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An essential health resource for current and former smokers

SmokersFitness.com - An essential health resource for current and former smokers

Category Archives: Tobacco Cessation

Hookah Research Results

The vast amount of research on smoking has been done on the harms of cigarettes, presumably because they’re the most common form of tobacco use and probably the most harmful. Recently, hookahs have become more popular, especially amongst college age people. In addition, in the Middle East and other parts of the world, hookahs are very popular. Some people are under the impression that hookahs are a safe alternative to cigarettes. They believe that the water filters out a lot of the harmful chemicals in hookahs and that whatever the water doesn’t get, the charcoal will get rid of.

Blue glass hookah

Unfortunately, there aren’t too many studies done on the health effects of hookahs. Although it’s generally agreed that the volume of smoke per hookah session is quite high (in fact, one 40 minute session can result in inhaling as much smoke as dozens upon dozens of cigarettes), the fact that the tobacco is not heated to as high of a temperature as in a cigarette may result in a lower amount of exposure to toxic compounds.

A recent study in Cancer Epidemiology, Biomarkers & Prevention compared the amount of nicotine and various carcinogens inhaled via hookah versus cigarettes, and found that while those who used hookahs had significantly less exposure to nicotine and certain carcinogens, levels of carbon monoxide and carcinogens such as benzene were higher. Benzene exposure for example is linked to the development of leukemia.

The study didn’t measure hard outcomes (i.e. it didn’t compare rates of cancer, heart disease, etc. between hookah users to those that smoke cigarettes). In fact, there aren’t any good, long-term head to head studies addressing this.

A 2010 review from the International Journal of Epidemiology did show that hookah smokers had more than double the risk of developing lung cancer, respiratory infections, and low birth weight babies, and 3 to 5 times the risk of having periodontal disease compared with nonsmokers. Of note, risks of throat and bladder cancers were not higher (which is the case in cigarette users).

The bottom line is that at this time, it’s unclear if hookah smoking is any better than smoking cigarettes. And even if it is, it certainly isn’t a safe habit, exposing the body to many harmful substances and increasing the risk of developing lung cancer and other diseases.

So if you do currently smoke a hookah as a safe alternative to cigarettes, quit, and take up a healthier habit (join a gym, play sports, take up gardening etc.)

- Tamir

(Image credit: Psych Central)

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Varenicline Update

Let me preface this post by stating that I have no financial or commercial ties to the manufacturer of Varenicline. This is written purely for the benefit of anyone who’s trying to quit and wants to know more about the different options out there.

Varenicline (otherwise known as Chantix in the United States and Champix in several other countries) remains one of the main medications that we use to help people quit smoking. A couple of years ago, questions were raised regarding a possible increased risk of heart attacks amongst users of Varenicline, based on a study in the Canadian Medical Journal.

Subsequently, the FDA issued a warning stating that Varenicline may be associated with a small risk of heart attacks in those who have heart disease.

In our book, I mentioned that due to the possible increased risk of heart attacks, I tended to shy away from using Varenicline in people with established heart disease.

Since then, more recent data from 2 separate studies published in the British Medical Journal,

1) Svanström et al (2012)

2) Prochaska & Hilton (2012)

did NOT show any significant association between the use of Varenicline and heart disease (although it’s worth noting that the study by Prochaska and Hilton did show a trend towards increased risk, though it didn’t reach statistical significance – which means that the small increased risk may have been due to chance). Furthermore, several people criticized the methodology of the original study condemning Varenicline.

So, where does this leave us? Varenicline probably doesn’t significantly increase the risk of heart attacks, even in those with heart disease. However, it’s impossible at this time to 100% exclude such a risk. On the other hand, MANY people who smoke will end up having a heart attack, and quitting smoking is probably the single best thing they can do to decrease their risk of having a heart attack. Therefore, if I have a smoker with heart disease who wants to quit smoking, in most cases I will probably offer other options first, but when push comes to shove, if Varenicline is the only thing that works, or if it has worked well for the patient during past quit attempts, then I have no problem offering it to them after a discussion of the risks and benefits.

One final note. In our book, I mentioned that Varenicline is associated with gastrointestinal side effects such as nausea, and that it does run a small risk of having people become depressed or even suicidal (which I haven’t yet witnessed personally, but there are such reports in the medical literature and the FDA does have an official warning regarding this issue). One other side effect which I neglected to mention in the book (due to an oversight) was the possible risk of insomnia and abnormal dreams, neither of which are per se dangerous, but are obviously quite distressing.

- Tamir

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Preventing worse menopausal symptoms

Many women going through menopause experience a variety of unpleasant symptoms; among the most bothersome are hot flashes and night sweats. With the exception of estrogen replacement therapy, which can unfortunately increase the risk of developing blood clots and breast cancer, there aren’t very effective treatments (yes, there are various medications and herbs that are used, but practically speaking, for many patients, these don’t produce satisfactory results).

Recent research conducted by the University of Queensland School of Population Health shows that there are many modifiable risk factors that can contribute to worsening hot flashes and nights sweats. The study team sampled 10,000 women, and found that those who smoked, gained weight, were diabetic, and drank too much alcohol had significantly worse symptoms.

Menopause symptoms

So if you’re currently going through menopause or are going to be there soon, this may be yet another good reason to quit smoking, lose some weight if you’re overweight, and cut down on the alcohol if you’re over doing it in that department.

- Tamir

(Image credit: 34-menopause-symptoms.com)

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Blame Your Genes?

You may have noticed that some people who take up smoking have no problem quitting, even when they’ve been smoking a lot, whereas others seem to quickly become addicted, even if they initially smoked only a few cigarettes on the weekend.

A recent study published in JAMA Psychiatry sheds some light on these differences. The researchers discovered that having a certain genetic profile made people more likely to become addicted and smoke more heavily. Interestingly enough, having the “high-risk” profile didn’t affect whether or not a person took up smoking to begin with.

If you’re having a hard time quitting, you may be wondering if you have the high-risk genetic profile. Is that why you’re struggling to quit?

At this point in time, it’s not possible for any of us not directly involved in a research study to know our genetic profile with respect to cigarette addiction. That’s why it’s important to not take up smoking in the first place. If you do smoke occasionally, give it up, since you don’t know whether you’re at a higher risk of getting hooked.

On the other hand, if you’re already addicted, and are having a hard time quitting, then by no means give up and resign yourself to a life of poor health. The rates of heavy smoking and propensity for addiction in people with the high-risk genetic profile was roughly 20-40% higher than in the low-risk group (depending on the outcome measured). This means that although you may be facing a harder time trying to quit, and perhaps are currently smoking more cigarettes than someone with a low-risk genetic profile, you still have a good chance to end up smoke-free if you keep trying.

Genes only go so far to explain human behavior. We are all born with certain predispositions. Some people have more of a tendency to overeat, others are lazy, and others hate exercise. You will agree with me that in most cases, with enough desire, people can improve their lot in life. Smoking cessation is no exception.

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Why we smoke

A recent survey that I mentioned in a previous blog post regarding how many times the average smoker attempts to quit, sheds some additional insight on the reasons people smoke. Granted this survey was conducted in England, and it’s possible that British smokers have dissimilar characteristics from their American counterparts; still, some fascinating findings emerge.

56% of male smokers versus 48% of female smokers smoke the most when out with friends. This is important to note with respect to trying to quit. If you are considering kicking the habit, but are surrounded by people who smoke, then there’s a real risk of temptation to light up. In addition, having friends who smoke may make you more likely to take up the habit yourself (although this is mere speculation and not a specific conclusion from the survey).

33% of female smokers stated that they smoked the most when under stress. This too we discuss in our book. Often times, people smoke to alleviate stress. However, much of the “anxiety” that is relieved stems from the withdrawal symptoms, which arise if you go too long without a cigarette. Too many people are under the impression that smoking is effective for stress relief even though this has been disproven.

55% of smokers believe that they became addicted to the psychological habits associated with smoking
before becoming addicted to nicotine itself. Again, the environmental triggers and associations that smokers have with cigarettes and the act of smoking may be as important as what actually goes on in the body on a cellular level with respect to becoming addicted and relapsing after successfully quitting.

30% of smokers hide their habit. 37% of those who hid their habit did so out of embarrassment. This is good news as it hints that perhaps smoking is not as “cool,” glamorous, or socially acceptable as in previous generations. 30% of those who kept their habit under wraps did so out of not wanting to worry a loved one.

Over 50% of smokers hated being told how bad smoking is for their health, stating that they already knew how bad it is. This perhaps is valuable with respect to trying to help loved ones to quit. It’s important to offer advice in a non-preachy, non-judgmental manner. I know that in my own practice several of my former and current smoking patients told me that many other doctors and other health care professionals have looked down at them and treated them with disdain and contempt as drug addicts when discussing their smoking habits.

Smoking wastes money

Finally, roughly 25% of smokers stated that financial reasons (i.e. cigarettes cost too much) were the main motivator for quitting rather than health concerns. This perhaps is a tool that can be used to get people to quit. In New York, where I reside, a pack costs roughly $10 due to very high cigarette taxes. This isn’t the forum to discuss the pros and cons of high tobacco taxes, but I can tell you that in my own practice, I have had several patients who have either cut down or quit smoking due to financial concerns.

- Tamir

(Image links to source: Bioethics.net)

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How many times does it take?

Many people who smoke and are considering quitting often wonder whether they’ll be successful or not. Furthermore, many people who had successfully quit smoking relapse and start again. Of those who relapsed, some unfortunately become discouraged and wonder if they’ll ever be able to quit for good.

In order to quantify things, I will refer to a recent study from the British Heart Foundation. The researchers surveyed over 2,000 smokers, and found that the average smoker needed FOUR quit attempts before finally kicking the habit for good. 25% of those surveyed had “lost count” of how many times they had quit smoking. 82% had at least one unsuccessful attempt.

Many of you might be wondering, “Why is he telling me this? I thought that it was much easier to quit smoking!”

However, the way I look at it is the exact opposite. Eventually, those smokers who wanted to quit, were in fact able to quit. Yes, it wasn’t easy. Yes, for most smokers it required multiple attempts. However, when all was said and done, they did end up quitting.

If an analogous situation arose in business, where it took several failed attempts before you could secure a huge sale or close a successful deal for thousands of dollars, would you be so quick to give up?

Persistence becomes so much more important when we’re talking about your health and your life. Therefore, if you’ve already tried to quit, even many times, and have given up hope of ever being successful, know that with persistence, you likely WILL succeed.

Of course, as we discuss in our book in the chapter on smoking cessation, there are many strategies a person can use to improve his or her odds of success when quitting smoking. These include enlisting the aid of your physician, using nicotine replacement products and other smoking cessation medicines, having a support group or counseling, and trying to identify and eliminate triggers that make you smoke.

Finally, to present a balanced view, I do want to note that there are smokers who are unfortunately unable to quit. Therefore, if you currently hang out with people who smoke and are tempted to take it up, or are a light or “social” smoker, then don’t take it for granted that you will be able to quit. Better to not start or to stop now while it’s still easy to.

- Tamir

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Further evidence that it’s never too late to quit

In our book, A Smoker’s Guide to Health & Fitness, as well as in several of our blog posts, we emphasize over and over again how important it is to quit, no matter how long you have been smoking.

A recent study published in the European Journal of Epidemiology, which followed close to 9,000 people aged 50-74 for close to a decade, adds further evidence to the benefits of smoking cessation in even long-time smokers. As expected, compared to non-smokers, current smokers had an over twofold risk of suffering a heart attack or a stroke after adjustment for other risk factors such as presence of diabetes, high blood pressure, elevated cholesterol, alcohol use, etc.

Current smoking advanced the chance of a heart attack by 19 years and that of a stroke by almost 10 years (i.e., a 60 year old smoker would have roughly the same risk of suffering a heart attack as a 79 year old non-smoker, and the same risk of having a stroke as a 70 year old non-smoker).

What was remarkable was that despite the fact that the smokers in this study had been smoking for many years (as mentioned above, the study included people from the ages of 50 to 74) those who quit during the study had a 40% less chance of having a heart attack or stroke, and roughly 5 years after quitting, most of the excess risk was mitigated.

So once again . . . quit – it’s never too late.

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It’s never too late!

When I was in medical school, a geriatrics professor brought two of her favorite patients to a lecture pertaining to longevity. One was 98 or 99 years old. The students were asking him about his secret to having lived such a long life. He mentioned how he always stayed busy, and instead of retiring, changed careers several times; in fact he was still active doing volunteer work. One of the students queried him regarding his health habits, particularly smoking. He stated that he still went walking daily, and although he did not follow a particular diet, he was careful not to overeat. As for smoking, he PROUDLY stated that a year prior, after 70+ years of smoking, he had finally quit!

What were the circumstances surrounding his decision? One would perhaps think a health scare. Actually, what made him quit was the fact that he moved into an adult assisted living facility, and his roommate required an oxygen tank in the room to help him breathe. The potential risk of an explosion was what made him give up his decades long habit.

The Daily Mail recently published a story about a lady who just gave up smoking at 102! Again, it was no health scare, but her children’s concerns that falling ash from a cigarette could cause a fire that led her to quit.

In A Smoker’s Guide to Health and Fitness, we emphasize how it’s never too late to quit. Now granted, both of the above people likely had the fortune of having inherited exceptional genes which allowed them to reach an advanced age; in addition, it’s unclear whether or not continuing to smoke would have significantly shortened their lives (perhaps not at all). However, one must admire the fact that even after 70-80 years of smoking, they gave it up. You would think that if they made it to 100 in spite of smoking, they would at least try other things to continue their habit (smoke outside or in an area that doesn’t have flammable materials).

The lesson to be learned is that even if you have been smoking for a long time, and think, “what’s the point of quitting now – whatever damage that was done is done” it’s still worthwhile. I’ll concede that perhaps you are one of the lucky ones who will live to be 100 no matter what you do. But such people are rare. Most people who continue to smoke unfortunately eventually end up sick or dead before their time.

- Tamir

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A look at the average lifespan of smokers, including those who quit

On average, how much does smoking shorten your life span? And does it matter when you quit?

CBS news - Dangers of Smoking

In our book, A Smoker’s Guide to Health and Fitness, we threw around different numbers regarding how much smoking reduces one’s life. As you all know, smokers have a much higher chance of developing many different life threatening conditions such as heart attacks, strokes, and different cancers. We quoted estimates in our book of anywhere between 6 and 14 years of life lost in smokers versus nonsmokers.

A very large study just published in the prestigious New England Journal of Medicine, on over 200,000 people showed that current smokers die roughly 10 years sooner than nonsmokers (again, depending on how much they smoke and for how long). Former smokers, depending on when they quit, fall somewhere in between.

Those who quit between the ages of 25 to 35 regained those 10 years back, compared to those who continued to smoke. Those who quit between the ages of 35 to 44 gained 9 years of life compared to those who continued to smoke, and those who quit between the ages of 45 to 54 gained 6 years of life.

I think the take home message from all this is obviously not to smoke; however, if you do smoke, quitting at a young age mitigates most of the harmful effects of having smoked. Furthermore, even if you smoked for many years, quitting still seems to return some of those years that you would have lost had you continued to smoke.

I do want to mention one last caveat: life is a game of probability, and these studies discuss how many years of life people lose on average. For the individual, depending on his or her individual genetic make up and other lifestyle habits such as diet and exercise (or lack thereof), these numbers may be radically different. For example, a 34 year old man who smokes heavily and also has a very strong family history of heart disease at a young age, eats a very poor diet, doesn’t exercise, and has a stressful job, may indeed suffer a heart attack at 35. Therefore, do not delude yourself into thinking that because you are young, you can keep on smoking for now without any serious harm, and you do not have to worry about quitting or otherwise improving your lifestyle until later on. Although this may hold true for many people, one never knows, so why take a chance?

- Tamir

(Image links back to its source: CBS news)

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Has someone helped you successfully quit smoking? Pay it forward

Many of us have been involved in situations in life where we’ve needed help from others, whether it was borrowing money, moving to a new house or apartment, getting a babysitter, or needing emotional support and a shoulder to cry on during difficult times. Some people are hesitant to accept help, often because they don’t believe that they’ll be able to reciprocate.

In some respects they do have a valid point – for instance, you’re unlikely to be in a situation where you provide financial help to a wealthy relative who wouldn’t require it anyway. Or if you’re sickly or physically disabled, you probably won’t be able to help your strong, 200-pound friend move a heavy dresser.

However, this is a distorted mindset. Each and every one of us has something to offer. Although you may not be able to reciprocate with the exact same thoughtful kindness you were given, you can still be helpful and supportive to others in many ways. You can reach out to them, spreading kindness and effecting long-term positive change in people’s lives. This concept is known as paying it forward.

This idea holds true in the realm of smoking cessation. A friend or loved one, perhaps someone who has never smoked, may have been there for you when you were struggling to quit smoking. You can do the same for others who are trying to quit. There are currently millions of people who smoke, and many of them want to quit or have quit but relapsed. One of the nicest things you can do is to support them in their time of need, much in the same way that someone supported you. Pay it forward. Whether it’s a friend or family member that you know and interact with face to face, or a stranger in an internet support group, you can help make the difference between that person carrying through and successfully quitting, or giving up and taking up smoking again.

- Tamir

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