But there’s one tiny check in the “pro” column for smoking: Cigarette smoking may have a protective effect on ulcerative colitis (UC). A review published in June 2020 in The American Journal of Gastroenterology noted that smokers were no more likely to experience severe ulcerative colitis flares. And, in some studies, smokers were less likely to need a colectomy than nonsmokers. An earlier study in The American Journal of Gastroenterology found that the heaviest smokers were the least likely to develop UC.
Why Might Smoking Have a Protective Effect on UC?
The key is probably the nicotine in cigarette smoke. According to Crohn’s and Colitis UK, nicotine may suppress your immune system, decrease the inflammation of ulcerative colitis, and boost production of the mucus in the colon that acts as a protective barrier. Also, nitric oxide, a chemical released by nicotine, may help calm intestinal spasms that trigger the urge to have a bowel movement by reducing muscle activity in the colon. All this is not to suggest that, if you’re a smoker, you should forget about quitting in a bid to stave off ulcerative colitis. And if you don’t smoke, it goes without saying that you should not consider taking it up. “I advise all my patients to quit smoking because of its multitude of adverse effects on the body,” says Matilda Hagan, MD, an inflammatory bowel disease specialist and co-medical director at the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore. She notes that there are effective treatments, including drugs and other therapies, that address ulcerative colitis. “It’s true that those medications can have side effects, but the negative effect of smoking long-term outweighs any negative effects of UC medications.” In a review published in January 2018 in Frontiers in Immunology, researchers noted that nicotine gum and nicotine patch therapy in UC patients may have some positive therapeutic effects on ulcerative colitis even for nonsmokers, but they warn that the patches may carry side effects. It’s also important to remember that not everyone can tolerate nicotine, and it may produce side effects, including acute pancreatitis, nausea, light-headedness and dizziness, tremors, headaches, and difficulty sleeping. A nicotine enema or delayed-release capsule seemed to eliminate the side effects, but studies on just how much they helped conflicted, meaning more research is needed before it is recommended for treatment. Clearly, no doctor is going to recommend you start or continue smoking as a treatment for ulcerative colitis. “Our aim will never be to promote smoking as a disease-controlling agent,” says Dr. Hagan. Speak to your doctor about other forms of treatment, including medication, dietary changes, or alternative therapies. Additional reporting by Jordan Davidson.
