Smokers' Health Page

	Minimising the Health Risks of Smoking
	Here you will find the information that medical and anti-smoking campaigners refuse to promote to the smoking community. You can reduce your smoking risks by adopting an appropriate risk reduction lifestyle - so read on and take action. Topics covered in this page are listed below and subject to ongoing development: MINIMISING THE HEALTH RISKS OF SMOKING -----1. Introduction (including relative risk v. absolute risk) -----2. Using this Information - YOU MUST READ THIS - -----3. What you need to do to reduce risks. --------3.1 Smoke less --------3.2 Choose your parents carefully! --------3.3 Four healthy behaviours --------3.4 Beneficial Foods -----------3.41 Fruit, vegetables and grains -----------3.42 Dark chocolate -----------3.43 Tea and antioxidants -----------3.44 Coffee's protective effects -----------3.45 Olive oil and fish oil -----------3.46 Herbs and spices --------3.5 Alcohol --------3.6 Exercise --------3.7 Aspirin for over-50s --------3.8 Food combining for health --------3.9 Organic food....under development --------3.10 10 ways to avoid cancer....under development -----4. Summary of key beneficial activities....under development The items still "under development" will be completed as soon as possible. (Please Note: There are a large number of links to references for the health issues raised, and these will open in one separate window, but it will be the same window used for all links - to avoid cluttering up your task bar.) 1. INTRODUCTION We all hear in the press from time to time reports about the latest fad for keeping you healthy, but very few stray into the area of smokers' health. For the anti-smoking lobby it is a taboo subject, since it doesn't seem to want smokers or the general public to think that there is anything smokers can do to reduce the health risks of smoking - it just wants everyone to believe that death from a smoking related disease is the early and almost inevitable outcome. That this is a cynical and callous position seems to pass by most of the public and press, with even the main medical establishments seeming to avoid giving pro-active health advice to committed smokers. It proves, if proof is needed, that the anti-smoking campaign is as much about ideology as it is about health. On this point, in Spring 2007, Gio Batta Gori of the Health Policy Centre USA says a policy proposed almost 40 years ago, to develop a cigarette which effectively reduced the level of harmful substances by 50%, was suppressed by the anti-smoking lobby. He says they therefore cynically condemned many smokers to a premature death over the next 40 years. Apparently the policy for a safer cigarette was again raised in 2001, but was once more smothered by the anti-smoking lobby. Also, the House of Commons (1999-2000) Select Committee on Health Second Report shows (paras. 142/143) that Imperial tobacco had attempted to introduce a safer cigarette in 1977, but its failure the company put down to "the Government's refusal to reduce levies on NSM products in relation to conventional cigarettes; adverse effects as a result of Government sponsored campaigns; and the fact that cigarette smokers preferred conventional cigarettes". What the "Government sponsored campaigns" were are not defined in the report. However, the Select Committee itself seemed committed to the production of a safer cigarette to try and reduce the health problems for committed smokers, and actually supports the concept in their final recommendations. But this recommendation doesn't seem to have been taken up. Why? If Gori's 2007 accusation is correct then this must be a serious indictment of the methods adopted by the anti-smoking lobby and further underlines the fact that ideology is clearly their driving force. Nevertheless, even if a safer cigarette were to be available smoking would still clearly have the potential to damage your health, so it makes sense to consider ways you can reduce these risks as much as you can. Health Risks or Health Benefits - Getting behind the published statistics It is beyond the scope of this article to go into the details of statistical analysis and statistical presentation of results, and those who wish to can research the topic themselves on the web. All I have been able to do at this stage is to present the results of research as they have been reported. However, there is one point worth bearing in mind when reading the research results described below. As a smoker you are at risk of developing a range of cancers - primarily lung cancer (smoking reputedly causes around 85% of cases of lung cancer - there are other causes e.g Mesothelioma where exposure rates of as little as a few months can cause this cancer many years later). Also smoking is "linked" to over a dozen other cancers including cancers of the mouth, larynx (voice box), oesophagus (food pipe), liver, pancreas, stomach, kidney, bladder and cervix, as well as some types of leukaemia. In addition there are risks relating to heart, circulatory system, chronic lung diseases and stroke. Also, of course, all smokers have a 100% risk of dying - and following the logic of some of the more extreme risk aversion groups prevalent in today's society, you might want to consider whether it was worth ever being born in the first place! The above risks are also risks for non-smokers of course, but the risks are reported to be higher for smokers - but what does "higher" really mean when you come to weigh up what it means to you personally?. Whenever you read about the risks of smoking, the risks are almost always referred to as relative risks such as "increased"risk, "higher risk", 50% higher risk, 10 times the risk, etc., and rarely as "absolute risks". The increased risk usually means an increased risk compared to someone who never smokes (but you need to look carefully at the definition to be clear). By absolute risks it means a statement which tells us, say, out of 100,000 smokers how many will die this year, or over the next five years, etc.? (and of course, the information is complicated by factors about intensity of smoking, age, sex, lifestyle etc). Relative risk doesn't really help you take an informed decision about smoking - information on absolute risk is much more useful. Unfortunately it is very difficult to find definitive information on absolute risk. (If anyone knows of a web-site that has managed to abstract and collate scientifically valid absolute risks around various aspects of smoking, then please contact me and I will link this page to it). Why is relative risk used more than absolute risk? - because it is easier to sensationalise relative risk, and sensationalism sells newspapers, sells research projects, brings in more funding for further research and generally makes it easier to manipulate public opinion. However, here is one graph showing absolute risks which helps put risks into perspective. Cigarette smoking is generally considered to be more risky than cigar smoking, although cigars can cause similar hazards if their smoke is inhaled. Cigarettes, cigar and pipe smoking cause comparable hazards for cancers of the oral cavity, pharynx, extrinsic larynx and oesophagus. The graph alongside comes from a wide review of cigar smoking reported in 1998 by the National Cancer Institute (US). It compared all available data on the health risks associated with cigar smoking with risks associated with cigarette smoking. The graph shown alongside relates to lung cancer specifically, and compares lung cancer death rates of cigarette and cigar smokers for various levels of cigar smoking and inhalation of the smoke. The upper solid line denotes a 20 cigarette a day smoker's death rate assuming commencement at age 18. By the age of 60 there are approx. 200 smoker deaths per 100,000 (or 2 per 1,000), whereas never-smokers have a lung cancer death rate of 12 per 100,000 at this age. Hence the 20 a day smokers have an increased risk of around 17 times those of never smokers. This would normally be reported in the press as "20-a-day- smokers at age 60 have nearly 20 times risk of dying from lung cancer than non-smokers", which sounds a lot more frightening than the absolute figures (2 per 1000) at age 60 - even after 42 years of smoking 20 a day. This puts into perspective the lack of any practical impact that occasional exposure to second hand smoke must have on absolute risk of cancer for non-smokers. The reduced lung cancer risks for cigar smokers can be seen in the various plots, with non-inhalers having the lowest risk at around 40 per 100,000 (0.4 per 1000) at age 60 , which equates to about 20% of the risk for typical 20-a-day cigarette smokers. So, if cigarette smokers adopted a "Social Smoking" philosophy, smoking quality, good flavoured cigarettes, obtaining the pleasure and satisfaction from circulating the flavour around mouth and nose as cigar smokers do and inhaling less, then it seems plausible that they would reduce their risks down towards the cigar smoking level. As age increases so does the risk. At age 85 the risk for the 20-a-day cigarette smoker is around 1000 per 100,000 (1 per 100), with non-inhaling cigar smokers' risks also increasing to around 260 per 100,000. Bear in mind that these are for lung cancer only, and when the other smoking risks as listed above are added they will increase the overall risk of death for a smoker. Also, while your own personal risk may not seem devastatingly high, when you multiply even these small rates by the numbers of people smoking, it does produce a very large number of smoking related deaths. It is this that so excites the medical establishment and safety conscious governments - and they use it in all manner of emotive ways to put pressure on you not to smoke. The more virulent anti-smokers and smoker-haters use these figures and methods in even more inflammatory ways, but of course they are not really worried about your health, they just don't like anyone smoking and will use (have used) all means at their disposal to force you to comply with their own lifestyle choice. It is all quite a vexed question, as one has to die of something, although if your number comes up at age 40, say, this is obviously no comfort to family and friends left behind. However, we are all living longer, but it appears that we mostly don't have good health and sound minds in these twilight years. Research says that we have about the same length of good quality life, it's just that when we finally become ill we just take a lot longer to die - and mostly of senile dementia, altzeimers and the like - and I personally, having seen it first hand, wouldn't wish that on anyone. There was a recent article in a British newspaper by a journalist who had just watched a friend die of cancer and, as he found it so distressing he was happy to forgo smokers' civil liberities and support the ban on smoking. Whilst one can feel for his loss, what about someone who loses a family member in a car accident. Should they ask to ban all cars? People do an unending list of dangerous things, go hang-gliding, climbing rock-faces, motor racing, motorcycling, jump out of aeroplanes, pot-holing, scuba-diving, skiing, etc. But that is their choice, and no-one resents them making that choice - and there aren't proposals to refuse them medical treatment if they succumb to the risks they have taken..... As I said, a vexed question...... could be a topic for another web-page - if I ever find the time! There has been, and will continue to be valid debate about the methods used for attributing deaths to smoking, but even if these statistics are acknowledged as upper estimates, it now appears that the scientific community at least is beginning to accept that smokers' risks can be reduced by adopting various lifestyle changes. In recent research (December 2007), Michele Forman, a professor of epidemiology at the University of Texas states that "Although this is a very preliminary analysis, it gives us some important clues about how everyone - smokers and non-smokers alike - might be able to reduce their risk of developing lung cancer" This page, will highlight scientific articles or reports which suggest how to reduce the health risks of smoking, and will be updated as time allows. back to topics list 2. USING THIS INFORMATION •••• PLEASE NOTE•••• The actions identified on this page do not constitute professional medical advice. For that you would need to investigate the original source of the information and obtain advice from your own Doctor before making up your own mind about whether to adopt any of them - particularly if you are currently taking any medication. Also, common sense comes into play - the research we all hear reported involves results covering a range of different people who may respond differently to the various factors involved, and results only give you the "average" type of response. In all studies there will be many complicating factors which introduce uncertainty into trying to establish the cause of the results found. The World Cancer Research Fund and the American Institute for Cancer Research (see in more detail in Section 3.10 below) indicate in their "Second Expert Report (2007)" on avoiding cancer through diet and exercise that: "No single study or study type can prove that any factor definitely is a cause of, or is protective against, any disease". However they do believe reliable judgments of the likely causes of disease can be based on assessment of a variety of well-designed epidemiological and experimental studies. Researchers in this field also indicate that a difficult area to resolve is the potential for synergistic (enhanced inter-related) effects of various factors both beneficial and harmful. Here the effects of certain nutrients, pollutants, etc., might be reasonably well understood when investigated by themselves, but when a number of these factors are present at the same time the overall effects might be greater than just the sum of the individual effects. Hence, the medical evidence is rarely unanimous, there is always some doubt involved. If you already have medical problems of one sort or another then the actions suggested by the research may not be appropriate. Use your common sense; and if you do adopt any of the strategies outlined below then whatever you do, do it gradually and in moderation while assessing whether it affects you adversely or not. Your body normally tells you how it is responding - if it feels good, then it is probably beneficial, if you feel bad after it, then it's probably not doing you any good. Get in tune with your body! back to topics list 3. WHAT YOU NEED TO DO TO REDUCE RISKS The articles below provide information how to adopt a healthier lifestyle to reduce the risks associated with smoking :- 3.1 Smoke less. It seems well accepted and general common sense that the fewer cigarettes you smoke, the lower the risk. Try to adopt the "social smoking philosophy", control when you smoke, go for a better quality cigarette and only smoke if possible when you have time to savour it and get the most pleasure and relaxation out of it. Try to reduce the depth of inhalation of the smoke. back to topics list 3.2 Choose your parents wisely! Very few cancers are genetically derived, it is the inheritance of mutated genes or genes that mutate during your lifetime that reduce your ability to fight cancers. Inherited genetic problems are not large however, and account for less than 10% of cancers . If you have a family history of more than one or two family members dying of cancer, then it seems you may be at increased risk yourself. Hence you need to take a common sense view of your risks and consult your doctor for better advice. back to topics list 3.3 Four relatively simple, healthy behaviours Apparently, for middle aged and older people:- "The millions of people resolving to live a healthier life in 2008 can take heart. Four relatively simple healthy behaviours, may add 14 years to your life, say researchers. Even better, they help no matter how fat or unhealthy you are already". It was in the reduction of deaths attributed to cardiovascular disease where the findings were most pronounced, with those scoring zero five times more likely to succumb than those scoring four. But there was also a relationship between score and cancer deaths. While the main analysis excluded people with known disease, the researchers found that those with serious conditions fared better the higher they scored than those who scored lower. The full research paper is shown here. The study covered 20,00 people in the Norfolk county of England over the period 1993-2006, ages ranging from 45 to 79 not, as far as they were aware at the time, having cancer or any heart problems. A point was awarded for each of the following: 1. not currently smoking; 2. consuming between one and 14 units of alcohol per week (one unit of alcohol is approx. equivalent to half a pint of beer or one small glass of wine); 3. eating five servings of fruit/vegetables each day; 4. not being inactive. This last category was defined as either having a sedentary (sit down most of day) occupation and taking half an hour of exercise a day, or simply having a non-sedentary job like a nurse or plumber. (The exercise criteria were based on reported hours of exercise per week, and the total divided by 7 to get an average daily amount.) The message seems clear - and quite welcome! If you currently smoke, you can only get a maximum of 3 points if you do the others, i.e. exercise, eat a diet with lots of fruit and vegetables, and drink moderately. On the graph this implies that out of a 100 people who scored 3 points 92 are likely be alive after 14 years and 8 are likely to be dead. If you don't smoke and also meet the other 3 requirements, you get the maximum of 4 points. This means that out of every 100 people scoring 4 points, 95 are likely to be alive after 14 years and 5 are likely to be dead. If you scored zero points, then out of the 100, 75 are likely to be alive with 25 being dead within 14 years. The other interesting point is that if you smoke, exercise and drink only moderately (but don't eat plenty of fruit and vegetables), you would be better off than someone who doesn't smoke but neither exercises, drinks, or eats the required fruit and vegetables. An iteractive version of this research is available at a University of Cambridge site called Understanding Uncertainty. (Requires Flash Player). The implications are that smoking as a risk in the relatively short term (14 years) is similar to the risks of not exercising, or not drinking at all, or drinking to excess, or rarely eating fruit and vegetables. The message is simple - if you don't want to give up smoking, then modify your lifestyle to include doing points 2, 3, and 4 as specified. If you are a regular pub drinker, then 7 pints of beer (14 Units) a week might be a bit difficult to keep to, but at least you will now know what you should be aiming for! back to topics list 3.4 Beneficial Foods 3.4.1 Fruit, vegetables and whole grains - roughage and anti-oxidants Roughage We have all heard the exhortation from the medical world that we should eat more fruit and vegetables - at least five portions per day is the current recommended advice to help reduce the risk of some cancers, heart disease and many other chronic conditions. Part of the reasoning is the body's need for roughage to function effectively. It was thought that it was the fibre absorbing water and bulking out which stimulates movement and transports toxins more quickly through the gut which reduces contact time with the wall of the intestine, so reducing damage that could lead to cancer. However, recent research indicates that when fibrous foods, which cannot be fully digested, rub up against a cell in the lining of the intestine, they rupture the outer cover and cell-protecting mucus is released. The cells then act within seconds to repair the damage, producing more beneficial mucus in the process. It appears that this mucus could also provide a lining against carcinogens we take in which might cause bowel cancer. Although this is not primarily applicable to smoking, it makes sense that if your body is functioning efficiently, and not labouring under the stress of trying to neutralise toxins in the gut, then it will have more potential to combat any toxins taken in while smoking. Anti-oxidants Briefly, "Antioxidant" is a classification of a number of organic substances, including vitamins C and E, vitamin A , selenium (a mineral), carotenoids and others. Fruit, vegetables and whole grains (cereals) have high levels of these substances which are thought to be effective in helping to prevent heart disease, cancer, and stroke, although as ever there is some conflicting evidence. At the molecular and cellular levels, antioxidants serve to neutralise certain particles called free radicals. In humans, free radicals tend to become oxidised, and this oxidation process can sometimes be carcinogenic. Free radicals are the natural by-products of many processes within and among cells. They are also created by exposure to various environmental factors such as air pollution, radiation, tobacco smoke, infection, and excessive sunlight for instance. If not neutralised these free radicals can cause damage to cell walls, certain cell structures, and genetic material within the cells. In the worst case scenario and over a long time period, such damage can become irreversible and lead to disease (e.g. cancer). Antioxidants play the housekeeper's role, "mopping up" free radicals before they get a chance to do harm in your body. Researchers have postulated that antioxidants prevent the possible carcinogenic effects of oxidation. For more information search the web for "antioxidant". This educational site is an example. Fruit, vegetables and whole grains Studies have consistently shown that regular consumption of fruits, vegetables, and whole grains is strongly associated with reduced risk of developing chronic diseases, such as cancer and cardiovascular disease. In fact, the recent "Second Expert Report (2007)" by the World Cancer Research Fund and the American Institute for Cancer Research (see in more detail in Section 3.10 below) states that :- Non-starchy vegetables probably protect against cancers of the mouth, pharynx (throat), and larynx (voicebox), and those of the oesophagus (food pipe) and stomach. There is limited evidence suggesting that they also protect against cancers of the nasopharynx, lung, colorectum, ovary, and endometrium (lining of the uterus). Allium vegetables (e.g. onions, garlic, shallots, leeks, and chives) probably protect against stomach cancer, with garlic also probably protecting against colorectal cancer; There is limited evidence suggesting that carrots protect against cervical cancer; There is limited evidence suggesting that pulses (legumes - fruits or seeds of anything that comes in a pod such as green beans, butter beans, broad beans, all dried beans (soy beans, kidney, haricot)), including soya and soya products, protect against stomach and prostate cancers; There is limited evidence suggesting that chilli is a cause of stomach cancer; Fruits in general probably protect against cancers of the mouth, pharynx, and larynx, and those of the oesophagus, lung, and stomach. There is limited evidence suggesting that fruits also protect against cancers of the nasopharynx, pancreas, liver, and colorectum. It is generally thought that this protection is attributed to the complex mixture of phytochemicals (non-nutritive plant chemicals that have protective or disease preventive properties) present in whole foods. Many thousands of phytochemicals have been identified but only a small proportion have as yet been investigated. Phytochemicals include antioxidants and deliver additional benefits through hormonal actions, stimulation of enzymes, preventing multiplication of cancer cells, anti-bacterial actions and physical binding actions which prevent the adhesion of pathogens to human cell walls. The numerous phytochemical extracts present in fruit and vegetables exhibit strong antioxidant and antiproliferative activities. These are thought to be enhanced by their additive and synergistic effects. Whole grains are cereal grains that retain the bran and germ as well as the endosperm. Common whole-grain products include oatmeal, maize (corn), brown rice, whole-wheat flour, sprouted grains, and whole-wheat bread. Refined-grain products include refined white flour, white rice, white bread and pasta (although whole-grain varieties of pasta are available). Whole grains are rich in many components, including dietary fibre, starch, fat, antioxidant nutrients, minerals, vitamins, lignans and phenolic compounds, all of which have been linked to reduced risk of cancer. Most of the components are found in the germ and bran which are reduced in the grain refining process. Dietary guidance recommends consumption of whole grains for the prevention of cancer especially gastrointestinal cancers such as gastric, colonic, and hormonally-dependent cancers including breast and prostate. However, the comprehensive "Second Expert Report (2007)"by the World Cancer Research Fund and the American Institute for Cancer Research (see later in Section 3.10 below) concludes that the direct evidence that cereals (grains), roots, tubers, or plantains affect the risk of any cancer remains unimpressive, but nevertheless states :- "However, foods containing dietary fibre probably protect against colorectal cancer; and there is limited evidence suggesting that such foods protect against oesophageal cancer. Dietary fibre is mostly found in cereals, roots and tubers, and also in vegetables, fruits, and pulses (legumes). All of these are highest in dietary fibre when in whole or minimally processed forms". So, the evidence is clear - if you want to reduce the risks - and it is clear from the above that you can - you need to adopt a diet rich in fruits, vegetables and whole grains. It may involve you in more effort planning and purchasing what you eat, but the evidence shows that it will help reduce your risks of getting cancer and/or heart and circulation problems. This next list of antioxidant levels in fruit and vegetables will help....... Foods containing high levels of antioxidants The US Department of Agriculture has developed a rating scale that measures the antioxidant content of various plant foods. The scale is called ORAC, which stands for Oxygen Radical Absorbance Capacity. They discovered that a small group of "super foods" have up to twenty times the antioxidant power of other foods. They recommend a daily intake of at least 3,000 units per day. The list below (courtesy USDA) gives the ratings for 100gm (~ 3.5 ounces) of each food. A 100gms is about the weight of an average sized lemon.

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