Thursday, September 3, 2009

The Case for Nicotine Maintenance

When people who are nicotine-dependent reduce or eliminate their intake of nicotine, they become moody, depressed, anxious, and irritable. They start making mistakes no matter how hard they try to concentrate. They have problems remembering things. Given these circumstances, is it any wonder that most people resume smoking within the first two weeks after quitting?

How long would most of us be able to get away with moodiness, forgetfulness, and making mistakes on the job? And how do such symptoms affect the performance of every-day tasks such as balancing the checkbook, taking medications, shopping, driving the car, or supervising children?

Many researchers suspect that people who are highly dependent on nicotine are using it to self-treat underlying disorders. This would explain why, for so many would-be quitters, their "withdrawal symptoms" do not disappear within the promised week or two. They go on, and on, and on.

Nicotine is being studied as a potential treatment for such conditions as attention deficits, Alzheimer’s, depression, anxiety, pain relief, Tourette Syndrome, inflammatory bowel disease, ulcerative colitis, schizophrenia, and epilepsy, as well as both treatment and prevention of Parkinson’s. Nicotine has none of the serious adverse effects that prescription antidepressants, corticosteroids, anti-seizure, anti-anxiety, and schizophrenia medications can cause.

There are additional adverse health effects associated with nicotine abstinence. When people quit smoking, they gain weight. For many years, the idea that this weight gain is relatively small and totally harmless prevailed. But research has shown that the average weight gain is not 5 pounds, it is 7 kilograms—more like 15 pounds. And many people gain 20, 30, or more pounds.

There’s more. The Multiple Risk Factor Intervention Trial (MRFIT) studied lifestyle interventions including diet, exercise, and smoking cessation to prevent the onset of diabetes. To the surprise of the researchers, those who succeeded in smoking cessation developed diabetes at a higher rate (11.5%) than the control group (10.8%) that received no lifestyle advice. Absolute risk for cardiovascular death is much higher in people with diabetes. In the same study, it was found that more quitters (35%) developed hypertension than non-quitters (27%). The authors observed, “Weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers.”

Nicotine replacement can postpone the weight gain. But currently available products are designed to provide low levels of nicotine and users are directed to decrease their use to zero. Once the user is weaned totally off nicotine, weight gain commences. Researchers at Harvard University found that ex-smokers who replaced higher proportions of their pre-cessation nicotine levels with nicotine gum gained less weight. It seems likely that full replacement of pre-cessation nicotine levels would prevent weight gain altogether. More importantly, permanent full replacement of pre-cessation nicotine levels prevents relapse to smoking.

Nicotine is not a carcinogen. Nicotine is not proven to cause heart attacks and strokes. Nicotine does not cause lung disease. Smoking can cause all of these, and it is the SMOKE--the product of combustion of the tobacco and paper, along with the thousands of additional carcinogens and toxins--that is the culprit.

The smoker you love may not be able to function without adequate levels of nicotine. And yet the attitude of the health organizations, anti-smoking groups, and even the FDA seems to be, “you should just quit or die.”