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TL;DR (Too Long; Didn't Read)

Another day, another creatine myth. For reasons that elude me, creatine myths continue to persist, despite good quality evidence to the contrary.

I wrote about creatine essentials in Mini Pause #15, debunking that it causes water retention and presenting its wide-ranging positive effects for perimenopausal women.

Today I want to talk about the myths around hair loss, and heat caffeine and creatine.

WHY

I recently shared on social media that I use creatine every morning. I usually put it in my water or in my coffee where I also add in collagen. A flurry of chaos ensued in the comments:

• “You can’t put it in something hot!”
• “It causes an increase in DHT and all my hair fell out. Do NOT use this!”
• “It causes you to gain body fat!”

This along with the other regulars like, “Doesn’t this cause bloating and water retention?” and “This causes kidney failure!”

So, clearly, we still have work to do with respect to creatine and its effect on the female body.

WHAT

First, it’s important to know that we produce creatine inside our bodies every day. It’s among the most well-studied supplements for improving exercise performance and has an incredible safety profile.

Creatine is stored primarily in the muscle (about 95% of our creatine stores are here) and it works by increasing energy availability during high-intensity activity. In the muscle, creatine is phosphorylated to phospho-creatine (P-Cr) and will donate its P to make energy.

So, the first point is that we make it endogenously.

Myth #1: Hair Loss

This stems from the idea that creatine can increase your testosterone, and therefore your DHT (dihydrotestosterone), which can have negative effects on the hair follicle.

The large body of evidence seems to suggest that this is not the case.

There are three randomized controlled trials [1][2][3] that do seem to suggest a small increase in testosterone and DHT, but the timing of the studies ranged from one to three weeks (certainly not long enough to establish this relationship), and used a loading dose (20-25g for a week).

For most active women, we are going to want to supplement with creatine long term, and with the exception of Olympic Athletes or bodybuilders, there is no reason to take a dose that high. If you are looking for the muscle benefits, 5g daily seems to be the sweet spot.

The bulk of evidence in other trials looking at creatine supplementation at anywhere between 3-25g daily found no significant elevated levels of testosterone or DHT.

Myth #2: Heat or Caffeine

Creatine is a pretty stable molecule in the presence of heat, with estimates of up to 148C / 298 F. So unless you enjoy scalding, third-degree burn heat water, adding it to warm drinks (including coffee and tea) should be just fine. Creatine tends to dissolve a bit better in warmer water too as compared to cold water.

Now, the real issue is, “Does creatine compete with the caffeine molecule in the body?” and the answer here does seem to be yes, but there is some nuance to this.

First, I’ll point out that caffeine does not influence creatine’s ability to increase muscle phosphocreatine storage and neither appear to affect the other’s concentration in the blood.

There is some limited evidence to suggest that chronic caffeine consumption in large dosage can effect the performance benefits of creatine (i.e., helping you lift longer and have more stamina). This is a relatively weak finding and not consistent across the data.

Another confounding variable may also be that taking both of these at the same time can cause some GI upset in some people.

So, to err on the side of caution, I will make sure my coffee size is relatively small (a proper sized cappuccino cup, not the triple quad venti huge-o-ccino variety at your local coffee house selling expensive, rancid coffee). Anything under 150mg of caffeine should be fine.

HOW

Start taking 3-5g of creatine monohydrate daily. This dose should take you about a month to fully saturate the muscle cells and start seeing improvements in performance at the gym.

Anchor it to a habit you are already doing (having a coffee or tea in the morning, taking your supplements, filling your water bottle for the gym). Creatine supplementation works best when you are consistent with it, so finding something similar that you are already doing will help fortify your new habit.

NOW

Pick yourself up some creatine if you don’t have one kicking around your supplement closet. Always opt for creatine monohydrate. This is what we have the data on.

I use the mindbodygreen Creatine+ with Taurine and the Equip Foods Pure Pre, a pre-workout formulated with creatine. (If you try either, use code DRSTEPHANIE to save 15%.)

Question of the Week

Q: Loving your newsletter and content as it’s been extremely helpful navigating year 46 and all the changes! I have a question regarding creatine that I haven’t been able to get help with.

“I take it and I definitely feel better while on it vs. when I took time away from it to assess how I felt. When I had labs taken for my functional medicine doctor, they flagged my creatinine level as high and said I shouldn’t take any creatine supplements because of my levels and fears regarding kidneys. I have no major health issues and keep up with proactive labs for information of what’s happening in my body. Any recommendations or experiences with this on labwork?”

Thank you to Nicole for asking this question.

Creatinine is a waste product of creatine, so with supplemental creatine, you would expect your creatinine levels to rise. But elevated levels of creatinine from creatine supplementation are in no way evidence of kidney failure.

Be sure to tell your doctor that you are supplementing with creatine for context so she doesn’t assume you are in kidney failure! You may also see eGFR (estimated rate of glomerular filtration) to be relatively “worse” as well, but this is again, due to creatinine levels.

This isn't something to be alarmed about and if you want a true sense of your kidney function you should order a Cystatin C test. This is a more accurate read on kidney function than creatinine.

YOUR TURN

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

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P.S.

OCT. 14-18: FREE ONLINE SUMMIT FOR PERIMENOPAUSE AND MENOPAUSE

If you missed last week’s Mini Pause, I want to be sure you see this information about a 5-day FREE online event featuring over 40 (now 52!) of the world’s top experts in women’s health and hormones called the Thriving in Perimenopause and Menopause Summit.

Dr. Mariza Snyder, my friend and a peer in the women’s health space, is the host. She’s a hormone expert and author who’s gathered people at the forefront of perimenopause and menopause research and care and interviewed them about the topics that matter to you in midlife. I’m thrilled to share that I’m a speaker at this event! Register HERE to claim your FREE spot.