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

E-cigarette Poisoning

The jury is still out as to what role (if any) e-cigarettes have in smoking cessation. However, it’s clear that their use has skyrocketed in the past few years. With the increased use, a new problem has surfaced – nicotine poisoning.

E-cigarettes contain liquid nicotine, which can be ingested. (Of course inhalation can also result in poisoning.) In 2010 it was rare to have a case of nicotine poisoning from e-cigarettes. Most cases were from accidental ingestion of cigarettes by children. Today, over 40% of the cases are caused by e-cigarettes with more than half the cases occurring in children under 5. Since e-cigarettes come in different shapes and colors, they can often seem appealing to little kids.

Symptoms of nicotine poisoning include nausea, vomiting, malaise, headache, rapid heart rate, elevated blood pressure, and sweats, but in severe cases can result in seizures and even death.

So if you’re currently using e-cigarettes, especially if you have children, keep them in a secure location. Better yet, quit altogether. There’s still no good evidence that they help people quit smoking.

- Tamir


Smoking damages sense of taste

Photo by Sarah Gordon of one of the Bloomington, Indiana brains

By now, most people know about the well-publicized harmful effects of smoking such as heart disease, cancer, and strokes. However, there are many “quality of life” problems that smokers suffer. They tend to be more short of breath. They tend to catch more respiratory infections. Their teeth tend to be yellow. They don’t tend to smell too good. They’re more prone to wrinkles.

A new study published in Chemosensory Perception shows smoking also affects how we taste food.

The authors performed taste tests on hundreds of volunteers comprised of smokers, ex-smokers, and non-smokers. The volunteers were given small amounts of salt, sugar, vinegar, and caffeine to test their ability to detect salty, sweet, sour, and bitter tastes respectively. While there were no pronounced differences between smokers and nonsmokers with respect to salty, sweet, and sour, smokers were twice as likely as non-smokers to not recognize bitter correctly (26.5% versus 13%). What was disturbing was that among ex-smokers, close to 20% still mislabeled the bitter group, suggesting that smoking might permanently damage your sense of taste. This would depend on how long and how much you’ve smoked before quitting.

So if you currently smoke and aren’t too worried about having a heart attack or cancer later in life, perhaps permanently damaging your sense of taste might be a motivator to quit. After all, I know that many of you who enjoy that morning cigarette, enjoy it with your morning coffee – precisely the type of beverage whose bitter taste gets affected by smoking.

- Tamir

(Image links to source.)


The link between waist circumference and disease

Waist circumference

In much of the medical world, obesity is defined by a calculation known as the Body Mass Index (BMI). BMI = one’s mass in kilograms divided by one’s height in meters squared. Basically, a BMI of 25 to 30 is considered overweight, 30 to 40 is obese, and 40+ is morbidly obese.

Although BMI is a decent measure of obesity, it can be misleading in many people who are either muscular with very little body fat, or in those with very little muscle mass and a pot belly. In the former category, which applies to many athletes, a person would be considered obese despite having minimal body fat due to the weight of his or her musculature. In the second group, a person would technically fall into a normal BMI range despite having a gut; this is due to them having very little muscle mass.

Therefore, a somewhat better indicator of obesity would be waist circumference. Indeed, a recent study from Mayo Clinic Proceedings shows that across a wide range of BMIs (20 to 50), both men and women with the largest waists had a significantly higher risk of dying younger mainly from heart disease, lung disorders, and cancer than those with small waists. The authors of the study pooled data on over 600,000 people from multiple studies covering an average of 9 years of follow up.

Men with a waist circumference of 43 inches or higher had an over 50% higher death rate than men with waists of under 35 inches. This translated to a life expectancy of 3 fewer years. Women with a waist circumference of 37 inches or more had 80%!! higher risk of death compared to those with a waist under 27 inches, translating to 5 fewer years of life.

We now know that it’s belly fat per se that’s linked to heart disease, diabetes, certain cancers, etc. Waist circumference is also a simple goal to reach for, and something that most people can easily grasp and visualize, unlike BMI which we equate with grade school math. Furthermore, those of you who are thin but have a pot belly still run many of the same health risks as heavier people despite having a normal BMI.

- Tamir


In denial

A common reaction I see when interacting with patients is denial. Let’s use a a couple of examples from my practice to drive home the point. (Names and other identifying features have obviously been changed to protect the identities of the patients.)

Case 1:

John, a pleasant 60ish year old gentleman, has been smoking up to 4 packs of cigarettes a day for decades. He was diagnosed with emphysema (a condition in which the parts of the lungs that help absorb oxygen are basically destroyed, causing shortness of breath) a few years ago, which caused him to cut down to roughly 3 packs per day. As you can imagine, emphysema is not his only medical problem. He’s chronically short of breath, fatigued, and forever catching respiratory infections. Yet in spite of it all, he refuses to acknowledge cigarettes as the top cause of his many ailments. Instead he’ll blame stress, or his diet, or side effects of medications. Sometimes he’ll simply question why we can’t find a cause for his poor health. I’ve tried to convince him to quit several times, but he’s concerned about the possible side effects of the various smoking cessation medications (as if smoking multiple packs a day is safer than any possible side effect of a medication). At the end of the day he’ll quip, “Yeah, yeah, I know I have to quit . . . but let’s get back to what’s going on with me. Why can’t I breathe well? Why am I so tired?”

Case 2:

Stacey, a bubbly 35-year-old lady, weighs in the vicinity of 280 pounds at a height of 5 feet 2 inches. She suffers from sleep apnea (a condition in which the airway becomes blocked throughout the night, causing the breathing to transiently stop or slow down – long term this damages the heart and lungs and can cause people to feel fatigued and wake up with headaches). She also has heartburn, knee pain and shortness of breath. Her blood sugar is on the high side, as is her cholesterol and blood pressure. Both of her parents have diabetes. Yes, she discusses losing weight in a sort of abstract manner. However, even though all of her problems are related to her weight, she always seems to blame them on other factors such as stress, a poor mattress, bad shoes, eating too much spicy food, etc.

Often, people who engage in unhealthy habits such as eating too much junk or smoking will blame the negative impact these behaviors have on their health on other, at times ridiculous, factors. Maybe admitting that their unhealthy habits are contributing to their poor health means that they’ll have to face up to the difficult decision to quit smoking or change the way they eat.

If this sounds like you, then it’s high time to take a hard look at where your life is likely headed. If you’re slowly smoking or eating your way to an early grave, then it’s better to tackle these bad habits now, even though it may be uncomfortable, rather than wait for something truly bad like cancer or a heart attack to strike.

- Tamir


An Inspirational Story

Often, when we’re stuck in a rut, it can become really hard to see the possibility of change. Maybe you’re overweight and don’t see how you’ll ever shed the weight. Maybe you’ve tried to quit smoking multiple times without long-term success.

One way to be inspired and persist is through learning about others who have overcome obstacles to achieve success and happiness.

I came across the following story in the British website, DailyMail. You can read the article yourselves; summing it up in a couple of sentences won’t capture its essence. Basically, the take home messages are that as long as you’re alive, it’s never too late to improve; if you really want something, persist at it; and success ultimately comes down to you. Inspiration and support from other people can help, but ultimately, it’s up to you.

- Tamir


Losing Weight with Friends

Losing weight with friends

Losing weight can be difficult. Even when if you initially lose the weight, as time goes on, it often starts to pile back on (for a variety of reasons).

A recent survey suggests losing weight with a friend as one strategy that can increase the chances of weight loss success.

In the survey, only 1 out of 5 people were able to keep the weight off after a month when going at it alone, as opposed to 1 in 3 when losing weight with a friend. There were several reasons attributed to the higher success rate, including being more motivated, not wanting to let their friend down, and not wanting to remain overweight while their friend looked slim. 71% of those surveyed stated flat out that they were more likely to lose weight if they did it with a friend.

The most important qualities in choosing a weight loss buddy included having someone who is reliable, someone who will work out with you, someone who will be tough on you if you cheat, someone who lives close to you, and someone you can celebrate with when you succeed.

For similar reasons, I’ll propose that when quitting smoking, it may be worthwhile to try it with a friend who currently smokes. Someone who’s addicted to cigarettes knows how tough it is; they can empathize. Furthermore, the qualities that make a person an ideal weight loss buddy can also make them ideal partners for smoking cessation.

So as soon as you finish reading this, go ahead and call your friend…

- Tamir

(Image links back to source.)


How writing things down can make you a healthier person

In our book and our blog, we discuss various ways to implement healthy changes into our lives. One way to help make these changes is by writing things down, whether on a mobile device, desktop computer, or paper, it doesn’t matter.

Writing things down


Many successful dieters keep a food journal, keeping track of what foods they consume. This provides an objective, birds’ eye view of your diet that can help you spot any junk food that creeps in. If you have to write down that candy bar or bag of chips you’re about to eat, maybe you’ll think twice and choose a healthier food. You could also keep track of the time of day you’re eating; there may be times when you have much stronger cravings for junk food, and you need to be aware of when and why.

Furthermore, many nutritionists use food diaries to help people change their diets. Due to a lot of confusing information out there, many people who believe they’re following a healthy diet may actually be derailing their efforts by inadvertently consuming unhealthy food. The nutritionist will look at the food diary and point out specific changes that can be implemented as improvements.


Writing down exercise routines can give you structure when working out. Whether you work out in a gym or at home, starting a workout with a concrete plan is often a more efficient way to exercise than wandering aimlessly from the exercise bike to the dumbbell rack, unsure how or where to proceed. In addition, writing down how fast you ran, how much weight you lifted, how many push-ups you were able to crank out gives you specific targets to try to surpass at the next workout.


Again, writing down a specific plan when trying to quit can allow you to have an objective look at the situation. You may find holes in your plan that reduce your chances for success. In addition, keeping a journal of your path towards quitting can be good positive reinforcement – you can see where you started and how far you’ve come.

Stress and mental health

Many mental health professionals have patients write down their thoughts, feelings, and attitudes as part of therapy. But even for people who aren’t in need of professional help, writing things down can in many ways be cathartic.

For example, let’s say you’re very upset at something that occurred at work. A coworker, or perhaps your boss, wronged you. You feel like going to them and telling them off. Or maybe a sharply worded e-mail is the way to go. Instead of doing anything rash, write down what you want to say to the person who wronged you. Don’t spare a detail. They were rude, obnoxious, hurtful. They deserve to be treated the way they treat others. You feel like punching them out. When you finish, look at what you wrote down. Often, the act of having written down your anger will help to calm you and make you realize that doing something over-the-top not only won’t help, but may in fact get you fired. (Just make sure to destroy what you wrote when you’re done so that it doesn’t somehow surface on your boss’s desk.)

Happy writing!

- Tamir

(Image links to source.)


Taking responsibility and combating common excuses

Many people who engage in self-destructive behaviors such as smoking, eating a poor diet, and not exercising, or even worse, abusing drugs or alcohol, are often so entrenched in their unhealthy lifestyles that they seem resigned to the idea that things will never change for the better.

For example, many people will blame their lack of exercise on long work schedules. Some will blame their continued smoking on stress. Others will overeat because they feel depressed. This may sound a bit harsh, but in most cases, these are all poor excuses. These circumstances don’t have to condemn you to an unhealthy life. And ultimately, the changes need to come from you.

Let’s look at some examples:

“I work long hours so I have no time to exercise”

On the surface, this seems legitimate. After all, if you wake up early, work a very long day, then come home at night exhausted (and perhaps do chores, spend time with your family, etc.) then how or when will you work out?

However, if you break down your day, you’ll see that you can quite readily fit exercise into almost every day. You can wake up 10 minutes earlier (which won’t significantly cut into your sleep) and do some calisthenics (push-ups, squats, jumping jacks), shadowboxing, or, if you have a treadmill do a quick intense workout (sprinting or fast walking). Take a quick shower, and just like that, you’ll probably feel energized, happy, and ready to take on the day.

During lunch, go on a brisk walk, or, if it isn’t feasible to walk outside, then perhaps walk up and down the stairs, do some isometrics at your desk, etc.

When you come home, either do another quick workout such as the morning one, or, incorporate physical activity into your family time. Shoot some hoops with your kids. Run around. Kick a soccer ball. Go on a brisk walk with your spouse. Anything besides plopping on the couch to watch television. On the weekends, when you have more time, do a longer workout of 45 minutes to an hour. Before you know it, in spite of your long work schedule, you somehow managed to fit in plenty of exercise.

“I’m smoking because I’m stressed out”

This is, in a way, a lame excuse. If you have a lot of stress, then do something about it.

Maybe you’re stuck in a situation in which the stress is constantly there (a mean boss, a sick loved one). Even in those situations, learn how to deal with the stress in a healthier manner. Exercise. Meditate. Try deep breathing exercises. Seek professional help from a therapist or psychiatrist. Continuing to smoke won’t make your stress go away or improve. In some ways, it may worsen it, since the nicotine withdrawal you feel between cigarettes will actually make you more agitated.

Also, passivity often keeps us from changing our lives positively. For example, if you have a horrible job, then perhaps look for a new one. Sometimes a pay cut may be worth having a less stressful job. If you’re stuck in an unhappy marriage, then seek professional help, or, if unfortunately things are absolutely awful then consider ending the relationship. Do what you can to change your life for the better. Your life is worth the effort.

“I’m binging out of depression”

This too is a very common scenario which unfortunately is misguided. I’ve personally had patients who’ve gained a tremendous amount of weight due to “comfort eating.” The same advice that applies to people who smoke out of stress applies here. Seek professional help. Depression is treatable. It’s a shame that people will spend years suffering and ruining their health instead of treating their depression.

The bottom line is that we’re often stuck in less-than-ideal situations in life. The easy thing to do is to engage in self-destructive behavior and put all the blame on your circumstances. However, though it takes more effort and planning, stepping up to the plate and taking responsibility for yourself is ultimately the way to go.

- Tamir


Older athletes: 10 amazingly athletic women over 60

Elderly women aren’t usually known for feats of physical prowess. They may stay active and carry out remarkable achievements in other areas; famous examples include Dr. Brenda Milner, the neuropsychology pioneer who still conducts research in her nineties, and Grandma Moses, a folk artist who took up painting in her seventies. But when it comes to physical activity, the most strenuous thing we think elderly women can do is knit an afghan. And yet, there are women who keep themselves in remarkable physical shape as older athletes. They set new athletic records and stay fitter than people decades younger.

If the following ten women inspire you to launch into a new fitness regimen, make sure you get medical clearance first.

(No joke. If you’re planning on an exercise routine that’s more strenuous than light walking, you really should see a doctor first; the risk of strokes, fractures, etc. is real, especially if you have a pre-existing medical condition such as weakened blood vessels or arthritis. Also, some of these women are truly extreme athletes who put their bodies through punishing physical feats.)

The good thing is, getting fit isn’t an all-or-nothing endeavor; even if you don’t wind up doing triathlons in your eighties, you can still enjoy better health by eating nutritious food and moving more.
Continue reading


Our kids are in worse shape: Physical fitness in decline among kids

Although we’ve generally made great strides in many areas of health and medicine in the past 20 years or so, in some areas we’re doing worse.

Fewer people smoke cigarettes today than years ago. We have medications and other treatments for diseases that a generation ago would have been a death sentence: diseases such as AIDS, certain cancers, and heart failure.

However, we’re losing the battle of the bulge. Obesity rates remain high, and a more worrisome trend is that many of our children are obese. In my own practice, it isn’t rare for me to see teens with high sugars, fatty liver, high blood pressure, back pain, high cholesterol, and other conditions that we tend to associate with people in their 50s or older.

Physically active kids

A recent study presented at the American Heart Association conference shows that on average, kids today are about 15% less fit than their parents were. The authors of the study looked at data spanning over 4 decades covering 25 million children aged 9-17. The studies focused on running fitness, roughly defined as how fast one could run a set distance or how far someone could run in a set time. The United States fared a bit worse than other countries.

It’s hard to know what specific factor is leading to this; the most likely explanation is a combination of things including increasing obesity rates and decreased physical activity. I remember as a child playing sports during recess and lunch in addition to gym class. Furthermore, after school we often played sports and at times I was a member of a team. Yes, I played some video games and watched TV. However, I was definitely active, even though I wasn’t by any means a star athlete (in fact I was mediocre in most sports – though I do remember holding the title of class tetherball champion for a few weeks in 6th grade).

In contrast, today most children are much less active. Many schools have drastically cut back on gym classes. More and more time is spent on the computer, in addition to time spent watching TV. This doesn’t bode well for the next generation. Unfortunately, some of the gains that we’ve made in life expectancy might be reversed if things don’t change.

So what’s the take home message for you? If you have kids (or nephews, nieces, etc.), then set a good example. Instead of a family night where you plop down on the couch and watch a movie, why not throw around a football, shoot some hoops, or play tag? Go on a family hike or bike trip. In addition, if you smoke and have children, consider quitting. The last thing you want is for them to see it as “no big deal” and smoke themselves. If they aren’t physically inclined, then at least limit the time they spend watching TV or being on the computer, both of which have been linked to obesity. And again, don’t preach what you don’t practice – cut down on your own TV and computer time. If your children see you working out and making physical activity an important part of your life, they may be more inspired to do the same.

- Tamir

(Image links to source: UWNutrition Program.)