Smoking and Ulcerative Colitis: What Doctors Want You to Know
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How Does Smoking Affect Ulcerative Colitis?

How Does Smoking Affect Ulcerative Colitis?
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Updated on April 29, 2025
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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.

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Ulcerative colitis is an autoimmune disease and a form of IBD. Complications from UC affect more than just the digestive track. Here are some things to watch out for.
5 Complications of Ulcerative Colitis

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How Nicotine Affects Ulcerative Colitis

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.

How Smoking Affects Your Gastrointestinal System

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
  • Increased risk of Crohn's disease and gallstones
  • Increased risk of additional damage if you have liver disease
  • Worsening of pancreatitis symptoms
  • 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.

Why Doctors Don't Recommend Smoking to Manage Ulcerative Colitis

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.”

Can Nicotine Replacement Therapies (NRT) Help People With Ulcerative Colitis?

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

How Does Smoking Affect People With Other Types of IBD?

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.

The Takeaway

  • 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.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Cigarette Smoking. Centers for Disease Control and Prevention. September 2024.
  2. Ali I et al. Association between ulcerative colitis and Helicobacter pylori infection: A case-control study. Heliyon. February 2022.
  3. Kannichamy V et al. Transdermal Nicotine as a Treatment Option for Ulcerative Colitis: A Review. Cureus. October 2020.
  4. What's in a Cigarette? American Lung Association. November 2024.
  5. Health Risks of Smokeless Tobacco. American Cancer Society. November 2024.
  6. Smoking and the Digestive System. Johns Hopkins Medicine.
  7. Caliri AW et al. Relationships among smoking, oxidative stress, inflammation, macromolecular damage, and cancer. Mutation Research. January 2021.
  8. Vona R et al. The Impact of Oxidative Stress in Human Pathology: Focus on Gastrointestinal Disorders. Antioxidants. January 2021.
  9. Gui X et al. Effect of Cigarette Smoke on Gut Microbiota: State of Knowledge. Frontiers in Physiology. June 2021.
  10. Tobacco Facts. American Lung Association. January 2025.
  11. Ulcerative Colitis. Mayo Clinic. November 2024.
  12. AlQasrawi D et al. Divergent Effect of Cigarette Smoke on Innate Immunity in Inflammatory Bowel Disease: A Nicotine-Infection Interaction. International Journal of Molecular Sciences. August 2020.
  13. Nicotine Replacement Therapy to Help You Quit Tobacco. American Cancer Society. October 2024.
  14. AlQasrawi D et al. Mystery Solved: Why Smoke Extract Worsens Disease in Smokers with Crohn's Disease and Not Ulcerative Colitis? Gut MAP! Microorganisms. May 2020.
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Yuying Luo, MD

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Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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