Episode 292: Creatine, Brain Health, Sex Hormones, Muscle Building, Insulin Sensitivity, Sarcopenia, Andropause, Mood, Motivation, BDNF, And More!

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Nov 20

Welcome to Episode 292 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine and Cynthia Thurlow, author of Intermittent Fasting Transformation: The 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging.

Today's episode of The Intermittent Fasting Podcast is brought to you by:

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Join Melanie's Facebook Group Clean Beauty And Safe Skincare With Melanie Avalon To Discuss And Learn About All The Things Clean Beauty, Beautycounter And Safe Skincare!

what is creatine?

the benefits of creatine

common misconceptions

body building supplementation

if you're considering supplementation...

what creatine does

Creatine Supplementation in Women’s Health: A Lifespan Perspective

GABA Research

creatine and brain health

LMNT: For A Limited Time Go To drinklmnt.com/ifpodcast To Get A FREE Sample Pack With Any Purchase! Learn All About Electrolytes In Episode 237 - Our Interview With Robb Wolf!

gender differences in creatine needs

creatine and sex hormones


muscle memory


low testosterone, mood and motivation


learning new things

age related changes in the body; Bone health

AVALONX berberine: Use The Code Melanieavalon For 10% On Any Order At Avalonx.Us And MDlogichealth.Com!

hormone replacement therapy


creatine sources and supplemental dosage

vegans and Vegetarians

Introducing... Creatine by Cynthia Thurlow

Our content does not constitute an attempt to practice medicine, and does not establish a doctor-patient relationship. Please consult a qualified health care provider for medical advice and answers to personal health questions.


Melanie Avalon: Welcome to Episode 292 of The Intermittent Fasting Podcast. If you want to burn fat, gain energy, and enhance your health by changing when you eat, not what you eat with no calorie counting, then this show is for you. I'm Melanie Avalon, biohacker and author of What When Wine: Lose Weight and Feel Great with Paleo-Style Meals, Intermittent Fasting, and Wine. And I'm here with my cohost, Cynthia Thurlow, Nurse Practitioner and author of Intermittent Fasting Transformation: A 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging. For more on us, check out ifpodcast.com, melanieavalon.com, and cynthiathurlow.com. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment and no doctor-patient relationship is formed. So, pour yourself a mug of black coffee, a cup of tea, or even a glass of wine if it's that time and get ready for The Intermittent Fasting Podcast.

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And one more thing before we jump in, are you fasting clean inside and out? When it comes to weight loss, we focus a lot on what and when we eat. It makes sense because these foods affect our hormones and how our bodies store and burn fat. But do you know what is possibly one of the most influential factors in weight gain? It's not your food and it's not fasting, it's actually our skincare and makeup. As it turns out, Europe has banned over a thousand compounds found in conventional skincare and makeup in the US due to their toxicity. These include endocrine disrupters, which mess with your hormones, carcinogens linked to cancer, and obesogens, which literally can cause your body to store and gain weight. Basically, when we're using conventional skincare and makeup, we are giving these obesogenic compounds direct access to our bloodstream.

And then in our bodies, studies have shown they do things like reduce our satiety hormones, increase our hunger hormones, make fat cells more likely to store fat, and more resistant to burning fat, and so much more. If you have stubborn fat, friends your skincare and makeup may be playing a role in that. Beyond weight gain and weight loss, these compounds have very detrimental effects on our health and they affect the health of our future generations. That's because ladies when we have babies, a huge percentage of those toxic compounds go through the placenta into the newborn. It is so, so shocking and the effects last for years.

Conventional lipstick, for example, often tests high in lead and the half-life of lead is up to 30 years. That means when you put on some conventional lipstick, 30 years later maybe half of that lead has left your bones. On top of that, there is essentially no regulation of these products on the shelves. That's why it's up to us to choose brands that are changing this. The brand that is working the hardest to do this is Beautycounter. They were founded on a mission to change this. Every single ingredient is extensively tested to be safe for your skin, so you can truly feel good about what you put on. And friends, these products really, really work. They are incredible. They have counter time for anti-aging, counter match for normal skin, counter control for acne and oily prone, and counter start for sensitive. I use their Overnight Resurfacing Peel and vitamin C serum every single night of my life and their makeup is amazing. Check out my Instagram to see what it looks like. Tina Fey even wore all Beautycounter makeup when she hosted The Golden Globes. So, yes, it is high-definition camera ready. 

They have so many other products, deodorant, shampoo and conditioner that I love, products for babies, and so much more. You can shop with us at beautycounter.com/melanieavalon or beautycounter.com/cynthiathurlow and use the coupon code CLEANFORALL20 to get 20% off your first order. Also, make sure to get on my clean beauty email list. That's at melanieavalon.com/cleanbeauty. I give away a lot of free things on that list, so definitely check it out. You can join me in my Facebook group, Clean Beauty and Safe Skincare with Melanie Avalon. People share their experiences, ask questions, give product reviews, and I do a giveaway every single week in that group as well. 

And lastly, if you're thinking of making clean beauty and safe skincare a part of your future like we have, we definitely recommend becoming a Band of Beauty member. It's sort of like Amazon Prime for clean beauty. You get 10% back in product credit, free shipping on qualifying orders, and a welcome gift that is worth way more than the price of the yearlong membership. It is totally completely worth it. So, again to shop with us go to beautycounter.com/melanieavalon or beautycounter.com/cynthiathurlow and use the coupon code, CLEANFORALL20 to get 20% off your first order. And we'll put all this information in the show notes. All right, now, back to the show.

Cynthia Thurlow: Hi, everyone, and welcome. This is Episode number 292 of The Intermittent Fasting Podcast. I'm Cynthia Thurlow and I'm here with Scott Emmens, cofounder and COO of MD Logic Health.

Scott Emmens: Cynthia, thank you for having me on the IF Podcast. It's a pleasure to be here with you today.

Cynthia Thurlow: Absolutely. Today, we're going to unpack creatine. I think this is certainly a supplement that I used to have probably prejudicial thought processes on, but the more I've understood the science and the more that I've understood about the benefits of creatine, both for men and women, the more I was interested in sharing the research and connecting with you. I'd really love to start the conversation there. What exactly is creatine? 

Scott Emmens: Creatine is organic acid that is endogenously produced in the body. You can also take it as a supplement. It's a combination of three amino acids, which are arginine, glycine, and methionine. It's produced in the kidneys and in the liver.

Cynthia Thurlow: Yeah, it's interesting. When I was doing my research before we even talked about bringing creatine to market, was it the liver and the kidneys produce 2 grams a day on their own and it's all stored in our skeletal muscle. And so, I think from my perspective as a clinician what I understood about creatine was that it was something just utilized by bodybuilders and what I've come to find out is there're so many variations of creatine, there're so many options available. The two consistent things that I saw in the literature that really stood out for me was the improvement on muscle health and muscle strength and then also the cognitive benefits. And so from my perspective, this is something that's applicable to everyone. It's not just gender specific, it really is applicable to everyone.

Scott Emmens: Well, it's been like a second coming from me, Cynthia, because I started out as a biology major and a bodybuilder in college. So, I'm very familiar with creatine. I'd used it back in the days when you took 20 grams and that was it. It was a bodybuilding supplement, 20 grams, by the way, is a lot, way too much, that can really cause some GI upset, kidney damage, and so forth over the long term. But at lower doses, it's really an effective product. What I was so blown away by was after 30 years out of the bodybuilding scene, gauged myself a little, I could not believe how many studies are continuing to go on with this product and how much more benefits that we're seeing across a wide array of issues including brain health. That was one thing that shocked me the most was the number of different studies that are ongoing, or that are in early trials for various different brain health issues.

Cynthia Thurlow: Yeah, and so because you started your experiences with creatine at a different stage of life, what have been some of the common misconceptions that you have seen or heard over the last 30 years particular to creatine use?

Scott Emmens: First of all, that it causes weight gain or weight gain in women, which is highly unlikely, it's not zero probability, that it can be very dangerous with a lot of controversy about the danger of creatine. It's in fact one of the most studied supplements that I've ever seen, it's been studied and researched well over 30 years at this point. So, its safety is pretty much unparalleled. And then the other misconception because, A, it's only for bodybuilders or for only for men, or that it's only for athletes. When in fact the research shows that there are many people that can benefit particularly by vegans and women that benefit from making sure to maintain muscle mass, especially postmenopausal. So, there's just a tremendous amount of research coming up. This is an [unintelligible [00:12:12] nutrient that your body requires creatine. In fact, if you have creatine, it can cause some pretty significant problems.

Cynthia Thurlow: Absolutely. It's interesting because I admittedly was a little prejudicial in my thought process, and I think it was because my knowledge of creatine was really related to the bodybuilding set. At one time, I was an ER nurse in inner city, Baltimore, and I saw quite a bit of people that are using anabolic steroids and they were using other types of supplementation. I'm sure that creatine probably got lumped in with some of the other side effects that were completely unrelated to the creatine utilization and more a byproduct of illegal exogenous use of anabolic steroids.

Scott Emmens: I can attest to that having been in that world, you would get approached with someone trying to sell you something that was illegal on a regular basis. And as a person of health, it just wasn't in my wheelhouse. So, I had to understand how these products worked. And I was a big supplement user in my early age because in order to compete with people that were using anabolic steroids, they can go eat a pizza and still look ripped. Whereas for me I was doing things like creatine and using things like boron and zinc combinations and other minerals, amino acids and branched chain amino acids and the essential amino acids way before they became popular or in vogue. There was definitely a large combination of people in joining creatine and other including diuretic cause other serious problem.

Cynthia Thurlow: Yeah, absolutely. For full disclosure, I had been skeptical about creatine until my very well researched trainer, who's also an attorney, she's got a really interesting background, she was actually sharing the research last fall and kept saying, "I really think you should consider supplementation with creatine." The one thing that I have found personally and we'll talk about this today, the benefits of creatine, how it works in the body was that I went from as a menopausal female, when women really do struggle with not only building but maintaining muscle mass unless they're taking exogenous testosterone. I was able to consistently lift heavier weight week to week and I was able to see more of those gains, and we track all of our metrics because she and I are a little bit OCD about this. For me, I kept saying, "If I am capable of achieving and maintaining muscle mass at this stage of life I am in, then this is something that can be really beneficial for other women and certainly other men that are considering wanting to build maintain muscle mass because we think of muscle as an organ of longevity." Certainly, I follow really closely with Dr. Gabrielle Lyon's work and she was very excited when I told her that I was seriously considering bringing creatine on as my first product in conjunction with MD Logic. 

Let's talk a little bit about what creatine does. From a technical perspective, creatine re-phosphorylates utilized ATP. So, ATP is this energy molecule in the body. Adenosine triphosphate becomes adenosine diphosphate when you move muscles, so your body's using this energy when you're moving your muscles and creatine actually attaches another phosphorus group to ADP. So, it's a way to keep recycling creating the stored energy. And for anyone that's listening that saying, "I don't even know what you're talking about." We're talking about what goes on inside the mitochondria. This is a very savvy science-oriented listener base. And so really think about this is going on in the mitochondria. So, the powerhouses of our cells.

Scott Emmens: I think what's important for people to understand too, is that sometimes we associate ATP with just our muscle cell. But in fact, it's all of our cells. It's your brain cells, your heart cells, all of the cells in your body, your immune cells, every cell in your body requires ATP for energy. If you run out of energy, then you're going to run out of life. What creatine is able to do is to your point, make that ADP back into ATP, which is the foundational molecule for energy, much faster, you got creatine stored in your body and creatine serum in your blood going to replace that quicker, and your brain and your heart probably use up more ATP and more energy that get into organs in your body. So, it makes sense when you think about how it could work for your brain because of the way that works on ATP.

Cynthia Thurlow: Absolutely. It's involved in energy mobilization and metabolism in the brain. I also think about the net impact on things like glycine and GABA, which impacts sleep. As women, especially in their perimenopausal years, 10 to 15 years preceding menopause and their ovaries are producing less progesterone, this is a time when upregulation of GABA is really important for high quality sleep. When you really dive into the research, one of the things I found interesting and there's a great article that we'll link up, it's called Creatine Supplementation in Women's Health: A Lifespan Perspective. Researchers here really talk about how creatine has a place throughout a woman's lifetime, not just perimenopause and menopause, but your menstrual cycle. We're not going to touch on pregnancy or lactation because I don't want to touch that with a 10-foot pole, but there is research that kind of touches on how this can be beneficial. 

It's not just as you said, it's not just the muscles, but it's really a systemic supplement that has a lot of benefits. The one thing that I really like about this article in particular is that it admits despite extensive research on creatine evidence for use among females is understudied, so they acknowledge like many things, there's not enough research being done on women in peak fertile years, in perimenopause and menopause. But they do see the importance, it actually says supplementation during menses, pregnancy, postpartum, during and post menopause. Again, we're not talking about pregnant or lactating women, but we'll talk about women that are still in their peak fertile years, perimenopause, and menopause, that there really are quite a bit of benefits from supplementation.

Scott Emmens: Yeah, absolutely. It's not surprising that it wasn't studied and even that happens, they're quite often. I did find it interesting that there are some variations in women that have or store creatine. So, I'd like to talk about that when we get a chance. But I didn't read this research that you read on sleep and GABA upregulation. Tell me a little bit more about that.

Cynthia Thurlow: It's interesting that it can have a positive net impact. There's an excitatory neurotransmitter and that's glutamic acid and then there's inhibitory neurotransmitter and that's GABA. The thought processes is that the creatine absorption will upregulate the inhibitory neurotransmitters, it also has some impact on neuronal ATP resynthesis, which impacts areas in the brain that will impact memory, cognition, and attention. Again, it's downregulating excitatory areas of the brain and helping to facilitate concentration as well as relaxation. There was research and in one of the articles that I had shared with you talking a little bit about the sleep piece, it wasn't a huge area of focus but I think in particular, for individuals that are north of 35 or 40, where sleep becomes much more of a-- I always say jokingly, it becomes an art form, all of a sudden you have to think a whole lot more about it. You have to think about what you're doing preceding bed, what you eat, what you drink, whether that's alcoholic or not, and all the things you need to do in order to help facilitate sleep.

One of the things that it talks about in particular was this brain metabolism and then also secondarily to that it's involved in the synthesis of key neurotransmitter, so it's actually found in the cerebral spinal fluid, which is important. There are actual dopamine and serotonin and creatine metabolites that they're finding in the cerebral spinal fluid, which means that it must have some good absorption. When we talk about the blood-brain barrier, there are some things that are able to cross the blood-brain barrier and there're some things that are not able to cross the blood-brain barrier and so that's pretty significant. If we're getting cerebral spinal fluid levels, then you've got some good absorption in the brain, which a lot of supplements and drugs do not have good absorption in the brain, and that can complicate how well or how effective they can be.

Scott Emmens: I saw another article on just specifically creatine and brain health and talk about being able to cross the blood-brain barrier. The fact that it was able to do that really gave the brain some neuroprotective properties as well. And they think that that also could be because the brain has more energy. That was interesting. I think this goes back to the ability to focus and concentrate, not get excited. It's usually if you have a stimulant or something that gives you energy going to make you jittery, but this has the opposite effect where it calms you, but also gives your brain the ATP that it needs to perform. And so, the hypothesis is that your brain fatigue comes from the fact that it's eating up the ATP faster than it can create it, so that that creatine crossing the blood-brain barrier really allows your cognition to be at a constant steady level, because, I think, where the real benefit for so many of us come from, if you're getting good sleep on top of that, well, then your cognition is going to just continue to enhance.

One thing I just want to go back to, Cynthia, you said when you first started taking it, you felt yourself getting stronger. I wanted to point that out because as a former bodybuilder and a trainer, one of the things that happens, you can start to lift heavier weight, it then becomes a positive cycle upward. Because as you lift heavier weight, you get stronger, as you get stronger, you get bigger and stronger muscles. Of course, you hit a point where you've hit a plateau, but the fact that that gives you that jumpstart to be able to lift heavier weights allows for both your skeletal system to get stronger, your joints to get stronger, as well as your muscles to get stronger and protect yourself from sarcopenia, and we're going to talk about later, which really is serious at the end of the day. I mean, it's sort of the beginning of the end stage of life and certainly a predictor for longevity.

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Cynthia Thurlow: I think that a good place to start is perhaps talking a little bit about gender differences. There's no question that men and women can both benefit. But it's interesting, from a perspective that women actually make less creatine than men as a standard. That could be related to so many different factors but understanding that just at a cellular level, our bodies make less of this substance. I would argue that it makes it even more important to consider supplementation to help maintain muscle mass, brain cognition. When we're really looking at such a small percentage of the population, back to brain health, only 7% to 8% of Americans right now are metabolically flexible. This is research looking post pandemic, pre-pandemic it was 12%. Now even less people. And so really thinking about ways to augment metabolic flexibility. One of those is really leaning into lifting weights, intermittent fasting or eating less often. It could be 12-hour feeding window, just really understand there are a lot of things within our control that we can do to utilize supporting health and wellness. 

I always say, "My greatest hope is that people look at-- They don't fear aging, but they understand that you don't want to just survive, you want to thrive at each stage of life." If you're peak fertile years, perimenopause, menopause, really important to understand you want to have a high quality of life.

Scott Emmens: Absolutely. There's definitely differences between men and women. Women do make significantly less creatine. From the research I could see, estrogen did play a role in that and it did go along with the cycle. There definitely seems to be something there, which to your point makes it all the more important for certain populations, I think women being one of them, which is ironic because it's been utilized in male bodybuilding role for so long. But in reality, women will benefit tremendously from creatine.

Cynthia Thurlow: Yeah. There's a really good graphic that's in this one study that I'm looking at. It's talking about the menstrual cycle may influence creatine homeostasis due to the cyclical nature of sex hormone regulation. You mentioned in particular that it's sensitive to estrogen, which also explains why women and perimenopause and menopause that are having these faltering amounts of estrogen may have even greater needs. But you can actually plot on this graph they have on the X-axis is creatine kinase activity and estrogen and progesterone concentrations and then on the Y-axis, they're looking at different phases. The follicular ovulation, luteal phases, which everyone in this podcast is very familiarized with. You can literally look at how they plot out. Glycogen storage, carbohydrate oxidation dependent on how much sex hormones are and where they are peaking and where they're ebbing and flowing throughout the menstrual cycle. 

It's interesting that we know that estrogen influences creatine and also creatine kinase, and that estrogen in and of itself is a master regulator of bioenergetics. What does that mean? As we are losing estrogen either in our menstrual cycle, or in perimenopause or menopause, it is a direct reflection of the loss of insulin sensitivity. So, obviously, in middle age, it's going to eventually be a permanent thing unless you're taking hormone replacement therapy. For menstruating women peak fertile years, they have cyclical alterations in their estrogen month to month and that is the ebbs and flows. They have days where it's higher and lower throughout their menstrual cycle, whereas with middle*aged women, they're on a downward trend. Ultimately, they'll be on a downward trend.

Scott Emmens: Yeah, that's very interesting. When you said that estrogen is the master hormone for-- what was the word that-- [crosstalk] 

Cynthia Thurlow: They use the term bioenergetics. 

Scott Emmens: Bioenergetics.

Cynthia Thurlow: Which makes sense.

Scott Emmens: So, essentially, once you have no estrogen, your bioenergetics is essentially completely downregulated.

Cynthia Thurlow: You're no longer in anabolic growth phase of any kind, you're really in this catabolic phase unless you're actively progressively working against it. From my perspective, is we've touched on sarcopenia, which is this muscle loss with aging. It's not a question of if but when. People if you think you do nothing and I can now recognize middle-aged women or even older women that are just skinny, and it's because they've lost their muscle mass. They really start replacing adipose tissue, which is highly inflammatory with our muscle tissue. I always use the analogy because I'm very visual. When we're looking at nonsarcopenic or healthy muscle tissue, it looks like filet versus a ribeye. People love eating ribeye but we don't want to become a ribeye, and I use that to understand, like the marbling in the meat is what starts happening to your muscle, because you're losing muscle mass. 

In fact, I was at an event this summer, actually, with Gabrielle Lyon and a few other people. There was a special type of scale that you stepped on. And it could tell you pretty accurately how much muscle mass you had on. She and I had a pretty good laugh when we're looking at my results. But the point I'm trying to make to everyone is that you want to maintain muscle mass, like your life depends on it. I don't think I appreciated that enough in my 20s and 30s. Certainly, you start seeing the slippery slopes. Forty is about when we start losing a significant amount of muscle mass, and then it just accelerates. So, you want to be doing all the things you can to maintain as much as possible, so that you're less at risk for metabolic diseases, insulin resistance, etc.

Scott Emmens: Cynthia, I've heard you talk about this on the IF Podcast before and in Everyday Wellness as well, that sarcopenia creeps up on you. But also, when you're in your 20s and 30s, what should you be doing? In my personal opinion and experience, people that have built up their muscle in their 20s and 30s, when they have all those natural anabolic hormones circulating through the blood tend to do much better when they hit their 40s and 50s if they're continuing, even if they're just doing a maintenance work out or just push up and pull ups, the basics. You'll see that the people that kind of had that foundation tend to stay better. It's never too late to start right, but if you're in your 40s, and you haven't been working out, you probably should hit the gym and get a trainer and learn how to work out is the point of no return. And that's the point where you've really got to face the fact that, "Hey, if I don't have muscle in my 60s and 70s, my knees are going to be rough. And that's the way you don't just have longevity, but you have health span. If you want to be healthy in your 80s, you got to be able to get yourself up out of a chair without using your arm, just to be able to stand up. And that sounds easy. But when you're 80, it's not so easy. 

I completely agree that, A, you've got to make sure that you have a foundation if you're 20 or 30 now you're listening to this podcast, start making your muscles strong now. You won't regret it. You will never regret having really strong lower legs and really strong arms and shoulders, and a strong back and a strong core. You've never going to regret that. And creatine is one of those things will help you get to that place in a very natural way. It's a natural substance that you get from meat, but your body is usually excreting more than it's taking in and extra creatine has been demonstrated time and time again to help you get there. 

The other statement which I thought was profound is that you're in a constant state of anabolic state, constant catabolic state after menopause. That basically means you're eating your own muscle tissue. And that is a dangerous place to be. I would really recommend those folks also hit the gym, take both protein whether that's in the form of essential amino acids or whether that's in the form of a protein powder, combined with the creatine, or get the protein from your diet. That’s how you got to be getting about a gram per pound, in my opinion, protein a day. It might be less, women may be 20 grams per pound, you definitely need to have that protein. And creatine is one of those things that'll make that proteins better for you. All that said, it's all going to work much better for you if you're working out with weight.

Cynthia Thurlow: No, I agree with you and you really bring up some excellent points. I always use myself as an example because it makes it relatable. We have muscle memory, so if we've been working our muscles for years, or even if we go through a period of time where we take a break, when we go back to training, we'll be able to get back to where we were a little bit faster than someone that's new. But in 2019, I spent 13 days in the hospital, I lost 15 pounds, all of which was mostly muscle. And there were many, many months where I was convinced, I was using bands. I mean they had me doing bodyweight exercise and then bands and then I could finally graduate to using weights. And the one thing my trainer said, because at that point I was coming back from a long hospitalization. I did hire a trainer because I didn't want to hurt myself. I remember him saying, "You're at an advantage. Although you've lost a lot of your muscle mass, your muscles once they start growing again, they'll know what they need to be doing." 

I encourage everyone to-- if you're not currently lifting or doing weight training, even if you start with bodyweight exercises and then graduate to bands and graduate to dumbbells and graduate to get to a point where maybe you're using machines, really take the time to be thoughtful about understanding the physiology of your body. I don't believe in having regrets, but I do wish someone had talked to me in my 20s and 30s about the fact that when you're at your peak bone and muscle mass, and then you just start to have this slow, slow decline that you may not even be perceptible for a long period of time. And men go through this too. Let me be very clear. Andropause is a real thing.

Men, much like women, they may not have as exaggerated demonstration, women go through reverse puberty, that's essentially what's happening in perimenopause. Men can go through andropause and they may have trouble maintaining muscle, they may have trouble building muscle. Most of the reason why men in the States start losing testosterone is from exogenous sources of estrogen mimicking chemicals, also from insulin resistance. Again, we go back to the same things about maintaining metabolic flexibility, how important that is, that I'm sure for those of you that are familiar with both Melanie and my single podcast, we talk a lot about toxins, we get exposed to our environment, our personal care products, our food, it is important, you do want to care about those things. But maintaining muscle mass is of particular significance. And if you're not currently lifting, you can change that. If you start off really simply, it can make such a big difference. 

The one thing that I found working in hospitals for over 20 years, there's nothing more sad than having a 55-year-old patient that can't get off a bedside commode because their muscles in their quadriceps, which are their big muscles in their legs have atrophied from lack of use. If you don't use it, you will lose it. And that's why I think it's so important to understand that we're not saying this is just related to aesthetics, we're just saying from a functional perspective, you want to be able to get out of bed, you want to be able to get off a toilet, you don't want to fall, fall risk is significant. You don't have to be 60, 70, or 80 years old to be at a fall risk. We had plenty of younger patients that were just so sedentary that they had really lost their muscle mass, they didn't even realize it until they got to the hospital and they were so weak, they just couldn't do normal, we call them ADLs, activities of daily living, and this is quite significant.

Scott Emmens: Yeah, absolutely. I can relate to that on two personal notes. First, at 52, I feel like I might be hitting andropause. Is that a real term?

Cynthia Thurlow: It is a real pause. It is a real term, but it's not utilized as openly probably as menopause.

Scott Emmens: It's getting more difficult for me to maintain muscle mass, but to your earlier point, two things. One, on a humorous note, you work out for 15 years, you put on 30 pounds of muscle, you spent 13 days in the hospital, and bam, you lose 15 [chuckles] pounds of the muscle like that. It's not quite fair on the working, how fast you lose that. But that goes to show you that if you're not maintaining it through diet and exercise and supplementation, you're going to lose it, just naturally. So, I do feel that. In fact, since we started working on this project together, I've been up my dose of creatine, I used to take every other day when I worked out. Now I'm taking it every day. I've actually seen a difference in about just the last couple of weeks. That's been nice. But my dad who is--

Cynthia Thurlow: [crosstalk]

Scott Emmens: Thank you. My day who is 74, this was four years ago, we went to Lake George, and we were at my uncle's house and he couldn't get out of the boat. I had to literally pick my dad up out of the boat. And I took my dad in the house and then we chatted as well later that night, I just sat him down and I said, "Hey, we're going to have to get you working out again because if you can't get out of a boat by yourself, and you're living on your own, I'm nervous where you're heading." I didn’t even call it sarcopenia but I said muscle wasting at your age is the first sign of you kind of going downhill. I know what your life goals are. And at 74, you shouldn't be not able to get out of a boat. And now he's on the Stairmaster doing an hour and a half a day, and I'm thinking he's doing better than I am. So, I'm really proud of him but I saw that firsthand at 74, he's in better shape at 78 than he was at 74.

Cynthia Thurlow: It just goes to show you that you don't have to be 20 and still see benefits from weight training and physical activity. We are designed as human beings to be active. I unfortunately, probably not our listeners, but looking at the general population here in the United States, people are far less active than they should be. It's almost like a domino effect. I'd plenty of cardiology patients that they would say, "It's too hard to get back in the game." One thing that I will share with the listeners is that, low testosterone and so that can happen in perimenopause and menopause. It can happen to men as well. It's important to know that a sign of low testosterone is a lack of motivation, a lack of desire. 

Last year, I was on a full complement of hormone replacement therapy and we found that I was on like way too much and so we stopped it. I had a six-week washout. You can imagine you go from feeling pretty good to then feeling pretty bad. I remember talking to Gabrielle Lyon and I said, "I can tell my testosterone is low because I have zero motivation to go to the gym, which is not me. I have zero motivation to do these things. So, I had to really just force myself to do it. But I want to just identify and be fully transparent and say that that can be a sign your testosterone levels are low if you're really feeling incredibly unmotivated." This also ties into one other benefit of creatine use that I think is really interesting. And we're looking at a study that it talked about, as an example, depression is not vis-à-vis, it's related to many factors, gut health, situational circumstances, etc. But we know that depression in women is two times higher. We know it's directly linked to hormone milestones like puberty. 

I have two teenagers, trust me when I tell you, they are grumpy and moody. It's also linked to menopause. What's interesting is that if you have a low creatine intake, either from diet or supplementation, you're at 31% greater incidence of depression than those that are taking exogenous creatine supplementation and/or getting it from animal-based protein. I thought that was really interesting, especially coming off the tail end of the past two and a half years. We won't mention what's been going on, we're all quite aware of it. But I think for a lot of people just also understanding that there's also this mental health benefit from creatine use that keeping adequate levels of creatine endogenously in the body is intricately interwoven with depression and anxiety as well.

Scott Emmens: That really struck me, was not only is it good for your cognition, your focus, but your mood as well. It seems to have from this early data we're looking at, some significant enhancement on your overall mood, motivation, and really depression, which is interesting. I'm not sure if there was a mechanism action identified in that but it's just remarkable how important creatine seems to be for your overall mental health.

Cynthia Thurlow: There was also some research I read about BDNF, so brain derived neurotrophic factor, which we know is a stimulatory protein, it diffuses across the blood-brain barrier, but we know that it increases new brain cell production. So, it's increasing neuroplasticity, while improving the performance of existing brain cells. And so higher BDNF is a lower risk of depression. So, I wonder if it's tied into that. It's interesting how just the process of aging and stress can decrease BDNF, especially those that are not actively learning your skills or hobbies. We're going to touch on neuroplasticity here but this is why you were going to be lifelong learners. We should always be learning. I just spent the weekend with one of my college roommates and we had an amazing time, and she's a teacher, and we were talking about this. She was saying even in like her own teaching population that she said those that are still continuing to take classes and learn are thriving, and those that are kind of at the standstill, colleges 30 years ago, and they haven't really taken-- they don't do continuing education, they're not investing in conferences, they're not listening to podcasts, they're not reading books, and how that's impacting their brain health. This just validates that aging and stress can impact BDNF. We also know that creatine in and of itself vis-à-vis can improve BDNF levels as well in the body. So, it's neuroplasticity, learning new things, exogenous supplementation can also be beneficial for brain health. 

Scott Emmens: Yeah, I'm obsessed with BDNF. Everything that I think can raise brain derived neurotrophic factor. I figure, "Well, how can that possibly hurt?" And exercise is one of those things. Again, we're back to a positive circle up. If creatine helps you get more motivated, helps you get better exercise, you get more exercise, we know exercise is good for BDNF as well. So, it's sort of a nice cycle upward instead of the cycle down. Lack of exercise is going to lower your BDNF, lower creatine is going to lower your BDNF. Again, this is a nice way to think [unintelligible [00:43:59] cycles down, how can you cycle up and the way that you do that, you take creatine which helps you exercise, which helps BDNF, which helps you exercise and helps BDNF. 

Just a quick aside, there was a recent study that came out as an avid tennis player, I have to mention this, they showed that tennis both extended your lifespan, but the longest of all sports, but also had the best impact on your overall brain health because it's both a sport of strategy, at the same time you're running around the court, but it also applied to pickleball for those of you who are getting into pickleball, which is the new rage. Even works in ping pong. Ping Pong had a really positive effect on the brain. So, you're looking for some exercises to help with your brain. Paddlesports, badminton, tennis, pickleball seems to be the best.

Cynthia Thurlow: Yeah, it's really interesting how important I think it is for people to be either it's the hand-eye coordination or just the concentration, but doing things that make you a little-- when I say uncomfortable, I'm not talking physically uncomfortable per se, but just intellectually, like pushing yourself, learning something new, getting outside your comfort zone. I have a friend that's learning, I don't know why she wants to learn a language. Someone in one of my group programs, who thinks she loves to do puzzles for that exact reason that she wants to push herself outside our comfort level. I was actually mentioning to my husband, he just started doing Brazilian jiu-jitsu right before the onset of the pandemic. He was a college athlete. Now that we're in a new part of the state, he is unable to play seniors level lacrosse. 

For him, he said, "It's like playing chess." But he gets to roll around on a mat with-- sometimes guys that are like 20 years younger than him, but he can hold his own and of course you know he is a former college athlete, he loves that. He gets that validation that he's still strong and virile. But I think for each one of us, we have to find ways to constantly be challenging ourselves. I think, on a lot of levels, we're just so fortunate to be in a time where information is accessible at any point in time. I have a large stack of books. I'm always reading. I'm always prepping for podcasts, but I haven't heard a lot about pickleball. I don't know how it differentiates from tennis, and I don't want to take like a huge rabbit hole jump. But I'm just curious how different is it than tennis, I know it's with a racket and a ball.

Scott Emmens: It's kind of if you were to combine ping pong and tennis and put yourself on the ping pong table, that would be the best way to describe that.

Cynthia Thurlow: Interesting. 

Scott Emmens: It's a lot less running and a lot more about sort of teamwork and strategy usually playing doubles. And it's just so much fun because it's fast paced and you get crazy wild points. It's just a lot of fun, but it's a lot of good exercise too without having to run all across the court. If you want to learn pickleball, it's the sport to get into. It's the fastest growing sport in America.

Cynthia Thurlow: I'll definitely have to check it out because my husband and I will be empty nesters in four years. For us, we're looking for all sorts of ways to do things together and new things together. Let's talk about some of the age-related changes that happen in our bodies and how creatine can potentially be a countermeasure to changes in muscle and bone strength. It can be implicated in reducing inflammation and oxidative stress. I did see a couple articles talking about improvement in bone reabsorption. But when I went down that rabbit hole, I didn't feel the strength of the research was strong enough to be able to say this is an indication per se. Maybe in the future, we'll hear more about it but I do think in particular for people in menopause, andropause, where we are de facto in a state of chronic low-level inflammation, sometimes high-level inflammation if we're insulin resistant and metabolically unhealthy, but how creatine can be beneficial for these specific timeframes.

Scott Emmens: Let's quickly address the bone issue. So, I went down the research rabbit hole on bone and couldn't find anything specific for creatine that was definitively positive. I think the reason for the mixed results, and this is just my personal opinion. But, again, I think it goes back to, if you're able to lift heavier weights or use heavier bands, really what we know for sure is that if you're putting weight on your skeletal system that can tolerate, it's going to stimulate proper bone growth given you have the right nutrition. I think what creatine can do is by making your muscles stronger, allowing you to lift heavier and heavier weights under the guidance of professional trainer and [unintelligible [00:48:34] hurt yourself. That, I think, in and of itself could be the way that creatine could help with bone. It may not be a direct result. It may be an indirect result of creatine. It's just a theory because I couldn't find anything definitive in the research.

Melanie Avalon: Hi, friends. I am so thrilled to announce that my next AvalonX supplement is official and almost here. It is something that I currently take every single day of my life and that is berberine. I first started taking berberine when I first started using a continuous glucose monitor which constantly monitored my blood sugar levels. I found that taking berberine had a dramatic effect on my fasting and post meal blood sugar levels. Berberine is a plant alkaloid which has been shown to rival Metformin when it comes to reducing blood sugar levels without any of the side effects. Blood sugar regulation is so important for health. It's a key factor in metabolic syndrome and preventatively taking care of your blood sugar levels or treating high blood sugar levels is so, so important for health and longevity. That's why I am thrilled to be making a berberine supplement. And it's not just blood sugar control, berberine has been shown to have so many benefits. It's been shown in studies to beneficially modulate adipose tissue. It can actually help change the composition of your fat to a more healthy profile. Think less visceral fat, which is the inflammatory fat found around our organs. 

It's also been shown to have beneficial effects on PCOS and reductions in inflammation and is a potent stimulator of autophagy, which is one of our favorite things. Berberine has also been shown to have a beneficial effect on blood lipids, which is huge, and I wanted to make the best berberine on the market. We looked so hard to find a source of berberine that tested to be high potency and free of pesticides. Yes, we did third party lab testing on our source, as well as testing to assure its quality. It is tested multiple times for toxins including heavy metals and mold, and has no problematic fillers. It also comes in a glass bottle to help prevent leaching of plastics into our cells and the environment. This is the berberine that you want, I promise. And it is coming midnight of Friday, December 16th. To get all of the updates about it, definitely get on my email list that's at avalonx.us/emaillist, we'll be announcing the launch special on that list. 

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Cynthia Thurlow: Yeah, I was the same. I went down that rabbit hole and I wanted it to be true. But I didn't feel like the research was strong enough to say this is an indication per se. But I would agree with you that someone that's going to work diligently about building maintaining muscle is very likely getting improvement in their bone health. One thing I just want to interject is that our bone building accelerates in puberty and then it plateaus. And then interestingly enough in andropause and menopause, but I can speak more specifically to women because I'm more familiarized with the research. What starts to happen as our bone diminishing activity starts, osteoclastic activity up regulates, which means we're actively breaking down bone as opposed to building bone. And that's why women in many ways are at greater risk for osteopenia, osteoporosis at that time in their lives. Obviously, osteopenia is kind of a lack of a better way to put it, it's a diagnosis that was created by the pharmaceutical company, it's really not a diagnosis per se because they're comparing the bone tensile strength of a 50-year-old to a 20-year-old and you can't compare that great of a difference in age. Osteopenia, I don't get terribly concerned about but obviously osteoporosis is significant, and really does need to be addressed proactively.

Interestingly enough, one thing that kind of accelerates a lot of these processes in the body in women is that as we have lower and lower estrogen level, so tail end of perimenopause because in menopause, we can have very high estrogen levels prior to going into menopause, is that this is what really drives inflammation, it drives the oxidative stress, it drives the degree of insulin resistance. And it also blunts muscle protein synthesis, and also satellite cell response to anabolic stimuli, which is a fancy way of saying strength training. It's not in your head. If you find that in perimenopause and menopause, it is a lot harder to build muscle, you are working against hormones. The hormones that are saying, "There's not enough estrogen around." Estrogen is definitely one of these hormones that we have estrogen receptors throughout our body, but directly impacts this muscle-protein synthesis, and so it is not in your head if you're struggling to maintain and build muscle. Estrogen and testosterone can definitely play a role in that.

Scott Emmens: The power of hormones is undeniable. You feel it when you go through menopause, you feel it when you go through andropause, you see it when people take artificial steroids. If you look a gentleman or woman on steroids, you can tell, at least I can tell. They're very powerful. People also underestimate the power hormones on your mental cognition as well. A lot of effects on your mentality, as you're alluding to earlier about when your testosterone lowered, you'd have no motivation. You think that's in your head, but it's not. It's a hormonal issue.

Cynthia Thurlow: Exactly. The Women's Health Initiative is a study that I definitely talk about on the podcast, but in 2002, the Women's Health Initiative really changed the narrative and the comfort level of clinicians prescribing hormone replacement therapy, made many, many patients scared. There's no other way to put it. Scared to take hormone replacement therapy. I did a really great podcast with Dr. Avrum Bluming and Dr. Carol Tavris talking about this. He's a clinician, he's a physician, he's an oncologist. She's a researcher and they really debunk the Women's Health Initiative. Unfortunately, it was done on an older population of women, they already had insulin resistant, they were former smokers or current smokers, they had high blood pressure, a lot of health issues, and they put them on synthetics, and then drew conclusions from that. I always like to just interject, there's no judgment, there's no shame. I see a lot of women who are fearful to take hormones and so they're white knuckling it into perimenopause and menopause. Each one of us has to make a decision. This applies to men as well. Each one of us has to make a decision that makes the most sense to us. But understanding that hormone replacement therapy can be very beneficial, in particular for muscle and bone and brain health, and cardiovascular health, etc.

Scott Emmens: I've heard that podcast and I paid very close attention because I was in the pharmaceutical industry in 2002 when that study came out, and I was partnered with Eli Lilly, I think they either funded this study. They were making a product for hormonal replacement therapy for osteoporosis is what it was. And doctors stopped using it and folks frenzy and I read that study, then I thought, "This seems awfully skewed." It's 20 years later and just the other day, I kid you not, I heard people talking about that study in a negative light, which is a lot what happened to creatine, what are some of the common misconceptions. People thought, "Well, it's bad for your kidneys, it's bad for your heart," and had all this negative press going into it. But that stuff is 20, 30 years old, it's been one of the most studied supplements there is. It's interesting that you use that study because this is tantamount to that like, this is one of the best things you could do. That study sort of ruined HRT for a lot of people, which is a shame.

Cynthia Thurlow: Absolutely, because there's a whole generation of women. I think about my mom's generation that have really suffered needlessly because they were told that it was going to give them cancer. We've now figured out that that's not actually the case. But let's sling back to sleep and sleep deprivation. The reason why I think this is particularly important, we get a lot of questions on the podcast about sleep. We know that high stress, chronic stress will actually deplete not just creatine stores, but actually ATP. So again, less energy circulating. And we know that supplementation with creatine based on the research that we've both been looking at, can impact tasks that rely on the prefrontal cortex, which is our executive functioning brain, the one that helps with cognition and attention and memory, very important. Also very important because we know women are more sensitive to sleep deprivation, and particularly women that are most at risk, or the women that are pregnant, breastfeeding, postpartum, and menopause.

Based on this research I was looking at and I thought that was really interesting, because for any woman that's listening that went through pregnancy and then had the postpartum period where you weren't sleeping for weeks or months on end, that's pretty harrowing, but also in the same research article, they were talking about menopause as the same degree of sensitization to sleep deprivation. I think a lot of women that are listening or women know of other women who have spent years of having terrible sleep deprivation in middle age both in perimenopause and menopause, and it's totally normalized. I think that's really, really unfortunate.

Scott Emmens: It is and there was actually a study, I don't know if it was one of the ones you have had send me or one that I had read separately, that talks specifically about creatine's ability to support brain fatigue and sleep deprivation. I wouldn't call that a band-aid, what I would call that is going to allow you to get the energy you need to function throughout your day properly, so that when you do go to bed, you're back in your rhythm because one of the things that we know about sleep is it's all about your rhythm, your circadian rhythm, your exposure to light, your lack of exposure to light in the evening, your cortisol spikes and peaks amongst other things, but sleep is a lot about rhythm. If you don't have enough energy during the day, and you're resting all day, and you're sitting down all day and you're not active, well then what's going to happen at night, is you're going to kind of be that wire-tired mode, you're exhausted, but yet you're tired. 

The information I looked at really said, "Hey, look, if you're in this sick deprived state, not only can it help you get out of it, and really help your brain heal itself and be as active as it was and it gotten that sleep." To me, that's a way to reset your circadian rhythm at least your energy circadian rhythm, and then you've got to do other things obviously to support that.

Cynthia Thurlow: I think it's really important. And it's something that I didn't realize until I was looking at the research that what has been different over the last couple months, in particular, because I've been taking creatine consistently, was my sleep quality is improved and how do I track that? I track that on my Oura ring? And then I probably will screenshot it and share it in IG stories and people say, "Oh, my gosh, how did you get that much deep sleep?" And I'm like, "I think it's a couple things." But I keep trying one thing, pulling that out, trying something else because sleep in many ways becomes an art form. And I don't think I ever thought about sleep to the degree that I do now. But knowing that potentially the creatine I've been taking has been improving that sleep support, which again I think most, if not all women, and men for that matter, would truly desire to have better quality sleep.

Scott Emmens: Yeah. I've been a chronic insomniac pretty much my whole life. Recently, I've been sleeping pretty good. Got the whole system down. I do the light in the morning, try to keep it dark in the evening, creatine, occasionally I'll do melatonin when I feel I just need to reset my clock. But I've been doing really well. I'm getting up at the same time every morning, going to bed at the same time every evening. And I have been taking creatine now for a couple of weeks almost every day.

Cynthia Thurlow: That's great. Well, probably important to talk about where we can get food sources of creatine. And then talking about dosing because I think that will be a huge question for many people. How much do I need? I'm carnivore-ish, do I really need more? The answer is yes. But what are some of the sources of animal-based protein that are most creatine dense, I guess is the way to put it.

Scott Emmens: It's going to be all of your essential meats. It's going to be steak, in turkey, things of that nature. I don't think fish has a ton, but it has more than that. But basically, the really only place you're going to get creatine in your diet is from various meats. So, it could be pork, it could be yak, it could be bison, but meat is really going to be the only substantive way to get it into your diet. Eating meat, you're going to really be at risk for being low in creatine. If you're a vegan or vegetarian, especially if you don't eat any fish, you're going to be at serious risk of a major creatine deficiency. Even if you're eating meat, there's not really enough per kilogram if you look, it's like, I don't know, I can't remember the exact numbers, maybe you've got it at your hands. But it's something like 0.8 milligrams per kilogram of meat. Well, the kilogram is 2.2 pounds. I don't eat 2.2 pounds of any meat. So, there's not a ton of creatine going in. And the data I looked at says that average woman stores about 100 grams of creatine and excretes a net 2 or 3 grams a day. Men hold 120 and excrete about 2 or 3 grams a day as well. So, you're always in this negative deficiency unless you're eating enough meat to compensate for that. 

When it comes to the dosing, for me it's somewhere between 3 and 5, or 3 and 6, or even I'd even go to 9 if I felt like I needed some creatine because I hadn't had meat in certain period of time. But I think it is dependent on what your diet is like, are you vegan? Are you a carnivore? Athlete? Like, for example, my daughter is a Division I track athlete and she runs the 400 meter, the 100 meter hurdles. No, that is a lot of energy. She's got three-hour practices every day. So, I've got her on 9 milligrams of creatine a day, broken up into three doses, one with breakfast, one with lunch, one with dinner. My [unintelligible [01:03:46] actually like to take 9 milligrams all at once. I don’t take 9, I usually take 3, 3, and 3 or 5 and 5. I like to break it up. I have her just on 3, 3 and 3. And that changed her trajectory because in high school she wasn't the star of the team. We put her on creatine, some amino acids, but this was the only thing, she practiced and trained with a lot of other things but she ended up finishing 100 meters [unintelligible [01:04:14] in Pennsylvania, six in the entire state of Pennsylvania. So, was it creatine? No, not alone, but did that help? Yeah, I bet you that helped.

Cynthia Thurlow: That's an incredible story. I think it's important for people understand that the average person listening could probably get away with 3 grams per day. Like Scott mentioned, his daughter's a Division I athlete, totally different. Needs based on research that we looked at, the vegetarians and vegans need probably 5 grams a day. And so just understanding that very athletic people, and by that, I mean ultra-level conditioned athletes. I'm not talking about person who does CrossFit twice a week. Although that's great, you're probably not the person that needs that high amount of creatine. And also, it's interesting depending on where a woman is in her menstrual cycle, she may need more or less. But we didn't want to get terribly nuanced about that because there're so many other factors that impact hormone regulation and insulin sensitivity throughout a menstrual cycle. But just understanding that 3 grams a day has been our recommended for the average person that includes myself. But certainly, if I were giving this to my very athletic, sports-oriented kiddos, it would probably be more because they're still growing.

And, obviously, if you are vegetarian or vegan, your creatine needs, because you're not eating animal-based food or products, is going to be higher. And what was interesting, and I just want to make sure I'd dovetail this into our discussion about vegetarianism and veganism, is that it was even discussed in some of the research that their needs for creatine just based on brain health or even higher because they're not getting those animal-based products. And we respect people's choices. I just wanted to make sure I mentioned that they have to take more creatine to ward off the brain health related concerns.

Scott Emmens: Yeah, absolutely. I think we all make our individual choices. We obviously respect those choices. But it is important for people to know when they make any choice, whether it's to eat meat, what those risks are, or to not eat meat, what that diet will require you to do. Like we know, most vegans know that vitamin B12 is an essential supplement. I would put creatine in that same bucket. If I were vegan, there's no question I'll be taking creatine. I take it anyway I'm not eating because I know I'm excreting a little more than I'm taking in. I can feel the difference. But for sure, if you're vegan, you're going to want to, at the very least you do some research on your own, talking to physician or a functional medicine specialist, and I think you'll find that creatine will be a great addition to your diet.

Cynthia Thurlow: Absolutely. Well, I want to make sure I'm respectful of your time because I know that you have a lot going on as well. This has been an incredible podcast. I hope listeners find it to be just super information savvy. A few things for listeners before we go. If you'd like to submit your own questions for the show, you can directly email questions@ifpodcast.com or you can go to ifpodcast.com and you can submit questions there. You can follow us on Instagram, we are @ifpodcast, I am @cynthia_thurlow_, Scott is @longevityprotocol, and MD Logic is @mdlogichealth. The show notes for today's episode that will have a full transcript as well as links to everything that we've talked about will be at ifpodcast.com/episode292. You can get all the stuff that we like at ifpodcast.com/stuffwelike.

This has been wonderful, and we will see you next week. And before we go, I wanted to make sure that I also included the link to get on the waitlist for my creatine. It's cynthiathurlow.com/new-shop/creatine. Gosh, that wasn't made easy, was it? Got to make things complicated. I'll tell my team make it easier next time. Scott, is there anything that you want to add before we go?

Scott Emmens: Well, yes, I would like to add that I have your updated information and the product by the time this airs, I think is November 21st, that the creatine will be available for purchase on November 21st. So, if you are not on the list already, you can order. It should be able to be ordered through your site, Cynthia, on November 21st.

Cynthia Thurlow: That's super exciting. I feel like this has been many months coming to fruition and I can't wait to share with the listeners the next product we're going to be working on.

Scott Emmens: I can't wait either. This has been great. Thank you so much for having me, Cynthia.

Cynthia Thurlow: Awesome. This has been so wonderful, and we will see you next week.

Scott Emmens: All right. Take care.

Melanie Avalon: Thank you so much for listening to The Intermittent Fasting Podcast. Please remember, everything we discussed on this show does not constitute medical advice, and no patient-doctor relationship is formed. If you enjoyed the show, please consider writing your review on iTunes. We couldn't do this without our amazing team. Administration by Sharon Merriman, editing by Podcast Doctors, show notes and artwork by Brianna Joyner, transcripts by SpeechDocs. And original theme composed by Leland Cox and recomposed by Steve Saunders. See you next week.

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