Dr. Patrick: I want to go back to your three...if it's too good to be true, it probably is. There was the third one, which is there's exceptions. Here's my jam.

Dr. Phillips: Go for it.

Dr. Patrick: Omega-3 and vitamin D. Okay. I...

Dr. Phillips: Check, check. So, my supplement shelf is small. I live a lot further North than you do, so we get less useful sunshine. Definitely, in the winter months, vitamin D is, yep, absolutely.

Dr. Patrick: So my question to you being a muscle expert, and me, you know, I guess people would call me an enthusiast. You know, I definitely try to follow the science. But there's widespread deficiency with vitamin D, no doubt, you know, across North America. And, you know, it is a steroid hormone that is doing similar things like testosterone in the sense where is a binding receptor going into the cell nucleus and regulating...

Dr. Phillips: Changing all kinds of genes. Absolutely.

Dr. Patrick: Yeah. Like, 5% of the protein encoding human gene a lot. So it's not just about bone homeostasis back to the RDA. But with omega-3... I do read a lot of the literature, and I certainly don't always get things right. But I've seen more than one. I've seen probably a handful of studies now looking at omega-3 supplementation and muscle mass, specifically, I think, there's older women...usually an older population. But it helping with...I think it may be helping prevent some of the atrophy or helping with lean muscle mass. Is that a real thing?

Dr. Phillips: It's a real thing. Like in our hands, I had a postdoc, Chris McGlory. He left the lab. He has a faculty position now at Queen's University. But when he came, he was an omega-3 guy, and he said, you know, "We need to study more of this in human muscle." So we ran a trial, and we ran it actually younger women. And then a bunch of people said, "Why do you run it in women?" I'm like, "Nobody ever asked you why you only run in men," right? So we did it in younger women for a number of reasons. There's not much research in younger women. And we did actually think that it might be more effective in women than men for reasons I don't fully understand, as you mentioned older women there as well. We supplemented one group with very high dose of omega-3 fatty acids, and we supplement the other group with, sort of, a corn oil placebo. And then we braced one of their legs for local disuse atrophy model for two weeks. And the women on the omega-3 supplement saw a really mild disuse atrophy response and then returned to normal much quicker than the other group who saw a much greater atrophy response and didn't get back to normal after two weeks of what we call passive remobilization. You remove the brace. You don't actively rehab. You just, like, go back do all your normal things. It's anti-catabolic for sure. You can have a nutritional intervention that can affect disuse like that. That's a profound finding. So you can imagine with respect to our disuse, you know, a catabolic crisis model, lots more work to be done. That's more Chris's area. He left. I'm like, "That's yours, man."

Dr. Patrick: Is he still doing it? Yeah, because...

Dr. Phillips: He's still doing it.

Dr. Patrick: I mean, you know, here's the thing is that we have this aging population. And it is much easier...as much as we want to get them to...first and foremost, can we get them to do any sort of resistance training? Obviously. But that is a struggle, especially for people that are much, much older. You know, getting them to take a pill is one of the easiest things that you can do.

Dr. Phillips: Yeah. One would think. Dr. Patrick: Yeah. Omega-3 is... I think there's just been more and more evidence that, you know, there's many benefits. I've talked about a lot of those. But, you know, I mean, the anti-inflammatory resolving inflammation in so many different ways. I mean, there's like the specialized pro-mediating molecules. There's the resolvans, the protectins, the maresins. I mean, it's doing...you know, it isn't just prostaglandins. It's not just, you know, this one, you know, pathway. I mean, it's doing a lot of things. And what role does inflammation...? So inflammation, I know from reading your work, inflammation in a diseased state like cancer or, you know, type 2 diabetes or things like this. I mean, it can be catabolic, right? Dr. Phillips: Absolutely. Dr. Patrick: What about the low-grade chronic inflammation, the unhealthy sedentary? Dr. Phillips: Yeah. Yoau know, the disclaimer is, you know, we've learned a lot about how to make muscle more anabolic in young individuals, and then we've extended that to healthy older individuals. We don't have older individuals participate in our study. If they're on, the list of medications is relatively long. So, they're probably the healthiest of the older population. We'd like to think that's a truer effect of aging rather than some meds that they're taking. But let me just say that chronic low-grade inflammation and what people call inflammaging is problematic. It's probably responsible for some of the anabolic resistance we talked about. So dampening the inflammation beforehand could help you get more anabolic. In extreme situations of, you know, so ICU or cancer or, you know, particularly cancer cachexia where people are...you know, they're swimming in inflammatory cytokines. And, you know, COVID gave us a little glimpse of this cytokine storm that some people experience. The prognosis becomes very poor. So we think a lot of things, you know, nutritionally can combat muscle disuse. But if you have a patient that's on bed rest and in an ICU, and they're, you know, massively inflamed, you can throw a lot of things nutritionally at these people, and it's just dust in the wind, nothing really happens. So, you know, the message is you've got to get inflammation under control before you're able to see the full and robust effect of a lot of the anabolic stimuli that we're talking about. It is an issue. And it's clearly something that people need to think about as they get older. I'm actually of the mind that, you know, the low-dose aspirin that a lot of people are taking to, sort of, tamp down inflammation is probably a good thing. But then also the flip side is to say, there is some degree of inflammation that needs to happen. So if you keep chronically suppressing inflammatory responses in younger people even, I don't think you get a full adaptation. So, some inflammation good and necessary, chronic low-grade inflammation, probably not good, definitely rampant inflammation in all kinds of clinical states. Yeah, that's really going to take the edge off of anything you do, both nutritionally and probably from an exercise perspective too. Dr. Patrick: Yeah. What you said makes a lot of sense. But obviously, you do want an inflammatory response when you need it, right, I mean, when you see a pathogen. And that is also why I think omega-3 is one of the best ways to kind of lower the chronic inflammation because it has to do with resolving in so many ways the resolving of the inflammation. Dr. Phillips: It's almost if you're turning down the burner, right? You know, it's taking the edge off of that. So now I agree. Yeah. Dr. Patrick: Right. Yeah. And then my last supplement to ask you about creatine monohydrate. There's evidence that it seems to be beneficial for muscle growth, for brain health. Like, is there side effects? Is there worry? What are your thoughts on it? Dr. Phillips: Yeah. So, again, short supplement shelf that's on there for me. I don't take it all the time. I have periods where I'm doing a lot of work. I try and, sort of, you know, ramp up the volume of work that I'm doing, and I will add creatine at that time. Now, I know a lot...I got friends who are saying, "Why aren't you taking it all the time?" And I get it. Probably about 40 years old now. So supplements go. It came and stayed, which makes it one of the number three categories. It sounds too good to be true. Its effects are pretty mild on muscle, but they're there. They're potent. They last. Now the brain and the cognitive side of things is...you know, the evidence is growing in that area too. If there were a danger with it, you know, that it was having...there was a lot of talk about "It's damaging your kidneys. It's doing, you know, this. You know, it's a guanidino compound, etc," we've got 40 years' worth of data with people on the supplement now. And we're not seeing some, sort of, rife wave of people who used it getting various forms of cancer, etc., which you would expect. Forty years is enough to see the effect. All the data reviewing it from a safety standpoint has given it two thumbs up. The adverse events are rare usually in combination because people are taking not only that supplement but several others. So, you know, pinning it on creatine per se hasn't shown any credence. So, it definitely gets an A grade from the effectiveness standpoint. I think it's good for younger and older people. I'm good with the health or the safety side of things as well. I do think people if they're going to try it should do it, sort of, gradually. It used to be you take these big loading doses. And I think most people now... A good friend of mine, Mark Tarnopolsky, neuromuscular physician, has all of his neuromuscular patients on it. So I think that that's a fairly robust endorsement of what it can do for people with compromised muscle function. And he recommends that these people just start with a dose of above, you know, 4 to 5 grams of creatine a day. Dr. Patrick: What is he using it like exactly for? Dr. Phillips: Well, I mean, all these people have is one of the overriding symptoms no matter what they have, whether it's a mitochondrial myopathy or some, sort of, dystrophy condition is muscle weakness. So, people do get a little bit of a boost. It may not be, you know, something that you or I would consider worthy. But if you're somebody who's close to that line where, you know, disability is here and ability is here, then creatine could be what it is that pushes you over that line. And again, you can go and read his papers. They're pretty robust studies done in all kinds of populations. So, yeah, try it, see what you think. Most people tolerate it very well. You don't need a fancy brand of it. The stuff they sell at Costco or whatever is just as good as anything else. The monohydrate form is the one to aim for. Don't be fooled by...creatine, insert your favorite derivative, monohydrate is the one that's been most studied and so probably the one you want to go for sure. Dr. Patrick: And it's good to know. So you don't actually have to be physically active to reap any benefits from it. That was the question I had because...I mean, again, thinking of parents and grandparents, right? That's the issue with the ones that are not physically active or that... I mean, there's people that walk their dogs and stuff, which is good that at least gives them some physical activity. But you don't have to be pumping iron and stuff to... Dr. Phillips: No, you don't. Dr. Patrick: Because I always thought about it that way. I'm like, "Well, I'm not like a gym rat. So do I need it?" Dr. Phillips: Yeah. No. You know, the stuff now with creatine that they're uncovering that makes me think, "Maybe this should be part of my regular routine" actually has less to do with the muscle and more to do with the brain and the cognitive performance that it...you know, it's come back several times now and proves. And, you know, you mentioned, I'm the director of PACE. It has a special place in my heart. And the truth is, is that you talk to people in PACE. Our oldest participant is 104. So I consider him to be the icon of wisdom. And people talk about when they get older from a health standpoint, they don't want to be a burden. And that always when you unpack it, it is round, "I don't want for somebody to have to take care of me because my physical capacity has gone down or that my mental capacity has gone down." They all fear that. So it's dementia and then it's physical inability to do things. And so I say, "Well, you're here working on the physical ability. But you're working on the dementia too." And they say, "Well, what else can I do?" I say, "Well, here's a list of, sort of, things." And by no means a dementia expert, but creatine might be something that older people might want to talk about for sure.