It is established that UC is more likely to be seen in non-smokers than smokers, and that smoking cessation is implicated for some individuals, because UC presents 6 - 18 months later in many more cases of smoking cessation than it would if unconnected. Indeed, if there is a genetic predisposition to UC (it tends to run in families), then perhaps this issue could be considered before cessation.
It is less certain that smoking after UC presents can help. Some UC patients assert there is a benefit for them; others report no effect. Some say nicotine is the agent, others that nicotine has no effect for them.
Some research appears to suggest that nicotine is effective for some people; others report it has no benefit for them.
There has been much discussion about other active agents in tobacco or cigarette smoke; anatabine is an obvious candidate due to its anti-inflammatory properties (since we are talking about an autoimmune disease with inflammatory effects). Tobacco contains several active alkaloids, such as nicotine, nornicotine, anatabine, anabasine, and myosmine. If someone wished to try anatabine for UC mitigation then in theory Snus or WTA ecig refills might provide a source (as long as the brand chosen actually contained the beneficial ingredient, whatever that might be). Some have tried this and reported no beneficial effect (as reported in this thread by one person). Other research (as reported here) mentions other compounds in cigarette smoke as the possible active agents.
So perhaps an investigatory procedure for mitigation of symptoms of active UC that do not respond to medication in a particular individual might go like this - move to the next step as each one fails:
- Try nicotine in the form of ecigs
- Try WTA refills (try each of the two brands available)
- Try Snus (several brands)
- Try anatabine. As anatabine for mitigation of autoimmune disease symptoms seems very expensive, perhaps it could be located in other formulations. As has been mentioned it is used in some NRT therapies, A.Cig and Cig.Rx come to mind. Also in rheumatism/arthritis medications.
- Try smoking 2 cigarettes a day.
- Try drastic dietary control measures.
Smoking therapy
Since UC can easily destroy a person's life, and that person may be young, and since destructive effects from smoking are generally measured in pack-years (i.e. are dose-dependent and onset is more often after decades rather than years), then one approach is low-dose smoking, if all else fails. It can't be recommended, but if a person's life is already ruined by the symptoms of a disease, and further issues can be delayed by 20 years (or never), then perhaps it is an acceptable solution for that person.
Drastic dietary measures
I know of a person for whom medical therapies did not work, who found out after decades of suffering from UC that dietary controls were more effective than anything else. On the surface these measures are not relevant, but they did work: cessation of all dairy products, all processed foods, and tapwater (only bottled water is consumed for any/all purposes including cooking). It worked for them, when nothing else of any kind did (excluding the surgery option). Tapwater was eventually shown as the most important factor (and it was conclusively demonstrated, with no possibility of error). But: it is far more difficult to modify a city resident's diet in this way than might be appreciated.
The surgery option
If all else fails then surgery will need to be considered. A large intestine removal is required, but modern techniques do not normally require a colostomy in a young person. The small intestine can be connected 'straight through', with a pouch type of procedure at the end (Parke's Pouch etc).
These procedures do not end the matter as some medicine and food supplements will probably always be needed subsequently (e.g. low-dose sulphasalazine, vitamin K, increased fluid intake); it is also not clear if those with severe secondary symptoms such as involvement of the liver, eyes and joints will benefit.
Low-dose smoking might be an acceptable solution in some circumstances, though all other options could be tried first; radical dietary change might work for some, though is much more difficult than is appreciated; surgery is the last option but will be required if all else fails - or simply if it is the preferred option. The modern methods, especially for younger people, are certainly a better option than living with severe UC symptoms since a normal life is not possible.
There is a cancer risk with UC that cannot be ignored, so surgery does have other benefits - other risks are removed. The risk for cancer is supposed to be 'dose dependent' again: the more of the large intestine that is involved, and the longer UC has been present, are thought to be relevant.
