Kick the Filthy Smoking Habit

No, I'm not a smoker. I tried smoking, and it did not agree with me.

I'm also not a physician. My academic background is in analytical chemistry. Suffice it to say that I'm not an expert on smoking cessation. Hence the picture. You can mentally substitute Larry the Quack for Donald Duck if you like.

I've known many smokers, some of whom have managed to quit. The overwhelming majority of successful quitters used the unassisted Cold Turkey method.

When my late father was in his fifties, his physician scared the bejesus out of him: Stop smoking immediately, or you'll die before your time. His father had already died from lung cancer. My father was emotionally ready to hear that message.

First, he switched from cigarettes to cigars. His rational: Since cigar smoke is stronger, I'm less likely to inhale, and less likely to get lung cancer. However a few months down the road, he became aware that he was inhaling the cigar smoke!

Then he went Cold Turkey. And while conquering the Tobacco Jones, he chewed a lot of gum!

My father's story is fairly typical of successful long-term quitters. They usually fail on the first attempt. Then they take stock, and try to understand what went wrong. The self-knowledge gained from that experience puts them in a stronger position to be successful on a later attempt.

One of my hiking companions used the Gradual Withdrawal method until she got down to five cigarettes per day, and then stopped abruptly at that point.

An online Scandinavian acquaintance successfully switched from smoking to Swedish Snus. The Swedish government takes a pragmatic approach to nicotine addiction: Harm reduction is better than smoking. As compared with the government regulations on tobacco products in the USA, the Swedish government has stricter safety standards for Snus manufactured in that country.

Swedish Snus does contain nicotine, but it does not contain benzo[a]pyrene and other polycyclic aromatic hydrocarbons (PAHs)--aka tars--found in tobacco smoke. Although nicotine has been demonized in the popular press, PAHs contribute more to lung cancer risk.

"Mike," another acquaintance, tried the nicotine patch, and it had no effect on his smoking addiction. His comment: The nicotine patch helps me to enjoy my cigarettes more!

This is really puzzling. If nicotine is the only addictive ingredient in cigarette smoke, why is oral or transdermal nicotine ineffective for some cigarette addicts? I call this Mike's Paradox. We'll return to it in the fifth section.

WebMD has a politically incorrect article about one beneficial effect of nicotine: Nicotine Slows Parkinson's Disease.

Sometimes it's difficult to distinguish between a brilliant idea and good scientific humor. Of course, these two things are not mutually exclusive.

Many years ago, I subscribed to a health newsletter, published by Durk Pearson and Sandy Shaw. They had a great suggestion for decreasing the harm of cigarette smoking. Do your homework, and find the published tar and nicotine levels for various brands of cigarettes. (I'm assuming that these measurements are reasonably accurate.) Then choose the cigarette brand with the highest nicotine:tar ratio. Why?

You want to satisfy your nicotine craving, while consuming the least amount of carcinogenic tars. I'd like to add one more thing.

Put out the cigarette as soon as the craving is satisfied. Then use a small scissors to cut off the burnt end, and put the remainder of the cigarette into small metal box, for later use. Cigarettes are expensive!

A long time ago, I saw my very first TV advert for a medication. It was for Zyban. (I found out later that it's supposed to help smokers quit). I was surprised for a couple of reasons. For many years, the FDA had been exercising a blanket prohibition on this type of advertising. Why did they inch back from their previous position?

Second, the advert said absolutely nothing about smoking! Zyban is here! Ask your doctor about Zyban! Blah, blah, blah.

I remember thinking at the time: What the dickens is Zyban? What's up with that?

It finally dawned on me that this was a trial balloon, designed to gauge the effectiveness of a new venue for medical advertising. If the dry run was successful, under-informed people would pester their doctors for Zyban prescriptions to address a whole host of medical issues. Then a survey of physicians could determine the extent to which this was actually happening.

Yes, we do have laws that require safety testing. And because of the Keefauver Amendment, efficacy testing is also required.

However I've never met anyone who was helped by Zyban, by Cytisine, or by Varenicline. The medical approach to assisted smoking cessation appears to be a case where helping people is secondary to the profit motive. Nevertheless it does some good. And it's reasonably cost-effective, because a few people do benefit from the meds, and from the hand-holding; and because smoking is so harmful.

What I'm saying is this: Be realistic. At the moment, there is no medical silver bullet for nicotine addiction. Your physician is not going to solve your smoking problem for you. At best, he can stack the deck in your favor. To a large extent, you're on your own. You'll need to discover what works for you, and then to apply your discoveries--even if they're politically incorrect.

The Wikipedia article mentioned the herb, St Johns Wort. There's probably something to this idea, and it may apply more to women than to men. One caveat: This herb affects the activity of an important liver enzyme, CYP3A4. This could be a concern if you're taking certain medications.

If you choose to experiment with St Johns Wort, you may want to schedule a Brown Bag Review with your pharmacist, outside of his normal working hours. Take all of your medications and supplements with you. And of course, pay him for his valuable time.

Here's an answer to Mike's Paradox, which I mentioned earlier. A study at the University of California at Irvine found a cross-addiction between nicotine and acetaldehyde. (Acetaldehyde is a by-product in the combustion of dried leaves from most plants, including tobacco.)

Acetaldehyde is a nicotine synergist. The craving for acetaldehyde is a component of cigarette addiction. Moreover acetaldehyde decreases the nicotine dose that's needed to satisfy the cigarette Jones.

The UCI study explains why nicotine patches and nicotine gum fail to satisfy the cravings that some cigarette addicts experience.

It's also been found that smoking dried leaves from a nontoxic plant is more satisfying for some cigarette addicts than oral or transdermal nicotine! Now we know why.

If you're not ready for Cold Turkey yet, here's a harm-reduction option. When you're at work, use Swedish Snus. After you get home, and have done all of your driving for the day, have a teaspoon of Sherry wine with each dose of Swedish Snus. (Note that the quantity of wine that I'm recommending is quite small.) Why?

The ethanol in the wine is metabolized into acetaldehyde. Sherry already has a little acetaldehyde (which contributes to the flavor), and should be slightly faster acting than other types of wine. Again, the acetaldehyde will give you more bang for your nicotine buck.

But if you're a recovering alcoholic, the Sherry would be a bad idea.

When you're ready to go Cold Turkey on the nicotine, it would also be a good idea to avoid alcohol at first.

Acetaldehyde (an ethanol metabolite) and nicotine have some overlapping effects. Having a drink could ignite your cigarette craving a few hours later. Moreover alcohol tends to decrease inhibitions. That could be a problem when you're struggling with nicotine cravings.

After you've successfully avoided cigarettes for a year, you may want to try a glass of wine or beer, to see if it causes nicotine cravings.

Do this experiment on a weekend when you're hanging out with emotionally supportive, non-smoking friends.

Avoid coffee. For many smokers, coffee increases the craving for cigarettes. If you enjoy a caffeine jolt in the morning, drink a cup of tea instead. I've tried some fantastic tasting Oolong tea from Taiwan.

Nicotine is a testosterone mimic. That's why the voices of heavy smokers--both men and women--tend to deepen after several years. And it partially explains why successful quitters tend to gain weight after kicking the filthy habit.

Middle-aged men who wish to give up smoking may fill the hormone void with a strength-training exercise that increases testosterone. One-leg Total Gym squats at home (or leg presses at your local gym) should be helpful in that respect.
Link to scientific journal article

Choose a resistance level where you can do a maximum of 8 repetitions. If you get winded from that, do 2 sets of 4, and take a minute to catch your breath between the two sets. Do the 8 max one-leg squats every other day. Of course, you'll need to gradually increase the resistance, because you'll get stronger over time.

I do one-leg squats for general health, and as cross-training for uphill hiking.

Copyright 2012 and 2013 by Larry Fields