Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And today, we're talking about creatine with fan favorite, Dr. Anirudh Rai. He's a primary care physician at Henry Mayo Newhall Primary Care.

Dr. Rai, always my pleasure to have you on because you give us so much great information to talk about things. So first of all, what is creatine? Tell us what it is.

Anirudh Rai, MD: Yeah, absolutely. It's always good to be on board here and get more information out. So, creatine is a supplement. Everyone is quite aware of it, and it's an important supplement because it's one that actually your body does make naturally, and it's also something you could ingest on its own. And typically, it's found in strong muscle, particularly in meat you could get a good dose of that as well, but there's supplements on board that help. And the idea is, as everyone's aware of, to improve muscle and gain and also improve somewhat in efficacy in sports and athletes use it quite often to just help them perform better in general.

Melanie Cole, MS: We've been hearing about it for years, and it used to be something, you know, that you could even find on the shelves at gyms. You know, in the weight room, you'd see it maybe on the shelves there, you could buy it. Is this just for athletes, for bodybuilders even specifically? Does it help the rest of us normal people?

Anirudh Rai, MD: That's a good question. And the answer is yes. Particularly some of the studies that have been done in these medical societies, they found out that patients who have what we call neuromuscular disorders, meaning that the nerves just don't work and their muscles start decaying, it's actually been effective In that environment as well, is to keep the muscles toned. And even in general population, we know that the creatine itself can be helpful, but the idea is to use the creatine you ingest and implement them into your skeletal muscles and use that sort of energy to help promote better growth. So, it is useful for just the general population and also for certain medical conditions as well.

Melanie Cole, MS: That's really interesting. So if we were thinking about using it, tell us a little bit about how it works. What does it even do, Dr. Rai, in the body that makes it helpful for muscles and bones?

Anirudh Rai, MD: That is a very complex question. The best way to describe it is creatine itself is a special molecule that binds to, let's say, certain receptors in your cells that promote what they call ATP production. And ATP is the, essentially the power that your cells need to function. And when the ATP is used, it becomes ADP, and creatine helps kind of convert the ADP to ATP, and that's energy. And that's energy your muscles use. Skeletal muscles use this quite often. That's why creatine is in that group of muscles. And it's, of course, injected—or I would say ejected—out of your body via the kidneys. So, your kidneys dispose of this extra waste, and we see it in our labs as creatinine. And of course, the words can be bit of a misnomer because they are very similar, but they're completely different chemical components. One's a supplement and another one's a waste. So the best way to describe it, it's a great source of energy your muscles use.

Melanie Cole, MS: You gave me a little PTSD there when you were talking about ATP, because I remember in graduate school and anyone who's been there, it's the Krebs cycle. And you're learning about that. And, oh my God, the tests we had to do. So, a lot of times, Dr. Rai, we hear with these supplements, even as good as they might be, it'd be better to get it from food sources. And you mentioned meats. Where else can we find it? And is this one of those supplements that is better to get from a food source or are we better to get it as a supplement?

Anirudh Rai, MD: That's a good question. And yes, typically we do see it in meats. And the reason for that is because the meats we get have that concentrated creatine in the muscle, because that's where this chemical predominantly resides. So yes, meats would be the primary way you could get creatine. I'm sure nowadays there are other components that are, I would say, a better derivative of them. But any way you could ingest them or get them one way or another would be good. I wouldn't say there's one is better than the other. You might get maybe a better concentration, let's say, of the supplements that are over the counter because they're tailor-made to have that there versus meats, which may not have a set amount of concentration of creatine. But I would say any form of creatine you can ingest is going to be good. The supplement tends to be a more concentrated way though, but meats are a good and natural source to get it.

Melanie Cole, MS: So, you know, as good as it is for the muscles, for our body, what about memory, focus, mental performance? Because so many athletes, that's really what they're looking for. Bodybuilders, athletes, they're looking for that real mental performance, that motivation. Can it help with that?

Anirudh Rai, MD: In a way, yes, but I wouldn't say it's the creatine itself that's directly implementing that. It's more of the effects that creatine has on the muscles leading to increased blood flow and just increased activity in the rest of your body, which promotes better muscle memory, promotes better performance. I mean, there are quite a bit of myths out there of creatine use, but it has been debunked quite specifically. I wouldn't say it directly helps memory, but it does help facilitate natural memory building due to the effects of creatine in the muscle and the rest of your body.

Melanie Cole, MS: Well, you brought up the word myths because I was going to ask you about that next. When people talk to you about these things, and I imagine they talk to you about so many things because you're such a well-rounded physician, what are some of the myths that you've heard about this?

Anirudh Rai, MD: Some of the myths that come to mind is some of my patients who tell me, "Is this kind of like a steroid where you get like bulky with it?"

Melanie Cole, MS: I've heard that one too.

Anirudh Rai, MD: Yeah, the answer is no. So, steroids are a completely different class when it comes to chemicals. Creatine is completely different when it comes to that. It does promote muscle growth, but not in the same way steroids do. So, it is not an anabolic steroid. So, it is something that will promote natural growth of muscles rather than an unnatural growth via anabolic steroids. That's one myth that I hear a lot of my patients call about. I don't know if there's other myths that come to mind for you, but there are quite a bit out there.

Melanie Cole, MS: Well, there are, and I've heard, you know, does it destroy your kidneys? But then, again, that's along the same lines as the steroids. Is it a steroid that's going to start destroying my kidneys right away? So, I mean, it doesn't really, even though it's excreted eventually that way as it turns into creatinine, right?

Anirudh Rai, MD: Absolutely. So, creatine doesn't directly interfere with the function of the kidneys. And of course, lab work actually will see a little bit discrepancy. If you are taking creatine supplements, labs will pick up on that and your creatinine may be a little bit higher up. But by definition and by studies, it won't decrease what we call your GFR, which is the general rate of which your kidney clears things.

So, your creatine may go up, but the function, which is the GFR, will stay the same. So, that is also a myth. I do hear a lot of my patients say, you know, "Are my kidneys messed up because of that?" And the answer is no. So, this is a very safe supplement to take even with issues. If you're having issues with kidneys, then that's something that you would want to talk to your doctor. Because if your kidneys are not working differently, then definitely I would say talk to your doctor, see if a supplement is beneficial for you because you would want to have good kidneys when you're taking this medication nonetheless.

Melanie Cole, MS: I agree with that. You want to make sure that if you're—I mean, really with any supplement, talk to your physician, talk to your trainers, your coaches. Make sure that you're safe to start taking some of these. That's just a little disclaimer we're going to throw out there. But as far as supplements go, is this in pill form, powder form? How is it generally ingested?

Anirudh Rai, MD: Usually, the ones I've seen most common are the powder where they mix it with either a smoothie or something, which is a little bit easier. But I'm sure nowadays they do have powder. I wouldn't be surprised if they have gummies or something else that makes it a little bit easier for people to kind of ingest it. But the powder form is the most common one I tend to see.

Melanie Cole, MS: And generally, it's mixed sometimes with a protein or some other amino acids. You know, maybe there's kind of a mix in there. If you were to tell someone, and I'm talking females, males, if it was realistically worth adding to our supplement regimen. You know, maybe we're taking B, maybe we're taking a multi, especially for maybe even a woman my age. Do you think realistically, Dr. Rai, it's something that we should consider?

Anirudh Rai, MD: I would say the short answer is yes and no. The yes is if you could tolerate it and use it properly, then of course. I would say if you're active, even just walking, I do believe you'll have some benefit. It doesn't have to be the same amount because there are a lot of theories about how much creatine you should take per day if you're doing certain activities, and then that's a little bit more in the realm of debate here and there.

But I would say a small supplement of creatine daily can help with just normal muscle growth and keep you going. And the more better way to indicate is if you're going to be using the creatine. So, if you're ingesting it, definitely walk more. You know, just be active in general. If you're a high-performing athlete, you may need a bit more to kind of help get you into that high-performance state.

So, creatine itself, I think from my perspective and from my patients' perspective, will be beneficial just for even as a small supplement. It could be in tandem with vitamins and minerals you're taking. But nonetheless, it is something that if you do take, make sure your body uses via walking and exercising

Melanie Cole, MS: And I'd like to add in hydration. Because if you are going to take something that does filter through the kidneys eventually, you want to make sure to keep hydrated and, you know, make sure that all this stuff kind of flushes out whatever extra your body doesn't really need to use.

But as always, I like to ask for your best advice when you're telling your patients, whether they're young patients, and that could be one in itself, supplements and our youth, supplements and our youth athletes. You know, I imagine, Dr. Rai, that we're seeing creatine in the high schools, especially in, you know, athletics and in collegiate athletics, see it in the locker room in some kids' lockers. I want you to give your best advice here to those athletes, to those youth, to the parents, to really anybody that questions this, because, I mean, how do we know what to believe? There's eight million of them on the shelf, but we do know that we can believe you.

Anirudh Rai, MD: I do appreciate it. And definitely the best advice I would say, if you have any questions, definitely talk to your doctor about it. They will have good knowledge in this subject as well, because it is something that's well-known. And I would say to anyone who's supplementing, whether they're young or in the professional level. And if you are supplementing it, the main thing is using it. If you're supplementing and not being active, then it's no use of getting that supplement. So, anytime you are supplementing creatine, make sure you use it. Even if it's as simple as walking, using that creatine to build those muscles is always going to be beneficial.

At the same time, like you mentioned, hydration is important. So, making sure you're getting the right amount of water because your body needs that water to function, get the creatine in the right place. And it's important to know that creatine, there's a lot of myths out there, but it's a very safe supplement if used in the right portion, the right amount, and talking to your doctor just to make sure they're aware of it and that they can inform you if anything else is changing in your body.

Melanie Cole, MS: Best advice as always from Dr. Anirudh Rai. Thank you so much. You really are a fan favorite because your information is just so clear and succinct. I just know your patients are so lucky when they get to see you. So, thank you again for giving us your time and all of this great advice.

And to book an appointment with Dr. Anirudh Rai, visit our website at henrymayoprimarycare.com. You can also visit the free Henry Mayo Newhall Hospital online health information library at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Until next time, I'm Melanie Cole.