What are the consequences of having to make your own creatine rather than relying on dietary sources?
Should Vegetarians Take Creatine to Normalize Homocysteine?
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
“Almost universally, research findings show a poor vitamin B12 status among vegetarians,” because they’re not taking vitamin B12 supplements like they should, and this results in an elevation in homocysteine levels that may explain why vegetarians were recently found to have higher rates of stroke.
Of course, plant-based eating is just one of many ways to get B12 deficient. Even laughing gas can do it… in as short as two days… thanks to the recreational use of whipped cream canister gas—that’s something new I learned today.
Anyways, if you do eat plant-based, giving vegetarians and vegans even as little as 50 micrograms once a day of cyanocobalamin, the recommended, most stable form of vitamin B12 supplement and their homocysteine levels start up in the elevated zone, and within 1 to 2 months their homocysteine normalizes right down into the safe zone under 10. Or just 2000 micrograms of cyanocobalamin once a week, and you get the same beautiful result, but not always. In this study even 500 micrograms a day, either as a sublingual chewable or swallowable regular B12 supplement, didn’t normalize homocysteine within a month. Now, presumably, if they had kept it up their levels would have continued to fall like in the other study. But, if you’re plant-based and have been taking your B12 and your homocysteine level is still too high, meaning above 10, is there anything else you can do?
Now, inadequate folate intake can also increase homocysteine, but folate comes from the same root as foliage, it’s found in leaves, concentrated in greens, as well as beans. But if you’re eating beans and greens, taking your B12, and your homocysteine level is still too high, then I’d suggest trying, as an experiment, taking one gram of creatine a day and getting your homocysteine levels retested in a month to see if it helped.
Creatine is a compound formed naturally in the human body that is primarily involved with energy production in our muscles and brain. It’s also naturally formed in the bodies of many animals we eat; and so, when we eat their muscles we can also take in some creatine through our diet. We need about two grams a day; so, those who eat meat may get like one gram from their diet, and their body makes the rest from scratch. There are rare birth defects where you’re born without the ability to make it, in which case you have to get it from your diet, but otherwise our bodies can make as much as we need to maintain normal concentrations in our muscles.
When you cut out meat, the amount of creatine floating around in your bloodstream goes down, but the amount in your brain remains the same; showing dietary creatinine doesn’t influence the levels of brain creatinine, because your brain just makes all the creatine you need. The level in vegetarian muscles is lower, but that doesn’t seem to affect performance, as both vegetarians and meat-eaters respond to creatine supplementation with similar increases in muscle power output. And, if vegetarian muscle creatine was insufficient, then presumably they would have seen an even bigger boost. So basically, all that happens when you eat meat is that your body just doesn’t have to make as much. What does this all have to do with homocysteine?
In the process of making creatine, your body produces homocysteine as a waste product. Now, normally this isn’t a problem because your body has two ways to detoxify it, using vitamin B6, or using a combination of vitamins B12 and folate. Vitamin B6 is found in both plant and animal foods and it’s rare to be deficient, but B12 is mainly in animal foods; and so, can be too low in those eating plant-based who don’t supplement or eat B12 fortified foods. And, folate is concentrated in plant foods; so, can be low in those who don’t regularly eat greens or beans or folic-acid fortified grains, and without that escape valve, homocysteine levels can get too high. If, however, you’re eating a healthy plant-based diet and taking your B12 supplement your homocysteine levels should be fine, but what if they’re not? One might predict that if you started taking creatine supplements, the level of homocysteine might go down since you’re not going to have to be making so much of it from scratch, producing homocysteine as a by-product, but you don’t know, until you put it to the test, which we’ll cover, next.
Please consider volunteering to help out on the site.
- Pawlak R. Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians?. Am J Prev Med. 2015;48(6):e11-26.
- Tong TYN, Appleby PN, Bradbury KE, et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study. BMJ. 2019;366:l4897.
- Lundin MS, Cherian J, Andrew MN, Tikaria R. One month of nitrous oxide abuse causing acute vitamin B deficiency with severe neuropsychiatric symptoms. BMJ Case Rep. 2019;12(2)
- Stockton L, Simonsen C, Seago S. Nitrous oxide-induced vitamin B12 deficiency. Proc (Bayl Univ Med Cent). 2017;30(2):171-172.
- Del bo' C, Riso P, Gardana C, Brusamolino A, Battezzati A, Ciappellano S. Effect of two different sublingual dosages of vitamin B on cobalamin nutritional status in vegans and vegetarians with a marginal deficiency: a randomized controlled trial. Clin Nutr. 2019;38(2):575-583.
- Sharabi A, Cohen E, Sulkes J, Garty M. Replacement therapy for vitamin B12 deficiency: comparison between the sublingual and oral route. Br J Clin Pharmacol. 2003;56(6):635-8.
- Navrátil T, Kohlíková E, Petr M, Pelclová D, Heyrovský M, Pristoupilová K. Supplemented creatine induces changes in human metabolism of thiocompounds and one- and two-carbon units. Physiol Res. 2010;59(3):431-42.
- Balestrino M, Adriano E. Beyond sports: Efficacy and safety of creatine supplementation in pathological or paraphysiological conditions of brain and muscle. Med Res Rev. 2019;39(6):2427-2459.
- Kraemer WJ, Beeler MK, Post EM, Luk HY, Lombard JR, Dunn-Lewis C, Volek JS. Chapter 49 - physiological basis for creatine supplementation in skeletal muscle and the central nervous system. In: Sen CK, Nair S, Bagchi D, eds. Nutrition and Enhanced Sports Performance: Muscle Building, Endurance, and Strength. 2nd ed. Academic Press; 2019:581-94.
- Blancquaert L, Baguet A, Bex T, et al. Changing to a vegetarian diet reduces the body creatine pool in omnivorous women, but appears not to affect carnitine and carnosine homeostasis: a randomised trial. Br J Nutr. 2018;119(7):759-770.
- Yazigi solis M, De salles painelli V, Giannini artioli G, Roschel H, Concepción otaduy M, Gualano B. Brain creatine depletion in vegetarians? A cross-sectional ¹H-magnetic resonance spectroscopy (¹H-MRS) study. Br J Nutr. 2014;111(7):1272-4.
- Shomrat A, Weinstein Y, Katz A. Effect of creatine feeding on maximal exercise performance in vegetarians. Eur J Appl Physiol. 2000;82(4):321-5.
- Steenge GR, Verhoef P, Greenhaff PL. The effect of creatine and resistance training on plasma homocysteine concentration in healthy volunteers. Arch Intern Med. 2001;161(11):1455-6.
- Van bavel D, De moraes R, Tibirica E. Effects of dietary supplementation with creatine on homocysteinemia and systemic microvascular endothelial function in individuals adhering to vegan diets. Fundam Clin Pharmacol. 2019;33(4):428-440.
Video production by Glass Entertainment
Motion graphics by Avocado Video
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
“Almost universally, research findings show a poor vitamin B12 status among vegetarians,” because they’re not taking vitamin B12 supplements like they should, and this results in an elevation in homocysteine levels that may explain why vegetarians were recently found to have higher rates of stroke.
Of course, plant-based eating is just one of many ways to get B12 deficient. Even laughing gas can do it… in as short as two days… thanks to the recreational use of whipped cream canister gas—that’s something new I learned today.
Anyways, if you do eat plant-based, giving vegetarians and vegans even as little as 50 micrograms once a day of cyanocobalamin, the recommended, most stable form of vitamin B12 supplement and their homocysteine levels start up in the elevated zone, and within 1 to 2 months their homocysteine normalizes right down into the safe zone under 10. Or just 2000 micrograms of cyanocobalamin once a week, and you get the same beautiful result, but not always. In this study even 500 micrograms a day, either as a sublingual chewable or swallowable regular B12 supplement, didn’t normalize homocysteine within a month. Now, presumably, if they had kept it up their levels would have continued to fall like in the other study. But, if you’re plant-based and have been taking your B12 and your homocysteine level is still too high, meaning above 10, is there anything else you can do?
Now, inadequate folate intake can also increase homocysteine, but folate comes from the same root as foliage, it’s found in leaves, concentrated in greens, as well as beans. But if you’re eating beans and greens, taking your B12, and your homocysteine level is still too high, then I’d suggest trying, as an experiment, taking one gram of creatine a day and getting your homocysteine levels retested in a month to see if it helped.
Creatine is a compound formed naturally in the human body that is primarily involved with energy production in our muscles and brain. It’s also naturally formed in the bodies of many animals we eat; and so, when we eat their muscles we can also take in some creatine through our diet. We need about two grams a day; so, those who eat meat may get like one gram from their diet, and their body makes the rest from scratch. There are rare birth defects where you’re born without the ability to make it, in which case you have to get it from your diet, but otherwise our bodies can make as much as we need to maintain normal concentrations in our muscles.
When you cut out meat, the amount of creatine floating around in your bloodstream goes down, but the amount in your brain remains the same; showing dietary creatinine doesn’t influence the levels of brain creatinine, because your brain just makes all the creatine you need. The level in vegetarian muscles is lower, but that doesn’t seem to affect performance, as both vegetarians and meat-eaters respond to creatine supplementation with similar increases in muscle power output. And, if vegetarian muscle creatine was insufficient, then presumably they would have seen an even bigger boost. So basically, all that happens when you eat meat is that your body just doesn’t have to make as much. What does this all have to do with homocysteine?
In the process of making creatine, your body produces homocysteine as a waste product. Now, normally this isn’t a problem because your body has two ways to detoxify it, using vitamin B6, or using a combination of vitamins B12 and folate. Vitamin B6 is found in both plant and animal foods and it’s rare to be deficient, but B12 is mainly in animal foods; and so, can be too low in those eating plant-based who don’t supplement or eat B12 fortified foods. And, folate is concentrated in plant foods; so, can be low in those who don’t regularly eat greens or beans or folic-acid fortified grains, and without that escape valve, homocysteine levels can get too high. If, however, you’re eating a healthy plant-based diet and taking your B12 supplement your homocysteine levels should be fine, but what if they’re not? One might predict that if you started taking creatine supplements, the level of homocysteine might go down since you’re not going to have to be making so much of it from scratch, producing homocysteine as a by-product, but you don’t know, until you put it to the test, which we’ll cover, next.
Please consider volunteering to help out on the site.
- Pawlak R. Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians?. Am J Prev Med. 2015;48(6):e11-26.
- Tong TYN, Appleby PN, Bradbury KE, et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study. BMJ. 2019;366:l4897.
- Lundin MS, Cherian J, Andrew MN, Tikaria R. One month of nitrous oxide abuse causing acute vitamin B deficiency with severe neuropsychiatric symptoms. BMJ Case Rep. 2019;12(2)
- Stockton L, Simonsen C, Seago S. Nitrous oxide-induced vitamin B12 deficiency. Proc (Bayl Univ Med Cent). 2017;30(2):171-172.
- Del bo' C, Riso P, Gardana C, Brusamolino A, Battezzati A, Ciappellano S. Effect of two different sublingual dosages of vitamin B on cobalamin nutritional status in vegans and vegetarians with a marginal deficiency: a randomized controlled trial. Clin Nutr. 2019;38(2):575-583.
- Sharabi A, Cohen E, Sulkes J, Garty M. Replacement therapy for vitamin B12 deficiency: comparison between the sublingual and oral route. Br J Clin Pharmacol. 2003;56(6):635-8.
- Navrátil T, Kohlíková E, Petr M, Pelclová D, Heyrovský M, Pristoupilová K. Supplemented creatine induces changes in human metabolism of thiocompounds and one- and two-carbon units. Physiol Res. 2010;59(3):431-42.
- Balestrino M, Adriano E. Beyond sports: Efficacy and safety of creatine supplementation in pathological or paraphysiological conditions of brain and muscle. Med Res Rev. 2019;39(6):2427-2459.
- Kraemer WJ, Beeler MK, Post EM, Luk HY, Lombard JR, Dunn-Lewis C, Volek JS. Chapter 49 - physiological basis for creatine supplementation in skeletal muscle and the central nervous system. In: Sen CK, Nair S, Bagchi D, eds. Nutrition and Enhanced Sports Performance: Muscle Building, Endurance, and Strength. 2nd ed. Academic Press; 2019:581-94.
- Blancquaert L, Baguet A, Bex T, et al. Changing to a vegetarian diet reduces the body creatine pool in omnivorous women, but appears not to affect carnitine and carnosine homeostasis: a randomised trial. Br J Nutr. 2018;119(7):759-770.
- Yazigi solis M, De salles painelli V, Giannini artioli G, Roschel H, Concepción otaduy M, Gualano B. Brain creatine depletion in vegetarians? A cross-sectional ¹H-magnetic resonance spectroscopy (¹H-MRS) study. Br J Nutr. 2014;111(7):1272-4.
- Shomrat A, Weinstein Y, Katz A. Effect of creatine feeding on maximal exercise performance in vegetarians. Eur J Appl Physiol. 2000;82(4):321-5.
- Steenge GR, Verhoef P, Greenhaff PL. The effect of creatine and resistance training on plasma homocysteine concentration in healthy volunteers. Arch Intern Med. 2001;161(11):1455-6.
- Van bavel D, De moraes R, Tibirica E. Effects of dietary supplementation with creatine on homocysteinemia and systemic microvascular endothelial function in individuals adhering to vegan diets. Fundam Clin Pharmacol. 2019;33(4):428-440.
Video production by Glass Entertainment
Motion graphics by Avocado Video
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Title
Should Vegetarians Take Creatine to Normalize Homocysteine?
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
This is the 11th in a 12-video series exploring stroke risk. If you missed the last few, see How to Test for Functional Vitamin B12 Deficiency.
This whole creatine angle was something new to me. I had long worried about homocysteine levels being too high among those getting inadequate B12 intake, but didn’t realize there was potentially another potential mechanism for bring it down other than vitamin B intake. Let’s see if it pans out in my final video of the series: The Efficacy and Safety of Creatine for High Homocysteine.
2023 Update: I recently put out a new video, Update on Vegetarian Stroke Risk.
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