Smoking has been shown to affect both types of IBD; Crohn’s and Ulcerative Colitis. However, smoking and nicotine have polarizing effects on these diseases. While smoking increases risk and severity of Crohn’s, it seems to aid in reducing some symptoms for those with UC. Now before you consider smoking to help your UC, I want to present you with all the facts as well as share my own personal journey with UC and nicotine. If you have IBD and have not considered quitting, I urge you to speak to your healthcare provider and assess your personal situation. Let’s take a look at the data together.
For those with CD, smoking and continuing to smoke, made them twice as likely to flare, require surgery, develop blockages, narrowing, and fistulas, as well as needing more and higher doses of steroids and immunosuppressants. It is also worth noting that women who smoke are more likely to develop Crohn’s and require surgery than their male counterparts. Cigarettes contain over 1,000 chemicals and it is still unclear how exactly they affect the gut and its biome. What we do know is that quitting or even reducing smoking frequency will help with CD symptoms, and after one year post smoking your risk for flare ups, surgery, and hospitalization rate falls to that of nonsmokers with Crohn’s.
On the other end of the spectrum, UC and smoking have been shown to reduce symptoms, although not all the data gathered agrees with this. What they do agree on, is the reduced risk of developing UC among nonsmokers is higher. This suggests a link to nicotine and more controlled symptoms for UC, although how it affects disease progression is still unclear. Many studies have been done with solely nicotine and UC (using patches). These studies found that nicotine was more effective than placebo, but not more effective than current UC medication in achieving remission, specifically 5-ASAs & steroids. Another study showed that those with left-sided UC who had stopped responding to mesalamine, were given nicotine patches and mesalamine enemas, 12 of the 15 patients achieved remission. However, nicotine was found to not do well as a maintenance therapy.
The exact reasons for these outcomes when smoking is not clear, however there are a few theories as to how nicotine is harmful or helpful to those with IBD. In UC it is suggested that the colon’s lining is very thin, and the nicotine helps rebuild the layers. Another theory is that nicotine slows down the colon by reducing muscle activity therefore reducing frequency and urgency. The last theory is that nicotine suppresses the immune system by reducing inflammation to the colon. Whatever the case may be, it’s clear more research should be done here before adding nicotine to your treatment regimen. We do know that smoking increases cancer risk, heart disease, and frequent infections like bronchitis. Overall, the negative effects of smoking outweigh any sort of positive ones.
I personally was a smoker when I was diagnosed with UC back in 2014. I smoked on and off during my four years of college, but picked up the habit to ultimately get breaks during my 12-16- hour shifts. In the restaurant world almost, everyone is still a smoker, and if you aren’t it’s very common that the only break you get is using the bathroom. In 2015, I was having consistent chest pain and decided to quit. I knew smoking increased heart rate, blood pressure, and risk of heart disease and I figured it would help my newly diagnosed UC too. My chest pain ended up being a rib that had just popped out of socket a bit, but boy was I wrong about quitting helping my UC! Shortly after quitting I experienced my second worst flare to date, my worst flare then. After contacting my gastroenterologist, they prescribed a high dose of steroids, and went over any recent history and changes. After telling my doctor that I quit smoking he said, ‘Bingo.” With a perplexed look on my face, he proceeded to tell me that quitting smoking in UC worsens symptoms. I found this out the hard way, but hopefully now you don’t have to! If you are a current smoker with IBD I challenge you to make a plan with your doctor to quit. It’s worth it!
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