Quitting Smoking And Ulcerative Colitis

The Specific Carbohydrate Diet

SCD is a dietary approach to managing inflammatory bowel diseases. It removes certain carbohydrates from the diet and permits others. The permitted carbohydrates are mainly non-starchy fruits and vegetables. All starchy food, like potatoes, rice and flour are cut out. No grains or grain products are allowed.

The diet was originally developed by Dr Sidney Haas, based on earlier work by other doctors looking after patients with coeliac disease. His work was carried on by Elaine Gottschall, whose young daughter had been diagnosed with incurable ulcerative colitis and who was successfully treated by Dr Haas.

Elaine wrote a book “Breaking The Vicious Cycle“, explaining SCD and why it works.

At first, fruits need to be stewed and liquidized but he is looking forward to eating more fresh fruit.

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Women who stop smoking attenuate their risk of Crohn’s disease but stopping smoking is also associated with increased risk of ulcerative colitis, and new research has shown that these associations persist for up to 20 years. There are limited long-term data on the influence of cigarette smoking, particularly cessation, on the risk of IBD, says first author Leslie Higuchi of Harvard Medical School, USA.

The investigators conducted a prospective study of 229,111 women aged 2555 years enrolled in Nurses’ Health Study I and II. Smoking habits were assessed by questionnaires every 2 years diagnoses of ulcerative colitis and Crohn’s disease were established from medical records. Information was collected over 32 years for NHS I and 18 years for NHS II. With prospectively collected and updated cigarette smoking information, we were able to examine the associations between smoking and IBD, avoiding potential recall and selection biases, explains Higuchi. During the follow-up period, 336 women developed Crohn’s disease and 400 were diagnosed with ulcerative colitis.

The risk of ulcerative colitis was considerably higher in former smokers compared with current smokers. Those who had quit 25 years ago had the greatest risk , but their risk was still increased up to 20 years later .

How Does Smoking Affect Crohns Disease Differently

Unlike with UC, smoking makes you more likely to get another inflammatory bowel disease known as Crohnâs disease. While UC and Crohnâs are similar in some ways, their differences include:

Genetics. While UC and Crohnâs have a lot in common, like inflammation, their genetics are different.

Immune system. The two conditions have different immune responses.

Environmental factors. Crohnâs disease and UC may be affected differently by your diet, the medications you take, and other things in your environment, like smoking.

While smoking cigarettes offers some protection against UC, it heightens your risk of Crohnâs disease. With Crohnâs, youâre more likely to have complications, frequent hospitalizations, need surgery, and respond badly to medication if you smoke.

This is the opposite in those with UC. Their hospitalization rates, number of relapses, and need for more drugs or surgery is a lot lower if they smoke.

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Influence Of Smoking On Disease Course

Active tobacco smoking has a protective effect on the severity of UC the disease course is more benign in smokers than in non-smokers. Flare-up, hospitalization rates, the need for oral steroids and, more importantly, colectomy rate are reported to be lower in smokers compared with non-smokers, though this has not been observed in all studies.

The link between smoking and colectomy in UC patients is controversial. In a retrospective analysis of a large series of UC patients, current smoking was found to decrease the 10-year cumulative colectomy risk from 0.42 to 0.32. A subsequent meta-analysis with a total of 1489 UC patients found the risk for colectomy to be lower in current smokers compared with non-smokers.

In agreement with these results, a population-based cohort study performed in Europe with 771 UC patients prospectively included and followed for 10 years revealed a lower relapse rate in smokers compared with non-smokers. Another similar study carried out in the Netherlands by van der Heide et al with 295 UC patients identified smoking after diagnosis as a protective factor for colectomy , whereas pancolitis at diagnosis was a risk factor.

As well as the study by Beaugerie et al, Boyko et al reported a lower hospitalization rate in patients who were smoking at the onset of UC, but could not identify a difference in the colectomy rate between smokers and non-smokers.

Nicotine And Ulcerative Colitis

Ulcerative colitis is largely referred to as a disease of non-smokers. Former smokers are at the highest risk for developing ulcerative colitis, while current smokers have the least risk. This tendency indicates that smoking cigarettes may prevent the onset of ulcerative colitis.

Researchers have discovered that it is the nicotine in tobacco cigarettes that have a positive influence on symptoms of ulcerative colitis. Nicotine is a naturally occurring substance in tobacco that has a complex effect on many organs and systems in the body. Nicotine is also highly addictive, and many people who smoke cigarettes have difficulty quitting despite serious health risks.

It is theorized that the nicotine in cigarettes affects the smooth muscle inside the colon. This effect may alter gut motility .

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Why Smoking And Nicotine Should Be Avoided

Following are some reasons smoking should be avoided, despite its somewhat positive effects on UC patients.

• In addition to tar and nicotine, an average cigarette contains 600 other components, many of which are dangerous.
• These components combine to create more than 7,000 chemicals.
• The majority of these chemicals are harmful.
• Many others are known to be cancer-causing.

Smoking reduces your risk of developing UC, but it also harms your digestive system in other ways. This is because the various chemicals in cigarette smoke and the significant amounts of pollution you breathe in when smoking can harm the tissues in your body.

Cigarettes are only one source of the elevated chance of suffering from negative health effects. At least 30 compounds in smokeless tobacco have been associated with cancer. There are several cancers linked to smokeless tobacco. Some are given below:

• Cancer of the cheek.
• Oesophagus being cancerous.

Nicotine tolerance varies among people. Studies have shown that many who tried nicotine therapy for IBD experienced side effects such as rashes, nausea, headaches, or sleep disturbance.

Although nicotine seemed to benefit those with active disease, it did not seem as helpful when used as maintenance therapy . Additionally, studies have shown that 5-ASAs and steroids are two more common IBD medication therapies that are more successful than nicotine.

Why Might Smoking Have A Protective Effect On Uc

The key is probably the nicotine in cigarette smoke. According to Crohns 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 youre a smoker, you should forget about quitting in a bid to stave off ulcerative colitis. And if you dont 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. Its true that those medications can have side effects, but the negative effect of smoking long-term outweighs any negative effects of UC medications.

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The Effect Of Current Smoking

Research shows that UC is less common in smokers than in nonsmokers. Studies also show that smokers who do have UC have fewer flare-ups, less need for steroids, and a lower rate of relapse into severe disease than people who dont smoke. Smokers may also have milder symptoms.

A persons sex may also play a role. Smoking has been found to delay disease onset in men but not in women. Men with UC who smoke typically experience milder disease, but women who smoke typically do not experience these protective effects.

Current smokers with UC are also at an increased risk of colon cancer compared to nonsmokers.

Should I Stop Smoking

There are many factors for current cigarette smokers with UC to consider. Flare-ups or other UC symptoms are more likely to occur if smokers decide to quit, but many treatments can help control UC symptoms if they worsen after quitting. One member shared, This May will be 10 years since I quit cigarettes. Absolutely the hardest thing Ive ever done. As for the flares dont use that as an excuse to keep smoking. If you’re gonna quit, quit.

Given that smoking is a major cause of cancer and death worldwide, the risks of smoking far outweigh the benefits for people with UC. If you are a smoker with UC, consider asking your physician for advice, encouragement, or help with smoking cessation. One MyCrohnsAndColitisTeam member said, If you can quit, I highly encourage it!

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What Did It Find

• The study included 9,616 people with the first diagnosis of ulcerative colitis, 6,754 of whom had their smoking status recorded at the time of diagnosis. Around 40% had never smoked, 47% were former smokers, and 13% were current smokers. The proportion of smokers remained constant throughout the 12-year study period, in contrast to a decline in smoking rates in the general population.
• The cumulative rates of oral corticosteroid use at one, three and five years among smokers and ex-smokers were similar to the rates for non-smokers .
• The risk of a flare of symptoms requiring corticosteroid use was similar among smokers, compared with never smokers , and among former smokers compared with never smokers .
• Smoking status was not linked to hospitalisation .
• The rate of colectomy was similar in smokers compared with non-smokers .

Effects Of Cigarette Smoke On The Gastrointestinal Tract

In addition to the respiratory and cardiovascular effects produced by cigarette smoke, several studies suggest that smoking is also harmful to the gastrointestinal tract, as summarized below . Cigarette smoke contains between 1014 and 1016 free radicals per puff , both in the gas phase and in the particulate phase. The active chemicals include aldehydes, quinones, benzopyrene, epoxides, and peroxides , which can induce the production of reactive oxygen species. If these are not neutralized by antioxidants, oxidative stress occurs, which causes tissue damage. Accordingly, it has been shown that cigarette smoking increases the incidence and relapse of peptic ulcer disease , and has been associated with IBD, CD, and the development of esophageal, stomach, liver, pancreatic, and colon cancer .

Table 1. Effects of cigarette smoke on the gastrointestinal tract.

Conversely, UC is a chronic and idiopathic inflammatory disorder of the colonic mucosa that begins in the rectum and usually extends proximally in a continuous manner through the entire colon or through a defined area. However, some patients with proctitis or left-sided colitis may have a cecal inflammation patch. Bloody diarrhea is the characteristic symptom of UC. The clinical course is unpredictable and is marked by alternating periods of exacerbation and remission .

IBD: Dissimilarities between CD and UC

Opposite Effects of Cigarette Smoking on CD and UC

Epidemiology

Proposed Mechanisms of Action

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How Does Smoking Status Affect Ulcerative Colitis

Depending on whether you smoke currently, smoked in the past, or have never smoked, the onset and progression of your ulcerative colitis may be different. Research suggests that ones smoking status likely has no influence on their chances of requiring hospitalization or a colectomy .

Pathogenic Mechanisms Of Smoking On Uc Patients

The exact mechanisms of action of nicotine and smoking in UC patients is not well known . Tobacco smoke contains hundreds of different substances including nicotine, free radicals and carbon monoxide. It is suspected that the main metabolite responsible for the impact on the course of UC is nicotine, however there is no absolute proof of nicotine being the sole active moiety. In consequence, probably the mechanisms are diverse and considering that the pathogenesis of UC is only partially understood, any dissertation on their possible mechanisms can only be hypothetical.

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Tolerability Of Transdermal Nicotine

Adverse effects during therapy with transdermal nicotine were significantly more frequent than with placebo in all three placebo-controlled trials . The side-effects most commonly observed with nicotine were nausea, light-headedness, headache, sleep disturbances and skin irritation. The number of nicotine side-effects was significantly higher even compared with prednisolone but it must be noted that the steroid was employed at a dose of only 15 mg daily. When administered in standard doses corticosteroids were no better tolerated than nicotine .

In general adverse reactions occurred much more frequently in lifelong non-smokers than in former smokers and tended to appear especially during the first 2 weeks of therapy . Treatment withdrawals because of nicotine side-effects ranged from 5.7 to 13% .

Although no clear correlation was found between nicotine plasma levels and incidence of adverse effects , it appears that daily doses of nicotine up to 15 mg are better tolerated .

On the whole transdermal nicotine treatment results in frequent side-effects, although most patients are able to complete the course of therapy. No withdrawal symptoms suggesting nicotine addiction have been reported either after 46 weeks of therapy in short-term studies, or after a period of up to 6 months in the only long-term study available . Clearly, alternative nicotine formulations able to minimize the adverse effects of nicotine patches are of interest.

Nicotine Might Be A Potential Treatment For Ucsomeday

Researchers are studying whether nicotine-replacement therapiesincluding gum, patches, and nicotine enemascan relieve UC symptoms in the same way smoking does. Although some people with UC report finding symptom relief from patches and gum, the science proving a benefit still isnt there. And right now, nicotine is not a recommended therapy for UC, Dr. Magier adds. He prescribes 5-aminosalicylic acid treatments , steroids, and anti-TNF injections instead.

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What Are The Implications

The risks to health of tobacco smoking are well-known, and advice to all smokers remains that these risks outweigh any potential benefits.

This study did not find any evidence to support the theory that smoking can reduce disease activity in ulcerative colitis, or that smoking has benefits for people with ulcerative colitis.

People with ulcerative colitis who smoke can be encouraged to stop, without it influencing their colitis.

Can Smoking Help Ulcerative Colitis

There’s no doubt that smoking causes a whole host of health problemslung cancer, heart disease, and chronic obstructive pulmonary disease, to name just a few. In fact, it’s America’s No. 1 cause of disability, disease, and death.

But there’s a strange twist for people with the digestive disease ulcerative colitis . Something in tobacco may help relieve symptoms and prevent new cases. It’s no reason to pick up the habit, but it may give scientists a promising area of research for new treatments.

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Crohns Disease And Smoking

Smoking is associated with a higher prevalence of Crohns and can increase the risk of developing it.1,2,3 These individuals who smoke also have a high risk of an increased disease severity, including increased relapse rates, a higher rate of corticosteroid, immunosuppressant, and biological drug use, narrowing of the gastrointestinal tract , increased rate of hospitalization and surgery, and more post-operative recurrence rates.4,5

A recently published study has also shown that peripheral arthritis is more common in people with Crohns who smoke or have a history of smoking .5

Should Smoking Be A Treatment For Ulcerative Colitis

Smoking is not recommended as a treatment for UC. Tar, not nicotine, is the chemical in cigarettes most linked to cancer. That doesnt mean nicotine is good for you. Any product that includes this highly addictive substance may have a negative effect on your health.

There are 600 ingredients in addition to tar and nicotine in the average cigarette. When combined, these ingredients produce over 7,000 chemicals. Many are poisonous. Others are known to cause cancer.

Smokers with UC tend to experience more hospital stays and fewer positive health outcomes overall than those who dont smoke.

The increased risk of experiencing adverse health outcomes extends beyond just cigarettes. Smokeless tobacco contains at least 30 chemicals linked to cancer. Cancers associated with smokeless tobacco include:

• pancreatic cancer

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Why May Smoking Have A Protective Effect Against Ulcerative Colitis

We dont really understand why smoking has a protective effect against Colitis. There are many chemicals in cigarettes that could be contributing to this effect. Nicotine is the most widely studied and is likely to be having an impact.People with Colitis may have a thinner mucus layer in the colon and rectum when compared to healthy people. Nicotine may increase the production of this mucus. Nicotine may also suppress the immune system and prevent inflammation in the colon. Another theory is that nitric oxide, released by nicotine, may reduce muscle activity in the colon and so reduce the need to go the toilet urgently.We know that the genes a person has inherited can contribute to developing Colitis. Smoking can change how a persons genes are expressed providing another potential mechanism for how smoking may influence the development of Crohn’s or Colitis.