Abstract
Based on theoretical considerations, experimental data with cells in vitro, animal studies in vivo, as well as a single case pilot study with one colitis patient, a consolidated hypothesis can be put forward, stating that “oral supplementation with creatine monohydrate (Cr), a pleiotropic cellular energy precursor, is likely to be effective in inducing a favorable response and/or remission in patients with inflammatory bowel diseases (IBD), like ulcerative colitis and/or Crohn’s disease”. A current pilot clinical trial that incorporates the use of oral Cr at a dose of 2 × 7 g per day, over an initial period of 2 months in conjunction with ongoing therapies (NCT02463305) will be informative for the proposed larger, more long-term Cr supplementation study of 2 × 3–5 g of Cr per day for a time of 3–6 months. This strategy should be insightful to the potential for Cr in reducing or alleviating the symptoms of IBD. Supplementation with chemically pure Cr, a natural nutritional supplement, is well tolerated not only by healthy subjects, but also by patients with diverse neuromuscular diseases. If the outcome of such a clinical pilot study with Cr as monotherapy or in conjunction with metformin were positive, oral Cr supplementation could then be used in the future as potentially useful adjuvant therapeutic intervention for patients with IBD, preferably together with standard medication used for treating patients with chronic ulcerative colitis and/or Crohn’s disease.
Highlights
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease, are chronic and relapsing-remitting inflammatory disorders of the gastrointestinal tract that may develop in genetically susceptible individuals in response to unknown antigenic triggers
It seems obvious that the creatine kinase (CK)/PCr system has a profound impact both on the innate and adaptive immune response, exhibiting significant immune modulatory effects [54] and, it may be inferred that patients with inflammatory bowel diseases (IBD), who often suffer from intestinal infections, may benefit by creatine supplementation as a general activator of immune responses [54]
There is growing evidence from human genetics, epidemiology, neuroimaging, as well as from animal studies that disruptions in brain energy metabolism, e.g., brain energy production, storage and utilization in the form of PCr and Cr [55] are implicated in the development and maintenance of depression, and that creatine has the potential to improve these disruptions in some depressive patients [56]
Summary
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease, are chronic and relapsing-remitting inflammatory disorders of the gastrointestinal tract that may develop in genetically susceptible individuals in response to unknown antigenic triggers. A dosage of 3–5 g of chemically pure Cr monohydrate per day as a long-term maintenance dose, without interruption needed, is generally recommended. For athletes in weight lifting and high-intensity performance disciplines, a short-term loading phase over 5–7 days with 20 g per day is recommended to quickly load the endogenous Cr pool in the muscles before switching to the above maintenance dosage [4]. Based on 30 years of practical experience with Cr supplementation and a very large number publications on this issue, involving athletes and regular people, as well as patients (children and elderly), oral supplementation with chemically pure Cr monohydrate if taken within the officially recommended dosages is safe for humans with no significant side effects Cr synthesis (AGAT or GAMT) or in the creatine transporter (CrT), the latter facilitating Cr uptake into target cells, lead to more or less severe Cr-deficiency syndromes in transgenic animal models, as well as in humans (for review see [7])
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