"Creatine: Beyond Strength and Power" with Dr Scott Forbes

EPISODE 187

[INTRODUCTION]

[0:00:00] LB: Welcome to episode 187 of The IOPN, We Do Science Podcast, the Institute of Performance Nutrition's Podcast. I'm the host, Dr. Laurent Bannock. Now, today we had a discussion about creatine. Creatine, you say, we've done this podcast before, yes, and I've also done this topic with numerous guest experts over the years, and that does include today's guest, Dr. Scott Forbes, from Brandon University in California. You'll be familiar with him if you're a regular. If not, catch up on previous episodes. Now, we're not just simply going back over old ground, although we will review some of the relevant evidence that pertains to the use of creatine monohydrate for various angles of training and performance. But the central question that we wanted to get into today was what about endurance exercise? What about it, you say?

Well, if you're into this topic, which all of you are, of course, you'll know that creatine is extremely well researched with huge amounts of evidence to support its use in strength training, gains in lean muscle mass, that sort of thing, but not so much in the endurance field. Although, of course, endurance athletes also need to undertake strength training, want to augment the carbohydrate fuel supplies and various other things.

Anyway, we're going to get into this topic in great detail, and it adds to the body of knowledge out there, and of course, the various podcasts that we've done. You can learn about those podcasts back at our website at www.theiopn.com. Whilst you’re there, check out our online master's level diploma in sports nutrition, our professional development program, which is our unique community resources, access to journals, that sort of thing, learn about that at our website. Of course, our research and all the other things that we're doing and lots of new stuff on our website, all at www.theiopn.com. Now, here's my conversation with Dr. Scott Forbes. Enjoy.

[INTERVIEW]

[0:02:14] LB: Welcome back to the Institute of Performance Nutrition's Podcast. I'm saying welcome back, both to you, the listener, but also Dr. Scott Forbes. You must be up there with, I'm just trying to think now. I've interviewed so many people over the years, but I haven't interviewed most of those people more than once or twice. This is where you're starting to go up my VIP rank, Scott.

[0:02:38] SF: Awesome. Yeah, I'm extremely happy to be here and happy to be back. You've interviewed some phenomenal creatine researchers, so I feel very grateful to be on the podcast.

[0:02:49] LB: Well, it's time for you to rise to the challenge here, Scott. Let's see what happens. I mean, look, we're going to talk about creatine, no big surprise. Like you say, big researchers, your long-time colleague, Darren Candow has been on, Eric Rawson, Craig Sale, and yourself, obviously. Now, I think it's safe to say, we're not necessarily going to have a new ground as it relates to what creatine is. It's not suddenly this big new discovery.

However, as I like to position a lot of these conversations around contextual considerations, we're trying to understand what these things are, mechanisms, tools in the toolbox, all that stuff. A lot of this does come down to what we're actually trying to do in terms of outcomes. Our focus with this podcast is about bridging this gap between science and practice and ultimately, helping practitioners make more informed decisions. It's complex stuff in this world of sport and exercise, nutrition, and so on. But there's always cool stuff that comes up. It's a rapidly evolving field. Folks like yourself come up with new ways of looking at these things.

Particularly, when I think outside of the traditional creatine focus, which is strength, power, the usual stuff and the stuff that we've talked about in great detail. Of course, where a huge amount of literature has been published, although sport, science, sport and exercise science, sport nutrition is relatively new compared to things like medicine and nursing and so on. Creatine's up there as being one of the most significantly studied substances in ergogenic aid, etc. etera. We'll come back to that in a minute.

Like I say, there are some different areas that come to interest, both for researchers and for us as practitioners that I wanted to talk to you about, which is why I've asked you to come back, Scott. Before we do this, why don't you just give us a quick overview as to who you are and what you're doing. We've got lots of repeat listeners, of course, lots of our loving fan base, geeks of sport and exercise nutrition, but there's lots of newbies, too. Tell us who you are.

[0:05:07] SF: Absolutely. I'm Dr. Scott Forbes. I'm an Associate Professor at Brandon University in the Department of Physical Education, which is located in Canada. Also, an adjunct professor in the Faculty of Kinesiology and Health Studies at the University of Regina. That's where the great legendary Dr. Darren Candow is located. I collaborate with him quite a bit and work with several of his students as well. That's been a phenomenal relationship.

Besides that, I'm a clinical exercise physiologist through our Canadian Society for Exercise Physiology and a high-performance specialist, which is a new certification that they've started to offer and actually helped develop that certification. I have that. Then I've also completed the IOC diploma in Sport Nutrition and I'm a certified sport nutritionist through the ISSN. I have a few qualifications behind me. But really, what I do is I'm an academic. I teach in the area of exercise science and I conduct research.

[0:06:14] LB: Scott, I think that's the first thing that people are going to want to know is of all the things that you can get into, now, of course, it’s the rockstar topic amongst protein and a few other things. What got you into creatine research?

[0:06:29] SF: Yeah, so I was very fortunate to do my masters at the University of Saskatchewan with Phil Chilibeck. He is one of the early researchers that looked at creatine combined with resistance training in older adults and pioneered that particular area of research. Phil Chilibeck's PhD student was Dr. Darren Candow. I was doing my masters with Phil Chilibeck at that time. Just basically, we started working on some creatine projects early on in my research career and just developed that relationship with Darren and Phil and continued on those projects until the present time.

Yeah, so I still work with those guys very closely and been very fortunate, basically, just random chance to make that connection. Yeah, it's been awesome. Then the reason why I think it's so awesome is because creatine continues to be one of those supplements that can enhance a variety of different tissues within the body. It's not just impacting muscle performance, but it can impact a variety of other tissues. That's what really gets me excited about creatine.

[0:07:43] LB: I mean, there's so much to talk about. We'll delve into those various areas. Then there's a particular couple areas I wanted to focus on today that will add to the previous conversations I've had with you and those other researchers that we've just talked about. Just on a joking side of things, there's an interesting correlation amongst most of you researchers and that is the lack of hair, if you don't mind my saying. What is going on there?

[0:08:10] SF: Yeah, absolutely. There was a study in rugby players where they showed an increased conversion of testosterone to dihydrotestosterone, or DHT. DHT has been linked to male pattern baldness. People always suggest that creatine causes baldness, although there is zero evidence to support that. Of course, myself, Dr. Darren Candow, Phil Chillibeck, Jose Antonio, lots of the creatine researchers around the world seem to lack hair. Maybe there is a connection. Maybe we need to expand our research area and look at creatine and hair loss.

[0:08:46] LB: I think this is a classic correlation does not equal causation, Scott type of conversation. Anyway, anyway. Well, look, you only have to walk into a sports nutrition type store, a supplement store, a natural health store where they'll tend to have a fitness bodybuilding type section. Why would they do that? Well, because sports nutrition supplements are huge, absolutely massive industry around the world, pretty much everywhere you'll find this stuff, even in very challenged economic climates, you're still going to see these types of products out there everywhere.

Of course, lots of people are into health and fitness and lots of people are wanting to get the most out of their training adaptations, whether it's for aesthetic purposes, or whether it's for functional purposes for their sport, or work, tactical athletes, that sort of thing. There's a whole lot of people here that are going to be interested in the potential that creatine can have for them. Do you want to just quickly summarize – this is an impossible task to do within a matter of a few minutes, but just quickly summarize what creatine is, or specifically creatine monohydrate is, and what the best-known reasons are for actually wanting to take it?

[0:10:05] SF: Yeah, absolutely. That is an impossible task, so I'll try my best. I think before I even talk about creatine, I think as you mentioned, creatine can help some of the adaptations. It's important to just exercise regularly, eat lots of fruits and vegetables and whole foods and get lots of sleep. I think those are things that we can't ignore and creatine is not going to fix. It's a supplement. It's only going to have a small impact. It can have a positive impact, but you need to have a good foundation and sleep, exercise and eating real food is obviously, the foundation, is required for optimal health. I think that's important for the listeners to understand.

What is creatine? Creatine is, it's made up of three amino acids and our bodies can synthesize creatine. Everybody has creatine within their bodies, but we can also get creatine from our diet. It's primarily red meat and seafood. If you're a vegetarian and you don't eat those, then you have lower amounts of creatine within your diet and also, lower amounts of creatine within your body as well. We can also get creatine from dietary supplements. You can go to your supplement store and purchase creatine as well. There's three ways to get it.

Once it gets into the blood stream, about 95% of creatine is taken up into the muscle. Once it's in the muscle, about two-thirds gets converted into phosphocreatine. Phosphocreatine is stored potential energy. Anytime you need to create energy quickly, or you're doing really intense exercise, you're going to utilize this particular energy system. Creatine can do a variety of other things, too. It can help bring more glycogen into the muscle. Carbohydrates, again, and another fuel. It could stimulate these satellite cells through different mechanisms that can increase IGF-1. It can do all these other things in the muscle that's important for muscle health and muscle performance.

[0:12:11] LB: Yeah. I mean, this is the thing that I find particularly interesting. This is why I want to throw it back in that term context. Relevance, by the way, what is the relevance of this? Is my new buzzword, Scott. You need to understand the strengths and limitations of said supplement, or said training protocol, or whatever. You obviously want to have some thoughts about what it is you're actually trying to achieve and then weigh up the cost of benefits of it all. Of course, one issue that comes with supplements is a lot of them don't do anything.

A lot of them may do nothing, but also be safe, particularly if you're testing for banned substances, if that's important for you as a tested athlete. Some supplements actually can provide some assistance, but it depends on a number of things. As you've already pointed out, there's a number of interesting areas with creatine. It's not just increasing strength or power, but we need to dig deeper into that. How does that happen? We're going to explore some of those things. I do find it interesting that whether we're talking about supporting glycogen storage and potentially utilization to intramuscular buffering capacity, even potentially reducing inflammation, reducing reactive oxygen species, I mean, preserving muscle mass in particularly interesting situations. That's just a few bits and pieces that we could get into.

Some of those things are relevant and some of them aren't, and/or there's a partnership involved, isn't it? You're not just taking creatine. Let's explore that a little bit before we get into the main topic, which is ultimately, a different area of training and performance, which I think that creatine could have some great value to, as long as you understand the relevance and the context of it. For the bigger, the better-known use of it, which is to assist with things like strength and power, let's just quickly get into that. I mean, how does creatine actually do this stuff?

[0:14:15] SF: It provides your muscles with a little bit more acidity to create that high-intensity energy. You can do a few more reps. Over time, it's been well established that creatine can enhance resistance training adaptation. You can make your muscles bigger and stronger. Important, it's a benefit for young adults, and it's also a benefit for older adults as well. That's been some of the research for the last 10 or 20 years, as showing that it's beyond just enhancing bodybuilder’s physique and performance, but it's also a benefit for a variety of different populations. That's the main mechanism is just by enhancing training volume is that you can train a little bit harder, and you can get bigger and stronger muscles over time.

Then in that older population, we've also shown improvements in functionality. We measure that by sit to stand. That's a functional test that you can perform. There's improvements when you take creatine. That's obviously a benefit for older adults. Sit to stand has been a surrogate marker for falls risk. Perhaps, creatine can influence falls. Although, that research has never been done, and that would be a very difficult question to answer in the research world. At least, creatine can improve sit to stand performance. That is a marker of falls risk.

[0:15:48] LB: When we look at these things, and we're going, “Right. Okay, it's going to help me or my athlete become bigger, faster, stronger.” The direct effects of consuming creatine is more to do with what happens when you store creatine right, which is something I want you to explain in a minute. The indirect effects, of course, are where it plays a partnership role in enabling adaptations to occur a certain way and/or for want of being extremely basic, train a bit harder, so that the training stimulus results in greater levels of stress followed by potentially greater adaptations to that.

Now, that's important, because people, we got this thing, you take a pill, ibuprofen, aspirin, pain gone. Taking creatine doesn't mean bigger, faster, stronger, right? Do you want to just quickly explain the mechanisms of action just generally in that regard?

[0:16:47] SF: Yeah, for sure. Yeah, it increases your capacity to train, but you actually have to train harder to get the benefits of creatine. Creatine could also act through other mechanisms as well. One thing is particularly during the loading phase, it's actually going to bring water into the muscle cell. That's going to cause the muscle cell to swell. That's going to stimulate, it's called myogenic regulatory factors. That increases satellite cells, and that increases the number of nuclei within the muscle. Muscle is myonucleated, which means it has multiple nuclei. For the muscle to grow, it has to increase the number of nuclei first. That's one thing that creatine can actually do is increase the satellite cell that turn into nuclei, which increase the capacity for the muscle to grow. Then as you mentioned, creatine has been showing to reduce inflammation and oxidative stress. That could all influence recovery and adaptation as well. There's lots of different mechanisms where creatine can work, particularly within the muscle cell.

[0:18:01] LB: I think, one thing that we'll start coming to mind, particularly for those that are plant-based, or vegan, or whatever, they're sitting, they’re going, “Hang on. I don't eat meat. I don't eat fish. I am absolutely not getting much, if any, creatine from my diet. I'm not entirely sure how much creatine my own body is making.” How necessary is it for that creatine to be present? How impactful is it by consuming a diet that is lower in these sources in their consideration of, well, should I maybe supplement this stuff? There is that interesting question that they're going to ask themselves. Perhaps, you could help them on that.

[0:18:45] SF: Yeah, for sure. Well, first of all, if you do eat meat, usually you have about 80% of your creatine stores within your muscle. Even if you eat meat, you'll still respond to creatine, or most people respond to creatine, and they'll have about a 20% increase within their muscles, so following supplementation. Whereas, vegans or vegetarians actually have lower amounts of creatine within their muscles. They might have 60% or 70% of their total capacity that they can store within the muscle. They'll respond better to creatine supplementation.

There's been some good work by Dr. Darren Candow and Darren Burke, Phil Chilibeck, so that I mentioned previously that looked at vegetarians versus omnivores. They found that vegetarians respond better to creatine supplementation. They got bigger and stronger muscles relative to omnivores. It's mainly associated with that just lower baseline levels of creatine within their muscles. That's also been shown by actually, my PhD supervisor, Dr. Gordon Bell at the University of Alberta and Dan Syrotuik, they looked at responders and non-responders to creatine. They found that responders had two important characteristics.

One, they had lower amounts of creatine within their muscles to begin with. That's why we think vegetarians, or vegans would respond better to creatine. Then the other factor is they actually had more type 2 muscle fibers. The individuals that responded better to creatine had on average about 63% of their muscle fibers were fast-twitch. Whereas, individuals that did not respond as well to creatine, they only had in the mid-30s percentage of fast-twitch fibers. They had a lot more slow-twitch fibers. Yeah, I definitely think that creatine could be a greater benefit for vegans, or vegetarians.

[0:20:50] LB: Yeah. I have no doubts about that. Of course, people are thinking there, well, do I need to eat meat and fish? Of course, we've discussed this many a time, you can get creatine from completely non-animal-based sources. We'll come back to that stuff when we talk about some practical stuff at the end of this podcast. I just wanted to come back to this topic of responders and non-responders, because it's an interesting one that is, how do we define responders and non-responders in this context? Because I know, depending on how you look at that, there can be some rather positive, or negative views of those terms. Do you want to just quickly explain what you meant by that?

[0:21:28] SF: Yeah, for sure. This was with regards to their increase in the amount of creatine within their muscles. That's how they identified responders and non-responders. Yeah, I think that term, you need to use that term very cautiously, because that doesn't mean that they might not respond to creatine in other capacities. We know that creatine can impact, for example, bone tissue, or brain health, or heart health.

To say that somebody's a non-responder to creatine based off that one measure or outcome measure is maybe not the best thing to do, because they might respond positively in other aspects. I think we need to be very cautious when we use the term responders and non-responders.

[0:22:11] LB: Yeah, of course. If we're saying, “Right. I want to get bigger, faster, stronger,” and it doesn't happen, it may have nothing to do with the creatine. It might be that you're just not training right. That's what I meant by there's a partnership consideration that we have to factor in. Also, whilst we're on this topic of responders and non-responders with the correct interpretation and definitions involved, the difference between how this stuff is generalized, of course, that has to be done with research, but we're dealing with individuals and people come in all sorts of shapes and sizes. Depending on what we're talking about, whether it's a training types and stimulus, but also, nutritional needs will vary from individual to individual. What are the individual considerations for this, you think, in terms of responding and not responding from creatine supplementation?

[0:23:07] SF: Yeah. Obviously, how much you get in your diet and your fiber type is probably the two most important things. There could be other things as well. There could be genetics, there could be the type of training that you're doing. There's a lot of context that can go into it. We know that it can enhance resistance training adaptations, but whether it can enhance endurance adaptations, or maybe high-intensity interval training, so that's become a popular trend in the research world and in the real world as well, a lot of people are doing HIIT training, or Tabata type training, and creatine potentially could have a positive effect in that particular situation.

[0:23:51] LB: It just so happens that that's the area that I wanted to talk more about, Scott, because it's not just that we've done loads of podcasts already with you and the others about increasing muscle mass, increasing strength. There's undeniable evidence to support that reason for taking creatine monohydrate, irrespective of whether you consume meat, fish, or your plant base. There's a good reason to take it, as long as you can, after thinking this through, cost to benefit. The cost of the product is not that much. It's not a particularly expensive supplement, but there might be other considerations, which I think are rather interesting when we think about endurance athletes who, I mean, there's various kinds of endurance, obviously.

Many of them will involve traveling great distances over a pretty significant amount of time, where weighing more than you might want to, having more muscle than you might want to, might be a consideration that is not necessarily beneficial to your endurance performance. On the flip side, the event that you're participating in might have a sprint finish involved. Everyone might be able to keep up with each other right until the last 200 meters. Then that last sprint finish is actually what differentiates the podium and non-podium athletes is a different way of viewing some of this stuff, and/or hill climbs, or looking after one's bones off season through strength training.

I mean, there's all sorts of considerations that I wanted to get in with you. I know we've talked about in the past, and something I personally have found of great use for creatine, for example, in football, or soccer players is the use that creatine can have on carbohydrate storage, for example, particularly in tournament football scenarios. This is most definitely not a conversation now about increasing strength and power. We are talking about all the other different ways in which creatine can be of use.

I think, centrally here, is if we move away from, say, strength training, or gaining bigger muscles or whatever, and we make this person-centric, athlete-centric, that person does different things at different times. Now, yeah, okay, some people will do the same thing in the gym week in and week out, but we're talking about athletes who will periodize their training. Depending on what they're doing and depending on what they're expecting to get from their training, the adaptations, we’ll then start to influence whether they might want to consider some of this stuff. Let's just go back to endurance athletes, because that's an interesting area for you to get into, Scott. How did that come your way?

[0:26:43] SF: Yeah. There's been a couple of recent papers examining creatine on either aerobic capacity, or aerobic power, VO2max, or just endurance performance. One was done by Reza Bagheri. They found actually that creatine was a detriment to VO2max. I think the first author was Damien Gras on that particular paper. Interestingly, they actually showed that it reduced absolute VO2max, but had no effect on relative VO2max.

Actually, in that particular paper, they showed that creatine might improve your ventilatory threshold. To me, if I was an endurance athlete, most endurance athletes, you want to improve your ventilatory threshold. That's probably the strongest predictor of endurance performance, particularly on the longer events. That got me thinking about, okay, well, maybe there's some context to this, besides just looking at VO2max, which I think was the key highlight in that particular paper that had caused this detriment to VO2max. Even though, I think there's lots of nuances to it.

Then there was another paper that just came out by Sergei Ostojic. Again, it showed that creatine had no impact on endurance performance. Although, again, if you look at that particular paper, there's a highlight that creatine could be a benefit for growing performance. They didn't try to synthesize it quantitatively. They just talk about it in the discussion. I've been – maybe you influenced me in a great way, but you made me think about the importance of context and nuances in the literature.

When I think about it, I think creatine overall isn't going to have a large impact on endurance performance. We know that your aerobic system, your ability to utilize oxygen, that's the predominant energy system that you're going to use when you're running these endurance events. I think that creatine, where it could play a role, is where there's big changes in pace in a particular event, or as you mentioned, the finishing kick.

I started looking into the literature, and there's actually a few studies to show support of this. There's a study in swimmers in a – they're doing a 400-meter race. They found that the last 50 meters was performed faster when they took creatine. There was a study in cyclists, where they did sprints every – I call it sprints, but every 10 kilometers, they did either one kilometer as fast as they could, and then four kilometers and that alternated every 10 kilometers for a 120 kilometers. They showed in the last one kilometer, or last four kilometers that it was actually performed faster when they took creatine.

Then there was another study where they did 30 minutes of steady state exercise. Then they made them do intervals. There's five 15-second sprints with 45 seconds rest. They gave them two minutes to rest, and then they repeated that again. They did another five 15-second sprints with 45 seconds rest. Afterwards, they made them do another 30 minutes of steady state exercise. What they actually found was during the intervals, they performed 18% more work when they took creatine. I think context is really important.

Just throwing all the studies together into a meta-analysis, you're going to find nothing. You're going to say, creatine doesn't work, or maybe even has a detrimental effect on VO2max. I think creatine can have a benefit in certain situations. When you watch sporting events on TV, you see that there's key moments in a race where somebody breaks away from someone like the pack. You're like, how did they do that? That was a big change of pace, or they had a great finishing kick and you're like, “Whoa, how did they do that? That was a great thing.” Maybe creatine could be a benefit in those situations.

[0:31:06] LB: Look, just music to my ears, obviously, all of these. I think if you're in a position where, well, either you're a researcher and you happen to have been an athlete yourself, which is definitely not me, not really. The other side of it, which is definitely where I've been, where I've seen the athletes train, not just perform, and across many different sports from yes, strength power, team sports. I've worked a lot in endurance sports as well. They do a lot of strength conditioning. There's all sorts of stuff. They have concerns about the integrity of their ligaments, joints. It's all the rage now. But bone health preserving bone masks. I mean, there's all sorts of things. There's various ways of approaching that through their training. Of course, that's the great thing about nutrition strategies and foods and supplements and so on, is that we can play a role in enabling these things to happen.

I think, yeah, if we simplify and generalize endurance athletes, just that, it's an oversimplification. Of course, when you apply that to research, that can be a very misleading thing. I guess, a great example of that is an assumption that an endurance event is, for example, a purely aerobic energy system-based performance. No, it isn't. There's a mix of substrates being used. There's a very good argument to manipulate the use of those different substrates. It makes me think actually of, if you look at elite, and by elite, I mean, Olympic level marathon runners, that's a sprint. Okay, a couple hours sprint roughly. I mean, it's a sprint.

If you go onto YouTube and you get members of the public to try and run at the same speed as some of these athletes, they can't keep it up for more than a few minutes. Maybe let's just quickly talk about that and why that's relevant to this consideration for creatine.

[0:32:58] SF: Yeah, absolutely. Creatine is that important substrate for high-intensity exercise. Anytime you're going above your VO2max and really doing hard sprints, or fast sprints, that's where this energy system becomes really important. I think in races in the real world, they're not run at a perfectly steady pace. There's a change in paces that happen throughout the race, or the finishing kick, which can influence it. Or in certain races, I went and got to watch a World Cup in Edmonton. It was for triathlon. There was a massive hill, which is integrated into the bike section of the course. I was like, “Whoa, man. That's got to be brutal to climb up that hill.” That's definitely going to push them into that – and above their anaerobic threshold and into anaerobic metabolism.

I think, again, if you could have creatine to help you out with that particular portion to create more muscular power, or muscular strength, that could be a benefit. Yeah. Also, as you mentioned, I think if you're really concerned about creatine during the competitive season, maybe it could be a useful supplement during the off season to help build more strength, power, help out with recovery, and yeah, it can enhance bone tissue, bone health, particularly for endurance runners, that's a big concern.

[0:34:31] LB: Absolutely. I mean, we haven’t even talked about brain health and cognitive function and all those things, which we have talked about in other podcasts on this topic. Again, just coming back to this, because it's such a muscle-centric conversation whenever we talk about creatine. The other side of this, which I think is very interesting, particularly as it relates to endurance performance, or adaptations to training that impacts endurance performance is the impact that this can have on neuromuscular activity and buffering capacity. Do you want to just talk about that? Because this is an area that isn't often discussed.

[0:35:06] SF: Yeah. Another positive effect of creatine is that it's going to reduce hydrogen ions. It can act as a intracellular buffer, which could be a benefit for high-intensity exercise, because we know those hydrogen ions are – those are the bad guys. It's not lactate, it's not lactic acid, it's hydrogen ions that are really causing all the detriment within the muscle. They're slowing muscle contraction. They're impairing anaerobic glycolysis through a slowing down phosphofrutokinase, the rate limiting enzyme and glycolysis.

Yeah, so that's another mechanism of creatine and how it can actually improve exercise performances through that buffering capacity. That's, I think, often not cited as one of the mechanisms of creatine. We know during endurance performance that that becomes a problem in the last finishing sprints of a race, for example. That's where you feel your legs really burning. Or if you're getting close to, or just above your threshold, you start to accumulate these hydrogen ions. Again, if you have a greater buffering capacity, then perhaps you can perform better. There's other supplements that might also influence buffering capacity. Traditionally, those show improvements in endurance performance, because of that particular mechanism.

[0:36:32] LB: Yeah, and that's great. Again, I find that to be another great argument for considering creatine supplementation and endurance. Obviously, we're talking about people who are maybe not necessarily at the elite end of the spectrum, although they're most definitely would want to do this, or consider it. But those that are looking at least to push their own boundaries and as you say, dip in and out of their various thresholds is where this is an interesting consideration.

You've already talked about VO2 kinetics. We've talked about ventilatory threshold, which is another great argument here and will be music to exercise physiologists, of course. What about the mitochondria itself? We talk about mitochondria being the powerhouse, the factory for energy production. Also, when we do talk about things like endurance capacity, substrate utilization, particularly phaloxidation, for example, we start to get a bit more interested in mitochondrial function, mitochondrial biogenesis, for example, is an argument that people will talk about. Training low carbohydrate, for example, because that stimulates mitochondrial biogenesis. What's the role that creatine can have on this? Why would that be of benefit then?

[0:37:54] SF: Yeah. I think it has a very small role, if any. As I mentioned that one meta-analysis actually showed a reduced whole body oxygen capacity with creatine supplementation. There is some mechanistic data to suggest that creatine might have positive effect. One is it could actually help once the ATP is formed in the mitochondria, it can help transport that ATP from the mitochondria to where the contractile components within the muscle. That potentially could be of benefit and actually, enhance ATP utilization. The actual evidence in humans is lacking to support that.

There is some studies in animal models to show an increase in mitochondrial biogenesis with creatine, perhaps by enhancing exercise capacity and leading to further adaptations. In humans, that data is definitely lacking. Yeah, there's definitely some positive animal mechanistic theories to why creatine could actually be of benefit to the mitochondria.

[0:39:04] LB: Yeah, great. Maybe further down the road, we might learn something. For now, that's not really a consideration we should be putting too much time and effort into. We go back to this muscle-centric conversation. Of course, muscles are made up of muscle fibers. On a very basic level, we would differentiate fast twitch and slow twitch muscle fibers. Now, to an endurance athlete, they might find themselves being attracted to endurance, because they're just genetically, distribution of fiber types that made them a little bit more likely to become endurance athletes. Of course, one of the great things about training adaptations is you can have an impact on some of this.

What are the things that the literature shows and your own research is showing as it relates to creatine and muscle fiber type, and/or increasing, or changing muscle fiber types in certain kinds of athletes? 

[0:39:56] SF: Yeah. We know for sure that endurance training shifts fiber types from fast twitch to slow twitch. It makes your muscles more oxidative. There was a really cool study. It was actually done at the University of Alberta. That's where I did my PhD, by Ted Putman. They had animals and they used what's called low chronic frequency stimulation. Essentially, if they use electrical activity and it zaps the rat, and that causes a muscle contraction. They do this at a very low intensity and they do it for long periods of time. That's simulating endurance training, or endurance activity where you're contracting your muscles, not in a maximum intensity, and you're doing it for long periods of time.

Although, in these animal models, it was really extreme. They were actually doing this for 12 hours a day. What they found was that's a very potent model to cause that shift in fiber type with fast twitch to slow twitch. Interestingly, as they gave these rats, or half the rats creatine, and what they found was that that chronic low-frequency stimulation still increased oxidative capacity in those rats receiving creatine, but it also helped to preserve the fast twitch components, or characteristics of the muscle.

To me, when I read that, I was like, “Oh, this could be really cool for endurance athletes that are performing lots of endurance training, like a high-volume training camp, if you took creatine as well, you're still going to get the benefits of that high-volume training, but you'll also preserve your fast twitch characteristics of your muscles, so you can still perform those high-intensity bursts of activity.” Again, maybe you can sprint a little bit faster than another athlete that wasn't consuming creatine. Again, that's in animals, so we need to replicate that in humans. When I read that particular paper, I thought of the context of why this might be important. I think for endurance athletes, particularly during a high-volume training camp, it could be a benefit.

[0:42:14] LB: Actually, you just raised an interesting point that we've – or I’ve talked about with many researchers on this podcast is the issue in research, which comes up with who have these experiments actually being done on? Is it humans? Is it males? Is it females? Is it young, old? Because there are differences, particularly if we're going to try and translate that into practice, or at least information that's relevant to inform practice, or decisions, or whatever. In this area, and in these studies, not just your own research that you've done in the lab, but when you're doing meta-analysis reviews, that sort of thing, how much do you take into account animal-based studies on this? Is there a value to that? If so, why?

[0:43:05] SF: Yeah. I think in the creatine world, you need to be extremely cautious because animals metabolize creatine differently than humans, particularly in the brain, but in other tissues as well. We need to be very cautious with using animal models. I'm an applied exercise scientist. I think we need to run these studies on humans to really find out the answer if creatine could be a benefit. I think those animal models can be useful to provide some mechanisms. As I mentioned, it was a really extreme model that was used in the animal model. I don't think any human wants to exercise for 12 hours a day. They definitely should not if they want to maximize performance.

You can utilize those models to show proof of concept. I think, those models are very effective. Yeah, I think we need to do those studies in humans and we need to be very cautious with translating animal creatine research to humans.

[0:44:14] LB: Yeah. No, thanks for that. I always raise these topics, because we're interested in evidence-based practice, or evidence-informed practice. You just got to be mindful where this stuff came from. A lot of research, particularly sports nutrition research is it might be done on humans, but for example, it's done on college students and not necessarily elite athletes. Not wanting to smash any dreams there for anyone. But there is a big difference between a college athlete and an Olympic athlete, for example. An NBA basketball player is not the same thing as your college basketball player.

Look, one thing that is really important in one's consideration of nutrition strategies, diet, supplements, etc., as it pertains to getting the most out of your training, getting the most out of your adaptations is this whole topic of recovery. Recovery is big and of course, there's many angles there, including things like sleep and all these other things. Of course, this is a place also for creatine. What roles does creatine play in the concept of recovery? What benefits are likely to occur as a result of that?

[0:45:32] SF: Yeah, so there's definitely evidence to show that even following endurance activity, like running a 30-kilometer race, that there's a reduction in inflammation in the muscle. There's also a reduction in oxidative stress. I think we need to be, again, cautious with regards to just interpreting that data as enhancing recovery. I think we need to do more research to really show if creatine can speed up recovery, or enhance recovery. We do know that if creatine is consumed while performing a high-intensity training program, that could benefit that particular training program. It can help with adaptations. But perhaps, that's by actually allowing them to do more work, train a little bit harder, and get further benefits.

There's some great research by Jeff Stout and Kristi Kendall showing that creatine combined with high-intensity interval training can enhance, for example, ventilatory threshold. Whether creatine can actually impact recovery and speed up recovery is actually, from my knowledge, less known. I'm not too sure that there's a huge amount of evidence to support that, besides manipulating some of these factors acutely, like reducing inflammation, or oxidative stress over the short term.

[0:46:57] LB: Yeah. No, well, that's very useful. Look, I think when we start talking about things like creatine, a lot of this has just got to come down to, yeah, we can argue the strengths and limitations, we can get all very theoretical about this, but what about research that's actually done on important performance related metrics? Things like time to exhaustion, time trial performances, that sort of thing. I know you've already talked about some of this indirectly, but what do the studies show in that regard?

[0:47:32] SF: Yeah. There is some evidence that it can enhance time to exhaustion. As we know, most performance races out there are not time to exhaustion races. They're actually time trials. The evidence to enhance time trials is quite limited. There is no strong evidence that creatine can actually enhance time trial performance. I think what we need to do, and I think the reason why there's actually no evidence to support that is because a lot of the things that we do, or performance metrics in the lab don't actually simulate what actually happens out in the real world where there is that change of pace, or there is that big finishing kick. I think if we do that, then there might be some benefits to creatine to actually enhance performance.

Yeah, you are right that there are different metrics, different tools to measure performance. Yeah, I think we need to do better jobs as researchers to really try to simulate what's happening out in the real world.

[0:48:37] LB: Yeah. That's the problem we're doing research though, isn't it? To bridge that gap between the lab and the real world is complicated stuff. I mean, albeit impossible in many different ways. That's why you have to piece everything together, don't you? That requires a fair bit of critical thinking and all that stuff. Look, from your perspective, you've been in this world for a long time as it relates to creatine research, and that's not the only thing that you do. You are one of relatively few people out there that have immersed yourself very deeply into this.

We've talked about some health, some performance aspects of this, both in this podcast and previous podcasts. But what we're focusing on here is endurance performance. Yes, there's different kinds of endurance performance, different kinds of endurance athletes, of course. From a practical application perspective, from what we know, and by we, I mean, what the research evidence tells us, what are the main potential practical applications? What are the recommendations you can offer us at this point that we should seriously consider?

[0:49:49] SF: Yeah. I think that creatine could definitely be of impact to endurance performances, where there's a lot of change in pace, where there's that finishing kick that's required. I think we need to look at the actual dose of creatine that's required to enhance adaptations. Traditionally, you would perform that loading phase, which is 20 grams per day. We know if you do that loading phase, and it also brings a lot of water into the muscle cell as well, which is important to stimulate muscle growth over time. That increase in water retention can actually increase body weight. I think we need to be cautious of that as providing that to endurance athletes.

Maybe there's ways to minimize that. I think we need to conduct more research in that area to see if maybe a lower dose of creatine, just taking three, or five grams a day, could actually get some of the benefits of creatine. We know that it can saturate your muscles with creatine, it just takes a little bit longer. Maybe you'll actually have a little bit less water in the muscle cell over time as well and less body weight gain. That's one theory, or speculation that we have. That's one suggestion, or practical application of creatine for endurance athletes.

The other thing is we need to do a better job of looking at females, particularly across the menstrual cycle. Abby Smith Ryan has done some recent work in that area and showing that creatine can influence water retention and body weight differently across the menstrual cycle. I think we need to do more research in that area. Then we know that creatine combined with carbohydrates can be a benefit for endurance athletes by not only increasing creatine uptake, but also glycogen uptake as well. Again, that could be a benefit for endurance athletes as well. We need to do more research in all those areas to really hold it all together and see if creatine can really impact endurance performance.

[0:52:01] LB: That's great, Scott. Knowledge is power. I know creatine helps increase strength and power and creatine knowledge helps to increase our power in this regard. No joking aside though, it's just interesting to have these conversations, because you wouldn't normally think about creatine and endurance, but perhaps you would now, the listener, the researcher, the practitioner, the endurance athlete. We've already discussed quite a few reasons why it should be considered as something you might want to put into your toolbox of options, off-season, on-season, and so on.

There's no doubt that there's still much more to learn. Thanks to you, and all the researchers out there that are continuing to contribute to the body of knowledge on this. I'm sure, we'll have more podcasts, more opportunities to discuss where we're at in the coming years. I just wanted to thank you for your time. Scott, as always, you know your stuff obviously, but you're good at translating this and explaining stuff. I appreciate it. I learned a few things myself, so that was good. Looking forward to having you back.

[0:53:10] SF: Happy to be here as always. Yeah, thank you very much for the opportunity. As mentioned earlier, I think you've also stimulated my mind as well with regards to context and nuances. I think that's important to pull out from the literature as well.

[0:53:25] LB: Well, I do. I try. I try. Well, look, thank you. That was great. I look forward to bringing another episode of We Do SCIENCE back to you all very soon. Take care, everyone.

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