Don’t get your health advice from TikTok. That is the somewhat obvious conclusion of a recent study looking at a new social media fad called “dry scooping”. The phenomenon is also not an isolated case, but typical of several troubling trends – the overall poor regulation of supplements, a relatively low level of scientific literacy among the public, exploitation by clueless “wellness gurus”, and the rise of social media as a significant source of factual information.

The study looked at TikTok for videos with the hashtag “#preworkout” and analyzed the results. The author was interested in videos about taking creatine powder prior to workouts. For background, creatine is an amino acid found mostly in muscle tissue and the brain. It has become popular as a supplement for athletes and body-builders, because it can enhance the production of ATP (the energy carrying molecule in cells) and therefore increasing exercise endurance and muscle building. There actually is a reasonable body of evidence that regular supplementation with creatine can provide these benefits (although modest in magnitude), and is largely safe when used correctly.

That last bit (when used properly) is the focus of the recent study. The author found 100 videos on TikTok about using creatine supplements as a pre-workout regimen, with a cumulative number of likes over 259 million. Only 8% of the videos depicted creatine supplements being used correctly (according to the manufacturers’ recommendations). The study did not address the fact that even when used as directed, the products themselves may not follow the evidence.

The idea of using creatine supplements as a pre-workout itself is dubious. The idea is to load up on creatine right before an intense workout or athletic event. Studies with creatine, however, show benefit from regular daily low dose supplementation, allowing time for creatine levels to build up in the muscles. Taking a large dose right before a workout is likely of no specific benefit. There may also be no benefit for moderate exercise, as the benefits are likely largely dependent on pushing exercise performance to one’s limits (by extending those limits slightly).

Therefore, the very idea of a preworkout creatine supplement is scientifically dubious. Therefore, users may not see a benefit from this specific practice, although they may perceive a placebo effect. Creatine powders, however, contain more than creatine. They also contain vitamins, which are likely worthless in most cases, if overall diet is adequate. But most importantly, they typically contain a very large dose of caffeine, from 100-400mg per scoop (the equivalent of 1-3 cups of coffee). Those taking more than the recommended dose, or larger athletes dosing by body mass may get the equivalent caffeine of 5 or more cups of coffee in their supplement. That is a large enough dose that there can be safety issues in terms of blood pressure and heart health, especially in the context of pushing oneself to the limits of physical performance.

The questionable benefits and safety of using creatine supplement formulations as a large pre workout dose (rather than a small daily dose) are exacerbated by the fact that many people are additionally using it not in accordance to product recommendations. The most common incorrect method for taking the supplement was “dry scooping”, which is a recent social media fad. The powders are meant to be dissolved in water and then taken as a liquid. This further aids in hydration and kidney function. Dry scooping is the practice of just eating the powder straight, perhaps with a few sips of water to help get it down. This can be very dangerous. Further, powders meant to be dissolved in water are often finely ground, which means they are an inhalation risk.

The videos also depicted individuals taking multiple doses or diluting the powder in either energy drinks, coffee, or alcohol. Taking creatine powder, with its high dose of caffeine, with an energy drink, which also contains a high dose of caffeine, significantly increases the risks.

The popularity of using creatine supplement incorrectly and unsafely is partly due to the high levels of scientific illiteracy in the public, specifically regarding health science. The public has been largely influenced by marketing campaigns to make them responsive to the supplement industry and snake oil in general. Products are sold as “natural” without any specific meaning, and used as a health halo to imply safety and efficacy often in the absence of scientific evidence or even a plausible rationale.

Another popular fallacy is that if some is good, more must be better. This is essentially the entire rationale behind most supplementation. The reality is that biological systems mostly follow the principle of complex dynamic homeostasis, where there is an optimal range and balance of nutrients, electrolytes, etc., and simply taking more of something is unlikely to improve the functioning of the system. Taking a small daily dose of creatine may help elite athletes push the limits of their performance, but likely has no benefit for everyday exercise or moderate activity. There is also no reason to think that loading, taking high doses, or dosing just prior to a workout should be of any benefit.

The other major factor in this harmful trend is the shifting of information and advice from edited, professional, trusted sources to “some guy on the internet”. This is a deeper problem beyond the scope of this article. But it means that doctors and other professionals need to be paying attention to the broader culture, not just their professional journals, to see what people are hearing and doing, and get involved in the conversation.

Author

  • Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.