Nicotine and Ulcerative Colitis: Dr. Ardis on the Colon

Ulcerative colitis is an inflammatory disease of the large bowel: the lining of the colon and rectum becomes ulcerated and bleeds, and in severe cases surgeons remove part or all of the colon. Dr. Bryan Ardis names it among the conditions for which, he states, nicotine has been published as a curative agent — one of a list that also includes Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, arthritis, myocarditis, autism and glioblastoma.

Of all the diseases on that list, ulcerative colitis is the one where nicotine has been tested most directly in people. The story begins with a puzzle doctors noticed in the early 1980s — the disease was strikingly rare in smokers and common in people who had just quit — and it runs through a series of randomized trials of nicotine patches, nicotine enemas and a Cochrane review. This page sets out Dr. Ardis’s statement first, then each of those studies as its authors reported it.

Table of Contents

  1. What Dr. Ardis Says
  2. Ulcerative Colitis in Plain Terms
  3. The Ex-Smoker Observation
  4. Nicotine Patches in Active Colitis
  5. The Maintenance Trial
  6. Nicotine Compared With a Steroid
  7. Nicotine Delivered to the Colon: Enemas
  8. The Cochrane Review
  9. How Nicotine Might Act on the Colon
  10. Safety Notes
  11. Dr. Ardis’s Own Work
  12. Key Research Papers
  13. Connections
  14. Featured Videos

1. What Dr. Ardis Says

Dr. Ardis set this out in a 2025 podcast appearance (Culture Apothecary) and in his book Moving Beyond the COVID-19 Lies: Restoring Health and Hope for Humanity.

Dr. Ardis states that nicotine “is also published to be a curative agent for ulcerative colitis,” which he describes as an autoimmune digestive disorder “where they actually cut out parts of your colon.” He states that it is published that nicotine can cure it. He presents this not as his own discovery but as something, in his words, that “the scientists have all known for decades and have published,” which medical professionals were not taught in medical school and which the mainstream media does not report.

Later in the same conversation he returns to ulcerative colitis as part of a list. Nicotine, he states, has an ability, found in plants, “to cure the body of all kinds of problems,” and he names Parkinson’s, Alzheimer’s, MS, ulcerative colitis, all arthritis, myocarditis, autism and glioblastoma tumors. For every one of those conditions, he states, billions of dollars of drugs are approved and prescribed each year, “when there is a curative agent known for all of them, or at least an agent that would improve their symptoms mightily,” and this has “already been proven for decades.” He states that the FDA and the pharmaceutical industry benefit from public fear of nicotine, because nicotine is an antidote to so many problems for which patients are otherwise prescribed drugs for life.

In the protocol he describes elsewhere, nicotine is taken by skin patch; his general patch approach is set out on the Nicotine Patch Protocol page.

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2. Ulcerative Colitis in Plain Terms

Ulcerative colitis (UC) is one of the two main forms of inflammatory bowel disease; the other is Crohn’s disease. In UC the inflammation is limited to the inner lining of the large bowel. It almost always starts in the rectum and spreads upward in one continuous stretch — sometimes only the rectum (proctitis), sometimes the left side of the colon (left-sided colitis), sometimes the whole colon.

The site’s full page is Ulcerative Colitis.

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3. The Ex-Smoker Observation

The research on nicotine and colitis did not start with nicotine. It started with smokers.

In 1982 three physicians in Cardiff, Wales — A. D. Harries, A. Baird and John Rhodes — published a short report in the British Medical Journal titled “Non-smoking: a feature of ulcerative colitis.” They reported that people with ulcerative colitis were markedly less likely to be smokers than would be expected — the observation that gave the paper its title. Professor Rhodes’s Cardiff group went on to run most of the nicotine trials described below.

Two years later Richard Logan and colleagues in Nottingham published a case-control study in the same journal. People with ulcerative colitis were much less likely to smoke than community controls matched for age and sex: the estimated relative risk for non-smoking was 3.8 on current habits and 6.2 when habits at the time the disease began were examined. That difference, they reported, was mainly accounted for by 42 of 55 patients who had given up smoking a mean of eight years before their colitis began. The authors wrote that the findings suggest smoking “directly or indirectly confers protection against ulcerative colitis.”

In 1989 Barbara Calkins pooled the published studies in a meta-analysis in Digestive Diseases and Sciences. She concluded that the link between not smoking and ulcerative colitis — and, in the opposite direction, between smoking and Crohn’s disease — was consistent with a causal relationship, and wrote that tobacco may contain some substance beneficial to ulcerative colitis patients, whose identification would be “a prudent next step.” In the same paper she wrote that she found no justification for changing the Surgeon General’s advice against smoking for these patients.

Nicotine was the obvious candidate for that substance, and nicotine patches, newly available for smoking cessation, offered a way to test it without smoke.

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4. Nicotine Patches in Active Colitis

Pullan and colleagues, 1994 (New England Journal of Medicine)

The first large randomized trial came from the Cardiff group, led by Rupert Pullan with John Rhodes. Seventy-two patients with active ulcerative colitis wore either nicotine patches or identical placebo patches for six weeks, without knowing which (a double-blind design). Doses were raised step by step; most patients tolerated 15 to 25 mg of nicotine per 24 hours. Every patient stayed on mesalamine, and 12 stayed on low-dose steroids, so nicotine was tested as an addition to standard treatment.

The authors concluded that adding transdermal nicotine to conventional maintenance therapy improves symptoms in patients with ulcerative colitis.

Sandborn and colleagues, 1997 (Annals of Internal Medicine)

An American team led by William Sandborn ran a second double-blind trial at a single academic referral center. Sixty-four non-smoking patients with mildly to moderately active colitis, despite their medication, received nicotine patches (31 patients) at the highest dose each could tolerate — 11 mg for a week, then up to 22 mg for three weeks — or placebo patches (33 patients).

The authors concluded that transdermal nicotine at up to 22 mg a day for four weeks is efficacious for controlling the clinical features of mildly to moderately active ulcerative colitis.

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5. The Maintenance Trial

In 1995 the Cardiff group, led by Gareth Thomas, asked the second question: can nicotine keep patients well once they are in remission? Eighty patients in remission wore nicotine or placebo patches for six months. After a three-week build-up most patients tolerated 15 mg over 16 hours a day. Unlike the 1994 trial, mesalamine was stopped once the nicotine dose was reached, so nicotine was tested on its own.

The authors concluded that transdermal nicotine alone was no better than placebo for maintaining remission, and that withdrawal because of side effects was more common on nicotine. In plain terms, the published trials describe nicotine helping an active flare when added to mesalamine, but not keeping colitis in remission when used alone.

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6. Nicotine Compared With a Steroid

In 1996 the same group compared nicotine patches head to head with prednisolone, the steroid most often used for flares. Sixty-one patients with active colitis received either nicotine patches (15 to 25 mg a day) or 15 mg of prednisolone daily for six weeks; mesalamine was stopped on day ten.

The authors wrote that, in patients who completed the study, nicotine alone appeared to be of only modest benefit in acute colitis and was not as effective as 15 mg of prednisolone a day.

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7. Nicotine Delivered to the Colon: Enemas

Because the patch trials kept running into side effects, researchers tried putting nicotine directly where the disease is. A liquid enema delivers a drug to the rectum and lower colon, and far less of it reaches the bloodstream.

Two pilot studies, 1997

Cardiff (Green and colleagues): in an open study (no placebo), 22 non-smoking patients with active colitis took a nightly enema containing 6 mg of nicotine for four weeks while their existing treatment continued. Seventeen completed the month; 16 of those 17 improved on the St Mark’s symptom score, 12 had less urgency and fewer stools, and 3 reached full remission with a normal sigmoidoscopy. Of 10 partial responders, 6 continued for a second month and 5 improved further, 2 to full remission. The authors called for controlled studies.

United States (Sandborn and colleagues): 10 non-smoking patients with left-sided colitis that had not responded to first-line treatment took nicotine tartrate enemas (3 mg nightly for a week, then 6 mg for three weeks). Five of the seven who completed four weeks improved clinically and on sigmoidoscopy; three stopped early because they could not retain the enema. None showed improvement under the microscope. Blood nicotine was undetectable or very low, and the authors described the enemas as safe and called for placebo-controlled trials.

The randomized enema trial, 2005

Those placebo-controlled results came from the Cardiff group in 2005 (Ingram and colleagues, Clinical Gastroenterology and Hepatology). One hundred and four patients with active colitis took 6 mg nicotine enemas or placebo enemas for six weeks, continuing their usual oral treatment.

The authors concluded that 6 mg nicotine enemas were well tolerated but were not found to be efficacious for active ulcerative colitis at that dose.

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8. The Cochrane Review

Cochrane reviews pool all the randomized trials on a question. In 2004 Joanne McGrath, John McDonald and John Macdonald reviewed transdermal nicotine for inducing remission in ulcerative colitis. Seven studies were identified and five met their criteria.

The reviewers concluded that transdermal nicotine is superior to placebo for inducing remission, that they found no significant advantage over standard medical therapy, and that its side effects are significant and limit its use in some patients.

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9. How Nicotine Might Act on the Colon

Researchers have proposed several ways nicotine could calm colitis. These come from laboratory and tissue studies and describe possible mechanisms, not treatment results.

The mucus layer

The colon lining is protected by a layer of sticky mucus gel. In 1994 the Cardiff group measured it in surgical specimens: in people without colitis it averaged roughly 107 to 155 micrometres thick depending on the part of the colon, while in ulcerative colitis it varied more and was stripped away where inflammation was acute. Crohn’s disease samples, by contrast, had normal or thicker mucus. Two years later a Liverpool team (Finnie and colleagues) cultured colon biopsies with nicotine and found it raised mucin (mucus protein) production to roughly 180–220% of control values; steroids raised it further. The idea that thicker mucus could explain why smokers are protected has been a recurring theme in this research.

The α7 receptor and the “cholinergic anti-inflammatory pathway”

Nicotine acts by binding nicotinic acetylcholine receptors. In 2003 Kevin Tracey’s laboratory reported in Nature that one of these, the α7 subtype on immune cells called macrophages, is required for the vagus nerve to switch off production of TNF, a major inflammatory signal. Stimulating the vagus nerve lowered TNF in normal mice but not in mice lacking α7. The authors listed inflammatory bowel disease among the conditions driven by excess TNF. This pathway is the one most often cited for nicotine’s anti-inflammatory effects, and it is set out further on the Nicotinic Acetylcholine Receptors page.

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Safety Notes

The full list of contraindications is on the Nicotine Patch Protocol page.

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Dr. Ardis’s Own Work

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Key Research Papers

  1. Harries AD, Baird A, Rhodes J (1982). Non-smoking: a feature of ulcerative colitis. Br Med J (Clin Res Ed). — PubMed PMID: 6802296
  2. Logan RF, Edmond M, Somerville KW, Langman MJ (1984). Smoking and ulcerative colitis. Br Med J (Clin Res Ed). — PubMed PMID: 6423062
  3. Calkins BM (1989). A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci. — PubMed PMID: 2598752
  4. Pullan RD, Rhodes J, Ganesh S, Mani V, et al. (1994). Transdermal nicotine for active ulcerative colitis. N Engl J Med. — PubMed PMID: 8114833
  5. Thomas GA, Rhodes J, Mani V, Williams GT, et al. (1995). Transdermal nicotine as maintenance therapy for ulcerative colitis. N Engl J Med. — PubMed PMID: 7885427
  6. Thomas GA, Rhodes J, Ragunath K, Mani V, et al. (1996). Transdermal nicotine compared with oral prednisolone therapy for active ulcerative colitis. Eur J Gastroenterol Hepatol. — PubMed PMID: 8864674
  7. Sandborn WJ, Tremaine WJ, Offord KP, Lawson GM, et al. (1997). Transdermal nicotine for mildly to moderately active ulcerative colitis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. — PubMed PMID: 9054280
  8. Green JT, Thomas GA, Rhodes J, Williams GT, et al. (1997). Nicotine enemas for active ulcerative colitis—a pilot study. Aliment Pharmacol Ther. — PubMed PMID: 9354193
  9. Sandborn WJ, Tremaine WJ, Leighton JA, Lawson GM, et al. (1997). Nicotine tartrate liquid enemas for mildly to moderately active left-sided ulcerative colitis unresponsive to first-line therapy: a pilot study. Aliment Pharmacol Ther. — PubMed PMID: 9305473
  10. McGrath J, McDonald JW, Macdonald JK (2004). Transdermal nicotine for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. — PubMed PMID: 15495126
  11. Ingram JR, Thomas GA, Rhodes J, Green JT, et al. (2005). A randomized trial of nicotine enemas for active ulcerative colitis. Clin Gastroenterol Hepatol. — PubMed PMID: 16271342
  12. Pullan RD, Thomas GA, Rhodes M, Newcombe RG, et al. (1994). Thickness of adherent mucus gel on colonic mucosa in humans and its relevance to colitis. Gut. — PubMed PMID: 8150346
  13. Finnie IA, Campbell BJ, Taylor BA, Milton JD, et al. (1996). Stimulation of colonic mucin synthesis by corticosteroids and nicotine. Clin Sci (Lond). — PubMed PMID: 8869420
  14. Wang H, Yu M, Ochani M, Amella CA, et al. (2003). Nicotinic acetylcholine receptor alpha7 subunit is an essential regulator of inflammation. Nature. — PubMed PMID: 12508119

PubMed Topic Searches

  1. PubMed: Transdermal nicotine and ulcerative colitis
  2. PubMed: Nicotine enemas for colitis
  3. PubMed: Smoking and ulcerative colitis risk

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Connections

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