Creatine researcher Dr Darren Candow discusses muscle, bone, brain health, and aging with Steven Bartlett
Steven Bartlett interviews Dr Dr Darren Candow, one of the world's leading creatine researchers, on The Diary of a CEO.
Summary
Dr Darren Candow, a kinesiology researcher who has published over 120 papers on creatine and conducted 30–40 studies in his own lab, joins Steven Bartlett on The Diary of a CEO. He argues that creatine is the most researched supplement in existence, surpassing protein and caffeine, and that its benefits extend far beyond muscle performance to include bone preservation, brain bioenergetics, cognitive function under stress, and potential applications in Alzheimer's disease and clinical depression. He presents evidence that the optimal dose varies significantly depending on the target tissue — with muscle requiring around 5 grams, bone requiring 8–12 grams, and a metabolically stressed brain potentially requiring up to 20–30 grams acutely. He also addresses five major myths about creatine — kidney damage, water retention, gender specificity, hair loss, and muscle cramps — and debunks each with reference to clinical evidence. The conversation broadens to cover resistance training, protein intake, the physiology of aging, and his personal health philosophy.
Key Takeaways
FULL TRANSCRIPT
Introduction and Background
Steven Bartlett: Dr Dr Darren Candow, what is the mission that you're on in your life?
Dr Dr Darren Candow: I think right now it would be to promote health and make people live longer, free of disease. It's fascinating how we've transcended our understanding of weight training, and now weight training is seeming to have these profound effects that cardiovascular exercise has — and gives you a bit more. So really focusing now on the benefits of lifting things, and how exercise and nutrition come into play. We're going to talk about creatine, but also how other macronutrients, especially protein, factor in. And then when you combine those two, are we doing enough to optimize longevity? We hope that we are.
Steven Bartlett: And what are the reference points you're drawing on? How do you know the things you know? Are you doing your own research?
Dr Dr Darren Candow: Yes. I did my graduate school in Canada — a cell biology degree — and then I moved into my master's and PhD looking at kinesiology. It's interesting that I fell into creatine supplementation research by accident. I was doing my master's on an amino acid called glutamine. At the time, about 20 to 30 years ago, glutamine was the biggest rage. Everybody was taking this non-essential amino acid hoping it would have body composition improvements. I sort of determined it was worthless in young healthy individuals from a body composition standpoint. At the same time, a good colleague of mine was doing creatine research, and I started to notice that these young biological males were getting bigger, stronger, faster — and then another study, bigger, stronger, faster. When you go to the research on creatine, it was very stimulating in the sense that we're now improving things that we know with aging go down. So I turned my focus completely to healthy aging and trying to get grandparents, great-grandparents, and parents to live longer, free of disease. But let's start young — start as early as you can and move forward.
Steven Bartlett: And so you got really compelled by creatine. What was it specifically that compelled you to start doing your own research on it?
Dr Dr Darren Candow: I started to take creatine myself. It's a natural metabolite that we're synthesizing in the liver and brain. If you take a little bit more — not a lot, just a little bit more — than what we're probably taking in from food sources such as red meat and seafood, can it have benefits? And sure enough, it's now the most researched supplement out there. It's overtaken protein and caffeine from an ergogenic perspective, and it's gone global — not just for males, but of course for females, centenarians, and the elderly. The explosion in this research has been very fascinating.
What Creatine Is and How the Body Uses It
Steven Bartlett: What is the physiological backdrop of why humans need creatine, but also why they might not be getting optimal amounts?
Dr Dr Darren Candow: Adenosine triphosphate, or ATP, is the energy currency of all our cells. Think of your muscle doing work — shoveling the driveway, walking — you're using your muscles and you need to maintain that level of energy. Well, creatine comes to the rescue to help maintain your energy currency. If Batman, which gets all the press, is ATP, then Robin is creatine. Creatine comes to the rescue as his best friend to help maintain those levels. Now, when you exercise at high intensity — sprinting, weightlifting — those ATP stores become jeopardized, and that's why creatine sacrifices itself to come to the rescue. That's why in anaerobic sports — the World Cup just started — those individuals will be using a lot of creatine stores in their muscle. The question is, do they have enough, and if they had more, could they play better?
Our body makes creatine naturally — about 1 to 3 grams a day — but only in two areas. This will be quite shocking for people: we're only actually making it in the liver and the brain. We don't make it in skeletal muscle, but we store 95% of it there. When it's being made in the liver or brain, the brain will keep it there, but in the liver it gets transported through the blood up to your skeletal muscle. The question is, what if we need more? That's where dietary creatine from red meat, seafood, or supplementation comes into play.
Steven Bartlett: So are we deficient in creatine?
Dr Dr Darren Candow: There are small populations who were unfortunately born with the inability to synthesize creatine — they would have a deficiency and are required to take supplementation. The other unique population is vegans and vegetarians. A vegan and vegetarian diet is extremely healthy, but the downfall is they're not getting any dietary creatine because creatine is only found in animal-based flesh — red meat, seafood, and poultry. They're naturally synthesizing about 1 to 3 grams a day through amino acids in their food, but vegans and vegetarians respond literally the best on the planet to supplementation because now they're taking in something that was previously absent entirely.
Steven Bartlett: Is it thought that historically we would naturally have consumed more creatine?
Dr Dr Darren Candow: That's a good point. Back in the hunter-gatherer age, a lot of meat was consumed — quite a bit through dietary products. Just to get 3 grams of creatine through food, you'd have to eat quite a bit of meat. And then it comes into the dilemma of what if you don't eat meat, or you just can't afford it.
Steven Bartlett: Creatine has exploded over the last couple of years. I saw a stat that said about 3% of women now take creatine, and in men it's slightly higher. It's still a little bit lower in terms of consumption in women. And I think that's in part because there are still some prevailing myths. When I speak to some of my friends — people who know that I interview a lot of health experts and scientists — they ask me what supplements they should definitely take. When I mention creatine, it's always met with a certain set of rebuttals. You've got some myths on the cards in front of you. Can you reveal them one by one?
The Five Myths of Creatine
Dr Dr Darren Candow: So this is definitely the number one myth: creatine damages your kidneys. When you take creatine into the body, it gets stored as creatine. But when you metabolize it — think of it as leaking from the muscle — it gets released as creatinine. Most people watching will recognize that from their blood requisition form, and right below creatinine is something called eGFR — glomerular filtration rate — which is an estimation of your kidney health. The problem is when individuals on creatine supplementation go to their doctor for annual blood work, their creatinine might be a little bit elevated, and that's only from the breakdown of the compound. Unfortunately, their filtration rate then appears lower. So their doctor gets really concerned and says, "Stop taking creatine because it's hurting your kidneys." What typically happens is they stop taking creatine, go back, check their kidneys again, and it's fine. So 99 out of 100 times, it's a false positive. There have been randomised controlled trials over several years showing that creatine causes no detrimental effects to the kidneys.
Steven Bartlett: I had exactly that twice on my blood test.
Dr Dr Darren Candow: Yes. And creatinine can also be elevated if you're on a high-meat diet or a little dehydrated. So always tell your doctor you're on creatine supplementation because your creatinine could be a little bit higher.
Myth number two: creatine makes you retain water. This is really important and I think it's one of the main reasons females were hesitant to take creatine. If you take too much too soon, it can lead to an increase in water retention. You've probably heard of the creatine loading phase — this is where supplement companies want you to take about 20 to 30 grams a day for about 5 to 7 days. That has been shown to increase water retention acutely, maybe for about 3 to 5 days. But after that, when you go on a maintenance phase of about 3 to 5 grams a day, that water retention goes away. The good news is that after about the first week, the water is inside your muscle. So now we're volumizing the size of the muscle — sort of like a balloon that's full of water. After a while, the water is going into the muscle and it's a lot bigger compared to a deflated balloon. Creatine is osmotic — water likes to follow creatine. By taking it into the muscle, the muscle gets a lot bigger. And that's good because a swollen muscle stimulates protein synthesis to get bigger and stronger.
Steven Bartlett: Oh, really? A swollen muscle stimulates protein synthesis?
Dr Dr Darren Candow: Yes. When you have water coming in, that's a really good thing. Creatine does that, and that's one of the main mechanisms why it works. When you're trapping water, it turns on all these signaling pathways that are involved in protein synthesis. And one of the most robust findings in the evidence is that creatine increases lean tissue mass and regional muscle thickness with weight training over time.
Steven Bartlett: Because a lot of people are concerned that they're going to put on lots of weight and be bloated with creatine.
Dr Dr Darren Candow: The interesting thing is that if you take smaller, more micro-dosed amounts, there's hardly any effect. And this might come as a surprise, but if you did a 6-week study pre and post after creatine, you only increase mass by about 0.86 kg, and the majority of that is lean mass. So at the end of the day, a pound and a half is not a lot. And lean mass — most people think of it as muscle, but lean mass in our body includes water, connective tissue, organs, as well as skeletal muscle. About 50% of our lean mass is muscle.
Myth number three: creatine is only for men. This is 100% false. When you look at the totality of all the evidence, females respond extremely robustly to creatine supplementation. They get profound benefits in strength, endurance, and performance. They lose a little bit of body fat. There was an idea that water retention was causing an increase in fat mass — we've done some meta-analyses now showing that creatine actually reduces fat mass. Females get an increase in lean mass as well. And from our lab's work on bone health, females do respond very favorably with creatine and bone.
Myth number four — I can't believe you did this one to me — creatine causes hair loss. Obviously, looking at me, a prolific creatine researcher who has been taking creatine religiously for about the last two and a half decades, people would say, "Well, obviously looking at him, creatine caused this." But I was going bald before I started taking creatine. This myth came from a study in rugby players decades ago where creatine at about 20 to 25 grams a day for 7 days increased a hormone called DHT — a precursor for testosterone, which has been linked to hair follicle loss and thinning. But the ironic thing is that when creatine was given to these young males, the hormone went up but was still within the biological range, and no measure of hair follicle thinning or loss was actually done. Just a few years ago, they decided to put this theory to the test, and 5 grams in young males for about 6 to 8 weeks of training caused no detrimental effect from hair follicle thinning. So there's no evidence to support that myth either.
Myth number five: creatine causes muscle cramps. I think this is so overplayed. When creatine is taken into the body and water follows it, you're super-hydrating the muscle. One of the main issues with muscle cramps is dehydration in the muscle. If anything, creatine decreases muscle cramps and super-hydrates. So in hotter environments — June, July, August — creatine is going to be one of your best friends.
Creatine and Muscle Performance
Steven Bartlett: We talked there about weight training. What is this graph showing?
Dr Dr Darren Candow: This is showing that when you take creatine supplementation, you actually get an improvement in training volume. When you go into the weight room, you look at the load you're lifting by the reps by the sets — it actually goes up. And when you don't take creatine, it would go down over time as well. One of the main reasons you get an enhancement in performance is that creatine seems to enhance training capacity. A lot of people say, "I've taken creatine, now I got an increase in the number of reps or sets that I can perform," and that probably leads to a stimulation of muscle growth over time.
This is an 8-week study, very short term. You can also see that the number of training sets came down when they weren't taking creatine, and then when they started to take it, it went up. This leads to another important point that's often not talked about: when you take creatine for at least a month, people ask, "How long does it stay in my muscles if I go on vacation?" In skeletal muscle, it takes about a month for those elevated levels to come back down. In the brain, we don't have a lot of evidence, but it's speculated to take anywhere between 5 weeks to about 3 months for those elevations to come back down.
Steven Bartlett: And this essentially means that if I take creatine, I will be able to train harder?
Dr Dr Darren Candow: Harder, or longer, or more frequently. One of the things creatine does is allow the muscle to recover quicker. So you might be able to get back to training sooner — if an athlete is training twice a day, for example. Either one of those seems to be one of the most plausible mechanisms.
Steven Bartlett: Why is there a big dip in the middle of this graph?
Dr Dr Darren Candow: That's showing where the individuals would train without creatine, and then take it over time. They start taking it at week four, and that's where the elevations go up. It goes to show that when you have creatine, everything is elevated. If you stop taking it, it takes about four weeks to come back down to the same level as a placebo. And then when they take it again, they get a rebound effect. I think this has application for people who have injured themselves and need to go back and start training — if you take creatine, it can accelerate the rehabilitation program.
Steven Bartlett: And it does that because it makes your training volume increase?
Dr Dr Darren Candow: It makes your training volume increase, and it can increase muscle mass gain. That's probably going to be a bit surprising to a lot of people. A lot of people take creatine expecting huge increases in muscle. You get an increase in lean mass by about 1.2 to 2 kg, but remember, only half of that is skeletal muscle. So creatine, yes, with weight training can improve muscle mass, but it has more robust evidence for muscle performance.
One of the big things is that it decreases something called protein breakdown. That might allow the muscle to maintain its integrity or recover quicker. But overall, when you combine creatine with a standard weight training program, you should expect a greater increase than weight training alone — and that's across all ages, which is really important.
Steven Bartlett: And the studies you've done in your own lab — how wide-ranging are those and how many have you done?
Dr Dr Darren Candow: We've done at least 30 to 40 studies in our lab. I've published over 120 papers just on creatine alone. And the interesting thing is that from young individuals to middle age to older adults, we see a very common theme: combined with weight training, creatine at about 5 grams or more seems to have beneficial effects on muscle mass, muscle strength, as well as performance.
Types of Creatine and Dosing
Steven Bartlett: Can you show me what 5 grams looks like?
Dr Dr Darren Candow: Absolutely. This would be a standard 5-gram dose — which is one scoop. Now, keep in mind that can be found in meat or seafood, but you're going to require a lot of food to match it.
Steven Bartlett: And you're saying we don't necessarily need to do this loading phase that bodybuilders would do?
Dr Dr Darren Candow: Correct. The loading phase is the most rapid way to saturate your muscles. That would be four scoops — about 20 grams — per day, and it's very effective. But the issue is it can cause some adverse GI tract irritation. A lot of people from a muscle perspective will just start with 5 grams a day, and that's very beneficial.
Steven Bartlett: And at 5 grams a day, what benefits am I getting?
Dr Dr Darren Candow: From a skeletal muscle perspective, you get a whole plethora. You definitely get an increase in lean tissue mass or muscle size, and then muscle performance — muscle strength, power, and endurance. And the one that never gets a lot of press, which should, is functional ability. An older adult's ability to sit to stand — getting off the toilet, out of bed, out of a car. As we get older, we're losing muscle strength, performance, and functionality, and creatine combined with weight training seems to come to the rescue there.
Steven Bartlett: Is there anyone that shouldn't take creatine?
Dr Dr Darren Candow: I can't find anybody that can't or shouldn't. The safety profile is exceptional. If they have pre-existing medical conditions, they definitely need to speak to their doctor. Besides that, I'm not seeing any reason a healthy individual can't take creatine.
Steven Bartlett: And pregnant women?
Dr Dr Darren Candow: That's an interesting area. A colleague of mine, Dr. Stacy Ellery of Australia, is now finally looking at human trials with pregnancy — going into breast milk and into the fetus. It's still in its infancy. The jury is still out, but as it currently stands, it seems to be relatively safe and well tolerated.
Steven Bartlett: Not all creatine is made the same. There are lots of different types — creatine monohydrate, creatine hydrochloride. What is the optimal type of creatine to take and why?
Dr Dr Darren Candow: By far, creatine monohydrate. And that goes against all the new marketing forms. Creatine monohydrate is simply creatine linked to one water molecule. When you take it into the body, the water molecule dissolves — it's identical to what's being produced in the liver and the brain. All the evidence you ever hear about the safety and efficacy of creatine is based on the old, boring, discovered-in-1832 creatine monohydrate. There are new market forms such as hydrochloride, which does have evidence behind it, but the only downfall with all these market forms is that none has ever been shown to be safer or more effective than creatine monohydrate.
The other big thing for your viewers: make sure it has Creapure or some form of creatine monohydrate on the label, and that it's also third-party tested. Creapure is from Germany — it has the highest standard of qualification and scrutiny. And then NSF certified or another third-party certification. So those are the three things I personally would look for: monohydrate, Creapure as the type, and NSF or third-party certification.
Steven Bartlett: What does NSF certification mean?
Dr Dr Darren Candow: NSF is the National Sanitation Foundation. It's a third-party organization that will independently take the supplement and test it, and then you get a certificate of analysis to confirm there are no contaminants like lead or arsenic. That's something for consumers to definitely be aware of when they go to the store.
The Dosing Dilemma
Steven Bartlett: We've got this thing here in front of us — the dosing dilemma. We talked about muscle. How many grams is optimal for skeletal muscle?
Dr Dr Darren Candow: Five grams. That's only going to be one little scoop. And you're correct — across the lifespan, 5 grams has been shown to be effective. But here's a little caveat: if you're over the age of 50, maybe you want a little bit more, because as we get older, the creatine in our lower legs is more jeopardized and therefore you might need a bit more. This is without the loading phase — if you just want to take a little bit per day.
Steven Bartlett: And do you have to take it consistently?
Dr Dr Darren Candow: Ideally, yes. There is evidence that you can just take it on training days, but we haven't talked about the brain yet. And the reason I think you should take it every day is that it likes to go to other tissues on a daily basis. About 7 or 8 grams seems to be a very safe and viable dose shown to be effective for improving muscle mass and performance.
Steven Bartlett: I do have an issue sometimes when I take a little bit more creatine — I feel, I wouldn't say lethargic, but I get a little bit dizzy almost.
Dr Dr Darren Candow: There is a mechanism for that. Creatine is the biggest methyl scavenger in the body, and methyl groups are used for everything — including synthesizing something called adrenaline and our neurotransmitters. When you take in too much creatine, typically on an empty stomach or in a dehydrated state, it spares methyl groups in the body. Since creatine is now being taken in as a supplement, these methyl groups are available to go elsewhere and do work, and they like to synthesize adrenaline. That's why you feel more energetic, so to speak.
Steven Bartlett: When you say synthesize adrenaline, what does that mean?
Dr Dr Darren Candow: That means you're creating more of the hormone called epinephrine — the fight-or-flight hormone. It gives you a little bit more of that, which is why sometimes you feel a little bit jittery.
Steven Bartlett: Sometimes I can feel a little bit sick as well if I do too much.
Dr Dr Darren Candow: Yes. And that's where the new area of interest for me is micro-dosing. We're starting to see some evidence now that if you take smaller amounts throughout the day, it does not have any adverse effects — if anything, it seems to be a little bit more tolerable. You could take a few grams in the morning, a few grams in the evening, or whichever. I think one of the best ways to take it that never gets any press is to put 5 grams in your water bottle during your workout. Now you're consuming a little bit of creatine as you do your weight lifting or cardio, and then you can consume a little bit in the morning as well. I take about 10 grams a day at minimum on a daily basis. Other people will take more or less, but that's just how I get it in.
Steven Bartlett: I find that if I take a little bit in the morning and then a little bit later, it's much better.
Dr Dr Darren Candow: That's correct. It seems to be more consistent and appreciated by individuals because if you are susceptible to any fluctuations in weight gain, water retention, or GI tract irritation, those seem to definitely go away. We've assessed over a thousand individuals in my lab and that seems to be a very viable approach.
There's not a lot of taste to it, is there?
Steven Bartlett: It's very bland, very boring.
Dr Dr Darren Candow: But with creatine, you can put it in anything — yogurt, juice, whichever. You can now put it in coffee. There's a little bit of controversy over the dose of caffeine, but I think anywhere lower than 350 milligrams is fine, and that's going to be most standard coffees or teas. Whichever allows you to become consistent is a great way to do it.
Creatine and Bone Health
Steven Bartlett: Okay, so bone. Tell me what I need to know about bone.
Dr Dr Darren Candow: So we talked about muscle. How many grams do you think for bone?
Steven Bartlett: The same — seven?
Dr Dr Darren Candow: Unfortunately, the lowest dose ever shown to have bone benefits is 8 grams, all the way up to 12. So now we're in a dosing dilemma already. We have a little bit of a disconnect between muscle and bone. Three to 5 grams seems to be really good for muscle, but bone needs to be a little bit more. That's primarily based on some of our work from our lab, where we've shown that about 8 to 12 grams a day with exercise — and that's crucial. If you do not exercise, there has never been a study ever shown to have bone benefits. But if you do perform weightlifting, one of the very cool things in post-menopausal females is that creatine seemed to reduce the rate of bone mineral density loss around the hip region. It didn't increase bone density, but it decreased bone density loss. It also seemed to maintain or improve the structure of the bone a little bit more. That has profound beneficial effects, especially as we get older. If those individuals on creatine were to fall, maybe they might not fracture their hip. And as we both know, if you fracture your hip, you're going to be placed in long-term care or you're going to be inactive for at least 6 months.
So creatine has some bone benefits. They're not dramatic — they don't improve bone density — so they're not going to be an osteoporotic cure. But there is something there, especially if you're prone to osteoporosis or osteopenia.
Steven Bartlett: And what's the mechanism that's stopping bone loss?
Dr Dr Darren Candow: It's very interesting. In a 24-hour cycle, creatine stimulates these bone-building cells to become more energized — think of Super Mario when he got the mushroom and became energized. Creatine does that. And then on the flip side, creatine seems to decrease the osteoclasts, or bone breakdown cells. So by a synergistic mechanism, it seems to cause this turnover to go a little bit better, causing the bone to maintain its structure. It's very similar to a bisphosphonate that someone would be taking to maintain their bone health.
Steven Bartlett: A bisphosphonate?
Dr Dr Darren Candow: Yes. It's a drug that a lot of individuals will take if they're prone to bone loss. Obviously creatine is not a drug, but it has some of those similar properties.
Creatine and the Brain
Steven Bartlett: So we've got muscle at about 7 or 8 grams, and bone a little bit more. What about the brain?
Dr Dr Darren Candow: The brain will naturally make its own creatine, very similar to the liver. Since the brain is actually making its own creatine, it may not require as much — or any — on a daily basis. This organ is about 2 kg but uses 20% of our daily energy at rest. Just think about that — 20% of the energy we're consuming from food is being used by the brain.
But what if you're stressed? Sleep deprivation — your dog got you up in the middle of the night and you couldn't fall back to sleep. University students cramming for a midterm. People up late watching the World Cup across different time zones. Then all of a sudden, the healthy brain becomes a metabolically stressed brain. A healthy brain on a non-stress day is naturally making enough creatine and it's fine. But now we get into the more difficult question: what about those metabolic stressors?
What if you were up for 24 hours? An ER doctor traveling different time zones — all these come into play. Remember, on a healthy brain with adequate sleep, the brain is actually making enough. But when you're stressed — night shift workers, military pilots, ER doctors — that's where the brain starts to rely on supplementation. Unfortunately, creatine really struggles to get through the blood-brain barrier. But if it does, you might need longer or higher dosages.
The best overall studies currently, using MRI for the brain, have shown about 20 grams seems to have some effect acutely. And two studies last year out of Germany showed even more. A classic study was done last year where they gave 30 grams to a group of young individuals who volunteered to be sleep-deprived for 21 hours. That level of creatine increased creatine levels in the brain and offset some of the negative effects. They've done a subsequent study going down to about 14 grams, and it didn't have the same effect.
So remember: a healthy brain likely doesn't need any creatine, but a stressed brain likely does. And the more stressed it is, the higher the dose seems to come into play. Overall, 20 grams seems to be the most viable dose when the brain is stressed. When you get from the healthy end of the spectrum, the brain likely doesn't benefit from supplementation because it's making its own. But in the stressed areas, it likely does.
The reason this has become so popular is that I think most people fall into the stressed environment. If they're not getting enough creatine through their diet and supplementation, that's why there's this big explosion in interest around taking more to check off all the boxes. I take 10 grams a day at minimum to check off muscle — that checks off bone for the most part — and I'm pretty sure over time 10 grams would do the most part for stress. Now, since I've just flown across different time zones today, I'm taking 20 to 25 grams acutely based on this. And then when I go back to a non-stressed environment back to Canada, I'll go back to my regular 10.
I look at the 10-gram dose or a little bit more as kind of being like a safety net. If you're only taking 3 to 5, you'll definitely get muscle benefits. Will you eventually get brain benefits? There's a small chance, but taking a little bit more — and remember, we're not talking about protein here. If we were talking about protein, the entire thing would be hundreds of grams. We're only talking about maybe 20 grams, and that may only need to be done acutely when you're really going through metabolic stress.
Look at university students — five final exams, hardly any sleep for a week. This is where this would come into play. Flight attendants or pilots flying from Canada to Europe and back — their circadian rhythms are all over the place. I watched one of the episodes of the Eras Tour, and I was marveled by 3 hours of performance in front of 90 to 100,000 people — all that running around — and then you see the performers totally gassed at the end, mentally exhausted. That's a situation where this could enhance performance. Then you think of athletes in the World Cup final — the pressure, the mental capacity — that's where creatine seems to come into play.
I think the big takeaway for people is that if you're going through periods of stress, a little bit more is okay. We don't know of any adverse effects and we don't think there are any. But if you're just taking creatine for muscle, bone, and the brain, you're likely going to be checking off all those boxes.
Steven Bartlett: And when we start getting the brain benefits at higher doses, what are those brain benefits recorded in the studies? Am I going to feel like I slept, or is it something more internal?
Dr Dr Darren Candow: You likely won't feel anything. However, when you get to tasks the next day — for example, you're up all night, you take a high dose of creatine, and then you have to go write the final exam — it's those things: memory, doing puzzles, basic tasks. What about a Stroop test?
Steven Bartlett: What's a Stroop test?
Dr Dr Darren Candow: I'm going to get you to do this. I apologize in advance. It's one of the most fatiguing things you can do, and it was one of the most robust studies to show the efficacy behind creatine. All I want you to do is look at the words and their corresponding colors. You'll notice that the color of the word is incorrect — so up here you might see the word "red" written in blue ink. The Stroop test asks you to read the color of the ink, not the word itself. I've tried it — I can only get through line two without making a mistake. I want you to do this out loud, as fast as possible.
Steven Bartlett: Okay. Green, red, yellow, green, blue, black, orange, red, blue, green, blue, pink, black, gray, yellow, red, blue, green. Oh — I failed.
Dr Dr Darren Candow: The study that they did — get this — they had to do this for 90 straight minutes. So you can imagine how fatiguing that is for someone studying for the MCATs for medical school, or going through midterms while sleep-deprived. And you're not sleep-deprived and you still struggled and got slower. Now imagine doing this for 90 minutes. In this classic study, they gave 20 grams of creatine before and after the test, and it really improved their ability with speed and cognition. It's just a simple example to show how our brain is seeing one thing while we have to maintain memory and cognition — and creatine can help maintain some of those factors. You won't feel anything, but performance of activities like that does improve.
Steven Bartlett: What else is there to know about the impact creatine can have on the brain? As a podcaster who sometimes sits here for many hours interviewing people on a range of subjects, I'm always trying to find ways to perform better mentally.
Dr Dr Darren Candow: It doesn't boost the brain — it likely just brings those levels back up to normal before stress, and it might give you a little bit more. There have been populations with Alzheimer's disease, clinical depression, and concussion where one of the biggest factors is that they have reduced creatine in their brain. So maybe supplementation can get through the blood-brain barrier, the brain says "I need help," and that's why you see some improvements there as well.
I like to think of creatine as a safety net for the brain. It certainly won't cause any detrimental effects. But it's always good to have that because you never know when you'll face a Stroop test situation. If someone's working on Wall Street, stuck in traffic for two hours — these all add up. It's a cascade of stressors that unfortunately most people go through. And now we have a nutrient that is being made in the brain, but during times of stress, it likely needs a little bit of help.
Creatine and Inflammation
Steven Bartlett: What about inflammation in the body? What is inflammation, and is there a link between creatine supplementation and inflammation?
Dr Dr Darren Candow: There is. I'm 49, and at the age of 40, I have this systemic inflammation that went up. We all know this because around the age of 30, you can work out and nothing hurts. And all of a sudden, you wake up one day in your 40s and 50s and things hurt. Systemic inflammation is happening all the time, and unfortunately it accelerates aging — we're more sore more often, and it can lead to a lot of arthritis or joint pain.
Creatine does have anti-inflammatory effects, but with a big distinction: creatine is not like acetaminophen or ibuprofen, which directly block inflammation as a drug effect. But it has been shown to decrease markers of inflammation specifically during long-duration exercise. This is an important distinction — weight training is too acute. But when you do an Ironman triathlon, those individuals who took creatine at 20 grams a day for 5 days beforehand had reductions in inflammation markers. That might allow that individual to recover quicker, not get ill, and then perform more optimally. From a weight training perspective, we see that it decreases markers of muscle damage. So it has these anti-inflammatory and anti-catabolic effects as well.
Creatine and Neurodegenerative Disorders
Steven Bartlett: What about people that have neurodegenerative disorders?
Dr Dr Darren Candow: Alzheimer's is the area we're really starting to focus on. A couple of single-arm studies came out last year by Matt Taylor and Aaron Smith showing that 20 grams a day for 8 weeks did increase brain creatine levels in Alzheimer's patients and seemed to improve measures of memory and cognition. Using the same mechanisms — it decreases inflammation, maintains brain bioenergetics, and it might actually have a neuroprotective effect as well. There's evidence in cell cultures and in rodents, but in humans we're still in the infancy. But if it can have any benefit to any neurological disease, it's huge. And there's a lot of hope, especially around Alzheimer's.
Steven Bartlett: There was an 8-week trial in Alzheimer's patients that also showed modest muscle gains and a 1.9 kg increase in hand grip strength, which is a key predictor of survival in dementia patients. And a landmark study of 20 Alzheimer's patients found that taking 20 grams of creatine daily for 8 weeks increased brain creatine levels by 11% and significantly improved cognitive test scores — that's from the Journal of Psychiatry and Brain Science.
Dr Dr Darren Candow: That one's really exciting, and I think more future studies will come out. The limitation with those is that there was no placebo to compare to. But again, it's just showing that yes, creatine can be used as an effective adjunct.
Creatine and Mental Health
Steven Bartlett: And because there is an impact on our brain, is there an impact on our mental health with creatine?
Dr Dr Darren Candow: Excellent point. The best lines of evidence here come from clinical depression and anxiety. The group out of Utah in the United States has clearly shown that creatine, in addition to other therapies — and this is important, creatine by itself has never been shown to be a standalone treatment — but with SSRIs, cognitive behavioral therapy, or methamphetamine use in populations under medical supervision, the addition of creatine seemed to improve symptoms. It's likely going back to all the ones we've already talked about: it improves bioenergetics, it improves neuromodulation. But it also, in animals, has been shown to improve a protein called BDNF, which is involved in brain plasticity. So there's a whole bunch of emerging evidence and hope that creatine one day will be used as a treatment in the toolbox for a lot of these clinical issues. PTSD also comes to my mind.
Steven Bartlett: There was a study published on PubMed from the Gatorade Sports Science Institute that said a study of over 200,000 adults found that those who consumed the least amount of creatine in their daily diet had the highest rates of depressive symptoms.
Dr Dr Darren Candow: Yes, that's correct. And the common denominator is that those with clinical depression or anxiety, when you measure their baseline creatine stores — very similar to concussion or Alzheimer's — they're reduced. So this condition or series of conditions is causing a disruption at the brain bioenergetic level, and creatine levels are decreasing.
Steven Bartlett: And there was another study on PubMed that said in a clinical trial of women with major depression, adding 5 grams of creatine to their daily antidepressant doubled their remission rate over 8 weeks.
Dr Dr Darren Candow: That's correct. Yes. That's from Perry Renshaw's group out of Utah — they do great work. Our hope, and I'm collaborating with some colleagues now, is to look at creatine as a standalone treatment versus placebo. Could it have some beneficial effects there? That's very exciting work to come.
Dietary Sources of Creatine
Steven Bartlett: If I don't want to supplement with creatine, what are the foods that are high in creatine naturally?
Dr Dr Darren Candow: They're primarily animal-based — seafood and red meat. Herring is going to have one of the highest concentrations, salmon as well as beef. Very small amounts in milk and dairy — you'd have to drink all the milk from a Jersey cow to get a sufficient amount. So it definitely comes down to animal-based flesh.
Creatine and Sleep
Steven Bartlett: There's a study I love that I've heard you talk about before — young athletes who took 5 grams of creatine daily slept an average of 1 hour longer on training days.
Dr Dr Darren Candow: Yes, we did that study a few years ago in young biological females who were healthy. On the days that they trained and took creatine, they actually slept an hour longer compared to a placebo. This is very interesting because creatine has brain bioenergetics, and there are two arguments. If it's making the brain recover, wouldn't you need less sleep? But in this study, it showed the opposite. Maybe these individuals trained at a higher capacity and allowed the brain to have more homeostasis to come back. This is a study that needs to be replicated in males as well. If creatine can improve sleep quantity, I think that's a game-changer. Everybody on the planet would raise their hand and say they need more sleep.
The Health Toolbox — Creatine, Exercise, and Nutrition
Steven Bartlett: Is there anything else we haven't covered as it relates to creatine?
Dr Dr Darren Candow: The expected gains versus the hype gains. I think there's evidence that creatine can have an effect, but I think it's getting overhyped, especially around the brain, for what it can do. It's one tool in the toolbox.
Steven Bartlett: What do you mean by that?
Dr Dr Darren Candow: Think of a toolbox — when you need to go fix things, you say, "Where's my toolbox?" You can't do anything without a plan. The most popular tool in anybody's toolbox is the hammer. From a lifestyle perspective, what do you think the hammer represents?
Steven Bartlett: Is it weight training? Is it cardio? Is it creatine? Is it protein? Or is it sleep?
Dr Dr Darren Candow: I say weight training is going to be the hammer. Now, what about the screwdriver? Always need a screwdriver.
Steven Bartlett: Creatine?
Dr Dr Darren Candow: No — I think aerobic training or sleep comes way before creatine. But most people say, "Hey, I can fix a lot of things with that." Now, we have a nice big toolbox. I like to think of creatine as the multifactorial wrench or screwdriver because creatine has profound benefits for muscle, a little bit for bone, of course the brain, and other areas of the body. You can hit something with this, you can open it up and fix something with this. When you put all these things in your toolbox, you're now having a greater comprehensive plan to improve health.
Steven Bartlett: So you said weight training was the hammer. Why do you consider it superior to cardio?
Dr Dr Darren Candow: If you were to choose one modality of exercise, weight training is a little bit superior to cardio. You get pretty much all the same benefits of cardiovascular exercise, and then you get more — obviously an increase in lean tissue mass and performance. Weight training, if done effectively, can actually improve mitochondrial health. You can improve VO2 max if done correctly. And you don't need a lot of it. So I think we've switched from just doing cardio to now incorporating weight training to be effective.
Steven Bartlett: What are the misconceptions about weight training and why are you so positive about it?
Dr Dr Darren Candow: I think one of the biggest myths is that you always need to lift heavy to put on muscle mass. World-renowned researchers in this area have clearly shown now that lighter weights performed to a lot of effort — almost to fatigue — can produce the same increases in muscle mass as lifting heavy weights. However, if your goal is just to get stronger, lifting heavy is always there. Some days if you have a little bit of soreness or you don't have a lot of energy, you can lift lighter weights but just to fatigue. Whereas other days, you come in Monday, you've had your coffee, you're ready to go — you can lift heavy. There's not one concrete way. There's a little bit of variety here as well.
Steven Bartlett: And why are you putting weight training above cardiovascular work?
Dr Dr Darren Candow: Cardiovascular exercise will make you live longer and healthier. But the downfall with cardiovascular exercise is it doesn't stimulate strength or the muscular system as much as we'd hope. Improving muscle mass is very difficult to do with cardio — maybe sprint interval training will do that. But the cool thing with weight training is you get cardiovascular benefits, but you also get those profound muscular benefits. So if I was to tell anybody, if there's one form of exercise to do, it's weight training — but you've got to do cardio as well. Do both.
Steven Bartlett: And if I just do weight training, what am I missing from not doing cardio?
Dr Dr Darren Candow: If you do weight training improperly — lifting very heavy weight with low repetitions all the time — you're likely going to jeopardize capillary density or mitochondrial health. These are things that move blood flow to and from your muscles. You could decrease VO2 max or a fitness parameter for metabolic health. So at the end of the day, everybody should be doing both. But if you only have time to do one, you still benefit, because the majority of the population doesn't do any.
Steven Bartlett: And how much, how often?
Dr Dr Darren Candow: It's amazing that it's a small amount. For cardio, most countries will say 150 minutes of physical activity at a moderate level over a week. I'm okay with that, but I'd like it to be higher and the intensity to be a bit higher. When you tell an average individual 150 minutes a week, most people say, "Well, I'm going to do 70, or I'm going to do 30." So we say, if you can do 21 or 22 minutes a day for seven days a week — a brisk walk or whatever — we'd like it to be at a higher intensity if possible.
When it comes to weight training, this might be surprising, but 2 days a week or more is all you basically need. You can do a whole-body routine. You don't need to go in there and just do chest and biceps Monday and then legs Tuesday. If you say, "I want to do whole-body training Monday, Wednesday, Friday," that is great as well. A little bit of volume or frequency goes a long way, especially as we get older.
Steven Bartlett: Why especially as we get older?
Dr Dr Darren Candow: Based on this graph here, it's clearly showing a detrimental effect. You have muscle mass on the y-axis, and then you're having all the catastrophic effects as we get older. From 20 to 40 years old, you can see great muscle mass — that's probably the area where you're going to have the most. But look what happens at 40, 60, 80, and if you live to be 100, it's catastrophic. You're losing muscle mass at an accelerated rate — on average about 1% per year after the age of 40.
Steven Bartlett: Even if you're training?
Dr Dr Darren Candow: If you're training, you're maintaining that. This is the average sedentary, inactive population. You lose strength at about 1 to 3% even faster. If we were to maintain resistance training, that muscle mass would plateau. I can't stress this enough — although we've focused on creatine, if you were to choose one thing to do today, it's exercise. And the only form of exercise that really maintains muscle is weight-bearing or resistance training. If that's the case, you're going to have way more muscle later on in life — you can pick up the grandkids, walk those stairs, do more functional things later on in life.
Steven Bartlett: Can you not just start at 60 years old?
Dr Dr Darren Candow: You can absolutely. You get profound benefits. You can be 80 or 100 and you still get benefits — it's never too late to start. But one of the things we've already talked about is if you do weight training and add in a little bit of creatine, it gets a bit higher. If you add in protein, it gets even higher. So nutrition — if exercise is king, the queen is going to be nutrition. They go hand in hand throughout the lifespan. You've got to have both.
Steven Bartlett: And on the subject of protein, you're saying that when combined with creatine, it's a force multiplier.
Dr Dr Darren Candow: It's a force multiplier when it comes to performance and lean tissue mass. There have been a few studies where combining high-quality protein with creatine has been shown to increase lean tissue mass and muscle performance a little bit more than each alone.
Steven Bartlett: Does the average person get enough protein through their diet?
Dr Dr Darren Candow: I think nowadays we do, and I think this is overhyped as well. If you're getting about 1.2 to 1.6 grams per kilogram — so if you're 70 kg, that's going to be on average about 84 to about 115 grams of protein — I think we're so conscious now of the health benefits of protein that most people are getting enough. If you're training really intensely five or six days a week and you take a gram per pound, that's probably the max. But a lot of times when you take excess protein, it doesn't all go to your muscle — it's used for other things like hormones and blood cells. I think most people are likely getting enough protein. The question is, are they getting enough high-quality protein? Vegans and vegetarians can definitely get enough protein — they might just need to eat a little bit more to get all those essential amino acids.
Creatine and Menopause
Steven Bartlett: Menopause. We talked a little bit briefly about it. Bringing together the subjects of muscle and creatine — how do those two things impact a woman's journey through menopause?
Dr Dr Darren Candow: We know from animal cells that estrogen is highly involved in creatine metabolism. Estrogen seems to be implicated in the enzymes that are needed to make creatine, and estrogen also has a huge impact on not only brain bioenergetics but muscle metabolism as well. So as the female goes from a premenopausal stage to perimenopausal stage to the post-menopausal transition, if estrogen is decreasing — and independent of their diet — we think creatine has bone effects and muscle effects. And of course we've talked about the cognitive effects. So from a whole-skeleton perspective, I think everybody should be taking it, but of course the perimenopausal and post-menopausal transition is particularly important. And that brings up a question about really young premenopausal females in optimal health — what if we built up their tissues more? Maybe that would offset the rate of decline over time as well. That's what we're hoping to get to.
Creatine and Children
Steven Bartlett: Is creatine safe for kids?
Dr Dr Darren Candow: It's interesting you bring that up, and the current body of evidence suggests yes, at recommended dosages. Good researchers in the United States have put out multiple reviews looking at creatine in adolescent children and teenagers, and it improves balance, agility, and body composition. If anything, they want to get at least 1 gram per day because in children, you want to have optimization for bone health as well as muscle development. But again, if any parents are watching, obviously talk to their medical practitioner. All the current reviews suggest that it's safe.
Steven Bartlett: And we're not talking about babies here — we're talking about adolescence?
Dr Dr Darren Candow: Yes, we're talking about adolescence all the way into teenage years. When it comes to babies or infancy, out of Australia, Stacy is starting to do that work there as well, but we don't have a lot of data in humans yet. That is an area to pay attention to for sure.
Safety Profile and Timing
Steven Bartlett: What is the most important thing we haven't talked about that we should have?
Dr Dr Darren Candow: I think one of the big things is the safety profile of creatine. There have been hundreds of randomised controlled trials now on creatine. The safety profile is exceptional. Last year they put out a study looking at over 25,000 cases, and creatine even over 10 grams a day for many years has been very, very safe and effective.
One area that comes up is timing — does it matter when I take it? We just got a paper accepted two days ago putting the nail in the coffin on this, and at the end of the day, you can take creatine at any time of the day. You can take it in the morning with breakfast, right before a workout, during, after, or before bed. It doesn't matter when you take it.
Steven Bartlett: So you can take it right before sleep and it won't impact your sleep?
Dr Dr Darren Candow: Currently we haven't exactly assessed the effect on sleep, but another study looked at it in the evening and it had no detrimental effect there either.
Steven Bartlett: What are the other questions you get asked most often?
Dr Dr Darren Candow: Can I spread out creatine throughout the day? Yes — if you were to take creatine in a gummy form, for example, you can have one or two every hour throughout the day. You don't have to take creatine all at once. You can take it in smaller amounts throughout the day. And there's been a study showing that 1 gram every 30 minutes up to a 20-gram dose seemed to retain more in the body, and that was beneficial as well.
Steven Bartlett: What do you think of these gummies?
Dr Dr Darren Candow: There have only been a few companies that have actually shown some validity and reliability. As long as they're third-party tested, they're very effective. The issue is whether the manufacturing process — trying to keep the creatine together — influences it. It can. The one you're eating is by Create from the United States. They have had multiple trials and are the first company to actually look at a randomised controlled trial showing improvements in volleyball players with the gummies. Children love them, and older adults too — this has become an area of interest where chewing ability or taste sensation has gone down. They're very convenient and effective. You can have these at your desk — you don't need the white powder to mix. Companies are coming up with more viable ways to get creatine in. But you always want to make sure the company is third-party tested, it uses a high-quality creatine, and it actually has a source of creatine in there.
I remember watching a YouTube video by a guy called James Smith, who's been on the show before, and he did some testing on off-the-shelf creatine and found that a lot of them didn't contain any creatine.
Steven Bartlett: 90% — and there were only a few that did. Isn't that crazy that you can go buy creatine and it has no creatine in it?
Dr Dr Darren Candow: Yes. That's why for the consumers watching, you've got to do a little bit of homework and look at those three things. Make sure it's third-party tested — it has a logo clearly on the packaging. If it doesn't, I would strongly advise you not to consume it.
Landmark Studies
Steven Bartlett: Of all the studies you've encountered on all the subjects we talked about — muscle, protein, creatine — are there studies that were pivotal in how you think about these subjects?
Dr Dr Darren Candow: There was a landmark study that came out in 1992 that clearly showed that 5 grams elevated creatine in the blood, but if you took multiple 5-gram dosages, it maintained that throughout the day. This is where the dose of 5 grams seems to be very, very viable. And another study showed that if you only want to take 3 grams, that seems to be the lowest most effective dose — you just need to take that for one month and you'll saturate your muscles. So you have options to take as little or as much as you want over time.
But I think one of the biggest studies we did was a two-year trial in post-menopausal women where we gave 0.14 grams per kilogram of creatine, and it really seemed to improve or have an effect on bone preservation as well as muscle performance. Those seem to be the landmark ones.
Supplements Beyond Creatine
Steven Bartlett: And what are the supplements that you take outside of creatine?
Dr Dr Darren Candow: On a daily basis, it's a probiotic with food in the morning and evening — I was taking it on an empty stomach, but I recently learned that's not optimal. I take two forms of magnesium — one before bed and one in the day, specifically magnesium L-threonate for cognition and function. I take 2,000 international units of vitamin D. I always take protein on a sufficient basis as well. And then I take about 4 grams of omega-3 fatty acids. I always take one of the omega-3 fatty acids post-exercise because that seems to be the best time to take it.
Steven Bartlett: So omega-3, magnesium, vitamin D, probiotics, creatine, and protein.
Dr Dr Darren Candow: Yes. Every now and then, since I don't eat a lot of red meat, I'll take iron — but not on a consistent basis. And I'm hoping the new one — this is an area of controversy — is NAD. It's a precursor for a main enzyme that's highly involved in metabolism. There's been evidence to suggest it goes down with aging, so my eye is closely on that to see if it's going to come into play. And a multivitamin — I started with Flintstone vitamins as a kid and I take a multivitamin a day as a safety net.
Why Older Adults Are Drawn to Creatine Research
Steven Bartlett: I noticed that when I looked at your video — the interview you did with Dr. Rhonda Patrick — a lot of the comments were from people in their 60s, 70s, and 80s. There was a 71-year-old, an 82-year-old, a 53-year-old contending with Alzheimer's. Why is that?
Dr Dr Darren Candow: I think it's the awareness and education now, and social media has really helped get our evidence-based research out to the public. The awareness that creatine is just not for young males to get bigger, stronger, faster — if anything, when you go to an aging body predisposed to age-related muscle loss, strength loss, functionality loss, bone loss, and atrophy in the brain, creatine has been shown to have effects there as well. So I think a lot of older individual populations are becoming more aware of the effects of creatine, and as we produce more research, it gets out to the public more often. I'm really excited and encouraged that creatine has sort of taken on a life of its own in the last decade.
Steven Bartlett: And are there direct weight benefits if I'm trying to cut fat by taking creatine, or is it indirect?
Dr Dr Darren Candow: It's indirect. It seems that if you increase lean mass, it might stimulate energy expenditure or turnover. And in animal models, it has been shown to have some beneficial effects from a cellular perspective on fat. But at the end of the day, if you are seeing a reduction in fat, it's likely that you're improving your metabolic health with lean tissue mass.
Making Creatine a Habit
Steven Bartlett: Do you think much about how to get these habits to stick? Because I imagine there are lots of people who are aware by now that creatine is a useful thing to take, but for whatever reason they still don't take it.
Dr Dr Darren Candow: Exactly. And I think that's one of the biggest reasons people don't. We've got to come up with ways to maintain consistency. Whatever vehicle you want to choose to maintain that in the run of a day is the best. If it's putting it in your coffee in the morning because you won't forget it, great. If it's putting a little bit in Greek yogurt, if it's using the gummies — whichever it is, as long as it's a viable source of creatine that makes it very practical and consistent for you, that's the best way.
Steven Bartlett: I found that having it on route to where I'm going is really important. When I come to my office in the morning, it's all on my desk. I have the supplements just on my desk. Even before I walked into the studio today, in the green room, it's on the green room table. When I'm at home, it is where the coffee machine is. And that has radically helped me. Otherwise, if it wasn't within my routine, it wouldn't happen.
Dr Dr Darren Candow: We have a jug on the counter with all our other supplements — it's in the pantry, it's close by. Because if it's in the garage, you forget about it.
Steven Bartlett: I think the other thing is that with some things like creatine, it's hard to really notice the difference sometimes.
Dr Dr Darren Candow: Excellent point. This is not like caffeine, which has an immediate effect. Unlike caffeine, creatine takes a while to notice the effects, and they come in indirect. You don't immediately notice a massive increase in energy or alertness. It's like after a week of weight training or even two, you're like, "Wow, I did more repetitions. I could do more weight. I recover quickly." That's one we hear quite often. You'll never notice it with your bone, but we have heard anecdotally with cognition — especially sleep deprivation — people do notice the effects. And I'm an N of one, but I notice jet lag goes down quite a bit when I take a high dose of creatine.
Steven Bartlett: If I start taking 3 to 5 grams of creatine today, am I going to notice the differences today?
Dr Dr Darren Candow: No. With 3 to 5 grams, you'll probably notice it in a few weeks, if not a month, from a muscle perspective. From a brain perspective, at that low a dose, you're likely not going to notice any effect because the brain is probably making enough. But if you're really metabolically stressed, you might notice some memory or cognitive benefits after a few days. At such a low dose, you need to be a little bit patient. But again, 3 grams could saturate your skeletal muscle in 30 days. So it's not that long a wait.
Steven Bartlett: And on the cognitive side — the cognitive benefits observed in the Stroop tests — had the participants been taking creatine previously, or was it just administered on that particular day?
Dr Dr Darren Candow: That one was taken a week in advance with the loading phase, so they really saturated the body to try to get the effects. But on the sleep deprivation study from Germany, they just gave one bolus mega-dose for 21 hours of sleep deprivation, and those individuals did perform better from a number of tests the next day. So if you've got something coming up Friday and unfortunately you're not going to get any sleep — at best one or two hours — then a high dose might come into play, and then you can go back to your more consistent routine.
I think what's happening is a lot of individuals are now thinking they need to take 20 or 30 grams on a daily basis based on those studies. And I say, wait a minute — are you getting enough sleep the next day? Because at that dose, we don't know if the neuron will swell with water, and if that's the case, is that potentially causing any detrimental effects in the long term? I would not recommend taking a mega-dose consistently over time. Could that downregulate your natural synthesis? These are all questions that we need to look at.
Personal Health Routine and Future Research
Steven Bartlett: Outside of the realm of creatine, outside of the realm of muscle, outside of nutrition generally — what are you doing to keep yourself healthy? What is your routine?
Dr Dr Darren Candow: I'm religious with exercise — I try to exercise at least 3 to 4 days a week with weight training, and add in at least 20 to 30 minutes of either moderate-intensity cardio or a spin class. I personally like to do alternating days — weight training Monday, Wednesday, Friday, and then cardio Tuesday, Thursday. On the weekends, hiking and things like that. I'm pretty religious with nutrients as well — I try to eat a really balanced diet. And my failure is getting enough sleep. I've had to cut caffeine out quite a bit by past noon to allow me to sleep — I'm probably a slower metabolizer of caffeine. I try to really take evidence-based research into my daily life and promote it that way.
Steven Bartlett: Is there anything you're particularly excited about in the work and research ahead?
Dr Dr Darren Candow: I'm super fascinated with the movement from the neck up. I think we know a lot about the neck down with creatine and exercise and other nutrients. I'm fascinated with the ability — what about concussion? Can a UFC fighter take creatine before they get hit? Could that decrease CTE or concussion or brain trauma later on in life? Think of boxing, Muhammad Ali — things like that. There's evidence in rodents that if you take creatine before head trauma, it really speeds up concussion recovery. So I'm fascinated with that as well — almost a prophylactic. Anybody involved in head trauma, I think you should definitely look at creatine as something to be taking just in case you get hit. And then of course everything with Alzheimer's or other areas of depression.
I'm fascinated that this nutrient, discovered in 1832, was boring for the longest time because we thought we knew everything — and now it's taking on a life of its own as having these profound benefits we never even thought would happen.
Steven Bartlett: A lot of people consider you to be the leading expert on this subject. Do you think there'll be a time where you stop researching creatine and move on to something else?
Dr Dr Darren Candow: I would have said yes about 5 years ago, but now no. There's too much to do. Even with skeletal muscle, if you were to say, "What's the best dose to take?" I say, "I have no clue." Every creatine researcher says, "I don't know." We still don't know the best dose that every person can take that will check off all the boxes, especially in the brain. We're just giving an estimate — I take 10, maybe you take 12, someone might take 15 — but at the end of the day, we still don't know the best supplementation protocol, the best dose. So for the next 20 years, I bet I'll still be focusing on creatine, along with other things as well.
Steven Bartlett: And on that subject of doses — is it different for different people?
Dr Dr Darren Candow: Excellent question. The thought was that the larger you are, you have more storing capacity in your muscle for creatine. If you're 50 kg versus 150 kg, you're going to have greater storing capacity, so the dose on a relative basis is likely higher. The more stressed the person is, they're likely going to require more because their natural machinery in the brain can't keep up. So it is very individualistic. I think we give out general recommendations to make it easy, but some people can take it very scientifically and base it on body weight. You can't go wrong with both approaches.
Making the Case for Creatine to Loved Ones
Steven Bartlett: I bet there are a lot of people this far into the conversation whose central question is: "I've got loved ones that I really want to start considering creatine supplementation for — cognitive benefits, muscular benefits, whatever." If their loved ones are now listening, and you had to make a case to them about why they should take creatine, what would you say?
Dr Dr Darren Candow: I would say creatine is one tool in that health promotion toolbox that might help you live longer and better, and allow you to maintain activities later on in life that you wouldn't have been able to do otherwise — and unfortunately, losing those activities leads to accelerated aging and a poor quality of life. It's like saying, "I'm going to save everything for retirement." My question is, why? You might not make it to retirement. So that's one of the things.
Aging, Fear of Death, and Personal Philosophy
Steven Bartlett: What is aging, in your definition of the word?
Dr Dr Darren Candow: It's catastrophic. Unfortunately, I'm going through it. I've noticed ever since I hit the fourth decade, things hurt a lot more and retaining muscle mass is a little bit harder. Think of the body's ability to withstand stress — it's not as high, and things start to break down quite fast. We all know things hurt more, we've lost muscle mass, we can't run as fast. Biological aging is kind of the deterioration of the human body. We need to come up with ways to stop the deterioration and, if anything, come up with ways to maintain the ability to live longer, free of disease.
Steven Bartlett: We have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they're leaving it for. This one's quite a tricky question: what is reality? What do you think all of this is — all this stuff that we can see and experience? Do you think it's a simulation? Do you think it's all real?
Dr Dr Darren Candow: This is all real, for sure. Because I think we can feel it. We all go through different emotions and things like that. So I think you can feel it.
Steven Bartlett: Are you religious?
Dr Dr Darren Candow: Yes. Catholic. Roman Catholic.
Steven Bartlett: And you're a family man?
Dr Dr Darren Candow: A French bulldog and a cat, as we talked about, and a wife at home. Really close to my family and stuff like that.
Steven Bartlett: And what is your goal — if we get to the end of your career and this was your last day and you had been successful?
Dr Dr Darren Candow: I think it would be a lasting impression on my students — that he changed my life in some way. And if I can make one person live longer, free of disease, and happier, I'm all for it. When you start to see the human body as people get older, you're like, "Oh, that person used to be young and vibrant." And then when you hear about people that can't do activities they love, or they can't travel, or they're afraid to — I'm like, you need to embrace today. I love that quote from Morgan Freeman in The Shawshank Redemption: "Get busy living or get busy dying." Because honestly, we have the ability with lifestyle choices to improve optimization. I want to see people live to be 120, 130, still active, still going. I think we're on the cusp with technology, and I think awareness around nutrition, exercise, sleep, laughter — oh gosh, if I could ask anybody to do one more thing, it'd be just to laugh more often. For me to be just a small piece of the puzzle promoting it — I think it's just beyond what I believe.
Steven Bartlett: Why did this pull you in? I ask that in part because the things that draw us in and make us curious tend to always have a bit of a personal reason.
Dr Dr Darren Candow: It was more that — am I scared to death? 100%. I can't think about it. Why? I just think it's weird for me. Maybe being religious, and then you think about it, and my brain stops. I can't think about it really.
Steven Bartlett: Yeah.
Dr Dr Darren Candow: It's almost like I want to live forever. And if I can think of ways to make me live — and partially get there, obviously it's not reality — but yeah, I'm scared to death of dying.
Steven Bartlett: Have you always been?
Dr Dr Darren Candow: Yep, 100%. Scared to death of heights. And I can't even talk about the death experience, because I think it sort of brings into perspective things that you just don't know.
Steven Bartlett: Did you ever lose anybody?
Dr Dr Darren Candow: Just friends and things like that, but nothing specific like parents or anything like that yet. But it's always been there. I don't know if it's the Roman Catholic in me or not, but it's like — whoa, I don't want that at all.
Steven Bartlett: You can't even talk about it?
Dr Dr Darren Candow: Can't even talk about it. No. It's kind of like I can talk about it in the sense that I understand it and it's realistic, but it's more that for some reason I don't even want to think about it, because I have so much passion for life that I don't even want to think about, "Oh, this could happen."
Steven Bartlett: And you believe you go somewhere after death?
Dr Dr Darren Candow: Oh, for sure. Heaven. Yeah.
Steven Bartlett: But if you do believe you're going to heaven, that sounds like a great place.
Dr Dr Darren Candow: I just want to spend more time here. There's still a lot of things to do.
Steven Bartlett: Makes sense. Well, thank you. Thank you for doing this.
Dr Dr Darren Candow: Thank you so much. This was great. You've done so much research on this subject that so many of my previous guests cite and talk about. It's great to have the source here. I applaud you for the work you've done, because at the end of the day, I think a lot of people do want to extend their health span — to live healthier for longer. There's a real epidemic of people having short health spans, being medicated from the age of 40 or 50, and then having that last couple of decades of life being incapable of doing the things they care about. And I think a lot of this research gives us an option, if we choose to take it, to live a better life.
Dr Dr Darren Candow: Thank you so much. Well done.