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.
Keywords: Adenosine mono-phosphate (AMP); Crohn’s disease; activated protein kinase (AMPK); creatine kinase (CK); creatine perfusion; creatine transporter (CrT); glucose transporter (GLUT); inflammatory bowel diseases (IBD); intestinal epithelial cell protection; intestinal tissue protection; liver kinase B1 (LKB1); mitochondrial permeability transition pore (mPTP); organ transplantation; phosphocreatine (PCr); pleiotropic effects of creatine (Cr) supplementation; reactive oxygen species (ROS); ulcerative colitis.