Stoptober: How to quit smoking Adapted from Optimum Nutrition Summer 2020 Feature We look at popular ways to quit for those who are giving up the habit this October If there has ever been a reason to quit smoking, it is the threat of COVID-19. According to experts, smokers who contract the virus, which attacks the respiratory system, are at a higher risk of serious illness. A review of studies including 2,473 COVID-19 patients confirmed that those with chronic obstructive pulmonary disease (COPD) — a disease associated with smoking — had a 63 per cent risk of severe disease and a 60 per cent risk of mortality. In comparison, critically ill patients without COPD had a 33.4 per cent risk of severe disease and 55 per cent risk of mortality. Although further research into the effect of smoking on COVID-19 is needed, what we can say for sure is that tobacco negatively impacts lung health, is a major cause of cardiovascular disease, and is the largest cause of cancer in the world; being associated with at least 14 different types of cancer including lung, oral cavity, bladder and liver. It also has an almost immediate effect on aesthetics, including premature wrinkles, discoloured teeth and yellowing fingertips. As soon as we quit, the body begins to heal. However, the addictive nature of nicotine does make quitting notoriously difficult, as withdrawing from it can cause depression and irritability. Ways to quit smoking Some quitters use hypnotherapy, or psychological approaches such as neuro linguistic programming (NLP) or cognitive behavioural therapy (CBT); but the most common methods used to quit are: Stop smoking medicines Nicotine replacement therapy (NRT) - patches, gums, vaping Third party counselling Going 'cold turkey' Which method is best? Out of these methods, compared with going cold turkey, there is overwhelming evidence that one-to-one behavioural support (counselling) in conjunction with NRT is more successful — by 225 per cent. Kevin Hood, a service coordinator at Kick-It, a free stop smoking service for residents of Hammersmith & Fulham, and Kingston-upon-Thames, stopped smoking 11 years ago through a stop smoking clinic. “Smoking is an addiction like any other,” he says. “As such, there is a certain type of masking behaviour, meaning there is something deeper down that is making [people] continue smoking. Nine out of 10 times, people will say ‘I smoke because I’m stressed’ and, as advisors, we try to find out what that stress is and how to alleviate it.” Stop smoking services provide either one-to-one or group sessions that last six weeks from the beginning of the quit date and six weeks’ worth of medication. Hood’s number one advice is to come into the process with an open mind. “Looking back with hindsight as an ex-smoker, you always build it up in your head to be a bigger task than it really is. I’ve had numerous clients that have quit and have said to me ‘I don’t know why I made such a fuss about it; it wasn’t as hard as I thought’,” he says. Hood also suggests using previous failed attempts as a learning curve to create a personal plan. “If you’ve learned that you can last X amount of time without smoking, that’s a given because you’ve done it before, so this time try and push the boundaries and see how much further you can manage to go,” he says. Robert West, a professor of health psychology and director of tobacco studies at University College London, stresses the importance of being able to talk to someone who is properly trained in helping people stop smoking. Discussing the best tactics, he highlights the importance of behavioural support and three key aspects to quitting: making a firm commitment to stopping and setting a definite quit date, also known as ‘not a puff rule’; providing strong social reward or praise as often as possible; and getting smokers to assume a non-smoker identity so that smoking is no longer seen as a part of their lives. “Smokers often talk about having a moment when, like Saul on the road to Damascus, they have an epiphany and re-evaluate their whole relationship with smoking. When this happens, they find that they can stop with less craving,” he says. Is vaping safe? There are around 2.8 million vapers across the UK, and Public Health England considers e-cigarettes to be 95% less harmful than smoking cigarettes. The NHS reports that a major clinical trial published in 2019 found that people who used e-cigarettes to quit, combined with to face-to-face support, were twice as likely to quit compared to those using other nicotine replacement products such as gums. Yet vaping is still controversial, with some experts warning that there is still not enough research into the effect it has on lungs. Last year, the US experienced a national outbreak of e-cigarette-related lung injury and by February 2020, a total of 2,807 hospitalised cases or deaths had been reported to the Centers for Disease Control and Prevention, USA. However, studies found that these e-cigarettes, many of which had been bought from informal sources like online dealers, contained traces of THC (cannabis oil) that may have been cut with vitamin E acetate. There was no evidence that vaping in the UK was affected. West suggests trying other nicotine replacement products to stop smoking before turning to vaping, because there still isn’t a complete picture of the potentially associated risks. “All we really know for now is that it causes some kind of lung inflammation — obviously not as much as with smoking, but you are still inhaling an irritant and nicotine directly into the lungs,” he says. Smoking and nutrition Quitting smoking can also positively impact levels of antioxidants in the body. Research has found that smokers tend to be deficient in antioxidants such as vitamins A, C and E, and in minerals such as zinc and iron. One explanation for this is that chemicals in cigarettes cause malabsorption of these nutrients. But the effect of smoking on appetite may also be to blame. “When people quit smoking, they have an increase in appetite and gain weight,” says West. “It’s not a behavioural thing; it’s down to the role nicotine plays…[it is]… an anorexic drug. If you give nicotine to a rat it will eat less.” Nevertheless, many smokers are afraid that once they quit smoking they will become vastly overweight. The NHS states that the average person gains five kilograms (11 lbs) in a year after stopping smoking. This, it states, is because of several factors including increased appetite, foods tasting better, and changes to metabolism. People may also start to use food as a replacement habit. To avoid excess weight-gain, the NHS recommends eating smaller portions until metabolism stabilises, keeping healthy snacks such as fruit and veg sticks to hand, and eating more mindfully. Further advice on quitting smoking can be found on the NHS website.