Creatine is one of the few topics I haven’t covered over the course of the last 15 years.
Creatine has a long history of use with bodybuilders. But new research suggests it may play a role in preserving cognitive function as well.
Nutrition Diva is hosted by Monica Reinagel. A transcript is available at Simplecast.
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Hello and welcome to the Nutrition Diva podcast, a show where we look into trends, claims, and headlines so that you can make science-backed decisions about what to eat. I’m your host, Monica Reinagel. And today’s episode was prompted by an email from Sandi, who wanted to know if I’d ever done a podcast on creatine.
Sandi is 75 years old and apparently something of a “super senior.” She says that her personal trainer has recommended creatine for both its muscle-building benefits as well as for cognitive function.
Creatine is one of the few topics I haven’t covered over the course of the last 15 years. To be honest, I thought of it primarily as a supplement for bodybuilders—so I left it for my colleagues on the Get-Fit Guy podcast to answer. (Which they have.)
But I have to give Sandi’s personal trainer credit for being aware of newer research on its potential benefits for older adults.
Creatine is an amino acid that we get from meat and fish. Our liver also makes creatine. It’s stored in our muscles, where it is used to power short bursts of high-intensity muscle work—such as the effort involved in lifting, carrying, or pushing something very heavy, or perhaps jumping from a standing position.
It’s been used by bodybuilders and weight lifters to improve performance gains for decades. And, unlike many of the things that bodybuilders might use to enhance performance, this one is both legal and supported by pretty solid research.
One important thing to note is that creatine doesn’t build muscle directly. Rather, it allows you to squeeze a little bit of extra effort out of your muscles. That effort is what builds muscle. And that little bit of extra effort that creatine makes possible during a workout can result in a little bit of extra muscle. Without the workout though, creatine doesn’t really do anything for you.
That small incremental gain might be meaningful to a competitive weightlifter, but I didn’t really see it as important to those of us who are lifting weights or working out for general health and wellness.
However, in recent years, there have been some interesting studies on the benefits of creatine specifically in older adults, who are at increased risk of muscle loss. And to be perfectly honest, I wasn’t aware of the research on creatine and cognitive function until Sandi (and her trainer) brought it to my attention.
Let’s start with the research on cognitive function. We already know that things like sleep deprivation can negatively impact our ability to think straight. Interestingly, sleep deprivation and other stressful situations are associated with decreased levels of creatine in the brain. And there’s some preliminary evidence to show that taking creatine supplements can both raise creatine levels in the brain and also reduce some of the cognitive processing deficits that accompany those brain-stressing situations.
I think what’s more relevant to Sandi’s situation (and probably, most of us) is research on cognitive function as we get older. And here, I think the best we can say is that the research is promising. Creatine appears to have beneficial effects on short-term memory and reasoning. For other aspects of cognition, including long-term memory, attention, reaction time, and things like the ability to find the word you’re searching for, there’re only a handful of studies and the results have been inconsistent.
Benefits of creatine supplementation were more apparent in vegetarians, which makes sense, because they presumably get very little creatine from their diets. And that suggests that older people, who may also have lower creatine levels, could also get more benefits than younger folks. At least one of the studies that looked specifically at older people did find some boost in cognitive power. But all of these studies were quite short in duration—most of them only a few days long.
Although I think there’s certainly enough here to merit more research, in my opinion, what we have so far isn’t strong enough to support a recommendation for ongoing creatine supplementation specifically for brain health. That may change. And if it does, I’ll update you!
There have also been a handful of studies looking at the effects of creatine supplementation on muscle mass and strength, specifically in older adults. A typical protocol starts with a “loading dose” of about 20 grams a day, spread out in 4 doses. You do that for 5-7 days, and then you go back down to 2.5 to 5 grams a day.
In most of the studies, supplementation did have a measurable benefit on strength and muscle tissue. But as with body-builders, the benefits of creatine supplementation are completely dependent on you also doing significant strength training, on an ongoing basis.
But, it’s important to note that dedicated strength training without supplementation also results in increased strength and muscle tissue in older adults. So, is that incremental boost that you get from creatine actually necessary? Does that extra little bit of muscle make any meaningful difference in your health and well-being? Or can you get the benefits that you want and need simply by doing strength training? (My educated guess is: yes.)
Of course, there may be scenarios where that extra boost (either in muscle or cognition) would be more meaningful. Perhaps in recovering from an injury or surgery or some other stressor? In other words, I wonder whether the true promise of creatine isn’t so much as a supplement that everyone over 50 needs to take, but as a supplement that might be used in more targeted situations. We’ll have to see where the research takes us.
Now I know some of you are more of the mind that if something like this helps even a little, then it might be worth it, as long as it doesn’t pose any risks. And the downsides appear to be few.
Creatine is cheap and appears to be safe, even at relatively high doses. That said, there are some common side effects, including stomach cramps, nausea, and diarrhea—especially with the higher doses. These can often be reduced by lowering the amount and spreading it out in smaller doses throughout the day. Taking creatine with food (and plenty of water) is also recommended.
We have time to fit in another Listener Q&A, this one from Viktoria, who writes, “What's the latest research regarding cranberry juice and the claim that it helps prevent UTIs in women?”
Cranberry juice or cranberry juice supplements are often recommended as a way to prevent painful urinary tract infections. Many women swear by it. But the research is murky. The supposed mechanism is a specific compound in cranberry that reduces the ability of bacteria to attach to the lining of the bladder or urinary tract. Without the ability to attach, they can’t get enough traction to create an infection before being flushed through the system.
But it’s been difficult to confirm their clinical effectiveness in controlled research studies. A 2013 meta-analysis of studies found no statistical reduction in UTIs in those consuming cranberry juice instead of a placebo. However, there were a number of factors that might have obscured the results. A lot of women dropped out of the study, for example. Unlike the sugar-sweetened cranberry juice cocktail that you may be familiar with, undiluted cranberry juice isn’t very palatable. (And the sweetened stuff just doesn’t contain enough of the phenolic compounds to have any benefit).
Cranberry juice supplements, which contain dehydrated, powdered cranberry juice, are one way around that issue. Although the research on them isn’t any more definitive.
Another factor in these trials is that the total number of UTIs that occurred was so low that it might have been hard to detect a statistically significant difference between the groups. A larger study might have had different results.
In 2016, a larger trial enrolled almost 400 women who had a history of recurring UTIs and randomized them into two groups. One group drank 8 ounces of a special cranberry juice beverage that was high in the anti-bacterial compounds (so, not the stuff you get at the grocery store). The other drank a placebo juice that looked and tasted similar.
After six months of drinking juice every single day, those taking cranberry juice reported 35% fewer UTIs than those who took the placebo. So, not exactly a home run. My friends at Examine.com calculated that, on average, you’d have to drink cranberry juice every day for 3.5 years in order to have one fewer UTI. It should also be noted that this latest study was funded by Oceanspray. That in and of itself does not invalidate the results, of course. But it may have influenced the study design in a way that increased the chances that a positive effect would occur.
So, Viktoria, if you enjoy cranberry juice, especially the unsweetened kind, and you’re prone to UTIs, there’s no harm in sipping on it. If nothing else, it’s a good source of antioxidants. But, unfortunately, it does not appear to be a silver bullet against UTIs. And I’m not sure taking a supplement every day would be worth it for the level of prevention it might provide.
This is Monica Reinagel, the Nutrition Diva. Thanks for sending your nutrition questions.
If you have a question you'd like me to answer, you can email me at firstname.lastname@example.org You can also leave me a message at 443-961-6206
If your question is more on the topic of behavior change, you might enjoy my other podcast, the Change Academy. Look for it wherever you listen.