Quit smoking – here’s how
Scientific support: Prof. Dr. Michael Hummel
In Germany, one in three people over 14 years of age still smokes. Although the consumption of “conventional” tobacco cigarettes is slowly declining, water pipes, e-cigarettes and tobacco heaters are becoming increasingly popular, especially among younger people. The composition of harmful substances in these products is different, but not necessarily less dangerous.
Smoking remains one of the most important risk factors for heart attack, stroke, arteriosclerosis and numerous other diseases. This does not only apply to heavy smokers: People who only smoke occasionally or passively also have an increased risk of cardiovascular disease and type 2 diabetes compared to non-smokers.
Quitting is always worthwhile at any age. A clear focus on motivational goals and the right tips will help you on the way to the last cigarette of your life.
Contents
1. How does smoking affect the body?
A burning cigarette releases more than 4,800 chemical substances, of which at least 250 are considered toxic and 90 carcinogenic. One of these carcinogenic substances is nicotine, a neurotoxin that, among other things, activates the reward center in the brain via the messenger substance dopamine. What often causes nausea and/or dizziness with the first cigarette is increasingly perceived as stress-relieving, relaxing and pleasantly stimulating over time. In people who routinely smoke cigarettes, certain docking sites (receptors) in the brain become less sensitive over time due to frequent nicotine intake. This creates a dependence: Smokers often have the feeling that they can only concentrate or relax effectively by smoking.
In the long term, cigarette smoke harms the body in many different ways. As a result, the life expectancy of smokers is reduced by up to 10 years. Around 14 in every 100 deaths in Germany can be attributed to the consequences of long-term smoking.
Among other things, tobacco consumption contributes to:
- cancer, such as of the lungs, throat and stomach, pancreas, kidneys and bladder
- cardiovascular disease, including arteriosclerosis and coronary heart disease (CHD)
- type 2 diabetes
- respiratory diseases, such as chronic obstructive pulmonary disease (COPD)
- chronic inflammation of the gums (periodontal disease)
- a weakened immune defense against respiratory infections
- poorer wound healing
Smoking during pregnancy has serious consequences: Children of smoking mothers are often born too small and too light. Smoking during pregnancy also increases the risk of malformations such as cleft lip and palate, impaired brain and lung development and sudden infant death syndrome (SIDS). Additionally, it is being discussed whether smoking during and before pregnancy also increases the likelihood of expectant mothers developing gestational diabetes.
2. What does smoking do to the heart?
Tobacco smoke affects the cardiovascular system in many different ways. Among other things, it damages the inner layer of the blood vessels (arteries) – the endothelium – and thus promotes deposits. This can cause arteries, which supply all important organs and tissues with oxygen-rich blood, to constrict and harden.
Experts refer to this as arteriosclerosis. In the coronary arteries, this leads to coronary heart disease (CHD). This means that the flow of oxygen-rich blood to the heart muscle is reduced. Some affected people experience this as painful feelings of pressure and tightness behind the breastbone (angina pectoris).
In addition, tobacco consumption increases the risk of blood clots (thrombi) forming and traveling through the blood vessels. If these get stuck in an unfavorable place and block an artery that supplies the heart or brain with oxygenated blood, a heart attack or stroke will occur. This does not only affect heavy smokers: Even individuals who only smoke occasionally or passively have a significantly greater risk of cardiovascular disease than non-smokers.
3. Can smoking cause type 2 diabetes?
Smokers have an increased risk of developing type 2 diabetes. Nicotine and other tobacco components affect blood sugar levels in various ways. As yet, not all connections have been fully researched.
Insulin production
Researchers believe that nicotine damages the insulin-producing cells in the pancreas, causing them to produce less insulin. This endogenous hormone is important as it prevents blood sugar levels from rising uncontrollably. It acts as a kind of door opener, ensuring that the sugar that enters the blood after a meal can be absorbed by the body’s cells.
Insulin effect
At the same time, various chemicals in cigarettes and other nicotine-containing consumer products cause an increase in inflammatory processes in the body of smokers. Inflammation makes the body’s cells less responsive to insulin. This means that more and more insulin is needed so that the sugar can be absorbed from the blood into the cells. This results in insulin resistance, one of the most important causes of type 2 diabetes.
Fat in the organs
Another reason why smoking increases the risk of diabetes is surprising at first glance: body fat. Although smokers are often relatively slim, the fat they carry is often particularly harmful. For example, fat often accumulates around the abdominal organs (visceral fat). This body fat releases a problematic mix of messenger substances and fatty acids into the blood and is therefore particularly harmful to health. It is considered a key risk factor for the development of insulin resistance and type 2 diabetes. It also increases the risk of cardiovascular disease.
Fat deposited inside organs is particularly unhealthy, as is the case with fatty liver. Certain endogenous messenger substances that are negatively affected by smoking, such as the stress hormone cortisol and thyroid hormones, also play a role.
Toxins
Elevated levels of the toxin arsenic have also been found in the blood of smokers. This could also contribute to a higher blood sugar level. Another toxin that is sometimes found in tobacco is cadmium. This heavy metal can cause weight gain and a lack of insulin in the body.
How high is the risk of type 2 diabetes as a result of smoking?
The extent to which smoking increases the risk of diabetes depends on the number of cigarettes smoked per day and how long a person has been smoking. This is why the figures in studies vary. Some estimate a 30 to 40 percent higher risk. Others estimate that smoking doubles the risk of diabetes. This means that under the same conditions, out of 1,000 non-smokers, around 100 will develop type 2 diabetes at some point in their lives. However, 130 to 140 in every 1,000 smokers will develop the disease according to one estimate, and as many as 200 according to another.
Does passive smoking also increase the risk of diabetes?
Many people – especially children – do not smoke themselves but are exposed to cigarette smoke through passive smoking. This smoke also has an impact on health. This is particularly true for people who were exposed to cigarette smoke as children and young adults. They develop type 2 diabetes significantly more often than people who neither actively nor passively smoke. The risk of diabetes rises with increased exposure to secondhand smoke. People who are exposed to a lot of secondhand smoke have a higher risk of diabetes than those who only occasionally sit next to smokers.
How does smoking affect you if you already have diabetes?
Smoking is particularly detrimental for people who already have type 1 or type 2 diabetes: Firstly, it increases the risk of diabetes-related complications, such as kidney damage (nephropathy), diabetic foot syndrome or impairment of the eyes. Secondly, smokers with diabetes have a greatly increased risk of heart disease, such as coronary heart disease (CHD), heart failure or a peripheral artery disease (PAD), which can also lead to a condition known as smoker's leg.
Good to know:
A combination of smoking, diabetes and overweight poses a particularly high risk to the heart and blood vessels. In practice, many people initially put on a few kilos when they give up smoking. From a health perspective, however, this is no reason to continue smoking: In the long term, the positive effects of quitting smoking far outweigh the initial weight gain.
4. What is the health risk of e-cigarettes?
No burning tobacco, no risk? Unlike conventional cigarettes, cigars and cigarillos, e-cigarettes contain cartridges filled with special liquids. These are vaporized by a heating element and inhaled. In fact, according to current scientific knowledge, the vapors produced in this way do not contain as many harmful substances as the smoke from a burning cigarette.
However, this does not mean that e-cigarettes are harmless: In addition to nicotine, vaporization releases other cell-damaging and potentially carcinogenic substances, such as formaldehyde, acetaldehyde and acrolein.
To date, there are very few reliable long-term studies on e-cigarettes and their health consequences, such as with regard to the risk of diabetes. However, the data collected so far indicates that “vaping” has a similar effect on blood sugar levels as conventional cigarettes. E-cigarettes can therefore presumably also promote insulin resistance and type 2 diabetes. It is also known that smoking e-cigarettes puts a strain on the cardiovascular system by:
- impairing the function of the blood vessels,
- increasing blood lipid levels,
causing increased oxidative stress and inflammation in the body.
5. What happens if I quit smoking?
The good news is that quitting smoking is always worthwhile! The short and long-term effects on health are particularly pronounced. This does not only apply to young people without pre-existing conditions.
A large review study has shown that people who stopped smoking after suffering a stroke reduced their risk of further strokes and heart attacks and lived longer overall compared to those who continued to smoke.
People with existing heart disease also reduce their risk of a stroke or heart attack by around a third. For people without diabetes, quitting smoking reduces the risk of developing the disease by 30 to 40 percent. For people with diabetes, giving up tobacco is all the more important in order to protect the blood vessels and prevent complications. For example, non-smokers have a lower risk of nerve disorders (diabetic neuropathy), a wound healing disorder and eye damage (diabetic retinopathy).
Not all damage caused by smoking can be reversed within a short period of time. However, as an example, the function of the blood platelets, which are more likely to form clots in smokers, normalizes after just a few days. Overall, the function and health of the blood vessels can continuously improve in the weeks and months after quitting smoking.
Other facts that can motivate smokers to quit include:
- The function of the airways improves just three days after giving up smoking.
- One week after the last cigarette, blood pressure begins to drop over the long term.
- Within a few years of stopping, the risk of most cancers decreases.
In addition, people who live smoke-free save money and have more time.
6. Five tips for quitting smoking
Giving up smoking is a challenge for most people – but one that you can definitely overcome. The following five tips will help you:
Tip 1: Set a date for quitting smoking.
Ideally within the next three weeks. During this time, observe your smoking habits and prepare yourself: Think in advance about alternative plans for typical everyday situations in which you smoke – for example, instead of taking a cigarette break at work, make a cup of tea or go for a walk around the block.
Tip 2: Dispose of all smoking utensils
Or put them out of sight when the day comes to stop smoking. It can also help to redesign your home “smoking corner” and replace the ashtray with a plant, for example.
Tip 3: Don’t lose sight of your motivation.
Keep reminding yourself of your primary personal motivation. It could be your own children or grandchildren, or perhaps even the image of you running up to the 3rd floor or up a mountain at a brisk pace and without shortness of breath.
Tip 4: Resist the urge.
If you get the urge for a cigarette, don’t give into temptation. Nicotine withdrawal can feel unpleasant for the body and mind. Many affected people become restless and irritable. It often helps if you are prepared and know that the worst cravings usually subside within a few minutes. You can keep your mouth and hands busy temporarily by rolling a massage ball over your hands, chewing gum or drinking cold water, for example.
Tip 5: Reward yourself for reaching milestones!
Treat yourself to something that makes you feel good: be it a nice book, a new item of clothing, a relaxing bath, a massage or even a slice of cake. However, do not try to replace cigarettes with snacks and sweets.
Good to know:
Calorie expenditure drops after quitting smoking, which can lead to an initial increase in weight. Counteract this with plenty of exercise in the fresh air and a balanced diet. If you do gain weight, don’t be too hard on yourself and make absolutely sure you stick to not smoking. Once you have managed to become smoke-free, you can then aim to lose weight – one step at a time.
If you feel like you can’t do it on your own, then get help to stop smoking. Some people find nicotine replacement products in the form of chewing gum or patches helpful. It is best to discuss this with your doctor. There are also special seminars, smoking cessation programs and smartphone apps to help you quit smoking.
The German Cancer Research Center (DKFZ), together with the Federal Center for Health Education (BZgA), offers a search for providers near you (Websites in German). A lot of helpful information is also available on the online information portal rauchfrei-info (Websites in German) of the BZgA.
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As of: 07.05.2024
