An essential health resource for current and former smokers - An essential health resource for current and former smokers

Junk Food: The New Smoking

As much as cigarettes have become more and more socially unacceptable over the past few decades, a new dangerous trend is replacing them – excessive junk food consumption.

Now, before you cringe and compare me to New York City’s ex-mayor Bloomberg with his bans on trans fats and oversized sodas, hear me out.

Overconsumption of junk food

It would be unacceptable to give children cigarettes as rewards for doing well in school – yet it’s completely ok to shower them with candies, slurpees, sodas, etc. At most business lunches, there are probably more unhealthy choices than healthy. Heck – I’ve attended lectures on diabetes and obesity where an abundance of pastries, cookies, and donuts were served. TV is full of ads for junk food, sodas, etc. And let’s be honest – in this day and age, someone is much more likely to go up to a person smoking a cigarette and chide them than to someone drinking a large soda while munching on a hot dog and fries.

I know what you’re thinking – smoking is much more dangerous then eating junk food; furthermore it’s addictive. While those arguments are certainly true, what I don’t understand is why junk food consumption for the most part is completely acceptable. As a result, we’re seeing the amount of obesity in both children and adults reach an all time high. The obesity-related illnesses such as diabetes, heart disease, stroke, liver disease, and certain cancers are threatening to reverse some of the gains that we’ve made in life expectancy.

The solutions isn’t to ban junk food…

I am not here to suggest banning junk food completely – such an idea is unrealistic and unnecessary. What I do propose is for us to take a long hard look at what we’re eating and what we’re feeding our children, and make small changes. Perhaps we can demand more healthy choices at school and at the workplace. Certainly, whatever is in our control currently should be optimized. Don’t add a third junky item to your child’s lunch bag – provide an apple or carrot sticks. Encourage your children to drink more water instead of sugar laden beverages – and do the same yourself.

I have a feeling that years from now we will look back with dismay at how an entire generation of people was being poisoned with horrible food much in the same way that we look back at how cool and acceptable smoking was for so many years.

- Tamir


Cigarettes today are more harmful than 50 years ago

A new study published by the Campaign for Tobacco-Free Kids explains the disturbing findings that came out last year in the Surgeon General’s Report on smoking. The report stated that in spite of the fact that the average smoker is smoking fewer cigarettes today, they’re at a higher risk of developing lung cancer and emphysema!

Why would that be? It seems that Big Tobacco has over the years engineered cigarettes into more palatable, more addictive products in a bid to get new smokers hooked. Since over the decades smoking has become less attractive and the industry has faced more regulation (e.g. warning labels on packs, a ban on advertising on TV), it’s essential for the tobacco companies to find other ways to reel in and keep new smokers.

Among the alterations in today’s smokes:

  • Increased nicotine levels to make the cigarette more addictive.
  • Increased ammonia levels which makes the cigarettes “smoother” as well increase the absorption of nicotine.
  • Increased sugar levels, which again, makes the cigarette easier to smoke as well as increases the absorption of nicotine through a byproduct of the burnt sugar called aldehyde.
  • Levulinic acid which once again makes the cigarettes easier to inhale through decreasing their harshness.
  • Bronchodilators which are chemicals that open up the airways, making it easier to inhale the tobacco deep into the lungs.
  • Menthol found in menthol cigarettes which cools the throat making it easier to smoke.
  • Increased nitrosamine levels which cause cancer. This is due to the specific tobacco blends being used in the U.S.
  • Ventilation holes in the cigarette filter which causes smokers to inhale more deeply, resulting in the tobacco smoke ending up deeper in the lungs.

There you have it – a more carcinogenic cigarette that’s inhaled deeper and is more addictive.

- Tamir


The link between depression and heart disease in women

As we’ve stated over and over again in our book and blog – it’s crucial to treat mental health problems. I quite frequently encounter patients who are told by unsupportive and/or ignorant family or friends that depression or anxiety are “all in the head.”


Unfortunately, nothing could be further from the truth. Being depressed or stressed most of the time results in actual physiologic changes in the body which cause real damage. Women particularly seem to be hard hit by the effects of untreated depression.

A new study published in the Journal of the American Heart Association followed over 3,000 people with known or suspected heart disease over 3 years. Women younger than 55 who suffered from moderate to severe depression had over TWICE the risk of developing a heart attack or dying.

So if you are depressed, please seek help. Not just for your quality of life, which in and of itself is a good reason, but to potentially save your life.

- Tamir

(Image links to source, under this license.)


A Lesson from the CARDIA Study

It’s not too late . . .

Let’s face it. Most young people don’t lead such healthy lifestyles. Due to a variety of factors, they’re more likely to smoke, overindulge in unhealthy food and alcohol (think of your college days), and often don’t exercise much. The prevalence of obesity among young people has also hit all time highs in many countries.

Healthy life choice

Each of these unhealthy behaviors alone damages the body, in particular the heart. In fact, unhealthy lifestyle choices synergistically cause blockages in the main blood vessels supplying blood to the heart. Fortunately, in most cases it takes decades for significant heart disease to develop. That means that we have ample opportunity to get our acts together.

That’s exactly what the Coronary Artery Risk Development in Young Adults (CARDIA) study published in Circulation set out to prove. CARDIA study researchers followed over 3500 young adults (age 18-30) over 20 years. At baseline, fewer than 10% of the study participants were keeping all 5 healthy lifestyle behaviors mentioned above (not smoking, not drinking too much alcohol, exercising, keeping a healthy diet, and keeping a healthy weight). At the end of the study, roughly 25% of the participants added at least one healthy lifestyle factor; unfortunately 40% kept fewer.

The good news for those who did improve was that for each healthy factor that was added, the risk of calcification in the blood vessels supplying the heart (which is a good predictor of heart disease) decreased by 15%. Conversely, each decrease in healthy lifestyle behaviors increased the risk of heart disease by 17%.

The bottom line is that if you’re young, even if you haven’t been living the healthiest life until now, it isn’t too late to change things around. Even making small changes can yield great benefits. On the flip side, if you used to be slim, more active, and eat a healthier diet, but have strayed over the years, then you should realize that real damage is being done and try to turn things around.

- Tamir

(Image links to source, under this license.)


Sitting and the risk of cancer

In past blog posts, we’ve discussed the increased risks of heart attacks and strokes that result from sitting too much. Well, there’s more bad news. Those who sit the most, especially while watching television, are at an increased risk of several different cancers as well.

A large study published in the Journal of the National Cancer Institute looked at data from dozens of studies investigating correlations between sedentary behaviors and cancer. The authors found that people who were most sedentary had a 24% higher risk of developing colon cancer, a 32% higher risk of endometrial cancer (cancer of the womb), and a 21% higher risk of lung cancer compared to those who were least sedentary. In addition, when the authors looked at cancer risk in terms of total time spent watching TV, the results were even worse – a 54% higher risk of colon cancer for those watching the most TV and a 66% higher risk of endometrial cancer. Presumably, TV watching was probably associated with other unhealthy behaviors such as eating too much junk. Every 2 hours a day spent sitting increased the risk of colon cancer by 8% and endometrial cancer by 10%.

People who sat all day fared poorly even if they exercised every day. It seems that sitting/not moving in and of itself is really bad for the body – so much so that the 30 minutes on the treadmill, while healthy, does not cancel out the ill effects of being sedentary.

What does this mean for us? If you have a job where you literally sit all day in front of a computer, then you need to do your best to get up and move around several times a day (set a timer to remind you). If your office or company is more progressive, then perhaps they won’t mind a standing desk or even one with a treadmill (I know, I know, that’s probably not happening).

While you’re not at work, don’t plop down in front of the TV for hours. If you must watch TV, then work out while watching your favorite shows, and be mindful not to over eat.

- Tamir


John Oliver Discusses the Supplement Industry

Starting with a look at the Dr. Oz Congressional hearing, John Oliver delivers a good monologue on the problems with dietary supplements and the industry that promotes them.

Just a heads up – there are occasional moments of “naughty language” (a word here and there), so you may not want to play this at work (where you should be hard at work anyway and not watching videos, right?)


- Hila


June 2014 Workout of the Month

Once again I’m providing 2 sample exercise programs – one more strenuous, one less strenuous. The workouts can be done as a stand alone program, or can be incorporated into an existing workout program. They are meant to be simple, requiring your own bodyweight or very basic equipment, but are comprehensive in that they cover most of the muscle groups and provide both strength and aerobic benefits.

Before you undergo any new exercise program, with the exception of light walking, get clearance from your physician. This is especially true if you are over 35, have a family history of heart disease or sudden death at a young age, smoke, or have other medical problems such as heart disease, diabetes, high blood pressure, arthritis, back pain, neck pain, knee pain, shoulder pain, etc.

If there’s any exercise that you are not sure how to do, seek guidance from an experienced person or trainer. You can look up any exercise on YouTube, etc. If any exercise feels wrong to you or is causing sharp pain, then do not do it. If I don’t mention a specific number of repetitions, then do as many as you can comfortably without excessively straining. Try to increase the number of repetitions every week by 2. If lifting weights, increase the weight by 2-10 pounds depending on the exercise and your level of fitness.

Since the weather is nice outside, let’s make this month’s workout outdoor based. Just don’t forget to bring plenty of water and preferably try not to work out from 10am to 3pm in direct sunlight to avoid heatstroke.

Program #1 (more strenuous)

Days 1,3,5

  1. Wind Sprints or Hill Sprints alternated with “clap” push-ups – after each sprint, do as many of the push-ups as you can do. Walk back to the starting position and repeat for 8-10 sets.
  2. Sandbag carries – Fill up a duffel bag with 100-150 pounds of sand, and carry it as far as you can any which way you can. Rest for a minute, and repeat for 3 sets.
  3. Frog hops – 5 sets with a minute rest between sets
  4. Sandbag overhead presses – fill up a large back pack with sand. Lift overhead as amy times as you can. Repeat with the other arm. Do 3 sets with each arm without rest between sets.

Days 2,4,6

Super Nature Hike – Find a natural park/reserve. Use common sense and safety precautions (avoid touching poison ivy, going where snakes or ticks might be). This regimen works as follows: You start with a brisk walk for a few minutes to warm up. From here on, alternate sprinting with walking. Along the way, if you come across a medium size rock, pick it up and lift it over your head as many times as you can. If you come across a sturdy branch, do as many pull-ups or chin-ups as you can. Sprint up any hill you encounter. Try to push or roll any log that you can manage. In addition, any log or rock you encounter jump over back and forth as many times as you can.

Day 7 – rest or brisk walk

Program #2 (less strenuous)

Days 1,3,5

  1. Swim laps for 20-30 minutes. Try different strokes.
  2. Bodyweight squats – 3 sets with a minute rest in between

Days 2,4,6

  1. Outdoor hike – find a natural park/reserve, preferably one that has hills. Use common sense and safety precautions (avoid touching poison ivy, going where snakes or ticks might be). Hike at a brisk pace. Whenever you encounter a large rock or log, do a set of push-ups against it. Every few minutes or so, when you come across a tress, try to push or pull against it as if you are attempting to uproot it.
  2. 3 sets of straight punches alternated with 3 sets of straight kicks. If needed, rest a minute between sets.

Day 7 – rest or brisk walk


- Tamir


Are e-cigarettes really going to help you quit smoking?

Disposable E-Cigarette

As the debate rages on regarding what if any role e-cigarettes have in smoking cessation, a new study, published in JAMA Internal Medicine casts doubts on their efficacy.

The authors looked at over 900 people who participated in an online survey regarding smoking behavior. 88 of those people had used e-cigarettes, most in the hopes that it would help them to quit. After a year, the e-cigarette users were no more likely to have quit or cut down on smoking than non-users. The study quotes a couple of other studies showing similar results, including a study done on quit-line users which found that those using e-cigarettes were less likely to have quit at 7 months.

The bottom line is that as of this writing, it’s probably best to stick to smoking cessation modalities that have been proven to work instead of turning to e-cigarettes. If nothing else is effective, then perhaps there’s room for further discussion about e-cigarettes.

- Tamir

(Image links to source, under this license.)


What’s in a cigarette?

Although all of us conceptually know that smoking is harmful, it’s hard to imagine the damage done to the body when you’re in good health and seem to be experiencing no ill effects from your cigarette habit.

A brilliant new graphic from Smoke-Free Forsyth, a webpage advocating smoking cessation for residents of Forsyth County, North Carolina, breaks down many of the harmful chemicals and substances in a cigarette in terms we can understand and relate to. Many of us have heard of these noxious chemicals in other contexts. Click on the link for the full list, but among the worst things found in cigarettes (quoted verbatim from the site):

Arsenic – used in rat poisons
Carbon monoxide – poisonous gas
Cyanide – deadly poison
DDT – a banned insecticide
Formaldehyde – used to preserve dead specimens
Lead – poisonous in high doses

Perhaps if you’re trying to quit, the next time you take a long drag on a cigarette, close your eyes and visualize the above ingredients making their way into your lungs and from there permeating your entire body and destroying it.

- Tamir


Sunbathing and mortality: Weighing different risks

Most of us have been taught to avoid the sun due to concerns over skin cancer. UV radiation from the sun can indeed cause damage to the skin, which down the line can lead to skin cancer.

Types of skin cancer

The most common skin cancers, basal and squamous cell carcinomas, are, for the most part, unlikely to kill someone. Due to their intrinsic characteristics, and due to the fact that they cause unsightly skin lesions which prompt treatment, they are unlikely to progress to a point at which they spread throughout the body and become deadly. On the other hand, melanoma, a third type of skin cancer, CAN be deadly and spread throughout the body. Furthermore, melanoma often starts as a small abnormal mole which many people can miss or pay little attention to.

But what about too little sunlight?

Lack of sunlight leads to deficiency in vitamin D. It’s quite hard to obtain vitamin D solely through diet since it isn’t found in any significant amount in most foods. Sunlight and supplements are pretty much the only way to obtain enough.

Low vitamin D levels may increase the risk of dying from heart attacks, strokes, and certain cancers, including . . . melanoma. I know this sounds odd, but it seems that sunburns/too much sun exposure increases the risk of a less aggressive form of melanoma whereas low vitamin D levels increase the risk of the more aggressive type.

A recent study published in the Journal of Internal Medicine lends further credence to the idea that some sun exposure is quite healthy. The study followed close to 30,000 women aged 25-64 for over 20 years, and found that those women who avoided the sun had approximately DOUBLE the risk of dying compared to those who had the highest sun exposure. Furthermore, with the exception of women who used tanning beds, the risk of developing melanoma or dying from it was not higher in the sun exposure group, presumably because of what I stated above that lack of sunlight (leading to low vitamin D levels) increases the risk of more aggressive types of melanoma.

The bottom line

I am NOT suggesting based on this study to go lie down on the beach all day and get burnt to a crisp. However, being deathly afraid of every little ray of sun and walking around slathered in sun tan lotion with a large brimmed hat for every short outdoor excursion seems harmful to one’s health.

There is no way for me to tell you exactly how much sun exposure is ideal. That is based on how dark your skin is and how powerful the sun’s rays are based on where you live and what time of the year and day it is. A simple way of gauging whether or not you are overdoing it is sunburn. If you are frequently getting sunburned then you are overdoing it and running the risk of skin cancer. However, if your skin gets a little color, then you probably hit the nail on the head.

One last note – in the winter in some areas of the world it is virtually impossible to have enough sun exposure to make adequate vitamin D levels. So it’s probably a good idea to take supplements. This also hold true for those of you who are never in the sun.

- Tamir