Creatine, Cellular Energy & the Modern Stress Epidemic

• Why is creatine far more than just a bodybuilding supplement, and how does it function as a critical cellular energy buffer?
• How does modern life increase our demand for ATP and phosphocreatine far beyond what our evolutionary biology was designed to handle?
• What role does creatine play in mitochondrial health, methylation balance, and cognitive resilience under stress or sleep deprivation?
• Why should muscle be viewed as a metabolic and endocrine organ rather than simply a cosmetic one?
• How can creatine supplementation support healthy aging, resilience, and brain function in both athletes and everyday individuals?

What We Discuss:

00:00 Intro: Creatine Isn’t Just for Gym Bros Anymore
01:30 What Creatine Actually Does Inside the Cell
03:45 Creatine as a Cellular Energy Buffer
05:00 The “Methylation Tax” Explained
06:00 Why Modern Life Increases Energy Demand
07:00 The Sympathetic Spiral of Doom
08:15 Should You Take Creatine Forever?
09:15 Muscle as a Metabolic & Endocrine Organ
11:00 Why Muscle Mass Matters for Aging & Resilience
13:00 Creatine, Vegetarian Diets & Protein Intake
16:45 Creatine for Brain Energy & Cognition
18:30 Why the Brain Needs Phosphocreatine
20:00 Neurotransmitters, Glutamate & Mitochondria
21:15 Is Creatine a Universal Nootropic?
22:00 The HOMeHOPe Perspective on Energy & Balance
24:30 Final Thoughts & Closing Remarks

Full Transcript:

[00:00:00] Boomer Anderson: Welcome back, everybody- Oh, yeah ... to another episode of the Health Optimization Medicine podcast. I've got the doctors, not to be confused with the TV show, Dr. Scott Sherr, Dr. Allen Bookatz, Dr. Ted Achacoso. Welcome back, guys. I wanna start this podcast with just, like, a little bit of powder, white powder. Ooh.

[00:00:49] Boomer Anderson: Don't harass me. Don't harass me. Don't, don't, don't do it. All right. Don't do it. Don't do it. Don't do it? Don't do 

[00:00:53] Dr. Scott Sherr: it. 

[00:00:53] Boomer Anderson: Should I do 

[00:00:53] Dr. Scott Sherr: it? Don't do it. Oh, don't do it. Come on, Jim Bro. What is it called? Dry, dry something. What is this? 

[00:00:57] Boomer Anderson: Dry, dry. Like, dry, dry- It's not dry heaving. Dry, not dry aging. Dry, dry [00:01:00] hurling. Um- 

[00:01:00] Dr. Scott Sherr: Dry- 

[00:01:01] Dr. Allan Bookatz: Dry socket

[00:01:02] Boomer Anderson: so here's- Something ... an interesting thing. In my hand right now, and, you know, this brand does not sponsor the show, but, you know, in my hand right now, I can tell you- Not yet ... 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.

[00:01:23] Boomer Anderson: 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, 

[00:01:35] Dr. Allan Bookatz: vegetarian diets, can't forget those- 

[00:01:37] Boomer Anderson: Mm-hmm ... and conditions where the brain or muscle is struggling to meet energetic demand.

[00:01:41] Boomer Anderson: Ladies and gentlemen, what are we gonna talk about today? 

[00:01:44] Dr. Scott Sherr: Boomer. 

[00:01:45] Boomer Anderson: Oh Vitamin B. I don't know. Vitamin B, baby. Actually, we're gonna be talking about creatine, and it's not just for gym bros anymore. Let's talk about where we're gonna go through this episode. First, I wanna touch a little bit on creatine and what it actually does.

[00:01:59] Boomer Anderson: Of [00:02:00] 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 gonna get a little bit- Creatine maxing ... into ... Creatine maxing, just like life maxing. Uh, we're gonna get- Fiber maxing, 

[00:02:16] Dr. Scott Sherr: looks maxing, you know?

[00:02:17] Boomer Anderson: Oh, man. He's maxing. A lot of maxing, you 

[00:02:19] Dr. Scott Sherr: know? All right. Well- There's 

[00:02:19] Boomer Anderson: a lot of maxing ... so first we're gonna look at what creatine actually does in the cell. Second, we're gonna look at creatine through health optimization medicine perspective. How does it affect things like cellular energy, amino acid metabolism, methylation, et cetera?

[00:02:32] Boomer Anderson: And then we're gonna talk about dosing, timing, form that may benefit most. But before we get started, guys, I wanna talk about Scott's most offensive comment- Me offensive? ... on social media ever. 

[00:02:43] Dr. Scott Sherr: Actually, 

[00:02:43] Boomer Anderson: I- This is why 

[00:02:43] Dr. Scott Sherr: creatine doesn't work for me, I think. This 

[00:02:45] Boomer Anderson: is the deal Yeah, yeah. So, so actually I shouldn't say most offensive.

[00:02:48] Boomer Anderson: I don't need to reserve, damn it. 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. Hmm. Now, Scott, how do you feel [00:03:00] about that? 

[00:03:01] Dr. Scott Sherr: I felt I felt like I wasn't being seen, you know? 

[00:03:06] Boomer Anderson: Oh, that's, that's so excellent. 

[00:03:09] Dr. Ted Achacoso: All, all, all they needed to do was to lift their shirt up and show that you actually had, you know, a two millimeter layer of fat on your abs.

[00:03:19] Boomer Anderson: There you go. That 

[00:03:19] Dr. Ted Achacoso: would have settled it. 

[00:03:21] Boomer Anderson: Scott, you got a lot of work to do on that two millimeters. Um, so- 

[00:03:24] Dr. Scott Sherr: My body fat percentage was just wasn't good enough, you know? And bicep to body fat percentage ratio, I don't know what- 

[00:03:31] Boomer Anderson: Hmm ... 

[00:03:31] Dr. Scott Sherr: you know, it's one of those- We're, 

[00:03:33] Boomer Anderson: we're inventing terms here today ... 

[00:03:34] Dr. Scott Sherr: I, I love j- there should be, there should be a ratio there.

[00:03:37] Dr. Scott Sherr: Like, you know, if you have a certain body fat percentage. Anyway, I'm just... I, I was, I was surprised, yet- I'm not surprised because the person that I was interviewing with, you know, is, had a lower body fat percentage than me, but much larger biceps, right? Mm. So yeah. So there you go. So, 

[00:03:52] Boomer Anderson: all right. Uh, uh, perhaps you should have been taking today's supplement.

[00:03:55] Boomer Anderson: So we're talking about creatine, right? I 

[00:03:56] Dr. Scott Sherr: do. 

[00:03:57] Boomer Anderson: Uh- I do take it ... let's get a little bit [00:04:00] into what creatine is, and we're gonna talk here from the cellular battery buffer. Uh, Dr. Ted, can you take us through the creatine story and what it is? 

[00:04:08] Dr. Ted Achacoso: That should be, uh, very simple to understand if you don't like to deal with, uh, all of the enzymes that deal with this biochemistry.

[00:04:15] Dr. Ted Achacoso: You know, you, you treat this as a rechargeable battery pack. ATP is actually the main energy source, right? And, uh, but it's actually also very depleted rapidly inside a cell. Remember in HOMeHOPe, we're looking at what's going on inside a cell. So what, um, uh, creatine does is that it actually binds with a phosphate group.

[00:04:35] Dr. Ted Achacoso: It becomes phosphocreatine, which becomes rapidly diffusible as a small molecule, and then it becomes what's called a phosphate donor, right, uh, to the, uh, ADP, which can then be pressed into ATP in the mitochondria. So what, that's, uh, that's simple. That's what it is. It's a rechargeable battery pack. But if you want to know what, um, or what, what really happens a little bit more, you know, there's a [00:05:00] cost of actually, um, uh, produce, uh, producing, uh, ATP...

[00:05:04] Dr. Ted Achacoso: uh, ADP- Mm ... back to ATP, right? It's called the, the methylation tax. And the body uses a lot of SAMe or S-adenosyl methionine to do that. Uh, remember, you know, you know, many years ago when it was vogue in Hollywood to like, oh, let's take SAMe for as an antidepressant. Well, actually- Mm ... it just actually increased the energy production in your brain because it improved the methylation, right?

[00:05:27] Dr. Ted Achacoso: But that's what called the methylation tax, uh, you know, when you're actually trying to produce a lot of, um- Tax 

[00:05:33] Boomer Anderson: man ... ATP. 

[00:05:34] Dr. Ted Achacoso: So if, uh, what creatine does is that it becomes, uh, phosphocreatine when it binds the phosphate, and then phosphate is immediately donated, right? Without imposing the, uh, methylation tax on the cell.

[00:05:47] Dr. Ted Achacoso: So that's what it does, right? It's, it's just a rechargeable battery pack. That's how you think about 

[00:05:52] Boomer Anderson: it. Okay. So, uh, thank you for that, and I, I really appreciate how simple of an explanation, even though it was biochem- Mm ... that was. [00:06:00] Let's go, let's go a little bit- Call it in ... into the health- Like the tax man

[00:06:02] Boomer Anderson: optimization medicine, uh, framework. Yeah, we can call up the tax man. It's just past April 15th. All of us have paid our taxes, hopefully. Uh- Or 

[00:06:09] Dr. Scott Sherr: working 

[00:06:10] Boomer Anderson: on it ... but let's go through- We filed 

[00:06:11] Dr. Scott Sherr: for extensions, you know, a few 

[00:06:12] Boomer Anderson: of us ... yeah, the health optimization medicine framework. Detect and correct, of course, as well as reassess.

[00:06:18] Boomer Anderson: How do we look at creatine within that health optimization operating system? 

[00:06:23] Dr. Scott Sherr: Well, I think the, uh, what, what Ted was describing is important, right? We, 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.

[00:06:40] Dr. Scott Sherr: But when we're looking at- optimizing somebody's mitochondria, we're looking at a nutrient optimization strategy, vitamins, minerals, you know, enzymatic processes, the gut, neurotransmitters, hormones that are all responsible for maintaining mitochondrial function, antioxidant capacity, oxidative stress, et cetera.

[00:06:59] Dr. Scott Sherr: And [00:07:00] so that's the primary, right? Because y- you don't wanna give creatine to a system that's really, really being taxed because creatine's not the, like, the answer, right? It's, it's a, 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, our system typically because we're in sympathetic all the time.

[00:07:21] Dr. Scott Sherr: 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, norepinephrine, epinephrine kind of stimulating mitochondrial function day in, day out, 365, 24/7. There's a s- there's a couple songs about this probably.

[00:07:38] Dr. Scott Sherr: Did 

[00:07:38] Boomer Anderson: you, you only do 24/7? You're 

[00:07:40] Dr. Scott Sherr: not hustling. I mean, I know, exactly. You know, 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 [00:08:00] people now to help them feel better.

[00:08:01] Dr. Scott Sherr: 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, right? So, 

[00:08:08] Dr. Ted Achacoso: uh, I mean- Yeah, I, I actually, I want to, just wanted to add quickly to that. The bo- the body has its own reserves of creatine, right? 

[00:08:16] Dr. Scott Sherr: Yes. 

[00:08:16] Dr. Ted Achacoso: But in order to create creatine, that's where you actually exert the methylation tax, right?

[00:08:21] Dr. Ted Achacoso: So you're, you're probably going to use about 40% of your body's SAMe to, to produce the extra creatine. And so then that's when supplementation, uh, right, becomes, uh, uh, actually almost necessary, uh, especially for this world that we have created, right? We have, uh, we have created a very, very sympathetic world that was very different from us during the evolutionary times, right?

[00:08:45] Dr. Ted Achacoso: So we, uh, we have turned night into day. We have, you know, we have all of these activities and poisons, et cetera, which actually require energy. And where will the body get the energy from? It's from ATP, right? And, and then when there is not enough, [00:09:00] uh, ATP, then phosphocreatine is, is, um, uh, uh, donates its phosphate, right?

[00:09:05] Dr. Ted Achacoso: Mm-hmm. To produce ATP. But then, then we need now more creatine, right, uh, to do that, and that's where you're gonna use, uh, 40% of your SAMe to produce more creatine, and that actually makes for the argument for supplementation. 

[00:09:18] Boomer Anderson: All right. So one question- Hmm ... that commonly comes up about creatine is should I be on creatine forever?

[00:09:24] Boomer Anderson: And, you know, uh, from a HOMeHOPe perspective, how do we kind of look at this? Is there better questions that we should be asking? 

[00:09:31] Dr. Allan Bookatz: That's a, that's a great question. I think I'll, I'll take that one. So one of the, one of the things that we see... Oh, so when we think about creatine, right? I think it actually is somewhat helpful to, to, you know, pay homage to, you know, its origins, at least in the, you know, in the, in the world of how it, it became popular, which was the, the bodybuilders, right?

[00:09:52] Dr. Allan Bookatz: And so, um, what's fascinating is that what... You know who, you know who you don't see come to the ER and fall that have hip- you know, [00:10:00] that who have hip fractures? People that have a lot of muscle. So I think that we probably should, you know, I know there's a lot of, uh, discussion right now with creatine and its, you know, its ability to help with sleep deprivation, and brain, and, and like Dr.

[00:10:18] Dr. Allan Bookatz: Ted said, it, it helps with offloading the methylation pathways and, uh, allowing the body to focus on other, other priorities, uh, you know, in a, in a overly sympathetic state. But if we go back to muscle, um, muscle is not necessarily cosmetic as we, as c- it, it's not necessarily a cosmetic organ like maybe skin and face, and I would challenge our, our listeners here to think of- Something to a degree, 

[00:10:43] Dr. Scott Sherr: you know?

[00:10:43] Dr. Allan Bookatz: Well- Maybe. It could be, yeah. 

[00:10:45] Dr. Ted Achacoso: Oh, uh, you, you mean, you mean, Alan, when you take off your shirt- 

[00:10:48] Dr. Allan Bookatz: Some people call 

[00:10:48] Dr. Ted Achacoso: it primarily ... when you take off your shirt off the beach, you say, "These muscles are for show. They're not for fucking work." 

[00:10:54] Dr. Allan Bookatz: Well, maybe they're a little bit for both. Glamour muscles. Glamour. A little bit for both.

[00:10:57] Dr. Allan Bookatz: Those 

[00:10:57] Dr. Scott Sherr: biceps, man. Come 

[00:10:59] Dr. Allan Bookatz: on. Well, [00:11:00] if we start to think of our muscles as actually an organ, like maybe like an endocrine organ as Dr. Ted said, it's, you know, more of our amino acid reservoirs. And so our body draws upon muscle proteins as, as we see during things like illness and surgery and, and when we're stressed, what happens, right?

[00:11:17] Dr. Allan Bookatz: 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, um, opposing, is our pancreas. So it's the tissue that absorbs and sucks up the glucose from our, um...

[00:11:39] Dr. Allan Bookatz: Or sorry, it, it's an adjunct to our, we'll call it, to our, um, our pancreas, right? And so it, it sucks up the extra glucose that's hanging around, um, that our pancreas can't necessarily produce enough insulin to, um, to, to capture and to drive into our cells. And so in addition to being this really cool fall prevention system, um, it actually [00:12:00] ends up being this, um, a really, a, a metabolic determinant of resilience that, uh, we haven't really considered, or at least we haven't talked about on this show, uh, in, in quite some time.

[00:12:10] Dr. Ted Achacoso: You know, that's actually a more recent concept that's only, uh, come up, like, in the past decade or so, where your actual matter, uh, muscle mass is actually... Look, you- 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 we were medical students, it's all about the thyroid.

[00:12:29] Dr. Ted Achacoso: The thyroid is, is the throttle, you know, when like we're, we're flying a plane, and so on. But then you notice that, uh, actually it's the muscle mass that actually also determines, like, the other half of your metabolic rate, right? So, uh- Yeah ... and that was an interesting shift in perspective for me- 

[00:12:45] Boomer Anderson: Mm ... 

[00:12:45] Dr. Ted Achacoso: when, you know, uh, when patients ask you why should, uh, especially women, um, who are in my age demographic, who don't like any muscle.

[00:12:54] Dr. Ted Achacoso: And I said, "No." I said, "You are getting older. You need all the muscle that you can get." [00:13:00] 

[00:13:00] Dr. Allan Bookatz: Yeah. Well, what's... 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're going to receive all of these wonderful benefits, uh, at least the, some of the metabolic benefits that we're talking about here.

[00:13:14] Dr. Allan Bookatz: 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, a signal and a substrate. So it looks, you know... And, 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.

[00:13:37] Dr. Allan Bookatz: 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 it the linchpin of where creatine falls in, you know, in that overall, um, you know, we'll call it the foundational framework for how we think about, um, how it could help with someone's [00:14:00] resilience.

[00:14:00] Dr. Allan Bookatz: And so- But we need training, we need the right amount of protein, and then we need, uh, the creatine. And of course, we can't forget sleep. And we talk about, Dr. Scott talks about the sympathetic spiral of doom. And, um, if we don't have the recovery window, then we then the time that we actually- Yeah ... uh, spend in adaptation- Yeah, yeah

[00:14:19] Dr. Allan Bookatz: doesn't occur. Yeah. And so we can't actually even build the muscle. That's right. That's 

[00:14:22] Dr. Ted Achacoso: right. So- And you know- Yeah ... um, I actually, uh, worked with a lot of bodybuilders before, right? And this was like, uh, so, 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?

[00:14:38] Dr. Ted Achacoso: It's, it's, it's, you know, it's like, no, you know, you, you're showing off your abs and everything else. Yeah. No, you should look like that when, you know- If, if you're 28- Mm-hmm, 

[00:14:45] Boomer Anderson: mm-hmm ... and not 7%, not sub 10% body fat, don't call Dr. Ted. Yeah. 

[00:14:49] Dr. Ted Achacoso: And, you know, and, and then it's like, you know, try looking at those who actually have, they still have washboard abs and they're past 50.

[00:14:56] Dr. Ted Achacoso: That's, you know, how you would like to look like, you know? When, [00:15:00] when you're, when you're young- Mm-hmm ... between 21 and 30 years old, you should look like that for fuck's sake. But anyway- ... uh, where it made a, a really, uh, impression for me, uh, uh, are actually in, uh, uh, those who eat very little protein, right?

[00:15:13] Dr. Ted Achacoso: Yeah, yeah. Um- Vegetarians especially ... and those, those are, um- Yeah, vegans ... on, on high carb, uh, diets, right? Especially, um, vegetarians who eat very little protein and then would eat a lot of, uh, plant-based carbohydrates in the form of bread, right? So a- and that actually, um, made an enduring mark in my practice.

[00:15:34] Dr. Ted Achacoso: It's like this is where I could ac- ac- actually there's this, this, uh, uh, clinical instead of per- for performance or, or for looks or anything like that. This one's actually helping a lot, uh, especially for, for older people. You know, uh, uh, Alan knows this, that, you know, the, the usual, uh, cause of the breaking of bones during a fall is not because they fell and the, the bones actually hit the ground, but it's a [00:16:00] failure of grasping, right?

[00:16:01] Dr. Ted Achacoso: A failure to grasp and actually support, and that is muscular, right? So it's like, uh... And that's, uh, hand strength. You know, they also, aside from hand strength, they lose balance, so you combine that with, with weak muscles and then the poor balance, you know, unable to break their fall. Then they, uh... At first we thought it was actually, you know, with the brittle bones.

[00:16:20] Dr. Ted Achacoso: It's not. It's actually from weak muscles. So that's where, where, um, uh, giving creatine actually made a mark in my practice. 

[00:16:27] Dr. Scott Sherr: Yeah. Uh- Looking at the studies, I was looking at 10... The- the, you know, vegetarians have 10 to 30% lower levels of creatine than people who eat meat. Hmm. Um, so they have less buffering, they have more f- fatiguing of muscles.

[00:16:41] Dr. Scott Sherr: 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. 

[00:16:54] Boomer Anderson: Okay. I, I wanna ch- uh, kind of do a little bit of a- uh, kind of dance [00:17:00] around the muscle conversation in creatine and kind of go into the brain conversation in creatine.

[00:17:04] Boomer Anderson: Oh. And this is one that I would say has come online a lot more in recent months, recent years. Uh, 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, uh, with it taking a large share of the body's energy, how does creatine play the role here?

[00:17:28] Boomer Anderson: Because this is also an interesting conversation. We have to be careful. How do we look at, you know, brain cognition in creatine, and what's the role of creatine there? 

[00:17:38] Dr. Ted Achacoso: Because creatine is actually a small molecule, uh, it can actually, uh, diffuse into the brain space and adds to the energy production of, uh, the brain.

[00:17:49] Dr. Ted Achacoso: The neurons actually are one of the first to die, uh, you know, uh, what ... uh, during, uh, cell death, right? The heart, uh, the brain, the kidneys. Why are they, why do they die [00:18:00] so quickly? Because they have so much mitochondria. 

[00:18:02] Dr. Scott Sherr: Yeah Right? 

[00:18:02] Dr. Ted Achacoso: Mitochondrial density, yeah. And they s- they actually need a lot of energy for- Mm

[00:18:05] Dr. Ted Achacoso: for work. And so neurons actually ... You know, muscles have a lot of glycogen, but neurons don't have glycogen. Uh, which are, you know- They can't store 

[00:18:13] Dr. Allan Bookatz: energy. 

[00:18:14] Dr. Ted Achacoso: Yeah. They cannot, they cannot store, uh, energy, right? So they actually rely on phosphocreatine, you know, for, um, during intense cognitive loads, sleep deprivation, metabolic stress, right?

[00:18:25] Dr. Ted Achacoso: And even if the phosphocreatine diffuses slowly, uh, the, there is a decrease in, um, in cerebral stores of, uh, phosphocreatine. So it, it mitigates mental fatigue, uh, you know, supports your working memory, provides you the protection, uh, against ischemic events, right? Or, or even, uh, actually brain trauma, right?

[00:18:44] Dr. Ted Achacoso: Yeah. Yeah. So you could see, you could see this that, you know, um- It's really, really important ... in hunter-gatherer societies, you know, we, we have a lot of, uh, red meat and fish, which is, uh, uh, has pre-formed creatine, right? But now we, with your plant-based diets, they're severely deficient in, uh, the [00:19:00] compound, and we are observing the evolutionary mismatch that way, right?

[00:19:04] Dr. Ted Achacoso: Mm. So, uh, so it's, it's like your health span, not just only your lifespan, but your health span, right? So as you can see, all of these, uh, kinds of things, uh, you would see the need for creatine 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 to 2,000 mitochondria per cell.

[00:19:30] Dr. Ted Achacoso: Wow. Whereas the body's average mitochondrial, uh, count is about 500 per cell. And of course, the cells in the body that don't have mitochondria are your red blood cells, right? So, so you could see there the discrepancy of having any 1 to 2,000 mitochondria versus just, uh, uh, 500 in an average cell. So you see there that, that, uh, actually the great need for creatine in those s- uh, cells.

[00:19:52] Dr. Scott Sherr: Yeah. Yeah, I also see here some, uh, uh, GABA. You know, there's a couple things with actually neurotransmitters themselves and how creatine modulates, including [00:20:00] supporting glutamate reuptake, so that reduces excitotoxicity. So a lot of glutamate around, you can have excitotoxicity compared to the GABA levels.

[00:20:07] Dr. Scott Sherr: You know, glutamate and GABA are always trying to be in balance. There's also stabilization of neur- of neuronal membrane potentials, which is extremely important as you're trying to, you know, enhance and modulate signaling. Um, and then also modulates dopamine signaling as well. So I think that these, these are probably maybe dir- indirectly related to its energy production capacity, but this is when you're actually looking at it from a neuron, uh, from a neuron, m- an actual neuron itself.

[00:20:30] Dr. Scott Sherr: What happens when energy's more effectively being used is that neurotransmission's gonna be more effective. Membrane potential's gonna be more effective. So I get this question a lot actually recently, which was I had somebody that came in, uh, a patient of mine, not a... Actually, somebody who's consulted with me.

[00:20:44] Dr. Scott Sherr: He had an in- he had taken an antibiotic. He took minocycline, which is like these, one of these old, uh- Mm-hmm ... tetracycline antibiotics and some. And, uh, he got this really weird symptom where he would get this brain fog, hungover feeling. Um, and he was reading into [00:21:00] glutamate and GABA sensitivity, and, like, it's a very specific type of neuron that gets affected by this particular drug, which is interesting.

[00:21:05] Dr. Scott Sherr: 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 for people to realize that many times when we have, like, you know, biochemical or, like, you know, or neurotransmitter issues, oftentimes it's, it's, it's mitochondrial and energy that are the problem.

[00:21:23] Boomer Anderson: Well, actually, we've kind of wrapped up a, a lot on- Mm-hmm ... here on creatine. So when we think about creatine, suffice to say it's not a nootropic for everybody, right? And, and it's not the universal nootropic. We're not talking here about NZT 48, 148. 

[00:21:37] Dr. Scott Sherr: Um- Or blue 

[00:21:37] Boomer Anderson: cannatine 

[00:21:37] Dr. Scott Sherr: for that matter, 

[00:21:38] Boomer Anderson: you know? Yeah, exactly.

[00:21:39] Boomer Anderson: Uh, but- 

[00:21:40] Dr. Scott Sherr: The legal equivalent. 

[00:21:41] Boomer Anderson: You know- Yeah ... w- it, it seems to have a role when the body's certainly stressed, uh, 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 wanna do in sort of the HOMeHOPe perspective and how this kind of fits into the framework?

[00:21:58] Dr. Ted Achacoso: Uh, yes. [00:22:00] Well, w- w- you know, uh, in, in, uh, in, in, in the, at this I, I delivered this three, three, three, sub three lecture, which you guys are already vomiting because you've already memorized it. But, uh, in order to make, um, uh, things clinical, right? Towards the end, how do you actually make these things clinical?

[00:22:16] Dr. Ted Achacoso: 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- Mm-hmm. Mm-hmm ... uh, uh, you know, uh, uh, clinical, is if you actually think of, uh, of, uh, creatine as belonging to the energy production part, right?

[00:22:41] Dr. Ted Achacoso: We, you can actually just divide the body into two parts One part that if, that actually, um, uh, produces energy, and the other part that consumes energy. So, but we have created a world or a context actually inc- uh, uh, uh, increases, uh, you know, uh, the need for energy in order to maintain structure and function, and therefore, uh, [00:23:00] uh, this is how we actually view, uh, you know, the, the role of creatine here is the energy production part, right?

[00:23:06] Dr. Ted Achacoso: And then the other one is balance, right? Uh, not all of us are bodybuilders, but we would like to preserve our muscle mass until we are, uh, in, in, uh, right chronological age or, and right, you know, uh, depending. But, uh, because of, you know, our, our, our body structures, uh, actually, uh, age differently, but we are concerned with the aging of the cell.

[00:23:27] Dr. Ted Achacoso: And the way the cell actually prevents itself from damage, right, is it uses energy to detoxify itself, right? It, it, uh... So essentially, all of these, uh, things that it produces, it, you know, e- 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.

[00:23:47] Dr. Ted Achacoso: And so when you are, for example, defending yourself from a, from, from a cold or, or, or, or something like that, if you have sufficient energy stores, you will be resilient and actually recover quickly. So for us, if you [00:24:00] just have a balance, right, uh, of that, not necessarily a surplus, but just a balance of how your energy's produced and how your energy's consumed, then you would have this, uh, dynamic equilibrium that actually goes inside the cell, right?

[00:24:14] Dr. Ted Achacoso: It's not, not, not really a surplus, not really, uh, a, a starvation, uh, 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 a cell also fucking requires energy, right? So, uh, so that's the, the way you look at it from a whole, whole perspective, right?

[00:24:37] Dr. Ted Achacoso: From an evolutionary lens, from an energy, uh, uh, perspective, and from the balance, uh, between the energy production and the structure function that the energy has to maintain. So that's how we look at it, uh, in HOMeHOPe. All 

[00:24:51] Boomer Anderson: right. Uh, to wrap things up, I have to ask Scott, how did you react on the day you heard that you were a sarcopenic doctor?

[00:24:58] Dr. Scott Sherr: Man, [00:25:00] 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. 

[00:25:18] Boomer Anderson: 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.

[00:25:25] Boomer Anderson: All right, um, to everybody tuning in here, this has been another fun episode of the Health Optimization Medicine Podcast. Scott is actually just- Ah ... going through a fit of enlightenment right now. I don't know. And so, uh, we'll sign off here. If you enjoyed this episode, please hit the like button, leave a comment.

[00:25:43] Boomer Anderson: Let us know what you thought, favorite questions, g- uh, things that you want answered the next time. Uh, smash subscribe too, and just let us know what you think. Smash it, yeah. Leave five star, r- leave five star reviews on Apple Podcast, Spotify, or wherever you listen to podcasts. This has been, uh, Dr. [00:26:00] Scott, the laughing man, uh, Dr.

[00:26:02] Boomer Anderson: Alan, as well as Dr. Ted signing off. Have a good night

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