Looking for a potentially effective Crohn’s disease treatment with a low risk of side effects? Well, today we’ll discuss one such treatment.

We won’t hold you in suspense for too long. In fact, we covered this supplement as generally beneficial for the gut in a couple of blogs already. So what is this miracle nutritional supplement for the gut? It’s the common muscle building supplement creatine.

Our previous blogs covered creatine as a potential treatment for IBD as well as a motility aid. Creatine likely works for both processes by providing needed energy to cells in the gut. The gut has a high need for energy due to the continual replenishment of the cells there. Cells in the gut renew every 3 or so days, one of the most rapidly replenishing tissues in the body.

Creatine acts as a reservoir for the rapid replenishment of energy. When we sprint all out for 10 seconds, creatine is the primary way in which our cells replenish their ATP stores. In the gut, having adequate creatine levels helps make sure our cells have enough ATP to carry out their many processes at all times.

As a Crohn’s disease treatment, creatine probably works in the same way. A case study published in 2016 discusses the use of creatine hydrochloride as a treatment for Crohn’s ileitis.

This is a very interesting case study in that the patient acted as his own control. It found that creatine hydrochloride provided a stronger beneficial effect than the anti-inflammatory drug mesalamine, commonly prescribed for ulcerative colitis and Crohn’s disease.

Let’s dig in!

Creatine as a Crohn’s disease treatment

This case study begins with a patient presenting with a long history of GI symptoms and rectal bleeding in the last segment of the small intestine: the terminal ileum. This is indicative of Corhn’s ileitis.

The doctor performed a colonoscopy and the patient’s score for Crohn’s disease severity(SES-CD) was a 4, indicating mild Crohn’s. Apthous ulcers were < .5cm in diameter with 10-30% ulceration.

At the time, the patient had been taking creatine hydrochloride and a medicine to treat anal fissures. He was taken off the creatine and treated with the anti-inflammatory mesalamine. During his follow-up 4 months later, the symptoms had worsened and his Crohn’s severity score increased to 7, moving into the moderate disease category.

The ulcers were now larger, 0.5-2.0cm, and covered a larger surface area(>30%). After discussing the treatment plan with his doctor, the patient decided to stop mesalamine and re-started the creatine.

After 6 months, another follow up appointment found his severity score drop back down to 3, indicating inactive disease. The ulcers were now smaller, <0.5cm, and covered a smaller surface area(<10%). Further follow-ups were planned since patients often experience periods of lower disease activity.

This is not smoking gun material to say that creatine is definitely an effective treatment for Crohn’s. However, recent mouse studies we covered in the previous blogs provide support that it may be an effective treatment. In mice, genetically knocking out creatine production caused cell death in the intestine, which was fixed with supplemental creatine.

Creatine is currently being studied in clinical trials as a therapy for IBD. Again, not smoking gun material, but given the safe track record for creatine use, it’s worth a try.

Taking creatine as a Crohn’s disease treatment-Safe dosage, timing, and potential concerns

Creatine is considered safe to consume as a nutritional supplement. Meat contains significant amounts of creatine, but not enough to meet general supplement dosing recommendations. Creatine monohydrate is the most common form, and the one with the most research backing.

Dosage

The standard recommended dose for creatine monohydrate in people who strength train is 5g/day, which is equivalent to the amount in 2.2lbs of meat. Loading is unnecessary over the long term.

As a supplement, 5g is 1 teaspoon of creatine monohydrate. Though a lower dose of 3g/day may also be effective in omnivores. Vegans generally need to supplement with more due to low meat intake.

It’s important to point out the dosage listed in the case study was 1,034g/day of creatine hydrochloride, which is either a typo or using the European convention of using a comma for a decimal point.

Important considerations

Higher doses of creatine, typically 10g/day, may lead to an upset stomach. Even in some individuals, 5g could upset your stomach, so splitting the dose up and taking them with meals is your best bet. Taking 1/3 of a teaspoon with each meal is a good idea.

It’s also important to increase your daily water intake if you take creatine. Creatine is an osmolyte, causing you to retain water. This isn’t a bad thing at all, but requires you to increase your water intake to prevent cramping.

A common myth around creatine is that it can cause kidney problems. While this has been determined to be false in healthy people, long term studies in those with kidney problems have not been published. Therefore, if you have a history of kidney problems, it’s best to discuss taking creatine with your doctor.

There is also a theoretical concern for people who have an overgrowth of methanogens in their gut. While some methanogens may be able to use creatine as an energy source, none that are found in the human gut have been shown to possess this ability.

But, if you decide to take creatine and have methanogen overgrowth in your stomach or proximal small intestine, you may want to be on the lookout. Additionally, since methanogens use CO2 to generate methane, you should avoid carbonated beverages while taking creatine as they are a major source of CO2.

Finally, in those with asthma participating in intense training for sports, creatine may exacerbate lung inflammation. Though the findings were not significant, it’s something you might as well pay attention to. So if you you have asthma, it’s important to discuss supplementation with your doctor.