Creatine, a naturally occurring compound composed of three amino acids, is predominantly stored in muscles and the brain, playing a vital role in energy metabolism. While most individuals obtain creatine through the consumption of seafood and red meat, vegetarians often have lower creatine stores due to the absence of these food sources in their diet. This article explores the potential benefits of creatine supplementation for vegetarians, examining its impact on muscle function, cognitive performance, and overall health.
Understanding Creatine and its Role
Creatine is a compound derived from three amino acids, primarily found in the body's muscles and brain. The body stores creatine as phosphocreatine, mainly in the muscles, where it serves as an energy source. Creatine is naturally found in animal tissues such as meats, fish, and poultry. Dietary intake of creatine is significantly reduced in individuals following a vegetarian diet, while in vegan diets, almost no exogenous source of creatine is consumed.
The Importance of Creatine
Creatine plays an essential role in energy metabolism. Approximately 90% of the body’s creatine is stored in muscle as free creatine and phosphocreatine. During high-intensity exercise, phosphocreatine is broken down into creatine and a phosphate molecule. The phosphate molecule is then quickly paired with an ADP molecule to form ATP. This ATP is then used to power muscle contraction. The concentration of phosphocreatine decreases rapidly after the onset of activity, leading to fatigue.
Vegetarians and Creatine Deficiency
Vegetarians, especially vegans, often consume less energy than omnivores, largely because of the high consumption of fiber in vegetarian diets which promotes satiety. A vegetarian diet may be lower in protein when compared to an omnivorous diet; therefore, a vegetarian diet requires careful planning to ensure adequate protein consumption.
As creatine is naturally found in animal tissues such as meats, fish, and poultry, there is decreased intake among vegetarian athletes. The amount of creatine is lower in serum, plasma, red blood cells, and muscle, but not in the brain in vegetarians versus omnivores. Further, vitamin B12 deficiency (common in vegetarians) is linked with impairment in methionine production, and this may lead to lower creatine biosynthesis.
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Addressing Nutritional Concerns
Creatine supplementation appears to be a logical approach to offset some of the nutritional concerns associated with vegetarian diets. Approximately 1 g/day of creatine is synthesized by the body from arginine, glycine, and methionine. In individuals consuming meat products, approximately 1 g/day is also consumed through foods. In vegetarian athletes, creatine stores could be lower because of reduced intake of meat. This has the possibility to affect their performance in high-intensity, short-term activities that largely rely on the anaerobic energy system pathways. Starting an activity with a high store of phosphocreatine helps to enhance performance as well as recovery. As vegetarians do not consume animal products, they may receive strong performance and recovery benefits with creatine supplementation.
Benefits of Creatine Supplementation for Vegetarians
Creatine supplementation in vegetarians increased total creatine, creatine, and phosphocreatine concentrations in vastus lateralis and gastrocnemius muscle, plasma, and red blood cells, often to levels greater than omnivores. Creatine supplementation increased lean tissue mass, type II fiber area, insulin-like growth factor-1, muscular strength, muscular endurance, Wingate mean power output, and brain function (memory and intelligence) in vegetarian participants.
Enhancing Muscle Performance
Creatine supplementation can improve creatine and phosphocreatine concentrations, and potentially enhance exercise performance and recovery in vegetarians. The majority of data provide strong support indicating creatine supplementation is beneficial, in particular, for increasing upper and lower body strength, high-intensity anaerobic activities (especially when done in a repeated, intermittent fashion), muscle mass, and recovery from exercise; however, creatine supplementation is unlikely to improve aerobic exercise performance. When combined with resistance training, creatine supplementation enables athletes to train at a higher intensity, leading to greater training adaptations, which result in greater anabolic gains. During high-intensity and short-term exercise which relies mainly on anaerobic energy system pathways, it may be advantageous to have a larger creatine pool to increase anaerobic exercise capacity and shorten recovery time between bouts of exercise.
Boosting Cognitive Function
Creatine is a fuel source for the brain, says study author Michele Skelton, Ph.D., associate professor of health sciences at Stetson University in Deland, Florida. The compound is mostly found in meat, poultry, and fish, so vegans and vegetarians often miss out on it. For them, taking the supplement regularly can boost cognitive function and increase lean mass by making more phosphocreatine (which your body converts into ATP for energy) in the brain, muscles, and other organs. Carnivores and pescetarians likely won’t get the same benefits from extra creatine because their levels are already optimal. If you’re vegan or vegetarian, ask your doctor if you need more creatine. Study participants took five grams daily and though they saw results in less than a month, Skelton notes the effects may take six to eight weeks to kick in. Creatine supplementation had a significant positive effect on working memory and intelligence. And if you’ve ever suffered impaired cognitive performance after a poor night’s sleep then regular creatine supplementation has been shown to help with that too.
Vegan-Friendly Creatine Supplements
Although creatine is found mostly in animal products, the creatine in most supplements is synthesized from sarcosine and cyanamide, does not contain any animal by-products, and is therefore “vegan-friendly”. The only precaution is that vegans should avoid creatine supplements delivered in capsule form because the capsules are often derived from gelatin and therefore could contain animal by-products.
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Research and Studies on Creatine for Vegetarians
Thousands of research trials have been conducted on the effects of creatine supplementation, mostly in omnivores; the results of these trials are summarized across a number of meta-analyses and systematic reviews. In our review of the literature, we found one systematic review on the effect of creatine supplementation in vegetarians; however, it included a review of only three manuscripts with two of the manuscripts derived from the same study. The conclusions from this systematic review were therefore limited. Our objective was to systematically review randomized and prospective parallel groups or cross-over studies on the effect of creatine supplementation (compared to placebo) in vegetarians (compared to omnivores where possible) for outcomes including body creatine stores and exercise performance. We hypothesized creatine supplementation would increase creatine concentrations in the blood and muscle of vegetarians (to a greater extent than omnivores) and this would lead to improvements in anaerobic exercise performance.
Systematic Review Methodology
Our systematic review was performed in accordance with the guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The literature search was conducted in PubMed and SPORTDiscus, including all dates up until 18 April 2020. Key words and Boolean phrases searched included “creatine” AND “(vegetarian OR vegan OR vegetarianism OR veganism)”. There were no restrictions on language or date. Since creatine supplementation can have short-term effects on muscle function, we considered any length of follow up. The following population, intervention, comparator, outcomes, and study types (PICOS) were included: The population was vegetarians. The intervention was creatine monohydrate supplementation. The comparator was either a placebo and/or participants who were omnivores. Outcomes included muscle, blood, or brain measurements of creatine or phosphocreatine, any exercise performance measure, lean tissue mass, muscle fiber area, anabolic hormones, creatine transporter levels, and cognitive performance. Titles, abstracts, and full manuscripts were reviewed for inclusion by two reviewers. Data extraction and determination of risk of bias using the most recently revised Cochrane risk of bias tool was also performed by two reviewers. When there were disagreements, the reviewers either came to a consensus or consulted a third reviewer.
Key Findings
Nine studies, published across 11 journal articles, were included. Creatine supplementation studies in vegetarians and effects on creatine concentrations and function of muscle and brain are summarized in Table 1. In Table 1, we present details such as type of vegetarian (i.e., vegan, lacto-ovo, ovo-vegetarianism) and length of vegetarianism of research participants. This was not always reported in the studies we reviewed; therefore, this is one aspect that can be improved in future studies, as these factors could impact response to creatine supplementation.
Practical Considerations for Creatine Supplementation
A loading phase isn’t necessary unless you want to experience the benefits of creatine much faster, which some power or strength athletes might wish to. Suggested examples of loading phases include taking 20-25 grams of creatine a day over four to five doses for five to seven days and then dropping to the regular maintenance dose of 3-5 grams per day. It is important that vegans ensure an adequate supply of all nutrients. As an alternative to supplementation, he suggests enriching plant-based meat substitutes and milk alternatives with creatine monohydrate, ensuring an uncomplicated supply: “The goal should be those vegan alternative products, such as meat, fish, egg, milk or cheese substitutes, are enriched with nutrients such as creatine and others, in addition to enrichment with certain micronutrients, so that these substitutes are good vegan equivalents to animal products from a nutritional point of view,” says Niko Rittenau. Vegan alternative products should be at least as nutrient-dense or even more nutrient-rich than the animal equivalent so that forgoing animal products does not come at the expense of health.
Safety and Potential Side Effects
When used orally at appropriate doses, creatine is likely safe to take for up to five years. Creatine might be unsafe for people with preexisting kidney problems. Combining caffeine with creatine might decrease the efficacy of creatine. Use of creatine with a daily amount of caffeine greater than 300 milligrams might also worsen the progression of Parkinson's disease.
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