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Mini Pause #39: More Creatine Myths Debunked ‌ ‌ ‌ ‌ ‌

Posted on by stephanie-estima

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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.

What I Recommend: Longevity

I'm pretty picky when it comes to supplements. I keep it simple and expect real results. There are two plant-based formulations I prefer backed by science for their longevity benefits.

Primeadine: This wholly plant-derived spermidine supplement promotes hormonal balance, healthy aging, energy, and hair growth. It also activates cellular renewal, or autophagy, which mimics the benefits of fasting. Spermidine supports sleep quality; memory, cognition, and brain health; and skin and nail health. Click HERE to choose from original or gluten-free formulas. Use code DRSTEPHANIE15 to get 15% off.

Qualia Senolytic: Senolytics are plant-derived compounds that can reduce your body's senescent “zombie” cell accumulation, which means your inflammation goes down and your energy goes up. This clinically tested formula also benefits your joints, workout recovery, and tissue rejuvenation. Click HERE to learn more and use code DRSTEPHANIE to get 15% off.

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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.

Mini Pause #28: Your Guide to Progesterone in Perimenopause

Posted on by stephanie-estima

What to Know & What to Ask Your Healthcare Provider

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

Progesterone is often the first hormone replacement women begin taking in perimenopause.

WHY

Progesterone is often the first hormone replacement women take in perimenopause. This is likely due to clinical symptoms like a shortened menstrual cycle, spotting, poor recovery from exercise, sleeplessness, and increasing anxiety or depression that is atypical for you.

Progesterone has several roles as it relates to the menstrual cycle, such as:

  • Decreasing uterine contractions to allow for implantation.
  • Increasing vascularization and blood flow to the uterus.
  • Increasing mucosal thickening in the cervix (to prevent more sperm from getting in, as well as serving an immune function to the woman [*]).

Progesterone has many functions in the body beyond regulating the menstrual cycle, too, like:

  • Bone formation [*] and prevention of osteoporosis.
  • Protection of neurons in both the central and peripheral nervous systems for neurodegenerative diseases.
  • It also interacts in the musculoskeletal system with estrogen to help form peak bone mineral density.

Progesterone is not solely for your uterus. It’s a systemic hormone. If you do not have a uterus, you can still benefit from supplementing with this hormone (although this must be discussed with your primary prescribing healthcare provider!).

WHAT

If you’re noticing your menstrual cycle shortening, or you’re noticing spotting a few days before your actual period begins, these are usually telltale signs that your progesterone levels are dropping. Coupling this with changes in mood, affect, sleep, or general recovery from exercise would certainly warrant a conversation with your provider about whether progesterone therapy is right for you.

HOW

There are several ways progesterone is administered. The two most common ways are oral, micronized progesterone and topical progesterone cream.

Prescribed oral micronized progesterone is called Prometrium and is chemically identical to the progesterone we make in our bodies. It’s available in 100mg or 200mg doses and recommended that you take it at night because it can cause drowsiness and even dizziness. Taking it before bed helps to minimize these common side effects.

A few other side effects to note with Prometrium that are true for some but not all women:

  • Water retention
  • Bloating
  • Increased appetite
  • Mood changes

While these side effects can be temporary when first starting the drug, it’s important to make sure you keep a log of any symptoms you experience to be able to communicate this with your provider.

In terms of dosing: If you’re still cycling, it’s commonly recommended for you to take the progesterone in the second half of your cycle, from the midpoint (usually day 14) to the first day of your period.

If you are menopausal, or you have no idea where you are in your cycle, there are a few schools of thought on progesterone best practices:

  • Take it daily, irrespective of where you are in your cycle.
  • Take it for two weeks, and then break for two weeks, mimicking the natural rhythms of progesterone secretion in the fertile years.

There is no “better” one way, so expect a bit of experimentation and dialogue between you and your primary prescribing healthcare provider.

NOW

  • If you are not already tracking your cycle–start! Even if it’s irregular. You need some foundational data.
  • If you notice changes in the length of your cycle, spotting, or mood and energy changes, it might be worthwhile discussing with your provider what your options are based on your health history.

Question of the Week

Q: As a 45-year-old woman, what are the ideal estrogen/progesterone levels or range to look for?

Gina asks a question that I think is difficult to answer for everybody because it’s only one part of three questions that you must consider. So, I can give you a framework to think about what is optimal for you.

We can look at ratios, but we are looking for 1) both absolute numbers to be optimal, 2) the relative ratios of each to be optimal, and then, 3) symptom management to be on point.

To be direct, you want an estrogen: progesterone ratio to be somewhere between 100 and 500. Anything less than 100 usually indicates that too little progesterone and too much estrogen in the luteal phase of the menstrual cycle.

It’s important to know that you can still experience signs and symptoms of estrogen dominance even if your estrogen and progesterone levels are within the normal range. This is why you and your healthcare provider should always consider ratios, absolute levels, and your menstrual cycle experience.

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.

What I Recommend: Supplements for Performance, Cellular Health & Aging

In last week’s Mini Pause #27, I laid out my supplement routine to answer your questions about what I take regularly to support my health and fitness goals, feel my best, and age well. I wanted to mention a few others that I rotate in that you may find are a good fit for your own lifestyle.

Essential Amino Acids (EAAs): These building blocks of protein are vital macronutrients for your fitness and overall health. If you’re a fitness professional, a competitive athlete, or regularly train for specific performance goals, the nine essential amino acids are a must. They are crucial to boosting your energy, building lean muscle, and helping your body repair and recover. Learn more about EAAs in this guide that makes the nerdy science easier to understand.

  • Try KION and use DRSTEPHANIE for a discount at checkout.

Fatty Acids: Essential fatty acids create better skin, hair, and nails, repair age-related damage to cells, and activate pathways that regulate sleep and mood. Fatty 15 is a science-backed, patented, and award-winning essential fatty acid formula that helps reverse 36 clinically relevant and aging-associated changes at the cellular level, effectively protecting your cells (and you) against age-related breakdown.

  • Try Fatty 15 and use code DRSTEPHANIE to get 10% off a 90-day subscription Starter Kit

Spermidine: Wholly plant-derived spermidine promotes hormonal balance, energy, and hair growth. It also slows aging on a cellular level by activating cellular renewal, or autophagy, which mimics the benefits of fasting. Spermidine supports sleep quality; memory, cognition, and brain health; skin and nail health–all of which can change during midlife.