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Paul Smith Johnson and Craig Sale discuss their research on beta-alanine supplementation, which increases muscle carnosine concentration, enhancing high-intensity exercise performance.
They note that beta-alanine doses of 1.6 grams per day over 16 weeks can be as effective as 6.4 grams per day over 4 weeks. Sale also highlights the importance of bone health, noting that men generally have higher peak bone mass but experience slower decline, while women experience more rapid bone loss post-menopause.
They emphasise the benefits of mechanical loading, diet, and lifestyle changes for bone health and muscle strength, and discuss the role of creatine in high-intensity exercise performance.
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0:00
Hi, I'm Paul Smith Johnson and I'm head of product innovation in My Protein. My name is Craig S. I am currently
0:06
professor of human physiology and nutrition at Manchester Metropolitan University where I work within the
0:12
Institute of Sport. What are your key focuses and what are you looking at mostly these days? I
0:17
think probably historically a lot of the research that I've undertaken is has related to supplementation particularly
0:23
with beta alanine supplementation to increase the muscle carnosine concentration and and from there then
0:28
looking at how that influences and particularly high intensity exercise performance and then more laterally
0:34
maybe some of the other physiological roles that carnazine might perform in tissues that might pertain to you know
0:40
various um diseases particularly cardioabolic disease and then the other sort of main strand of My research has
0:47
been in relation to bone health and and bone metabolism. So we've done a lot of work initially when I was undertaking
0:54
some work at Kinetic Limited where they do a lot of defense and security type research was was around stress fracture
0:59
injury in military personnel. Subsequently then coming back into academia I've expanded that back out
1:05
into sort of stress fracture injury in athletes but then also the effects more broadly of of diet and exercise on on
1:12
bone health and bone metabolism. One thing that that I've started to see across beta aline usage is is the amount
1:18
that you need to take every day to to get a benefit. So I guess the first question is do we see a positive effect
1:24
of using beta aline to enhance carnosine levels and is it true that you need to
1:29
have far more than than what most people associate to betalene usage to get the
1:35
benefit. So first of all yes. I mean I think there's pretty robust evidence now that you get a solid
1:42
increase in the muscle carnosine concentration or content when you supplement with beta alanine. So
1:47
carnosine is essentially a deptide. It's it's beta alanine and histadine. One of the things that we've shown over time
1:53
that actually it's the beta alanine the rate of beta alanine availability that limits carnosine synthesis in the
1:59
muscle. So hence why we supplement with beta alanine. You would get the same effect if you supplemented with
2:04
carnosine. But then when you when you provide carnosine, the carnosine then gets basically split in the blood by an
2:11
enzyme called carnosinise into its constituent amino acids anyway. So even if you give carnosine, you're still
2:17
splitting it in the blood to histadine and beta alanine. And so then when you
2:22
reuptake the beta alanine and the histadine into the skeletal muscle, there's another enzyme there called carnosine synthes that puts them both
2:28
together again to make carnosine. So it's it's really then the amount of beta
2:33
alanine that's available that limits how much carnosine that you can store. So then when you supplement it, it's really
2:40
we think it's it's largely the total amount of beta alanine you provide over time. So you can load the sceal muscle
2:46
over time with quite small amounts, you know, maybe 1.6 grams per day. A lot of the traditional dosing strategies we've
2:54
used have been 6.4 four grams per day, but we're trying to sort of load as much as we can within a relatively short term, maybe sort of four weeks. And and
3:01
a lot of that really is more about study design than anything else. But I mean, you would get reasonably similar
3:08
increases if 6.4 grams per day for four weeks with 3.2 grams at 8 weeks or 1.6
3:16
grams for 16 weeks. So, it's the the total amount over time and those increases seem relatively
3:21
robust in the sceal muscle. So once you once it's once kind of disease in the sceal muscle it takes quite a long time
3:26
then for it to come back out again. So it's it's a fairly robust increase and in the contrast to some supplements once
3:33
you've increased it you don't very often see that many individuals who don't respond to it if that makes sense. So,
3:40
you know, when you supplement with it, uh, there aren't very many people that don't respond to that supplementation
3:46
with an increase in the muscle carnosine content. In the contrast to to some other supplements who you might get responders and non-responders
3:52
essentially is what I'm saying. You don't find very many non-responders to beta alanine supplementation.
3:59
To have as much as six grams a day of beta alanine isn't a particularly comfortable process because of the the
4:05
analesia, the the tingles that you get from it. Is that the right word analesia? Is that paristhesia?
4:10
Paristhesia. Sorry. If someone were to take that much betalene or regular take as little as one gram a day for for
4:17
multiple weeks. What kind of benefits do you see from the research? Like what is the the output of that and how much does
4:23
it actually impact performance? The first thing to say there is usually within the 6.4 g per day dose we
4:29
normally split that. So we normally take maybe four doses of 1.6 g. And usually if you take four
4:36
doses of 1.6 six grams of the sustain release formulation for example then you don't tend to get as much paracthesia.
4:43
Again it's quite individual. Some people suffer from paristhesia quite significantly and other people can take
4:49
a a similar dose and not feel it or take a bigger dose and before they feel anything.
4:54
But generally speaking in the research we're trying to of course avoid paristhesia because obviously if a
5:01
participant were to experience paristhesia they kind of then know they're on beta alanine. So it destroys the double blinding of the experiment.
5:07
Practically of course it doesn't really matter so much and you might even even indeed get a bit of a placebo or a belief
5:14
effect from some of the paristhesesia. But usually what we would do is we would split that 6.4 gram dose into four doses
5:21
across the day if we needed that much. But you could of course go you know much much lower doses for for longer periods
5:27
of time. And again it kind of really depends on how quickly you need to load it. So then what are the performance effects? Well, generally speaking, most
5:34
of the effects are on high intensity exercise performance because the
5:40
predominant benefit of increasing the carnosine content in the skeletal muscle is to increase the buffering capacity in
5:46
the sceal muscle. So essentially when you're conducting highintensity exercise, you're getting that lactic
5:52
acid production and you get that lactic acid dissociation, you get an increase in hydrogen ion content. And that
5:58
hydrogenion content can have a number of delletterious effects on the ability of the muscle to to perform or to perform
6:05
over time. So we do see again with beta alanine supplementation relatively
6:10
robust performance improvements and and generally speaking you see better or or
6:16
more stable improvements in exercise capacity rather than performance. you still do see high intensity performance
6:23
benefits usually somewhere in the region of exercise that maximally lasts between
6:29
about 30 seconds and about 8 n 10 minutes somewhere around that mark where
6:35
you know an accumulation of hydroine in the skeletal muscle might be limiting to performance anything that's more
6:41
endurancebased is a little bit more more questionable what what is the the paristhesia effect
6:47
like we we use it in some of our products and and some people like it and some people don't. But what is actually
6:53
happening in mechanistic terms? We don't really know 100% exactly what causes the
6:59
paristhesia. It was uh proposed mo you know somewhat most recently and we think
7:04
the best guess at the moment is is there's a number of these neuronal receptors that are just firing in response to
7:11
to the beta alanine. But essentially the feeling is a little bit like pins and needles.
7:16
Mhm. So you get this kind of pins and needles feeling and usually occurs in the extremity. So it can be the fingers,
7:22
the face, the the legs, the buttocks, those kinds of areas where you get this kind of tingling sensation. So it can be
7:29
anything from quite a mild tingling and most people can put up with that. So it it can be at very high doses quite a
7:36
strong pins and needles type sensation which people are a lot more against.
7:42
And again, you're absolutely right. over you know goodness knows how many years I've studied beta alanine
7:48
supplementation you get some people who are quite quite keen on the sensation quite like it in fact and some people
7:53
who really dislike it yeah yeah that's it most like it's 50/50 some people either like it and it makes
7:59
them feel like they've had something and that that's what goes into a pre-workout for example and you have some people that just don't like it whatsoever and
8:06
it's probably because of the impact or how strong that paristhesia effect is right
8:11
yeah quite possibly um I think I think that would would be the case. Yeah. I mean, I think again, some people are particularly
8:17
susceptible to it. Some people aren't as susceptible to it. It's It's funny that people get that
8:23
effect in different parts of their bodies as well. So, I I feel it in my face. Some people would say that they feel it on the tops of their head. Some
8:30
people feel it in their hands. It again, I assume that's just genetic, right? Don't really know is the answer to that
8:36
question. I I don't think there's a really good rationale for who gets it and who gets it where. I mean obviously
8:41
it stands to reason when you're using maybe sort of standardized absolute doses that perhaps maybe smaller people
8:47
might be a little bit more susceptible to it. That was always an initial thought because the relative dose per
8:53
unit of body weight would be higher. I mean know I don't think there's any real clear rhyme or reason
8:58
to to who experiences more or less paristhesia and where and where they experience it. Craig, you also mentioned there that
9:04
more recently you've been focusing a lot on on on bone health and and and bone
9:09
research. I suppose and maybe you could put it put it better than me. Some of the things that that we talk about is
9:14
just kind of the the differences between between men and men and women and kind of the long-term like bone stability and
9:22
and what what happens on a on a gender difference. I guess this is a really hard question to answer in a succinct go
9:28
but kind of what what is actually happening there? Why do we see and is it true that that men's bone rates decline
9:34
slower than than what females do and and what is the reason for that? So, so generally over time the broad pattern of
9:41
your bone response as you age is kind of similar between men and women. So if we
9:47
think about it broadly three main areas or three main characteristics of the bone response to aging. The first is
9:53
growth and development. So during you know childhood, adolescent, early adulthood you get this you know really
9:59
rapid bone growth such that you reach peak bone mass somewhere between your
10:05
20s and 30s. Bone then stabilizes for a little bit and then you enter into this period of age related decline kind of
10:13
you know bit similar to muscle 50 55 years of age maybe some people sooner some people later you know same as
10:19
muscle. Now the the differences between men and women in those circumstances is generally speaking men attain greater
10:26
peak bone mass than women. So they have a higher amount of peak bone mass during their 20s and 30s than women do. And
10:34
women lose a little bit more bone mass as they age, particularly around um the
10:39
permenopause and the menopausal period. Estrogen, for example, has quite a protective effect on the bone. And so
10:45
when you remove that stimulus, the that the rate of bone loss is is quite significant, particularly during the you
10:52
know, sort of the one to twoyear permenopausal period, it's really quite or the one to two years around
10:57
permenopause, I should say. It really is quite a rapid rate of of bone loss at that point. So as a result of that
11:03
generally bone related diseases like osteopenia and osteoporosis are a little bit more common in women than they are
11:08
in men. But that's not by any stretch to say that it's a a disease that only
11:14
influences women. It does also influence men. It's just that the rates are a little bit higher in in women than than
11:19
in men. So what kind of um nutrition or behavioral interventions can you have to
11:25
help prevent bone loss? and what can you do at an earlier age to set you up well for the future to to kind of negate that
11:32
that decline. So I think if we think about it there there are a number of um non-modifiable
11:37
factors that influence bone strengthening and weakening. So things like an individual's race, sex, genetics, etc. might have a profound
11:44
influence on that bone response across the life course. And of course the downside to that is there's not an awful
11:50
lot you can do about those things. But there are also a number of modifiable factors and a lot of those do relate to
11:56
sort of lifestyle responses. So for example, you know, I think personally one of the biggest influences is
12:01
mechanical loading. If you think about the amount of exercise that an individual does, then that has quite a
12:07
profound stimulating effect on bone formation and that can be quite protective. Other behavioral factors
12:13
like smoking is detrimental to bone. So I mean that's there there's very little good news as far as smoking is concerned
12:19
and and the bone health response. And then there are a number of factors in relation to diet and nutrition. I think
12:25
most people be aware of things like vitamin D and calcium being quite positive for the bone. But there are a number of other nutrients that are
12:32
important for bone and bone metabolism. Uh things like vitamin K for example could be could be quite important. Dairy
12:40
intake because it's got a number of nutrients like calcium, like phosphorus. exact for example and all of those
12:47
things will have you know potentially positive effects on um the bone and and
12:53
certainly you wouldn't necessarily want to be deficient in those nutrients as far as the bone is concerned and then
13:00
there are you know sort of things like protein for example which there's there's historically a bit of a a pro
13:06
and a con for the bone that's been espoused as far as protein is concerned but generally my view would be that it
13:11
would be broadly positive uh for for the bank. I've heard and read before that
13:17
there's a there's a correlation between between grip strength and leg strength on all course mortality. Is that true?
13:24
And and if it is, what what is that based on? And if it's not true, you can say. Yeah. I mean I think there are you know
13:30
so so again you know there are those associations and that's one of the the problems that we've got is that
13:36
historically when you look at this from an evidentiary perspective there aren't that many studies that have followed individuals over you know a number of
13:43
years to directly look at the effects of reducing muscle on various outcomes
13:50
whether that be you know mortality whether that be falls whether that be fractures whether that be whatever. So
13:56
the majority of the data, no there are some but the majority of the data we've got are associational and those associations between muscle strength and
14:03
either all cause mortality or um specific forms of mortality like cancer mortality for example you know do exist.
14:10
What becomes a little bit more different is is teasing out cause and effect versus an association. But nonetheless
14:15
those associations are there. Um, of course, one of the things that it's
14:20
difficult to tease out is whether that's the effect of the muscle strength itself or whether it's an effect of the fact
14:26
that some of the things that you do to have higher strength also predispose you to, you know, better outcomes from a
14:34
morbidity and mortality perspective. So, for example, you just, you know, you're more active probably. You do other
14:40
things that that obviously help you to age Yeah. better. Yeah. Yeah, there's something to be said
14:45
about kind of the behaviors that goes into an individual to make them that way that may prevent consequences.
14:52
Yeah, exactly. So, I mean, it's probably unlikely that if you just train your grip strength from now until you're 80
14:57
that that's going to have much of a much of an effect. Yeah. It's it's more it's more analistic
15:03
picture than that, I think. Yeah. It's kind of like when when someone they they look at the way someone eats and they kind of draw a
15:10
conclusion from that. But the person eats in that sort of way is also probably more likely to be the person that takes the stairs in work or cycles
15:17
to work and and behaviors around kind of just the diet alone that has kind of resulted in in that that the way that
15:23
they are. Yeah, that's right. And I mean there are ways of you know statistically teasing out the the the effects of these things
15:29
to try to to limit it to you know the research question you set yourself around the effects of a particular type
15:35
of exercise or a particular type of strength outcome on morbidity and mortality outcomes. But nonetheless
15:40
there's still going to be a significant amount of crossover there. So it's very very hard in an aging you know in a
15:45
study of aging to tease out effects like that. Yeah. what's what's a true aging effect versus what's a physical activity
15:52
effect, for example, is really quite difficult to to tease out. Do you need to exercise every day to be
15:57
healthy? And and if not, how much exercise is is recommended h for a healthy lifestyle?
16:04
That's a really really difficult question to to to answer. So I mean, do you need to exercise every day? No, I
16:11
don't I don't think you do. I think probably you want to exercise most days. Is it best to have one particular type
16:18
of exercise or a mix of exercise? I would suggest it's probably best to do a mixture of exercise. So, things that
16:24
target different tissues and different systems is is always going to be um beneficial. And in terms of what the
16:30
minimum doses to stay healthy, again, that's a really difficult question because it's likely to be highly individual for a start. You know, you
16:36
are always advised to choose your parents really, really carefully. First of all, in terms of minimal doses of
16:42
exercise, um, you know, probably, you know, three to five times per week, 30
16:49
minutes plus, maybe per session with, you know, a mixture of intensity,
16:54
certainly including some moderate to vigorous physical activity within that. So, this is probably going to be quite a
17:00
hard question to answer, but what does the research say about the kind of the values of the differences between
17:06
strength training and endurance for for longevity? Is is one better than the other?
17:11
You know, in terms of the research, how much research is there that's really looked into that over time, separating out pure endurance type activity, pure
17:18
resistance type activity, and people who can do both. I'm not sure I'm not sure how
17:24
clear the ev the the research evidence is on on relation to that question, but intuitively to my mind, I think you need
17:31
a bit of both. I think those things target different systems. They diff target different tissues quite often.
17:37
they they they target different elements of health if we want to describe it in that way. So from my perspective, you
17:45
know, I think having done some endurance type aerobic type exercise up until sort
17:51
of middle age, late middle age is the sort of thing that's probably going to get you to that stage without having too
17:56
many other or help you to get to that stage without having too many other major health implications. But certainly
18:03
as you start to get into your late 50s, something like that, going into your early 60s, having done some resistance
18:09
exercise training is going to be really, really important to how well you you age. Trying to help you to stay more
18:15
active, more abil, you know, greater ability to get upstairs, get in and out of a chair, greater ability to be able
18:22
to resist falling over if you do fall over, having a greater protection. To my mind, the answer would be you're always
18:27
better off doing both than just one or the other. What is it that athletes do uh to look after their health that the
18:34
everyday population can take inspiration from? It's a really good question because not
18:39
everything an athlete does is necessarily particularly healthy. I think we also need to, you know, need to
18:44
acknowledge that that the way in which maybe sometimes an athlete eats, an athlete trains is is for a very specific
18:50
purpose and that is for high performance. So it's not necessarily focused on their lifespan or their
18:55
health span. But I think one of the things for me that I think is it's probably a very simple message, but it's
19:02
probably a very good take-home message is that they exercise regularly. They exercise regularly with purpose and they
19:08
focus to a large extent on on rest and recovery also, including sleep. So turn
19:14
up regularly, do some exercise, do it with focus. Yeah. And then rest and recover. I I think your your point about
19:20
exercising with with purpose is is really really poignant. you know, it's it's kind of people that are going to
19:25
train and there to to achieve something and potentially the general population who are looking to just maintain their
19:31
health and look after their their longevity is that when they are going to do whatever exercise modality that it is
19:37
is that you're you're doing it intently and you're not just I guess going through the through the motions so to speak and you're using your finite time
19:43
that you have to get the most out of it. I suppose in order to get the most out of a workout within a given time frame and let's let's you know be honest most
19:50
people are relatively time poor. So I think trying to get something
19:55
you know focused out of each and indiv each each and every session is you know is quite important. You know those
20:00
sessions don't necessarily have to be long to be effective. You know that that is certainly a take-home from an athletes perspective that could benefit
20:07
the general population. Okay. From from our observation sleep is becoming much more important to to to
20:13
people and when we talk to our customers and we we we see people's behavior changing people seem to be prioritizing
20:19
sleep more. from your perspective, why is that? What is it about sleep that
20:24
helps recovery and and and why is it important to to prioritize it? Yeah, I mean, I think again, I'm no
20:31
sleep expert by by any stretch of the imagination, but but certainly if we include sleep and recovery as as sort of
20:38
part of the the same thing. Certainly that is vitally important to the way in which we try to maximize adaptations to
20:45
training whether that be resistance type exercise training or endurance type exercise training you know. So so a lot
20:51
of the regenerative um processes a lot of the adaptive processes that go on in and around
20:58
tissues like sceal muscle like bone occur when we rest when we recover. Um
21:04
those adaptations are occurring during those periods of time. It's not it's not during that responsive part of the
21:10
exercise itself where we're adapting. It's in the it's in the rest and recovery periods of from the exercise
21:16
where we're we're adapting. So that's why it's really really important you know optimal um recovery and regenerative processes what relate to
21:25
our adaptations in muscle in bone in in other tissues. And so that's why it's
21:30
that's why it's really important to if we can as much as possible optimize recovery and sleep. The the other factor
21:36
of course about sleep is if you've had a terrible night's sleep and you've got a training session the next morning,
21:43
we all know, we've all been there. It's much much harder to get a really good training session in if you're if you're tired,
21:49
if you're rested, recovered, you've had a good night's sleep than actually your subsequent training session is far more
21:57
effective. It's going to be a better quality. It's going to be of better intensity maybe or better duration maybe. then your adapt
22:03
adaptations are going to be even stronger again. So, it's got that sort of double-edged benefit to it.
22:09
I've I've also noticed that that when I or when people don't sleep as well at night, the next day that I I find that
22:16
they crave more energy. So, more food. They kind of might crave high energy, calorie dense food as opposed to kind of
22:23
a a lower energy diet because they're tired and they're potentially looking for something to kind of give them give
22:29
them an Yeah, quite possibly. Yeah, starting at a kind of ground zero, um, how much
22:36
protein is it recommended to have to to either maintain or increase muscle mass
22:43
every day? I think generally speaking now, we're we're thinking about going a little bit beyond the RDA of 0.8 grams per sorry,
22:50
0.8 grams of protein per kilogram body weight per day. I think we're probably at a stage where we know that that's not
22:57
optimal as far as trying to increase or maintain skeletal muscle mass is concerned. So generally probably
23:04
somewhere between 1.2 and 1.6 g of protein per kilogram body weight per day is is going to be about the right amount
23:12
of total intake. So how should someone consume protein throughout the day? Is it okay to have
23:17
all of that in one go or is it better to to to distribute it evenly throughout the day? By far and away the most
23:23
important thing is the total amount of protein that you you consume across the day from from a skeletal muscle point of view. I think it's probably better if
23:30
you can evenly distribute it across meals. Don't think that's necessarily
23:37
essential but certainly I think from an optimal situation point of view then
23:42
that kind of a separation would be would be better probably certainly going to be better than trying to consume it
23:48
in in a single meal that's for sure. The other missed opportunity under certain circumstances again where you're looking
23:53
to optimize might be you know just before you go to bed or or you know before you you go to sleep.
23:59
We've seen that the people will choose a casein protein before bed because of how
24:04
it's digested. Is is that true? And does it matter the protein source before bed?
24:09
Is is the benefit the same? Well, I think that's the reason. So if you look at casein, it's you don't get quite
24:14
the same speed of amino acid appearance in in the blood as you get with something like whey for example, but
24:21
that response lasts a little bit longer. And so I think what the idea is is that
24:26
with that casein protein intake over that period of time where you're asleep, which is obviously, you know, however
24:31
long you you sleep for, six, seven, eight hours more if you're if you're lucky, that that that slower but longer
24:37
appearance would be more usable over o over the evening time. Whether that's
24:43
essential to do it or not, I'm not really quite so sure. But I think, you know, from a theoretical point of view, that that does make some some sense. Can
24:50
you can you explain why exercise is beneficial for for bone health? Generally speaking, some exercise is
24:58
more beneficial for bone health than other types of exercise. Generally speaking, when we look at the responses,
25:03
um high impact or high magnitude or multidirectional types of activity are
25:09
particularly good for promoting bone formation. So things like high impact activities like volleyball or something
25:15
like that or um multidirectional movements, tennis, basketball, I mean
25:21
basketball and football for example, combine both the high impact and the multi-directional movement. And then you got high magnitude types of activities
25:28
like resistance exercise training are also good and particularly if you can promote you know significant movement
25:33
around around a joint. However, nonweightbearing types of low impact
25:41
repetitive activity like cycling, like swimming for example, aren't generally
25:46
or even walking for that matter, aren't generally as good for the bone. The the question then is, well, is doing
25:52
those types of activity better for the bone than doing nothing at all? And the the jury's a little bit out on that.
25:57
Some research would suggest yes, it is. Some research would suggest no, it's not. But certainly if we think about the
26:03
way in which the bone would respond to exercise, it's going to respond better to those kind of high impact
26:10
multidirectional high intensity high magnitude types of activity. To a lot of
26:15
the the general population, cycling, cycling is is is a good hobby. Lots of
26:21
people go out. Lots of people maybe play golf. that go for walking but they from what you're saying there they may not
26:27
inherently be the best form of like exercise when it comes to kind of looking after for bone health. So I
26:33
guess my question is is kind of what what can those individuals do to kind of
26:38
supplement their their regime to to look after bone health and then maybe a bit of an explanation as to why those lower
26:44
impact um sports aren't the same as kind of those high impact sports for for bone health. Generally if you think about the
26:50
way in which the bone responds positively to a stimulus. So so usually what happens is um you get an impact on
26:57
the bone. So so the b the bone responds to two kinds of stimuli from a mechanical loading point of view. So it
27:04
responds to compression. So that's essentially where you apply a force onto one side of the bone and it causes the
27:10
bone to compress and and to and to bend. And of course that's induced maximally by impact type of activities. And then
27:17
you've also got the effects the torsional effects on the bone the twisting effects on the bone that also
27:23
provide a stimulus. So when that happens essentially the there are cells in the
27:29
bone called osteoccytes and these osteoccytes detect if you like they're the sensors of the bone they sense that
27:34
this activity is going on and that the bone may need to respond by strengthening itself to withstand this
27:42
kind of activity. And so they then essentially send out a number of signals
27:47
that promote other cells to enhance the rate at which we form new bone. These are called osteoblasts, these cells. And
27:54
these cells increase the rate at which the bone is formed. And it does that to protect itself against these kinds of
28:00
impacts or these kinds of forces that are being applied to it. So of course if you think about the types of activity that would maximally cause that
28:06
compression or the torsional effect on the bone it is those high impact types of activity or those or those high
28:11
magnitude types of activity. So if you take cycling for example where you've still got some some muscular action
28:18
occurring on the bone but you don't have that kind of weightbearing impactful type of exercise or you don't have that
28:25
really high magnitude type of uh activity like lifting heavy weights for example then the stimulus for the bone
28:32
to grow is not as great. One of the things that they could potentially do, for example, is introduce a small amount
28:38
of either weight training to their to their general training regime or some
28:44
hopping type of skipping type of activity. But actually, you don't need an awful lot of that high impact
28:49
activity to generate a a strong stimulus for the bone. Only a few sort of loading cycles would be enough to,
28:56
you know, to to to maximally stimulate the bone with then a long rest and then a performance in a few loading cycles.
29:02
Can a nutritional intervention kind of offset it? So using things like calcium or vitamin D, is that enough or does it
29:08
have to be some sort of exercise intervention? I would suggest it probably would be better off to include some kind of
29:14
exercise intervention. I mean I think you know undoubtedly if you look at the effects of on bone formation
29:21
particularly then certainly the effects of me mechanical loading of the type that we've just spoken about would be
29:27
you know far more beneficial than or far more effective than than just a nutritional supplement alone. But I
29:33
think certainly making sure you're not deficient in some of those key nutrients
29:39
that underpin bone like calcium, like vitamin D, like um phosphorus, like magnesium to a certain extent is
29:46
important. And certainly if you're going to be deficient, then it is useful to at least get sufficient. I have a question
29:52
on on creatine. And before we kind of go into the more the more detailed stuff, can can you help try and explain what
29:58
what creatine is and and why people would supplement with it? So creatine is a naturally um occurring substance
30:03
within the body. You can you can make it from three am amino acids glycine, arginine and methionine. Um and that
30:10
gets synthesized between the kidney and and the liver. And you can sort of synthesize maybe a gram two grams per
30:17
day. And you can also then get potentially another gram a day from from the diet particularly if you're an
30:23
omnivore. You you eat meat and fish. So within the muscle it's particularly useful as um a high energy buffer. So
30:31
essentially as you shuttle between phosphor creatin creatin the phosphol
30:36
creatin can donate its phosphate group onto ADP to produce ATP. And as as we
30:42
probably know ATP is the energy currency of the body and you need ATP for muscle contraction. As you shuttle creatine and
30:49
phosphor creatin and you shuttle ADP and ATP, you get this donation of the of the phosphate group of phosphor creatin to
30:56
ADP to make ATP. The ATP gets used, you get ADP and the phosphor creatine gets
31:01
used, you get creatin and then you refphosphorilate that creatine and then the the cycle carries on. So it acts as
31:08
that that high energy buffer for when the ATP demand from the skeletal muscle
31:14
is really really high. So when you're performing for example highintensity exercise and the rate of requirement for
31:21
ATP is very very high. You can't necessarily match that from from other
31:27
um oxidative metabolism and so that's when the creatine becomes useful. So the
31:32
theory is obviously with supplementation that you increase the creatin stores
31:38
within the muscle and that enables you then to resist that fatigue during highintensity exercise or repeated
31:45
highintensity exercise over time if any. What kind of sports or exercise would would creatine or increasing
31:51
creatine intake um help with? So historically it's been more related to that again that high intensity exercise
31:58
types of performance um either sort of you know single sprints or more more often even repeated sprint sort of field
32:05
that there have been studies that have looked at it more in relation to endurance exercise performance but
32:11
obviously you know mechanistically it doesn't necessarily make as much sense there in the same way as as we were
32:17
talking about earlier beta alanine doesn't make as much sense there unless of course you're talking about highintensity efforts within an
32:23
endurance um type of event and what does the uh the research suggest in terms of how much creatine to
32:30
supplement uh to to get any benefits from it? Yeah. So again, generally speaking from
32:35
from that perspective, you're you're talking about loading the muscle and traditionally it was sort of four times
32:42
5 grams per day that was suggested to uh increase the content over about 5 to
32:49
seven days. So usually there's a little bit of a ceiling in sceal muscle somewhere around 150 to 160 millol per
32:57
kilogram dry muscle and usual levels are somewhere around sort of 120 to 140 mill
33:02
per kilogram dry muscle. You can also take it in much lower doses. You can take like three grams five grams a day
33:08
over a longer period and you would get the same you get the same outcome. We often hear about how creatine um
33:15
increases water retention w within the muscle. Is that true? And can you explain it a bit?
33:21
Yeah, it's true. So, so creatine is is stored with water in the sceal muscle. So, you kind of do also get that
33:26
intracellular water increase. And and that's also what's somewhat responsible
33:32
for the small increase in in body weight that you experience when you take cryin. Certainly, if you take it to load it
33:37
under under those sorts of circumstances, then yes, you get a bit of intracellular water retention and you
33:43
also do get a bit of associated um weight gain. Mhm. Is there a benefit difference
33:48
between men and women in terms of creatine supplementation? I mean, I think in my opinion, I haven't seen any compelling evidence to suggest
33:55
that you need a a women's specific focus on creatine. I think creatine is creatine. I think it,
34:01
you know, I think I'd flip the question the other way round and almost say there's no different there's no there's
34:06
no reason why women shouldn't be taking creatine as well as men. Um, but is there any specific reason? Um, I don't I
34:13
don't think I've seen any compelling evidence yet to suggest that that is the case. Are we confident that that creatine
34:19
long-term is is safe? And is there much data to to to suggest that? Certainly, creatine is one of the most
34:26
studied um sort of dietary supplements out there. And I think we are certainly reasonably confident that that it is
34:32
safe within the sort of dosing parameters that we've been talking about and that are that are recommended. There
34:39
aren't a huge number of studies that that sort of look at creatine intakes
34:44
over years. There are some um which are you know indicating that that broadly it's safe but I mean there aren't a huge
34:51
number. But in terms of the evidence we've got now broadly we are I mean pretty
34:56
confident I think that it's it's a safe supplement within the dosing limits that we've talked about with a few
35:02
exceptions. For example, an individual with um kidney problems or existing kidney disease might want to be much
35:08
much more careful about whether they take a creatine supplement or not. That's not to say that they definitely can't, but I would certainly be seeking
35:14
some sort of medical advice before going down that route. But otherwise, under normal healthy conditions, I think it's
35:21
it's pretty safe.