Mar
01
2014

Smoking Remains A Health Hazard

Recently new statistics came out that show that 48.8 million people in the US (19% of the population) still smoke. 22 % of the population are male, 17% female. Smoking is responsible for 20% of all deaths in the US (1 in 5 deaths). It is interesting to note that in the older age group (above the age of 65) only 8% are smoking, but 22 % of the 25 to 44 year old group is smoking. Among the American population Native Americans have the highest percentage of smokers (32% are smokers). 10% of Americans of Asian descend smoke. Blacks, Whites and Hispanics are placed in between them and the American Indians. Finally, people who can least afford it (who are below the poverty level) have the highest percentage of smokers (29% smoke) while 18% of people above the poverty level smoke. Education seems to have a protective effects when it comes to smoking: of the least educated group of people 45% are smokers while only 5% with postgraduate education smoke.

Effects of cigarette smoke on the body

As this link shows the concoction of various ingredients in the smoke of cigarettes causes various parts of the body to react differently to these chemicals. Here is a rundown of diseases caused by smoking cigarettes.

1. Lung cancer: This is the most common cause of death in women who smoke, more common now than breast cancer. 90% of lung cancers in women are due to smoking. The same was true in males, but as a group they now smoke less than in the past.

2. Other cancers:  cervical cancer, kidney cancer, pancreatic cancer, bladder, esophageal, stomach, laryngeal, oral, and throat cancers are all caused by smoking. Recently acute myeloid leukemia, a cancer of the bone marrow has been added to the list of smoking related cancers.

3. Abdominal aortic aneurysm: As cigarette smoke destroys elastic tissue, it is no wonder that the loss of support of the wall of the aortic artery leads to the development of large pouches, which eventually rupture with a high mortality rate due to massive blood loss.

4. Infections of lungs and gums: Smokers are prone to infections of the lungs (pneumonia) and of the gums (periodontitis).

5. Chronic lung diseases: emphysema, chronic bronchitis, asthma.

6. Cataracts: lack of perfusion of the lens leads to premature cataract formation.

7. Coronary heart disease: hardening of the coronary arteries, which leads to heart attacks, is very common in smokers.

8. Reproduction: reduced fertility in mothers, premature rupture of membranes with prematurely born babies; low birth weight; all this leads to higher infant mortality. Sudden infant death syndrome is found more frequently in children of smoking moms (Ref. 1).

9. Intermittent claudication: after decades of smoking the larger arteries in the legs are hardening and not enough oxygen reaches the muscles to walk causing intermittent pausing to recover from the muscle aches. If it is feasible a cardiovascular surgeon may be able to do a bypass surgery to rescue the legs, often though this is not feasible and the patients lower legs or an entire lower limb may have to be amputated.

10. Others: osteoporosis is more common in smokers; poor eye sight develops due to age-related macular degeneration that sets in earlier and due to tobacco amblyopia, a toxic effect from tobacco on the optic nerve; hypothyroidism is aggravated by smoking and menopause occurs earlier.

Smoking Remains A Health Hazard

Smoking Remains A Health Hazard

What happens in the lung tissue in smokers?

Ref. 1 gives a detailed rundown of the changes in the lung tissue as a result of exposure to cigarette smoke. The various components of cigarette smoke lead to an activation of special white blood cells, called monocytes that after stimulation turn into tissue macrophages. In addition neutrophils (regular white blood cells) also get stimulated. Between them they produce cytokines and chemokines and the neutrophils secrete elastase that digests elastic tissue in the lungs. Breakdown products of the elastic tissue serve as a powerful stimulus to the immune system to mount an autoimmune response. After some time of being exposed to cigarette smoke the immune system considers part of the lining of the lungs as foreign and cytotoxic lymphocytes attack the lining of the air sacs (alveoli). Lung specialists consider chronic obstructive pulmonary disease (COPD or emphysema) to be an autoimmune disease (Ref.1).

The sad part is that when this condition has progressed far enough, even quitting smoking may be too late to stop the autoimmune disease by itself as the body has been sensitized and the immune system is convinced that the altered lung tissue should be attacked. Add to this that carcinogenic substances and toxins in cigarette smoke damage the DNA of all cells and the energy producing mitochondria, and the stage is set for the combination of chronic inflammation and the release of free radicals to cause all of the diseases mentioned above.

Quit smoking still important

It is extremely important to quit as soon as possible to avoid the full-fledged sensitization of the immune system against ones own lung tissue. Studies have shown that 36% of survivors of heart attacks will successfully quit, 21% of healthy men with a known risk of cardiovascular disease will quit when asked to do so and 8% of pregnant women will quit. When a physician examines a patient in the office and asks a smoker to quit smoking 2% of these smokers will respond and still not smoke 1 year after this doctor’s visit. This may not sound like much, but it is an encouraging effect. Perhaps the most important fact is what I mentioned in the beginning of this blog: the least educated group of people smoked the most (45%) while the most educated people smoked the least (5% of people with a postgraduate education). My hope is that the Internet and other educational media will contribute to education to convince people how important prevention is.

Pharmacological assistance to quit smoking

Nicotine replacement therapy can involve any of 2- and 4-mg nicotine polacrilex gum, transdermal nicotine patches, nicotine nasal spray, the nicotine inhaler or nicotine lozenges. Discuss with your doctor what may be best in your case. Typically one of these products is used for 3 to 6 months.

Bupropion is an antidepressant with a nicotinic acetylcholine receptor affinity. Bupropion is useful to help with the withdrawal from nicotine addiction, which occurs in depressed or non-depressed people. It strictly has to do with the stimulation of the nicotinic acetylcholine receptor.  Typically the dose is 150 mg of a sustained released bupropion tablet per day for 7 days prior to stopping smoking, then at 300 mg (two 150-mg sustained-release doses) per day for the next 6 to 12 weeks. 44% quit at 7 weeks versus 19% of controls. A newer nicotine partial receptor stimulator, varenicline, has been compared to bupropion. It was slightly more effective in helping people to get off cigarettes. Varenicline is started at a dose of 0.5 mg per day for 3 days, then 0.5 mg twice daily for 4 days, followed by a maintenance dose of 1 mg twice daily. If nausea is a problem, lower doses can be used. Varenicline has been approved for a 3-month period with an option of a second 3-month period, if relapse occurs. Discuss with your doctor what is best for you.

According to Ref. 1 a combination therapy of bupropion and nicotine patch was more effective than either one alone.

Will power, hypnotherapy

Hypnotherapy to quit smoking has been popular, but is not as effective as it is often claimed. Will power, measured by the “placebo” response is quite effective given the fact that nicotine is very addictive and yet 19% in the placebo group were able to quit on their own. According to Ref. 1 varenicline treatment for 12 weeks produced abstinence for 9 to 52 weeks and was compared to bupropion and placebo. The abstinence rates were 23%, 15%, and 10% for varenicline, bupropion, and placebo. This means that will power was still 2/3 as effective as bupropion and 43% as effective as varenicline. Don’t underestimate will power!

Conclusion

The best scenario is to never start smoking. The second best is to quit as soon as possible. Unfortunately, the third scenario of continuing to smoke is still very prevalent worldwide. I have seen the damage done first hand in practicing medicine, which motivated me to never smoke. But I am aware of the difficulties of quitting because of the highly addictive nature of cigarette smoking. Where is the support from governments on this? The problem is that the government benefits from taxation of cigarettes. Nevertheless it is laudable that there are government sites through the CDC to help you quit smoking.

At the end we are all responsible for our own health. If you are presently smoking, psych yourself up for the day that you will quit. Quitting means that you are deciding actively to live longer. Studies have shown that it takes often several attempts before you eventually quit successfully.More information on some of the topics mentioned:

1. Lung cancer and other cancers: http://nethealthbook.com/cancer-overview/overview/epidemiology-cancer-origin-reason-cancer/

2. Heart attack: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

3. Chronic obstructive pulmonary disease: http://nethealthbook.com/lung-disease/chronic-obstructive-pulmonary-disease-copd/

Reference

1. Mason: Murray and Nadel’s Textbook of Respiratory Medicine, 5th ed.© 2010 Saunders

Last edited Nov. 7, 2014

Apr
01
2008

Eat Your Veggies To Protect Your Eyes

A study at Brigham and Women’s Hospital in Boston has shown that nutrition impacts eye health. Over a stretch of 10 years Dr. William Christen followed a group of 35,551 health professionals age 45 and older. They provided him with detailed information about their dietary habits and vitamin supplements-they were permitted to take multivitamin but were requested not to take vitamin A, vitamin E or beta-carotene. None of them had cataracts in the beginning of the study, but 2,031 did develop cataracts during the follow up period. Dr. Christen and his team analyzed the data and found that those individuals who were the highest consumers of carotenoids- individuals with an intake of 6,617 mcg of lutein and zeaxanthin- were 18% less likely to develop cataracts than those who consumed only 1,177 mcg per day. Also, the group that consumed higher amounts of vitamin E (intakes of about 262.4 mg per day) was 14% less likely to develop cataracts. Lutein is a substance that is found in high concentration in eye tissue. It is readily available in many foods, such as green and yellow vegetables, yellow-fleshed fruit and in egg yolks.

Eat Your Veggies To Protect Your Eyes

Eat Your Veggies To Protect Your Eyes

New research from the National eye Institute in Baltimore has also confirmed the benefits of carotenoids for healthy eyes. Lutein and zeaxanthin offer protection against age-related macular degeneration. There is no need to shop for supplements. Just bring on the green vegetables: broccoli, brussels sprouts, kale, collard greens, and spinach. Add some corn, the spice saffron and some eggs, and enjoy the taste and the health benefits.

More information about cataracts: http://nethealthbook.com/eye-diseases-and-eye-related-topics/cataract/

Reference: The Medical Post, March 8, 2008, page 25

Last edited November 3, 2014

Feb
01
2006

Macular Degeneration Risk Less With Vitamins

Age related macular degeneration (AMD) is one of the more frequent reasons for loss of vision in the ageing population. The disease is also the most prevalent reason for blindness in developed countries.
A group of researchers from the Netherlands made it their mandate to investigate, in which proportion antioxidants were useful in the prevention of AMD. Supplementation with vitamins C, D and E was used and also beta-carotene and zinc. The observations were made using questionnaires from the Rotterdam Study (1990-1993).

The group on which the research concentrated consisted of inhabitants 55 years of age or older living in a middle class suburb of Rotterdam. Of 5836 at the baseline with a risk of AMD 4765 had reliable data of their dietary habits. At the end of the study 4170 participated in the follow up.
Dietary intake of vitamin E and zinc was inversely associated with the development of AMD: the group with an intake of vitamin E and zinc had less macular degeneration than those whose diet was deficient. A higher than median intake of all the four nutrients, vitamin E, zinc, vitamin C and beta-carotene showed even more benefit. The risk to develop macular degeneration was reduced by an impressive 31 %.

Macular Degeneration Risk Less With Vitamins

Macular Degeneration Risk Less With Vitamins

These results are of importance to the ageing population and the elderly. A high dietary intake of the four nutrients is important in the risk reduction of age related eye diseases like AMD.

Reference: JAMA. 2005; 294:3101-3107; Vol. 294, No. 24, December 28, 2005

Last edited December 6, 2012

Aug
01
2005

New Drug Reverses Macular Degeneration

Age-related macular degeneration in the past meant blindness for the patient. In more recent years laser surgery could be a sight saver, but it also meant a more invasive treatment.
The arrival of new anti-angiogenic drugs that can reverse age-related macular degeneration has received a lot of attention at the recent Schepens International Society ophthalmology meeting. The new drugs Macugen (pegaptanib sodium injection) and Lucentis (ranibizumab) were showing that they stopped the disease in 95% of cases. They were injected into the vitreous of the eye, and the vision of those patients who took it, actually improved.
Macugen has been approved by Health Canada and will be launched for use in September 2005, according to Pfizer, the company behind the drug therapy.
The research goes back to the 1970’s with the discovery of a process that forms new blood vessels in the body allowing tumors to thrive and metastasize. This research revolutionized the understanding of cancer. The new anti-angiogenic drugs fight a protein that induces angiotensin and is responsible for the abnormal blood vessel growth under the retina. This blood vessel growth causes macular degeneration (the wet form).

New Drug Reverses Macular Degeneration

New Drug Reverses Macular Degeneration

Dr. Judah Folkman, a Harvard professor of cell biology, gave the presentation and he stated that this new approach would be “a lot of hope to patients.”

More information about macular degeneration: http://nethealthbook.com/eye-diseases-and-eye-related-topics/retinal-problems/macular-degeneration/

Reference: The Medical Post, July 5, 2005, page1, 58

Last edited October 29, 2014