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

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


Exercise Improves Chances of Cancer Survival

In our book and blog, we repeatedly plug the multiple health benefits of engaging in regular exercise. A new study in the Journal of Physical Activity and Health shows that this holds true in cancer survivors as well.


Some people, when faced with a cancer diagnosis, will do their best to treat the cancer with surgery, chemotherapy, and/or radiation, but will otherwise neglect their diets and physical activity levels. In some cases, they’ll also continue to smoke. This is due to the mistaken belief that once someone has cancer, there’s no point in changing lifestyle habits that are usually thought of as preventative measures.

However, there’s strong evidence that quitting smoking, even after someone is diagnosed with different cancers, can both prolong life and improve quality of life. The study mentioned here shows that the same is true with exercise.

The researchers followed a cohort of over a thousand men (average age 71) who were diagnosed with different cancers. Through questionnaires, the researchers determined the men’s physical activity levels. The results were quite impressive. Those who burned over 3,000 calories a week had half the death rate of those who burned fewer than 500 calories weekly! Even those who burned between 500 and 1,000 calories weekly saw a 23% reduction in mortality.

Although unfortunately this study only looked at men, there’s no reason to suspect that the same wouldn’t hold true in women.

None of us should ever experience cancer; that’s our fervent hope. However, it’s worthwhile to have the knowledge that aside from standard treatments, there’s an aspect of cancer prognosis that people have control over. Lifestyle choices matter.

- Tamir


Even one a day is bad

As we’ve discussed in our book and blog, there’s a misconception that light smoking (smoking a few cigarettes a day) isn’t too bad. After all, many other unhealthy things we do in moderation are probably not too bad. For instance, if someone who has an otherwise healthy diet and is physically active indulges their sweet tooth a little with a cookie or a candy bar here and there, for the most part, it probably won’t affect their health too much.

Woman smoking

Not so with smoking. I’m not going to suggest that smoking 1 or 2 cigarettes a day is as bad as smoking 2 packs, but its harmful effects are proportionally much worse than almost any other unhealthy habit. New research from University College London shows that people who smoke as little as 1-4 cigarettes daily TRIPLE their risk of having a heart attack.

Only 1 in 7 light smokers felt that they were addicted, but only a quarter believed that light smoking significantly impacts one’s health.

So, if you’re a social smoker, or like to have one in the evening with a beer (or one in the morning with your coffee), then at the very least know that it’s harming your body much more than you may realize. Maybe this will spur you to quit completely. Because you smoke so little right now, it will probably be much easier to quit than if you were puffing away on one or two packs a day. Furthermore, many light smokers only do it for social reasons, such as when they go out with friends. Otherwise, smoking isn’t a part of their daily routine. If this describes you, then by tweaking your social life a bit (e.g. hanging out in smoke-free areas), quitting should really be no big deal.

- Tamir

(Image links to source: Wikimedia Commons.)


2014 Surgeon General Report: Smoking increases the risks of these diseases…

Surgeon General Warning

In our book as well as our blog, we have discussed the many different diseases that have been linked to smoking. The 2014 Surgeon General Report, which recently came out, updates its list of different diseases that smoking increases the risk of developing.

Let’s start off with diseases that were on the list before this new report. If you smoke, you may want to sit down for this one. Here goes:

Throat cancer. Laryngeal (voice box) cancer. Esophageal (the tube connecting the throat to the stomach) cancer. Cancer of the airways. Lung cancer. Stomach cancer. Acute Myeloid Leukemia (a type of blood cancer). Pancreatic cancer. Kidney cancer. Cervical (the junction between the vagina and the womb) cancer. Bladder cancer. Stroke. Blindness. Cataracts. Gum and dental disease. Aortic aneurysm (a weakening of the main blood vessel delivering blood from the heart to the body; this increases the risk of a catastrophic rupture). Heart disease. Diseased blood vessels. Pneumonia (lung infection) and other respiratory infections. Asthma. Chronic obstructive pulmonary disease (COPD) – a condition in which the lungs are slowly destroyed, leading to slow death by suffocation. Reduced fertility. Hip fractures. Overall poor health and quality of life.

This list already sounds pretty bad, right? Well, it’s now known that smoking increases the risk of the following conditions as well:

Liver cancer. Colorectal (large intestines and rectum) cancer. Age related macular degeneration (a leading cause of blindness). Birth defects. Tuberculosis (a particularly nasty, hard to treat infection). Diabetes. Ectopic pregnancy (a condition in which the embryo implants outside of the womb, which can cause major problems). Erectile dysfunction. Rheumatoid arthritis (a condition in which the immune system attacks and destroys the joints). A weaker immune system.

The report didn’t mention cosmetic problems such as increased wrinkling, yellow teeth, and bad breath, which have also been linked to smoking.

Hopefully this will be enough to at least give you pause before you next light up. Maybe you’ll even consider quitting.

- Tamir


Vitamin E Intake Among People with Alzheimer’s

Preventing or fighting Alzheimer's

Alzheimer’s disease, the most common form of dementia, is a scourge that as of this writing, has no effective cure. The few medicines that are available don’t work that well and often have multiple side effects. Families and caregivers of people with Alzheimer’s who expend a lot of both physical and emotional exertion in taking care of their loved ones are often left frustrated by the lack of effective treatment.

Can Vitamin E Help People Who Have Alzheimer’s?

Recently, a new study shows that vitamin E, a cheap, readily available supplement, has something new to offer. The two year study published in JAMA followed roughly 600 people with mild to moderate Alzheimer’s dementia. The participants were divided into 4 roughly equal sized groups and received either high dose vitamin E (2000 IU daily), memantine (a dementia medication otherwise known by its brand name Namenda), a combination of both vitamin E and memantine, or placebo (a fake pill containing no active ingredients).

People in the vitamin E group experienced an approximately 20% decrease in cognitive decline, which roughly translates into 6 months. No such benefits were seen in the other groups (including the combination group, which, perhaps means that memantine and vitamin E may somehow counteract each other’s effects). Although the results weren’t amazing, in a disease such as Alzheimer’s, in which we don’t have much to offer, it’s quite impressive. Furthermore, high dose vitamin E seemed to be quite safe – no major side effects were noted.

Does This Mean You Should Take Vitamin E to Prevent Alzheimer’s?

For those of you who may be thinking of taking vitamin E to prevent dementia, don’t waste your money. Previous studies have shown that it doesn’t work. Furthermore, vitamin E doses of over 400 IU a day may increase mortality.

The bottom line

The results of this study are very specific to people who currently suffer from mild to moderate Alzheimer’s dementia. If that includes you or a loved one, then consider discussing with your physician the initiation of vitamin E (it isn’t a good idea to start on your own volition – there are some medications and/or medical problems that may make high dose vitamin E unsafe).

For the rest of us, it still comes down to prevention. Smoking cessation, a healthy diet, regular exercise, and taking care of your blood pressure, cholesterol, and blood sugar are still the best (and only) way we have to prevent dementia.

- Tamir

(Image links back to source.)


New hypertension and cholesterol guidelines

Blood pressure readings

If you’re one of the millions of Americans who suffers from hypertension (high blood pressure) and/or high cholesterol, then listen up. Over the past few weeks, the treatment guidelines and recommendations have changed quite drastically.

Cholesterol Guidelines

Let’s start with the cholesterol guidelines. In the past, doctors were mainly concerned with specific cholesterol numbers (you may recall your doctor discussing your “good” and “bad” cholesterol). Well, for the most part, unless your cholesterol is super high (which is rare), then the recommendation to take cholesterol medicine is largely based on a person’s risk of having a heart attack or stroke over the next 10 years.

Furthermore, for the vast majority of people under the age of 40, there’s rarely a reason to be on cholesterol medicine unless the person already has heart disease, or, as I mentioned above, their cholesterol is very high. For people over 40, medication is recommended for those whose 10 year risk is 7.5% or higher. What goes into calculating the risk? There are online risk calculators which factor in traditional heart disease risk factors such as smoking, diabetes, high blood pressure, high cholesterol, and age.

What does this mean for you? If you’re currently over the age of 40 and don’t have heart disease or diabetes, then depending on your other risk factors, you may not need to take cholesterol medicine, even if your cholesterol is on the high side. You shouldn’t stop the medicine by yourself; rather, schedule a follow up with your doctor to see if you still need to be on medicine. If you do smoke, then strongly consider quitting, which may drop your 10 year risk to less then the 7.5% threshold.

Blood Pressure Guidelines

Moving on to blood pressure. The new guidelines are not as strict regarding blood pressure treatment goals. For example, in people over the age of 60, the blood pressure to aim for is something less than 150/90 (instead of less than 140/90). In people with diabetes, the new goal is to treat the blood pressure to less than 140/90 rather than 130/80.

This means that if you were having side effects on higher doses of medicine, or if you were on the border of needing medicine, you may benefit. Again don’t make any changes yourself without speaking to your doctor. If you’ve been on the same medications for a while and are doing well with your current regimen, then leave things alone.

The bottom line

The bottom line is not to change anything yourself, but to talk to your doctor. Also, focus on improving your overall risk of heart disease through quitting smoking, following a healthy diet, exercising, and losing weight if you’re overweight. By adopting healthy lifestyle measures, you may be able to stop some or even all of your medications. And if you were right on the verge of needing meds, you may not require them.

- Tamir

(Image links to source: Wikipedia.)


More ways in which maternal smoking hurts newborns

In our book, we discuss the harms of smoking while pregnant and its association with low birthweight, premature delivery, and other complications during pregnancy. These effects are all bad enough. However, it seems that even if the baby survives the pregnancy without any of these problems, he or she is at a significantly higher risk of dying or being seriously ill for at least the next year.

A study published in the Pediatric Infectious Disease Journal examined 17 years of data on hospitalization rates and death rates in babies. They found that in the first year of life, babies born to moms who smoked during the pregnancy were over 50% more likely to die! In addition, they were over 50% more likely to be hospitalized, including a 70% higher risk of hospitalizations from respiratory infections. And in case you were wondering, the authors of the study were looking at healthy, normal weight babies, not small or premature ones.

If you’re a female smoker who’s either considering becoming pregnant or is already pregnant, then I can’t think of a better reason to quit than saving your future child’s life. Even if you aren’t too concerned about your own health, then do it for your unborn kid. Even if it’s hard, and even if you end up failing multiple times, keep at it. Enlist the help of your obstetrician and other health care professionals, friends and family. Your baby will thank you for your efforts.

- Tamir


Dental Health = Heart Health

Dental health is linked to heart health

Among the many terrible effects of regular smoking is its potential to ruin your dental health. Of course, many of you know that smoking will stain your teeth, which looks cosmetically unappealing. In addition, smokers have overall worse dental health.

Some of you may think, “So what? I’ll spend an extra couple of sessions at my dentist.”

The problem is more serious than you think. There’s mounting evidence that poor dental health may kill you, literally. Several studies have linked periodontal disease to heart disease as well as strokes. Among them, a recent study published in the Journal of the American Heart Association measured the rate of plaque build up in the carotid artery (the main artery supplying blood to the brain) and dental health in over 400 people in the course of three years. Carotid artery thickening is a known marker for both heart attacks and strokes. The study found that those with the worse dental health had the most amount of plaque build-up in the artery.

It isn’t conclusively known why gum disease increases the risk of heart disease. Many strains of bacteria found in the mouth are also found in arterial plaques; scientists speculate that their presence causes inflammatory changes that damage the lining of the blood vessels, causing plaque build-up and perhaps clots.

Whatever the mechanism is, the important take home message is to not neglect your dental health. Among the most important changes you can make is to brush and floss regularly, and of course quit smoking if you currently smoke. In addition, regular visits to your dentist can help.

- Tamir

(Image links to source: Wikipedia.)


Antibiotic Overuse and C.diff colitis

Many of you who smoke or used to smoke may be aware that smokers tend to catch more respiratory infections, including some that require antibiotics. In fact, even smoking as little as one cigarette a day can double one’s risk of developing pneumonia. Obviously, the best way to reduce your chances of developing a respiratory infection is to quit smoking. In addition, making sure to get your flu shot. And if you currently smoke or have asthma, diabetes, or certain other medical problems, a pneumonia vaccine can also reduce the chances of developing a serious respiratory infection requiring antibiotics.

Overuse of antibiotics

However, even with these precautions, you could still get sick. One of the biggest problems in this country is the unnecessary use of antibiotics. A lot of it is the fault of physicians, who, pressed for time, or perhaps because of ignorance, prescribe antibiotics for every cold. I suppose that it takes more time to discuss the self-limited nature of most mild respiratory infections with patients than to quickly scribble “z-pack” or some other antibiotic on a prescription pad.

C.diff up close

Resistant bacteria – C.diff

We are reaping the fruits of our bad decisions. The rate of resistant bacteria in the general population has skyrocketed over the past decade. Amongst the most serious infections that we now see is a bug known as clostridium difficile, or c.diff for short. When someone takes antibiotics, many of the “good” bacteria that live in the intestines are wiped out. C.diff, having no competition, is able to settle down and start spreading, causing a severe intestinal infection. Lest you think this is like any other stomach bug in which you have the runs for a few days and then feel better, it isn’t. C.diff can lead to hospitalization, and at times may be fatal. In addition, some people end up needing emergency surgery in which part of the bowel is resected. Others need months of antibiotics due to the relapsing nature of this infection. In some cases stool transplants are needed (yes, it’s what it sounds like – someone else’s feces is transplanted into your colon).

The sad thing is that up until a few years ago, it was rare to see a case of c.diff outside of chronically ill hospitalized or nursing home patients. Nowadays, young and healthy people are showing up with it. Some studies show that for certain antibiotics, the risk of developing c.diff is as high as 5%. This may not sound like a lot, but 1 out of 20 people catching c.diff after being on antibiotics is a very large number due to how many antibiotics are prescribed for respiratory infections, bladder infections, skin infections, etc. every year.

Protecting yourself

So what can you do? First and foremost, try to avoid antibiotics if you don’t need them. If you’re otherwise healthy, then most respiratory infections, including bronchitis, sinus infections, and ear infections as well as regular colds do NOT require antibiotics, even if you’re a smoker. Symptomatic care and time is all that’s needed. If your physician is quick to write you a prescription for one, ask him or her if it’s really necessary. Often, doctors are conditioned to (wrongly) offer antibiotics because they believe that every patient wants it.

If you do need antibiotics (your symptoms are severe, worsening, or haven’t gone away within a couple of weeks, or if you have other medical problems such as emphysema), then take probiotics. Probiotics are healthy bacteria which can replenish what was wiped out by the antibiotic. Some yogurts contain them, but it’s probably more effective to buy a supplement. Take the probiotics while you’re on the antibiotics, and continue them for several weeks afterwards. Don’t take the probiotic at the same time as the antibiotic – rather space it apart at least a few hours. Also, try to buy a formulation that contains several different strains of bacteria, which may make the supplement more effective.

In addition, certain antibiotics such as clindamycin and levaquin are more likely to lead to c.diff. If your physician does recommend an antibiotic, voice your concerns and ask if you can be prescribed an antibiotic which is less likely to lead to c.diff (note that practically ALL antibiotics carry some risk).

Finally, be vigilant. If you develop diarrhea even 2-3 months after having taken antibiotics, it’s a good idea to follow up and be tested for c.diff (this requires a stool test, which at times has to be repeated even several times).

- Tamir

(Image links to source: Wikipedia.)