Friday Q&A: creatine supplements; a pill version of Ozempic; vitamin B12 with an elevated MCV; & microplastics
Answering your burning questions! 🔥
ICYMI 👉
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In this week’s reader-submitted Q&A, we’re tackling these questions:
Is creatine worth trying for menopausal women who lift weights?
Are there any legitimate pill alternatives to Ozempic injections?
Should I worry about elevated MCV despite taking B12 supplements?
Do my efforts to avoid microplastics actually make a difference?
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The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: CREATINE SUPPLEMENTS AND MENOPAUSE
Hi there! I have a question about creatine. I am hearing more and more about menopausal women and creatine, especially women who lift heavy weights as I do. Do you recommend it? If so what dosage? Is there a supplement company you recommend?
-Molly
Dear Molly,
Creatine is definitely having a moment in the spotlight, so I am glad you asked! When taken as a supplement, creatine can enhance strength, muscle growth, and recovery. It’s also very safe to use. Creatine is a naturally occurring compound that helps produce energy during short bursts of intense activity, like weightlifting or sprinting. It’s stored in muscles and plays a key role in ATP production, which fuels these activities.
The most common and effective form is creatine monohydrate. The usual dosage is 3-5 grams per day, with or without a "loading phase." Some people start with 20 grams a day (divided into 4 doses) for the first week to quickly saturate muscles, but you can skip this phase and simply take 3-5 grams daily—though it will take a bit longer to see the full benefits. It’s best to take creatine with a meal or post-workout to improve absorption, especially if combined with carbs or protein.
While most people don’t experience significant side effects, water retention and mild digestive discomfort are common. There’s no evidence that creatine harms kidney function in healthy individuals, but those with kidney issues should consult a doctor first. For optimal results, drink plenty of water since creatine draws water into your muscles.
If you're looking to boost performance, build muscle, or improve recovery, creatine is a reliable, well-researched supplement. I wish I could tell you I have a favorite company to use, but I don’t. I suggest reading reviews online and seeing which one people you trust recommend. I hope that helps!
QUESTION #2: PILL VERSION OF OZEMPIC
Hi Dr. McBride, is there a legitimate, healthy, real, scientifically sound pill version of Ozempic- to avoid injections?
-Susan
Hi Susan,
Yes, there is a scientifically sound, healthy, and legitimate pill form of a medication similar to Ozempic. It's called Rybelsus, and it contains the same active ingredient—semaglutide—as Ozempic. Approved by the FDA for type 2 diabetes, Rybelsus is made by the same manufacturer, Novo Nordisk. While it isn’t formally approved for weight loss like its injectable cousin Wegovy, many patients do lose weight a side effect.
Rybelsus works in much the same way as Ozempic: it mimics the hormone GLP-1 to help regulate blood sugar, slow down digestion, and increase feelings of fullness. The main difference is that it’s taken orally once a day rather than injected weekly. However, the pill must be taken on an empty stomach with a small amount of water first thing in the morning, followed by a 30-minute wait before eating or drinking anything else. While Rybelsus may be less potent for weight loss compared to the injectable version, it tends to cause more gastrointestinal discomfort. In my experience, this is a common limiting factor.
New oral GLP-1 drugs—including a pill version of tirzepatide, the compound in Mounjaro and Zepbound—are also in development and may soon expand the options. If you're considering a non-injectable route, Rybelsus is a well-studied and valid alternative for people who prefer to avoid injections.
QUESTION #3: VITAMIN B12 LEVELS
Hello! I'm 54 years old. Since my early 20s, my MCV has been elevated. About 10 years ago, a doctor recommended taking 1000 mcg of B12. I had my annual bloodwork this week and my MCV continues to be outside of the range, and my B12 is 105 pg/ml over the reference range. What are your thoughts on B12 and do you think it has anything to do with my elevated MCV?
-Kimberly
Hi Kimberly,
Your elevated MCV for over 30 years is intriguing, and you're right to connect it with B12. The MCV measures the average size of your red blood cells, and both B12 and folate deficiencies classically cause large red blood cells—which is exactly what an elevated MCV indicates.
Here's what's puzzling about your situation: despite taking 1000 mcg of B12 for a decade and having B12 levels well above normal range, your MCV remains elevated. This suggests a few possibilities worth exploring.
First, there could be an absorption issue. Even with high-dose supplementation, some people can't absorb B12 effectively due to conditions like pernicious anemia, certain GI disorders, or past stomach surgery. Ironically, you can have sky-high B12 levels in your blood but still be functionally deficient at the cellular level.
Second, folate deficiency can also cause elevated MCV, and B12 supplementation alone won't fix that. Has your doctor checked your folate levels recently?
Third, other factors can elevate MCV: thyroid disorders, liver disease, alcohol use, and certain medications. Plus, sometimes people have a baseline higher MCV that's simply their “normal.”
The fact that your MCV has been consistently elevated since your twenties, before you started supplementing, suggests this might be your personal baseline rather than a deficiency state. Some people just naturally have larger red blood cells.
I'd recommend asking your doctor to check your folate levels, thyroid function, and consider testing methylmalonic acid and homocysteine—these can reveal functional B12 deficiency even when B12 levels appear adequate.
The bottom line: It's worth one comprehensive workup to make sure we're not missing something treatable.
QUESTION #4: MICROPLASTICS
I’ve heard about microplastics getting into our brains and potentially causing dementia and cancer, so I've stopped drinking out of plastic water bottles and heating food up in plastic containers. Do these changes help? Is there anything else I should be doing? Or is this overkill?
-Hilary
Dear Hilary,
Your concern about microplastics is completely understandable—the headlines are genuinely alarming. The research showing plastic particles in our brains, placentas, and bloodstream is real, but here's where I try to help patients find the middle ground between panic and complacency.
The changes you've made are smart and low-effort wins. Avoiding heating food in plastic containers is particularly important since heat increases chemical leaching. Switching from plastic water bottles to glass or stainless steel eliminates a major daily exposure source. These aren't overkill—they're reasonable precautions that cost you nothing in terms of health or convenience.
Here's the reality check: microplastics are everywhere. They're in our food supply, tap water, air, and even sea salt. While the brain studies are concerning, we don't yet know what levels cause harm or whether the particles we're detecting are actually causing the diseases we're worried about. The research is evolving rapidly, but definitive answers about health impacts are still years away.
Other practical steps that make sense: use a water filter that removes microplastics, choose fresh foods over highly processed ones when possible, and consider glass or stainless steel food storage containers. But don't let this consume your mental energy or stress you out—chronic worry about environmental toxins can be more immediately harmful than the exposures themselves.
The bigger picture matters more: the habits that definitively protect against dementia and cancer include regular exercise, quality sleep, stress management, maintaining social connections, and not smoking. These proven strategies deserve far more of your attention than microplastic avoidance.
Your instinct to make reasonable changes without going overboard is exactly right. Keep doing what you're doing, but don't let microplastic anxiety hijack your overall health focus.
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
ICYMI, check out my recent Q&As on:
Can we go back to the sunscreen point made earlier this week? I know things don’t have to be either/or BUT are there any studies weighing the number of cases of dangerous falls due to osteoporosis (where lack of vitamin d is a contributing factor, of course, though I suspect a challenge to isolate as a variable) versus skin cancer? Perhaps I am overthinking but I made the point we conflate things; we similarly seem to isolate solutions as if there were no trade offs. not sure i am making sense but thought I would ask….