Elson M. Haas MD“A basic, wholesome diet helps to at least reduce some of the risks of smoking addiction, which may be influenced by nutritional deficiencies. This plan, especially with adequate fruits, vegetables, and whole grains, will help to provide some of the necessary, protective antioxidant nutrients, beta-carotene, vitamins A, C, and E, and selenium, all of which will help lower risks of cancer and other smoker’s maladies.”
Cigarette smoking, the main way we take in nicotine, is the single greatest cause of preventable diseases (these are the progressive, serious diseases) and probably creates the most difficult addiction of the commonly used drugs. Smoking is a high-priced addictive pleasure (and sometimes displeasure) that is costly, not only in dollars but in lives as well.
In the United States alone, cigarette smoking causes a third to a half million deaths per year (over 1,000 per day) and is responsible for about 25 percent of the cancer deaths and 30–40 percent of the coronary heart disease. It also increases the incidence of atherosclerosis, strokes, and peripheral vascular disease. Diseases of the lungs—colds, flus, acute bronchitis, pneumonia, COPD (chronic obstructive pulmonary disease), which includes emphysema and chronic bronchitis, and lung cancer—are all much more common in smokers. Other infections or allergies are also prevalent, and rapid aging of the body and especially the skin results from the generally poor oxygenation of tissues and the other chemicals and physiological effects of regular cigarette smoking.
Smoking clearly decreases life expectancy for all age groups. One-pack-a-day smokers double their chances of death between the ages of 50 and 60, while two-packers triple theirs. And smoking also affects the life expectancy of nonsmokers close to them in heart and proximity. Of all the common drugs, nicotine intake from cigarette smoking clearly has the least benefits and the most negative consequences.
The estimated cost of smoking is somewhere between $50 and $100 billion a year. Some 650 billion cigarettes are sold yearly in the United States in this $18–25 billion mega-business. Marlboros and Winstons top the list with nearly 50 percent of the market. The 650 billion count averages about 4,000 cigarettes per year per person over age 18. Recent estimates suggest that about 38 percent of the over-18 population in the United States smoke. Percentages of adult smokers are even much higher in most European countries and some parts of Asia. In addition to the cost of the cigarettes, there are many billions spent medically to treat the problems that afflict smokers and many more billions in lost work and productivity caused from diseases generated by smoking.
I am happy to say that now only 10 percent of doctors in the United States smoke; the percentage used to be much higher. The number of cigarette smokers, which for many years has increased steadily, is tapering off somewhat. Worldwide however, there is still about a 2–3 percent yearly rise in smokers. The dangers of nicotine and smoking are now so generally accepted and well documented that it would seem that more people would be stopping or not even starting. The fact that fewer doctors smoke (or admit that they smoke) is at least representative of these health dangers. People want doctors to do healthy things and to set healthy examples.
Since most nicotine intake is from smoking cigarettes, that is the focus of this section. Cigar and pipe smoking, chewing tobacco, and snuff also pose some health risks, but far less than cigarette smoking. The regularly inhaled smoke contains tars composed of literally thousands of chemicals, including those used in tobacco cultivation as well as in cigarette making. These agents add other health risks in addition to the nicotine, which directly acts on the cardiovascular and nervous systems. There are over 30 potentially carcinogenic chemicals contained in cigarette smoke.
Tobacco comes from a large-leafed nightshade, or Solanaceae, plant. It is one of a few plants that contain the psychoactive alkaloid, nicotine. Tobacco causes joint pain in some people; this seems correlated to the theory that arthritis is in part a result of an allergy to the nightshades, which also include potatoes, tomatoes, eggplant, and peppers.
Nicotine has been widely used throughout history, first in North America. Supposedly, Columbus and other visitors were interested in it and carried some tobacco and seeds back to Europe, where its use caught on rapidly and eventually spread to Africa and the Orient. Tobacco was outlawed by several countries during the early 1600s, but to no avail; then the governments eventually found ways to profit from its use. This seems fair, since it costs them in the long run with lost health and productivity of their people. The addictive nature of nicotine has been clear for hundreds of years, as people have found ways to smoke during poverty, famine, and war.
Sigmund Freud was fascinated with tobacco and obsessed with cigars (smoking more than 20 a day). He fought his addiction to nicotine (and apparently to cocaine) through much of his life, though he experienced mouth cancer, angina pain, and multiple surgeries. Freud’s dance with death and his inability to get off tobacco probably generated his theory of Thanatos, our deep subconscious longing for death, manifested in part by our destructive habits.
Smoking is clearly a deadly pastime. Its addictive nature is revealed by the fact that many strong-minded and strong-willed people cannot stop smoking, even if they are otherwise health conscious or faced with death. And most smokers, over 80 percent, declare that they want to stop smoking, and plan to at some time. In my years working in hospitals, I saw the most bizarre smoking phenomena, such as lung cancer or emphysema patients smoking between ventilator treatments or patients who breathed through tubes in their necks after tracheostomies, actually putting cigarettes into the tubes to inhale. Our passion for puffing is persistent.
Nicotine is the addictive drug found in tobacco. Even though some people start smoking for the image or the ritual, they may easily become hooked. The “up” feeling that smoking produces is likely correlated with the increased blood pressure and heart rate, as well as the production of fatty acids, steroids and possibly other hormones or neurotransmitters. Nicotine mimics acetylcholine, which then improves alertness, memory, and learning capacity. Other neurotransmitter stimulation of norepinephrine and endorphins by nicotine may help balance moods and increase energy. The liver’s increase in glycogen release gives a satisfying lift in the blood sugar.
The addiction to nicotine is probably stronger than addictions to most other drugs. The initial irritating effects progress to chronic irritations, yet these are covered by the physiological and, in many instances, the psychological need (although the latter is usually secondary). Heroin addicts and people addicted to other powerful drugs have commonly referred to nicotine as the hardest drug to kick. The American Psychiatric Association has described smoking as an “organic mental disorder.” Their statistics suggest that around 50 percent of people cannot stop when they try to and that, of the people who do stop, about 75 percent of them begin again within one year.
Are There Benefits in Smoking?
There obviously must be a few, or so many people would not smoke, but it is very clear that the risks outweigh the pleasures by far. Many people find smoking relaxing, but this may be a result of calming the hyperactive withdrawal symptoms. People do experience mental stimulation and improvement of hand-to-eye coordination and work activities, probably as result of nicotine’s vascular-neurological stimulation. The benefits that smokers experience were well described in Dr. Tom Ferguson’s book, The Smoker’s Book of Health, from his interviews with hundreds of smokers. They felt better able to deal with stress and to unwind and relax. Smoking helped control their moods, improve concentration and energy levels, especially with fatigue, and reduce withdrawal symptoms, obviously. Social comfort, work breaks, reduced pain and anxiety, increased pleasure, and less boredom were also correlates for some who smoked. Smoking also usually reduces the appetite and taste for food, so it may help people to reduce food intake, a positive step for the weight conscious. The average smoker weighs six to eight pounds less than the nonsmoker. In Life Extension, Sandy Shaw and Durk Pearson note that nicotine seems to reduce distraction by outside stimuli in people working in highly stimulating environments—that is, it desensitizes people. I see this as creating a smoke screen that protects us from relating to others and keeps us in our own world. It is clear that people who work in crowded, noisy, busy offices with other workers, computers, machines running, and lots of hustle and bustle tend to smoke more frequently than do workers in more private situations.
Yet, most employers now know there is a distinct disadvantage in hiring smokers. The smoke interferes with office morale, and it is more costly. Some estimates suggest that employing a smoker costs businesses nearly 5,000 yearly. This cost comes from increased absenteeism, death risk, incident of accidents, and property damage or cleaning bills from smoke, as well as less productivity. Dr. Ferguson points out that most people are aware of this and the health hazards of nicotine and cigarette smoke. They clearly want to quit, but have not found a way to get rid of withdrawal and craving. Finding ways to reduce stress and clear those conditioned responses to want to smoke takes a great deal of effort.
What Does Nicotine Do?
Nicotine, the active and addictive ingredient of tobacco, is a mild central nervous system stimulant and a stronger cardiovascular system stimulant. It constricts blood vessels, increasing the blood pressure and stimulating the heart, and raises the blood fat levels. In its liquid form, nicotine is a powerful poison—the injection of even one drop would be deadly. It is the nicotine, not the smoke, that causes people to continue to smoke cigarettes, but it is the cigarette smoke that causes many of the problems.
Cigarette smoke is a combination of lethal gases—carbon monoxide, hydrogen cyanide, and nitrogen and sulfur oxides—and tars, which contain an estimated 4,000 chemicals. Some of these chemical agents are introduced by current tobacco manufacturing processes. Although tobacco has been smoked for centuries, only recently has it moved from the naturally grown and dried process. It appears that in the last century the negative effects of smoking have skyrocketed. My belief, which is shared by many authorities, is that much of the added risk is produced by the chemical treatment and unnatural processing of tobacco. The little research that has been done on this (it is not sponsored by the industry) suggests that natural tobacco poses much less cancer risk, as well as cardiovascular disease risk, though this is predominately from the nicotine, which is not changed by processing.
Dangers in modern tobacco products include pesticides used during growth and chemicals added to the tobacco to make it burn better or taste different. Chemicals added to the leaves and papers to enhance burning are among the major causes of fire deaths in this country, as cigarettes continue to burn after they have been put down. The forced burning also makes people smoke more of each cigarette in order to complete it. Sugar curing and rapid flue drying are also associated with increased toxicity of cigarettes. Kerosene heat drying contaminates the tobacco with another toxic hydrocarbon. Using a natural tobacco, such as some imported from France or Germany and a few U.S.-made cigarettes (possibly Shermans and More), may reduce the smoking risk. If a cigarette does not go out when left alone, it has been chemically treated.
Other toxic contaminants in cigarettes include cadmium (which affects the kidneys, arteries, and blood pressure), lead, arsenic, cyanide, and nickel. Dioxin, the most toxic pesticide chemical known to date, has been found in cigarettes. Acetonitrile, another pesticide, is also found in tobacco. The nitrogen gases from cigarettes generate carcinogenic nitrosamines in the body tissues. The tars in smoke contain polynuclear aromatic hydrocarbons (PAH), carcinogenic materials that bind with cellular DNA to cause damage. Antioxidant therapy, particularly with vitamin C, is protective against both PAH and nitrosamines, and extra C also blocks the irritating effects of smoke. Smoking itself reduces vitamin C absorption; blood levels of ascorbic acid average about 30–40 percent lower in smokers than in nonsmokers.
Radioactive materials are also found in cigarette smoke; polonium is the most common. Some authorities believe that cigarettes are our greatest source of radiation. A smoker of one and a half packs per day may be exposed to radiation equal to 300 chest x-rays a year. Radiation is a strong aging factor. Acetaldehyde, a chemical released during smoking, causes aging, especially of the skin, as it affects the cross-linking bonds that hold our tissues together.
Cigarette Chemicals*
| Carbon monoxide | Hydrogen cyanide | Ozone |
| Vinyl chloride | Formaldehyde | Napthalenes |
| Acetaldehyde | Hydrazine | Arsenic |
| Formic acid | Cadmium | Nickel compounds |
| Lead | Nitric oxide | DDT |
| Pyrene | Methyl chloride | Hydrogen sulfide |
| Benzene | Acetronitrile | Nitrosamines |
| Acrylonitride | Phenols | Benzopyrene |
| Polynuclear aromatic | Ammonia | Hydrocarbons |
| Polonium-210 | Radioactive compounds | Endrin |
| Acids | Dimethylnitrosamine | Alcohols |
| Ethylmethylnitrosamine |
Cigarette smoking causes three primary degenerative-disease-producing effects:
- Irritation and inflammation
- Free-radical generation
- Allergy-addiction.
It is clear that cigarette smoke is a constant and chronic irritant to the body tissues, most specifically the oral cavity and respiratory tract. The polluting effect from cigarettes results less from nicotine than from the thousands of chemicals, including hundreds of poisons and carcinogens, contained in the smoke and tar. Supporting the nicotine addiction without the smoke (by using chewing tobacco, snuff, or nicotine gum) will reduce many of the undesirable respiratory effects of cigarettes. Cigarette smoke is a potent free-radical generator, also primarily a result of the many chemical irritants. And tobacco users exhibit the classic allergy-addiction picture. Studies testing smokers and nonsmokers in a variety of ways have shown that tobacco is a common allergen. Smoking causes irritation and many symptoms; stopping smoking causes cravings and withdrawal symptoms, so that smoking is needed for relief from the withdrawal. The ups and downs are associated with the chemical release of adrenal hormone and endorphins, such as that seen in allergies.
The main risk factor is the number of cigarettes smoked over time. “Pack years” is a common measurement in medical lingo. Someone who smoked one pack per day for 15 years and then two packs per day for 20 years would have 55 pack years, which is fairly high; even 20 pack years will increase the risk of many chronic problems, chiefly lung disease (bronchitis and emphysema), lung cancer, and heart disease. Smokers have twice the risk of death prior to age 65 than nonsmokers, and there is an average reduced longevity of 5–10 years for smokers, varying from lighter to heavier users. For shorter-term problems, such as bronchitis, smoking more than 25 cigarettes per day is associated with a high risk and smoking between 10 and 25 per day with a moderate one; smoking fewer than 10 cigarettes daily poses a low risk. The length and depth of inhalations also contribute to nicotine and tar intake.
There are also different levels of addiction. Least addicted are those who smoke only socially—at parties with friends—and usually only during certain parts of the day or week. They may smoke primarily for psychosocial or image reasons. Next are those who smoke in response to stress, mainly at work. They may stop and start. These first two smoking types are usually less addicted than heavier smokers, and it is easier for them to cut down or stop. The third type of smoker is the more serious, all-day-long smokers who have a fairly strong physical and psychological addiction; for these people, going more than an hour without nicotine causes the onset of withdrawal symptoms, such as irritability, anxiety, or headache. Often, the psychological influences lead to more frequent smoking of cigarettes than even the physical needs require. The extreme, “graduate” level smoker is the “chain smoker.” He or she puffs nearly constantly, usually consuming three packs or more a day, and is strongly addicted. The latter two types often need medical and psychological support unless some special circumstance or divine intervention motivates them to stop immediately. Specialized stop-smoking programs are often needed, and even these are only sometimes helpful. Currently, about a third of adult men and women smoke in the United States. Between 10 and 20 percent of previous smokers have quit, leaving only 40–50 percent of adults who have not been regular smokers, and even most of them have at least tried cigarettes. But now by popular demand, from medical and social support, over 1 million smokers of the 50 million in the United States are stopping yearly, and they will immediately begin to lower their cancer and cardiovascular disease risks as well as reduce the negative effects on their lungs and other tissues.
Contrary to current marketing hype about low-tar, low-nicotine cigarettes, there are no safe cigarettes. Some of the newer “lights” may be even worse than regular cigarettes. Users inhale more deeply and smoke more in order to is satisfy their nicotine needs. Unless they have a low ratio of tar to nicotine, there are more risks posed by the increased chemical tars in the cigarettes. More carbon monoxide, hydrogen cyanide, and nitrogen gases are consumed with many of these low-nicotine cigarettes, and this can increase the oxygen deficit, heart disease, and lung damage associated with smoking. What smokers really need are high-nicotine, low-tar cigarettes, so that they need to smoke less to get their nicotine and have less exposure to the more carcinogenic, destructive tars. Even better will be ways to get nicotine to the blood without smoke. Nicotine gum works well, nicotine skin patches and nasal sprays are being researched, and soon there may be capsules or tablets to satisfy the craving. They will still be hazardous to our health but much less so than cigarettes, and will clearly get rid of pollution and secondary smoker risks.
What Are the Risks of Smoking?
Cigarette smoking probably has more harmful effects than any other commonly used drug, and affects more organs and tissues than most others. The total destructive nature of this one drug in the worldwide population is surpassed by no other, even though there are many drugs for which one dose is much worse than one cigarette. This is because it is so addictive and people use it so frequently for so long.
Diseases Associated with Smoking
| Atherosclerosis | Acute bronchitis | Allergies |
| Hypertension | Chronic bronchitis | Rhinitis |
| Heart disease | Emphysema | Sinusitis |
| Coronary artery disease | Lung cancer | Other infections |
| Peripheral vascular disease | Mouth cancer | Burns |
| Myocardial infarction | Tongue cancer | Peptic ulcers |
| Stroke | Laryngeal cancer | Varicose veins |
| Polycythemia | Esophageal cancer | Hiatal hernia |
| Low birth weight infants | Bladder cancer | Osteoporosis |
| Increased infant mortality | Kidney cancer | Periodontal disease |
| Alzheimer’s disease | Pancreatic cancer | Senility |
| Vitamin/mineral | Cervical cancer | Impotence |
| deficiencies |
The CVD problem is primarily responsible for the decreased life expectancy associated with smoking, even more so than lung cancer, which usually results from 20–30 years of use. Circulatory effects start immediately and precipitate the development of CVD, mainly by increasing blood fats and blood pressure. Remember, the three primary contributors to CVD are smoking, hypertension, and high cholesterol, and smoking itself increases the incidence of the other two. Nicotine particularly lowers the level of the protective HDL cholesterol while increasing the supposedly destructive LDL cholesterol. It decreases circulation, especially of the hands and feet, and increases peripheral vascular resistance, so that the heart has to work harder with every beat. These factors contribute to the commonly elevated blood pressure of smokers. Nicotine’s effect on increasing platelet aggregation leads to more cases of cerebrovascular accidents (CVAs), or strokes, and myocardial infarctions (MIs), or heart attacks. Diabetics who smoke are at a very high cardiovascular risk, as nicotine increases blood fats and blood vessel effects and may increase insulin needs.
Symptoms and Problems Associated with Smoking
| Heartburn | Surgical complications |
| Allergies | Nutritional deficiencies |
| Angina Pectoris | Stains on teeth and fingers |
| Hoarseness | Increased pregnancy risks |
| Cough | Increased caffeine use |
| Headaches | Increased alcohol use |
| Memory loss | More divorce |
| Anxiety | More job changes |
| Fatigue | More home changes |
| Lowered immunity | Fires, at home and outdoors |
| Low sexuality | Higher insurance rates |
| Cold hands and feet | Wasted money |
| Leg pains |
High blood pressure and atherosclerosis are associated with an increased risk of strokes. Cerebral aneurysm (ballooning of the artery wall) occurs more commonly in smokers than in nonsmokers, and ruptured aneurysms are often fatal or at least lead to lifelong impairment. Hypertension can also be more serious in smokers; a rapid rise in blood pressure requires prompt control or it may also be fatal.
Peripheral vascular disease—that is, disease of the extremity arteries—is much more common in smokers. This may manifest as intermittent claudication (pain in the legs with walking), as the poor circulation caused by atherosclerosis and vasoconstriction reduces oxygen delivery to the muscles, leading to arterial insufficiency and pain much like that of angina pectoris. Buerger’s disease is a specific arterial disease in smokers that may be caused by a hypersensitivity or allergy to tobacco. The inflammation and scarring of the arteries of the arms and legs caused by this disease in a small number of smokers are associated with pain and decreased function. Amputation may be needed if stopping smoking or drug therapy does not help. It would seem much easier and wiser to give up smoking than body parts, or life itself.
Although snuff and chewing tobacco are less toxic because they cause less air contamination, with chronic use the nicotine absorbed from them affects the circulatory system almost as seriously as smoking. There are currently over 10 million chewers addicted to nicotine, and even though they are not exposed to smoke, and thus, have reduced lung damage and lung cancers, tobacco chewers still have the negative cardiovascular effects of nicotine and a higher incidence of mouth, tongue, and throat cancers than smokers. The smoke from cigars and pipes is not usually inhaled, so less nicotine and tars are absorbed with their use, though local irritation is possible. If we want to do ourselves a favor, particularly for our heart and blood vessels, we obviously will not use tobacco at all.
For smokers, the lungs are the other key area of concern. Chronic inhalation of tobacco smoke leads to eventual destruction of the lung tissues through a process of irritation, inflammation, and scarring. Our respiratory tract includes the oral airway, the nose and sinuses, the larynx area, the large bronchial tubes, the smaller bronchioles, and the millions of tiny alveolar sacs at the depth of lung tissue where the massive surface area that contacts the blood stream allows the various inhaled substances to be absorbed. Primarily oxygen and carbon dioxide are exchanged there, but nicotine and other liquids and gases may be absorbed as well. Carbon monoxide, sulfur and nitrogen gases, hydrogen cyanide, and various metals and chemicals may also get into the body through the lungs. The respiratory tract can be used as a route for medication, mainly to affect lung function.
Smokers have a higher than average incidence of respiratory infections, including colds and flus, bronchitis, and sinusitis. By most estimates, smokers have at least twice as great an incidence as nonsmokers of these diseases, particularly acute bronchitis and bad flus. Cigarette smoke causes a decrease in the action of the cilia, and even temporary paralysis of these fine hairs on the mucous linings, which help protect the deeper tissues by pushing out microorganisms and other foreign materials. Smoke also decreases phagocyte activity by diminishing macrophage function. The thinning and drying of the mucus itself cause the bronchial tubes to become dry and irritated. This not only decreases defenses, but leads to much of the inflammation, hoarseness, and chronic cough associated with smoking.
Chronic bronchitis, one form of chronic obstructive pulmonary disease (COPD), results from long-term irritation, loss of mucus protection, and recurrent infection secondary to smoke, with a subsequent loss of function and lung capacity. This limitation in respiratory function occurs even in early smoking. When smoking is stopped, much of the function returns, unless there is lung tissue scarring, which is irreversible. Generally, smoking decreases lung capacity and endurance and often even the desire or ability to exercise. Emphysema, the other form of COPD, results from progressive alveolar scarring and loss of lung elasticity, and thus, the diminished ability to expand and contract—the basic breathing function. The irreversible damage that occurs from the chronic inhalation of tars and nicotine can cause respiratory crippling in later years, totally limiting activity and requiring regular breathing treatments. Exposure to other chemicals, usually industrial types, can also lead to lung scarring and emphysema, especially bad when combined with smoking.
Tobacco smoke is a carcinogen (many of the poisons in cigarette smoke are known carcinogens) and is the main contributor to our most deadly cancer, cancer of the lungs. This problem used to be almost exclusive to males, but now females have been smoking more, and their rates of lung cancer and death from this disease are rapidly catching up with those of the men. Equal rights to life and death! Recent studies show that the incidence of lung cancer is higher in people with low beta-carotene levels, so this is a protective nutrient. Further research will likely reveal that other nutrient deficiencies increase cancer rates, especially low levels of the other antioxidants. This has already been shown to be true for selenium.
Smokers are from five to ten times more likely to contract lung cancer than nonsmokers. These rates are even further increased with occupational exposure to agents such as asbestos, coal, textiles, and other chemicals. With regular alcohol use, smokers have greater than fifteen times the risk of lung cancer of nonsmokers.
Many other cancer rates are higher for smokers, particularly for alcohol-drinking smokers who are exposed to other carcinogenic chemicals. Smokers also have higher rates of cancer of the bladder, cervix, pancreas, esophagus, lips, mouth, and larynx. The risks are increased even further with a high-fat diet and probably with other habits that contribute to cancer, such as emotional stress, low-fiber diets, obesity, and so on. Smoking is the major cause of cancer of the mouth, tongue, and larynx, the latter being almost exclusive to smokers. Regular alcohol use along with smoking brings an increase in gastrointestinal tract cancers as well.
The incidence of cervical cancer has recently been shown to be increased in smokers, theoretically because chemicals from the smoke get into the blood and are released into the uterus and cervix. Deficiencies of nutrients such as vitamin A and folic acid may also be contributing factors in this cancer. Smoking is further implicated in bladder cancer as the bladder is a site where cigarette carcinogenic chemicals can be concentrated.
Cigarette smoking is clearly a common allergy-addiction. Symptoms of both irritation and allergy may appear when smoking is first begun and then decrease with continued smoking. Symptoms will increase with avoidance and increase further with full withdrawal before they diminish. This is classic for allergies as well as drug addictions. In addition to tobacco smoke being an allergen, many people with other allergies or with lowered immunity are very sensitive to smoke. Some people with allergies have even noticed that certain foods may stimulate the desire to smoke; the mechanism for this is unknown.
Cigarette smoking itself lowers general immunity, causing sedation of the protective phagocytic cells and cilia, as well as other effects. Cigarette smoke may be a powerful brain allergen, as nicotine goes rapidly to the brain. Many people, nearly 50 percent according to some reports, also notice decreased thinking ability with smoking (others notice improvement). And in the long run, the increase in atherosclerosis and subsequent decrease in blood circulation to the brain lead to further memory and thinking problems and early dementia. Recent research shows a four times increased risk of Alzheimer’s disease in smokers over nonsmokers.
Cigarette smoking also increases the aging process through many effects, including chronic irritation, free-radical formation, atherosclerosis, lung inflammation, and the breathing of other toxic gases, such as carbon monoxide. The poor oxygen delivery to the skin and general dehydration of the tissues caused by smoking seem to cause an increase in deep wrinkles, or “smoker’s face.” This begins soon after age 30 in smokers. By age 40–50, the facial wrinkles of smokers are similar to those of nonsmokers 20 years older. I can often correctly guess that people are smokers just by knowing their age and looking at their skin, if I have not already smelled smoke on their clothes or breath. The wrinkling and aging effects may also result from nutritional depletions associated with smoking, such as deficiencies of vitamins C, B1, and B2, folic acid, zinc, and calcium. In addition to the carbon monoxide in smoke, acetaldehyde can also weaken the tissue cross-linking, causing more skin aging.
Worldwide reports suggest that smoking also affects sexuality and reproduction. In men, it has been shown to lower sperm counts and motility and thus sexual potency and reproductive ability. Smoking may also cause genetic mutation. There appears to be a slightly higher incidence of congenital malformations in the offspring of men who smoke.
In women who smoke, there are clearly more miscarriages and smaller babies. There are many increased risks for pregnant smokers as well as for their fetuses and infants. Besides resulting in babies with lower birth weight than those of nonsmoking women, which may result from a decrease in blood circulation and thus a lower oxygen and nutrient supply to the fetus throughout pregnancy, smoking increases the incidence of miscarriages, stillbirths, congenital malformations, and early infant deaths. Nicotine gets into breast milk and may decrease its production. I believe that early nicotine exposure may cause a greater likelihood of smoking addiction in later life. Smoking around newborns and infants increases their susceptibility to many diseases, particularly colds, bronchitis, and pneumonia. The increase in the number of teenage girls who smoke creates more problems in pregnancy than occur in adult smokers; in pregnant teenagers, poor development and lack of placental circulation and oxygen lead to more fetal and newborn deaths, more hospitalized newborns, and babies that are slow to learn.
Women in general have a higher incidence of many problems since more of them have started smoking. In addition to the worst, lung cancer, these include bronchitis and emphysema, hypertension and heart attacks, strokes, and hemorrhages. The use of birth control pills increases the risk of circulatory problems even further; for example, women who smoke and use the pill are 25 times more likely to suffer heart attacks than women who do neither.
High-Risk Smokers
| Pregnant women | Alcoholics or alcohol |
| Nursing mothers | abusers |
| Diabetics | Those with existing |
| Birth control pill users | smoker’s diseases |
| Family history of heart disease | Those who work with |
| Hypertensives | toxic chemicals |
| Patients with high cholesterol | Those having surgery |
| Heavy smokers | Ulcer patients |
| Obese people | Type A personalities |
| Very thin people |
Another hazard of smoking is burns, which may be caused directly by cigarettes as well as by fires generated by them, as smoking is a major cause of fires and fire deaths. Smoking also eats away at the teeth and gums, creating disease, and stains the teeth, tongue, and fingers. It reduces appetite and taste for food, which definitely tends to interfere with good nutrition. Smoking often decreases the taste for sweets but increases the taste for more stimulating fatty or spicy foods. More caffeine and alcohol tend to be consumed by smokers than by nonsmokers.
Smokers also have more frequent job changes, as well as home and spouse changes. Problems with alcohol are associated with smoking, and many people who try to withdraw from alcohol and other drugs tend to smoke more. Smoking can weaken the memory, and with its destructive nature, it tends to lessen the desire and positive attitude toward life, which may be the reason why smokers experience more of these life changes.
What About Secondary Smoke?
The smoke from cigarettes that nonsmokers breathe has become a big issue in the last decade, a clear human rights issue. I will limit my comments here to saying that I feel that being exposed to secondary or “sidestream” smoke is a violation of my right to breathe clean air. To broaden this, pollution of Earth is a violation of the rights of us all and our future generations. We need to all do our best to minimize pollution and exposure to pollutants and to improve our methods of handling of wastes and industrial by-products.
Secondhand smoking occurs at work, at home, and in restaurants and shops (minimally outdoors). Sidestream smoke may be even more dangerous than mainstream smoke, since it is not filtered. Of the 16 or so poisons that arise from burning cigarettes, most are known carcinogens. Much of the ammonia, formaldehyde, acetaldehyde, formic acid, phenol, hydrogen sulfide, acetonitrile, and methyl chloride is filtered through the tobacco and cigarette filters and is more concentrated in the smoke that passive, involuntary smokers inhale. The blood level of carbon monoxide in secondhand smokers is more than 50 percent higher than that of those not exposed and often exceeds that of light firsthand smokers. And what about houseplants that surround smokers? It would be interesting to see research on the changes in growth and health and the chemical makeup of common plants; they may indeed do better than we humans.
The 22nd Annual Surgeon General’s Report on Smoking and Health focused on “sidestream” or secondary smoking. Since tobacco is used by more than 30 percent of Americans, it is a major concern. This report suggested that in excess of 70 percent more tars, two to three times the amount of nicotine and carbon monoxide, and seventy-three times more ammonia than found in mainstream smoke are present in sidestream smoke, which also contains lead, arsenic, cadmium, vinyl chloride (a strong liver carcinogen), benzene, oxides of nitrogen, and various radioactive substances. This information was cited in Dr. Rollin Odell, Jr.’s, article “Deadly Effects of Side Smoke,” printed in the San Francisco Chronicle (January 10, 1987).
The conclusions drawn from a review of more than 2,000 studies regarding sidestream smoke is that it increases the incidence of most of the smoking diseases. Children of smokers have increased incidence of respiratory infections, ear infections, and lower lung function than children of nonsmokers. Sidestream smoke increases the risk of COPD (emphysema and chronic bronchitis), heart disease, and lung cancer. An estimated 3,000 cases of lung cancer a year are caused by secondhand smoking. Nonsmoking wives of smokers have been shown to have a life expectancy four years shorter than that of nonsmoking wives of nonsmokers. This may even be more pronounced for nonsmoking husbands of smoking wives. A chronic nonsmoker’s “smoker’s cough” or hoarseness may develop as well. Sidestream smoke probably increases the cancer risk of everyone involved. More common secondary smoker symptoms include eye and nasal irritation, worsened allergies, headache, and cough.
Clearly, smokers endanger not only their own health but the health and lives of others as well. The surgeon general should change the warning on the cigarette package to say “Smoking is hazardous to the health of yourself and those around you.” It is wonderful for nonsmokers now that smoking is not allowed on airplanes and in many public places. Many cities have passed ordinances restricting smoking in various ways publicly. Truly, people should be protected from cigarette smoke indoors. I believe it should be against the law for parents (and others) to smoke in cars when children are with them or in any closed area where children are present. I have seen many cases, and heard about more, where children have had low grade allergies or infections when exposed to regular household smoke. However, we also need to be compassionate, understanding, and supportive toward anyone with destructive health habits. I have noticed more and more smokers being courteous to those around them. Dr. Odell puts forth the goal of a smoke-free society by the year 2000. A radiation oncologist himself, he finishes his article with the assumption that “the brown plague will soon be only a footnote to the history of our time, just as the black (bubonic) plague is to the time of the Middle Ages.” However, until we can rid our world of the “brown plague,” we must protect ourselves from secondhand smoke. A good air filter can be very effective in removing from the air many of the toxins generated by burning cigarettes. A basic multiple vitamin-mineral and antioxidant formula will help protect us internally. The daily program should include at least:
Smoker’s Simple Nutrient Plan
| Vitamin C | 1,000–2,000 mg. |
| Beta-carotene | 15,000–25,000 IUs |
| Vitamin A | 5,000–10,000 IUs |
| Zinc | 15–30 mg. |
| Selenium | 200 mcg. |
| Vitamin E | 400 IUs |
Dietary Recommendations
No support program for smokers will be as effective as stopping and then working to regain the health lost by smoking. A wholesome diet and nutritional supplements although even the best program cannot offer immunity to cigarettes.
While the diet is, of course, important, I believe that for smokers taking supportive, protective nutrients is even more essential. Many smokers do have an adequate diet; I have seen smoking macrobiotics, smoking vegetarians, and smoking health enthusiasts. However, there is a tendency for poor dietary habits to accompany the destructive smoking habit. Many smokers tend to eat more meats, fatty and fried foods, and refined foods than nonsmokers. It is important for smokers to avoid other addictions. Sugar, coffee, alcohol, and meats should be minimized or avoided if possible.
A basic, wholesome diet helps to at least reduce some of the risks of smoking addiction, which may be influenced by nutritional deficiencies. This plan, especially with adequate fruits, vegetables, and whole grains, will help to provide some of the necessary, protective antioxidant nutrients, beta-carotene, vitamins A, C, and E, and selenium, all of which will help lower risks of cancer and other smoker’s maladies. In addition, some raw seeds and nuts, legumes, sprouts, and other proteins should be consumed. Water is an essential nutrient to balance out the drying effect of smoking. A daily intake of two to three quarts is suggested, depending on how many high-water-content fruits and vegetables, salads, and soups are consumed.
Caffeine beverages increase the need for water, as they are also dehydrating. Smoking usually generates a mild acid condition in the body, and an alkaline diet is helpful to balance this. A high-fiber diet also helps in detoxification, maintaining bowel function, and reducing the risks of smoking. The overall plan for smokers is to increase the wholesome foods—fruits, vegetables, and whole grains—and to lower the intake of fats, cured or pickled products, food additives, and alcohol.
An alkaline diet is even more important during the cigarette withdrawal and detoxification periods. The increased blood alkalinity that results from a diet high in fruits and vegetables, even mainly raw food consumption, helps reduce the craving for and interest in smoking. Studies have shown this to be true, and I have heard this regularly from the hundreds of patients I have seen in smoking cessation programs.
The alkaline diet is not necessarily a lifelong program, although, as I discussed elsewhere in this book, it is wise for our diet generally to be more alkaline than acid. During cigarette withdrawal, a vegetarian or raw food diet may be sufficient for the average person to help reduce nicotine craving. This can be used for three to six weeks to aid in the detoxification process. Fasting has also been employed by some smokers to help eliminate their habit. It does allow for rapid transitions, but it can also be somewhat intense. It might be reserved for the more durable and strong willed or the overweight or hypertensive smoker.
Stop Smoking Diet
| Increase Alkaline Foods | Reduce Acid Foods | |||
| fruits | figs | meats | beef | |
| vegetables | raisins | sugar | chicken | |
| greens | carrots | wheat | eggs | |
| lima beans | celery | bread | milk | |
| millet | almonds | baked goods | cheese | |
The diet for detoxification is also low in fat and high in fiber. It is important to keep the energy and bowels moving. The raw foods (and vegetarian) diet helps with both. This includes several salads of leafy greens daily, and some snacks of fruits, vegetables, nuts, or seeds. Some of the high-protein algae, such as spirulina and chlorella, also help during withdrawal and detox. Since cigarettes are such a rapid ager and a key cancer risk, the dietary suggestions in Cancer Prevention and Anti-Aging programs are useful here as well (see Chapter 16).
Supplements
Many supplements are useful for smokers or during withdrawal and detoxification. An acid urine increases the elimination of nicotine and thus increases the craving. So, while an alkaline diet may slow down the detoxification of nicotine, it also reduces the desire for smoking. To support the body alkalinization during smoking cessation, I recommend sodium or potassium bicarbonate tablets, one to be taken with cravings for a total of five or six daily, along with the fruit- and vegetable-based, high-fiber diet.
A general “multiple ” with additional antioxidant nutrients are part of the smoker’s program. The antioxidants help reduce the toxicity of smoke in primary and secondary smokers and also help lessen the free-radical irritation during the detox period. Vitamin E, 400–800 IUs daily, specifically helps stabilize the cell membranes and protects them and the tissue membranes from the free-radical and chemical irritations generated by cigarette smoke. Selenium, as sodium selenite or selenomethionine, at a level of 200–300 mcg., supports vitamin E and also reduces cancer potential, which is so much higher with chronic smoking. Selenium also lessens sensitivity to cadmium. Vitamin A reduces cancer risk and supports tissue health, and beta-carotene specifically protects against lung cancer in smokers. Smoking clearly depletes body vitamin C levels, probably by increasing antioxidant demands and reducing absorption. Therefore, smokers need regular vitamin C intake to help neutralize the toxins. Supplementing 500–2,000 mg. four or five times daily is recommended. (Note: Both vitamin C and niacin are mild acids, which may increase ulcer risk, as well as nicotine elimination and craving in smokers. If these nutrients are used in higher amounts, extra alkaline salts such as the bicarbonates or calcium-magnesium ascorbates, may be used.) Extra zinc, 30–60 mg. a day, like vitamin A, helps protect the tissue and mucous membrane health.
There are many other helpful nutrients needed during smoking and detox. First, we need to support the B vitamins that are more easily depleted in smokers, mainly thiamine (B1), pyridoxine (B6), and cobalamin (B12). The B12 may also help to decrease the cellular damage caused by tars and nicotine. Niacin (B3) helps in opening up the circulation that is constricted with nicotine. It also lowers cholesterol, which may reduce the risk of atherosclerosis. Pantothenic acid may reduce the aging of the skin and support the generally stressful lifestyle. Folic acid should be taken in higher amounts, such as 1–2 mg. daily. Coenzyme Q10 is also helpful in dosages of 30–60 mg. daily. Extra choline may support the brain and memory.
Besides zinc and selenium, other minerals also are important. Magnesium and molybdenum are needed in higher amounts than usual. Copper is needed at levels of 3–4 mg. daily, when used along with a higher zinc intake (60–100 mg.). Zinc also helps reduce cadmium absorption and toxicity. Vitamins C and E, selenium, and L-cysteine also help to reduce cadmium toxicity.
L-cysteine is very helpful to smokers and during detoxification. Along with thiamine and vitamin C, it protects the lungs from smoking damage and from acetaldehyde generated by smoke. It helps reduce smoker’s cough. Glutathione, formed from L-cysteine, is part of the protective antioxidant enzyme system. Heavy smokers might use 250–500 mg. of glutathione, up to 1,500 mg. (500–750 mg. more usually) of L-cysteine, with 5–6 g. of vitamin C, 150 mg. thiamine, and the total B vitamins and amino acids to balance the specific ones used.
To prevent obesity, it is very important to be aware of eating properly when stopping smoking. Smoking reduces appetites and the taste for foods and probably increases metabolism as well as nervous energy. It is natural to want to eat more and enjoy food more when not smoking. Over half of ex-smokers will gain weight, and this is more common in the heavier (use) smokers. If weight gain is undesirable (many smokers are underweight), a weight-control diet should be instituted as smoking is stopped.
Research has shown that smokers crave and eat less sweets than nonsmokers. This changes with smoking cessation (the taste buds come alive again), so new nonsmokers need to watch out for this. The alkaline, high-fiber, low-fat diet is helpful in maintaining weight. Another amino acid, L-phenylalanine, can help reduce the appetite if taken before meals in amounts of 250–500 mg. Because it has a mild tendency to raise blood pressure, this should monitored if the blood pressure is of concern. Often, however, the blood pressure drops somewhat with smoking cessation. More choline may improve fat utilization and maintain weight, as may the amino acid L-carnitine. Regular exercise, walking, and getting used to breathing deeply of the fresh air are also part of our new plan.
Smoking Cessation
There are many reasons to stop smoking. Health benefits are clearly number one. Lower risks of cancer, heart disease, and lung problems and better resistance to disease, by-products of smoking cessation. Our life expectancy is improved when we do not smoke. Also, we can save a lot of money in three ways: 1) no cost of cigarettes, which are costing more and more, 2) reduced health and life insurance premiums, and 3) lower medical expenses with improved health.
Stopping smoking may require a major change in our whole relationship to ourselves and our health. We will need to decide to love, support, and nurture ourselves in the best way possible. Often, changing our attitude first makes it easier for us to give up our health-denying habits, such as smoking. If we want to be optimally healthy, we just cannot smoke.
Even though I do not smoke, I know that it is a very difficult habit to break. In general, it is difficult for nonsmokers to really appreciate and understand the connection smoking has to the smoker’s psyche and to his or her whole life. The level of addiction, which is based on the amount and number of years of smoking, will determine the ease of stopping smoking. If you light up first thing in the morning or if you smoke more than two packs a day, you probably have a serious addiction, and it may be harder to stop than for lighter smokers.
There are many different plans for stopping or decreasing smoking. The best way is just to decide and stop cold turkey, go through the withdrawal, and forget it. Then there is no back and forth, no doubt; the decision is made, and strength and willpower provide the success. The program here will help in this. The success rate for those who make the decision and just stop is much better than for those who use other methods. They do not need tapes, counselors, or group support; they only count on themselves. Those who depend on others to stop smoking have more relapses.
Smoking withdrawal, however, may not be easy. The first three days to a week can be very difficult; for some people, the struggle may last for as long as a couple of months. Usually, the first 12–24 hours are the peak of withdrawal, when symptoms may appear. Cigarette craving is almost always present. Headaches, anxiety, irritability, dizziness, and insomnia are fairly common. Other smoking withdrawal symptoms include muscle aches, sore mouth, inability to concentrate, drowsiness, heart palpitations, depression, and gastrointestinal upset, such as nausea, vomiting, cramps, diarrhea, or constipation. Over time, weight gain is not uncommon; this may result from an increased appetite and slower metabolism, probably both. Those fire sticks tend to push our metabolic pedals.
During withdrawal, I suggest taking vitamin C (as a mineral ascorbate to reduce acidity) in amounts of about 1 gram every one or two hours. This may help reduce nicotine cravings. Other nutrients and dietary plans discussed earlier may also be used. The maximum dosages listed in the table at the end of this section can be used for support during withdrawal.
If you just cannot give up nicotine, there are other ways to get rid of cigarettes. Nicorette, a nicotine gum, is a very useful tool. This supports the nicotine addiction without providing the harmful smoke chemicals. It reduces withdrawal symptoms, and research shows a better long-term quitting percentage with the nicotine gum than with other methods. It is, however, a temporary aid which can be obtained only with a doctor’s prescription. It is not ideal, but it is better than smoking tobacco. Nicorette still produces the cardiovascular effects of nicotine but a minimum of the lung and cancer problems. It may cause some symptoms, such as nausea, lightheadedness, hiccups, and muscle tension or jaw aches from chewing. It does, however, immediately help one to stop smoking, as most of the craving is for the nicotine. The psychological, conditioned, and social addiction patterns of smoking itself must also be handled, and the former smoker should be off the gum within two or three months.
Daniel Redwood DC
Richard A. Passwater PhD