It's a fact that smoking cigarettes poses serious health risks. The Centers for Disease Control and Prevention (CDC) warns that smoking can harm every organ in the body and may cause health conditions such as cancer and heart disease.
While some research has suggested that the nicotine in cigarettes may benefit those with ulcerative colitis (UC), a form of inflammatory bowel disease (IBD), the risks of nicotine use far outweigh any potential benefits for UC symptoms.
Here, we unpack some of the theories about how nicotine may ease some symptoms of UC, and explain why using nicotine products for any reason is still strongly discouraged.
Researchers aren't sure why nicotine may have a protective effect on ulcerative colitis, but they have theories. One study noted that nitric oxide, a chemical released by nicotine, reduces muscle activity in the colon. This may soothe the intestinal spasms characteristic of UC.
Another theory is that nicotine suppresses the immune system, preventing it from mistakenly attacking healthy tissues.
Nicotine may also have a beneficial effect on mucus production. Benjamin McDonald, MD, PhD, a gastroenterologist at UChicago Medicine River East in Chicago, says there is some evidence that nicotine increases mucus production in the colon (which forms a protective barrier in the colon) and can suppress inflammatory responses.
Nicotine is one of approximately 600 ingredients found in cigarettes and the only one that may have any benefit for UC. Many other ingredients in cigarettes are toxic, and some can cause cancer.
Products such as vapes, snuff, and chewing tobacco also contain nicotine. But the available research only looks at the effects of cigarettes, so it isn't clear if these methods would have the same effects on UC. Additionally, there are many health risks associated with these products, including stroke and heart disease, and cancers of the pancreas, esophagus, and mouth.
As mentioned, smoking negatively affects most of the organs in the body. The gastrointestinal (GI) system is no exception. Smoking can harm your GI system by causing:
Heartburn and peptic ulcers, which are harder to treat in smokers
Cancers of the digestive system, including stomach and colon cancer
Smoking can also harm the body on a cellular level by causing oxidative stress. Oxidative stress occurs when there is an imbalance of molecules called free radicals and antioxidants in your body. It can damage certain molecules in your cells, such as proteins and lipids, and cause them to become cancerous.
In a person's GI tract, oxidative stress can contribute to the development of conditions such as:
Colorectal and gastric cancers
IBD
Peptic ulcers
Smoking may also alter the pH level inside your intestines. This change might allow certain bacteria to thrive, which can alter the balance of gut microbiota. Researchers believe this may contribute to the development of IBD.
Doctors strongly advise against smoking, even as a treatment for ulcerative colitis. Smoking has far too many negatives that will always cancel out any potential benefits.
The American Lung Association notes that smoking is the number one cause of preventable death in the United States and kills more than 490,000 people every year.
”Years ago, patients who developed severe ulcerative colitis symptoms after quitting smoking were (on occasion) asked to consider returning to smoking tobacco,” says Dr. McDonald.
“Today, we are very lucky to have numerous safe, effective treatment options for ulcerative colitis. Smoking is not an appropriate therapy for ulcerative colitis.”
Effective treatments for ulcerative colitis include:
Anti-inflammatory drugs
Immunosuppressant drugs
Biologic drugs, which target certain proteins made by your immune system
Small molecule drugs, which reduce inflammation
Other medications, such as painkillers or iron supplements
Surgery
Speak with your doctor about what treatments may work best for you. Your doctor can also answer any questions you might have about nicotine treatments. Harsh Sheth, MBBS, a gastroenterologist and a bariatric surgeon in Mumbai, India, says, “It's important to acknowledge these short-term effects [of nicotine] in medical research, but to educate patients thoroughly on the full picture. The goal should be to find safer alternatives that mimic the effects of nicotine without inviting the damage caused by smoking.”
A review from August 2020 notes that some clinicians may recommend the use of NRTs to treat people with ulcerative colitis.
The authors state that nicotine patches were able to reduce ulcerative colitis severity in one study. But participants also experienced nausea, headaches, and acute pancreatitis. Researchers found that nicotine enemas or oral capsules reduced these side effects. It's worth noting that this information came from older studies, so more up-to-date research is needed.
Five different types of NRT are approved by the U.S. Food and Drug Administration (FDA). They all have their benefits and their drawbacks. Here are the different options, along with their common side effects:
Patches, which may cause skin irritation, headaches, or sleep disturbances
Gum, which may cause jaw pain, upset stomach, lightheadedness, or nausea
Lozenges, which can cause hiccups, heartburn, nausea, or headache
Nasal spray, which can cause nose and throat irritation, sneezing, or coughing
Inhalers, which may cause coughing, mouth or throat irritation, or headache
Although smoking may help ease ulcerative colitis symptoms, the same can't be said for Crohn's disease. Smoking can have a negative impact on Crohn's symptoms, and can cause:
Microbial infection
Immune dysregulation, in which the immune system attacks healthy tissues
Issues with the mucus membranes, which line areas such as the nose and intestines
Researchers aren't sure why nicotine may have some mild benefits in one and not the other. They believe it may be due to the substance's effects on bacteria that are thought to contribute to the development of Crohn's disease. A study found that white blood cells infected with these bacteria had an inflammatory response when exposed to nicotine.
Although some older research says nicotine may have some small benefits for those with ulcerative colitis, there is not enough current research to recommend it as a viable treatment.
Smoking is extremely harmful to your overall health. If you smoke, talk to your doctor, who can recommend the most effective ways to quit.
If you're having difficulty managing ulcerative colitis symptoms, speak with your doctor about coming up with a safe and effective treatment plan.
