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 (Sandkühler 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:
- Storage: Approximately 95% of the body's creatine is stored in skeletal muscle, with the remaining 5% in the brain, kidneys, and liver
- Conversion: The enzyme creatine kinase attaches a high-energy phosphate group to free creatine, creating phosphocreatine (PCr)
- Energy release: During high-intensity activity, PCr rapidly donates its phosphate group to ADP, regenerating ATP within milliseconds
- 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.
Where This Fits in the Evidence
Sandkühler et al. (2023) is one of the more direct tests of a long-standing hypothesis: that people who eat no dietary creatine have the most to gain cognitively from supplementing it. In this randomised controlled trial, vegetarian and vegan participants improved on working memory and processing speed, with magnetic resonance spectroscopy confirming their brain creatine actually rose. It turns the suggestion raised by Rae et al. (2003) into a cleaner result, albeit in mostly young adults over a short window. As a recent RCT it strengthens the vegetarian-cognition case; the surrounding evidence is collected in our research library.
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.
- doi:10.1017/S0007114523002416
What This Means for You
If you eat little or no meat, this is the study that applies most directly to you: with low baseline stores, a daily dose is more likely to show up as a real difference in working memory and processing speed than it would in a meat-eater. The practical move is simply consistency — these were everyday cognitive gains from steady supplementation, not a pre-exam trick. Omnivores can still benefit, but should expect a smaller and less certain effect.