Online Consultation	CD-ROM Version
Exercise eBook	Health Check eBook
Printer Friendly Pages	Make A Donation
Pain Gone Pen	Pain Products From Amazon

The fact that you're reading this page probably means that you have thought about how to stop smoking. Use the simple advice and information here to understand how the chemicals in tobacco smoke affect the different systems in your body.

Read about about smoking cessation - how to give up and stop.

Most people would think about the risks of cancer associated with smoking, but there are many other silent effects that accumulate over the years, contributing to an early death, chronic illness and disability.

This is what you gain - a synopsis of the benefits of stopping smoking from www.NetDoctor.co.uk

The Effects Of Smoking

Your Wallet

Brain

• Mood
  • Nicotine is a centrally acting drug. In low doses it acts as a brain stimulant causing a feeling of being high.
  • In higher doses, it acts as a brain depressant, producing feelings of calmness (anxiolysis).
• Addiction
  • Nicotine is also highly addictive, causing changes in the numbers of naturally occurring nicotine receptors in the brain. A sudden reduction of a regular smoking habit induces a withdrawal reaction, with craving associated with agitation and restlessness, making it very hard for the user to give up.
  • Therefore the easy way to stop smoking is to treat the user like any other drug addict i.e. slowly reduce the drug over a period of time so that the central nervous system effects are minimised.
  • Take the Nicotine Dependency Test. When you've finished the test, click on the Back arrow at the top of the page.
• Appetite and Taste
  • Nicotine is a direct appetite suppressant in the brain. This may explain why in general smokers are slimmer than their non-smoking counterparts.
  • Nicotine also alters taste function in the tongue. This may explain why smokers often complain that food tastes bland, and why they add more salt to their food so that they can taste it.
  • Developing a normal appetite after quitting can lead to putting on weight. This is due in part to the return of a normal appetite. However, smokers generally take less physical exercise than non-smokers. The cure for weight gain after quitting therefore, is to radically increase the amount of physical activity you take each day, so that the calories are burnt off.
• Psychology
  • Most social smokers use nicotine as a recreational drug, where it is used together with alcohol to enhance feelings of well being and elation.
  • Most regular smokers would admit to using the drug as a means of calming their nerves, such that they begin to feel more jittery and anxious when nicotine levels are low, making them desperate for their next "fix".
  • It may be that regular smokers in general have more problems with anxiety, and use nicotine as a treatment for it. Recognising this psychological need is important before embarking on programmed withdrawal.

Heart

• Nicotine stimulates the cardiovascular centres in the brain stem causing a sustained rise in heart rate and blood pressure. It also acts on the peripheral circulation causing an increase in the peripheral vascular resistance (how hard it is to pump the blood around the system).
• These three factors cause an increase in the work done by the left ventricle (main heart pump). The increase in work also increases the amount of oxygen consumed by the left ventricle.
• In established coronary heart disease (narrowing of the coronary arteries), the coronary arteries are not able to supply enough oxygen to the left ventricle during periods of exercise causing angina symptoms (acute heart cramp caused by shortage of oxygen).
• Smoking places an extra load on the heart because of its effects on increasing blood pressure, heart rate, left ventricular work and oxygen consumption. Therefore those with established angina can see a vast improvement in their exercise tolerance by stopping smoking as this extra load is removed. In some cases reduction in angina medication is possible.
• Stopping smoking can also reduce the need for hypertension treatment, allowing the peripheral vascular resistance to fall back to normal. Reduced salt intake because you can begin to taste your food again also contributes to the drop in blood pressure.
• The longer the smoking habit, the longer it takes for the cardiovascular risk to diminish. Doctors do not yet know when the effects have become irreversible.

Lungs

• Carbon Monoxide
  • Non-smoking city dwellers have about 2.5% carbon monoxide in their blood streams. This comes from carbon monoxide pollution in the air we breathe (other smokers and car exhausts).
  • Regular smokers can have up to 15% carbon monoxide in their blood streams, the source coming from the slow inefficient burning of tobacco.
  • Oxygen is normally carried in the blood stream by a molecule called haemoglobin. Each haemoglobin molecule when fully saturated (100%) carries 4 oxygen molecules giving blood its red colour. Carbon monoxide binds to haemoglobin in the blood stream displacing the oxygen it normally carries. So instead of normally having 100% of the haemoglobin saturated with oxygen, smokers are down to about 85% of normal. This is like living half way up Mount Everest !!
  • This means that there is also a 15% reduction in the supply of oxygen to the peripheral tissues.
  • An interesting fact is that machines designed to measure oxygen saturation (pulse oximeters) cannot pick up carboxyhaemoglobin (what you get when you mix carbon monoxide with haemoglobin), and therefore they over estimate your oxygen saturation i.e. the machine will tell you that you are 97% saturated with oxygen, when you're really sitting at 85%.
  • The only way to tell what your real oxygen level is is to have an arterial sample tested using a Co-oximeter, and these aren't generally available except in intensive care units.
• Particle Removal
  • In the trachea (Main Wind Pipe) there is a system of fine hairs (cilia) which continuously beat rhythmically removing dust and other inhaled particles from the lungs (Mucociliary Escalator ). These particles are lifted upwards to the top of the trachea, where they are then swallowed into the stomach .
  • Smoking causes a decrease in the cilia length, making them short and stubby, beating less efficiently.
  • The mucociliary escalator stops working properly causing a build up of dust and other particles in the lungs.
  • Type II alveolar cells normally move around in the tiny air sacs in the lungs (alveoli) devouring and removing dust particles like a vacuum cleaner.
  • Smoking causes a reduction in the numbers and speed of movement of these type II alveolar cells - just like using the vacuum with the bag full - very inefficient.
  • The reason why smokers develop a chronic cough, is that the accumulation of debris causes irritation of the lining of the trachea and bronchi (smaller lung tubes), as the normal mechanism for removal has failed. Regular smokers find that they need the first cigarette of the day to make them cough enough to remove the sputum that has accumulated overnight. The smoke irritates the lining of the trachea, making them expectorate.
  • The main source of dust in smokers lungs is carbon soot particles from the burning of tobacco. Smokers lungs are blacker than normal because of the slow build up of soot over time.
  • As the soot is released during smoking, it adsorbs various toxins released in the tobacco smoke. When the soot particles reach the inside of the lungs, the toxins slowly leach out over a period of time, increasing the risk of cancer formation.
• Chronic Infection
  • Inefficient particle removal in the trachea and in the alveolar cells, markedly increases the risk of chronic bronchitis.
  • Chronic Bronchitis is defined as cough and sputum production each day for more than 3 months in the year.
  • Chronic infection and intermittent more serious infections lead to progressive lung destruction. The normal architecture of the lungs is destroyed (emphysema),  making the lungs less efficient at transferring oxygen to the blood stream.
  • This leads to breathlessness, poor exercise tolerance, and the need for the continuous use of oxygen by mask.

Circulation

• Viscosity
  • Chronic lack of oxygen in the circulation (85% -v- 100%), stimulates the production of more red blood cells by the bone marrow by way of compensating for the reduced oxygen delivery.
  • The normal haemoglobin content of blood is between 12 and 14 g/dl. Smokers often have levels as high as 17 g/dl.
  • An increase in haemoglobin content increases the stickiness or viscosity of the blood as it flows around the body.
  • Not only does this make the blood harder to pump around (another strain on the heart), but it also makes the blood more likely to clot.
  • The effect contributes to the increase in heart attacks and strokes seen in smokers, which are due to occlusion of small diseased blood vessels by thrombus (thrombosis = clot formation in the presence of arteriosclerosis).
  • Smoking whilst on the combined oral contraceptive pill significantly increases the risk of a DVT in the major leg veins.
• Intermittent Claudication
  • People with narrowed arteries in the legs often develop cramps in the calves during exercise (intermittent claudication). This happens because oxygen consumption in the calf muscle has outstrips the body's ability to supply it.
  • Smoking worsens the supply of oxygen to the muscles by making the blood more sticky, so that fewer red blood cells can pass down the narrowed arteries. Nicotine also stimulates the arteries in the legs to constrict, again contributing to a reduced peripheral circulation in the presence of narrowed arteries.
  • Stopping smoking can significantly reduce claudication symptoms, improving exercise tolerance.
• Leg Ulcers
  • Ischaemic leg ulcers are much more common in smokers with peripheral vascular disease. Not only are these ulcers less likely to heal, but they are more likely to progress to gangrene requiring amputation.
• Gangrene
  • Severe restriction of blood flow to the legs can cause gangrene, requiring amputation of the leg(s). Smokers are much more likely to require this because of poor circulation.

Digestion

• Nicotine stimulates the production of gastric acid in the stomach and duodenum.
• Smokers have an increased risk of developing stomach ulcers because of this.

Skin

• Nicotine denatures Vitamin C so that most smokers are chronically vitamin C deficient. Vitamin C is necessary for protein repair in the skin.
• It has been suggested that smoking for 10 years adds another 4 years to how old you look - mainly in the number of skin wrinkles and creases, but also in the peripheral perfusion of your skin.
• Smoke for 20 years - add an extra 8 years. Smoke for 30 years - add 12 years.
• The worrying thing is that if vitamin C deficiency shows on the outside as aging of the skin, what is it doing to the organs on the inside - are they biologically older as well !!

Healing

• Smokers take longer to heal after surgery or any other traumatic event.
• They are deficient in vitamin C, an essential vitamin for protein repair.
• Their circulation is sluggish in the peripheries causing a reduction in oxygen supply to healing tissue, and their blood carries less oxygen because of high levels of carbon monoxide.

Anaesthetic Risk

• As you can see above, smoking affects nearly every system in the body. Having an anaesthetic as a smoker carries an increase risk of the following:-
  • Heart attack, stroke, leg thrombosis, pulmonary embolism (clot in the lung)
  • Post-operative chest infection, lowered blood oxygen levels requiring oxygen therapy
  • Wound dehiscence (burst wound caused by coughing), wound infection with delayed healing.
• If you are going to have an operation, it is sensible to stop smoking at least 6 weeks before hand so that some of the effects on your systems can reverse. However there is no guarantee that all of the effects can be reversed.

Your Children

• Before Birth
  • Smoking reduces placental efficiency causing children to have low birth weight i.e. starved in utero
  • It also increases the risk of premature labour requiring a stay on the neonatal intensive care unit.
  • Smoking may have a role to play in the development of pre-eclampsia.
• After birth
  • Children whose parents smoke (passive smoking) are 6 times more likely to develop chronic chest complaints like asthma, recurrent chest infections, and also glue ear.

Cancer Risk

• Smoking has been associated with an increase in the risk of developing the following types of cancers:-
  • Lung - can spread early to the bones and spine
  • Mouth (tongue), Pharynx (throat), Oesophagus (gullet), Stomach
  • Kidney, Bladder, Cervix, Vulva (outer lips), Penis
• You can see a sort of pattern to these areas. They all have contact with toxins present in tar, either on the way into the body, or on the way out.

If you have read the section above, and you're not seriously frightened by your smoking habit and what it's doing to you, then you may need a psychiatrist !!

To stop smoking you have to accept that you're a nicotine addict. If you stop suddenly and you're not prepared or mentally strong enough, you will fail because of the craving and withdrawal reaction.

You may also need to accept that you use nicotine as a nerve calming drug to treat your sub-clinical anxiety state. Counselling on these issues with your GP may be be necessary before you go any further.

Remember, if you fail to stop smoking, the only person you're letting down is yourself. You have to make a contract with yourself before starting.

The secret to any drug withdrawal is that reductions of around 10% will not cause severe withdrawal reactions, and therefore will increase your chances of success.

When you withdraw from nicotine, changes occur in the numbers of nicotine receptors in the brain and body. These changes are towards normalisation of nicotine receptor function, and take several days to weeks to occur. This means that the slower the withdrawal the better chance you have of being successful. If you go too fast, the receptors may not keep up with you, precipitating a withdrawal reaction with craving.

I don't advocate nicotine patches for the following reasons:-

• The step between each patch size is too large i.e. larger than 10%
• The rate of descent from the top dose to the bottom dose is too fast to allow the nicotine receptors in your body to keep pace.
• It costs money for your GP to prescribe the patches. With the method described below, it is you who is footing the bill, and it is you who gains in the long term. Doesn't that give you a nice rosy glow.

Step 1

• Be honest with yourself and admit to how many cigarettes you smoke per day.

Step 2

• Each morning count the number of cigarettes you need for the day into a container with a lid. Take the container with you everywhere you go. If you work, don't take your usual cigarette packet with you. If you don't work, give the packet to someone else in the house you can trust. If you both smoke then why not try to stop together.

Step 3

• Gradually reduce the numbers of cigarettes smoked each day by following the tables below.
• Pick the correct column to start with -  Red  for 30/day,  Amber  for 20/day, and  Green  for 10/day. It should take you between 10 and 18 weeks to stop altogether.

Step 4

• Alter your lifestyle.
• Change your diet.
• Take regular exercise.
• Look at the Pain Clinic Health Check eBook to see how healthy you are.
• Use distraction therapy, learn to do something else with your hands. Take up a new hobby.
• Enjoy your sex life again - you'll be less short of breath, and penile function should also improve. (Yes I forgot to mention, smokers are much more likely to be impotent due to the effects on their peripheral circulation).
• Distribute this page to all your smoking friends, but be quick, you may find you're the only one left !!

Other Ways To Stop

Acupuncture

• Acupuncture has been shown to be useful when combined with other techniques (Evidence).

Hypnotherapy

• Hypnosis has been shown to be useful when combined with other techniques (See The Stop Smoking Centre).