at creating without exercise, you do get muscle performance benefits. So that's very beneficial. And you get also some cognitive benefits independent of exercise.

So that is very nice. And there's some data with disuse or immobilisation showing that creatine can maintain the size of our muscle and strength, even when you're mobilised with like a cast on your arm or something like that. So that has application.

But for those that are, as you talked about in specific cohorts, creating can give some very small muscle performance benefits without exercise.

[Angela Foster] (1:07:02 - 1:07:04)
Okay, even with just aerobic exercise?

[Dr Darren Candow] (1:07:04 - 1:07:10)
Yeah, or even if they did nothing, that's where some of them improve strength, endurance and power.

[Angela Foster] (1:07:10 - 1:07:21)
And last question, if I want to be highly productive during my day, would there be an argument for say, taking that 10 to 12 grammes and just going, right, I'm going to drip feed, I'm going to have three or four in the morning, and then another set of lunch and then another set in the evening?

[Dr Darren Candow] (1:07:22 - 1:07:35)
100% Yeah, absolutely. So and the more stressed you are, the more demands it is to the body. So if you were to take, say, I want to take 10, you could do five and five, you could do all 10 or you could do three, three and four, whichever you like.

Yeah.

[Angela Foster] (1:07:35 - 1:07:55)
Amazing. Thank you so much. I feel like I've had a whole masterclass.

Okay. Yeah, you're such a wealth of knowledge and resource. Darren, how can people find you connect with you learn from you?

I know you're like super busy with all your students and your papers and your research. Yeah, I'm sure audience would love to do so.

[Dr Darren Candow] (1:07:56 - 1:08:05)
I think Instagram is kind of the most popular. So at Dr. Darren Cando, I talk a lot about creating research, a lot of things out there to make people live longer free of disease. So that's probably the best place.

[Angela Foster] (1:08:06 - 1:08:07)
Yeah, that's the best place to keep up with all the research.

[Dr Darren Candow] (1:08:08 - 1:08:09)
Absolutely. Yeah.

[Angela Foster] (1:08:09 - 1:08:17)
Amazing. Thank you. We'll link to that in the show notes.

Thank you so much for coming on today. It's been really super interesting. I'm going to go over this one again and again, I think.

[Dr Darren Candow] (1:08:17 - 1:08:19)
Thank you so much for having me. Take care.

[Angela Foster] (1:08:19 - 1:09:43)
I hope today's episode inspired you on your journey to vibrant health and high performance. Make sure you check out the show notes for a summary of all the important links to everything we talked about. And if you enjoyed this episode, hit the follow button and share it with a friend on social media.

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Have a beautiful day and always remember you are worthy of your dreams. Now for the legal stuff. This podcast is for informational purposes only and does not constitute medical, nutritional or other professional advice.

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Download my free Ultimate Guide to Creatine for Women here: https://academy.angelafosterperformance.com/creatine-guide 

What if creatine isn’t just for bodybuilders—but a potent, research-backed tool for women’s health, performance, and longevity? Angela sits down with Darren Candow, a leading expert on creatine and Professor and Director of the Aging Muscle and Bone Health Laboratory at the University of Regina, Canada. Together, they unpack the groundbreaking science behind one of the most misunderstood supplements. From brain energetics and mood stability to bone density, fat loss, and anti-aging, this is your comprehensive guide to creatine beyond the gym.

KEY TAKEAWAYS:

• Creatine for Cognitive Health: It crosses the blood-brain barrier slowly but significantly, especially under stress or sleep deprivation.
• Dosage Evolution: 10g/day may be optimal for full muscle, brain, and bone saturation.
• Bone Health & Aging: Combined with resistance training, creatine may help preserve bone density, especially post-menopause.
• Body Composition Benefits: Contrary to myth, creatine reduces body fat over time and improves lean mass, even in women.

Disclaimer: The High Performance Health Podcast is for general information purposes only and do not constitute the practice of professional or coaching advice and no client relationship is formed. The use of information on this podcast, or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for medical or other professional advice, diagnosis, or treatment. Users should seek the assistance of their medical doctor or other health care professional for before taking any steps to implement any of the items discussed in this podcast.