Creatine for Ultrarunning with Scott Forbes, PhD | KoopCast Episode 176

Trail and ultra runners, what is going on? What's happening? Welcome to another episode of the KoopCast. As always, I'm your humble host, Coach Jason Koop. And this episode of the podcast will hopefully answer the question for you, is creatine supplementation worth it as an endurance athlete and an ultra marathon runner? This is one of the most common questions that I get asked on a weekly basis. And I think that the genesis of a lot of this question comes from the fact that creatine supplementation has a longstanding reputation as an effective supplement in power and in speed sports, as well as in the bodybuilding community. Yet, those translated benefits aren't quite as clear in an endurance application and certainly in an ultra marathon application. So to peel back the curtain a little bit on what creatine's benefits might actually be for ultra marathon runners, we have on the podcast today, Dr. Scott Forbes, who's an associate professor in the Department of Physical Education Studies at Brandon University, as well as an adjunct professor in the Faculty of Kinesiology and Health Studies at the University of Regina in Canada. Dr. Forbes is a certified sports nutritionist through the International Society of

Sports Nutrition, as well as a clinical exercise physiologist and high performance specialist through the Canadian Society for Exercise Physiology. So he comes to the table with both clinical and practical experience working with athletes and also looking at things through the research lens. He has also published over 110 peer-reviewed manuscripts in five book chapters. His research examines various nutritional and exercise interventions to enhance muscle, bone, and brain function in a variety of different populations. However, probably his most passionate area is the area of creatine. In fact, he is known as Dr. Creatine. That is his Instagram handle. You guys go and check it out.

And I wanted to bring on Scott to the podcast today to discuss this very interesting aspect of creatine supplementation for endurance athletes. Now, there are no caveats to this podcast. Dr. Forbes is not paid off by Big Creatine. You guys know that I have no sponsors or endorsements of any type type. So we can tell you the situation as it is with all the caveats and nuances, and you guys can make correct decisions from that. You can trust the information that is contained in this podcast. And I think as you listen to it, we do take a very practical and nuanced approach to creatine. Even though Scott is a huge fan of creatine supplementation, it does come down to a very pragmatic. He does come down to a very pragmatic point of view. Okay. With that out of the way, I am getting right out of the way. Here's my conversation all about creatine supplementation for endurance athletes and ultramarathon runners with Dr. Scott Forbes.

Well, welcome to the podcast. Thanks. Yeah. Happy to be here. And any chance I get to talk about creatine, I get really excited. So I know that's going to be the topic for today. So yeah, I'm really pumped to be here. So I always want to know right off the bat, when somebody makes a really specific thing, their thing, and in your case, it's creatine, right? And like you said, right out of the gate, I'm really excited to talk about this, right? So you're obviously super passionate about it. It's literally your Instagram handle, Dr. Creatine. So what got you into it? You got to tell me what the fascination for you in particular with this particular substances. Yeah. So I did my undergraduate degree and my master's degree at the University of Saskatchewan in Canada. And I was very fortunate to be able to work with two really kind of creatine prominent researchers. So Dr. Darren Kandow and Dr.

Phil Chillebeck. And so they were conducting some creatine research right when I was getting interested in conducting research. And so some of my first studies were done on creatine. So that kind of got me interested in that particular supplement. But basically, I got interested in sport nutrition, just because I was an athlete, and I wanted to better my performance. So I was actually a paddler. So I used to do canoeing. So yeah, it's an Olympic sport. But yeah, basically, it's similar to rowing, you try to go from point A to point B as quickly as possible. And that was my particular sport. But actually, I also got into running as well. So once I kind of moved on from paddling, I started running cross country, not until my fourth year of my university, my undergraduate degree. And yeah, just got really interested in cross country running as well.

So I think one of the things that we can kind of both appreciate is that creatine is one of the most researched sports supplements out there. And it might be the most you can probably tell me the statistics on it. But we know a lot about it, I guess, is kind of what I'm saying. And in the supplement and in the nutrition world, that's actually more rare than not, because most of the times these things come around, and there's very little evidence or there's just mechanistic speculation on how they work. Creatine is very far removed from that. It's been studied in a number of different applications for years, across a whole variety of subject pools, whether they're recreational or untrained or trained or even elite athletes, across a whole host of different types of sporting applications, from strength sport to endurance sport to even recovery from different types of modalities and things like that. And I think it's, it's when that is the case, one of the things that makes all of the research difficult is to try to kind of encapsulate it into what's really actually meaningful. And the way that I've really, the way that I've kind of internalized it in my brain after trying to, after seeing it evolve over the course of the last 25 years of my coaching career, it's really creatine supplementation for strength and power. That's kind of the primary reason that we, that we think about creatine supplementation, or at least the original one, right? Creatine supplementation for endurance athletes and then creatine supplementation for health

reasons. And this is the latter is probably more, some of the more recent phenomenons. So I wanted to get your kind of overall perspective on those three different categories. And if that's even, even a correct alignment on how to, on, on how to look at it based on your, you know, based on your experience. Yeah, absolutely. And to kind of go back to your first question of kind of why I've, well, I told you why I started in the creatine world, but the reason why I've continued with it is because there are so many benefits to creatine. So I've also studied a variety of other nutritional supplements, things like L-arginine. That's what I did my PhD work on. And essentially I spent five years showing that L-arginine had no effect on either aerobic exercise or strengthening exercise at different doses. And so I spent a lot of time trying to investigate that particular supplement.

And I found absolutely no benefit to that supplement. So. Which is kind of remarkable, right? You can spend so many years like researching something. And at the end of the day, you're like, you know, there's nothing here, nothing to see here, people. Which I think is also important information as well. But yeah, the reason why I've stuck with creatine is because there's so many kind of benefits to it. And it seems like each study there's like, okay, yeah, it does enhance muscle mass, muscle performance. It does, you know, enhance function in older adults. And now we know that it can start to impact other tissues in the body. But this particular question was kind of focusing on three different areas of research. So the first is that strength and power. And yes, there is substantial amount of evidence across a variety of different age spans as well, that creatine combined with resistance training or strength training can enhance muscular strength and power.

So if you just take creatine, and you sit on the couch all day, you're definitely not going to get bigger or stronger muscles, you actually have to go to the gym. And it could help basically build bigger, stronger muscles. I like that clarification, by the way. Yeah, exactly. So that's really important. And yeah, it can be a benefit for younger individuals, but also older adults as well. So it can also enhance function and prevent loss of muscle mass or even help you gain a little bit of muscle mass as you age, which is pretty cool and pretty exciting. And so we've got that, right? We've got the strength training piece, which is relatively well established. And we'll continue to we'll continue to discuss that on and off again, throughout the course of this podcast. And then there's these two other areas, right for endurance athletes, and then for just general health reasons.

Yeah, for sure. So from the health perspective, as I mentioned, it could be a benefit for older adults just to maintain kind of function, but also enhance muscle mass and muscle strength. And then we know that creatine can impact other tissues in your body as well. So we actually have evidence now that creatine could be a benefit for your bones. So it can make your bones a little bit stronger. Again, you have to combine that with strength training. And we also know that creatine can also impact your brain as well. So if you supplement with creatine, you can get a little bit more creatine in your brain. And that can have some positive impacts on cognitive function. So there's other areas that are being investigated. And there's lots of different chronic diseases or clinical populations that could also benefit from creatine as well. So there is that whole health area that's, that's really kind of exploded, as you mentioned, in the last 10 years.

And what about for endurance athletes, this is going to be the population of people that is like, most relative to the audience here, it's a bunch of ultra marathon runners that are listening to this podcast. What can we say about creatine as a broad umbrella, we're gonna get into it specifically, but as a broad umbrella, what can we generally say about creatine supplementation specifically for endurance athletes? Yeah, so this is also kind of an emerging area of research, but it's probably the least studied area out of the three domains that you mentioned. So strength and power, there's a huge amount of research to show that it could be a benefit for the health population, it's exploding, there's, there's a lot of research in that particular area, and it's, it's growing. But for endurance athletes, I would say there's, there's relatively few studies done on creatine supplementation and endurance exercise.

So a lot of it is theoretical, or based off of a few kind of relatively small studies. So if you look at those studies, there are certain kind of instances where, where creatine can be a benefit. And so I mentioned at the start, when we were talking that, that we recently published a narrative review, and there's, there are certain areas where creatine can be a benefit. But if you look at just creatine to enhance continuous steady state exercise, which is often done in a laboratory setting, then there's no real benefit to creatine supplementation. So you need to understand context and where it could actually be a benefit.

I really appreciate that approach, Scott. And in the way that I've kind of, the way that I've encapsulated is it's more of the tangential benefits, right? It's not the direct benefits to the exercise itself, meaning you're going to take creatine supplementation and it's going to impact that workout that you do 30 minutes later, an hour later, or something like that, which is the typical way that athletes will look at ergogenic aids. But there may be some tangential benefits associated with either medium or long-term use that can kind of pile on to the rest of the adaptations that are kind of going on at the same time. Absolutely. Absolutely. And here's, here's also what I appreciate about the creatine research. The long time listeners this podcast will understand that I get pretty skeptical around supplementation. I am generally a low supplement person. I use it very specifically and very directive. And a lot of the research that a lot of the research and quotes comes out or the claims, I guess is a better way to put it.

The claims that come out in the supplement industry, uh, uh, for the really the past 10 or 15 years, honestly do a disservice to the effective supplements that are actually out there because the effective supplements that are actually out there that have been researched for decades and have copious amounts of positive benefits associated with them, like creatine themselves kind of look boring. And so, so boring now that I'm thinking about it, it's kind of like one form of creatine that we're going to get into. That's the, the, the, almost the exclusive hitter in this, uh, in, in this arena. But, um, uh, my, my point with that is, is normally when you have a supplement that can lay claim to this whole host of benefits, a lot in strength training, some in health, and then maybe some in endurance running, normally that puts my antennas up, you know, the whole panacea effect. If it's, you know, that good for everything, there's probably something, something wrong with it. Right. But in this case, I don't think, I don't think that that's true. I actually think that the research is robust enough and we've been doing it for a long enough period of time that it can be stood on firmly and say, yeah, these, these, these kind of benefits are real. And we can also be honest about where they are either theoretical, as you mentioned, or they just need to be studied more to tease out the context.

Yeah, absolutely. And I would also just like to point out that, uh, I've never received a penny, a dime from any creatine supplement company. And, uh, the reason I just get excited about it is because the science behind it, because there's so much robust science behind creatine supplementation and that's my passion towards it. Um, but, uh, yeah, people think I'm, I'm lining my pockets with these selling creatine products and I have never, I've never done that. I just enjoy the research and and I'm passionate about the science. Well, we'll get into the fact why there's probably not a lot of money left to be made unless you're already doing it. Right. There's probably not a lot of money left to be made in the creatine industry in a second, but let's give, let's, let's kind of go back to one-on-one stuff. So for the unfamiliar to the kind of naive audience out there that has heard of creatine as a bodybuilding supplement or even misconstrued as a steroid, what is it? Cause you know that that misconception is out there as well. So what is, what is creatine? Where can we, where can we find it either in nature or in a supplemental form? Yeah. So creatine is actually just made up of three amino acids. So amino acids are the building blocks of protein. So anytime you consume protein, you're consuming amino acids. So creatine is formed of, of just three of those amino acids. And actually our bodies are synthesizing creatine, um, right now. So every single person

in the world has creatine within their, within their bodies and 95% of creatine within your body is actually stored in the muscle, but you can also get, uh, creatine from food sources, primarily red meat and seafood. So things like salmon, heron, um, beef, um, contain a fairly high amount of creatine. And those are kind of good food sources to obtain creatine in your diet, or you can obviously buy a supplement as well. So those, those are kind of the three ways that we get creatine within our bodies. And once you get creatine into your body and they get into your muscle cells, they get, uh, converted into this molecule called phosphocreatine, which is essentially a stored potential energy.

So you can use, you can break down phosphocreatine to make this molecule called ATP, which is just the energy currency within the muscle. And the thing about this particular energy system is that, um, it can make ATP very, very rapidly. So if you're doing anything that's really intense, then, um, this is where this particular energy system becomes important. And so the, the kind of the typical benefit that we see with creatine supplementation, it's almost along these, this, like it's this, like, uh, this, this road that's going down to parallel paths. The first one is the energetic one that you just mentioned, right? It can, it contributes to, to just your normal metabolism and how you produce energy across that particular domain spectrum, which is very short, very intense, 10, 12, maybe, maybe 15 seconds. And there's, then there's this other side that you mentioned kind of on the onset where there are these amino acids that are the building blocks of protein.

And it has an effect upon that protein, uh, along that protein building process before we get too far into that, because those are adaptations that may or may not probably don't apply as much to endurance athletes. Why, why is it ergogenic to take supplemental creatine above and beyond what you can actually find in the diet? I think the listeners would kind of enjoy to, uh, to understand and appreciate how much creatine you can actually derive from these natural sources compared to going into your nutrition supplement store and buying a huge bottle of creatine monohydrate and then dumping it into your water bottle and what those relative amounts are and why it's so, and why it's effective to take the doses that are typically recommended. Yeah, that's, that's a great question. So our bodies can only synthesize about one gram of creatine per day. And essentially that's not enough to, uh, saturate your muscles with creatine. And so then you can, uh, obtain creatine in your diet as well, but it's actually very difficult to achieve, uh, sufficient levels of creatine in your diet again, to saturate your muscles. So even if you're, um, eating animal based products, you're eating red meat, you're eating seafood. Um, you still will, we'll have about 80% saturation of creatine within your muscles.

And then that's why if you take a supplement on top of that, you can, again, you can saturate your muscles with creatine. You can have a hundred percent full, uh, creatine, uh, content within your muscle. So if you don't eat red meat and you don't eat seafood, so you're vegetarian or vegan, you're, you actually have lower amounts of creatine within your muscle and you might be more responsive to creatine supplementation. So essentially, um, yeah, this is, this is one of the few supplements where you can take on top of a healthy diet and it's going to have some benefit just by kind of filling your muscles with a little bit more creatine. Okay. So now we're going to get into forms and I want to give you the floor on this because, um, the supplement industry is F let's just like call it out. It is right. I mean, it's, it's, it's kind of a disaster. And I think that the, the part of the reason it's a disaster can be exemplified by what a lot of supplement companies have done with, with just standard creatine. You have all this micronized creatine heat and creatine hydrochloride, and you can go through all of the different ways that it's been contrived. So I'll ask you right out of the gate. Is there any reason that somebody should pay extra for any of these fancy forms of creatine? And you can go through them all if you want to, as opposed to your plain vanilla run-of-the-mill creatine monohydrate. Unless you want to support, uh, the creatine supplement companies,

that's the only reason you just want to line their pockets. There's absolutely no reason to take, um, any other form of, of creatine. And I'm a, I'm a pretty cheap guy. So I like the fact that creatine monohydrate is the cheapest form of creatine. So that is the best form. There's no other form that's been shown to be superior to that. Um, as you mentioned, creatine HCL or hydrochloride has been very well marketed. Yeah. And a lot of people think that, uh, you know, it has less water retention has, they have less bloating because of it, but the scientific literature is not supportive of that. There is no evidence to actually support that in, in, uh, in humans. And, uh, it doesn't enhance absorption or retention of creatine in the muscle. So yeah, there, there is no evidence for that, but people claim that all the time. But, uh, yeah, creatine monohydrate is the best and it's also the cheapest form of creatine. Okay. So create play, if you want to supplement playing creatine monohydrate, which you can find a high quality supplement of that kind of anywhere. Um, I, I, I wanted to get that out of the way right from the get-go because I did get a lot of questions on Instagram and from, uh, just people that I know that are interested in all of these different forms of creatine for the, for the express advantage that you mentioned it, you know, the, these other forms either saturate the muscle better or to a greater extent, or they don't cause as much water retention or bloating,

or it's absorbed better, or it's somehow more effective. And what you're kind of telling, you know, the world here is, is just stick with creatine monohydrate. There's no other reason to go to any other format. Yeah, absolutely. Yeah. There's no evidence for that. And there are maybe four or five recent reviews looking at alternative forms of creatine and they all come to the exact same conclusion that creatine monohydrate is the best. Okay. So we're going to jump now and into endurance athletes. And I want to kind of stick with endurance athletes first as kind of a broad category. So we're talking 5k, 10k all the way up to the marathon, more Olympic type programs. And then maybe we can extrapolate that a little bit into, uh, into an ultra marathon situation. You mentioned that you recently did a review paper on this.

And when we were offline, we were talking a little bit about some of the, uh, some of the speculation that's been going on in terms of how creatine might actually affect, affect endurance athletes, just from a fundamental perspective. If you just kind of like walk through the scientific basis, uh, basics. So let's, let's start with that. Like how might creatine actually, uh, how create, how create, how might creatine actually help an endurance athlete who's out there training and racing in the typical Olympic events? Yeah. Um, so that's a great question. So if you look at the different energy systems, if you think of endurance exercise, that's primarily using your aerobic energy system. So that's where you use oxygen, your mitochondria to create ATP. And that's the most important energy system. That's why you got to do high volume training and, uh, do some interval training to enhance mitochondrial efficiency and, and all those good things that happen within the muscle. And as I mentioned, the creatine energy system is really just important for really intense exercise. But, uh, if you look at, uh, endurance events, um, they're typically not done at a steady state. So there's like kind of key parts of a race where you might have to run up a hill and work really hard, or you might, uh, try to drop your competitor and surge in a race, or you might have a finishing kick in a race to, to win that event. And that's where I think creatine could be a benefit

for endurance athletes. So it's not going to have, it's not going to play a big role overall for steady state exercise, but it could have a really important, um, kind of aspect on the, those critical, I call them race defining moments. Um, we also know that combining creatine with carbohydrates actually bring more carbohydrates into the muscle and that gets stored as glycogen. And we know that that's important for endurance athletes as well. That's why carbohydrates are, are important or people, uh, consume pasta before a big event, um, because that benefits their performance. So if you can bring a little bit more carbohydrates into the muscle with the combination of creatine and, uh, carbohydrates, that's going to be a benefit as well. So you mentioned this, um, kind of undulating intensity that is found in a lot of endurance events and a lot of runners will think about how a marathon plays out where there's difference in particularly last three or four years, to be honest with you, where there's surges in the middle of the race and people are trying to kind of like break the pack up as the, uh, as the race goes along the quintessential, uh, sport format for this though, as cycling, um, especially cycling stage races where there's, you know, sprint points in the middle of the stage, or there might even be smaller climbs in the middle of the stage.

And the Peloton is gradually trying to, trying to create competitive separation across all of these different areas. And there was a really neat study done, um, several years ago where they took a three hour cycling time trial and they, and they interspersed it with sprints throughout the middle of that three hours. And I can't remember how many of them there actually were. And they used two different types of supplements. One was a carbohydrate supplement and then one was carbohydrate with creatine, as you kind of mentioned earlier. And the creatine group had better sprint performances for this, for this three hour group. Do you remember that study? And do you want to opine on a little bit on it and how that plays into everything? Yeah, for sure. So that was conducted out of Australia at the Australia Institute of Sport. And they always have really high quality elite athletes that are involved in those studies. It was actually a 120 kilometer time trial.

And every 10 kilometers, they alternated between doing a one kilometer sprint or a four kilometer sprint. And they were asked to do those sprints at an all out effort. So this is a pretty challenging kind of exercise performance test. And yeah, they showed that the group that consumed creatine performed the last four kilometer and last one kilometer sprint in that race at a higher power output compared to the non creatine group. So that suggests that yeah, creatine can help you with kind of those finishing sprints. And then they also because creatine can increase water retention and, and you're going to gain a little bit of body mass. That's a worry for some endurance athletes. But they actually did a hill climb performance test after that 120 kilometer time trial. And they actually showed that creatine wasn't detrimental to that hill climb performance test as well. So that was some interesting findings as well.

So somehow the power output that they could, or the higher power output that they could elicit, overcame the increase in body mass, right? Is there's one benefit kind of supersedes the detriment essentially. Yeah, exactly. So with creatine, you're going to enhance muscular power. So you're going to be more powerful, but you're going to weigh a little bit more. And so on a hill climb, it actually just kind of neutralized itself. So there was no detriment and there was no kind of negative effect, but if you can enhance sprints during the race, overall, that could be a benefit for an endurance athlete. Well, in this weight gain piece, I want to dig into a little bit more because it's one of the, it's one of the things that commonly gets cited as a reason for endurance athletes not to take creatine is that you're going to gain specifically that you're going, your VO2 max is going to get worse. I think we will, we can kind of start with that and then you can go back in the research and kind of tease that out. But so why is that the case? Why does creatine make an athlete's VO2 max or does it make it worse? And then why?

Yeah. So I think that question is a bit controversial. So there's been, there's been two recent systematic reviews and what those are is where they look at all the literature that's been published and they put them all together and they try to come up with kind of an answer based off all the science. And so there is one particular systematic review where they showed that creatine actually reduced their VO2 max, but this was based off of absolute value. So just liters of oxygen per minute. And we know that creatine can increase body mass. So my assumption was when I first saw that I was like, okay, if it's bad for your absolute VO2, so it made your absolute VO2 lower.

And if your body weight goes up, your relative VO2 is going to be much lower. Right. Double negative. Yeah, exactly. But if you actually look at that study, creatine had no effect on relative VO2 max, but it had a negative effect on absolute VO2 max. So to me, that doesn't make sense. Yeah, that doesn't make sense. It doesn't make sense at all. And so that's based off the literature. So it's not that clear in the literature of creatine actually negatively impacts VO2 max. And I'm not too sure why it would actually be of detriment to VO2 max besides that increase in body mass. So I think that's something for researchers to continue to look at and to try to find out, you know, does it influence stroke volume or oxygen delivery or oxygen use of the muscle? But to me, the only negative side of creatine is that it could actually increase body mass.

Yeah. I mean, the only other plausible explanation is, is does it actually shift substrate metabolism somehow? And you mentioned the potential to shift it into the PCR system, which is so negligible on a, in a graded exercise test that it's not going to have a difference, but it can, it actually can in some way shift the proportion of carbohydrate, fat and protein that you're actually using that then would shift the oxygen consumption in some material way that could impact VO2 max. Yeah. And I don't think that would be a major determinant. And there's actually some evidence that creatine could actually help transport ATP from the mitochondria to the contractile units within the muscle. And so perhaps helping transport that ATP could actually improve your efficiency with regards to oxygen utilization as well. So maybe you could push that energy system a little bit further with creatine in the muscle. So again, that's totally theoretical and no one has actually kind of shown that to influence whole body oxygen, uh, uh, consumption. But, uh, to me, there's, there's no real detriment to creatine on VO2 max.

Yeah. Okay. So one of the, one of the things that's well established with creatine supplementation is just that you get body weight gains primarily, if not exclusively through pushing more fluid into the muscles. Why we, you mentioned the weight detriment that this could actually cause an endurance athlete. They simply weigh a little bit more. Can you describe a little bit of the magnitude of that? Because there are a lot of athletes out there that are trying to think, is this actually material? If I put on half a kilogram or a kilogram of body water mass in the event that I'm doing, is that actually a material detriment? And then as a tag on to that question, what might actually be the benefit of hydrating the muscle more in advance of a race or just during day to day training?

Yeah. So it's about 1% of your body weight is that's how much, uh, kind of body weight you're going to gain. So it can have a negative, uh, effect on particularly running performance. So there's, there's one study and I say that based off the literature, because there's one study to show that running performance was, um, negatively influenced following a loading phase of creatine. So they took creatine 20 grams per day for seven days and they showed that their running performance got worse on a 6k race. So there is some evidence to support that, that gain in body mass. And that's what the authors speculated that it was due to the gain in body mass actually impaired their running performance. But there are several other studies and, um, that show that creatine does, does not have any negative influence on performance. Um, and then particularly for cycling or swimming, I think it could be, um, have a positive effect on performance. The, so if help me clarify this though, if the potential performance, uh, decline is solely due to the weight gain and it's 1%, the typical formula that's used in a endurance application is for every, every 1% of weight increase or decrease that you're going to have, you're going to get about a three quarters percent movement in the running

economy, which there therefore affects the performance about a proportional amount. Is that what they're, is that what they're finding in the endurance performance performance, or is there some other mechanism at play aside from the body weight gain? That's what I kind of don't understand. Is it, can we, can, can we divide it out into the body weight gain and then something else, or does it just unknown? Um, it's, I would say it's unknown. Um, and, and as I mentioned, it's the only, there's only one study that's actually showing that there's a detriment and there's also positive effects that are happening within the muscle. So you have that gain in body mass, but you also enhance muscular power, uh, you enhance, uh, glycogen storage, um, and there's other benefits as well. So I think if you just take creatine for the short term, you're going to gain some body mass and that could have a negative detriment, but if you use it as a kind of a, an ergo, ergo genetic aid, uh, throughout your training for longer periods of time. And, uh, particularly during your off season where you're trying to enhance muscle strength and power, I think that could have some great benefits.

Here's the thing is here's the way that I would put that is even if that 1% is real, let's just take it at face value, right? That's not that much. I think that from an acute performance perspective, I would take that 1% ding every single day in training and probably even in an elite athlete situation in competition because it's so small compared to all of the other small things that are out there that it's probably not that big of a deal. Now, would I have an athlete creatine load in advance of a race specifically for the race? Probably not. But would I have them do that during training to reap some different adaptive benefit? Absolutely. Because if I take a 1% decline in the, in a training performance, that it's not like that realizes itself in any sort of material detriment on the adaptive side of things. Yeah, I would totally agree with that. And there's actually some really cool research in, uh, using a rat model and they used what's, what's called chronic low frequency stimulation and what they did. So basically if you want your muscle to contract, you need to send an electrical signal from your brain to your muscles. Um, but they put these little, uh, electrodes on these rats and it would send electricity into the muscle and cause a muscle contraction, but they would do it at a low frequency. So, um, it wasn't like a really intense muscle contraction. It was just a little muscle contraction and they would do it for long periods

of time. So they actually did it for 12 hours a day. And this is like, this is like crazy ultra marathon runners. Like dream, you know, to be able to train and run for 12 hours a day. So maybe you're not quite that extreme, but, uh, in this particular model, that's what they did. And they showed that if you, if you did that, um, you got really good oxidative adaptation. So you got a lot of mitochondria and your mitochondria got really good at using oxygen. But what they showed was the group that took creatine. It helped to preserve the fast twitch characteristics of the, of the muscles in those rats, um, compared to the non creatine group. So to me, that's like those, again, those are the muscle fibers that are important for kind of intense, like there's a lot of force sprinting up Hills, uh, having that finishing kick, doing the surges and the races. And at least in the, in the rat model, if you're doing really high volume training, I think that's one, uh, one possibility to where you might want to implement creatine to help preserve kind of that fast twitch characteristics of your muscles. Yeah. And you know, when I heard you mentioned that on another podcast, I can't remember which one it was, but what was spinning through my brain is, is that actually gives a better use case for strategic supplementation at, at distinct points during the year, because sometimes,

especially during the specialization phase. And in particular with the audience that we're talking about very low intensity, 60% of VO two max, maybe 70% of VO two max, like that type of intensity for very long periods of time. You kind of want to get rid of all the fast twitch fibers that you want to in that type of performance context during that specialization phase. I'm not saying throughout the entirety of the year, but during the specialization phase, that's kind of a desired adaptation is to have all of your slow switch muscle fibers kind of operating, uh, as at, at high of a capacity as they actually can. And so when I think about that, it makes me also think about the timing within the year of how you're incorporating these, this particular type of supplement, because I'm viewing the value proposition along the adaptive spectrum, not necessarily along the, I want to perform better, immediately after I take this from an acute, uh, ergogenic perspective.

Yeah, absolutely. So I think if you're doing high volume training, this is one time where, where creatine could be a benefit. And then of course, the other time is just when you're trying to enhance, uh, your, your muscle performance. So if you're trying to get stronger and more powerful muscles, um, that would be another time where I would really recommend taking creatine supplementation. And then one other benefit to, uh, creatine supplementation, again, when you combine it with, uh, strength training is that it can enhance your bone strength as well. So there's kind of more and more evidence coming out, looking at that particular, uh, effects of creatine and for endurance athlete, that's, I think an important, uh, thing to consider as well. So most of the research has been done and just healthy, older individuals. So we, we don't have any research actually in an endurance athletes, but I know a lot of endurance athletes that have, uh, you know, stress fractures and things of that nature. And I think creatine could be a benefit in those situations. Well, speaking of that, and I agree that there's, that's another positive in terms of the, these things is otherwise specified as why you might actually want to use this, uh, use this as a, as a, as a supplement to aid aid in training. Is there any other benefit though, along the injury spectrum? So either that could be preventative of injury, either from a mechanistic perspective or from a research perspective, what they've seen in the literature or recovering from an injury, soft tissue injury or, or a bony injury

that we can either mechanistically speculate on, or that has actually been teased out on the research. Yeah. So there's kind of two, uh, things that come to mind when you ask that question. So one, there's actually some research in football players where they showed that those that took creatine had fewer incidents of muscle strain, muscle injuries, and also they had fewer incidents of heat illness as well. Um, so again, that can be wild. We're going to talk about that. Yeah. So that's, that's pretty, pretty crazy, but yeah, there's, there's, so there's evidence to show that creatine can be preventative of muscle injuries. And then the other thing too, is there's a couple studies looking at immobilization. So essentially, um, if you get injured and you have to put a cast on, for example, then that limb is immobilized for a certain period of time.

And they've shown that if they supplement with creatine, it lessens the, the detriments of that immobilization. So they lost less, um, strength and they lost less muscle mass over that, that period of time. So if somebody again gets, gets an injury and, um, can't train then, uh, or has to immobilize the limb, then creatine could be a benefit in that particular situation. A lot, usually those immobilization studies are great to point out, uh, the signaling pathways that get enhanced from taking a particular supplement. That's why I, because you see that not just in creatine, but in other types of supplement where they're using it in a post-surgical type of setting, or the athlete is immobilized for whatever, and something is preserved to a greater extent as compared to the non-supplement group. And it always kind of comes back to the signaling that's, that's propagated or enhanced. Yeah, absolutely. And I think it's just some of the extremes. So we study exercise, like the benefits of exercise, but, uh, immobilization is the complete opposite. So it's, you can't move that limb for a certain period of time. And we're going to look at kind of the impact of that. So it's just along that exercise continuum. Actually one study that wasn't involved with creatine, but, uh, it's called cross education. So one study I was involved with as a participant in the study, but they trained the non-casted limb. And then it showed that training that limb could prevent loss of strength and muscle mass and the cast of limbs.

So I thought those results were pretty cool. And, um, yeah, I just wanted to, to mention that as well. Those are cool studies. I totally, I totally agree with you. Okay. You brought this up in the heat illness piece of it. And one of our, one of our coaching staff actually wanted to know the answer to, to, to this question is can creatine can supplementation with creatine potentially positively affect exercise in the heat? And the answer to that is yes, it can. Um, so there, there is some evidence to show that, uh, exercising in the heat can be enhanced with creatine supplementation. This is primarily because creatine is going to bring water into the muscle cell. And so it's going to increase hydration, within the muscle and that can help with thermal, thermal regulation and reduce cardiovascular strain. So, um, there are some benefits and, uh, one particular study that I read recently looked at combining creatine with glycerol and showed additive benefits of both those together versus just glycerol alone. So, um, yeah, there, there's definitely some, some research to show that creatine can be a benefit for thermal regulation and enhance exercising in the heat, which was interesting to me because most of the time when we think about improving thermal regulatory properties through some sort of nutrition intervention, we're thinking about increasing the amount of plasma volume that's circulating around because that's going to dissipate heat to a greater

extent than the water. That's kind of trapped in the, that's kind of trapped in the muscle, but the fact that they might be additive, right? That there might be some sort of added effect to having water within the muscle and then water circulating around the plasma to actually dissipate the heat that the muscles are then generating, right? Cause that's where all the heat is actually coming from is actually an interesting additional mechanism, I guess is what I would saying, what I would say. Yeah, for sure. So yeah, both those things can reduce cardiovascular strain, having more plasma volume, um, hence hydra, uh, hydration, drinking, um, is really important because if you don't, when you sweat, you lose plasma volume and to maintain cardiac output, which is the amount of blood that's flowing around your, your body per minute. Um, your heart has to work harder and that creates more stress in your body. And, um, so you need to stay well hydrated.

So I'm not saying just take creatine and glycerol and don't worry about hydration. Hydration is the number one thing and having a good, uh, sport drink, for example, is really important. Um, but, uh, yeah, creatine and glycerol, in addition to those things could have a positive benefit. The magnitude of the benefit is always important to realize because a lot of times you can say, okay, this does a benefit. Like we do this in training interventions all the time, right? Well, we introduced this training intervention. It has this effect. I'm like, well, what if you compare that to another training of intervention, right? You're comparing it to some sort of, you know, baseline. What if you compare it to another training intervention or what if you just give the athlete more time to train? Is that going to be a bigger benefit than just the intervention itself? Yeah, for sure. And I think that's important in the, the nuance nuances of the research world. So sometimes we control the exercise intervention. So we want everyone to do the same training, but if you look at like creatine, it actually allows you to train a little bit more.

Um, so if you look at a research study and it controls training volume per se, then they might not show any benefit of creatine, but that's not because creatine doesn't work. It's because of the, uh, design of the research study. So you need to be, uh, kind of knowledgeable in that particular area. And as you mentioned, there's, there's other things that can have a, a bigger impact on, uh, performance. So yeah, people ask me about supplements all the time. Like my students will come and say, Oh, should I be on creatine? I'll be like, are you training consistently? Are you eating real food and your vegetables? Um, are you, uh, getting a sufficient sleep? And usually they say no, no, no. And then I'm like, okay, well, creatine is going to have like no impact on your, on your performance. So maybe try those three things first. Those are going to have a massive impact before you start to, uh, even consider creatine supplementation.

I'm so glad that you mentioned that Scott. I appreciate that clarification. Okay. So let's just say that your student is an endurance athlete. They come to you and say, should I take creatine? And they are sleeping correctly. They are training correctly. They are eating enough fruits and vegetables. They are eating enough total amount of calories and their macronutrients are in line and things like that. How would you go about advising them to start taking creatine in the context that we have kind of mentioned a few times, which is as a training aid, essentially, we're trying to enhance the training in some way. We can either train more. The training that we do do is more effective. Maybe it's preventative against bony stress injuries, things like that. What does it actually look like? How much do we need to load? Do we need to cycle? Let's run through the whole thing. Yeah, for sure. So first, creatine monohydrate, as we mentioned previously. So just get the powder form and you mix it with water. Simple. Super simple. Uh, the next is, uh, yeah, traditionally we do a loading phase. So you take 20 grams per day for five to seven days and you separate that 20 grams into four doses throughout the day. And that's going to saturate your muscles. So right now the average omnivore has about 80% saturation. So they'll get about a 20% increase in the amount of creatine within their muscle if they do that loading phase, but you do not have to do that loading phase. So if

you just take a lower dose of creatine, you will get a 20% increase. It just might take three or four weeks, um, to do that instead of one week. So it depends on the individual's goals. So if they want to get the benefit of creatine really, really quickly, then they can do that loading phase. If they just want to take it for general health and they want to try out the supplement, um, and maybe they just want to get the benefit of creatine in a one year or two years down the line, then, uh, really if you do the loading phase or not, it makes absolutely no difference. Why 20 grams? Uh, that was originally done in the 1990s and that's the dose essentially that they showed was, uh, was effective to, to saturate the muscles in that short period of time. So could you take 15 grams? Absolutely. I'm sure that would be just as effective, but we know that if you take, uh, just three grams of creatine per day, it actually takes 28 days to saturate your muscles. And we know that if you take 20 grams per day, it takes, it takes about six days to saturate your muscles. So there's some sort of dose dependent response. Yeah, absolutely. So is there a continuum there for sure? Like you can take, um, you know, 10 grams or 15 grams and, and probably get the similar benefits to, uh, to the 20 gram dose,

or it might take between the three grams and the 20 gram kind of length of time. But, uh, yeah, there's, there's, uh, kind of a continuum. Okay. Before we go after the loading phase, since we are talking to an extreme audience and they will take a more is better approach. Why not 40 grams? Why not 50 grams? Why not 10 grams? You know, once on the hour, every eight hours for a total of 80 grams. Cause you know, that's, that's like the audience's thought right now. It's like, well, it's 20 grams is good. I could do 40. It's no problem with that. Yeah. So if you, you can, you can take too much creatine. Um, and, uh, so there's been actually case studies of individuals taking like 200 grams of creatine per day. So they probably have that thought process. Hey, 20 grams is good. And they actually had some negative health consequences from that. So, um, I would not advise taking that huge dose of creatine and taking more is not better. So, um, we know that taking 20 grams per day, you're going to saturate your muscles in, in six days. So it's not necessary to take any more creatine than that. And your, your muscles can only absorb so much creatine per day. So, um, you're just going to waste your money and, um, perhaps cause some other negative health effects within your body as well by taking any more creatine than that.

Okay. Any other caveats on this initial dosing for vegetarian, vegans, really light athletes, cause we're going to have some people, some, you know, women are probably listening to this podcast that are 50 kilograms or, you know, maybe even lighter than that. Any other caveats that you want to throw into the, to the dosing piece? Yeah. So, um, a couple of things, if you combine creatine with carbohydrates, I mentioned that you can actually get more glycogen or carbohydrates into the muscle, but you can also get more creatine brought into the muscle. So when you're loading your muscles with creatine, I recommend to consume it with either a carbohydrate source, um, and or protein because both protein and creatine will stimulate insulin or protein and carbohydrates will stimulate insulin.

And that's going to help with creatine uptake. I also suggest to take creatine close to your exercise session, because we know that if you perform exercise, that it also sensitizes the muscle and you can get more creatine brought into your muscle as well. And then, um, I'm trying to think of other things as well. Anything for the vegans or the vegetarians, are they better candidates, worse candidates because they're not getting, you know, the same amount of creatine through their diet, or are they more or less sensitive because of that? So, uh, they'll take the same dosing strategy. They'll just have a larger, uh, response to the creatine supplementation. So they'll, uh, they'll get some further benefits compared to an omnivore just because they're getting less in their diet.

Um, and then you mentioned, uh, if like a smaller athlete or a bigger athlete, if, uh, they need the same absolute dosing. And the answer to that is again, not clear in the literature, but a lot of our studies, we actually use a relative dosing strategy. So we don't, we typically don't do the loading phase and we give kind of like a moderate dose and it's based off your body weight. So we actually just use 0.1 grams of creatine per kilogram of body weight per day. So if you're 50 kilograms, then you would take five grams per day. If you're a hundred kilograms, you would take 10 grams per day. So a bigger athlete might require a little bit more. They just have more muscle mass, more turnover of creatine within their body compared to smaller athlete. And so you can try that relative dosing strategy as well. Okay. So you've got this initial load phase, which is more than what you just, just mentioned right there, 20 grams per day and remind the listeners how long that's for again. Uh, five to seven days. So the research looked at six days, but we say five to seven just to give a bit of a range. We'll split the difference there. Um, then what, then what is the strategy after the loading phase?

Then you drop just to a maintenance dose, which is typically three to five grams per day. And then how long is the maintenance dose for forever? Yeah. So that's, uh, you can take creatine, um, daily for multiple years and, uh, you can, uh, have great benefits because of that. But if you miss, like, say you're like taking creatine and you miss a day, you're not going to instantaneously lose all of your gains because, uh, once creatine is saturated in your muscle, it actually takes about four to six weeks to return back to baseline. So that's why some people will cycle on and off creatine. So they might take creatine for four weeks, really saturate their muscles with creatine, and then they'll go off creatine for four weeks, allow the muscle creatine levels to slowly return back to baseline, and then they'll supplement with it again. So that's another, uh, strategy as well. But again, there's no literature to show, um, or comparing cycling of creatine versus taking creatine continuously. So we can't really answer that from a scientific perspective.

And that's what I was going to ask. If you cycle it and potentially go off, there are you, does that, does that affect the adaptive benefits that you might be getting from chronic supplementation or from the, and or the chronic workouts that you're doing? And it doesn't seem like that's been teased out quite yet. Yeah, exactly. Yeah. It hasn't been teased out. And, uh, yeah, we don't know. Maybe it's, uh, maybe it's a benefit to cycle on and off creatine. Um, and there's some theoretical rationale to support that, or there's also some benefit to taking creatine every single day, just to maintain that kind of saturation levels. And, um, again, if you just have more energy within your muscles, over a longer period of time, that could be a benefit as well. So we really don't know if, uh, cycling on and off creatine is just as good, um, compared to taking it every single day.

In your experience, what are most athletes actually endurance athletes actually doing? Are they, are they using a cycling model or are they using more of a steady state model? I would say they're cycling more with creatine on and off. Um, but I know some people that, uh, in the strength world that have taken creatine for like 10, 15, 20 years and they're like, I take it every day, no matter what. And, uh, yeah, that's like, and they're usually pretty jacked people, but they also are very consistent with their, uh, resistance training as well. So me personally, I cycle on and off creatine. I'll take creatine when I'm really trying to build muscle and build strength and, and, or doing like a high volume endurance, uh, kind of phase of my training, but otherwise I'll, I'll cycle off creatine. And I know that might be crazy to, to hear that Dr.

Creatine doesn't always take creatine, but, uh, yeah, that's the truth. Okay. So did you mention that Dr. Creatine? Give me the case against it. Like, are there, are there, is there a particular group of people or group of athletes that are not good candidates for this or the supplementation would be deleterious? I would say there's probably not. Um, so yeah, so creatine could be a benefit for almost any athlete out there. I, I would say there's, uh, a further benefit in certain situations. So if you have lower creatine stores within your muscle, just naturally because either you're a vegan or vegetarian, or for whatever reason, you just have lower amounts of creatine within your muscle, you tend to be more responsive to creatine supplementation.

But even in people that, uh, consume a lot of red meat or seafood, they respond positively to creatine supplementation. It just might be to a lesser extent. And then we also know that, uh, fiber types can also play a role in your responsiveness to creatine as well. So if you have more type two muscle fibers, you tend to respond better to creatine supplementation compared to if you have more type one muscle fibers. So for ultra endurance athletes, like type one muscle fibers are important. Um, and they probably have more type one muscle fibers. So they might be actually less responsive to creatine supplementation, but it's still going to have that positive effect. And that's from a muscle perspective. It could also be a benefit for other tissues. As I mentioned, like bone health and brain health and all those other things as well. So other things to take into consideration. Yeah. Okay. You mentioned a lot of the research and you're very familiar with this, but you also know where the gaps are currently. What do you want to see research specifically from an endurance perspective in regards to creatine supplementation? Yeah. So I think we need to do some really good studies looking at, uh, like changes in pace, surging or finishing kicks with creatine supplementation. So more kind of realistic kind of, uh, uh, events and also changes in terrain.

So I think it's important to go out to the real world and really try to see if creatine could be a benefit in the real world where there's changes in terrain. And then we also need to do some, uh, some creatine studies in the ultra marathon world as well. So the ultra races, uh, to, to really see if creatine could be a benefit in those particular situations. They're difficult to study in the lab and, uh, it's difficult to recruit a large sample size, but, uh, that, uh, isn't a reason to not conduct those studies. So I think we need to just do a better job and, and maybe recruit some, uh, ultra runners to, to try out creatine and run a research study. Ultra runners will always, we're, we're good Guinea pigs, man. Like, you know, you're used to the college students who are good Guinea pigs for like beer and pot studies and things like that.

They'll always like jump in for the coffee is the other one, right? Caffeine. But ultra runners are kind of willing to like get on a treadmill for four or 10 hours. Like every time I come into the research world and you know, we start talking about ultra runners, they come to the kind of the same conclusion is, is they can't get their endurance athletes to get on an ergometer or treadmill for a couple hours, but they can get the ultra running crowd to kind of do it. So there you go. You've got a great subject group. Yeah, they're, they're pretty crazy. I dip my toe into the world last year. I tried a 50 kilometer race and, uh, yeah, it was pretty brutal actually. So it was a bit too far. I didn't train the best in preparation for it, but, uh, yeah, so I'm doing actually a race this year called sinister seven. Yeah. It's in crow's nest past in Canada and, um, I'm doing it a part of a team. So, uh, my wife's family is actually involved in, uh, each leg of the race. So there's seven legs, but it's a hundred mile race in, in, uh, yeah, in the Rocky mountains there. So it should be pretty fun. You'll love it. It's a classic race, man.

Well, I appreciate your time, man. This has been extremely helpful for me as a coach. It's going to be helpful for the audience as well. Uh, both from a knowledge perspective, but then also from a practical implementations perspective, like we mentioned at the very end, where, where can people find more about you and your work? And if, even if there is some general, like creatine resources and things like that, that I can link up in the show notes, can you tell a listener something about that? Yeah, for sure. Probably the best is on Instagram. So my, you can search out Dr. Creatine. You can find me on Instagram. That's probably the easiest way. Um, and then, uh, yeah, you can search on PubMed. That's where you find like all the journal articles. So if you're a really big nerd and you want to read some of my work, you can, uh, Google search Forbes and creatine on, on, on PubMed, and you can, uh, read all my articles. And if you can't retrieve them because there's a, they cost money, um, just send me an email. So you can contact me at Forbes S at Brandon U dot CA. And that's, uh, probably the best ways to contact me. And then there's one really good, uh, resource on creatine and it was done by the International Society for Sport Nutrition or the ISSN. And, uh, they got together a bunch of the experts in the world on creatine and they wrote this position stand and, uh, it has all kind of the, the nuances and benefits and, um, of creatine supplementation as well. So it was re it was

published in 2017 and I know they're currently updating that position stand as we speak. So hopefully there'll be a new position stand published in the next year or two, um, kind of showing the, the emerging benefits of creatine as well. I will, uh, link up that paper in the show notes cause I've read it and I appreciated it, uh, a lot. Uh, thank you for your time again. And for all the, and for all the work that you do. And, uh, I hope to bring you or one of your colleagues back on the podcast when that review paper comes out that, uh, we mentioned earlier. Absolutely. Yeah. We'd be happy to discuss creatine even further. All right, Scott. Appreciate it. All right, folks, there you have it. There you go. I hope everybody out there appreciated Dr. Forbes really unfiltered and enthusiastic approach to creatine supplementation. As I mentioned from the onset of this podcast, neither one of us have an agenda other than he is very enthusiastic about it.

And I just want to get the right information into people's hands. I hope you guys appreciate that. If you guys like this podcast, please share it with your friends, share it with your training partners, share it on social media. I appreciate all the love. And I hope that this information can reach a wider audience and get this information into the correct people's hands, because I know you guys have friends. I have friends. You have training partners and people that are curious about if creatine supplementation is right for them as an endurance athlete. And I hope the information contained within this podcast can be somewhat of a directional arrow for them to follow in their particular journey. All right, folks, that is it for today. And as always, we will see you out on the trails.