Episode Transcript
[00:00:05] Speaker A: So today on TPL Media, we're lucky enough to have Dr. Mark Tarnopolski. And thank you, Doc, for being with us. Dr. Mark, is that okay if I call you?
[00:00:16] Speaker B: My call you. No problems. Yeah,
[00:00:17] Speaker A: most
[00:00:18] Speaker B: people do.
[00:00:19] Speaker A: All right, so doctor, we've found you, or we came across you, because Shar and I both use creatine. So we, we had this conversation about creatine. And you know, it's interesting because, you know, my age, it was kind of the forbidden fruit when we started using it. And we used, was a small group of us kind of found it at the gym. We had this conversation and then we went to our GPS years different times, and we were, we were given some advice not to use it because our creatine levels were off. So then we got off creatine and then over time, friends and that we got started using creatine again, became more popular. It kind of disappeared for a while out of the mainstream, and now it's being heralded as kind of the wonder drug of doing a bunch of things that quite frankly, from sleep to brain to fitness, which was where I found it.
And Shara, she found it basically because we got on a health kick, on a fasting kick, and she started to implement it into our coffee routine in the morning.
So, you know, for the folks at home, Doc, can you give us a, you know, creatine, a little bit of your history with it, what you've seen over the years, kind of how it kind of came and went out of the scene and where it is today.
[00:01:50] Speaker B: Yeah, so first of all, maybe I'll just explain for some folks what creatine is because there's a lot of misunderstanding.
So creatine is a compound. It's actually two amino acids which are stuck together. And it's made from first our kidneys, then a compound called 1 adenoacetate, goes to the liver, liver then sticks this thing called a methyl group on it and we make creatine. So about a gram or so is made every day from all of us, just through natural synthesis. That's your endogenous creatine. So then it was well known that certain products, things like beef and steak and fish, so the meat of animals contains high amounts of creatine. So what happened is in the late 80s and early 90s, people were saying, you know, should we take creatine because it's in muscle? So maybe it's there for a reason.
So in muscle, what happens is creatine gets converted to a high energy thing called phosphocreatine which is really an energy buffer. And so the original rationale behind taking it was to say, if we can increase our phosphocreatine, maybe we can increase the energy in muscle. So things like doing repetitive sprints, high intensity exercise, when we need that early burst of energy, folks will do better. And that's what the original studies did show that when younger people were doing athletic type of activities, in the first 10 to 20 seconds of activity, they could put out more power because by taking extra creatine in the diet, you could then increase your muscle creatine levels and then there'd be a little bit more of an energy buffer. That's really where the research started. Roger Harris, unfortunately, he passed away recently. He's sort of the godfather of the creatine research and did a lot of the stuff with muscle biopsy, showing how it works in muscle. And that was sort of the original concept, so lots of athletes were using it. So in the late 80s, pretty much every sprinter in the world, 100 meters, 200 meters, was taking creatine to give you that extra energy boost. Throughout many decades of research, ourselves included, it's pretty clear that it does more than that. It shuttles energy between the powerhouse of our cell called the mitochondria and what's called the cytosol, which is sort of the outer part of our cell that contains these high energy compounds.
It also reduces something called oxidative stress, which you might be familiar with, free radicals or antioxidants, which some people take. Creatine actually does have some antioxidant protection, and that's perhaps some of the long term benefits that people are seeing in the brain. We've actually given creatine to folks and shown using these things called gene arrays. And it does change a lot inside muscle and even decreases the breakdown of protein and muscle.
So there was a lot of interest, as I mentioned, in the early 90s, showing that we could take extra creatine in our diet, increase muscle creatine and phosphocreatine, increase exercise performance.
So where I got interested is I'm a genetic specialist in neurologic diseases and we have patients with muscular dystrophy. We did muscle biopsies back in 1999 to take a look at creatine. And what we found is creatine and phosphocreatine were very low in these diseases, disease states. So we published a paper in Boys with a Horrible Muscle Disease called Duchenne Dystrophy, showing that we could also increase their strength and their function and even their muscle mass when we gave them creatine.
So we then went on and colleagues of mine like Darren Kandow who's University of Regina said, well, what about more popular things like aging? We know people get skinny muscles, their mitochondria don't work properly and bones get thin. So people started looking at the benefits of creatine in older adults.
So we did a study in 2003 and again in 2007 showing that older adult men and women who exercise for four and six months, depending on which study we were looking at, and they gained more muscle mass and better function when they trained with creatine. So those are just some of the original studies we were involved in. And like you say, it seemed to attenuate a little bit. Although certainly in the clinic it's now standard of care for muscular dystrophy. So we've always continued to investigate it and be interested.
But folks more recently started to look at potential brain benefits in people who are sleep deprived.
Vegan vegetarians, for example, have low muscle creatine and there have been some benefits from cognitive perspective when they take creatine.
So we could go on and on. There's just so many potential benefits and studies that have been done that I think we know a lot more about the potential benefit now that we did even 20, 30 years ago.
[00:06:38] Speaker A: A very quick favor before we continue. A large percentage of you who watch or listen to TPL Media every week aren't subscribed yet. Our simple commitment to you is that if you find value there, if these discussions make you think, if you want our uncensored debates, deeper dives and extended sit downs, head over to TPLMedia CA and subscribe there directly. It takes just five seconds, costs nothing, keeps you informed. So thank you. Now back to the show.
[00:07:11] Speaker C: Dr. Mark. So can you tell us about competitive men? What are the benefits for women? Does it help for menopause or brain function and how much they should take it?
[00:07:25] Speaker B: Yeah, it's a great multiple questions there. So certainly we've done studies and pretty much every study we've done we have equal number of males and females in our study because we have seen some sex based differences. One of the reasons why women tended to shy away from creatine is everyone said I'm going to get bloated.
So essentially there is some rationale there. When you first start taking creatine as a supplement, it comes into our bloodstream, it gets taken up mostly in muscle. About 90 to 95% of all the creatine is in muscle. So when it goes into muscle and you increase the concentration, water comes along for the ride. So the muscles do swell a little bit. But that's kind of how it works in one sense, because that slight swelling that you get actually decreases protein degradation. And what we found is we looked at men and women, then we gave them a high dose of loading. So in the old days, we used to use 20 grams over a short period of time, you know, four to seven days, that was the loading phase. And what we found is that the males would gain about 1.5 kilos and the women would gain about 400 to 500 grams. So much less. But the problem is, if you look on the scale, you think you're gaining weight, but what you're gaining is water in the muscle, which is a good thing.
And so it's not increasing fat. And I've heard people say, oh, creatine is going to make me fat. There's no calories. There's. So that that weight that you see with creatine is actually good weight. It's lean body mass weight. So I think more recently, people have realized that going through menopause, it's absolutely certain that there's a decline in bone density, and there's more evidence. And we're doing studies right now with Allison Shea, who's a world expert in menopause, taking a closer look at body composition, which is fat and muscle, and how does that change through menopause? So certainly the bone benefits for older adult women going through menopause, we have done many studies showing benefits to bone now, using bone markers and even using Petri dish bone cells, and using some preclinical models where we've damaged the bone with corticosteroids, which is a thing called prednisone. And we see benefits. In fact, our boys with Duchenne dystrophy who are on prednisone, their bone markers look better when they take creatine.
So getting all of that research together, I think women are becoming increasingly aware of the potential benefits to maintain muscle, maintain bone, especially as we age. Now, a lot of folks think, okay, aging begins at 65. No, it doesn't. You know, even by age 30, we're starting to see early changes. So really, it's a lifelong thing that people need to be thinking about exercise and optimal supplementation, which, you know, I think for most people should include creatine to sort of attenuate that slow decline which we're all experiencing. I just turned 64 this this week, and you know, I'm definitely not as strong as I was in my 20s and 30s. So I'm doing exercise and taking a number of different supplements, including creatine, to try and mitigate those declines. So your second question is how much?
The problem is there's a lot of misinformation. So the first studies that came, seminal study in 1992 with Roger Harris, it's very clear that if you give 20 grams a day for four to seven days, you load muscle. You can't keep loading. So muscle will go up, you know, 20 to 25%. And that's about as far as it'll ever go. Brain on contrast, when you take creatine, goes up about 9%. So it's about half the increase that we see in muscle, but it follows a similar pattern. So studies have shown to load brain 20 grams over four to seven days. We can increase the concentration in brain, which is what we've shown in muscle. A study everyone seems to forget is that in 1996, the top researcher, Eric Haltman, showed that if you take 3 grams of creatine every day for a month, you hit that same level that people were getting on the 20 grams. So if for some reason you forgot to take your creatine, you need to load in four to seven days, yeah, sure, you might need 20 grams, but for most of us that are taking it from a lifelong healthspan perspective, you know, three to five at most is all you need. And it may be we never compared 3 to 5 in older adults, but we gave 5 grams to older adult men and women in 2003 and 2007. And we showed that we maximize their muscle. So after four months and six months staying on it constantly, their muscle is still at the absolute maximum level.
So clearly showing that if you start going above that, you're just spending more money and just peeing out the creatine and, you know, it's a complete waste of time. And the same almost certainly holds true for brain. There's all this hand waving that you need to take 20 grams a day. But one of the top colleagues in the world, Serge Ostiak, showed that people that had chronic fatigue after four months taking four grams of creatine get their brain loaded to a maximum level. So again, I think if you forgot your creatine and you need to load in a week, yeah, you might need 20 grams. But all of us who are taking it for health and for long term cognitive benefits, you know, I think 5 grams would be your sort of maximum dose based on
[00:12:47] Speaker C: I'm taking five grams a day, so I think I'm good.
[00:12:50] Speaker A: Yeah. Well, it's interesting, Dr. Mark, because, you know, you, we've listened to other shows and people come on and they say when I'm sleep deprived, I amp up on my creatine. But that's a great point. They're probably not taking daily creatine, or if they're taking daily creatine, they actually think that they want to.
Increasing it will give them kind of a more cognitive advantage for the day given their sleep deprivation.
[00:13:23] Speaker B: Yeah, I mean, it's a complete lack of understanding of biology, science and the literature.
And you know, if you, if, if you want influencers to determine what you're going to do versus actually doing the science and understanding it, it just makes no sense. Muscle like brain is it probably even more like this, that is, you know, takes a while to load once you're there. They've done studies in muscle, but not yet in brain, where if you stop, it takes about a month for that creatine to go back to baseline for your muscle. And it's almost certain that brain's the same. The only difference between brain and muscle is that you get about half the increase in brain, about 9 to 10%, whereas you get 20 to 25% muscle. But the benefits in the brain from that level of increase, which, you know, sir Joestrift has shown four, six months, you still see, especially with sleep deprivation, some improvement in functional complex tasks.
Certainly vegans who get no creatine from their diet seem to derive more benefit.
There have been innumerable studies in pre clinical models. Okay, so again, it's hard to do these in humans where they induce a stroke or there's head trauma, or we genetically manipulate to cause Alzheimer's, Parkinson's, Huntington's, Lou Gehrig's disease. Every one of those models clearly shows benefits from creatine. And the amount that is given to the animals in those studies is pretty equivalent to the 5 to 7 grams that a human would take. So in physiologically reasonable amounts, we're likely benefiting from things like mild cognitive impairment.
If you have diabetes or high blood pressure and you're at risk for stroke and you unfortunately have a stroke, if you have that creatine on board, by taking your three to five grams every day, you are likely to derive some benefit and have less damage. So there's many reasons, I think, to take, you know, these optimal, lower, you know, 3 to 5 grams to keep your muscles and your brain at a nice loaded level. But taking extra Right before flying to Europe or something is not going to suddenly burst it up. You have a ceiling of about 9% increase in weight and 20 to 25%.
[00:15:35] Speaker A: Right. Hey, question for you. So kidneys.
Can we chat about this for a minute? You know, is there. And that was always, I think, or one of the things that people kind of cautioned people about when they took creatine. And I think you've seen that. Is there any, ever been any studies that have actually talked about negative effects of creatine on the kidneys?
[00:15:55] Speaker B: There's a lot of hand waving, but unfortunately the hand waving ignores the real research. So what happened in, when we were doing our studies in the early 2000s, there was a lot of negative press that came out both with cancer risk and more importantly with the kidneys. So big journals love negative press. Drug companies love to bash exercise and nutrition. So what happened is in two prestigious journals they published garbage stuff which could never pass peer review with anything else other than trying to bash a supplement. And what they found is one individual who took 20 grams a day, which I would never condone, who had pre existing kidney issues, is creatinine went up.
So the issue here is lack of understanding from most doctors of biology and that is that creatine, when it goes into muscle, gets non enzymatically converted to creatinine. Creatinine then is excreted in the urine. So what happens is that if we are on a constant dose of creatine in our diet, then we hit an equilibrium and our creatinine in the blood will reflect what's going on with our kidneys. If our kidneys stop working, then the amount of creatinine coming into the system is constant, then it'll start building up your creatinine. Right, because you're not getting rid of it. So people have conveniently used creatinine as a marker of kidney function and unfortunately the creatine came along for the ride in a negative connotation. And that is that when you start taking more creatine, your creatinine will drift up a little bit if your kidney function is constant. So then people interpreted that, that it was kidney damage, but it's not. It's an increase what we call rate of appearance of creatinine into the system. And so the second publication was published in the New England Journal where a athlete was taking 20 grams, again, not recommended. There's no logic behind it. But even if it's low dose and they had what's called interstitial nephritis. What they didn't report is the most common cause of interstitial nephritis from a drug is taking anti inflammatories. And as a former top sport athlete for many decades, I can tell you many of us take anti inflammatories, but they didn't report on that, so they just immediately assumed it was the creatine. So essentially, yes, creatinine will creep up a little bit, not because your kidneys are damaged, but because there's more coming into the system.
So when we measure creatinine excretion, which is the true measure of your kidney function, by collecting 24 hour urines in older adults who already have partially compromised kidneys, we found that the creatine did not affect that proper measure of creatinine excretion through the kidneys. And if anything, it was slightly better. There's other independent measures of kidney function and many studies have shown that when you take creatine, those measures, which are independent of using creatinine as your marker, showed that there was no damage to kidneys. So that's a huge myth which unfortunately does persist. And even doctors, you know, they just sometimes don't even know the difference between creatine and creatinine, which is really a shame.
[00:19:06] Speaker A: Yeah, no, no. And I've had that, unfortunately I've had that incident happen to me.
Creatine monohydrate. So the differences. And there's different, what I understand and you help me with this a little different types of creatine. So.
And the most common one is the monohydrate, from what I remember.
[00:19:29] Speaker B: You're absolutely.
[00:19:30] Speaker A: Is there, is there, is there better or is it when you, you know, what do you, yourself, you say you take creatine, do you take monohydrate? Do you, is there a.
[00:19:42] Speaker B: Yeah. So there's, and you know, I've been involved. I published about 30 papers in the area. So we're, we're pretty familiar with this and we've seen things come and go.
So the first thing is creatine is bound to something. So it's sort of like, you know, sodium in salt, it's sodium chloride. So it's creatine and something else. So creatine and monohydrate means that there's water, but you can also have creatine citrate, creatine hydrochloride, there's a whole bunch of other salts that you can combine it with. And I remember very early on there were patents on. I won't say what it was, but it was creatine in a their salt. And someone challenged the patent saying this is garbage. Because at the end of the day, once it comes into your body, the creatine comes off and it's the creatine that goes into your muscle. So it doesn't matter what the salt is. But they were trying to claim that you get better absorption and your muscle levels go higher.
I know from Roger's work, you know, you have this limit, you can't go any higher. Once you're at, you know, 150 millimoles kilogram in your muscle, you can't go higher than that. So we were commissioned to do some research to look at this. So blindly we gave people creatine and this other salt, creatine monohydrate or placebo. And what we found is creatine in the other salt loaded muscle the same as did creatine monohydrate. Of course it is, it's still a molecule of creatine stuck to whatever. So there's also a creatine hydrochloride, which is hydrochloric acid. I tried one of my patients, creatine hydrochloride on my tongue. I burnt the end of my tongue. So, you know, the other issue I would say is at the end of the day, 95% of the research and essentially every step study, you know, hardcore molecular science work, pre clinical work and pretty much every proper clinical trial is creatine monohydrate. So why would you want anything else? The only thing I can see is that people are trying to sell a product, capture market share, make a fortune because creatine monohydrate is the least expensive, so it's almost commoditized and people are looking for all sorts of other stuff.
And then it also matters, the form.
So again, we were commissioned years ago there was a big lawsuit about muscle something usa, I can't even remember. And it was this tiny little dropper and they said, you know, this is creatine monohydrate. One dropper has five grams of creatine. So first of all, the dropper at most could hold maybe a few milligrams of creatine because creatine doesn't dissolve very well. And it was crystal clear water. And they were trying to say it was something for 60 bucks for a little dropper saying you get all the benefits of creatine without the bloating.
So essentially, you know, you just have to measure it and there's no creatine. So they Tried to say that, you know, people don't have the proper methods of measuring creatine, which is pretty straightforward with our hplc.
So there's so much garbage out there, liquids, you know, total garbage, most of them. Creatine does not dissolve well at all. So if there's a tiny little amount in a gallon of water, you might get a gram into a gallon and dissolve it. But anything more than that, it'll precipitate up to the bottom. And if you leave it for a long period of time, it converts to creatinine. So things like gummies, which have a lot of water in them, if there's no expiry date by two months, they're pretty much useless and they've converted to creatinine. If a gummy is clear and in Canada, I can't even believe it, there's products out there with clear gummies trying to say that they fit five grams into a tiny gummy, which only weighs one grammar. So it's new biology to me. Maybe AI has found a way to squeeze five grams into one gram and it's crystal clear. It can't be crystal clear because creatine does not dissolve well at all. So it's totally opaque. If you had creatine. So there's a lot of garbage. So stick to creatine monohydrate, stick to the powders.
If something, you know, the full confession, you know, we've actually created a company based on all of our research and so we've created a Kunchy tablet with dry tablet.
So something that's dry is creatine is not going to break down liquids, gummies, or in the case, unfortunately, in Canada, we have some gummies that have zero creatine in them.
So something dry is good, whether it's the powder, crunchy tablet or if you had it in dry capsules, those are the only ways that you can take it. Knowing that you're what you're buying gives what Jeffrey Container.
[00:24:03] Speaker D: Hey, before we go any further, please hit the subscribe button right now. If you want the raw debates, the full uncut conversations you won't see here, head straight to TPL Media CA subscribe and lock in your membership. Trust me, you don't want to miss what happens behind the paywall. All right, back to the show.
[00:24:20] Speaker A: You know, Dr. Mark, you know, and probably for another show, but you hit on something earlier about the supplements you take as you age. So. And I took that because, you know, I've always been super curious. Done. You know, I do. We do A lot of research, Shar and I, different ages, but quite frankly, we, we try to peg sort of what's going on in our bodies based on where we are as we age and, and you know, not for this show, but another show we'd love to have be back. Cause I'd love to talk to you about some of the things we're doing and actually under, you know, if you're comfortable, talk to you about what you've done over the years. Sure.
Because it's the number one question we get when we did, when we have dinner parties and we have people over, you know, and we're talking about, you know, our fasting routine and you know, we do some biohacking now that I think is pretty cool and has helped us with some, some issues. But, you know, I'd love to get you on and say, you know, what are the things that work for you? You know, your background and being the, you know, with the McMaster, the hospital and your neuromuscular neuro metabolic clinic and that experience. But also talk about, I know you, you're an entrepreneur and you had you mentioned you have your own company Exercise, I think it's called, and talk to you also because I think from what I've read in your bio that talks about health span optimization, which is really interesting, I think, to our viewers and us.
[00:25:53] Speaker B: Yeah, no, certainly I could talk about that a lot, you know, and our company started well after we did the research. So all of this research that I'm talking about today was done far before we started the company.
Every study done with the company is done through third party independent blinding. So we have an independent contract research organization which holds the codes. Everything is randomized, double crossover, and the data is freely accessible to regulatory bodies.
So locked data.
If anyone thinks that you change the data, you can go to an independent third party and access our data just to make sure. So we're pretty confident in the data. Most of what I'm talking about today, everything in fact so far, is stuff that we did well before we started the company. Of course, when we started to get all of this, this data and we see the health care fraud that goes on in Canada, even with the NPN system. I could go on and on and on about the complete health care fraud and the garbage out there. I felt it was incumbent upon me that I had to get something out there that's real. The problem is, you know, we've spent many, many, many, many, many too many millions of dollars doing the proper science. And you don't get credit for it. You can get an influencer, you know, as you're saying, you know, hand waving, take 20 grams, you know, and your brain's going to be great. And do it right before you fly to Europe without any knowledge or any background in science. And they're selling way more than we are. But ultimately it's the right thing to do. You've got to do randomized double blind clinical trials. It's got to be third party blinded. You have to follow Health Canada guidelines and, and be honest. But people are cheating. So, you know, on one of our products here, there's an NPN number.
I thought the NPN system in Canada was legit. We follow the rules. But I've seen many products, like I told you, that gummy being sold in Canada for $49.
One tiny little gummy was supposed to contain 2.5 grams of creatine. It was crystal clear. There is zero creatine in that gummy and it has an NPN number. And yet our government does not regulate it. It drives me to drink the $2,000 we spend for each batch that we make to make sure that what's on the label is in here is not done by other individuals. And yet the people we go to to manufacture our stuff, you know, they follow the guidelines and they won't put our stuff out until we show them that certificate. So I don't know where this stuff is coming from. It's being done, but I'd love to talk to you about that. The creatine is one of the worst culprits in healthcare for life, unfortunately, because people are trying to make a buck and that they don't care about people's health, they care about making money, which is unfortunate.
[00:28:38] Speaker A: Yeah, no, I appreciate that and thank you for taking the time. I know you have patience today and I know you fit us in to do the interview and the show, but definitely I want to rebook some time with you to actually go through that routine and maybe get a little extra time. Because just talking about sort of how you see the different supplements as you age and how you've used them to benefit. And I know you're an athlete, I know you, you've been a, you know, an athlete your whole life. So talking about that, how that's kept your performance and also control the inflammation in your body, that's another one, quite frankly, that, that I think ski and I've wrestled with most of my life, you know, having played contact sports early in my life. But yeah, I'd love to have that conversation and set up that show. So appreciate the time. And I'm sure the viewers, really great information for today will love the show. So thank
[00:29:35] Speaker C: you. Thank you, Dr. Mark.
[00:29:37] Speaker B: My pleasure. Look forward to talking to you again.
