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Introduction
I have been weightlifting since my early 20s and have always appreciated the extra strength it provides for my athletic endeavors. My body always responded to it in proportion to the effort I put in. Lately, however, with my Lyme disease and Parkinson’s, I have been weak and have had trouble training as hard. The critics on my home front tell me that I am getting old, but I am hoping that I will improve if I control my medical problems. I am not asking for a miracle, but it would be nice if I could get my bench press over 120 lb for 8 repetitions and my gym climbing up past 5.8 again.
Prior to the last few years, I ignored supplements except testosterone replacement. I have used this since my mid-40s, when I had a critically low testosterone blood level of 200 ng/dL. I blamed it at the time on my stressful career in cosmetic surgery, which involved dealing with all those darn women! I could not have done it without Judy.
I have known about creatine for decades and had it repeatedly suggested to me, but until yesterday, I was a creatine virgin. When I mixed it in kefir, I found out how easy it was to take. I also started growth hormone last week, and I am hoping that this, plus some peptides and the creatine, will lift my spirits, energy, and response to exercise. Growth hormone at life extension or supplement doses is no miracle, and I don’t feel anything yet. Thirty years ago, when I took testosterone and growth hormone together, I became a little inappropriately flirtatious with some of my patients.
Summary
• Creatine is a small molecule that the liver and kidneys make from arginine, glycine, and methionine. About 95 percent is in skeletal muscle, with smaller pools in the brain, heart, and pancreas.
• The cell uses creatine phosphate to rebuild adenosine triphosphate (ATP) during the first 10 to 15 seconds of all-out work. Oral supplementation raises the muscle reservoir by 10 to 40 percent.
• Monohydrate is the form to use. 700-plus studies stand behind it. Hydrochloride, ethyl ester, nitrate, and other variants cost more and offer no advantage.
• Daily 3 to 5 grams saturates muscle in 3 to 4 weeks. A loading phase of 20 grams a day in 4 doses for 1 week reaches the same point in 7 days. 5 grams is roughly 1 rounded teaspoon.
• Brain effects need higher and longer dosing. Studies on cognition, sleep deprivation, and Parkinson’s have used 10 to 25 grams a day. Animal data show creatine pre-loading reduces brain damage by up to 50 percent after experimental head injury.
• Most commercial creatine comes from China. Half of randomly tested products exceed European safety thresholds for at least 1 organic contaminant. The German Creapure brand from AlzChem is the only Western producer and the cleanest material on the market.
How creatine works
Creatine is a small nitrogen-containing compound the liver and kidneys synthesize from 3 amino acids: arginine, glycine, and methionine. The adult body holds 80 to 130 grams of it. About 95 percent is contained in skeletal muscle. The brain, heart, and pancreas hold the rest. Daily turnover is 1 - 2 grams, replaced through diet (red meat and fish) or internal synthesis.
Inside the cell, creatine kinase attaches a phosphate group to creatine, forming phosphocreatine. When a muscle contracts, ATP breaks down into adenosine diphosphate (ADP) and releases a phosphate group. Phosphocreatine then donates a phosphate back to ADP, regenerating ATP within milliseconds. This shuttle handles the first 10 to 15 seconds of all-out work. After that, glycolysis takes over, then aerobic metabolism for sustained output.
The cell holds more phosphocreatine than the diet alone delivers. Oral creatine pushes the muscle reservoir up by 10 to 40 percent. The bigger reservoir means more sprints, more reps, faster recovery between sets, and somewhat heavier weights moved over a training cycle.
Time course of effects
Loading and steady dosing both lead to muscle saturation. The loading phase is 20 to 25 grams a day, split into 4 servings of 5 grams each, for 5 to 7 days. Muscle reaches full creatine stores by the end of the first week.
Steady dosing is 3 to 5 grams a day from the start. The same saturation point arrives at 3 to 4 weeks. Loading produces faster results and a slightly larger initial weight gain. Skipping the load avoids the gastrointestinal upset some people get from large single doses.
Once stores fill, they drain slowly. Stop taking creatine and muscle stores fall back to baseline over 4 to 6 weeks. Strength gained during the period stays as long as training continues.
Strength, weight, and exercise response
Most studies show 5 to 15 percent increases in maximum power during short, repeated bouts of work. Strength tests, vertical jump, sprint times, and bench press all respond. Endurance exercise for more than 20 minutes shows little to no benefit because the phosphocreatine system has long since shut off.
The first week brings 1 to 4 pounds of weight gain. This is water pulled into muscle cells along with the extra creatine. The cells swell, which itself triggers protein synthesis. Over weeks and months of training, lean tissue follows.
Without resistance training, creatine still increases muscle stores and offers some recovery and cognitive benefits, though strength and lean-mass gains depend on lifting weights. Carbohydrate taken at the same time improves uptake by raising insulin, which signals muscle to absorb creatine more aggressively. Taking a small amount of protein with the dose adds to this effect.
Testosterone, growth hormone, insulin-like growth factor 1 (IGF-1), and thyroid all push muscle to use creatine more efficiently. A man with low testosterone who corrects the deficit will see a much larger response to creatine than the same man before correction. Adding growth hormone to the mix should compound the effect.
Effects on the brain
The brain is a 2-percent-of-body-weight organ that consumes 20 percent of the body’s resting energy. It depends on the same phosphocreatine shuttle as muscle. Brain creatine, however, is harder to raise than muscle creatine because the blood-brain barrier slows uptake. Standard 3-to-5-gram daily doses produce small or undetectable changes in brain creatine over a month.
Studies on cognition and sleep deprivation have used 10 to 25 grams per day, or single high-bolus doses of 0.35 grams per kilogram (around 25 grams for a 70-kilogram man). At those doses, brain phosphocreatine and ATP rise, and cognition under stress (sleep loss, hypoxia, mental fatigue) improves. A 2024 Scientific Reports study by Gordji-Nejad and colleagues showed a single 0.35 g/kg dose reversed metabolic and cognitive decline during 21 hours of sleep deprivation.
Depression studies, mostly in women, show that creatine added to standard antidepressants improves response. The mechanism is the same: better cellular energetics in neurons running short of fuel.
Parkinson’s and other neurological diseases
Mitochondrial dysfunction is central to Parkinson’s pathology. Dopaminergic neurons in the substantia nigra fail because their energy machinery falters, and creatine supports that same machinery. Mice given oral creatine before exposure to a classic Parkinson’s-inducing toxin (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, abbreviated MPTP) showed protection of dopamine neurons in early animal-model work.
The Neuroprotection Exploratory Trials in Parkinson's Disease (NET-PD) pilot gave 60 patients 10 grams of creatine a day for 2 years. Treated patients showed improved mood and a smaller increase in dose of dopaminergic medications than the placebo group. This led to NET-PD Long-term Study 1, published in the Journal of the American Medical Association in 2015. About 1,700 patients with early Parkinson’s took 10 grams of creatine a day or a placebo for 5 years. The trial stopped at the planned interim futility analysis, and creatine did not slow clinical progression on the Unified Parkinson’s Disease Rating Scale (UPDRS).
Brain effects scale with higher doses than muscle effects, and 10 grams a day is at the low end of what crosses into brain tissue meaningfully. The trial did not test 20 or 25 grams. The negative result is a verdict on a dose, not a verdict on the compound.
Some Parkinson’s specialists still recommend creatine. The safety profile is excellent, the energetic rationale is strong, and a failed primary endpoint does not rule out benefit at higher doses. Creatine produced no harm in 5 years of daily use at 10 grams a day, which is itself a useful data point.
In Huntington’s disease, creatine showed early animal-model promise but failed human trials at similar doses. Trials in amyotrophic lateral sclerosis (ALS) have also been negative. Across these conditions, the same pattern recurs: animal models show benefit, human trials at conventional doses do not. Whether higher doses would change the result remains unanswered.
Traumatic brain injury and football
The metabolic crisis that follows a concussion resembles a brief energy famine. ATP drops, calcium floods cells, glutamate floods synapses, and the brain spends days to weeks repairing the damage. Cerebral creatine concentrations fall after even mild head injuries. The rationale for creatine pre-loading in collision-sport athletes follows directly from this picture.
Rats given creatine before experimental head trauma show up to 50 percent less neuronal damage than controls. Cellular ATP holds up better, and cognitive recovery proceeds faster. A 2023 systematic review of human and animal data concluded that creatine offers neuroprotection when given as prophylaxis. Results are more reliable than when the supplement is started after injury.
Human concussion trials are sparse but encouraging. A pediatric traumatic brain injury (TBI) study using 0.4 g/kg/day for 6 months reduced post-concussive symptoms (headache, dizziness, fatigue) compared with controls. Professional football and hockey players have been taking creatine for decades, partly for performance and partly on the hope of head-injury protection.
The effect on tissue swelling after injury is indirect. The compound itself pulls water into cells (intracellular swelling). After a contusion or muscle tear, this same property helps cells maintain volume and ATP levels throughout the healing phase. Exercise-induced muscle damage markers (creatine kinase in blood, myoglobin, soreness scores) all run lower in creatine users than in controls. A 28-day pre-loading protocol of 3 grams per day reduced post-exercise soreness and inflammation in a recent randomized trial highlighted by Schwarzenegger.
Sourcing and purity: the China question
The global creatine market is a Chinese industry with a single Western exception. AlzChem GmbH, in Trostberg, Germany, is the only commercial creatine manufacturer outside Asia. Its product, Creapure, undergoes batch-by-batch high-performance liquid chromatography (HPLC) testing and meets the Food Safety System Certification (FSSC) 22000 standard. Purity runs above 99.9 percent. Dicyandiamide (DCD) stays under 20 mg/kg against a European Food Safety Authority (EFSA) limit of 50 mg/kg, and dihydrotriazine (DHT, a potentially harmful manufacturing byproduct) is undetectable.
Chinese product is not uniformly bad. Reputable Chinese manufacturers with HPLC-tested batches produce material indistinguishable from German output. Traceability is the weak point: most retail tubs ship without a verifiable chain of custody back to the synthesis plant.
A peer-reviewed survey of 33 commercial creatine products found that 50 percent exceeded EFSA-referenced thresholds for at least 1 organic contaminant. Common impurities include creatinine (an indicator of degraded material), DCD, and DHT. None is acutely toxic at typical levels, but DHT is the one chemists worry about.
The Creapure logo on a tub is the simplest quality marker. Brands that license Creapure pay extra for it and advertise the relationship. Generic creatine monohydrate with no source disclosure is a coin flip on purity.
Glycine, by comparison, is uniform across the market. The molecule is too simple to adulterate profitably, manufacturing produces few problematic byproducts, and pharmaceutical-grade glycine from any source meets the same specifications. Creatine is not in that category. Source matters, and at high doses for neurological use, it matters more.
The Orgain product I bought at Costco
Orgain Micronized Creatine Monohydrate sells at Costco for around $17 in store, or $22 online with shipping. The 1.48-pound (23.8-ounce) tub holds 135 servings of 5 grams each, which works out to roughly $0.13 to $0.16 per dose. The label says “banned substance tested,” which addresses doping concerns but not manufacturing impurities. The product does not carry the Creapure logo, so the source is most likely Chinese.
Customer reviews report decent solubility (consistent with micronized particle size) and no off-taste or grit. For general muscle and recovery use at 5 grams a day, the product is reasonable. For high-dose neurological use at 15 to 25 grams a day, a Creapure-licensed brand is the more conservative choice. Momentous, Thorne, MyProtein Creapure, and NOW Sports Creapure all carry the German material.
Why monohydrate is the form to use
Creatine monohydrate has 700-plus peer-reviewed studies behind it. Every other form (ethyl ester, hydrochloride, nitrate, magnesium chelate, buffered Kre-Alkalyn) has been tested against monohydrate and either tied or lost. None has shown meaningfully better absorption, retention, or performance. Monohydrate also costs less by an order of magnitude.
Hydrochloride and other variants dissolve more readily in water. Solubility is not absorption, however. The intestine readily takes up creatine from monohydrate, and once in the bloodstream, the molecule is identical regardless of the starting form. Schwarzenegger and most of the bodybuilding establishment have settled on this point: monohydrate is the answer.
Micronized monohydrate has a smaller particle size than standard monohydrate. It dissolves faster and produces less grit when stirred into liquid. The molecular content is identical, and the Orgain Costco product is micronized.
Dosing and physical measurements
5 grams of creatine monohydrate is roughly 1 rounded teaspoon, or 1/3 of a tablespoon. Density varies between micronized and standard grades, so the same teaspoon holds 4 to 5 grams. A digital kitchen scale gives the only accurate reading. Many users weigh once, mark the volume on a chosen scoop, and use that scoop afterward.
Volume conversions for monohydrate powder:
• 5 grams = approximately 1 rounded teaspoon = 1/3 tablespoon = about 5 mL by volume
• 10 grams = approximately 2 rounded teaspoons = 2/3 tablespoon = about 10 mL
• 20 grams = approximately 4 rounded teaspoons = 1 1/3 tablespoons = about 20 mL
Standard maintenance for muscle: 3 to 5 grams a day. Larger people (over 200 pounds) and heavy lifters benefit from 5 to 7 grams. The body excretes the surplus as creatinine in urine.
Loading: 20 grams a day (4 doses of 5 grams) for 5 to 7 days, then drop to 3 to 5 grams. Loading saturates muscle in 1 week instead of 3 to 4 weeks.
Brain and neurological use: 10 to 20 grams a day, sustained. Single pre-stress doses of 0.3 to 0.4 g/kg (about 20 to 30 grams for a 70-kilogram man) raise brain phosphocreatine measurably within hours.
Football pre-game use: anecdotal practice in the professional and college ranks involves 10 to 20 grams in the 24 hours before kickoff, on top of regular maintenance. The data behind the practice are animal models, magnetic resonance spectroscopy (MRS) scans, and indirect markers. The practice is reasonable and low risk. Whether it prevents a specific concussion is unproven.
Pre-injury continuous use: athletes facing season-long high-collision risk often run 10 grams a day continuously. This dose pattern is what the animal protection studies most resemble.
Voices from the field
Arnold Schwarzenegger covers creatine often in his daily newsletter, Arnold’s Pump Club. His position: monohydrate is the correct form. Bloating worry is overblown because the water enters cells, not under the skin. Brain doses run higher than muscle doses, around 10 to 20 grams a day. Dorian Yates, the 6-time Mr. Olympia, has made the same case in interviews with Peter Attia.
Rhonda Patrick, PhD, the cell biologist, calls creatine one of the most evidence-supported supplements available. Mike Israetel, PhD, a sports physiologist, has said in interviews that researchers have not found any reliable way that creatine harms healthy people taking 5 grams a day. Joe Rogan and Elon Musk have both endorsed it publicly. The consensus across the strength-sport world is uniform in a way few supplements achieve.
Among Parkinson’s specialists, opinions are split. Some have moved on after the negative NET-PD trial. Others continue to recommend 10 to 20 grams a day on the grounds that the trial did not test the dose suggested by animal data.
Synthesis
For my situation, with Lyme infection, Parkinson’s, and a return to lifting after a weak period, the supplement makes sense at the higher end of the conventional range. 5 to 10 grams a day for the muscle response, with growth hormone and peptides pushing the muscle to use creatine more aggressively. The Costco Orgain product supports muscle. Switching to a Creapure-licensed brand is the cleaner choice if I move toward higher doses for the nervous system.
The negative NET-PD result deserves weight. Creatine is not a cure for Parkinson’s. The energetic rationale survives the trial result, however, and combined with the negligible safety risk, daily use at 10 grams or above is defensible for someone living with the diagnosis.
Mixing in kefir is a good move. The carbohydrate and the small amount of casein lift insulin and creatine uptake. Splitting the day’s dose (morning and after training) reduces gastrointestinal upset and keeps blood levels steadier across the day.
40 years of weightlifting taught my body to respond to inputs. The inputs changed because of the disease, not age. Adding creatine at this point is another input aimed at the same response. The answer arrives in 3 to 4 weeks.
Postscript
My triathlon physique from this time was achieved without supplements or hormones of any kind. The photographs above were taken from my cosmetic surgery website, DrYoho.com, which is still available on the Wayback Machine. The current site at that URL is being used as a backup for my Substack.
Judy did not tell me she ever took creatine until last week. She still looks great over 30 years later:
Selected references
1. Cleveland Clinic. Creatine: What It Does, Benefits, Supplements & Safety. Plain-language overview of creatine biology, indications, and safety.
2. Wikipedia. Creatine. Comprehensive entry covering biochemistry, history, and dosing.
3. Kieburtz K et al. Effect of Creatine Monohydrate on Clinical Progression in Parkinson Disease (NET-PD LS-1, JAMA 2015). The 1,700-patient, 5-year futility trial that ended high-dose hopes for creatine in Parkinson’s.
4. Bender A et al. Creatine supplementation in Parkinson disease: a placebo-controlled randomized pilot trial (Neurology 2006). Earlier 60-patient pilot showing mood improvement and reduced dopaminergic dose escalation.
5. Gordji-Nejad A et al. Single dose creatine improves cognitive performance during sleep deprivation (Scientific Reports 2024). Magnetic resonance spectroscopy study showing acute brain uptake of high-dose oral creatine under cellular stress.
6. Creapure. Quality and manufacturing. AlzChem documentation on the German purity standard and DCD/DHT limits.
7. ThriveOn Health. Is Creatine from China Safe?. Survey of 33 commercial products. Half exceeded European contaminant thresholds.
8. Costco. Orgain Micronized Creatine Monohydrate, 1.48 lb. Product page with serving size, price, and ingredient list.
9. Pinedo-Jauregui A et al. Neuroprotective effects of creatine supplementation in mild TBI management among contact sport athletes (Journal of the International Society of Sports Nutrition 2025). Scoping review of creatine and concussion data from animal and athlete studies.
10. Ainsley Dean PJ et al. Potential for use of creatine supplementation following mild traumatic brain injury (Concussion 2017). Review of pre-injury creatine loading and post-concussive recovery, including the pediatric TBI trial.
11. Schwarzenegger A. Common Creatine Questions and Answers. Plain-language Q and A on creatine basics from the Schwarzenegger fitness site.
12. Forbes SC et al. Effects of Creatine Supplementation on Brain Function and Health (Nutrients 2022). Narrative review of brain creatine, GAA precursor strategies, and neuroprotection data.
13. Antonio J et al. Common questions and misconceptions about creatine supplementation (Journal of the International Society of Sports Nutrition 2021). Position-stand-style review of creatine FAQ in sports nutrition.
The audio here was done with an AI
The consensus is that elevenlabs.io is the best program for transcribing text into voice. To prepare it for its task, I uploaded two hours of samples from my best recordings. These were mostly from my book dictations, where I used a basic sound studio in my closet and then had a sound engineer delete the mistakes. When I use the service, I cannot tell the AI voice from mine.
The program is expensive enough that I use it on only about half of my dictations. The rest I still do manually, and you can distinguish these by the occasional coughs and errors I make.
I also use Wispr Flow, a dictating AI, all day, every day.
This saves me over half my editing time and is my most useful and cost-effective affiliate link. I was struggling with one of its competitors, but when I started Wispr, I liked it so much that I bought a year’s membership for $144.
The backstory is that these programs, with their modest monthly charges, work as well as DragonDictate, the former gold standard. This used to cost about $800.
I have an affiliate link HERE for you to use when you buy—and if you do much writing, you have to get it. Your price is the same as if you searched for the website and bought without using it. You are going to love this thing.
