AMA #69: Scrutinizing supplements: creatine, fish oil, vitamin D, and more—a framework for understanding effectiveness, quality, and individual need

Peter Attia

Mar 17, 2025

Episode description

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In this "Ask Me Anything" (AMA) episode, Peter explores the complex world of supplements by introducing a practical framework for evaluating their effectiveness and relevance to individual health needs. Rather than providing a simple list of recommendations, Peter aims to equip listeners with the tools to critically assess supplements on their own. He then applies this framework to discuss research on several popular supplements, including creatine, fish oil, vitamin D, B vitamins, and ashwagandha. Additionally, he covers key factors in assessing supplement quality, helping listeners develop a deeper understanding of how to make informed decisions based on their personal health goals.

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We discuss:

Overview of episode topics [1:45];
How Peter evaluates patients’ supplement regimens, and common misconceptions about supplements vs. pharmaceuticals [3:00];
A framework for evaluating supplements [6:15];
Evaluating creatine: purpose of supplementation, dosing, and mechanism of action [10:00];
Creatine: proven benefits for muscle performance, potential cognitive benefits, and why women may benefit more [15:15];
Creatine: risk vs. reward, kidney concerns, and choosing the right supplement [18:45];
Evaluating fish oil: its primary purpose as a supplement and how to track levels [20:45];
Fish oil: how omega-3s impact inflammation, heart health, and brain function, and the strengths and limitations of current

Mindsip insights from this episode:

Skip creatine loading phase for optimal muscle stores

The old 'loading phase' for creatine is unnecessary, as 3 to 5 grams per day is sufficient to fully maximize muscle stores.

#creatine

#muscle

Navigate supplement quality challenges in health industry

The problem of poor quality and nefarious behavior in the pharmaceutical industry is likely 10 to 100 times worse in the supplement space.

#supplement

Evaluate supplements based on deficiency, performance, and risk-reward profile

Before taking any supplement, you should ask if it's for deficiency or performance, lifespan or healthspan, if it has a biomarker, and what its risk-reward profile is.

#risk

#supplement

Understand regulation differences between supplements and pharmaceuticals

The primary difference between a 'natural' supplement and a pharmaceutical drug is the level of regulation, as some supplements like red rice yeast are effectively unregulated drugs.

#regulation

#supplement

Audit supplements by justifying what to keep

When evaluating your current supplements, the best mental model is to metaphorically dump everything out and then justify what should be added back in.

#supplement

Choose creatine monohydrate for optimal results

Creatine monohydrate is the only version you should take, as it is wildly inexpensive and there is no evidence that other forms are superior.

#creatine

#supplement

Inform your doctor about creatine before blood tests

You must inform your doctor you are taking creatine before a blood test, as it can artificially inflate creatinine levels, a key marker of kidney function.

#blood-test

#creatine

Leverage creatine supplementation for women's hormonal health

Women may benefit from creatine supplementation even more than men, especially during periods of hormonal change like perimenopause, due to having lower baseline stores.

#creatine

#women

Boost memory with creatine supplementation

A 2023 meta-analysis of 16 randomized controlled trials found that creatine supplementation had a positive effect on memory.

#creatine

#memory

Peter Attia

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