An essential health resource for current and former smokers

Category Archives: Illnesses And Complications

How many smokers will die of smoking-related illnesses?

A recent study addresses this question, and the findings are grim.

For more details, check out this write-up at the Washington Post.


Is it heart disease?

Heart disease is still the #1 killer in the United States, causing roughly 600,000 deaths. The main risk factors are smoking, diabetes, high blood pressure, high cholesterol, age, and family history of heart disease at a young age. Although you can’t control age or family history, the first four risk factors are in our control through a combination of healthy lifestyle choices and, if need be, medication.

Signs of heart disease

One of the big problems that people face is not realizing the signs of heart disease. Most people know that crushing left-sided chest pain could be a heart attack or angina. Some know that left-sided chest pain radiating to the jaw or left arm can also mean heart disease. But many don’t realize that other common symptoms could be signs of heart disease as well. These include:

  • Heartburn or indigestion
  • Nausea
  • Shortness of breath on exertion
  • Dizziness on exertion

Understanding the symptoms

That’s not to say that if a person has any of the above they for sure have heart disease. Indeed, several benign conditions can lead to these symptoms as well. However, if you experience any of these symptoms during exercise, other physical exertion, or when emotionally upset (say after a heated argument) and they occur on a regular basis, then it’s worth checking out, especially if you have any of the risk factors mentioned earlier in the post. Women, the elderly, and diabetics are especially prone to having atypical symptoms, which is a reason heart disease is at times missed.

Lastly, erectile dysfunction (ED) is a marker for heart disease. If you suffer from ED and you’re in your late 30s or older, then it’s worth mentioning to your physician, and being worked up for elevated cholesterol, sugar, blood pressure, and at times for heart disease as well.

Again, I want to emphasize that you shouldn’t be paranoid and assume every symptom that you feel is a heart attack; however, by being vigilant and pragmatic, you ensure that you will be able to receive proper care and prevent any potentially lethal problems.

– Tamir


A link between cycling and prostate cancer?

In our book and blog – we heavily promote exercise as one of the best ways (along with a healthy diet and quitting smoking) to prevent many different diseases, including heart disease, diabetes, strokes, and certain cancers in addition to improving quality of life and increasing life expectancy.

However, we mention that often doing just one type of exercise, or exercising too much (e.g. marathon running) can at times lead to injury and in the case of doing too much can actually damage the heart and weaken the immune system.

Military cyclists in pace line.jpg

A recent study published in the Journal of Men’s Health shows a correlation between too much cycling and a risk of developing prostate cancer in men over 50. Data from over 5,000 men was analyzed; those who cycled more than 8.5 hours a week were over 6 times likely to report having prostate cancer. Those who cycled over 3.75 hours but less than 8.5 hours a week had an almost 3 fold increase.

The design of this study is such that it doesn’t per se prove that excessive cycling causes prostate cancer. For example, it’s possible that men who cycle more end up having more urological complaints stemming from sitting on a hard narrow seat for too long which leads to medical investigations that uncover cancer. However, the study did show that cyclists were no more likely to contact their primary care physicians than those who did not cycle. Furthermore, excessive cycling has been previously linked to testicular cancer as well as prostatitis (inflammation of the prostate), so that it’s at least plausible that the repeated trauma to the region of the prostate that happens during long bouts of cycling can lead to the development of prostate cancer.

The bottom line is that for now, it isn’t known for sure if too much cycling does cause prostate cancer. However, since it’s possible, and given that the magnitude of the potential harm (over a 6 fold increase in those that cycled the most) is huge, it probably is a good idea to cycle less than 3.5 hours a week and otherwise vary your workouts by incorporating other types of exercise.

– 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


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


New research on Vitamin D and cancer

In our book and blog, we’ve commented on the numerous health benefits of vitamin D. Many people today are vitamin D deficient, some profoundly. This is due to the fact that very few foods contain significant levels of vitamin D. Humans were meant to obtain it from the sun (the UV rays from sunlight hitting our skin causes a reaction which produces vitamin D). Because many of us aren’t exposed to much sunlight, and even when we’re in the sun, many of us slather on a ton of suntan lotion to prevent skin cancer, the end result is wide spread vitamin D deficiency.

Some consequences of low vitamin D levels

Low vitamin D levels have been linked to many poor health outcomes. Two recent studies add to the growing body of evidence.

The first study, published in Clinical Cancer Research, looked at the link between vitamin D deficiency and prostate cancer. They screened 667 men ages 40-79 at high risk for prostate cancer for vitamin D deficiency. In European men, low vitamin D levels were linked to an over three and a half fold risk of having aggressive prostate cancer. In African Americans, the risk was over four fold. Furthermore, vitamin D deficient African Americans had more than double the risk of being diagnosed with prostate cancer.

The second study, published in the Journal of Clinical Endocrinology and Metabolism, looked at data from 25 studies on over 17,000 people who were diagnosed with breast cancer, colorectal cancer, or lymphoma (a type of blood cancer). Those that had the lowest vitamin D levels at diagnosis had a higher risk of dying from colon cancer and lymphoma, and lower disease-free survival from breast cancer and lymphoma.

Are you vitamin D deficient?

It’s a shame that anyone should be harming their health by having undetected vitamin D deficiency. There’s a simple blood test known as vitamin D OH 25 which can be done by any lab and accurately tests your levels. Aim for a level of 40 (although levels over 30 are probably ok as well). Less than 20 is quite low, and less than 10 is very very low – in fact, many people with very low levels feel tired and achy.

Most adults need about 2000 IU a day of vitamin D3 to maintain adequate levels, although this varies widely depending on one’s sun exposure, diet, and amount of body fat. That’s why it’s better to have it checked. Vitamin D is a fat soluble vitamin which means that it does not get absorbed on an empty stomach or with a light snack. It needs a meal that contains some fat.

The one caveat I have is not to overdo it. High vitamin D levels can cause a lot of problems including kidney damage and kidney stones – so more is definitely not better.

– Tamir


Breast Cancer and Physical Activity: Recent Research

In our book and blog, we repeatedly stress the benefits of exercise and physical activity in general. Unfortunately, many people still associate working out simply with losing weight, not realizing its other multiple health benefits. What ends up happening is that people who are naturally thin or of normal weight, and can stay that way without much effort, become lax about incorporating physical activity into their lives. They figure, “I’m thin anyway, why sweat at the gym.”

It turns out that – even if they’re thin – people who don’t move are damaging their bodies. Research links lack of physical activity to a high risk of dying young, suffering a heart attack, stroke, diabetes, colon cancer, and having a weaker immune system. New evidence adds breast cancer to the growing list of diseases potentially caused by being sedentary.

Breast cancer physical activity

A recent study presented at the 2014 International Conference on Obesity questioned close to 20,000 women (average age of 56) about their physical activity levels. 13 years later, they touched base with the participants to check on their overall health. 900 of the women had died during that time. The researchers found that the women who reported the lowest level of physical activity were 40% more likely to have developed breast cancer, irrespective of weight.

Unfortunately, being obese also increased one’s chances of developing breast cancer by close to 60%. The take home message is that if you’re an obese woman, incorporating physical activity into a healthy lifestyle is essential. But even for women who are already of normal weight, resting on your laurels isn’t a great idea either. It’s increasingly apparent that there’s virtually no one on this planet who would not benefit from moving.

– Tamir

(Image links to source.)


Another reason to quit smoking: Your kids’ carotids

Secondhand smoke exposure is a controversial subject. On the one hand, there are those who make it out to be almost as bad as smoking (I’ve even heard people who claim that it’s worse than smoking!). On the other hand, there are those, mostly from pro-smoking groups, who completely minimize any possible danger from secondhand smoke.

The truth is somewhere in between. There’s no doubt that secondhand smoke is nowhere near as harmful to one’s health as actual smoking. However, there are studies that link it to several adverse health outcomes.

A recent study published in the European Heart Journal checked the thickness of the carotid arteries (the main blood vessel supplying blood to the brain) in over 2,000 people. Thicker vessels mean that they’re more diseased with unhealthy plaque that’s clogging them; it’s also a marker for blood vessel health in the rest of the body, including the vessels that supply blood to the heart.

On average, people whose parents both smoked when they were children had blood vessels that were over 3 years older than their peers who grew up in nonsmoking homes. In homes with one parent smoker, the study authors were unable to discern a difference. Perhaps when only one parent is smoking, he or she goes outside or away from others who don’t enjoy the smoke; in contrast, when both parents are smoking they’re likely to both be sitting around the house, such that the children are inhaling more smoke.

Again, if you have children and smoke around them, you’re causing serious harm to their health. It’s already known that children of smokers suffer more asthma, respiratory and ear infections, and are at increased risk of Sudden Infant Death Syndrome. This study adds further damning evidence. So if you’re cool with what cigarettes are doing to you, then fine, continue to smoke. But at least do it in a way that isn’t harming your kids. Then again, even if you smoke away from your young ones, but end up dying at a young age because you smoked, that would devastate your family as well.

– Tamir