June 2008 PDF

Wean off of antidepressants and still feel better—every single day

I’m against the overuse of drugs, and antidepressants are especially overused in the treatment of low mood and depression. There’s mounting evidence that they don’t work for anyone but the most severely depressed patients. Yet if you tell your doctor you’ve been feeling down, it’s likely he’ll have a script written before you finish your sentence.

Think of depression as a symptom that may signal an underlying physiological condition. By taking a drug that could potentially band-aid a more serious condition, the result is you receive a non-diagnosis.

If you have a clear family history of depression, understand that genes play a large role and you may benefit from medication. Behaviors learned as a child in a depressed family may compound the problem. The right medication or combination of drugs in the hands of an experienced practitioner can literally give you back your life.

But take a close look at your life situation first. Prolonged stress due to economic hardship, work demands, unhealthy relationships and social isolation can result in a huge load that affects your ability to manage your mood. Then there are the things you may be doing to yourself—such as eating poorly, leading a sedentary lifestyle and not getting enough sunshine. Even exposure to toxic chemicals in your water, food, and the air you’re breathing can contribute to your mood.

See why it’s not as easy as taking one pill for relief?

Looking beyond the tip of the iceberg

Trouble handling stress over the years can have a snowball effect, taking a serious toll on your brain and mood. Chronically elevated levels of cortisol disturb normal neurotransmitter functioning and proper balance. Adding fuel to the fire can be a lack of good nutrition. The combination of a prolonged stress response and a poor diet can result in insulin resistance, throwing off your sex hormone balance, which in turn can aggravate your mood problems. Excess cortisol and insulin will continue to drive sex-hormone imbalance—and those mood challenges. The cycle will continue until it feels insurmountable. But there are ways to get control back—without spending your life on prescription drugs.

Sleep habits impact mood

Sleep issues are often linked to depression­­––but not in the way you might think. Although a small percentage of patients (15 percent or so) have the desire to sleep too much, the most common sleep disturbance is actually insomnia.

Lack of sleep can cause your serotonin levels to dip. Research has yet to discover whether dips in serotonin cause depression or whether depression leads to dropping serotonin levels. And if you aren’t getting enough sleep, your body is missing out on the very important restorative process that allows your systems to regenerate and recalibrate while you snooze.

Another sleep disturbance that has been strongly linked to depression is obstructive sleep apnea. Serotonin is a neurotransmitter needed by the nerves that control your breathing. As you can imagine, a lack of this neurotransmitter can lead to the breathing problems associated with sleep apnea. And having this condition can wreak havoc on your ability to conquer depression. Go to www.google.com and type in “Epworth Sleepiness Scale” where you can self-evaluate for this condition. Report your results to your doctor and have him work with you on the various, excellent non-drug treatments that are available.

Put the brakes on—or your thyroid will

Low mood commonly goes hand in hand with a sluggish thyroid, or hypothyroidism—another commonly missed problem.

Hiding at the root of most thyroid issues is overwhelming stress. If you run your engine at maximum speed for too long, you put your body into a prolonged stress response. Your thyroid gland acts as a kind of speed trap, regulating your metabolism. It can potentially slow it down in order to slow YOU down.

I recommend having your thyroid checked so you can rule it out as a culprit in your depression. If you’re feeling low, a TSH level above 2.0 could spell thyroid problems. Ask your doctor to check your Free T3 thyroid-hormone level. T3 is the active form, and T4 is the less-active storage form. A low or even a low-normal T3 could spell a problem. Your treatment options range from mind-body therapies (more on this in a minute) such as ginseng, ashwagandha or rhodiola—all of which promote hormonal balance—to thyroid hormone replacement or to some combination of these, depending on your individual case.

Depression relief from the inside

While you’re working on solving any of the various physiological factors that could be potentially affecting your mood, there are some healthy habits you can begin developing right away. These include managing your reactions to events so that you won’t have a bout of those low-mood symptoms.

There are natural, effective treatments that don’t involve risky drugs. Some of the side effects of the commonly prescribed drugs can include dizziness, anxiety, loss of libido, insomnia, excessive tiredness, and nausea. That’s just the short list. I’m happy to report that the following treatments share none of these ill effects. I believe that the cornerstone of any depression-treatment plan should include one or more of the following:

• Deep breathing
• Meditation and prayer
• Biofeedback (see www.heartmath.com)
• Guided imagery and hypnosis

These are just some of the things that can help you regain your balance and learn to take control of your response to life’s challenges (and there will always be some). The key here is to determine which therapy (or combination) will work best for you. I’ve found with many patients, including those who are already practicing prayer and meditation, that adding biofeedback can make a big difference in their mood. This method trains you to recognize stress signals and relax when you feel their onslaught.

The power of talk

Cognitive Behavioral Therapy (CBT) can successfully treat mild and moderate depression without a need for medication. In more severe cases, CBT plus medication can work better than medication alone. With the guidance of a therapist, you have the opportunity to examine negative thought patterns you may not even realize you have. When you recognize such thought patterns and practice new, more positive ones, you will feel and function better. Your brain actually undergoes the physical changes associated with the healing of depression. The key word here is practice. Don’t count on a magic-wand effect—there’s no such animal. Ask your doctor for a referral to someone specializing in CBT.

Exercise—the next blockbuster drug?

Big Pharma doesn’t want this information to leak out, but here you have it: Study after study confirms that regular exercise—even as little as 30 minutes of walking five days per week—can improve depression as much as medication. Now, a depressed person may think “That’s the last thing I feel like doing.” If you get moving, the dividends for that investment in time and effort will pay off.

For one thing, your breathing changes with the exertion of exercise, and the deeper breathing can help expel tension your body is holding. Exercise has also been linked to improved sleep—giving your body that shot at restoration it needs each night. And endorphins are also released—your body’s natural painkiller—helping you to literally feel better. These resultant good feelings begin a new cycle toward a greater sense of well being.

Start out slowly and set small goals for yourself. The best exercise is one that you enjoy doing. Dancing, riding a bike, and walking your dog around the neighborhood are just some ideas to get you thinking about what’ll work for you.

Get your essentials

By nourishing yourself with the unprocessed whole foods your body was designed for, you’ll give your brain the nutrients it needs to run itself and balance your neurotransmitters. Nutrients you’ll particularly want to include are:

Omega-3 fatty acids: Take at least 2,000 mg total EPA plus DHA daily. They regulate and improve brain-cell functioning. For the most detailed explanation of how this works, I recommend you read The Omega 3 Connection, by Andrew Stoll, M.D., a Harvard psychiatrist who treats both depression and bipolar disorder with doses ranging from 1,000 mg to over 5,000 mg daily.

B vitamins and folate: Make sure you get enough from food (including blackstrap molasses and brewer’s yeast) and supplements. In one study with depressed patients on antidepressants, researchers looked at the effect of taking 10 mg each of B1, B2 and B6 compared to a placebo. The participants given the B-vitamin treatment showed improvement in their cognitive function and their symptoms of depression. I recommend you get one of the 50 mg formulations that are available. Up to 100 milligrams (1,000 mcg for B12) are certainly safe, as B vitamins are water-soluble and get excreted promptly in the urine. Make sure you also take 400 to 800 micrograms of folate per day. The need for folate in depression is well established.

Vitamin D: Low levels of vitamin D disturb normal neurotransmitter functioning in the brain. Ask your doctor to test your 25-hydroxy vitamin D levels. You’ll want to get your blood level of 25-hydroxy vitamin D to between 50 and 60 nanograms per milliliter with 1,000 to 2,000 IUs of D3 daily.

These are fundamental supports for basic good health and have a direct bearing on your mood and sense of well being, whether you take antidepressants or not.

Go beyond the basics

I recommend that anyone who uses supplements for depression, be sure you work with an experienced professional. You’ll save time and money, and have a much better chance at success. That said, I also recommend the following remedies as useful in safely treating fatigue, low mood and depression (especially in its milder, more prevalent forms).

Rhodiola rosea: This is an herbal adaptogen from Russia that helps normalize and balance your stress hormones and brain neurotransmitters. I see many patients with mild to moderate fatigue, low mood and poor sleep that’s due to the crippling combination of too much stress and a bad diet. Most of these patients’ adrenal glands are overworked and their thyroids are borderline sluggish. Rhodiola can help correct these imbalances while you work on the all-important diet, exercise and stress-handling issues. Most people will experience benefits with a daily dose of 100 to 400 mg. New Chapter’s Rhodiolaforce 100 (www.newchapter.com) comes with instructions on how to build your dose.

• SAMe: An essential molecule found in your body, SAMe is considered a methyl donor. Methylation plays a role in numerous key pathways, including brain neurotransmitter function. Unlike commonly used SSRIs, which can take anywhere from two to six weeks to produce an effect, you can feel improvement with SAMe in a few days to a week. That’s all the time some folks may need. And if you’re severely depressed, SAMe can augment standard drug therapy. Start with 200 mg and gradually adjust upward over 2 to 4 weeks to as high as 800 mg twice daily. Costco actually sells the least expensive, high quality SAM-e.
  
• St. John’s wort: This is the most commonly prescribed antidepressant treatment in Germany for mild to moderate depression. And it’s usually used as an alternative to conventional meds—not in addition to them. There was a highly publicized study in JAMA a few years ago that showed results no better than placebo. (Many studies actually show consistent benefit.) But here’s the story the media didn’t tell you: the popularly prescribed Zoloft tested out lower than St. John’s wort! Also, St. John’s wort is not recommended for severe depression—so it was a waste to even test for that. But there’s no denying the lengths that some will go to make a point to discredit a natural remedy. Quality products are Nature’s Way Perika, Puritan’s Pride St. John’s Wort (www.puritan.com) and New Chapter’s St. John’s SC27.
  
• 5-HTP: 5-hydroxy-tryptophan is a precursor compound to serotonin, the “contentment and healthy sleep” neurotransmitter that’s the target of SSRI drugs like Prozac, Zoloft, Paxil and Lexapro. 5-HTP can be an effective agent (alone or in combination with other treatments) for mild to moderate depression. (It’s also a safe sleep aid—that same tryptophan that causes the post-Thanksgiving-dinner snooze effect.) Dose: Try 5 to 50 mg at bedtime. Jarrow, NOW, Swanson and Nature’s Way are all widely available and reliable products.
  
• Theanine: This amino acid from green tea does some very interesting things in the brain. It can create a “calm focus” by 1) boosting brain dopamine, which stimulates thoughts, language and motivation, 2) acting gently at the GABA receptors in a way that decreases anxiety, and 3) reducing blood levels of the stress hormone epinephrine. The overall effect is subtle but pronounced—especially on people who are neither calm nor focused. Use it alone, with other supplements, or with medication. Caution: green tea does contain caffeine, which can contribute to those sleep problems I just mentioned, as well as the jitters. To avoid those effects, choose decaffeinated green tea.

10 ways to forget dieting—and start losing

Type the word “diet” into www.google.com, and 281 million results pop up. At least, that’s what the number was when I sat down to write this article. It’s probably more than that already.

There’s an entire industry built around weight loss. We’re bombarded with hundreds of diet books every year, each one promising an end to your weight woes.
Please, save your money.

I’m against the commonly understood idea of dieting—“magic-cure”––because the science doesn’t support it. Generally, the primary focus of such diets is deprivation and semi-starvation. It’s one thing to make permanent lifestyle changes in terms of your overall diet. But it’s another thing entirely to briefly overlay a temporary fix atop your life and expect it to maintain sweeping changes indefinitely. Deprivation diets stress your body, which perceives a threat and winds down your metabolism in order to conserve energy. This completely defeats the purpose of what you’re trying to accomplish.

Another casualty of dieting is the ability to feel good about food. You have to try to tough out the cravings brought on by a lack of the nutrients needed to run your body. As soon as you start associating “healthy food” with hardship, rather than as pleasurable and beneficial, it’s a recipe for failure.

Here’s something I hear frequently: “Dr. Inglis, Weight Watchers (or any similar diet) worked for me last year. I’ll try that again.” I ask, “Have you been able to keep the pounds off?” The usual reply is a puzzled, “No… I gained it all back and then some.” This is an example of a diet that doesn’t work. And research shows that over 90 percent of people who go on diets regain their weight by the end of one year. The mostly low-fat, high-carb diets touted by the so-called “experts” may result in weight loss on a short-term basis. They’re notorious, however, for high rates of dropout over the long term. You’re better off just cutting the carbs and making sure you get enough natural fat, which for many people actually means adding fat to their diet. (I’ll delve deeper into that in just a minute.)

The worst thing you can do is to keep losing weight just to put it back on again. You’ll end up with a metabolic nightmare that will raise your risk for all those chronic, degenerative diseases you’re trying to avoid in the first place, including heart disease, diabetes, dementia and cancer.

Here are some key tips on normalizing your body weight while supporting good health and keeping yourself off the dead-end and dangerous diet bandwagon.

This food group is beneficial—really

One of the more common problems I see is with people who are now on a “healthy diet” but aren’t getting enough fat. They believe cutting way back on fats is the answer to losing weight. It’s an assumption born of media misinformation. Here are the scientific facts: too many processed and refined carbs and sugary snacks tell your body to store fat—not fat itself. Now, that doesn’t mean to run out and indulge every chance you get on a fast food, burger-and-ice-cream meal. Cutting back on fatty foods and all the bad stuff they harbor, such as antibiotics, hormones and pesticide residue (and who knows what else), is a very smart idea. Skip processed cooking oils (the soy and corn varieties, for example) and trans fats (aka hydrogenated and partially hydrogenated fats) in any amount. Healthy omega-3 fats from fish and nuts are perfect alternatives. Monosaturated fats from things like nuts and olive oil are also very healthy. Moderate amounts of saturated fats from organic dairy products and meats are also good.

An emotional bond with food

Your overwhelming hunger may stem from a chokehold bond with your emotions. Symptoms run the gamut. You may be self-medicating a mood problem by using food. You may eat more when you’re angry, or when you’re stressed. In some homes, food is used either as a special reward or as punishment for children. This conditioning can continue to follow you long into adulthood. If these underlying problems aren’t addressed, no amount of “scientific dieting” or learning to eat this food or that one will help you to accomplish your goal. I think you would find it beneficial to work with a behavioral psychologist or an eating-disorders professional.

Rest to reduce

If you’ve tried to get rid of extra pounds that just won’t budge, evaluate your sleep habits. One study showed that women getting five hours or less of sleep each night were 32 percent more likely to gain a significant amount of weight over a 16-year period, and 15 percent more likely to become obese.

Scientists theorize that your basal metabolic rate (which is how many calories you burn while resting) may be affected. Also, a minimum amount of sleep can cause more cortisol to be released. Your body feels it’s under attack, not able to do its normal nighttime repair work. And more cortisol can cause an increase in hunger pangs, leading to overeating.

Return to old-school ways

Folks used to cook a meal and sit down together at the table. Now it’s a rare occasion for families to do that. What a shame! Many Americans have lost touch with traditional, healthy ways of eating, thanks to the industrialization of our food supply by greedy corporations. If you eat standing up or on the go, while watching TV, or while paying your bills, turn your attention to learning (or relearning) how to cook. It will help you to reestablish a healthy relationship with wholesome, real food. If you have a nice-sized local hospital, it may offer healthy-cooking classes. Hospitals with a good program for heart-disease patients tend to offer classes to help their patients make healthy lifestyle changes. You can make such changes before you become a heart patient.

Fill up on fiber

You need fiber, and I’m not talking about a fiber supplement. (Yech!) By eating filling fiber-rich foods, you’ll be less likely to suffer from cravings that draw you to the refrigerator in the late afternoon or before you go to bed at night. By consuming a reasonable amount of natural fats and protein, your body will be supplied with an optimum amount of vitamins and minerals in order to function. This will help you fend off any odd cravings you may get, which are really your body’s way of telling you that you’re probably low on some vital compound. Nutrient-dense fruits and vegetables are terrific fiber choices. Other good choices are beans, nuts, brown rice, bran and whole grains, like barley and brown rice.

Build up your muscles

When you cut calories and do only regular aerobic exercise, here’s what happens: You lose muscle. And because muscle burns calories, you’re actually working against yourself. Muscle will even burn calories while you’re at rest, making it metabolically active—unlike fat. Plus, strength training (whether it’s weightlifting, elastic bands, yoga or chopping wood) makes it easier for you to do the myriad of things you work to accomplish every day, such as getting up out of a chair, lifting a package dropped off by the postman, and cleaning up the yard after a heavy downpour. And few things assure healthy aging like the healthy muscles you gain by strengthening them. The beauty of a strength-training program lies in the results—which you’ll notice in just a few short weeks. Won’t the kids be impressed when you can remove the lid from your own pickle jar again?

Count your steps

Here’s the perfect tool to help you reach your weight-loss goals: a pedometer. You’ll have the opportunity to figure out smart ways to increase your daily steps. Most of you should aim for 10,000 steps per day, which comes to about three to five miles—depending on the length of your stride. Adding just 30 extra minutes of brisk walking, evenly spread throughout the day, can translate into a 2- to 3-pound weight loss per month. You’ll notice that you feel better, and your risks of heart attack, diabetes, dementia and premature death will all go down. You can pick up a pedometer at most local sports shops or at a Wal-Mart or similar store.

Avoid overly packaged foods

If Americans simply cut out packaged, processed baked goods, snacks and frozen foods, along with the oceans of soft drinks we consume, we’d lose the big bellies. Big Food would in turn go belly up, and half the doctors might have to start pounding the pavement looking for a new line of work. The more real food you enjoy, the less junk food you’ll put in your body—and that will help eliminate the cycle of cravings that nutrient-poor foods induce. If you can grow some of your own food, you’ll also get a healthy amount of exercise in the bargain.

Give yourself two weeks

Speaking of cravings, it helps to be mindful of your behavior patterns. When people change their diets to include real, wholesome and healthy foods, they may sometimes find their old habit of bingeing still lingers. If this sounds like you, start by slowing down and chewing your food a bit more thoroughly. Pay attention to the sight, sounds and pleasures that eating can bring. Think of your meals as more of a ritual. Watch your portions, and learn your cues for feeling satiated. You may be used to a second portion, but do you really need it? Wait 15 minutes before putting more food on your plate. This gives your body time to register satisfaction and to reduce hunger. The good news is that if you stick with this practice of mindfulness, you may find that within two weeks you’ve gotten used to less food than before. And hopefully they’re better-tasting, healthier, more fulfilling choices.

Natural supplements

Don’t get the wrong idea—I’m not about to recommend the latest weight-loss “miracle pill.” If those pills were such a miracle, no one would suffer from weight problems and a Google search would only turn up 281 listings—not 281 MILLION. But I do recommend a good dose of omega-3 fatty acids from fatty, cold-water fish. Omega-3s actually support normal fat burning, and they help to regulate your appetite and burn fat to boot. Some adaptogens, such as Rhodiola rosea, can also help normalize your metabolism by balancing your stress hormones. More to the point, make sure you get enough key multitasking micronutrients that you need to run your body, such as magnesium, zinc and B vitamins. A good daily multivitamin/mineral supplement ideally taken twice per day is a blanket insurance policy to help prevent deficiencies and the cravings they induce. I prefer food-based multis. Good products can be purchased from New Chapter, Mega Food, Garden of Life and Standard Process.

Forgotten cures
Scrap the tranquilizers and brew this instead

Tranquility in a mug? You bet. Specifically, you’ll need to concoct a strong brew of green tea if you want to calm jittery nerves.

And whose nerves aren’t jittery these days? Especially if you regularly feed at the doom-and-gloom news trough served daily on your television. It’s hard to avoid—and that’s just one stressor in these modern times that have us all running on empty and worn to a frazzle.

Green tea offers a whole host of excellent health benefits, including antioxidant and anti-inflammatory effects as well as cancer protection, brain support, weight-loss promotion and arthritis relief. There’s one compound in green tea in particular that I want to tell you about: theanine. It’s a remarkable multitasking amino acid that’s abundant in this healthful drink.

Theanine crosses the blood-brain barrier, so it’s able to directly affect neurotransmitters that regulate your mood and sense of well-being. It also promotes the production of nerve growth factor (NGF), which slows brain aging and possibly protects against Alzheimer’s disease.

But if you’re taking an antianxiety medication, such as Ativan, Valium or Klonopin, here’s the link you should know about. GABA receptors are the targets for benzodiazepines, the widely used class of tranquilizers that includes the trade names I just mentioned.

Well, theanine also acts on GABA receptors­­––without the addiction and side-effect potential of those drugs. By increasing GABA activity, theanine helps calm anxiety. In the brain, the calming GABA and excitatory glutamate convert into each another and ideally coexist in a healthy balance based on your individual and specific needs. Theanine, the structure of which is similar to both, supports that balance.

In addition, theanine increases brain dopamine (a neurotransmitter that improves motivation and concentration). If your dopamine level is low, you just don’t feel like doing much. Theanine also promotes alpha-wave production in the brain. Alpha waves predominate when you’re in a calm, rested meditative state. Also, the theanine in green tea helps calm the excitatory effect of caffeine and reduces blood levels of the stimulating stress hormones epinephrine and norepinephrine (aka adrenalin and noradrenalin) in the brain. For all of these reasons, the term “calm focus” is often applied to indicate the mental state it can put you in.

To tie in with the first article in this month’s newsletter, here’s a way to help treat low mood and depression. Most cases of depression are accompanied by anxiety. For this reason, theanine can be an excellent support for people suffering from mild to moderate depression symptoms, whether or not they’re taking a medication.

Be aware, though, that theanine may lower serotonin levels slightly in some people. Studies have shown both lowering and heightening effects. This needs to be kept in mind if you’re already on an SSRI antidepressant, as these are used to boost serotonin levels. I find that theanine in combination with St. John’s wort, which definitely supports healthy serotonin levels, is often effective in alleviating mild to moderate depression.

Another benefit you can expect from theanine is restful sleep, and it may also help to increase growth-hormone secretion during sleep. Growth hormone helps build muscle, burn fat and supports bone health. Theanine has been shown to shrink tumor tissue in test-tube studies due to the benefits it supplies to the immune system.

For general brain support, I recommend taking 100 to 200 mg of theanine. Take it in conjunction with omega-3 fatty acids from fish oil or cod-liver oil for a total of 1,000 to 2,000 mg total DHA and EPA.

And for mood support, take 100 to 200 mg up to twice per day. Another reasonable use is simply 100 to 200 mg up to twice per day on days you need it, when you’re feeling especially anxious. As always, you’ll be better off working under the supervision of a health professional who has the relevant experience and knowledge to guide you in treatment.

Your Questions Answered
Creatine—not just for uber-athletes

Q. I’ve been reading reports on a supplement called creatine. It’s supposed to build muscle and make you stronger. Is it just for weightlifters? I’m 58 this year and am a basically healthy guy, but with a growing paunch I try to manage with running and a little strength training. What would this supplement do to help with that?
––J. G., N.C.

A.Creatine isn’t just for athletes, though it has no doubt become associated with them. And because of that connection, it is one of the best-studied sports supplements and is generally regarded as effective for most users. Athletes like it because it allows them to train harder and for a longer period. Also, it delays fatigue—thus encouraging muscle growth and gains in strength.

Creatine is a naturally occurring amino acid created in your body that boosts levels of adenosine triphosphate (ATP), which is a fundamental player in the production of energy in the cell. It works as a source of quick energy over the first 30 seconds during intense physical exertion to increase the force of muscle contractions. Creatine can also increase lean muscle mass through a likely combination of fluid retention in the muscle cells and its ability to boost production of ATP.

This close connection to muscle strength is drawing the attention of researchers. They’re interested in using creatine to treat Parkinson’s disease, Amyotrophic Lateral Sclerosis (also known as Lou Gehrig’s disease), and a wide variety of other severe inborn neuromuscular diseases in which normal energy production is impaired. Well-designed studies are under way in all these areas. It might be reasonable to expect a meaningful treatment effect from creatine, with a reduction in symptoms and a slowing of the disease process—if not a total cure.

But it’s not just for building stronger muscles. This amino acid may have a positive effect on thinking and memory as well. Studies have been done with students and the elderly that have clearly shown benefits for both groups.

You can get creatine naturally in fish and meats. The supplement form is usually used for physical training or for other broad health purposes. For instance, vegetarians and people who don’t eat much meat are likely to notice more benefits when they supplement. The usual dose for athletes involves taking a 20-gram-daily loading dose for a five-day period and then dropping down to a 5-gram daily maintenance dose. I recommend the more prudent approach of using a steady 5-gram dose. Levels may take a bit longer to build up, but side effects are less likely. Side effects are related to the ability of creatine to attract water to the tissues it permeates. This can result in rapid weight gain of a few pounds due to fluid retention and, if you don’t consume enough water when you take it, dehydration and stress on your kidneys. For these reasons, anyone with kidney or liver problems should not take creatine. It may be prudent for people with liver disease to avoid it as well, although there is no clear-cut research thus far showing liver toxicity.

Other side effects may include bloating, cramps and diarrhea. Again, skipping the loading dose can reduce the possibility of side effects. Most experts agree that creatine is safe at normal doses over the long term. In this case, little is known about real safety beyond 12 months—although there are many people who have now been using it for years without experiencing any difficulty. And creatine does not alter hormone levels.

If you choose to take supplemental creatine, I should mention that it’s usually taken in cycles—even though there’s some debate on how to do this. A plan that calls for two months on and one month off is reasonable for most people. What happens is that once you stop taking it, your body’s receptors notice that and respond by increasing in number. So when you restart your creatine-supplementation cycle, you get a kind of recharging effect. Some companies that offer a good product are Jarrow (www.jarrow.com) and Twin Lab (www.twinlab.com).

For maximum energy and muscle support, you should include a regular program of strength training two to three times per week. Ideally, you should take creatine about one hour before you work out. The liquid forms can be taken even 20 minutes before. But also take it on days you’re not exercising, as it may help with muscle recovery. As a rule, stick with pure monohydrate formulas. Always consume an 8 oz. glass of water, or water mixed with fruit juice, when you take creatine. Continue to drink fluids throughout the day.