Clearing the Air: Smoking's Role in Irritable Bowel Syndrome

How Smoking Affects Irritable Bowel Syndrome (IBS)

Smoking tobacco is linked to multiple diseases and has been identified as the number one preventable death cause worldwide. I can imagine that giving up smoking must be difficult, and when it comes to functional digestive disorders like irritable bowel syndrome (IBS), it might be worth kicking the habit.

There is a lot of research associating smoking with IBS, especially IBS-D. A 2021 study from Alimentary Pharmacology & Therapeutics noted that people who smoked heavily (> 20 cigarettes per day) had significantly higher amounts of diarrhea and bowel urgency than non-smokers diagnosed with IBS-D. Furthermore, a 2022 prospective study revealed that people who quit smoking had a 27% decrease in gastrointestinal symptoms associated with IBS compared to those who continued to smoke.

Intriguingly, a 2017 systematic review investigating the relationship between smoking and IBS couldn’t establish a substantial connection. All this to say, there is still much to be addressed with how smoking is directly linked to IBS; however, it is safe to say that smoking is not beneficial to overall health. Smoking cessation should be part of the treatment plan for individuals with IBS. 

Here are several possible ways smoking can influence IBS:

• Smoking-induced immune suppression (lowering your immune system)
• Altered gastrointestinal motility (how quick or slow your GI tract moves; typically, smoking increases GI motility and can cause an increase in diarrhea)
• Changes in gut blood flow, which can affect GI motility 
• Increased inflammation in the GI tract (leading to leaky gut, dysbiosis/gut bacteria imbalance)
• Reduction of pancreatic function leading to malabsorption

It's worth highlighting a noteworthy connection: a relationship between smoking and IBS-related anxiety and stress may exist. Research has shown that anxiety and stress can contribute to developing IBS and are associated with smoking and other coping mechanisms. This raises an important question: Does anxiety and stress, smoking, or a combination of both elevate the risk of IBS? Exploring this relationship could provide valuable insights.

Smoking's impact on inflammatory bowel disease (IBD) varies: it worsens Crohn's disease symptoms but may have a milder effect on ulcerative colitis, though the reasons remain unclear. However, it's crucial to note that this isn't a justification for smoking. Tobacco products contain numerous harmful compounds with poorly understood effects, and even nicotine-containing products may exacerbate Crohn's Disease symptoms.

Suppose you are someone who currently smokes or is considering taking up this habit. I hope this encourages you to consider quitting and avoiding this habit altogether. Many free resources are available to help, including smokefree.gov and the Substance Abuse and Mental Health Services Administration (SAMHSA). 

Here are some helpful tips that might support you in your effort in quitting smoking:

• Nicotine patches/gum – a great way to start your journey if you desire to quit smoking
• Mind-body practices like prayer, meditation, yoga, breathing exercises, etc.
• Limit controllable triggers. Talk on the phone or doodle instead of smoking
• Cognitive-behavioral approaches
• Acupuncture or cold laser therapy
• Hypnosis
• Increase physical activity- go for a walk or jog
• Join a support group or community

Regarding diet and lifestyle, if you quit smoking, you may notice several changes, like the potential to increase weight and more intense food cravings. Here are some helpful tips on how to best manage your diet when you decide to kick this habit (*plus some extra tips for those following a Low FODMAP diet for IBS):

1. Eat a well-balanced diet- make sure to incorporate good sources of protein (lean chicken, beef, fish, eggs, pork, beans, nuts, etc), plenty of nutrient-dense Low FODMAP plant foods (blueberries, strawberries, bananas, oranges, cantaloupe, honeydew, kiwi, eggplant, carrots, cucumbers, lettuce, olives, potatoes) and fiber-rich, Low FODMAP carbohydrate sources (puffed amaranth, buckwheat, millet, gluten-free oats, rice, quinoa).

2. Stick to portion control at meals to avoid over-consuming calories. This will help prevent excessive weight gain.

3. Get active- find a way to incorporate more movement into your lifestyle- being active can help keep your mind from focusing on the need for smoking.

4. Manage your snacks- choose low-calorie, nutrient-dense options and avoid highly processed snacks or high amounts of added sugars and trans and saturated fats.

*If you experience food cravings- drink a glass of water; if you are still hungry 15 minutes later, get a snack.

*Low FODMAP snack ideas: Rice cake + peanut butter; lactose-free cottage cheese with blueberries or other Low FODMAP fruit; corn tortilla chips with FODY’s salsa; hard-boiled egg; tuna pouch with gluten-free crackers or rice cake; lactose-free plain yogurt with FODMAP-friendly fruit.

5. Drink plenty of water- aim to hydrate with at least 64-80 oz per day unless otherwise directed by a healthcare practitioner.

*Make sure to talk with a registered dietitian to help manage a Low FODMAP diet, as this can be challenging for some.

Overall, it is safe to say that smoking is not recommended for optimal health. As a gut health enthusiast, I highly recommend limiting and eventually avoiding smoking or using any nicotine-containing product, as their full effects on the body are still unknown. Please talk with a healthcare professional if you have additional questions.

1. _{Başpınar, M. M., & Basat, O. (2022). Frequency and severity of irritable bowel syndrome in cigarette smokers, Turkey 2019. Tobacco Induced Diseases, 20(March), 1–8.}
2. _{Gui, X., Yang, Z., & Li, M. D. (2021). Effect of cigarette smoke on gut Microbiota: State of knowledge. Frontiers in Physiology, 12.}
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