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Sports Med 2006; 36 (4): 293-305

0112-1642/06/0004-0293/$39.95/0

LEADING ARTICLE

2006 Adis Data Information BV. All rights reserved.

Vegetarian Diets
Nutritional Considerations for Athletes
Angela M. Venderley and Wayne W. Campbell
Department of Foods and Nutrition, Purdue University, West Lafayette, Indiana, USA

Abstract

The quality of vegetarian diets to meet nutritional needs and support peak
performance among athletes continues to be questioned. Appropriately planned
vegetarian diets can provide sufficient energy and an appropriate range of carbohydrate, fat and protein intakes to support performance and health. The acceptable
macronutrient distribution ranges for carbohydrate, fat and protein of 4565%,
2035% and 1035%, respectively, are appropriate for vegetarian and
non-vegetarian athletes alike, especially those who perform endurance events.
Vegetarian athletes can meet their protein needs from predominantly or exclusively plant-based sources when a variety of these foods are consumed daily and
energy intake is adequate. Muscle creatine stores are lower in vegetarians than
non-vegetarians. Creatine supplementation provides ergogenic responses in both
vegetarian and non-vegetarian athletes, with limited data supporting greater
ergogenic effects on lean body mass accretion and work performance for vegetarians. The potential adverse effect of a vegetarian diet on iron status is based on the
bioavailability of iron from plant foods rather than the amount of total iron present
in the diet. Vegetarian and non-vegetarian athletes alike must consume sufficient
iron to prevent deficiency, which will adversely affect performance. Other nutrients of concern for vegetarian athletes include zinc, vitamin B12 (cyanocobalamin), vitamin D (cholecalciferol) and calcium. The main sources of these nutrients
are animal products; however, they can be found in many food sources suitable for
vegetarians, including fortified soy milk and whole grain cereals. Vegetarians
have higher antioxidant status for vitamin C (ascorbic acid), vitamin E (tocopherol), and -carotene than omnivores, which might help reduce exercise-induced
oxidative stress. Research is needed comparing antioxidant defences in vegetarian
and non-vegetarian athletes.

Vegetarian diets are receiving increased scientific scrutiny and popularity among the general public
for potential health-promoting benefits. The American Dietetic Association (ADA) states that well
planned vegetarian diets are healthful, nutritionally
adequate, and provide health benefits in the prevention and treatment of certain diseases.[1] Vegetarian
diets tend to be higher in complex carbohydrates,
fibre, fruits, vegetables, antioxidants, phytochemi-

cals and lower in saturated fat and cholesterol than


omnivorous diets.[1-3] Numerous studies have reported diverse health benefits of consuming a vegetarian
diet, including lower risk for heart disease, hypertension, diabetes mellitus, obesity and some types of
cancers.[4-13] Other factors considered when choosing a vegetarian diet may include environmental
issues, religious and moral beliefs.[14] Recent estimates suggest that approximately 2.5% of American

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Venderley & Campbell

adults and 4% of Canadian adults consume vegetarian diets.[1]


A small proportion of athletes have adopted a
vegetarian diet with the goal of obtaining health,
training and performance benefits.[15,16] Endurance
athletes, especially triathletes, runners and cyclists,
may consume a vegetarian diet in order to meet
increased carbohydrate needs and to assist in weight
control.[14] In a National Runners Health Study
survey of 9242 runners, investigators found 351
vegetarian runners (3.8%).[17] Of those, 289 were
lacto-vegetarians and 62 were vegans. Several well
known athletes have also adopted vegetarian eating
patterns, including Dave Scott (six-time Ironman
winner), Andreas Cahling (champion bodybuilder),
Surya Bonaly (French Olympic figure skater), Pavo
Nurmi (long-distance runner with 20 world records)
and Billy Jean King (tennis champion).[18]
The ADA supports that the energy and macronutrient needs of competitive athletes can be met
through a vegetarian diet.[19] Yet, concern exists
among coaches and trainers that a vegetarian diet
may not fully support the nutritional requirements
and performance goals of athletes, especially when
they perform high-intensity sports.[20] The purpose
of this article is to describe different types of vegetarian diets, to highlight nutritional considerations for
vegetarian athletes, and to discuss the potential impact of vegetarian diets on athletic performance. As
such, this review focuses on the nutritional implications of vegetarianism and potential effects on athletic performance, and complements previous related reviews;[16,20,21] it is not meant to be a comprehensive meta-analysis of the topic.
1. Types of Vegetarian Diets
A vegetarian diet is a plant-based diet that consists mostly of fruit, vegetables, grains, legumes,
nuts and seeds, and excludes beef, pork, poultry and
fish. There are several different types of vegetarian
diets with each one varying slightly (table I).[14,15,18]
Two main categories are lacto-ovo-vegetarian and
vegan.
The potential health benefits of a vegetarian diet
have prompted some people to reduce the consump 2006 Adis Data Information BV. All rights reserved.

tion of animal-based foods, and to possibly eliminate the use of some, especially red, meats. This
eating style typically has been referred to as semivegetarian. While this term has gained popularity in
its use, it is ambiguous and should be avoided since
the consumption of meat, no matter how little, is
carnivorous.
1.1 Lacto-Ovo-Vegetarian Diet

A lacto-ovo-vegetarian diet is the most common


type that vegetarians follow.[14,15,18] The plant-based
diet excludes meats, poultry and fish, but includes
milk, other dairy products and eggs. Nutritional
deficiencies are less commonly seen with this eating
pattern when an individual consumes a variety of
plant foods, egg and dairy products. Dairy products
provide good sources of protein, calcium, vitamin D
(cholecalciferol) and vitamin B12 (cyanocobalamin), the nutrients typically of concern in a vegetarian diet. While most vegetarian diets generally contain lower amounts of fat than omnivorous diets, it is
advisable for vegetarians to balance the use of fulland lower fat dairy products and to maintain total fat
intakes within the range of 2035% of daily energy
need.[14,15,18,22]
There are two variations of the lacto-ovo-vegetarian diet: a lacto-vegetarian and an ovo-vegetarian
diet. A lacto-vegetarian diet excludes eggs and egg
products and an ovo-vegetarian diet excludes milk
and milk products.[14,18,22]
Table I. Types of vegetarian diets
Type

Food patterns

Lacto-ovovegetarian

Excludes meat, poultry and fish, but includes


milk, other dairy products and eggs
Lacto-vegetarian excludes eggs and egg
products
Ovo-vegetarian excludes milk and milk products

Vegan

Excludes meat, poultry, fish, eggs, dairy


products, gelatin, honey and animal-derived
additives
Macrobiotic excludes some fish, eggs, dairy
products, tropical fruits, processed sweeteners
and vegetables of the nightshade family such as
potatoes, tomatoes, eggplant and peppers
Fruitarian predominately consumes raw or dried
fruits

Sports Med 2006; 36 (4)

Vegetarian Diets and Athletes

1.2 Vegan Diet

A person practicing a vegan diet avoids all


animal products including beef, poultry, pork, fish,
eggs, dairy products, gelatin, honey and animalderived food additives. The diet consists primarily
of fruits, vegetables, grains, legumes, nuts and
seeds. A person who consumes a vegan diet may be
at increased risk of inadequate intakes of some nutrients that are mainly found in animal products; these
include vitamin B12, vitamin D, calcium and zinc.[18]
The macrobiotic diet is a type of vegan diet that
few vegetarians follow. It is based mainly on grains,
vegetables and legumes with emphasis on rice and
sea vegetables.[18] It excludes beef, pork, poultry,
some fish, eggs, dairy products, tropical fruits,
processed sweeteners and vegetables of the nightshade family such as potatoes, tomatoes, eggplant
and peppers. Nuts, fruits and seeds are consumed in
moderation and fish may be consumed in limited
amounts, if at all.
A fruitarian diet is another form of vegan diet and
least followed among vegetarians.[18] It is based
predominately on the consumption of raw or dried
fruits, although it can include some nuts, seeds and
vegetables such as squash, tomatoes, eggplants, peppers and avocados. Deficiencies in protein and calcium are among some of the nutrient concerns with
the diet. Needs for calcium and protein can be met if
large amounts of nuts and seeds are consumed.
However, this type of diet is generally not recommended and would be a challenge to plan in order to
meet nutrient needs of an individual.[18]
2. Nutritional Considerations for Athletes
Who Consume Vegetarian Diets
2.1 Energy

Athletes have higher energy needs because of the


increased demands of physical activity.[18,19] Energy
needs range from 2000 to 6000 kcal/day or more
depending on the athletes body size, body composition, sex, training programme, and type and intensity of the sport they perform.[18,19] Vegetarian diets
are capable of providing sufficient energy to meet an
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295

athletes needs. However, some athletes, especially


those who choose to consume a vegan diet, may be
challenged to consume sufficient quantities of food
to meet their energy needs if their food choices have
lower energy density (lower fat and higher fibre).
Very high fibre diets will slightly decrease energy
availability due to a reduction in metabolisable energy (i.e. the amount of ingested energy that is digested, absorbed and available for use or storage).
Energy intakes among vegetarians are also typically
lower than non-vegetarians.[18,23] The joint position
statement on nutrition and athletic performance
from the ADA, the American College of Sports
Medicine (ACSM) and the Dietitians of Canada
(DC)[19] emphasises that all athletes, including those
who consume a vegetarian diet, must consume sufficient energy to support optimal performance, maintenance of lean tissue, and immune and reproductive
functions.
There are several ways to increase the energy
intake of a vegetarian athlete.[14,18] The athlete can
eat more frequent meals and snacks, and include
meat alternatives (e.g. textured vegetable protein,
tempeh and tofu), dried fruit or fruit juices, honey
and jams, avocados, nuts, nut butters and seeds in
their diet. Coaches and trainers are encouraged to
periodically monitor the weight of a vegetarian athlete to ensure that energy needs are being met,
especially if lean body mass is favoured in their
sport.[19] To help avoid gastrointestinal discomfort,
new vegetarian athletes should continue to include
energy-dense, lower fibre foods and to gradually
introduce higher fibre foods into their diet over the
course of 34 weeks.
2.2 Macronutrient Distribution

The ACSM, ADA, DC joint position statement


appropriately emphasises that specific recommendations for the macronutrient distribution of an individual athletes diet will depend on the persons body
size (weight and height), body composition, sportspecific energy needs and sex.[19] Provided that sufficient energy is consumed to meet the energy demands of higher intensity training and to maintain
bodyweight, a vegetarian diet is well suited to proSports Med 2006; 36 (4)

296

vide the 78g carbohydrate and 1.21.7g protein/


kg day recommended.[19,24] Vegetarians, especially
vegans, consume the majority of their energy in the
form of carbohydrate.[2,18] Summarising dietary data
from 63 research studies, Messina and Messina[18]
reported that among the general public, the carbohydrate intake of vegans ranges from 5065% of energy and lacto-ovo vegetarians ranges from 5055%,
compared with 50% for non-vegetarians. Nieman[24] suggested that most endurance athletes, especially those training >6090 min/day, should consume between 6070% of energy as carbohydrate to
maximise muscle glycogen synthesis, and submitted
that a vegetarian diet may be an optimal diet for
athletes because it includes numerous higher carbohydrate, lower fat foods and adequate protein.
The ACSM, ADA and DC joint position statement supports that sufficient carbohydrate intake is
required to enhance endurance performance, but
cautions that making dietary recommendations
based on proportions of macronutrient intakes may
be misleading for some athletes, especially those
with very high or low energy needs, and may not
result in optimal nutrient intakes. For the general
public, the acceptable macronutrient distribution
ranges for carbohydrate, fat and protein are 4565%,
2035% and 1035%, respectively.[25] These ranges
are considered acceptable for vegetarian and nonvegetarian athletes alike, with the understanding that
a modest 10% increase in protein intake is recommended to adjust for the incomplete digestion of
plant proteins.[19]
It is important to understand that the suggested
10% increase in protein intake is not the same as a
10% increase in energy intake from protein. For
example, consider a 75kg endurance athlete who
requires 4000 kcal energy/day and consumes a vegetarian diet that contains 10% of energy as protein
(400 kcal/day, 100g protein/day, 1.33g protein/
kg day). To increase protein intake by 10%, the
athlete would need to consume 10 more grams of
protein per day, which represents about 40 kcal/day
energy and would increase total protein intake to
1.47g protein/kg day. In contrast, a 10% increase
in energy intake as protein would double total prote 2006 Adis Data Information BV. All rights reserved.

Venderley & Campbell

in intake to 20% of energy (200g protein/day, 2.67g


protein/kg day), which greatly exceeds the athletes
protein needs.
2.3 Protein

Vegetarian diets generally contain less protein


than omnivorous diets. Summarising dietary data
from 63 research studies, Messina and Messina[18]
reported that protein intakes among vegans, lactoovo-vegetarians and omnivores ranged from
1012%, 1214% and 1418% of energy, respectively. Coaches, trainers and athletes continue to
question whether a vegetarian diet can provide adequate protein to meet the increased dietary needs of
highly trained athletes.[26] The ADA and DC 2003
position paper on vegetarian diets states that typical
protein intakes of lacto-ovo-vegetarians and vegans
appear to meet or exceed requirements and athletes
can meet their protein needs by consuming vegetarian diets.[1] It was once thought that various plant
proteins had to be consumed in the same meal in
order to provide all essential amino acids; however,
complementary meal planning is not required.[1,16,19,27] A vegetarian diet can supply all essential and nonessential amino acids from plant
foods alone if a variety of these foods are consumed
over the course of a day and energy intake is adequate.
While all athletes may benefit from careful dietary planning to support athletic performance, athletes
who consume a vegan diet may require special consideration to ensure adequate protein intake. There
are a wide variety of high-protein vegetarian food
and beverage products now on the market to assist
vegetarian athletes to meet their protein needs conveniently. Proteins in egg, dairy and soy (tofu,
tempeh and textured vegetable protein) are all highquality and provide the essential amino acids necessary for protein synthesis. Other sources of protein
typically incorporated into vegetarian diets include
legumes, dried beans, peas and nuts.
The recommended dietary allowance (RDA) for
protein is 0.8g protein/kg day for all apparently
healthy adults, with no increase for persons who
habitually exercise.[25] The Food and Nutrition
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Vegetarian Diets and Athletes

Board stated that In view of the lack of compelling


evidence to the contrary, no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise.[25] This view contrasts
with the ACSM, ADA and DC committee,[19] and
others,[28,29] who suggested that the protein needs of
well trained endurance and strength athletes were
higher than for sedentary persons. The ACSM, ADA
and DC committee specified that endurance and
strength-training athletes may have protein needs of
1.21.4 and 1.61.7 g/kg day, respectively.[19] The
higher protein need of athletes is considered necessary to support the modestly increased use of protein
as an energy source during exercise (amino acid
oxidation), and the needs for amino acids for the
repair of damaged muscle following exercise and for
muscle hypertrophy. When evaluating these apparently conflicting recommendations, it is important to
emphasise that the higher protein recommendations
proposed by the ACSM, ADA and DC committee
are for highly trained, elite athletes. Consistent with
the Food and Nutrition Board statement, there is
little scientific support for recreational and non-elite
athletes to consume more protein than sedentary
individuals.[30,31] However, the adequacy of the
RDA to optimise athletic performance continues
to be questioned and requires further evaluation.[32]
3. Vegetarian Diets and Performance
In his 1999 review, Nieman[20] documented the
findings from about eight cross-sectional and shortterm intervention studies from the 1970s, 1980s and
early 1990s, and concluded that a vegetarian
diet, even when practiced for several decades, is
neither beneficial nor detrimental to cardiorespiratory endurance, especially when carbohydrate intake,
age, training status, bodyweight, and other confounders are controlled for. Among these studies,
Cotes et al.[33] investigated the effects of a vegan diet
on the physiological response to submaximal exercise, not in athletes, but in sedentary individuals.
The study group consisted of 14 women who consumed a vegan diet supplemented with vitamin B12,
66 non-vegetarian housewives with social backgrounds comparable to the vegans, and 20 non 2006 Adis Data Information BV. All rights reserved.

297

vegetarian office workers with similar physical activity levels to the vegans. The assessments included
forced expiratory volume and forced vital capacity
by spirometry, cardiovascular response to submaximal exercise on a cycle ergometer, and estimates of
thigh muscle width from circumference and skinfold
measurements. There were no differences in the
variables measured in vegans compared with the
non-vegetarians. The results showed that a vegan
diet does not impair the physiological response to
submaximal exercise.[33]
Hanne et al.[34] studied the effects of different
vegetarian diets on physical fitness. Various fitness
parameters were used to compare vegetarian (31
lacto-ovo-vegetarians, 13 lacto-vegetarians and 5
vegans) with non-vegetarian athletes matched for
age, sex, body size and type of athletic activity. No
significant differences in fitness parameters were
found between vegetarian and non-vegetarian athletes in a variety of physical fitness, anthropometric
and metabolic measures, including aerobic and anaerobic capacity, hand grip, back strength,
haemoglobin, total serum protein and pulmonary
function. While the results of this study generally
support that consumption of a vegetarian diet does
not impair the capacity to perform aerobic and anaerobic exercise, the study also underscores the importance of defining and controlling the types of
subjects studied and other experimental design issues.[15] It is difficult to apply these findings when
the subjects consumed a wide variety of diets for
which the energy and macronutrient contents were
not documented, the subjects performed numerous
types of athletic activities ranging from long-distance running to football to basketball, and the subject age range was 1760 years.
Raben et al.[35] studied the effect of a lacto-ovovegetarian diet and a mixed diet with meat on endurance performance in male athletes. The study group
consisted of eight well trained male endurance ath 2max)
letes with a mean maximal oxygen uptake (VO
of 67 mL/kg/min. The athletes were fed a lacto-ovovegetarian diet for 6 weeks and a mixed diet for 6
weeks. An aerobic endurance test was performed on
subjects using a cycle ergometer or treadmill after 0,
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298

3 and 6 weeks of consuming each diet. Average


2max was 4.93 L/min before subjects consumed
VO
the mixed diet and 4.83 L/min before the vegetarian
diet. After consuming the diets for 6 weeks, average
2max was 4.90 L/min with the mixed diet and
VO
4.79 L/min with the vegetarian diet. No significant
changes in endurance performance were found after
6 weeks when athletes were fed either a mixed diet
with meat or a lacto-ovo-vegetarian diet. The results
from the study showed that a lacto-ovo-vegetarian
diet does not affect endurance performance.[35]
In their 2004 review of the nutritional considerations for vegetarian athletes, Barr and Rideout[21]
noted that a paucity of data exist on the effects of a
vegetarian diet on athletic performance from well
controlled, amply powered research studies, and that
few (if any) have been reported since the 1999
review by Nieman.[20] We concur that better research is needed to directly compare athletic performance of vegetarians and non-vegetarians since
few well conducted studies exist.[14,15]
We are unaware of any published research addressing whether consumption of a vegetarian diet
influences body composition, muscle hypertrophy,
and muscle strength and power in resistance-trained
athletes. However, at the other end of the muscle
size and strength spectrum, this issue has been addressed in sedentary older men. Campbell et al.[36,37]
observed that older men and women who were
habitualised to a lacto-ovo-vegetarian diet did not
experience measurable muscle hypertrophy after a
12-week strength training programme. The programme (three sets of eight repetitions at 80% of
maximal strength capacity for a variety of large
muscle group exercises, 3 days/week) had previously been documented to cause muscle hypertrophy in
older men who consumed an omnivorous diet.[38]
Campbell et al.[39] then directly compared the effect
of a meat-containing diet (beef, poultry, pork and
fish) and a lacto-ovo-vegetarian diet on muscle size
and whole-body composition in older men. During
the 12-week period, nine men were fed a meatcontaining diet that provided 125% of the RDA
from protein and ten men were fed a lacto-ovovegetarian diet that provided 100% of the RDA for
2006 Adis Data Information BV. All rights reserved.

Venderley & Campbell

protein. Whole-body density, fat-free mass, and


whole-body muscle size increased in the meat diet
group and decreased in the vegetarian diet group.
Type II muscle fibre area of the vastus lateralis
muscle increased with strength training in all men,
consistent with a hypertrophy response, with a trend
for the increase to be greater in the meat diet group
(16.2 4.4%) than in the vegetarian diet group (7.3
5.1%). Gains in maximal muscle strength with
training were not influenced by the diet consumed.
The results showed that consuming a diet containing
meat contributed to greater gains in fat-free mass
and muscle hypertrophy with strength training than
did consuming a lacto-ovo-vegetarian diet.[39] Caution is warranted when interpreting these results
because the study diets were not completely controlled and the men assigned to the vegetarian diet
group tended to decrease their energy and protein
intakes over time, which might have influenced the
adaptive responses to training.[21]
In a subsequent study from the same research
group with better dietary control, Haub et al.[40,41]
noted no differences in muscle strength, power and
size gains after a 12-week period of strength training
in older men who consumed an omnivorous (beefcontaining) or lacto-ovo-vegetarian (soy-containing) diet. Both groups of men were counselled to
consume a basal lacto-ovo-vegetarian diet and were
provided 0.6g protein/kg day from portioned quantities of beef or soy foods, with total protein intakes
not different between groups (129144% of the
RDA).[40] The beef group experienced increases in
serum high-density lipoprotein cholesterol (HDL),
low-density lipoprotein cholesterol (LDL) and total
cholesterol (CHOL), with no changes in triacylglycerol (TG), the CHOL/HDL ratio, or the TG/HDL
ratio. In contrast, the soy group did not experience
any changes in the lipid-lipoprotein profile parameters during training. Among all subjects, differences
in the saturated fat/fibre ratio and cholesterol/fibre
ratio and increases in carbohydrate intake over time
were the main predictors of changes in lipid-lipoprotein profile parameters. Collectively, the results of
these studies[36,37,39-41] suggest that the quantity of
protein rather than the source of protein contributed
Sports Med 2006; 36 (4)

Vegetarian Diets and Athletes

to the variations in body composition and muscle


hypertrophy responses to strength training among
older men who consumed omnivorous versus lactoovo-vegetarian diets. The results also suggest the
need to include assessments of various health-related parameters, such as lipid-lipoprotein profile,
when assessing the relative efficacy of omnivorous
versus vegetarian diets with exercise training. Finally, these results underscore that nutrition-exercise
interactions may affect the health and adaptations to
training of a wide range of people, from previously
sedentary older men to elite athletes.
4. Creatine
Creatine supplementation has gained popularity
over the years among professional and recreational
athletes due to its possible effects on enhancing
exercise performance and body composition
changes with training. As recently reviewed by
Volek and Rawson,[42] hundreds of research studies
have been conducted and numerous review papers
written on whether creatine supplementation functions as an ergogenic aid for metabolic adaptations
to acute exercise and chronic training, as well as
sports performance. The preponderance of data support that creatine supplementation is ergogenic, especially for short-term, high-intensity exercise[43]
and resistance-training-induced gains in lean body
mass, maximal muscle strength and weightlifting
performance.[42]
The major role of creatine in the body is in
energy metabolism.[18,21,44] Creatine is synthesised
endogenously from the precursor amino acids arginine, glycine and methionine at a rate of about 1 g/
day. Dietary intake of creatine-containing foods,
predominately meat, fish and poultry, also provide
about 1 g/day. Greater than 90% of the total body
pool of creatine is located in skeletal muscle where it
exists primarily as free creatine and creatine
phosphate (phosphocreatine). Average total creatine
concentration in skeletal muscle of young adults
who do not use creatine supplements is about 120
mmol/kg (range 100150 mmol/kg). About twothirds of the total creatine in muscle exists as creatine phosphate, the storage form of creatine that
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299

serves as an energy source during exercise. During


intense exercise, creatine phosphate is broken down
to creatine and phosphate by the enzyme creatine
kinase, and the high-energy phosphate molecule
rapidly combines with adenosine diphosphate
(ADP) to form adenosine triphosphate (ATP). The
rapid resynthesis of ATP during exercise helps provide a steady energy source for muscle contraction.
Creatine phosphate concentration declines rapidly
during maximal exercise and its depletion prevents
adequate ATP production and the bodys inability to
match ATP demand and supply contributes to muscular fatigue. Elevated muscle creatine content increases the rate at which creatine phosphate is resynthesised during recovery from exercise and may
enhance exercise performance and recovery time for
an athlete during short repeated bouts of maximal
exercise. For this reason, many athletes, especially
vegetarian athletes, may consider using creatine
supplementation to increase muscle creatine stores.
Creatine supplementation regimens often include
ingestion of 2025g creatine/day for 37 days,
clearly an intake not possible via the diet. A lower
dose of 3 g/day over approximately 4 weeks also has
been documented to significantly elevate muscle
creatine concentration.[45] Creatine supplementation
may increase muscle creatine concentration by
>30%, although variability in this response has been
noted, with initial muscle creatine content an important factor of supplementation-related creatine uptake.[46] While it is possible to obtain up to 3 g/day of
creatine by consuming very high quantities of striated tissue foods, few people are likely to consume
this amount of meat. Raw beef contains about 30
mmol creatine/kg dry weight.[47] However, exposure
to high temperatures for long periods of time catalyses the conversion of creatine to creatinine. Thus,
depending on how meats are cooked, there might be
a large decrease in the creatine content (<3 mmol/kg
dry weight). Nonetheless, athletes who consume
high amounts of meat products may already have
high muscle creatine concentration and would not
respond as greatly to supplementation.[21] Conversely, athletes who habitually consume a vegetarian
diet may have lower muscle creatine concentration,
Sports Med 2006; 36 (4)

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Venderley & Campbell

which has been hypothesised to make them more


responsive to supplementation-related improvements in sports performance.
Research in young adults documents that consumption of lacto-ovo-vegetarian[48] and vegan[46]
diets decreases muscle total creatine concentration.
Lukaszuk et al.[48] reported decreased muscle total
and free creatine concentrations in 16 men who
consumed for 3 weeks a lacto-ovo-vegetarian diet
that contained 1.5g protein/kg day, compared with
unchanged concentrations in 16 men who continued
to consume an omnivorous diet that provided comparable quantities of protein. Subsequent supplementation with 0.3g creatine/kg day and 20g
Polycose 1 for 5 days increased muscle total creatine among all subjects, with no difference in postsupplementation creatine concentration between diet groups. The comparable muscle creatine concentration between vegetarians and omnivores postsupplementation suggests that initially lowering
muscle creatine concentration by consuming a vegetarian diet is not a viable strategy to achieve a higher
maximum concentration with supplementation.
Lukaszuk et al.[48] speculated that the reduction in
muscle total creatine concentration with the onset of
consuming a vegetarian diet might be due to decreased methionine, glycine and arginine intakes,
amino acids required for endogenous creatine synthesis. This interpretation should be viewed with
caution because vegetarian diets are generally considered to provide all essential amino acids, and
these subjects consumed almost twice the RDA for
protein. The amino acid content of the diets provided to these subjects were not presented in the report.
It is also known that consumption of a creatine-free
vegetarian diet fully activates, and meat consumption suppresses, the enzyme glycine amidinotrasferase, which is the rate-limiting enzyme for creatine
synthesis in the kidney.[49]
Burke et al.[50] reported similar findings in a
double-blind study with young men and women who
were recreational athletes. Eighteen vegetarians and
24 non-vegetarians participated in an 8-week resistance-training programme. Subjects were randomly
1

divided into four groups: (i) vegetarian with creatine


supplementation (16.8g creatine/day during a 7-day
loading phase and 4.2g creatine/day during a 49-day
maintenance phase); (ii) vegetarian with placebo
supplementation; (iii) non-vegetarian with creatine
supplementation (supplementation same as vegetarian + creatine); and (iv) non-vegetarian with placebo
supplementation. The study results showed that: (i)
habitual vegetarians (lacto-ovo-vegetarian or vegan)
had lower concentrations of intramuscular total creatine and phosphocreatine concentrations than nonvegetarians at baseline; (ii) the vegetarians experienced greater gains in muscle total creatine and
phosphocreatine with creatine supplementation; and
(iii) the post-supplementation total creatine and
phosphocreatine concentrations were not different
between diet groups. Greater increases in benchpress strength, type II muscle fibre area and wholebody lean mass were observed in both creatine
groups compared with the placebo groups. The vegetarian + creatine group had greater increases in
muscle total creatine, lean tissue mass and total
work performance for knee flexion and extension
than the non-vegetarian + creatine group. These
findings suggest that creatine supplementation is
ergogenic and that vegetarians experience greater
metabolic, body composition and performance responses to creatine supplementation.
Shomrat et al.[51] examined the effect of creatine
supplementation on anaerobic exercise performance
during three, 20-second maximal cycling tests
(modified Wingate anaerobic test) in seven vegetarians and nine omnivores who consumed 21 g/day of
creatine per day for 6 days, compared with eight
omnivores who consumed a glucose placebo. Maximal exercise performance was determined before
and after creatine supplementation. Creatine supplementation increased body mass ~1.1kg and mean
work performance by ~5% for both diet groups, and
peak work performance by ~5% in the omnivorous
group only. These parameters were not changed
with supplementation in the glucose-control group.
The results of this study support that creatine supplementation is ergogenic for both vegetarians and

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2006 Adis Data Information BV. All rights reserved.

Sports Med 2006; 36 (4)

Vegetarian Diets and Athletes

omnivores, and do not support that the habitual


consumption of a vegetarian diet lowers maximal
exercise capacity.
5. Iron
Iron is critical in sports nutrition. It is used for the
synthesis of haemoglobin and myoglobin, essential
components in the transport and delivery of oxygen
to the muscles.[15,18,52,53] Athletic training, especially
endurance training, and competition tend to reduce
iron stores.[15,18,52-54] Iron stores are also depleted
when iron needs are not adequately met in the diet.[15,18,52,53]
Vegetarian diets generally contain as much or
more total iron than omnivore diets.[18,27,55] Total
iron intake is usually higher in vegans than in lactoovo-vegetarians because dairy foods contain relatively little iron. Lacto-ovo-vegetarian athletes generally consume about the same amount of total iron
as non-vegetarian athletes.[18] Concerns over the
iron status of vegetarian athletes are usually based
on the bioavailabilty of iron from plant foods rather
than the amount of total iron present in a vegetarian
diet.[3,15,18,20] Plant foods contain only non-haeme
iron, which is less absorbed than haeme iron found
in animal products. An individuals iron status, the
amount of total dietary iron consumed, and the
bioavailablity of the dietary iron are three primary
determinants of iron absorption. The ingestion of
red meat (beef) is documented to increase bioavailable iron intake and haematological status in individuals who had previously consumed a lacto-ovovegetarian diet preceding a 12-week period of
strength training.[56]
Shaw et al.[57] examined iron intake and status in
55 vegetarian and 59 non-vegetarian students.
Haemoglobin, plasma transferrin, plasma iron,
transferrin saturation and plasma ferritin were used
to assess iron status. Vegetarian students consumed
higher amounts of soy products, which are rich
sources of iron but contain phytate, an inhibitor of
non-haeme iron absorption. Daily total iron intake
was not different between vegetarians and non-vegetarians, with ranges from 1618 mg/day for males
and 1216 mg/day for females. Vegetarians had
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301

lower ferritin and higher transferrin concentrations,


which indicate lower iron stores but a higher amount
being transported in the blood. Ferritin concentration in vegetarians was half that of non-vegetarians.
Although vegetarians had a higher iron content in
the blood, iron stores were reduced.[55,57] These results suggest that vegetarian diets provide ample
total iron but absorption, especially non-haeme iron
absorption, may be impaired due to inhibitors such
as phytate and fibre, thus reducing iron stores and
increasing the risk for iron-deficiency anaemia. Vitamin C (ascorbic acid), present in fruits and vegetables, can largely counteract the effects of iron inhibitors and may provide a means for vegetarian athletes
to partially offset the effects of reduced iron bioavailability.[1,18,20,27,55]
Iron-deficiency anaemia may be a detriment to
performance, especially aerobic performance, since
iron is critical in oxidative energy metabolism.[15,52,53] However, iron deficiency anaemia is
rare in vegetarian athletes and a mild iron deficiency
is not likely to impair performance.[16,20] Messina
and Messina[18] reported that only 10% of athletes
have anaemia and that it is more commonly found
among endurance athletes. A study by Snyder et
al.[58] documented lower iron stores in nine female
long-distance runners who consumed a restricted
meat (semi-vegetarian; <100g red meats/week) diet
compared with nine runners who did not restrict red
meat intakes. Dietary total iron intakes were the
same between the two groups (~14 mg/day), but
haeme iron intake and iron bioavailability were
higher in the unrestricted meat group. Lower serum
ferritin concentration and higher total iron-binding
capacity were observed in the restricted meat group.
No differences between groups were reported for
serum iron and haemoglobin concentrations, and
haematocrit. These findings suggest that female
vegetarian athletes who restrict meat intake have
altered iron status, which may be related to a decrease in the bioavailability of the iron consumed in
their diets. These findings are limited by the small
number of subjects studied and the lack of documentation of the amount of meats consumed by the
unrestricted meat group. Other research supports
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Venderley & Campbell

Table II. Micronutrients of special concern for vegetarian athletes


Micronutrient

Function

Sources in a vegetarian diet and comments

Iron

Required for synthesis of haemoglobin and


myoglobin, essential components in transport and
delivery of oxygen within blood and to the muscles

Fortified breakfast cereals, bread, textured vegetable


protein, legumes, dried beans, soy foods and meat
alternatives, nuts, dried fruits and green leafy vegetables,
vitamin C (ascorbic acid) enhances iron absorption

Zinc

Involved in immune function, protein synthesis and


blood formation

Legumes, whole grains, cereals, nuts, seeds, soy and dairy


products, vitamin C and soaking beans, grains and seeds
enhances zinc absorption

Vitamin B12
(cyanocobalamin)

Coenzyme required for normal metabolism of


nerve tissue and of protein, fat and carbohydrate

Dairy products, eggs, fortified soy milk and cereals

Vitamin D
(cholecalciferol)

Necessary for bone growth, promotes bone


Dairy products, eggs, fortified soy milk and cereals
mineralisation, aids in absorption of calcium and
maintaining nervous system, and normal heart action

Riboflavin

Coenzyme involved in production of energy, stored


in muscles and used during muscular fatigue

Dairy products, soy milk, soy yogurt, soy cheese, fortified


breakfast cereals, grains and textured vegetable protein

Calcium

Necessary for blood clotting, nerve transmission,


muscle stimulation, vitamin D metabolism, and
maintaining bone structure

Dairy products, calcium-fortified soy milk, tofu, soy yogurt,


cereals, low oxalate green vegetables such as broccoli, bok
choy and kale

that low iron stores increase the risk for iron deficiency anaemia and may adversely affect physical
performance, especially aerobic activity.[14,18,27]
Vegetarian athletes can increase total iron intake
by incorporating more leafy green vegetables such
spinach, soy foods, legumes, dried beans, iron-fortified grains (such as fortified breakfast cereals), nuts,
seeds and dried fruits (table II).[1,14,15,20,59,60] In addition, include fresh fruits, vegetables or juices rich in
vitamin C to enhance iron absorption.[61]
6. Zinc
Zinc is another nutrient of concern in a vegetarian
diet. Zinc is an essential trace mineral that is a
component of >100 enzymes and is involved in
immune function, protein synthesis and blood formation.[15,18,27] Total zinc intake is generally lower
in vegetarian athletes than non-vegetarian athletes.[15,18,20] The best sources of zinc are animal
products, meats and dairy products in particular,
which provide 5070% of the zinc in an omnivore
diet. In a vegetarian diet, zinc is found in legumes,
whole grains, nuts, seeds, soy and dairy products
(table II).[14,15,18,27]
It may be difficult for a vegetarian athlete to
maintain clinically normal plasma zinc concentration because exercise, especially strenuous exercise,
increases zinc loss from the body.[15,20,54] Exercise 2006 Adis Data Information BV. All rights reserved.

induced losses of zinc occur in urine and may represent up to 79% of dietary zinc that is absorbed.[62]
Zinc losses may also be substantial for athletes who
exercise in hot, humid environments, although training and environmental acclimatisation may decrease
these losses.[62] Zinc status may also influence exercise-induced changes in zinc mobilisation, with the
combined stresses of low zinc intake and maximal
exercise contributing to alterations in some body
zinc pools, as reflected by a reduction in circulating
exchangeable zinc.[63] Zinc bioavailability also appears to contribute to zinc deficiency in vegetarians.
As seen with iron, zinc absorption from plant foods
may be impaired by phytate, a potent zinc inhibitor.[2,15,18,20,27] A food preparation technique vegetarian athletes may want to consider that enhances
zinc absorption is soaking beans, grains and seeds
(table II).[1]
7. Other Nutrients
Vegetarian athletes may be at risk for low intakes
of several other nutrients including vitamin B12,
vitamin D, riboflavin and calcium (table
II).[1,14,15,18,19] The main sources for these nutrients
are in animal products but can be found in many
alternative sources suitable for vegetarians. To help
meet calcium needs, vegetarians, especially vegans,
should consider consuming calcium-fortified soy
Sports Med 2006; 36 (4)

Vegetarian Diets and Athletes

milk, tofu, soy yogurt, cereals and low oxalate green


vegetables such as broccoli, bok choy and kale.
Requirements for riboflavin can be met by consuming soy milk, soy yogurt, soy cheese, fortified breakfast cereals, grains and textured vegetable protein.
Lacto-ovo-vegetarians can meet their vitamin B12
needs by consuming dairy foods and eggs. Vegans
should consume vitamin B12 fortified foods such as
fortified soy milk and fortified cereals.
8. Antioxidants
While findings among studies are not completely
consistent, increased oxygen consumption and oxidative stress associated with higher intensity, longer
duration exercise is reported to increase production
of free radicals and other reactive oxygen species,
and to promote lipid peroxidation.[20,64-67] The
bodys antioxidant defence system combats free
radical formation and relies on dietary intake of
antioxidant vitamins such as vitamins A (retinol), C
and E (tocopherol). However, it is still questionable
whether or not the bodys antioxidant defence system can keep up with increases in free radical production during exercise and whether additional antioxidant supplementation would be beneficial to athletes.[20,64,66] Nieman[20] recommends that athletes
who regularly perform intensive training should
consume diets rich in antioxidants. Vegetarians usually consume large amounts of fruit, vegetables, and
whole grains, nuts and seeds, which are rich in
antioxidant nutrients and may reduce oxidative
stress and risk for various diseases including heart
disease, cancer and arthritis.[2,4,6,18,20,65,67] Vegetarian
diets are also higher in phytochemicals that may be
potent antioxidants.[1,2,6,18,67]
Summarising dietary data from several studies,
Rauma and Mykkanen[2] reported that vegetarians
typically consume 5001200g of fresh fruits and
vegetables per day, have dietary intakes of vitamins
C and E and the pro-vitamin -carotene above the
RDA, and have higher antioxidant status for vitamins C and E, and -carotene than omnivores. The
higher antioxidant statuses were reflected by higher
serum or plasma concentrations of these vitamins
and pro-vitamin, respectively, in vegetarians versus
2006 Adis Data Information BV. All rights reserved.

303

omnivores. For vitamin E, the enhanced antioxidant


status was more consistently found when plasma or
serum vitamin E was expressed in relation to serum
cholesterol concentration. A higher vitamin E/cholesterol ratio in vegetarians versus omnivores reflects enhanced protection of LDL from oxidation.
In contrast with the antioxidant vitamins, vegetarians may have comparable or lower plasma or serum
concentrations of the antioxidant minerals zinc, copper and selenium, consistent with lower dietary
bioavailability of these micronutrients.[2] Burri[68]
commented that while lower than omnivores, dietary intakes of these antioxidant minerals is likely to
be adequate to support oxidative balance in cells.
Documentation of the antioxidant status of vegetarian and non-vegetarian athletes is lacking.[2,21,68]
It is unclear whether the use of antioxidant supplements (in addition to dietary intake) can safely
and effectively help trained athletes reduce oxidative stress and increase performance, recovery time
and allow for more intense training.[64-66] Clarkson
and Thompson[64] concluded from their review of
the available literature that antioxidant supplements
may or may not reduce exercise-induced oxidative
stress and does not lead to performance benefits.
This supports the continuing controversy regarding
whether athletes should consume antioxidant supplements. No such controversy exists regarding the
benefits of ingesting an antioxidant-rich diet that
includes a variety of fruits, vegetables, whole grains
and other foods that are easily incorporated into a
vegetarian diet.
9. Conclusions
All athletes should carefully plan their diets to
contain sufficient energy and nutrients to fully support their training and competition. There is sufficient evidence to indicate that a well planned vegetarian diet can meet the energy and macro- and
micro-nutrient needs of an athlete and may reduce
the risk for certain chronic diseases. Limited data
from well controlled studies are available to support
or refute that consumption of a vegetarian diet influences athletic performance. At present, the majority
opinion is that athletic performance is neither comSports Med 2006; 36 (4)

304

Venderley & Campbell

promised nor enhanced by habitually eating a vegetarian diet.


Acknowledgements
No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest
that are directly relevant to the content of this review.

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Correspondence and offprints: Dr Wayne W. Campbell, Department of Foods and Nutrition, Purdue University, 700
West State Street, West Lafayette, IN 47906-2059, USA.
E-mail: campbellw@purdue.edu

Sports Med 2006; 36 (4)