The End Welcome back, everybody, to another episode of the Health Optimization Medicine Podcast. I've got the doctors, not to be confused with the TV show, Dr. Scott Scher, Dr. Alan Bukatz, Dr. Ted Achikoso. Welcome back, guys. I want to start this podcast with just like a little bit of powder, white powder. Don't arrest me. Don't do it. Don't do it. Don't do it. Don't do it. Don't do it. Don't do it. Come on, Jim, bro. What is it called? Dry something? What is it? It's not dry heaving. Not dry aging. Dry hurling. Dry socket. So here's an interesting thing. In my hand right now, and this brand is not sponsored to the show, but in my hand right now, I can tell you one of the most researched supplements on the planet. It's been known as a performance supplement since way back in the day. I remember my dad trying to convince me not to buy this stuff at the local GNC when I was younger. It's known as a cellular energy buffer. It's a muscle brain nutrient. It touches methylation. It reflects mitochondrial demand. It may matter more in aging, sleep deprivation, cognitive stress, vegetarian diets. Can't forget those. And conditions where the brain or muscle is struggling to meet energetic demand. Ladies and gentlemen, what are we going to talk about today? Boomer. Oh, vitamin B, vitamin B, baby. Actually, we're going to be talking about creatine. And it's not just for gym bros anymore. let's talk about where we're going to go through this episode first i want to touch a little bit on creatine and what it actually does of course it's had a bit of a resurgence in popularity in recent years going from people that were low dosing three grams a day creatine to mega dosing creatine uh we're going to get a little bit into creatine maxine just like life maxing fiber we're going to get looks maxing you know oh man he's mad at max all right so first we're going to look at what creatine actually does in the cell. Second, we're going to look at creatine through health optimization medicine perspective. How does it affect things like cellular energy, amino acid metabolism, methylation, et cetera. And then we're going to talk about dosing timing form that may benefit most. But before we get started, guys, I want to talk about Scott's most offensive comment on social media ever. This is why creatine doesn't work for me. I think this is Yeah. So, so actually I don't need to reserve. I shouldn't say most offensive. I am corrected. The thing that offended him most was on a podcast where he got called a sarcopenic doctor. Now, Scott, how do you feel about that? I felt like I wasn't being seen. You know? Oh, that's so excellent. All you needed to do was to lift your shirt up and show that you actually had, you know, a two millimeter layer of fat on your abs. There you go. Scott, you got a lot of work to do on that two millimeters. My body fat percentage just wasn't good enough, you know? bicep to body fat percentage ratio. I don't know what, you know, it's one of those, we're inventing terms here today. I watch it. There should be, there should be a ratio there. Like, you know, if you have a certain body fat percentage, anyway, I'm just, I was, I was surprised yet. I'm not surprised because the person that I was interviewing with, you know, is at a lower body fat percentage of me, but much larger biceps. Right. So, yeah. So there you go. All right. Perhaps you should have been taking today's supplement. So we're talking about creatine right i do uh let's get a little bit into what creatine is and we're going to talk here from the cellular battery buffer uh dr tech can you take us through the creatine story and what it is that should be very simple to understand if you don't like to deal with uh all of the enzymes that deal with this biochemistry you know you treat it as a rechargeable battery pack atp is actually the main energy source right and but it's actually also very depleted rapidly inside the cell. Remember in Home Hope, we're looking at what's going on inside the cell. So what creatine does is that it actually binds with a phosphate group. It becomes phosphocreatine, which becomes rapidly diffusible as a small molecule. And then it becomes what's called a phosphate donor, right? To the ADP, which can then be pressed into ADP in the mycotocondis. So that's simple. That's what it is. It's a rechargeable battery pack. But if you want to know what really happens a little bit more, there's a cost of actually producing ATP back to ATP, right? It's called the methylation packs. And the body uses a lot of SAM-E or S-adenosylmethionine to do that. Remember many years ago when it was a vogue in Hollywood to like, oh, let's take SAM-E as an antidepressant. Well, actually, It just actually increased the energy production in your brain because you improved the methylation, right? But that's what's called the methylation tax, you know, when you're actually trying to produce a lot of... Tax, man. So what creatine does is that it becomes phosphocreatine when it binds to phosphate, and then phosphate is immediately donated, right? Without imposing the methylation tax on the cell. So that's what it does, right? It's just a rechargeable battery pack. That's how you think about it. Okay. So thank you for that. And I really appreciate how simple of an explanation, even though it was biochem, that was. Let's go a little bit into the health optimization medicine framework. Yeah, we can call it the tax, man. It's just past April 15th. All of us have paid our taxes, hopefully. But let's go through extensions. Yeah. The health optimization medicine framework, detect and correct, of course, as well as reassess. How do we look at creatine within that health optimization operating system? Well, I think the, uh, what, what Ted was describing is important, right? We need help making more energy And I think that evolutionarily we are so much more stressed and requiring ourselves these bodies to make more energy on a regular basis And so that's why creatine becomes helpful. But when we're looking at optimizing somebody's mitochondria, we're looking at a nutrient optimization strategy, vitamins, minerals, enzymatic processes, the gut, neurotransmitters, hormones that are all responsible for maintaining mitochondrial function, antioxidant capacity, oxidative stress, et cetera. And so that's the primary, right? Because you don't want to give creatine to a system that's really, really being taxed because creatine is not like the answer, right? It's a valve that kind of pops open when we need it. That's why some of us, so many of us need it as much as we do because we're taxing our system typically because we're in sympathetic all the time. And this is what I lovingly call the sympathetic spiral of doom, as you know, guys. And this is the sympathetic activation mitochondrial dysfunction loop with cortisol and norepinephrine, epinephrine, kind of stimulating mitochondrial function day in, day out, 365, 24-7. There's a couple songs about it. You only do 24-7? You're not hustling. I know, exactly. So that's the problem. And so I think that's the framework that we use is like creatine can be a fantastic adjunct to the work we're doing at optimizing somebody's health, but it's not going to be the foundation per se. It's going to be that addition that we can give people now to help them feel better. And hopefully over time, they need less creatine to maintain their capacity. And that's why it doesn't affect me at all. I don't need any creatine. So, yeah, I mean, actually, I want to just want to quickly do that. The body has its own reserves of creatine, right? Yes. But in order to create creatine, that's where you actually exert the methylation tax, right? So you're probably going to use about 40% of your body's SAMe to produce the extra creatine. And so then that's when supplementation becomes actually almost necessary, especially for this world that we have created. We have created a very, very sympathetic world that was very different from us during the evolutionary times. So we have turned night into day. We have all of these activities and poisons, et cetera, which actually require energy. And where will that body get the energy from? It's from ATP. And then when there is not enough ATP, then phosphor creatine donates this phosphate to produce ATP. But then we need now more creatine to do that. And that's where you're going to use 40% of your SAME to produce more creatine. And that actually makes for the argument for supplementation. All right. So one question that commonly comes up about creatine is, should I be on creatine forever? And from a home hope perspective, how do we kind of look at this? Is there better questions that we should be asking? That's a great question. I think I'll take that one. And so one of the things that we see, so when we think about creatine, right, I think it actually is somewhat helpful to pay homage to its origins, at least in the world of how it became popular, which was the bodybuilders, right? And so what's fascinating is that, you know who you don't see come to the ER in fall that have, you know, who have hip fractures? People that have a lot of muscle. So I think that we probably should, I know there's a lot of discussion right now with creatine and its ability to help with sleep deprivation and brain. And like Dr. Ted said, it helps with offloading the methylation pathways and allowing the body to focus on other priorities in an overly sympathetic state. But if we go back to muscle, muscle is not necessarily cosmetic. It's not necessarily a cosmetic organ like maybe skin and face. And I would challenge our listeners here. Some people would disagree. Maybe it could be. You mean, Alan, when you take off your shirt off the beach, you say, these muscles are for show. They're not for fucking work. Well, maybe they're a little bit more. It's glamour muscles. Glamour muscles, man. Come on. Well, if we start to think of our muscles as actually an organ, like maybe like an endocrine organ, as Dr. Ted said, it's more of our amino acid reservoirs. And so our body draws upon muscle proteins, as we see during things like illness and surgery. And when we're stressed, what happens, right? We lose muscle mass. And so, you know, rather than thinking muscle being cosmetic and, you know, being bodybuilder, let's think of it more metabolic. and the endocrine organ that I would say it's probably most similar to is or it would be opposing is our pancreas so it's the tissue that absorbs and sucks up the glucose from our or sorry it's an adjunct to our we'll call it to our our pancreas right and so it it sucks up the extra glucose that's hanging around that our pancreas can't necessarily produce enough insulin and to capture and to drive into our cells. And so in addition to being this really cool fall prevention system, it actually ends up being this, a really metabolic determinant of resilience that we haven't really considered, or at least we haven't talked about on this show in quite some time. You know, that's actually a more recent concept that's only come up right in the past decade or so, where your actual muscle mass is actually, If you look at it, that's about 50% of the determination of your metabolic rate, right? Because it's how fast you're consuming energy. Before, when you were medical students, it's all about the thyroid. The thyroid is the throttle, you know, when we're flying a plane and so on. But then you notice that actually it's a muscle mass that actually also determines like the other half of your metabolic rate, right? So that was an interesting shift in perspective for me when, you know, when patients ask you, why should, especially women who are in my age demographic, who don't like any muscle. And I said, no, I said, you are getting older. You need all the muscle that you can get. Well this is what I find really fascinating about it is that you know people think they can just take creatine in the morning and all of a sudden they going to receive all of these wonderful benefits at least some of the metabolic benefits that we talking about here And we all know the body is wise, the body is not wasteful. And so what it looks for, it looks for things like the signal, it looks for the signal and a substrate. So it looks, you know, and so when we put all these things together, we have, we'll call it training or, you know, some type of resistance type of activity. And that'll be, we'll call it the stimulus or the signal for adaptation. And then as we know it, we need to give it the basic building materials and we'll call that protein. And then we need something to ensure that that signal can actually be fully expressed. And that's, I think, that the key kind of we'll call the linchpin of where creatine falls in, you know, in that overall, you know, we'll call the foundational framework for how we think about how it could help with someone's resilience. And so, but we need training. We need the right amount of protein. And then we need the creatine. And of course, we can't forget sleep. And we talk about, Dr. Scott talks about the sympathetic spiral of doom. And if we don't have the recovery window, then the time that we actually spend in adaptation doesn't occur. And so we can't actually even build a muscle. You know, I actually worked with a lot of bodybuilders before, right? And this was like, so I had to study creatine and pathways and stuff, but that did not impress me as much. It's like, for me, it's like when you're 28, you really should look like that. Right? It's like, no, you know, you're showing off your abs and everything else. No, you should look like that. If you're 28 and not sub 10% body fat, don't call doctors out. And, you know, and it's like, no, try looking at those. So actually have, they're still watchboard abs from their past 50. that's you know how you would like to apply no when when you're when you're young you're 21 and 30 years old you should look like that for fuck's sake but anyway uh where it made a really uh impression for me uh are actually in uh uh those who eat very little protein right yeah vegetarians those are high carb uh diets right especially um vegetarians who eat very little protein and then would eat a lot of plant-based carbohydrates in the form of bread. And that actually made an enduring mark in my practice. This is where I could actually, there's this clinical, instead of for performance or for looks or anything like that, this one is actually helping a lot, especially for older people. You know, Alan knows this, you know, the usual cause of the breaking of bones during a fall is not because they fell and the bones actually hit the ground, but it's a failure of grasping, right? The failure to grasp and actually support. And that is muscular, right? So it's like, and that's a hand strength. You know, they also, aside from hand strength, they lose balance. So you combine that with weak muscles and then the poor balance, you know, unable to break their fall. At first, we thought it was actually the brittle bones. It's not. It's actually from weak muscles. So that's where giving creatine actually made a mark in my practice. Yeah, looking at the studies, I was looking at 10. Vegetarians have 10% to 30% lower levels of creatine than people who eat meat. So they have less buffering. They have more fatiguing of muscles. um usually they're more susceptible to exercise fatigue sleep deprivation and cognitive load um so all you vegetarians out there should be at least supplementing with creatine that is for sure okay i want to uh kind of do a little bit of a dance around the muscle conversation and creatine and kind of go into the brain conversation and creatine. And this is one that I would say has come online a lot more in recent months, recent years, and talk about creatine for brain energy and cognition, because, you know, the brain's only 2% of our body weight, but it's very metabolically expensive. And so with it taking a large share of the body's energy, how does creatine play the role here? Because this There's also an interesting conversation. We have to be careful. How do we look at brain cognition and creatine? What's the role of creatine there? Because creatine is actually a small molecule. It can actually diffuse into the brain space and adds to the energy production of the brain. Neurons actually are one of the first to die during cell death, right? The heart, the brain, the kidneys. Why do they die so quickly? Because they have so much mitochondria. Yeah, mitochondrial density. And they actually need a lot of energy for work. And so neurons actually, you know, muscles have a lot of glycogen, but neurons don't have glycogen. They can't store energy. Yeah, they cannot store energy, right? So they actually rely on phosphocreatine, you know, for intense cognitive loads, sleep deprivation, metabolic stress, right? And even if the fossil creatine diffuses slowly, there is an increase in cerebral stores of fossil creatine. So it mitigates mental fatigue, you know, supports your working memory, provides your protection against ischemic events, right? Or even actually brain trauma, right? So you could see this that, you know, in hunter-gatherer societies, you know, we have a lot of red meat and fish, which has preformed creatine, right? But now with a blood-based diet, they're severely deficient in the compound. And we are observing the evolutionary mismatch that way. So it's like your health span, not just your lifespan, but your health span. So as you can see, all of these kinds of things, you would see the need for creating the most in the cells that have very little glycogen stores and have a high energy requirement. Brain, heart, kidneys, liver, these are the ones that have 1,000 to 2,000 mitochondria per cell, whereas the body average mitochondrial count is about 500 per cell And of course the cells in the body that don have mitochondria are your red bell cells right So you could see there the discrepancy of having any 1 to 2 mitochondria versus just 500 in an average cell So you see there that actually the great need for creatine in those cells. Yeah, yeah. I also see here some, I'm going to go about, you know, there's a couple of things with actually neurotransmitters themselves and how creatine modulates, including supporting glutamate reuptake. So that reduces excitotoxicity. So there's a lot of glutamate around. You can have excited toxicity compared to the GABA levels. Glutamate and GABA are always trying to be in balance. There's also stabilization of neuronal membrane potentials, which is extremely important as you're trying to enhance and modulate signaling. And then also modulates dopamine signaling as well. So I think that these are probably maybe indirectly related to its energy production capacity. But this is when you're actually looking at it from an actual neuron itself. What happens when energy is more effectively being used is that neurotransmissions can be more effective. Membrane potential is going to be more effective. So I get this question a lot actually recently, which was I had somebody that came in. I had a patient of mine, actually somebody who's consulted with me. He had taken an antibiotic. He took minocycline, which is like one of these old tetracycline antibiotics. And he got this really weird symptom where he would get this brain fog hungover feeling. and he was reading into glutamate and GABA sensitivity. And like, it's a very specific type of neuron that gets affected by this particular drug, which is interesting. But he's like, well, is this a neurologic thing? Is this like a GABA thing? I'm like, well, it kind of is, but it's more actually a mitochondrial issue that's manifesting that way in these particular cells, right? So I think it's just important people to realize that many times when we have like, you know, biochemical or like neurotransmitter issues, oftentimes it's mitochondrial and energy that are the problem. Well, actually we've kind of wrapped up a lot here on creatine. So when we think about creatine, suffice to say, it's not a nootropic for everybody, right? And it's not the universal nootropic. We're not talking here about NZT 148. Or blue canatine for that matter. Yeah, exactly. The legal equivalent. You know, it seems to have a role when the body's certainly stressed, when the brain is stressed, when you might be sleep deprived, but it also plays a huge role in muscle as we age. Is there any kind of wrap up do you guys want to do in sort of the home hope perspective and how this kind of fits into the framework? Yes. Well, you know, in the others, I delivered this 3-3-3-7-3 lecture, which you guys are already vomiting because you've already memorized it. But in order to make things clinical, right, towards the end, how do you actually make these things clinical? When you take a look at it from an evolutionary lens, you will see that the world has changed, Right. There's a mismatch between the world before and the world now. So you can see then that we have a lot more energy requirements. And that's the second one to make it, you know, clinical is that you actually think of creatine as belonging to the energy production part. Right. You can actually just divide the body into two parts. One part that actually produces energy and the other part that consumes energy. But we have created a world or a context actually increases the need for energy in order to maintain structure and function. And therefore, this is how we actually view the role of creatine here is the energy production part. And then the other one is balance. Not all of us are bodybuilders, but we would like to preserve our muscle mass until we are in right chronological age or unright, depending. But because our body structures actually age differently, but we are concerned with the aging of the cell. And the way the cell actually prevents itself from damage is it uses energy to detoxify itself. right it so essentially all of these things that it produces it you know for each there's for each thing that it does it functions it actually has to use energy for that right there's no such thing as a free lunch and so when you are for example defending yourself from uh from from a cold or something like that if you have sufficient energy stores you will be resilient and actually recover quickly. So for us, if you just have a balance, right, of that, not necessarily a surplus, but just a balance of how your energy is produced and how your energy is consumed, then you would have this dynamic equilibrium that actually goes inside the cell, right? It's not really a surplus, not really a starvation condition, but just enough for the cell to be able to produce energy and sustain itself without producing too much trash or garbage, right? Because remember, garbage collection inside itself also fucking requires energy, right? So that's the way you look at it from a Hong Kong perspective, right? From an evolutionary lens, from an energy perspective, and from the balance between the energy production and the structural function that the energy has to maintain. So that's how we look at it in Hong Kong. All right. To wrap things up, I have to ask Scott, how did you react on the day you heard that you were a sarcopenic doctor? I felt like influencing was hard, you know? And, you know, it's difficult to be in a situation where people just judge you, you know, for just doing the best you can, even if it's not very good. Well, I thought it was a very good episode. So give yourself a pat on the back. Maybe take a little bit more creatine next time and you'll be okay. All right. So everybody tuning in here, this has been another fun episode of the health optimization medicine and podcast. Scott is actually just going through a fit of enlightenment right now. And so we'll sign off here. If you enjoyed this episode, please hit the like button, leave a comment, let us know what you thought, favorite questions, things that you want answered the next time. uh smash subscribe too and just let us know what you think the five star the five star reviews on apple podcast spotify or wherever you listen to your podcast this has been uh dr scott the laughing man uh dr allen as well as dr ted signing off have a good night
