Smoking and IBD

What is the connection between smoking and IBD?

Cigarettes contain thousands of toxic chemicals with severe health effects. Smoking lowers life expectancy and is a well-known cause of cardiovascular disease such as heart disease, heart attack, heart failure, stroke, and aneurysms. It causes cancer of the lung, mouth, throat, voice box, oesophagus, pancreas, bladder, kidney, liver, cervix, ureter, nose, nasal sinuses, stomach, blood, and bowel, and increases breast cancer risk. Lung cancer remains one of the leading causes of death in Australia. Smoking also causes premature ageing, leading to increased wrinkles at a younger age, a dull skin tone, yellowing of teeth and fingernails, and brittle hair.

When you smoke, many harmful chemicals are absorbed into the bloodstream and travel all the way down to your gut. This can damage the lining of your gut, disrupt the balance of healthy bacteria in the gut microbiome, and impair your immune system. This puts your gut at risk to harmful substances (like toxins) crossing the intestinal lining. Your immune system responds to the toxins as a threat, which triggers inflammation and worsens your symptoms.

To learn more about the importance of a healthy gut microbiome, visit our gut microbiome and IBD page.

Crohn’s disease

Smoking is a well-established risk factor for developing Crohn’s disease. If you already have Crohn’s disease, smoking can make the disease more severe and lead to more complications. You’re very likely to experience more frequent flare-ups that impact your daily life.

People who smoke are more likely to need treatment with corticosteroids and immunosuppressants. Smoking can also reduce the effectiveness of Crohn’s disease medications (e.g., anti-TNF medications like infliximab), further increasing the risk of flare ups and further intestinal damage. There’s also a greater chance of requiring surgery, as well as an increased risk of post-surgery complications. Smoking is also linked to a higher risk of developing complications outside the gut, such as osteoporosis. These risks reduce once you quit smoking, no matter how long you’ve been smoking.

Ulcerative colitis

The link between smoking and ulcerative colitis is more complex. Some research suggests that smoking may be protective against developing ulcerative colitis. That is, current smokers are less likely to develop ulcerative colitis than those who do not smoke. Some studies have also found smokers with ulcerative colitis have lower complication rates (e.g., less flare ups). However, smoking can reduce the effectiveness of medications and increase the risk of post-surgery complications in people with ulcerative colitis.

Smoking reduces life expectancy and is not a safe or recommended strategy to prevent or manage ulcerative colitis. The risks of smoking are extreme and affect nearly every organ in your body. Even one cigarette a day greatly increases your risk of disease and long-term complications.

If you have ulcerative colitis and you stop smoking, your symptoms may temporarily worsen. However, the long-term benefits of quitting far outweigh the risks. If you’re concerned about managing symptoms after quitting, your IBD team can help you create a treatment plan that will make you feel more confident in controlling your symptoms as you stop smoking.

Microscopic colitis

Research shows that people who currently smoke or have smoked in the past are at significantly higher risk of developing microscopic colitis than those who have never smoked. While more evidence is needed to understand how smoking affects symptoms and remission rates of people with microscopic colitis, avoiding smoking is still strongly advised.

What about vaping?

Vaping, also known as electronic cigarettes or e-cigarettes, is generally considered less harmful than smoking traditional cigarettes but has many of its own risks. Vaping products do not contain tar or carbon monoxide that is found in cigarettes, but they do contain many toxic chemicals that affect your health. Some of these chemicals are known to cause cancer. Vaping can also cause inflammation in the body, shortness of breath, and permanent lung damage. Vaping is not recommended for people with IBD, and more research is needed to understand how it may influence IBD symptoms and long-term outcomes.

Why should I quit smoking?

There are so many reasons to quit smoking. Three main reasons include:

1. Improve your health

As soon as you stop smoking, your body starts to heal. Over time, your risk of many diseases begins to fall. Within months and years of quitting, your health risks can return to those of someone who has never smoked.

Your sense of taste and smell will start to improve after just one week of quitting. You’ll quickly notice that exercising is easier, because your heart will start to work more efficiently. Within three to six months, your lung function will improve, and you’ll be less likely to cough and wheeze.

Quitting also lowers your risk of colds, flu, and other chest infections, which can help you avoid time off work and reduce your need for medications. You’ll most likely experience less flare-ups, have a reduced risk of surgery and IBD complications, and be able to reduce corticosteroid use. In the long term, your risk of lung cancer and coronary heart disease will significantly reduce.

2. Save money

Smoking is very expensive. Once you quit, you might be surprised at how much money you save. If you smoke 13 cigarettes a day (the average in Australia), quitting will save you approximately $182 a week or $9490 a year! Some people find it motivating to track exactly how much they would have spent on cigarettes and put that money toward something enjoyable, like a meal out, a massage, or a holiday.

3. Better surgery outcomes

If you’re preparing for surgery, quitting smoking is highly recommended. This is because post-surgery, the risk of blood clots in the legs and lungs is increased for smokers. People with IBD already have a higher risk of blood clots, and smoking adds to that risk. It also increases the chances of post-surgery complications such as infections, pneumonia, and sepsis. Quitting smoking before surgery can significantly reduce these risks and improve your recovery.

Resources to help you stop smoking or vaping:

It’s never too late to quit. You’re more likely to stop smoking if you have support:

• Speak to your general practitioner (GP), gastroenterologist, pharmacist, or IBD nurse. Your team can help you make an action plan to stop smoking and support you through the process.
• Quit is a dedicated organisation that helps Australians quit smoking or vaping. They offer a free Quitline that you can call for help from 8am-8pm Monday to Friday. You can also sign up for QuitMail to keep you accountable to your goals and access a range of resources to assist you on your journey.
• Nicotine replacement therapy can also help you stop smoking. Products like nicotine patches, gums, lozenges, or mouth sprays are available at supermarkets and pharmacies. These products provide a lower, safer dose of nicotine that was previously consumed from cigarettes or vapes and ease the withdrawal symptoms. Nicotine patches are available on the Pharmaceutical Benefits Scheme (PBS) at a subsidised price. Your GP can provide a prescription and talk to you about other options that are available to help you quit smoking or vaping for good.