Month: November 2013

Great American Smokeout: Time to Quit

photo of cigarette stubs in ashtray
Photograph courtesy of olumi_day via a Creative Commons license.

Smoking used to be portrayed as being glamorous in advertisements and movies. In old films, actors constantly smoked cigarettes and a tough guy usually had one hanging out the side of his mouth. It’s debatable whether smoking still makes you look cool though, especially since there are fewer and fewer public places you’re even allowed to smoke. Plus we now better understand the health risks of tobacco products.

Tobacco use is the single largest preventable cause of disease and premature death in the United States, but nearly 44 million Americans still smoke cigarettes – 1 in every 5 adults. There are also 14 million cigar smokers and 2 million pipe smokers.

Tobacco use is not quite as widespread in California, where just over 1 in every 7 adults smokes cigarettes. In the past year, 61 percent of these smokers attempted to quit.

There are many good reasons to quit smoking, and health concerns usually top the list. Half of all smokers who keep smoking die from a smoking-related illness, including lung cancer, other types of cancer, heart attack, stroke, or lung disease. Women who smoke are also more likely to miscarry or have a baby with a low birth-weight.

There are both immediate and long-term health benefits when smokers quit. After quitting for:

  • 20 minutes, your heart rate and blood pressure drop.
  • 12 hours, the carbon monoxide level in your blood drops to normal.
  • 2 weeks – 3 months, your circulation improves and lung function increases.
  • 1 – 9 months, your coughing and shortness of breath decrease.
  • 1 year, your risk of heart disease due to smoking cuts in half.
  • 5 years, your risk of various cancers (mouth, throat, esophagus, and bladder) is cut in half.
  • 15 years, your risk of heart disease is the same as a non-smoker.

Cigarettes are also expensive. You can use a savings calculator to see how much money you would save if you quit smoking. For example, a pack of cigarettes costs $6.77 on average in California. If you smoke a half pack (10 cigarettes) per day, this adds up $24 per week or $1220 per year.

Of course, the nicotine in tobacco is very addictive so quitting can be difficult, but the chance of success is increased with help. There are many treatment options used to help smokers quit and many of these treatments are covered by health insurance.

The most effective quitting method is a combination of counseling, social support and the use of cessation medication. The most common form of counseling is through telephone-quit lines, which provide free support and advice from an experienced cessation counselor. The counselor can provide a personalized quit plan, self-help materials, the latest information on cessation medications, and social support. For instance, 1-800-QUIT-NOW is a free national counseling service. Many clinics and hospitals also have counselors and support groups that you can meet with face-to-face. Counseling and support groups are also available online.

There are a variety of cessation medications that are available either over the counter or with a prescription. Nicotine replacement therapies deliver nicotine to help reduce the severity of nicotine withdrawal symptoms. The nicotine dose is gradually reduced over time. Nicotine gum, lozenges and patches can be purchased over the counter, whereas nicotine inhalers or nasal sprays require a doctor’s prescription.

Bupropioin SR (Wellbutrin or Zyban) is a non-nicotine prescription medication that acts on the chemicals in the brain that are related to nicotine craving. It can be used alone or with nicotine replacement products. Verenicline (Chantix) is a non-nicotine prescription medication that blocks the effects of nicotine, so it should not be used in combination with nicotine replacement products.

It is important for smokers to speak with their doctor and/or a cessation counselor to make a personalized quit plan that is right for them. And this week is a good time to get started, just in time to take part in the Great American Smokeout on November 21. Smokers across the nation will use this Thursday to make a quit plan, or plan in advance and quit smoking.

The Great American Smokeout happens every year on the third Thursday of November. It started in California back in 1976 when nearly 1 million smokers quit for the day, then the American Cancer Society expanded the program nationwide the following year. It has drawn attention to the deaths and chronic diseases caused by smoking, resulting in laws that ban smoking in restaurants and other public places.

The Great American Smokeout is celebrated with rallies, parades, stunts, quit programs, and “cold turkey” menu items. For instance, the community is invited to receive up-to-date cessation information, resources and giveaways at UCSF Medical Center’s Great American Smokeout event from 9-10 am and 12-1 pm on the Parnassus, Laurel Heights, Mission Bay and Mount Zion campuses. UC Berkeley is also celebrating the event with a “cold turkey” give-away – get a free cold turkey sandwich in exchange for a pack of cigarettes from 11 am – 2 pm at Sproul plaza.

This is a repost of my KQED Science blog.

Controversy Over Calcium Tablets

Photograph courtesy of Kham Tran via Wikimedia Commons.
Photograph courtesy of Kham Tran via Wikimedia Commons.

You’ve probably seen the “got milk?” commercials featuring celebrities with milk mustaches, which advertise the nutritional benefit of drinking calcium-rich milk. Your body needs calcium to maintain strong bones and perform other important functions like moving your muscles. If you don’t get enough calcium by eating foods like milk or supplements, then your body pulls calcium from bone.

Your bones are alive. Your body constantly removes old bone and replaces it with new. But as you get older, you often lose bone faster than you can grow it so bones can become weak and break easily. Osteoporosis and low bone mass affect about 52 million people in the United States and result in a fracture every 3 seconds worldwide.

To help prevent Osteoporosis, the use of calcium supplements is common – 43% of U.S. adults and almost 70% of postmenopausal women regularly take calcium supplements. But are these effective and safe? Recent research studies have reported inconsistent results on the benefits and risks of taking calcium supplements.

Calcium supplements commonly cause indigestion and minor constipation, and they infrequently cause kidney stones. Several recent studies suggest that they also increase the risk of heart attacks, but other recent studies disagree.

At the center of the controversy is a 2010 study published in the British Medical Journal. The study analyzed data from 15 randomized, placebo controlled studies of calcium-only supplements. The authors conclude that calcium supplements are associated with a modest increased risk of having a heart attack. Due to the wide use of these supplements, this could affect a large portion of the population. They advise, “A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.”

The authors speculate that taking a calcium supplement causes a dramatic increase in the amount of calcium in your blood, unlike when you gradually get calcium from eating dairy products. This may cause calcifications in your blood vessels and heart, leading to an increased likelihood of having a heart attack. High levels of calcium in the blood may also increase blood clotting and stiffen arteries, both known to cause heart problems.

Although several studies agree with the 2010 British Medical Journal study, they have been criticized by other scientists. The criticisms focus on their patient selection, the number of patients who didn’t take the supplements for the entire study, the methods of statistical analysis, and not monitoring the intake of other dietary nutrients that might alter calcium effects.

In addition, several other research studies recently found no risk of heart problems due to calcium supplement use. For instance, the 2010 Women’s Health Initiative trial analyzed data from over 36,000 women taking calcium and vitamin D supplements and it showed no significant increase in heart problems.

Further research is needed to sort out these inconsistent research findings. But experts seem to agree that it is best to get your recommended daily calcium by eating calcium-rich foods. “A reasonable approach is to preferentially encourage dietary calcium intake and discourage the routine use of calcium supplements,” advises Dr. Douglas Bauer, a professor at the UCSF Medical Center.

How much calcium you need depends on your age. The Institute of Medicine recommends healthy adults to eat foods containing 1000 to 1200 mg of calcium per day. But more calcium isn’t always better. They also recommend avoiding a calcium intake above 2000 to 2500 mg per day to reduce risk of health problems like kidney stones.

In order to meet these recommendations, a useful first step can be to track what you eat during a typical week using a food diary. After calculating how much calcium you usually eat each day, you may need to change your diet to include more calcium-rich foods.

The top calcium-rich foods are yogurt, cheese, milk, sardines, dark leafy greens (collard greens, kale, bok choy, and spinach), fortified cereals, fortified orange juice, and soybeans. For example, you can get the recommended daily 1000 mg of calcium by eating 1 packet of fortified oatmeal (100 mg), 1 cup of 1% milk (305 mg), 8 ounces of nonfat plain yogurt (452 mg) and ½ cup of cooked spinach (146 mg).

“If it is not possible to consume enough calcium from the diet, the use of calcium supplements is most likely safe and not associated with cardiovascular outcomes,” said Dr. Douglas Bauer in a recent press release. But he advises against exceeding the Institute of Medicine guidelines.

This is a repost of my KQED Science blog.