CHAPTER 3.
CLEARING THE AIR ON HARD FACTS—WHAT SMOKING DOES TO YOUR BODY.
Smoking is a major health hazard. There is now an exhaustive body of evidence—including hundreds of epidemiological, experimental, pathological, and clinical studies—to demonstrate that smoking increases the smoker’s risk of death and illness from a wide variety of diseases. The U.S. Surgeon General has called cigarette smoking “the chief preventable cause of death in our society.” The National Institute on Drug Abuse has estimated that in the U.S. alone, smoking is responsible for approximately 350,000 deaths per year.
Most smokers accept the fact that smoking is harmful, but many think of this risk as something like a game of roulette: They believe that each cigarette they smoke is like placing a bet. The “prize” is a heart attack, lung cancer, or some other disease. If your “number’ comes up, you’ve had it, but if you are “lucky” and your number never comes up, you may avoid the hazardous effects of smoking altogether and live to a ripe old age totally unaffected by your smoking habit.
This is a serious misconception. Every cigarette you smoke harms your body. Here’s a better analogy:
Suppose you lived near a chemical plant that emitted a number of toxic wastes that had seeped into the town’s drinking water, so that every time you took a drink of water, it did a small amount of damage to your body. After you’d lived there for a few years, you might notice that you didn’t have quite as much energy as you used to. And after five or ten years, you might notice that quite a few of the townspeople seemed to be getting ill with one thing or another.
In the same way, every cigarette you smoke damages your body. The more you smoke, the greater the damage. True, there have been people who lived into their seventies and eighties even though they smoked all their lives, but unless they were either extremely light smokers or did not inhale, they almost certainly suffered substantial physical impairment as the result of their smoking while they were alive. If they had not smoked, they would in all likelihood have lived longer.
Smoking Risks—Rules of Thumb
• Lung cancer risk—increases roughly 50 to 100 percent for each cigarette you smoke per day.
• Heart disease risks—increases roughly 100 percent for each pack of cigarettes you smoke per day.
• Switching to filter-tip cigarettes reduces the risk of lung cancer roughly 20 percent, but does not affect the risk of heart disease.
• Smokers spend 27 percent more time in the hospital and more than twice as much time in intensive care units as nonsmokers.
• Each cigarette costs the smoker five to twenty minutes of life.
• A smoker is at twice the risk of dying before age sixty-five as a nonsmoker.
Inside a Smoker’s Body
Let’s take a look at what happens inside your body each time you light up. You may be surprised to learn how quickly tobacco smoke can produce harmful effects.
Eyes, Nose, Throat
• Within a few seconds of your first puff, irritating gases (formaldehyde, ammonia, hydrogen sulfide, and others) begin to work on sensitive membranes of your eyes, nose, and throat. They make your eyes water and your nose run. They irritate your throat. If you continue smoking, these irritating gases will eventually produce a smoker’s cough. One of the reasons many smokers prefer menthol cigarettes is that menthol is an anesthetic that masks the smoker’s perception of this irritation.
• Continued smoking produces abnormal thickening in the membranes lining your throat. This thickening is accompanied by cellular changes that have been linked to throat cancer.
Why Smokers Frequently Experience a Morning Cough
Because you haven’t smoked all night, the cilia in your bronchi, which were knocked out of action by the toxic effects of cigarette smoke the day before, begin to come to life and attempt to clear the accumulated mucus out of your air passages. This cleansing action brings up a thick yellow or yellow-green mucus, which triggers the cough reflex in the back of your throat.
Lungs
• From your very first puff, the smoke begins to chip away at your lung’s natural defenses. Continued exposure can completely paralyze the lungs’ natural cleansing process.
• Your respiratory rate increases, forcing your lungs to work harder.
• Irritating gases produce chemical injury to the tissues of your lungs and the airways leading to the lungs. This speeds up the production of mucus and leads to an increased tendency to cough up sputum.
• This excess mucus serves as a breeding ground for a wide variety of bacteria and viruses. The makes you more susceptible to colds, flu, bronchitis, and other respiratory infections. And if you do come down with an infection, your body will be less able to fight it, because smoking impairs the ability of the white blood cells to resist invading organisms.
• The lining of your bronchi begins to thicken, predisposing you to cancers of the bronchi. Most lung cancers arise in the bronchial lining.
• Farther down, inside your lungs, the smoke weakens the free-roving scavenger cells that remove foreign particles from the air sacs of the lungs. Continued smoke exposure adversely affects elastin (the enzyme that keeps your lungs flexible), predisposing you to emphysema.
• Many of the compounds you inhale are deposited as a layer of sticky tar on the lining of your throat and bronchi and in the delicate air sacs of your lungs. A pack-a-day smoker pours about eight ounces—the one full cup—of tar into his or her lungs each year. This tar is rich in cancer-producing chemicals, including radioactive poloniumm 210.
Experiment: Breathe in a full mouthful of smoke, but don’t inhale. Blow the smoke out through a clean white handkerchief is roughly equivalent to the amount each puff leaves in your lungs.
Heart
• From the moment smoke reaches your lungs, your heart is forced to work harder. Your pulse quickens, forcing your heart to beat an extra 10 to 25 times per minute, as many as 36,000 additional times per day.
• Because of the irritating effect of nicotine and other components of tobacco smoke, your heartbeat is more likely to be irregular. This can contribute to cardiac arrhythmia, and many other serious coronary conditions, such as heart attack. A recent Surgeon General’s report estimated that about 170,000 heart attacks each year are caused by smoking.
Blood Vessels
• Your blood pressure increases by 10 to 15 percent, putting additional stress on your heart and blood vessels, increasing your risk of heart attack and stroke.
• Smoking increases your risk of vascular disease of the extremities. Severe cases may require amputation. This condition can produce pain and can increase your risk of blood clots in the lungs.
Skin
• Smoking constricts the blood vessels in your skin, decreasing the delivery of life-giving oxygen to this vital organ. As the result of this decrease in blood flow, a smoker’s skin becomes more susceptible to wrinkling. This decreased blood flow can be a special problem in people who suffer from chronically cold hands and/or feet (Raynaud’s Syndrome).
• Smokers are at particularly high risk for a medical syndrome called “smoker’s face,” which is characterized by deep lines around the corners of the mouth and eyes, a gauntness of facial features, a grayish appearance of the skin, and certain abnormalities of the complexion. In one study, 46 percent of long-term smokers were found to have smoker’s face.
Blood
• Carbon monoxide—the colorless, odorless, deadly gas present in automobile exhaust—is present in cigarette smoke in more than 600 times the concentration considered safe in industrial plants. A smoker’s blood typically contains 4 to 15 times as much carbon monoxide as that of a nonsmoker. This carbon monoxide stays in the bloodstream for up to six hours after you stop smoking. A 1982 University of Pittsburgh health survey found that nearly 80 percent of cigarette smokers had potentially hazardous levels of carbon monoxide in their blood. Research suggests that these abnormally high carbon monoxide levels may play a major role in triggering heart attacks.
• When you breathe in a lung-full of cigarette smoke, the carbon monoxide passes immediately into your blood, binding to the oxygen receptor sites and figuratively kicking the oxygen molecules out of your red blood cells. Hemoglobin that is bound to carbon monoxide is converted into carboxyhemoglobin, and is no longer able to transport oxygen. This means that less oxygen reaches a smoker’s brain and other vital organs. Because of this added carbon monoxide load, a smoker’s red cells are also less effective in removing carbon dioxide—a waste product—from his or her body’s cells.
• If you continue to smoke for several weeks, your number of red cells begins to increase, as your body responds to chronic oxygen deprivation. This condition, characterized by an abnormally high level of red blood cells, is known as smoker’s polycythemia. In addition, smoking makes your blood clot more easily. Both of these factors may increase your risk of heart attack or stroke.
Male Reproductive System
• Two recent studies by Dr. Irving Goldstein and colleagues at the New England male Reproductive Health Center, Boston University Medical School, found a possible link between smoking and erection problems. In the first study, the researchers found that among a population of 1,011 men with erection problems, 78 percent were smokers—more than twice the number of men with erection problems found in the general population. The researches concluded that decreased potency might result from the negative effects of smoking on the blood vessels leading to the male reproductive organs.
• In their second study, the researchers measured the blood flow to the penis in 120 men who had come to their clinic with erection problems. They found that decrease in blood flow was proportional to the number of cigarettes smoked. Dr. Goldstein believes that smoking is the leading cause of impotence in the U.S. today.
• In addition to diminishing potency, smoking adversely affects the fertility of male smokers by decreasing sperm count and sperm motility as well as altering sperm shape.
Female Reproductive System
• Women who smoke heavily show a 43 percent decline in fertility. Women smokers are three times more likely than nonsmokers to be infertile. Women who smoke also have fewer reproductive years: They reach menopause an average of 1 ¾ years earlier than nonsmokers.
Smokers’ Bodies Get Less Oxygen
Because carbon monoxide lowers your blood oxygen carrying capacity, the blood delivers less oxygen to all the organs of the body. At the cellular level, oxygen is used to supply organs with the energy they need. Less oxygen means less energy.
In addition, more than thirty cancer-causing chemicals travel via the smoker’s bloodstream to every organ of the body. The organs most sensitive to these carcinogens are the stomach, the kidneys, the bladder, and the cervix.
Cigarette smoking also weakens the immune system by depressing antibody response and depressing cell-mediated reactions to foreign invaders. As a result, smokers are more susceptible to a variety of infections. These impairments are reversible if the smoker stops smoking.
Why Smoking makes You Less Fit
Although a smoker’s blood carries less oxygen, the nicotine in tobacco smoke increases the heart rate, requiring more oxygen. This is why smokers become short of breath more easily than nonsmokers. The high concentration of carbon monoxide also reduces the level of oxygen that is carried to the brain. This can produce lethargy, confusion, and difficulty in thinking.
Smoking Impairs Taste and Smell
Continued smoking will also result in a loss of your senses of taste and smell. This occurs so gradually that it may go unnoticed, but the end result is the decreased sensitivity of two very important sense perceptions.
Smokers Die Young
In addition to producing the short-term damage described above, smoking dramatically increases the risk of illness and death. Eight major studies (involving over 2 million people) have all found that smokers die sooner than nonsmokers. The average increase in death rate among smokers was 61% overall. For smokers in the two most vulnerable age groups (35 to 45 and 45 to 55) the death rates were 86% and 152% higher.
This means that the average nonsmoker lives more than eight years longer than the average heavy smoker. Here is what smokers lose in years:
• Light Smokers give up 4.6 years of life in exchange for smoking.
• Moderate Smokers give up 5.5 years of life.
• Heavy Smokers give up 6.2 years.
• Very heavy Smokers give up 8.3 years.
Below are some figures that show the portion of deaths attributed to smoking:
Lung Cancer 85% - 90%
Bronchitis & Emphysema 85%
Mouth Cancers 70%
Throat Cancer 50%
Bladder Cancer 30% - 50%
Esophagus Cancer 20% - 40%
Pancreas Cancer 35%
Arteriosclerosis 33%
Heart Disease 30%
Kidney Disease 15% - 25%
Smokers Have More Illnesses
In addition to dying younger, smokers have increased rates of both acute and chronic illnesses. The U.S. Public Health Service has estimated that cigarettes are responsible for:
• 81 million missed days of work per year
• 145 million days spent ill in bed every year
• 11 million additional cases of chronic illness per year
• 280,000 additional cases of heart disease
• 1 million additional cases of chronic bronchitis and emphysema
• 1.8 million additional cases of chronic sinus problems
• 1 million additional cases of peptic ulcer
Compared to nonsmokers, smokers have higher rates of disease, emphysema, chronic bronchitis, peptic ulcer, allergies, and impairments of the immune system. As well, pregnant women who smoke have more stillbirths and babies of reduced birth weight. And children of smoking mothers are more likely to have continued difficulty developing physically and even socially throughout their lives.
Lung and Other Cancers
Cancer is a term used to describe the abnormal growth of cells that may result in the destruction of healthy tissue. Persons exposed to certain environmental carcinogens are at increased risk of some cancers. Smokers who inhale tobacco have been found to be at substantially increased risk for lung cancer. They are also at higher risk for cancers of the larynx, mouth, esophagus, bladder, kidney, and pancreas.
Smoking is the principal cause of the massive rise in death rates from lung cancer over the past 40 years. The U.S. Public Health Service estimates that 85% to 90% of all U.S. lung cancers are caused by smoking. The risk of lung cancer increases with the number of cigarettes smoked, how deep you inhale, and the tar content of the cigarettes you smoke.
The age at which you began smoking is also a major factor in the development of lung cancer. Males who started smoking before the age of fifteen have nearly four times the rate of lung cancer as those who began smoking after age 25. The cancer-producing effects of smoking are not seen for many years. It usually takes at least 15 to 20 years of smoking to produce lung cancer in a human.
For those smokers who are able to quit, the risk of lung cancer begins to decrease immediately. It continues to drop for the next 10 to 15 years, when it reaches a point only slightly higher than the risk for nonsmokers.
Cardiovascular Disease
The effects of smoking on the heart and blood include increased blood clotting, an increased level of catecholamines, increased heart rate, decreased oxygen supply to the heart muscle, increased irritability of the of the electrical conducting system of the heart, and increased blood pressure. As a result, a smoker risk of heart disease, stroke, and other vascular abnormalities is, on average, about twice that for nonsmokers. The severity of heart attacked among smokers tends to be proportional to the cumulative dose of tobacco smoke they have inhaled in their entire smoking lives.
Other Diseases and Conditions
1) Emphysema: Virtually everyone with emphysema gets it as the result of smoking. Smokers are also at increased risk for chronic cough, respiratory infections, and audible abnormalities in the lungs.
2) Osteoporosis: Smokers are at increased risk of thinning of bones. The bone fractures that result from loss of bone tissue are a major health problem, especially among post-menopausal women, and both men and women over 70. Researchers at the Mayo Clinic recently estimated that osteoporosis is responsible for 1.2 million fractures in the U.S. every year. Many of these fractures are fatal. Survivors frequently require long term nursing home care.
3) Smokers experience more respiratory complications during surgery.
4) A recent National Cancer Institute study showed that women who smoke have one-and-one-half-fold risk of invasive cervical cancer. Women who smoke 40 or more cigarettes per day had a two-fold risk. Those who smoke unfiltered cigarettes are at a particularly high risk.
5) Smokers are at increased risk of cancers of the larynx, mouth, esophagus, bladder, pancreas, kidney, and stomach.
6) Smokers are at increased risk for both peptic and duodenal ulcers.
7) Smokers are at increased risk of gum disease.
8) Recent studies suggest that smokers may be at four-fold risk of developing Alzheimer’s disease.
9) Smokers are at increased risk of being hurt or killed in house fires (as are all people who live with or near them). Some 39% of the people killed in fires caused by negligent use of cigarettes were not the smokers involved.
Effects of Tobacco Smoke on Nonsmokers
Nonsmokers exposed to smoke-filled rooms show carbon monoxide blood levels equivalent to those of light smokers. Among adults exposed to tobacco smoke, the most common symptoms are eye irritation, headaches, nasal irritation, and cough. Exposure to smoke can also trigger or aggravate allergic symptoms. Respiratory illness is more common in children exposed to tobacco smoke. And there is now considerable evidence to suggest that passive smoking may increase the risk of both heart attacks and lung cancer among the nonsmokers.
Effects of Cutting Down and Quitting
The good news for smokers is that the great majority of negative health effects caused by smoking are dose-related. That is to say, the risk is proportional to the number of particles that pass into the body.
Thus every step you can take to reduce the risk of your “dose” of tobacco smoke will help improve your health.
Quitting will reduce your risk the most, but cutting down can help reduce your risk as well.
