Smoking

The Anatomy of Smoking

By Emmanuel Arroyo, LAc
27 May 2010


Each year 443,000 people or 1 out of 5 die in The United States of America due to smoking or second hand smoke. Diseases caused by smoking cost $96 billion dollars on health care every year.

The vast majority of smokers are male (23.5% vs 18.3%) between the ages of 18 to 64 with a higher incidence between white non Hispanic population (22.8%) followed by black non hispanic (21.5%) and 14.7% Hispanic.

From all the causes of death lung cancer is the number one and from all the cases of lung cancer reported 90% are among men and 80% among women.¹Other types of cancer that are attributed to smoking are lip, oral cavity, pharynx, esophagus, pancreas, larynx, cervix, urinary bladder, stomach, myeoloid leukemia and kidney.

Smoking has also been linked to coronary heart disease, increase chances for stroke, peripheral vascular disease due to poor blood circulation and abdominal aortic aneurysm. Second hand smokers that are exposed to cigarettes at home or work see an increase of 20 to 30% chances of cardiovascular problems.

The CDC reports the incidence²  of lung cancer among United States population as follow black, white, american native/alaskan native, asian/pacific islanders and hispanics respectively but a look at the information from below we observe latino population is experiencing a higher death rate

• Smoking is responsible for 87% of the lung cancer deaths in the United States. Overall, lung cancer is the leading cause of cancer deaths among Hispanics.
• Lung cancer deaths are about three times higher for Hispanic men (23.1 per 100,000) than for Hispanic women (7.7 per 100,000). The rate of lung cancer deaths per 100,000 were higher among Cuban-American men (33.7) than among Puerto-Rican (28.3) and Mexican-American (21.9) men.
• Coronary heart disease is the leading cause of death for Hispanics living in the United States. Among Hispanic subgroups in 1992–1994, death rates for coronary heart disease were 82 per 100,000 for Mexican-American men and 44.2 per 100,000 for Mexican-American women, 118.6 per 100,000 for Puerto-Rican men and 67.3 per 100,000 for Puerto-Rican women, and 95.2 per 100,000 for Cuban men and 42.4 per 100,000 for Cuban women.³ 
  

Smoking and The Brain⁴ 

It has been observed that the thalamus, hypothalamus and basal ganglia are directly affected by nicotine which causes an increase on nicotinic receptors, a decrease on their turnover and increased desensitization.
The thalamus comprises part of what is called diancephalon and has sensory (mostly) and motor functions.  All axons, except olfactory, connect here prior to be sent to the cerebrum.
The hypothalamus controls the pituitary gland, homeostasis, emotion, thirst, hunger, circadian rhythms, and control of the autonomic nervous system.
Basal ganglia is a set of 3 components known as caudate nucleus, putamen and globus pallidus which are connected to the thalamus that in turn sends motor signals to the cortex.⁵
Nicotinic receptors are a subdivision of what is known as cholinoceptors; nicotinic receptors once activated will increase dopamine⁶, epinephrine and norepinphrine which will exert effects on the sympathetic system.
It is obvious that the Hypothalamus-Pituitary-Adrenal axis⁷ (HPA) is involved.
Let me summarize what I just said: dopamine, epinephrine and norepinephrine are released when nicotinic receptors are activated by nicotine, this explains why people eventually develop peripheral vascular disease⁸. Peripheral vascular disease is just a reaction of what is known as fight-flight response, during this response the heart rate increases, blood is diverted to the extremities, the blood poorly reaches the abdominal cavity and the pupils are dilated...The body starts using more glucose in preparation for fighting or running. When a person is constantly under the fight-flight response glucose intolerance⁹ (insulin resistance¹⁰)will be reached which over time might become into diabetes. With a hyper HPA Axis many hormones will peak but eventually exhaustion, insufficiency or deficiency will be reached causing adrenal insufficiency¹¹. Dopamine which exerts control on pleasure and reward seeking behavior¹² explains why people get addicted and the involvement of the thalamus and hypothalamus can help explain why smokers experience a whole gamut of signs and symptoms during and after smoking and their overall state after not smoking for a while .
Nicotinic receptors have affinity to muscles but they don't contract until high levels of nicotine have being reached and when it does the person might suffer respiratory arrest.

Why Quitting Is So Difficult?¹³ 

It is believed that smokers that quit easily could have had lower basal nicotinic receptors before they started smoking versus those that are having a hard time quitting.
It has been observed that there might be a genetic component, monozygotic twins have been linked to increased addiction but they easily can cut with it versus dizygotic twins which addiction is low but quitting is more difficult.

Male and Smoking?

It has been showed that male that smoke have a high chance of developing Erectile Dysfunction.¹⁴

A Parent to Be?

Researchers from Yale University School of Medicine in New Haven conducted a study with 181 teens and they found girls that were exposed to nicotine suffered both visual and auditory attention deficits, while boys had listening difficulties.¹⁵

Are You HIV +?¹⁶ 

Then you should know that HIV smokers have a higher chance of developing COPD (Chronic Obstructive Pulmonary Disease).

Withdrawal Symptoms

• cravings for tobacco
• irritation
• anger
• weight gain
• concentration problems
• depression
• headaches
• fatigue
• constipation
• restlessness
• insomnia
• dizziness
  

Your Options

You have several options: the use of conventional medicine or the use of alternative medicine.

Alternative Medicine¹⁷ 

After analyzing the effects of nicotine in the hypothalamus-pituitary-adrenal axis, dopamine and the well known carcinogenic substances in cigarettes I could suggest the following steps: Detox, Strengthening the hypothalamus-pituitary-adrenal axis and relieving cravings. For Detox I suggest Tiao He Cleanse, ALJ and Lymph Gland Cleanse (HY) after that Adrenal Support, Liver Balance TCM, Mood Elevator TCM, Stress Relief TCM, and Nervous Fatigue TCM (all from nature's sunshine) for the moodiness, jumpiness, edginess, irritability,restlessness, anxiousness and Lobelia for the cravings.

Another alternative is the use of therapeutic grade essential oils. Anise helps eases, reduces and eliminates the cravings one drop under the tongue is more than enough, but careful it is very warm and might irritate your mouth hence put it on top of your finger tip and apply. Carrot seed oil and rosemary seed oil are good to help in the detox process, one drop of each in a glass of water every day could be more than enough to help you detox. To regulate and balance your adrenals the best essential oils are pine, cedarwood, angelica root, sweet basil,fir needles,geranium rose,and spruce you can apply one drop of each on the kidney area on your back right where the kidneys are located (see picture below for an idea).

the kidneys are located in the lumbar area between the last thoracic vertebra (T12 or the last rib attaching to the spine and the third lumbar vertebrae) I recommend putting it level with L2-lumbar 2.

For the moodiness, crankiness you could put some lavender, tangerine and geranium rose essential oil on your wrists where the watch wraps around...You could try some herbal teas such as chammomile and rooibos; try green tea, oolong, and white tea as well preferably the ones that do not come in tea bags.

Acupuncture has been recommended by NIH (National Institute of Health) and WHO (World Health Organization) for smoking cessation. The treatment is simple and consists on applying 5 needles on each ear and 2 needles on each arm one in the wrist and the other one on the elbow area for 30 minutes or more every other day. The treatment aims to stop cravings, edginess, irritability and other withdrawal symptoms this will help to stop smoking. Remember acupuncture and aromatherapy wont stop you from grabbing a cigarette that part is supplied by you; acupuncture makes the quitting easier...

Conventional Medicine

Conventional Medicine offers nicotine replacement therapy, Varenicline (Chantix), Bupropion (Wellbutrin), Clonidine, Nortriptyline, Monoamine Oxidase Inhibitors (MAOI), Selective Serotonin Reuptake Inhibitors (SSRI), Opioid receptor antagonists, Bromocriptine, anxiety drugs, nicotinic receptor antagonists(ie Mecamylamine), glucose tablets, Inhibitors of the hepatic P-450 enzyme (ie Methoxsalen), Cannoboid-1 receptor antagonists (ie Rimonabant), nicotine vaccines and counseling. For Varenicline side effects read the information below and for Bupropion go to notes.

Varenicline (Chantix)

Below I am including information of the side effects of Varenicline, it has been copied and pasted from its official site. Note that below the table there are other other conditions that Varenicline may cause and that is why they use the words RARE and INFREQUENT which means that there is always a possibility that someone might develop the conditions and most notably is that the liver comes with abnormal tests and increase weight.
WARNING    "There have been reports of depression, mania, psychosis, hallucinations, paranoia, delusions, homicidal ideation, aggression, hostility, anxiety, and panic, as well as suicidal ideation, suicide attempt, and completed suicide in patients attempting to quit smoking while taking CHANTIX".

SYSTEM ORGAN CLASS High Level Group Term Preferred Term	CHANTIX 0.5 mg BID N=129	CHANTIX 1 mg BID N=821	Placebo N=805
GASTROINTESTINAL (GI)
GI Signs and Symptoms
Nausea	16	30	10
Abdominal Pain *	5	7	5
Flatulence	9	6	3
Dyspepsia	5	5	3
Vomiting	1	5	2
GI Motility/Defecation Conditions
Constipation	5	8	3
Gastroesophageal reflux disease	1	1	0
Salivary Gland Conditions Dry mouth	4	6	4
PSYCHIATRIC DISORDERS
Sleep
Disorder/Disturbances
Insomnia **	19	18	13
Abnormal dreams	9	13	5
Sleep disorder	2	5	3
Nightmare	2	1	0
NERVOUS SYSTEM
Headaches
Headache	19	15	13
Neurological Disorders
NEC
Dysgeusia	8	5	4
Somnolence	3	3	2
Lethargy	2	1	0
GENERAL DISORDERS
General Disorders NEC
Fatigue/Malaise/Asthenia	4	7	6
RESPIR/THORACIC/MEDI
AST
Respiratory Disorders NEC
Rhinorrhea	0	1	0
Dyspnea	2	1	1
Upper Respiratory Tract  Disorder	7	5	4
SKIN/SUBCUTANEOUS TISSUE
Epidermal and Dermal Conditions
Rash	1	3	2
Pruritis	0	1	1
METABOLISM & NUTRITION
Appetite/General Nutrit. Disorders
Increased appetite	4	3	2
Decreased appetite/Anorexia	1	2	1
* Includes PTs Abdominal (pain, pain upper, pain lower, discomfort, tenderness, distension) and Stomach discomfort ** Includes PTs Insomnia/Initial insomnia/Middle insomnia/Early morning awakening

The overall pattern and frequency of adverse events during the longer-term trials was similar to those described in Table 1, though several of the most common events were reported by a greater proportion of patients with long-term use (e.g., nausea was reported in 40% of patients treated with CHANTIX 1 mg twice daily in a one-year study, compared to 8% of placebo-treated patients).

Following is a list of treatment-emergent adverse events reported by patients treated with CHANTIX during all clinical trials. The listing does not include those events already listed in the previous tables or elsewhere in labeling, those events for which a drug cause was remote, those events which were so general as to be uninformative, and those events reported only once which did not have a substantial probability of being acutely life-threatening.

Blood and Lymphatic System Disorders. Infrequent: anemia, lymphadenopathy. Rare: leukocytosis, splenomegaly, thrombocytopenia.

Cardiac Disorders. Infrequent: angina pectoris, arrhythmia, bradycardia, myocardial infarction, palpitations, tachycardia, ventricular extrasystoles. Rare: acute coronary syndrome, atrial fibrillation, cardiac flutter, cor pulmonale, coronary artery disease.

Ear and Labyrinth Disorders. Infrequent: tinnitus, vertigo. Rare: deafness, Meniere's disease.

Endocrine Disorders. Infrequent: thyroid gland disorders.

Eye Disorders. Infrequent: conjunctivitis, dry eye, eye irritation, eye pain, vision blurred, visual disturbance. Rare: acquired night blindness, blindness transient, cataract subcapsular, ocular vascular disorder, photophobia, vitreous floaters

Gastrointestinal Disorders. Frequent: diarrhea. Infrequent: dysphagia, enterocolitis, eructation, esophagitis, gastritis, gastrointestinal hemorrhage, mouth ulceration. Rare: gastric ulcer, intestinal obstruction, pancreatitis acute.

General Disorders and Administration Site Conditions. Frequent: chest pain, edema, influenza-like illness. Infrequent: chest discomfort, chills, pyrexia.

Hepatobiliary Disorders. Infrequent: gall bladder disorder

Investigations. Frequent: liver function test abnormal, weight increased. Infrequent: electrocardiogram abnormal, muscle enzyme increased, urine analysis abnormal.

Metabolism and Nutrition Disorders. Infrequent: diabetes mellitus, hyperlipidemia, hypokalemia. Rare: hypoglycemia.

Musculoskeletal and Connective Tissue Disorders. Frequent: arthralgia, back pain, muscle cramp, musculoskeletal pain, myalgia. Infrequent: arthritis, osteoporosis. Rare: myositis.

Nervous System Disorders. Frequent: disturbance in attention, dizziness, sensory disturbance. Infrequent: amnesia, migraine, parosmia, psychomotor hyperactivity, restless legs syndrome, syncope, tremor. Rare: balance disorder, cerebrovascular accident, convulsion, dysarthria, facial palsy, mental impairment, multiple sclerosis, nystagmus, psychomotor skills impaired, transient ischemic attack, visual field defect.

Psychiatric Disorders. Infrequent: disorientation, dissociation, libido decreased, mood swings, thinking abnormal. Rare: bradyphrenia, euphoric mood.

Renal and Urinary Disorders. Frequent: polyuria. Infrequent: nephrolithiasis, nocturia, urethral syndrome, urine abnormality. Rare: renal failure acute, urinary retention.

Reproductive System and Breast Disorders. Rare: sexual dysfunction. Frequent: menstrual disorder. Infrequent: erectile dysfunction.

Respiratory, Thoracic and Mediastinal Disorders. Frequent: epistaxis, respiratory disorders. Infrequent: asthma. Rare: pleurisy, pulmonary embolism.

Skin and Subcutaneous Tissue Disorders. Frequent: hyperhidrosis. Infrequent: acne, dry skin, eczema, erythema, psoriasis, urticaria. Rare: photosensitivity reaction.

Vascular Disorders. Frequent: hot flush. Infrequent: thrombosis.

States, What are They Doing?

Some states cover through medicaid the following: nicotine replacement therapy, Varenicline (Chantix¹⁸), Bupropion¹⁹ (Welbutrin) and counseling; the following table has been created according to CDC²⁰ information and it depicts the states that offer Medicaid assistant for quitting.
PWO stands for pregnant women only.

Table 1

STATE	NONE	ALL MEDS + COUNSELING	ONLY MEDS	SOME MEDS	COUNSELING
Alabama	X
Alaska				X
Arizona					PWO
Arkansas				X	X
California			X
Colorado		X			PWO
Connecticut	X
Columbia, District			X
Delaware			X
Florida				X
Georgia	X
Hawaii			X
Idaho			X
Illinois			X
Indiana		X
Iowa				X	PWO
Kansas				X
Kentucky					PWO
Maine				X	X
Maryland				X	X
Massachusetts		X
Michigan				X	X
Minnesota		X
Mississippi			X		PWO
Missouri	X
Montana			X
Nebraska	X
Nevada			X
New Hampshire			X		PWO
New Jersey			X
New Mexico		X
New York				X
North Carolina			X
North Dakota				X	X
Ohio			X
Oklahoma		X
Oregon		X
Pennsylvania		X
Rhode Island					X
South Carolina			X
South Dakota				X
Tennessee	X
Texas				X
Utah			X		PWO
Vermont			X
Virginia			X		PWO
Washington		PWO
West Virginia				X	X
Wisconsin				X	X
Wyoming				X	X
TOTAL	6	9	17	15	17

Summary

1 state (Washington) covers all the medications but counseling is only offered to pregnant women, 1 state (Iowa) offers some meds and only counseling to pregnant women and 2 states (Arizona and Kentucky) only cover counseling for pregnant women, 4 states (Virginia, Utah, New Hampshire and Mississippi) provide all meds and only counseling to pregnant women; 8 states (Colorado, Indiana, Massachusetts, Minnesota, New Mexico, Oklahoma, Oregon, Pennsylvania) include all the medications plus counseling, 6 states ( Texas, South Dakota, New York, Florida, Alaska and Kansas) offer some medication but no counseling, 8 (Wyoming, Wisconsin, West Virginia, North Dakota, Michigan, Maine, Maryland, Arkansas) are offering some meds plus counseling, 6 states do not offer meds or counseling at all (Tennessee, Nebraska, Missouri, Georgia, Connecticut, and Alabama), 13 states (Vermont, North and South Carolina, Ohio, New Jersey, Nevada, Montana,  Illinois, Idaho, Hawaii, Delaware, Columbia and California) only provide all the meds while Rhode Island only offers counseling.

Table 2

	Total States	Percent
No Meds	9	18%
Meds	41	82%
All Meds	26	61%
Some Meds	15	37%
Only Pregnant Women	1	2%
No Counseling	24	48%
Counseling	26	52%
Plus All Meds	9	34.61%
Plus Some Meds	9	34.61%
Only Pregnant Women	8	30.78%

About The Author

Emmanuel Arroyo is a New York State Licensed Acupuncturist and Chinese Medicine Herbalist, and has been trained as an acupuncture detox specialist; has special interests on pain management, men's health and currently is researching depression and its alternative treatments. Emmanuel Arroyo works with chakras and essential oils are used as an aid to open and balance each chakra. Essential oils are used mainly to restablish emotional and psychological balance. To set an appointment you can call 917-324-1140 or you can contact him via email at dr.agujas@gmail.com

Disclaimer

You should consult a physician or professional. This information is intended for educational purposes and Emmanuel Arroyo, LAc is not responsible for any result by self prescription or treatment.

notes

¹ http://www.cdc.gov/cancer/lung/  Retrieved 27 May 2010  5:35 PM

² http://www.cdc.gov/cancer/lung/statistics/race.htm  27 May 2010 6:30 PM

³ http://www.cdc.gov/tobacco/data_statistics/sgr/1998/highlights/hispanics/index.htm  Retrieved 27 May 2010 4:56 PM

⁴ http://jpet.aspetjournals.org/content/282/1/7.full  Retrieved 27 May 2010 7:49 PM

⁵ http://thebrain.mcgill.ca/flash/d/d_06/d_06_cr/d_06_cr_mou/d_06_cr_mou.html  Retrieved 27 May 2010 8:09 PM

⁶ http://en.wikipedia.org/wiki/Nicotine  retrieved 27 May 2010 8:25 PM

⁷ http://qjmed.oxfordjournals.org/cgi/content/abstract/102/7/469  Retrieved 1 June 2010

⁸ http://www.webmd.com/heart-disease/peripheral-vascular-disease  Retrieved  1 June 2010  4:00 PM

⁹ http://www.ncbi.nlm.nih.gov/pubmed/744572  Retrieved 1 June 2010 4:15 PM

¹⁰ http://circ.ahajournals.org/cgi/content/short/112/3/332   Retrieved 1 June 2010    4:17 PM

¹¹ http://en.wikipedia.org/wiki/Glucocorticoid   Retrieved 1 June 2010  4:30 PM

¹² http://theacupunctureguy.blogspot.com/2010/01/depression-allopathic-approach-and.html Retrieved 1 June 2010  4:35 PM

¹³ http://jpet.aspetjournals.org/content/282/1/7.full  Retrieved 27 May 2010

¹⁴ journal of Urology. 166(5):1624-1632, November 2001. McVary, Kevin T; Carrier, Serge; Wessells, Hunter; The Subcommittee On Smoking and Erectile Dysfunction Socioeconomic Committee, Sexual Medicine Society of North America Retrieved from  http://www.pedresearch.org       11 April 2007

¹⁵ http://www.msnbc.com/id/18046454 Retrieved 13 April 2010 

¹⁶ http://ycci.yale.edu/resources/docs/YaleCTSAGrantApplication.pdf  Retrieved  27 May 2010  7:00 PM

¹⁷ This information is mainly written for alternative health care practitioners.

¹⁸ For side effects please visit http://www.rxlist.com/chantix-drug.htm

¹⁹ Bupropion is offered as ER, SR, IR (Extended Release, Sustained Release, Immediate Release) and are also used for depression. Bupropion lowers the seizures threshold which causes an increase in seizures.

²⁰ http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/pdfs/by_state.pdf  Retrieved  27 May 2010 11:37 AM