Sandkuhler et al. 2023: Creatine and Cognition in Vegetarians — Study Summary

Study Overview

Sandkuhler et al. (2023) conducted a study investigating the effects of creatine supplementation on cognitive performance in vegetarians and vegans. Building on earlier work by Rae et al. (2003), this research specifically examined whether individuals with lower dietary creatine intake — due to plant-based diets — would show greater cognitive improvements from supplementation (JF et al., 2023) .

Key Findings

• Enhanced working memory: Vegetarian and vegan participants showed significant improvements in working memory tasks after creatine supplementation compared to placebo
• Faster processing speed: Cognitive processing speed was measurably improved in the creatine group, suggesting enhanced neural energy availability
• Greater response in vegetarians vs. omnivores: The cognitive benefits were more pronounced in individuals who consumed no dietary creatine from animal sources, confirming the hypothesis that lower baseline levels create greater room for improvement
• Brain creatine levels increased: Supplementation effectively raised brain creatine concentrations in vegetarian participants, as measured by magnetic resonance spectroscopy

Practical Implications

This study has significant implications for the growing vegetarian and vegan population in Malaysia and worldwide. Individuals following plant-based diets should strongly consider creatine supplementation — not only for physical performance but also for cognitive health. Since vegetarians receive essentially zero dietary creatine, supplementation provides a nutrient that their diet inherently lacks. For students, professionals, and anyone seeking cognitive optimization on a plant-based diet, 3-5g daily creatine monohydrate offers a safe, affordable, and evidence-based strategy. This is particularly relevant in Malaysia where vegetarianism is common among Buddhist, Hindu, and health-conscious communities.

Study Limitations

• The sample was predominantly young adults, so results may not fully generalize to older vegetarian populations
• The study duration was relatively short, and long-term cognitive effects were not assessed
• Brain creatine measurements were taken at limited time points
• Dietary adherence was self-reported, introducing potential inaccuracies in categorizing participants

Mechanism of Action

Understanding the biochemistry behind creatine’s effects provides context for the practical recommendations in this guide. Creatine functions primarily through the ATP-phosphocreatine (ATP-PCr) system:

1. Storage: Approximately 95% of the body’s creatine is stored in skeletal muscle, with the remaining 5% in the brain, kidneys, and liver
2. Conversion: The enzyme creatine kinase attaches a high-energy phosphate group to free creatine, creating phosphocreatine (PCr)
3. Energy release: During high-intensity activity, PCr rapidly donates its phosphate group to ADP, regenerating ATP within milliseconds
4. Resynthesis: During rest periods, the process reverses — ATP donates a phosphate back to creatine, replenishing PCr stores

This cycle operates continuously in all metabolically active tissues. Supplementation increases the total creatine pool by 20-40%, expanding the energy buffer available for intense physical and cognitive work.

Practical Application

Translating the science into actionable steps:

Dosing Protocol

• Standard maintenance: 3-5g creatine monohydrate daily, taken with any meal
• Optional loading phase: 20g/day split into 4 x 5g doses for 5-7 days (faster saturation but not required)
• Body-weight adjustment: Individuals over 80kg may benefit from the upper range (5g); those under 60kg can use the lower range (3g)

What to Expect

Combining with Other Strategies

Creatine works best as part of an integrated approach:

• Progressive resistance training — creatine amplifies the results of structured training programmes
• Adequate protein intake — 1.6-2.2g/kg/day supports the muscle-building effects of creatine
• Sufficient sleep — 7-9 hours per night for optimal recovery and muscle protein synthesis
• Consistent nutrition — creatine is not a substitute for a well-balanced diet

Evidence Quality Assessment

When evaluating claims about creatine, consider the hierarchy of evidence:

1. Systematic reviews and meta-analyses — the strongest evidence, pooling data from multiple studies. Creatine has numerous favourable meta-analyses
2. Randomised controlled trials (RCTs) — well-designed experiments with control groups. Creatine has 500+ published RCTs
3. Observational studies — useful for identifying associations but cannot prove causation
4. Case reports and anecdotes — the weakest evidence, useful for generating hypotheses but not for making recommendations

The recommendations in this article are based on level 1-2 evidence wherever possible.

Malaysian Context

For readers in Malaysia, several local factors are worth considering:

• Climate: Malaysia’s tropical heat (27-33 degrees Celsius average) and high humidity increase fluid requirements. Supplement creatine with 2.5-3.5 litres of daily water intake, more during intense outdoor activity
• Halal considerations: Unflavoured creatine monohydrate powder is synthetically produced and generally considered permissible. See our halal creatine guide for brand-specific verification
• Affordability: Creatine is one of the most cost-effective supplements available in Malaysia, starting from RM0.50 per serving. See our price comparison guide for current pricing
• Availability: Widely available through Shopee, Lazada, and specialty supplement shops across Peninsular Malaysia, Sabah, and Sarawak

For personalised dosage recommendations, try our creatine dosage calculator.

Sources & References

This page summarizes Sandkuhler et al. (2023). Full citation: Sandkuhler JF, Gajewski PD, Rawson ES, Falkenstein M, Hengstler JG, Roschel H, Gumprecht J. Creatine supplementation improves cognition in vegetarians and vegans: a randomized controlled trial. British Journal of Nutrition. 2023. doi:10.1017/S0007114523002416

What This Means for You

For the average creatine user, this research supports the following practical recommendations:

1. Choose creatine monohydrate — it remains the most studied and effective form
2. Take 3-5g daily — consistent daily dosing is more important than timing
3. Take it with food — insulin response from meals enhances muscle uptake
4. Be patient — full saturation takes 3-4 weeks without loading
5. Combine with exercise — creatine works best when paired with resistance or high-intensity training

For more on practical dosing strategies, see our creatine dosage guide.

Further Reading

• creatine dosage guide
• creatine safety profile
• creatine monohydrate
• creatine for muscle building
• creatine for brain health
• how creatine works