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Creatine N=1: Muscle Gains and Brain Games

I’ve been into weight lifting for about 20 years now. I started when I was a teenager in high school mainly because my high school baseball coach and the school’s weight lifting coach were the same person. Getting fitter and stronger was a necessary part of just getting better.

I grew to really love working out. I legitimately just felt better on days that I exercised. It also helped to have the testosterone of a teenager and young adult where really minimal training led to bigger biceps almost overnight!

But despite two decades of strength training, I never really got into the cycle of using supplements to enhance my training efforts. I didn’t have any philosophical stance against supplementation, it just wasn’t something I wanted to do for the extra money that I would use to spend on it. My main goal for exercise more about feeling good than about aesthetics, so why bother?

Fast forward to 2017, and I’m going through my stack of interesting papers about traumatic brain injury and neurodegenerative diseases when this guy shows up:

Creatine and Its Potential Therapeutic Value for Targeting Cellular Energy Impairment in Neurodegenerative Diseases

It’s been well known that creatine provides performance enhancing benefits for sport and training by improving the ability for muscles to use energy. Thousands of studies generally support this effect on muscle [Source]. It is known.

It Is GIF - It Is Known GIFs

Apparently creatine through it’s action on cellular mitochondria has therapeutic potential to help the brain.

Image result for whoa meme

Therapeutic potential is cool and all, but lots of things have biological potential. Was there any supporting data that showed supplementing with creatine could affect the brain? If it could, then it’s possible that just taking a cheap supplement like creatine could help with age related muscle loss on top off addressing some of the cognitive decline we all experience as we get older.

So what’s out there?

Creatine appears to preserve cognition during periods of neurologic decline and neurolgic stress. A randomized trial of creatine vs placebo on healthy adults under laboratory controlled oxygen deprivation with some striking results. [Source] While the placebro group tanked across multiple cognitive tests with oxygen deprivation, the creatine group not only showed reduced decline, but actually showed slight improvement in 2 domans of cognition.

Cognitive scores under oxygen deprivation. Creatine in black compared to placebo in white.

Creatine supplementation has also shown an ability to mitigate some of the cognitive effects of sleep deprivation, bipolar depression, and possibly traumatic brain injury. While creatine has shown promise in animal models of Parkinson’s Disease, it has been largely ineffective in improving quality of life in patient’s with PD.

But what about healthy individuals? The results get a little more fuzzy here. Studies have shown improved cognitive performance in healthy vegetarians and healthy aging populations, but results in healthy young adults were unremarkable.

So it looks like creatine has good upside for helping the brain during metabolic distress or metabolic decline, but young healthy people has slight or no difference.

N=1 with Dr. Chung

So that brings us to our current experiment. Being creatine ignorant all my life, I wanted to see what kind of physical, mental, and cognitive effects we might have by just taking 8 grams per day.

Here are some baseline physical numbers:

  • Weight 185 lbs
  • Bench Press: 225 lbs
  • Back Squat: Recent 310 lbs, lifetime 315 lbs
  • Deadlift: Recent 365, lifetime 400 lbs

For cognitive testing, I used a platform that we test in our office called Cambridge Brain Sciences and an app called Brain EQ.

Brain EQ:

Brain EQ App Pre-creatine scores and averages

Cambridge Brain Science Tests

Cambridge Brain Science Cognitive Test. Pretty average, but those years of teaching people Stroop makes me pretty good at Double Trouble

Mostly pretty average scores. Though taking these tests are humbling and make you feel like an idiot frequently.

In particular, I didn’t feel great about my spatial processing and my memory scores. No matter who you are, it never feels good to be on the bottom end of the bell curve, even if that curve is still average.

Ouch. I’m not as good at navigating space as I thought

So we had our baselines and now we did our creatine protocol.

I basically took 8 grams per day of Metagenics Creatine Monohydrate.

Kept my workouts and diet the same and I intentionally avoided any cognitive training to avoid a practice effect from baseline to followup. No other interventions done for roughly 4 weeks.

Results

Alright, so let’s see what happened.

Physical Numbers:

  • Weight: 192 lbs
  • Bench Press: 235 lbs (10 lb increase)
  • Back Squat: 325 lbs (10 lb increase)
  • Deadlift: 365 lbs (no change)
Image result for nod yes
So far so good

How about the cognitive scores?

BrainEQ: Mostly unchanged. My reaction time and speed on rapid scanning improved slightly, but I did worse on other scores.

Post Creatine: Brain EQ Scores some what worse except speed tests.

Cambridge Brain Sciences: Improved on 7 scores with 2 being a lot better. Did slightly worse on 5 scores.

7 Scores improved with 2 showing large improvement. 5 Scores worse.

The scores that improved the most naturally came from the tests I did worst on.

The Bad Scores that jumped up.

So What Does It All Mean?

Overall, most of the cognitive scores seemed to be the same. Many scores improved and some decreased but only one score appeared to show a statistically significant difference.

The scores that seemed to improve the most happened in the tests that I did poorer than expected so there was room for a regression to the mean.

My physical strength numbers were substantially better and I can only really attribute creating to the change. I’ve tried maxing out my back squat numerous times in the past 3 years, getting over 315 has always seemed like it was really out of reach.

Overall it looks like my short experience with creatine fits with what’s in the scientific literature so far

Being someone who is mostly cognitively normal, the literature seems to show that creatine doesn’t really change much in terms of cognitive scores.

However, in conditions of increased mental stress or potential nutrient deficiency, creatine seems to have the ability to buffer the cognitive decline in stressful brain states.

This might include:

  • Traumatic brain injury
  • Aging
  • Sleep deprivation
  • Post-exercise/exertion fatigue

Since creatine doesn’t appear to have much downside in patients with healthy kidneys, there seems to be a space where taking a daily dose of 5-8g/day can have some benefit in building the storage and availability of creatine for stressful events.

Final Thoughts

Some final thoughts. Overall I felt really strong and pretty good mentally during the experiment. However, it may be coincidental or not, I did have some digestive unrest and my bowel movements were noticeably decreased.

I’ll run the experiment again under similar conditions and again with high fiber plant heavy diet and see if this offsets some of those digestive effects.

1 rep max squat: a future biomarker for brain health?

When people think about growing new brain cells and optimizing brain health, they think about playing games like Sudoku or Luminosity. The idea being that we need mental games to flex our mental muscle.

The problem is that mental games like Sudoku and Luminosity have failed to demonstrate any meaningful evidence that it alters brain or cogntive function. They can make you good at Sudoku-related tasks or LUminosity-related games, but that’s about it.

There is one thing that has consistently shown improvements in cognitive, cellular, and neurological measures of brain function:

Exercise

A 2018 study showed that the dis-use of leg muscles was associated with decreased production of neural stem cells and decreased maturation of the supporting cells in the brain.

While this study was done in rats, it does help to explain some important phenomenon seen in humans.

Neurodegenerative Disease, Leg Exercises, and Stem Cells

Neurodegenerative diseases consist of brain and nervous system illnesses like multiple sclerosis, Parkinson’s Disease, an ALS. One of the big commonalities with this class of neurological disorders is that they they will eventually take away your independent ability to move.

Dr. Danielle Botaii, one of the authors of the study, wanted to investigate whether it was the gradual deterioration or the nervous system compromised muscular function, or if there was a possibility that loss of mobility from these diseases accelerated brain deterioration. [Source]

The study used mice and restricted the use of their hind legs and were compared to control mice who roamed normally. The researchers found that the mice who didn’t have normal use of their legs showed:

  • 70% decrease in neural stem cells compared to controls
  • Decreased maturation of support cells in the brain
  • Decreased expression of key genes for mitochondrial health

All of this to say that simply taking away the function of their legs could have significant ramifications for the ability of the brain to develop, adapt, and repair properly. With compromised stem cell production, less glial cell maturation, and worse energetics, you deal the brain a harder hand to play with. So much of our brain is built to provide action and resistance to gravity, and your legs play a huge role in that.

Squatting Your Way to a Better Brain

So the title of this article was definitely hyperbolic and click-baity. Guilty as charged. But the idea of squatting your way to better brain health sounds pretty sexy when you’re a doctor that lifts.

Working on that Snatch/Overhead Squat…..for brain health purposes

It’s super unlikely that your 1 rep max squat is going to be useful as a brain biomarker (though one can hope!), but there’s growing evidence that moving your legs frequently and often is phenomenal for your brain. One might even be able to make the case that running, jumping, squatting, and any other movement that keeps your legs strong may have more brain benefits than weight loss benefits.

There’s been ample evidence in mouse models that showed steady state running had significant effects on brain cell growth in a key memory area of the brain called the hippocampus. There’s also been compelling studies showing sedentary behavior reduced brain volume in parts of the brain which couldn’t be overcome by casual exercise.

There’s really no human evidence yet that shows that squatting will change the brain, but I feel strongly that preserving leg strength is one of those key things that differentiate those that age poorly and those that age with grace.

It’s definitely way too early, but I say we jump start the movement to 1RM for your Brain and let the evidence come in after the fact. Squat regularly and squat often friends.

Is Cardio Useless? Your Brain Says No

Is Cardio Useless

 

As of the timing of this post, I consider myself primarily a weightlifter when it comes to fitness. If you follow my social media posts on Instagram, Twitter, and Facebook you’ll mainly see photos and videos of squats, snatches, cleans, and other movements that involve heavy barbells.

A popular trend in fitness is to condemn forms of exercise called steady-state cardio, which is your classic endurance exercise like long distance running, rowing, cycling, etc. Critics will say steady-state cardio is ineffective for putting on muscle mass and strength as well as a negligible effect on weight loss so it should be discarded as a form of exercise.

Whenever gym bros start talking about cardio

Whenever gym bros start talking about cardio

All of those things are pretty accurate. Cardiovascular exercise has a marginal effect on strength and hypertrophy, and in the absence of diet no form of exercise really promotes weight loss. But this doesn’t mean that cardiovascular exercise is useless. The effect that cardiovascular exercise has on your brain can be life changing.

Cardio and Neurogenesis

Neurogenesis is a term that scientists use to describe the growth of new neurons. For decades it was a widely held belief that all of the brain cells you are born with are the ones that you will have forever. In more recent years, scientists have identified parts of the brain that do produce new brain cells on a regular basis……just a lot more slowly than something like your skin.

One particular region in the brain that is well known to undergo neurogenesis is called the hippocampus.

This little chunk of brain is one of the few areas that can produce new neurons regularly.

This little chunk of brain is one of the few areas that can produce new neurons regularly.

 

The hippocampus is a piece of our brain that is associated with the formation of memories and in learning. It’s been well established in rat studies that neurogenesis happens in this part of the brain, and exercise enhances this process. [Source] But that’s just a rat study. Does this actually happen in humans?

While we can’t put humans on a treadmill for 30 minutes and cut out their hippocampus, there are studies that imply that neurogenesis happens in humans after cardiovascular exercise too [Source]. These studies have showed that exercise improves memory scores, increases the size of the hippocampus, and produces higher amounts of brain derived neurotrophic factor which is the chemical compound associated with neurogenesis.

That’s pretty amazing stuff! This is the type of stuff that helps to explain why people that exercise regularly have a lower risk of dementia. It also helps us understand how exercise can help combat things like ADHD and other brain related disorders.

Does Weight Training Have the Same Impact?

Scientists who did the study on rat brains found that aerobic exercise had double the amount of neurogenesis as sedentary rats. They also found that rats who did resistance exercise had very little effect on the rat brains, even though the rats got physically stronger. Source

Now we have to take that with a grain of salt because:

  1. Rats aren’t people.
  2. The way that the scientists “strength trained” the rats is by tying a weight on their tails and making them climb with it. Not a terribly good comparison to men and women who voluntarily lift weights recreationally.

The biggest take away from this study is the way that aerobic exercise seems to pump up that brain derived neurotrophic factor which may be a key to making your brain grow and heal.

While the effects of weightlifting on neurogenesis hasn’t been studied yet, there is compelling evidence that suggests weight training is beneficial in people with early stages of memory loss. Resistance training has been shown to improve general cognitive performance ¹, improve blood flow to memory areas of the brain ², and save seniors with memory problems money ³.

All Exercise Is Beneficial

At the end of the day, all kinds of exercise is beneficial for different reasons. We have developed a stronger understanding for how cardio can benefit the brain, and there is data that shows that weight training also gives the brain a boost.

There’s no need to shame someone’s exercise of choice. There are so many people that don’t move at all, that anything that a person can do to be active and move regularly will provide them a substantial benefit.

Now if you’re a fitness junkie already, then taking a balanced approach and incorporating something you usually avoid is a great recipe to get the maximum benefits of exercise.

If you are someone that lifts weights 4 days a week without fail, then maybe taking a 2 mile run or row would be a great addition to your weekly regiment. If you run daily and never do strength, then you should definitely look into resistance training to supplement your cardiovascular fitness.

Your brain thrives on exposure to new things.  Beyond some nice looking muscles and better heart health,, the biggest benefit of exercise is making your brain better.

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Stop Complicating Mobility Work

Stop Complicating Mobility

Read Time: [5 minutes]

It’s been interesting to see how Crossfit has affected the consumption of goods and services across the entire landscape of fitness.

I was talking to a good friend of mine who has been a personal trainer for over 20 years. He was there well before Crossfit became a fitness phenomenon and he’s been able to see how the landscape changed because of it. He was telling me that  rowing machines used to just collect dust and chalk used to cost pennies on the pound.

One of the more interesting trends is the rise in demand for better ways to take care of yourself. People are actively looking up videos about mobility, stretching, and exercise to help make their bodies feel and function better.

If you were to talk to people in the world of therapy, corrective exercise, or sports medicine, they would tell you that getting anyone to do home care was like pulling teeth. People wanted quick fixes and for the doctor or therapist to do all of the work for them. Even getting professional athletes; people who get paid to keep their bodies in shape; to do home care was a chore.

The rise of guys like Kelly Starrett (MobilityWoD), Ryan DeBell (The Movement Fix), Zach Long (The Barbell Physio), Tim Simansky (The WoD Doc), and Scott Mills (The Full Body Fix) have seemingly done the impossible. They’ve made self-care a lot sexier.

But Then It Got So Complex

Chiropractors and physiotherapists all over the world saw how well these pioneers executed their programs and started blogging and making videos showing their tips and tricks for mobility.

But does anyone get the feeling that a lot of the tips and tricks are turning into a competition to see who can make their drills look more complex or complicated than the last guy?

It also feels like there’s a bunch of tools and objects being sold that are redundant, but look crazy enough to be worth buying. For example:

Supernova vs Lacrosse Ball

 

Anyone need to up their stability exercise game?

 

For most people, the best mobility is time spent in the desired position

I was working with a guy that just started Crossfit. He came from a traditional body building background so he was in phenomenal shape, but he really liked the Crossfit style workouts and wanted to be great at it. However, he was having a lot of issues with his squat.

If you know anything about Crossfit, you know that the squat and all of it’s variations are fundamental to success. It had never really been part of his regiment, so his mobility was lacking and was complicated by his sheer bulk and strength.

His heels would come off the ground, lower back would round, and knees dived inward in a squat with no weight.

His coaches gave him a variety of advice like:

  • Mash your ankles with the lacrosse ball
  • Mash your quads with a foam roller
  • Tie a band to the rig and floss your hips
  • Do this yoga pose

He did all of these things for several weeks, but he just wasn’t getting anywhere from an improvement stand point. This isn’t anything against the knowledge of his coaches, because they weren’t wrong, they were absolutely right to make the recommendations they made.

The problem was that those recommendations wasn’t the primary issue. His biggest issue was that his body spent very little time in a full squat position. Sometimes the mobility answer is just that simple. Spend time in the desired position.

So what’d we do?

His goal was to get to the bottom of his squat. So we got him to spend time in the bottom of the squat for minutes at a time.

I had him perform this drill against a wall every day for a total of 5 minutes.

Static Wall Squat Drill

Static Wall Squat Drill

Within 2 weeks, he could squat with his heels on the ground. In another 2 weeks he could keep his chest up 50% more.

Once he could squat with good technique, then we had him perform the drill off the wall in neutral, and on the wall with his hands over head so he could prepare for the overhead squat.

Overhead Wall Squat

 

It isn’t mindblowing or sexy, but sometimes the answers just have to be….

Simple.

Sometimes mobility means training the muscles and your nervous system to just spend time in the desired position.

We just have to make sure that we keep the person’s goal in mind for a mobility recommendation.

Start Easy, Master Skill, Increase Load, Increase Difficulty

This isn’t to say that different tools and complex movement patterns aren’t important. They are! The better your body is able to handle and tolerate simple tasks, then complexity of movement is what allows for further growth and improvement.

But sometimes we have to take a step back and look at where we currently are, and ask ourselves if we are ready for a more complex movement.

As an example, I like to use the average person doing an overhead squat. If your overhead squat causes you to bend your elbows, lean off your heels, and collapse your lumbar curve then you have some glaring mobility issues in the overhead position.

If you cannot do a basic overhead squat, do you think it is going to benefit you to do more complicated drills like a snatch or a Sots press? Probably not. You need to get your Overhead Squat position right first.

Here is the basic formula:

  1. Perform the easiest variation of a movement.
  2. Mobilize and practice movement in desired range of motion
  3. Master complete movement with full range of motion
  4. Increase weight
  5. Increase difficulty and complexity

So if you want to do the same with the squat:

  1. Being with partial squat using a ball or bench.
  2. Use mobility techniques and practice being in the desired range of motion
  3. Master a full depth squat without assistance
  4. Slowly increase to using a barbell and increasing weight
  5. Progress to pause squats, overhead squats, pistol squats, etc

Going from steps 1 through 5 can take weeks and weeks of practice. In some cases, it may take several weeks just to perform a basic movement to mastery. But you will get their a lot better, safer, and faster when you tackle this with a plan as opposed to throwing together random mobility strategies from a Youtube video in a haphazard way.

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