On March 1, 2006, a ban on smoking in Oklahoma restaurants went into effect. Only facilities that have a separate room, complete with its own ventilation system, can offer patrons the opportunity to smoke during or after their meal. Oklahoma had previously raised the state tax on cigarettes to $1.03 per pack, an 80 cent increase.

Despite these actions, Oklahoma ranks third in the nation in percentage of active smokers. State cigarette sales were down in 2005, but there is no evidence that this was due to a significant decrease in the number of smokers. Most of the decrease in sales can be traced to an increase in cigarette purchases from suppliers outside of the state.

This should not be terribly surprising. In an attempt to discourage smoking, the Dutch government increased the price of cigarettes by more than 70 % between 1988 and 1996. Despite the sharp rise in cost, the number of smokers rose. While the price of cigarettes in the Netherlands is twice the United States’ average, a greater percentage of its citizens smoke (35 % in the Netherlands compared to 23 % in the United States).

Nicotine is a highly addictive substance and inhalation is the optimum form of delivery. The more rapid the effect of a substance is felt, the more addicting it is. When an individual takes a drag on a cigarette, his or her brain experiences a nicotine “hit” in just 11 seconds. This is faster than if the nicotine was injected intravenously.

Studies comparing nicotine to heroin, cocaine, and alcohol demonstrate just how addictive cigarette smoking actually is. When drug users were asked to rate their desire for a substance, nicotine received a score similar heroin and cocaine. When they were asked about their need to have a substance, however, nicotine was rated significantly higher than any of the other drugs. When smokers attempt to stop smoking on their own, two out of three resume smoking within 72 hours. In fact, 40 % of people who have surgery for cancer of the larynx (voice box), a smoking-related disease, resume smoking at the earliest opportunity.

This is not to say that smoking cessation is impossible. Many smokers have successfully kicked the habit. It does suggest that quitting is extremely difficult and that many smokers will never be successful in their attempts to stop. Surveys have shown that sixty percent of smokers would like to quit, but are unable to do so.

The nature of nicotine has much to do with its addictiveness. The drug actually has opposite effects, depending upon the dose taken. When taken at a low dose, nicotine is stimulatory, making the user feel more alert and energetic. Low doses cause the pulse rate to increase and trigger a rise in blood pressure.

Higher doses of nicotine cause the person to feel more calm and relaxed. The heart rate will slow and the blood pressure will fall. Studies have shown that smokers quickly learn to subconsciously adjust how hard and how frequently they suck on a cigarette to adjust the nicotine dose to their needs at any particular moment.

This has interesting implications when it comes to the use of “light” cigarettes, which are viewed by many as an alternative to quitting. Laboratory studies showing that “lights” enable smokers to cut down on tar and nicotine exposure do not hold up in the real world.

The amount of tar and nicotine obtained from various brands of cigarettes is determined by using a machine that draws smoke at a consistent rate. When low tar cigarettes are evaluated by the sucking machine, lower doses of tar and nicotine are registered than those measured from standard cigarettes. This is because air being drawn in through tiny holes in the filter dilutes the tar and nicotine reaching the machine’s sensors.

When a smoker switches to a low tar cigarette, however, he or she simply sucks harder and more frequently to obtain the needed dose of nicotine. (The converse is also true. If someone who has been smoking “lights” switches to a higher rated brand he or she will draw with less force to maintain the nicotine level he or she is accustomed to receiving.)

Unfortunately, the harder someone draws on a cigarette the more carbon monoxide is inhaled in the process. Smokers are therefore being duped. Low-tar cigarettes not only deliver the same dose of nicotine as standard cigarettes when smoked by actual people, they deliver a greater dose of carbon monoxide. When greater amounts of carbon monoxide are inhaled, the body manufactures more red blood cells in an attempt to compensate for the loss of oxygen-carrying capacity. This thicker, sludgy blood impedes circulation and increases the risk of stroke.

Menthol-flavored cigarettes carry a similar challenge. Menthol affects the nerve endings in the throat and bronchial tubes, creating a cooling sensation. This allows the smoker to inhale more deeply and retain the smoke in the lungs for a longer period of time. This has the effect of increasing exposure to the compounds contained within the smoke.

Tar has been shown to contain over 4,000 chemicals, of which 60 are known to increase the risk of developing cancer. Some of the better known chemicals found in cigarette smoke are cyanide, formaldehyde, wood alcohol, ammonia, benzene and acetylene (the fuel used to fire welding torches). Carbon monoxide, which blocks the ability of the hemoglobin molecule to carry oxygen throughout the body, and nitrogen oxide, which causes constriction of blood vessels, are two of the gasses found within the smoke. Nicotine creates smoking’s desirable effects and is the primary reason cigarette smoking is so addictive.

Smokers pay a heavy price for experiencing the pleasurable effects of nicotine. Male smokers die, on average, 13 years earlier than their non-smoking peers. Women smokers fare even worse, having their live expectancy cut by 14 ½ years.

I once saw a dramatic example of the effect of cigarette smoking on life span. A 78 year-old man came to my office because he was experiencing severe shortness of breath. He had started smoking cigarettes when he was six years old and had averaged 3 packs per day over the next seventy years. Being in his upper seventies should have qualified him as the poster boy for the tobacco industry, a shining example that smoking is not harmful.

Unfortunately, that was not the case. On examination the man was found to have advanced emphysema. That he would die before reaching the age of eighty was a near certainty. He was about to become the first person on either side of his family to die before the age of 95. Born with an optimum genetic code, he had cut at least 15 years off of his life by choosing to smoke. That, as Paul Harvey would say, is the rest of the story.

The reasons for the observed decrease in life expectancy are many. A dramatic rise in respiratory diseases is one. The hot, noxious gases inhaled when a drag is taken from a cigarette directly irritate and damage the lining of the respiratory tract. Mucus production increases and, because the gases destroy the ability of cilia (sweepers) to move the mucus upward, bronchitis and pneumonia occur with much greater frequency than in non-smokers. Further damage to the structure of the bronchial tubes leads to emphysema, a condition in which stagnant air becomes trapped in the lungs and fresh, oxygen-rich, air is unable to reach the air sacks where the exchange of oxygen and carbon dioxide takes place.

The ongoing irritation of the cells lining the bronchial tubes sets the stage for the development of cancer, a process that takes several decades. Stopping smoking decreases the risk of cancer development, but ex-smokers remain more likely to develop lung cancer than non-smokers throughout their lives.

Cigarette smoking has devastating effects upon the circulatory system. Premature coronary artery disease (heart attacks), carotid artery disease (strokes), and peripheral artery disease (leg pain or amputations) are common in smokers.

Just as the heat and chemicals of cigarette smoke irritate the bronchial tubes, so they inflame the tissues of the mouth and throat. Gum disease occurs at a much higher rate in smokers. The incidence of lip, mouth, laryngeal, and esophageal cancers is dramatically increased in smokers.

Other cancers also occur with an increased frequency. Cancers of the bladder, kidney, pancreas, and colon, for example, have been demonstrated to be related to cigarette smoking.

In addition to premature death, smokers face disabling conditions more frequently. Smokers are at an increased risk of vision loss. Both macular degeneration (a loss of central vision) and cataracts occur more frequently and at younger ages in cigarette smokers.

Non-cancerous growths called polyps are also more common in smokers. Even if laryngeal polyps are not present, chronic irritation of the vocal cords often causes a deep raspy hoarseness in a smoker’s voice.

Osteoporosis and degenerative disk disease of the spine are diseases that occur more commonly in smokers. Each of these entities can result in chronic pain or disability.

Finally, cigarette smoking has profound effects on the skin. This is felt to be due less to topical irritation of the exhaled smoke than to constriction of capillaries that diminishes the ability of oxygen and nutrients to reach skin cells. The damage is clearly visible as accentuated wrinkling, especially around the eyes (crow’s feet) and upper lip, and a pale, grayish complexion. At an all-school reunion several years ago I was amazed at how easy it was to detect the women smokers as each class posed for its picture. Each looked years older than their non-smoking peers.

Two facts are abundantly clear. The first is that smokers are more likely to experience physical disabilities and to die at much younger ages than those who have chosen not to smoke. The second is that a sizeable percentage of smokers will never be able to kick the habit.

Given that smokers face a dismal prognosis of disability and death and that many will not be able to quit, it seems appropriate to explore ways that these captives of nicotine can improve their chances of avoiding or delaying the catastrophic consequences of their decision to smoke.

One of the most basic, yet most effective, measures a smoker can take to improve his or her health is to begin drinking purified water instead of other beverages. This strategy provides multiple benefits. Unlike beverages such as coffee, sodas, and alcoholic drinks that create an urge to smoke, water actually diminishes the need to smoke. In addition, drinking enough water to keep the urine pale will enable the body to flush toxins, including those associated with cigarette smoke, more efficiently.

Free radical damage is one of the underlying causes of disease. Everyone has to address the issue of free radicals, which damage cell membranes, DNA, LDL cholesterol, and other body constituents (See Health By Design 4: 9, Free Radicals: Agents of Aging). Winning the battle against free radicals is critical to survival.

In smokers this challenge is amplified exponentially. Many of the chemicals contained in the tar component of smoke are potent free radicals. In addition, many of the gases in smoke are also free radicals. Research has shown that cigarette gases contain one quadrillion free radicals per puff. (A quadrillion is a thousand trillion - 1 followed by 15 zeros.) This number does not include the free radicals found in the tar portion of the smoke!

The onslaught of free radicals quickly overwhelms the antioxidant defense system of a smoker. Unbalanced molecules that are routinely converted to harmless substances in non-smokers continue to wreak havoc in smokers. This is clearly seen in the results of single-nutrient studies such as those in which smokers were given supplemental beta-carotene.

Antioxidants neutralize free radicals by donating electrons to them. When an antioxidant, such as beta-carotene, donates an electron to an unbalanced molecule the antioxidant itself becomes unbalanced. In the case of beta-carotene, for example, molecules such as the beta-carotene peroxyl radical are formed when beta-carotene quenches other free radicals. If the beta-carotene peroxyl radical is not neutralized, it may do as much or more damage as the original free radical.

Antioxidants perform very poorly as Lone Rangers. They are designed to be team players. Fat-soluble nutrients, such as vitamin E and beta-carotene, remain in the body for extended periods of time. As they do their jobs they are to be recycled by water-soluble nutrients such as vitamin C and B vitamins, which donate electrons before passing quickly out of the body. Other nutrients, including minerals like selenium and plant compounds such as oligoproanthocyanidins, play important roles as well.

While studies looking at one or two antioxidant nutrients (the ATBC, CARET, and Physician’s Health Studies) have demonstrated an increased risk of lung cancer in participants smoking one pack of cigarettes or more daily, a study from Linxian, China, demonstrated a 55 % reduction in lung cancer and a 13 % overall cancer reduction in smokers given a combination of beta-carotene, vitamin E, and selenium. While I certainly do not advocate limiting antioxidant supplementation to those three nutrients, the study demonstrates that benefits accrue when antioxidant nutrients are allowed to work in harmony.

I am dismayed when I see well-intentioned, but misguided marketers promote “Smoker’s Vitamins” that contain woefully inadequate amounts of a few basic nutrients and proudly proclaim that they are “free of beta-carotene”. Smokers have been demonstrated to be seriously deficient in beta-carotene, a nutrient that is critical to eye health, one of the many areas in which smokers face higher than average risks. To fail to provide it as part of a balanced support regimen is foolhardy at best.

Smokers have also been demonstrated to have difficulty maintaining safe levels of homocysteine. This suggests that the body’s ability to repair the damage caused by free radicals is severely compromised. It also indicates that the body’s tissues are less able to cope with a diminished oxygen supply, something that is a natural consequence of the smoking process.

The body of a cigarette smoker is like an ancient city whose army has been decimated by enemy forces and which lacks the resources to repair the breaches in the wall. Unless it receives reinforcements and supplies, its fall is simply a matter of time. Unless a cigarette smoker provides his or her body with strong nutritional support, he or she will, as the statistics suggest, experience a profound decline in vitality and die nearly 1 ½ decades earlier than expected.

What, then, can a smoker who has been unable to quit do to improve his or her chances of maintaining a higher quality of life and adding some of the years that have been taken away? The body’s antioxidant defenses need to be bolstered. Repair capacity must be restored. Loss of bone strength must be countered. Inflammation must be reduced. These measures cannot be achieved by selectively supplementing one, two, or even a dozen nutrients. Broad, all-encompassing support must be given.

The base should be a comprehensive, well-balanced formulation that provides optimum daily allowances of all vitamins, minerals, essential amino acids, and other nutrients needed for maintenance and repair activities. The product I have chosen to use and recommend is called Lifetime. While non-smokers are encouraged to take one tablet or two capsules for every thirty pounds of body weight daily, smokers should increase the amount to one tablet or two capsules per twenty pounds of body weight daily. Doing so will dramatically decrease the amount of free radical damage incurred. It will also lessen the tendency for platelets to clump together abnormally, another phenomenon that occurs more frequently in smokers.

Because oligoproanthocyanidins (OPCs) augment the antioxidant activity of vitamins and minerals, they should be included in the regimen. The product I use is OPC-2000, which contains not only grape seed extract, but grape skin extract. The skin extract, called resveratrol, also supports the body’s ability to reverse damage that, left unchecked, can lead to cancer. I recommend that non-smokers take 1 capsule per 100 pounds of body weight daily, but smokers should double that amount.

HCY Formula is a combination of nutrients designed to lower levels of homocysteine and optimized the body’s ability to repair tissue and DNA damaged through a process called methylation (See HBD 6:2 Homocysteine, Repair, and Maintenance). Three capsules are taken twice daily.

A combination of calcium, magnesium, phosphorus, boron, and vitamin D is important to counter the tendency to lose bone mass and develop osteoporosis. The name of the product I recommend is Liquid Calcium Magnesium by Vitality.

Finally, the skin should be nurtured with antioxidant-rich topical formulations daily. One such product is called Miracle Skin Repair.

These supplements are not a substitute for smoking cessation. They are, admittedly, the second-best option. Even so, I believe that second-best is infinitely superior to continuing to smoke without providing reinforcement and supplies. Providing the nutrients listed is almost certain to improve the quality and quantity of a smoker’s life.

Perhaps the potential benefits can best be appreciated when viewed in the context of real people. My son-in-law, Alex, is an orphan. His mother died when he was seventeen. She, a smoker who took no nutritional supports, was only forty-nine. She did not live to see Alex graduate from college, she was not present at his wedding, and she never saw her grandchildren. If supplementation had only extended her life by half of the number of years statistics suggest cigarette smoking took away, she would have experienced all of those joyous events.

His father, also a smoker, died at the age of sixty-two. He did not live to see his son, who chose to follow him into the band director profession, receive outstanding achievement awards. He did not live to enjoy watching his son’s 6A band perform on stage or march in competitions. He missed the birth of Alex’s daughter and he missed watching her grow. Had his life been extended by half of the years smoking took away, he would have prized those moments.

Nutritional supplementation is not a panacea. It is unlikely to completely reverse the devastating effects of cigarette smoke on the body. However, given what is known about what causes the damage and how it proceeds, intensive supplementation is capable of dramatically improving smoker’s lives.