Volume CXXXIII, Number 14 February 1, 2002 f

Quitting smoking
JEFF BENSON M.D.

Dear Dr. Jeff: "I've smoked on and off for a few years, and am now thinking about quitting (again). I'm a little concerned about mood swings and weight gain. Any suggestions?" D.C.

Dear D.C.: Congratulations on even thinking about quitting again! You've already taken a crucial step towards success!

This is the last one. I swear. (Karsten Moran, Bowdoin Orient)

Quitting smoking is likely the hardest thing you'll ever do. It's easier to quit alcohol or heroin than cigarettes. Fortunately, there is lots of help available.

Many people find using a nicotine patch or gum very helpful. There are many reasons people like to smoke, and nicotine dependence is only one of them. Using a nicotine replacement aid allows you to address those other reasons without simultaneously having to deal with nicotine withdrawal. The more you've smoked, the more things you'll need to relearn to do-and to enjoy-without cigarettes. Also, unlike nicotine gum or inhalers, patches maintain a steady level of nicotine in your body. In this way, wearing a patch helps you break down the craving-satiation-craving-satiation cycles which drive your chemical addiction.

Mood swings are a predictable part of any withdrawal process. Many people find "mood stabilizing" medications like Bupropion (aka "Wellbutrin" or "Zyban") to be useful. They help you to smooth things out, make you feel a little less crazy, and reduce your cravings.

Nicotine is a stimulant. It helps you focus, and it increases your metabolism and heart rate. After you quit smoking, your neurologic and metabolic "thermostats" need to readjust and reset themselves. This process can take a few weeks, and is probably the source of many of the more unpleasant side effects of quitting smoking. It's also the reason most people initially gain weight after quitting.

Nicotine suppresses your appetite and, by causing your liver to release glycogen, also raises your blood sugar. When you quit smoking, you'll probably feel hungry more often. Your metabolism will slow down. If you eat the same as you did when you were smoking, you'll use up fewer of those calories and store more.

There are other reasons why new ex-smokers tend to gain some weight. Smoking dulls your taste buds and your sense of smell. After you quit smoking, food tastes better-and so you may want to eat more. And, of course, there are the cravings and the oral fixation to deal with.

If you stick to three well-balanced meals a day, and minimize high-calorie snacks, your post-quitting weight gain will be small. Get regular exercise, and learn some relaxation techniques. The bottom line is this: you'd have to gain well over one hundred pounds in order to match the health risks you'd taken by smoking!

Be sure to plan how you'll deal with those social situations in which you've always smoked ahead of time, especially if you'll be drinking.

Keep reminding yourself of all the wonderful things you're doing for yourself by quitting smoking. Your blood pressure will be lower, your immune system stronger, your lung capacity greater. Your risk of contracting lung and other cancers, as well as heart disease and stroke, will decrease. You'll be able to do more physically, you'll (soon!) feel better, your skin will clear up, and your sense of taste will improve. Plus, you'll save a LOT of money!

Quitting smoking is far and away the single most powerful step you can ever take to further your health and well-being-and that of those around you. Secondhand smoke is the third leading cause of preventable death in the U.S. For every eight smokers who die as a result of their smoking, one nonsmoker also dies as a result of secondhand smoke.

All of us at the Health Center would be delighted to help you quit smoking. You can also check out a support group, or take a smoking cessation class, at MidCoast's HelpLine (call 373-6585). You can contact the Maine Tobacco Helpline for advice and support (call 1-800-207-1230), or you can check out the American Cancer Society websites www.cancer.org/tobacco/quitting.html and www.cancer.org/tobacco/tips.html.

To your health!

Jeff Benson, M.D.
Dudley Coe Health Center