Smoking

It's Never Too Late to Snuff Out This Major Risk

Long before all of the illusions about tobacco evaporated like a stale smoke ring, lighting up was the thing to do. In the Sunday comics, joltin' Joe DiMaggio, the pride of the New York Yankees, told young baseball fans, "They don't get your wind. . . . So mild, athletes smoke as many as they please." Betty Grable, who would eventually die of lung cancer, was a popular World War II pinup girl and cigarette smoker. In the 1950s a cigarette dangling from James Dean's lips defined coolness for an entire generation.

But not only was smoking hip, manufacturers claimed that it also was healthy. It steadied nerves, increased energy, and suppressed appetite, they said.

In fact, for several years one tobacco company proclaimed that more doctors smoked its brand than any other. Attractive young women from tobacco firms regularly visited doctors' offices to replenish the supply of free cigarettes available in waiting rooms for patients.

So when you were enticed to begin puffing—along with a lot of other unsuspecting men and women—the powerfully addictive nature of smoking and its devastating effects on the body were virtually unknown.

But now that you know better, can quitting after even decades of smoking really make a difference? You bet. The evidence is unimpeachable: Stamping out your last cigarette at 60, 70, or even 80 can halt many of the worst effects of smoking.

"Quitting will significantly reduce your risk of stroke, heart disease, and cancer regardless of your age and improve your quality of life," says Thomas Brandon, Ph.D., associate professor of psychology at the State University of New York at Binghamton and a smoking-cessation expert.

Who Is the Older Smoker?

If you are like the typical male smoker in his sixties or seventies, you began at age 17 and have smoked about 27 cigarettes a day for 51 years. If you are a woman in the same age range, you probably first lit up at about age 24 and have been smoking 20 cigarettes a day for 45 years.

And like about 80 percent of the people who smoke, you have probably tried to quit at least once. But 46 percent of the older smokers doubt that smoking is very harmful or that the benefits of quitting are really worthwhile.

If you're among those people, ponder these facts: Within 8 hours of quitting, your pulse rate and blood pressure drop, and oxygen levels in your body rise. Within 24 hours your risk of a heart attack dips. At around a month your circulation improves, your energy levels surge, and your lung function expands by up to 30 percent. By 1 year your risk of heart disease is half that of someone who continues to smoke. In 5 years, your stroke risk begins to slide; and in 10 years, your chances of getting lung cancer are the same as that of someone who has never smoked.

"I've had 75-year-old patients tell me that the day they quit smoking, in their thirties and forties, was the greatest day of their lives. The feeling of finding something that you had thought you had lost—your health—is better than if you had never lost it at all. And to know that your risk of sudden death from smoking-related heart disease has dramatically decreased—is tremendous," says Alan Blum, M.D., assistant professor of family medicine at Baylor College of Medicine in Houston.

Each Puff Is Harmful

With each puff a smoker inhales more than 4,700 chemicals that have a wide-reaching effect throughout the body.

Some of the milder effects include accelerated wrinkling of the skin, yellowing of the teeth and fingers, and slow wound-healing. Smoking also increases the risk of osteoporosis, hip fractures, cataracts, diabetes, tooth loss, and emphysema.

Then there is smoking's real downside. Every day, 1,147 Americans die of smoking-related causes. That adds up to more than 418,000 lives annually, making smoking the most preventable cause of death in the United States. Nearly 80 percent of those deaths are caused by cardiovascular disease and cancer. Specifically, 29 percent of all smoking-related deaths are attributed to lung cancer.

Here is a quick look at how smoking magnifies the impact of certain diseases and how quitting can slash your risk of developing them.

Smoking Breaks Your Heart

The chemicals in tobacco smoke, including nicotine and carbon monoxide—the same gas found in automobile exhaust—raise blood pressure, constrict blood vessels, and starve the heart of oxygen, forcing it to work harder. At the same time, smoking increases the stickiness of blood platelets so that they are more likely to form dangerous blood clots. It also raises total and low-density lipoprotein (the so-called bad cholesterol), lowers levels of high-density lipoprotein (the good cholesterol), and accelerates the accumulation of plaque in arteries causing atherosclerosis, also known as hardening of the arteries.

People age 64 and over who smoke have arteries clogged with about the same levels of plaque as people a decade older who have never smoked, according to researchers at Bowman Gray School of Medicine of Wake Forest University in Winston-Salem, North Carolina.

The bottom line is that a person who smokes is three times more likely to develop heart disease and has four times the risk of having a stroke as a nonsmoker. In addition, one in every four deaths is linked to smoking.

If you quit, your risk of a heart attack is sliced by 50 percent in one year, and after about five years your chances of having a stroke can be slashed to virtually the same risk as someone who never smoked.

Cancer: Smoking Tops the List

Smoking is linked to one in three cancer deaths and nearly 90 percent of all lung cancers. Smoking is associated with cancer of the mouth, throat, esophagus, bladder, pancreas, kidneys, and 30 percent of cervical cancer.

"If it weren't for smoking, these cancers would barely exist," says Andrea LaCroix, Ph.D., associate professor of epidemiology at the University of Washington School of Public Health and Community Medicine in Seattle.

Tobacco smoke contains at least 43 cancer-causing substances that can scramble a cell's genetic code, causing it to reproduce abnormally. Constant exposure to the toxic compounds in smoke can cause these abnormal cells to gradually transform into cancer.

But if you quit—even at age 65—your risk of developing lung cancer by age 75 is less than half that of someone who continues to smoke, according to researchers at the University of Michigan. The risk of developing many other cancers—including those affecting the mouth, kidney, and pancreas—begins to diminish within 10 years of quitting.

"The time to quit smoking is when you still feel fine, because by the time you develop cancer and it is detected, it may be too late to cure it," says Teresa Hayes, M.D., an oncologist at Baylor College of Medicine in Houston. "If you quit smoking, not only will you stop adding to your risk, but if you do develop cancer, your chances of survival will be better because your body will be in better shape and you'll be able to tolerate whatever therapy is needed better than someone who continues to smoke."

Quitting Is Easier Than You Think

Like four of every five smokers, you may want to quit and may have tried several times only to be lured back to tobacco. But don't blame yourself. It's not a sign of weakness, smoking-cessation experts say. Nicotine, the prime ingredient in tobacco, is one of the most addictive drugs known. Once you're in its grasp, it takes a determined effort to break free, particularly if you have been smoking for many years. But you can do it.

"Many older people have smoked for so long that they don't think they can overcome it. But I've helped people who have smoked for 50 years quit successfully," says Gary DeNelsky, Ph.D., director of the smoking-cessation program at the Cleveland Clinic. "Quitting isn't easy, but it isn't like climbing Mount Everest either."

In fact, of the people over age 65 who have ever smoked, 77 percent have stopped, according to the Office of Smoking and Health at the Centers for Disease Control and Prevention in Atlanta. That still adds up to nearly 16 million people who continue to smoke after age 65.

How to Become Smoke-Free

About 1.3 million Americans break free of tobacco's hold each year and become nonsmokers. Most quit on their own using a variety of techniques ranging from Nicotine Anonymous to nutrition.

Remember that the first 7 to 10 days of any effort to quit smoking are the toughest because you'll go through withdrawal symptoms—such as upset stomach, difficulty concentrating, drowsiness, insomnia, and irritability—as your body adjusts to the lack of nicotine, Dr. Brandon says.

Once nicotine is flushed out of your body, your cravings should gradually subside. But you still may be tempted to smoke for months or even years afterward. (Eleven years after he quit, President Dwight Eisenhower scribbled, "God, I wish I had a cigarette," on a memo pad during a tense meeting with Soviet Premier Nikita Khrushchev.) But the longer you go without smoking, the more likely you will be able to resist the urge.

"Everybody needs to find his own way to quit. That's the key. You have to be motivated to quit and be creative in finding ways not to smoke," says Mitchell Nides, Ph.D., a psychologist at the University of California, Los Angeles.

But no matter how you choose to quit, smoking-cessation experts say there are a few fundamentals to keep in mind.

Set a quit date. People who designate a definite day to quit and stick to it are more likely to stop smoking than those who don't, Dr. Brandon says. Avoid picking stressful holidays like New Year's Day or Thanksgiving, and don't select a date that is weeks or months away. Chances are that your resolve to quit will melt away by then. Instead, once you decide to stop, choose a day that falls within the next two weeks.

Go cold turkey. President Eisenhower began smoking when he was a cadet at West Point. By World War II Ike was up to four packs a day. In 1949 doctors advised him to cut back on his smoking. He tried it for a few days then decided that rationing his cigarettes was worse than not smoking at all. So he quit cold turkey and never had another cigarette in his life, says Stephen Ambrose, Ph.D., author of Eisenhower: Soldier and President.

All that he did was put smoking out of his mind and developed "a scornful attitude toward those weaklings who did not have the willpower to break their enslavement to nicotine," Dr. Ambrose says.

It worked for Ike, and it can work for you.

"If you quit cold turkey, you'll probably have a week to 10 days of withdrawal, but then you'll be almost over it. Most people find it a lot easier to quit cold turkey than to gradually reduce their smoking," Dr. Brandon says.

Toss 'em overboard. On your quit date, throw out all of your tobacco products. Don't hold back. If you have any hidden in places like sweaters, pockets, and glove compartments, toss those as well, says C. Tracy Orleans, Ph.D., director of Tobacco Control Research at Fox Chase Cancer Center in Philadelphia and principal creator of Clear Horizons, a self-help smoking-cessation program for people age 50 and older. Be sure to get rid of lighters, matches, and ashtrays.

Banish the booze. Alcohol dissolves your resolve and makes it easier for you to light up again, says Thomas Cooper, D.D.S., a nicotine dependency researcher and professor of oral health sciences at the University of Kentucky College of Dentistry in Lexington. Avoid drinking for at least a month after you quit.

One is never enough. Nicotine is a lifelong addiction, so smoking just one cigarette—even after years of abstinence—can lead to another and another.

"'Smoking one won't hurt me,' has probably been the downfall of more smokers who are trying to quit than any other single thing," says Dr. Cooper, who smoked for 36 years before quitting in 1984.

Psychologically, smoking just one often makes people who have quit feel bad about themselves. And to cope with those bad feelings, they will smoke more cigarettes and quickly tumble back into the habit, Dr. Nides says.

If you're severely tempted, get away from the situation or call a supportive friend who can help talk you out of it, Dr. Nides suggests.

Behavior Modification: Change Is Good

When you wake up, you smoke. Take out the garbage, you smoke. Go bowling, you smoke.

The urge to have a cigarette is often triggered by everyday tasks and routines. But if you change your behavior, you can become a nonsmoker, doctors say. These self-help techniques, used alone or in combination, will help.

Write an instruction book. Every time you smoke, jot down the time of day and what you were doing. Then describe the step-by-step process of lighting up. A description of an after-dinner cigarette, for example, might read: "I push my chair back from the table. I take a deep breath. I reach into my pocket and grab the package. I tap the package on the table. I slip out a cigarette and twiddle it in my right hand. I put the cigarette in my mouth and reach for my lighter. I light the cigarette and take my first puff."

This record keeping is an important starting point for later changes, because it helps you become aware of your smoking patterns and the complex rituals that you have created for lighting up, says Dennis Gersten, M.D., a San Diego psychiatrist in private practice and publisher of Atlantis: The Imagery Newsletter.

Switch hands. Once you are aware of your smoking rituals, try to break up that routine somehow.

"You can try to break the pattern any way you want, but I find that switching hands makes people very uncomfortable, which turns out to be a good thing. I had a patient who had been smoking for 40 years. He simply switched from smoking with his right hand to his left, and that was the end of his smoking. It broke the pattern right on the spot," Dr. Gersten says.

Short-circuit stress. "A lot of people smoke to cope with stress. So when you quit, you have to come up with some new coping devices," says Michael Cummings, Ph.D., senior research scientist and director of the smoking-cessation clinic at Roswell Park Cancer Institute in Buffalo, New York. For starters, try deep breathing, meditation, squeezing a rubber ball, or pushing your tongue into the roof of your mouth for 10 to 15 seconds.

Quit early in the week. "We suggest that our patients try to quit on a Monday or a Tuesday of a busy week," Dr. Cooper says. "You don't want to quit smoking when you have a lot of time on your hands to think about it."

Dive into the smoke-free world. Plan out your day so that you'll be less tempted to smoke. Browse in a smoke-free shopping mall, eat in a smoke-free restaurant, or go to a movie or museum where smoking is prohibited, suggests Dr. Nides.

Give yourself daily pep talks. Every morning and at bedtime, write down all the reasons why you want to quit. It will reinforce your resolve to stop smoking. "It's easy to forget why you're trying to quit when you're going through nicotine withdrawal. So reminders are an important way to keep yourself on track," Dr. Brandon says.

You also might try jotting down something you did that day—like walking a mile—that you weren't able to do when you smoked, Dr. Nides says.

Let's make a deal. Sign a contract with yourself, Dr. Brandon suggests. Every day that you go without a cigarette, reward yourself—buy a magazine, sleep in for an extra 30 minutes or take a long stroll.

If you smoke, punish yourself with an activity you detest, like cleaning out the refrigerator or washing out the gutters, Dr. Brandon says.

Give to your least favorite charity. In the first two weeks after you quit, every time you give in to the urge to smoke, pledge a dollar to an organization that you absolutely despise, Dr. Brandon says. It should be such a detestable group that it will make you think twice before lighting up. At the end of each day, give the money to a friend or spouse and insist that they send it off.

"Some people have told me that this particular technique helped stop them from smoking for those critical first few days," Dr. Brandon says.

Save those dollars. Put the money that you would normally spend on cigarettes into a clear container so that you can see it add up. After six months, use that money for a big reward, like a dream vacation, Dr. Brandon suggests.

Stall for time. When an urge hits, if you can delay lighting up for just a minute or two it may pass, Dr. Cummings says. Carry a picture of your grandchildren or other loved ones and pull it out every time an urge strikes. Write down the reasons why you want to quit and keep the list handy for these moments, too.

Nutrition: Eat Well, Stay Smoke-Free

If you start eating like a nonsmoker eats, you may even become one, says William McCarthy, Ph.D., director of science at the Pritikin Longevity Center in Santa Monica, California.

In fact, dietary changes when used in conjunction with other smoking-cessation methods can be a potent ally in your effort to quit, Dr. McCarthy says.

"Dietary changes are a way of moving away from the smoker lifestyle," Dr. McCarthy says. "If you simply extinguish the cigarette and do nothing else about your lifestyle habits, you will still be acting and living like a typical smoker."

Smokers tend to eat more meat, drink more coffee and alcohol, eat fewer fruits and vegetables, consume fewer cereals and grains, and are more likely than nonsmokers to be deficient in vitamins A, C, E, and minerals like calcium, selenium, and zinc.

Smokers who begin eating a typical nonsmoker's diet are more likely to be smoke-free a year later than those who attempt to quit without dietary changes, Dr. McCarthy says.

Dietary changes—particularly cutting fats and adding fruits and vegetables like oranges, apricots, carrots, and sweet potatoes, which are loaded with antioxidants—can help offset some of the ill effects of smoking and reduce your risk of stroke, heart disease, and cancer, says James Scala, Ph.D., a nutritional biochemist and author of If You Can't/Won't Stop Smoking. Antioxidants like vitamin C help block or reverse some of the harm done by free radicals, which are unstable molecules that damage cells and tissues. "Research indicates that it is sensible to take up to 1,000 milligrams of vitamin C daily and about 400 international units of vitamin E to reverse some of the bad influences of smoking," says Dr. Scala.

A good diet also will help you cope with some of the challenges of quitting, such as weight gain, Dr. Scala says.

Fear of gaining weight is an imposing barrier for many smokers who are trying to quit. In a survey of 1,234 people who smoked, ages 50 to 74, nearly half believed that gaining 20 pounds is more harmful than smoking. "Actually, you would probably have to gain at least 100 pounds to equal the health risks of continued smoking," says Robert C. Klesges, Ph.D., professor of psychology and preventive medicine at the University of Memphis in Tennessee.

In reality, about half of all people who quit smoking don't gain weight, and those who do put on about 10 pounds. The weight gain only occurs shortly after you quit smoking, and you do not continue to gain weight any faster than someone who had never smoked.

The following dietary changes may help prevent excessive weight gain after you quit. But Dr. McCarthy suggests that you alter your diet long before you stop smoking, because waiting until the day you quit may make it too difficult to make major changes in your diet at the same time that you have to cope with nicotine withdrawal. So adjust your diet first. Then, when you feel comfortable with your new eating habits, quit smoking.

Balance the pyramid. If you follow the basic U.S. Department of Agriculture food pyramid guidelines, you'll be eating more like a nonsmoker and may be less tempted to light up again, Dr. McCarthy says. That means 2 to 4 servings of fruits; 3 to 5 servings of vegetables a day; 2 to 3 servings of dairy products like milk and cheese; 6 to 11 servings of breads, rice, and cereals; and no more than one 3-ounce serving of meat, poultry, or fish or 2 to 3 servings of beans, eggs whites, and nuts.

Sip on OJ. Tobacco smoke destroys vitamin C. Replenish your supply by drinking two 8-ounce glasses of orange juice daily, particularly in the first few days after you quit, Dr. Scala says.

Orange juice will also help flush nicotine out of your body and help you become nicotine-free faster, Dr. Cooper says. Avoid orange juice, however, if you're using the nicotine patch or gum, because you want that nicotine to stay in your body to help avoid withdrawal symptoms.

Cap the caffeine. Laying off tobacco increases the stimulating effects of caffeine. So if you drink coffee, you may feel more jittery and might start craving a smoke, Dr. Brandon says. Switch to decaffeinated coffee and drink no more than two 8-ounce cups a day, he suggests.

Stay fluid. Carry a squeeze bottle of water around with you. Whenever you feel the urge for a smoke, take a swig of water instead, Dr. Cummings says. Water helps flush nicotine and other tobacco toxins out of the body and speeds withdrawal. In addition to the normal amount that you drink, he recommends having another six to eight glasses daily when you're trying to quit.

Eat breakfast. People who smoke often use a cigarette to elevate blood sugars and suppress appetite, Dr. Cooper says. It's important to replace your early-morning smoke with an energizing low-fat breakfast like a bran muffin and a glass of apple juice.

Be Johnny Appleseed. Snacking on an apple twice daily for the first 90 days after you quit will help get you past the midmorning and midafternoon slumps without reaching for a cigarette, Dr. Cooper says.

Try new foods. Avoid eating or drinking any foods that you link with smoking, Dr. Brandon says. So if you have always had a cup of coffee and a muffin for breakfast followed by a cigarette, try a glass of milk and a piece of raisin toast instead. The change can dampen your urge to smoke.

Make food work for you. In the first few days after quitting, keep low-fat foods like breadsticks, crackers, carrots, celery, and popcorn handy to toss into your mouth whenever you feel the urge to smoke. If you need something to do with your hands, try eating foods that require peeling, such as oranges, sunflower seeds, tangerines, nuts in the shell, or artichokes, suggests C. Barr Taylor, M.D., professor of psychiatry at Stanford University School of Medicine and author of The Facts about Smoking.

Indulge your sweet tooth. If eating a sweet will prevent you from smoking, do it, Dr. Taylor says. If possible, avoid high-fat sweets like cake, ice cream, and chocolate. Instead, pick alternatives that are lower in fat like jelly beans, sherbets, hard candies, or fruits like grapes, bananas, or dates.

Meditation: A Single Thought Can Banish Urges

The average person has about 15,000 thoughts a day. If you're trying to quit, it can seem like every one of those thoughts is the same: Smoke!

But meditation can help you dampen that mental noise and help you become a nonsmoker, says Dr. Gersten.

Meditation is a form of concentration that allows you to focus your mind internally and step back from your thoughts and feelings, Dr. Gersten says. In its simpler forms, meditation uses pictures, words (mantras), objects (such as a candle flame), or sensations (such as breathing) to focus the mind. If your mind begins to drift, you refocus your attention on your chosen image or word.

Studies have shown that meditation can help reduce the severity of many medical conditions, including anxiety, asthma, migraines, high blood pressure, and chronic pain. And it can help you quit smoking, Dr. Gersten says. Every time you feel an urge to smoke, try this meditation. Each time you inhale, say the word "peace," and as you exhale, say "love." If your mind begins to wander, refocus it on the words. Do that for five minutes, and by then the urge to smoke may have passed or subsided to the point that you can resist it, Dr. Gersten says.

"This meditation will help you deal with the craving. You're not saying that the urge to smoke isn't there," Dr. Gersten says. "You're acknowledging that the urge exists, but you don't have to do anything about it. You just turn your mind back to your mantra."

Nicotine Fading: Letting Go Slowly

Although going cold turkey is your best bet, there is a gradual alternative that works for some people, says Dr. Orleans.

The process is known as nicotine fading, and Dr. Orleans calls it a form of "cool turkey" because it prepares you both physically and psychologically for the day when you finally quit altogether.

"Quitting abruptly on a target date is the best way to go," Dr. Orleans says. "But nothing says that you shouldn't prepare yourself for your quit date. Nicotine fading is one of the ways you can do that."

By making small weekly drops in nicotine, you avoid strong withdrawal symptoms when you quit, particularly if you smoke a high- or medium-nicotine brand.

High-nicotine brands include unfiltered cigarettes and any filtered brand that isn't labeled with the words "mild," "light," or "ultra-light." Medium-nicotine brands are labeled "mild" or "light." Low-nicotine cigarettes bear words like "extra mild," "ultra," and "ultra-light."

The program allows two weeks to complete the nicotine fading process if you smoke a high-nicotine brand, and one week for medium- or low-nicotine brands.

Let it fade. Fading is fairly simple, Dr. Orleans says. If you smoke a high-nicotine brand, switch to a medium for one week and then to a low brand for another week before you quit. That way you will cut your dose of nicotine by one-third each week. If you smoke mediums, switch to lows for a week, and if you smoke lows, try an ultra-low brand for a week.

Don't jump off too fast. Avoid going directly from a high-nicotine brand to a low one, Dr. Orleans says. If the nicotine in your body drops too rapidly, it can cause cravings and withdrawal symptoms, which will defeat the purpose of fading.

Be cautious. The way you smoke affects how much nicotine you take in, so keep your cigarette use on an even keel. Dr. Orleans warns that if you switch to lower-nicotine cigarettes but smoke more of them, you risk getting the same dose of nicotine that you were getting before. Also, avoid inhaling more often or deeply than you have in the past and try not to cover the tiny airholes near the bottom of the filter with your fingers or lips.

Keep that date. Having an absolute quit date is a must with nicotine fading, Dr. Orleans says. Without it, you may be tempted to think that cutting back on nicotine is good enough. It isn't. For the sake of your health, you need to shake the habit completely.

For more information on the Clear Horizons program write to: Fox Chase Cancer Center, 510 Township Line Road, Cheltenham, PA 19012.

Prescription for Prevention

Quitting smoking is the most important thing that a person can do to slash the risk of stroke, cancer, and heart disease. Even if you have smoked for years, quitting at 60, 70, or 80 can reverse many of the worst effects of smoking and improve the quality of your life.

Do:

* Set a quit date and stick to it.

* Throw out all of your tobacco products on your quit date.

* Quit cold turkey.

* Plan out your day so that you'll be less tempted to smoke. Browse in a smoke-free shopping mall, for example.

* Eat like a nonsmoker. A balanced diet that includes at least five servings of fruits and vegetables like apples and carrots can help reduce your urge to smoke.

* Drink at least two 8-ounce glasses of orange juice daily. It will help flush nicotine out of your body. Orange juice, however, is not recommend if you are using the nicotine patch or gum.

* Persevere. Nicotine, a prime ingredient in tobacco, is one of the most addictive substances in the world. It may take several attempts to quit. But if you keep trying, you will become a nonsmoker.

Don't:

* Drink alcohol for at least 30 days after you quit smoking.

* Drink caffeinated beverages like coffee, tea, or colas. Caffeine can increase your urge to smoke.

* Let stress defeat your effort to quit. Practice relaxation techniques like meditation.