Quit It Part 2

The continuing saga of My Adventures in The Land Without Fags **

(Part 1 is here)

TWO MONTHS
The monkey on my back is no longer a mandrill, more of a vervet.

I still want to smoke, sometimes A LOT, but it’s slowly becoming more an emotional and mental need, a kind of nostalgia. I miss it like Wendy missing Neverland.

For the first time, smoke smells bad to me. A friend was smoking Rothmans, admittedly one of the stinkiest fags, and I didn’t like it. Up until now, I’ve stood next to friends while they smoked and even followed people in the street a couple of times (yes, I know).

The IBS has mostly calmed down. For the first month, my digestion was seriously messed up and sometimes I looked five months pregnant, not because of the stress of quitting but because of physical withdrawal from chemicals that have controlled appetite and digestion for over 30 years. It takes a while for that to normalise (and it pisses me off when people assume IBS is caused solely by stress and, by implication, that I’m a feeble, neurotic woman).

The weight gain is holding steady at around 3kg. I’m exercising like buggery to get rid of it but so far, no dice. I haven’t noticed any difference at the gym with the weights but I can go harder on the cardio and being really out of breath at the end feels good, an endorphin rush I haven’t had for years. My knees aren’t so keen though.

I spoke to my dentist about whether the inhalator is having an effect on my oral health and he said that as long as my mouth isn’t permanently dry, it should be OK long term. On the upside, circulation to my gums is greatly improved already. On the downside, the fast recovery means they are much more sensitive so a session with the hygienist was nasty even with painkilling gel.

I’ve discovered that when someone kisses you, they can’t taste the nicotine from the inhalator, so that’s a bonus.

I’ve noticed that inhalators are sold in the pharmacy section of my supermarket whereas vaping equipment is sold with smoking products.

The rage has mostly gone although there are still moments. I haven’t done anyone actual harm but I’ve come very close a couple of times. They deserved it. I can now see the appeal of being a vigilante superhero – judge, jury and executioner. I may have to work on that. Or buy a cape and mask.

Things not to say 1: If I say I want to smoke, don’t say ‘No you don’t’ and think you’re being helpful because I really do. Acknowledge the craving and help me deal with it by distracting me – make me laugh, do a little dance, whatever.

Things not to say 2: ‘What, still?’ Yes, still. Just because smoking doesn’t cause extreme and obvious behavioural changes like some drugs and alcohol can doesn’t make it any less powerful an addiction. I’m bored with it too, with how much attention it takes up - even when I’m thinking about something else at the same time. I want it to be over and done with. So kindly take your short attention span elsewhere.

Things not to say (or think) 3: Stop making a fuss and get on with it, you shouldn’t have been smoking in the first place. There’s a moral judgement attached to some people’s response to addiction, even if they don’t admit it. It’s based on ignorance about genetics, personality, environment, whether the people you most closely identified with did it, changing social acceptance, legality, and smugness. A lot of smugness. No one factor makes anyone a victim destined to be an addict but it’s a complex, multi-factorial thing and judging from your moral high ground really doesn’t help.

THREE MONTHS
The vervet has shrunk to a pygmy marmoset. I’ve decided to give her a name – Sparky. ***

Do I still want to smoke? Yes, every day, mostly in the evenings. But not for as long or as intensely as before, and it’s not making me miserable that I can’t.

I’m having regular dreams where I light up, then realise what I’ve done and wake up really angry with myself, so it looks like my unconscious is rooting for me too. Shame it can’t have a word with my metabolism.

From a 3kg peak, weight gain is now 1.5kg. I’m eating a bit less than I was before I quit but there really wasn’t much I could trim off my diet and now I’m hungry a lot of the time, which is miserable. The Nicotine Replacement Therapy is supposed to help with metabolism, hunger and weight gain. Maybe I’d have gained a lot more without it, there’s no way of knowing.

Public health and other advice websites assume that all smokers are fat bone-idle slugs so their weight gain advice is mostly just to be more active and avoid snacking, which is no use to me at all.

I’m trying HIIT as part of my regular workout (High Intensity Interval Training – basically doing sprints). There are many variations and I’m doing a 2:1 ratio: 20 second sprints then 10 seconds slower on the bike, repeated for four minutes, at the end of every workout (two weights, two cardio per week) plus an extra cardio session with HIIT, plus a lot of walking. Research shows HIIT is better for weight loss than longer periods of less intense cardio. I don’t know if I’ll be able to go back to my normal gym routine once I’ve lost the weight or if I’ll have to keep up this level of intensity forever to keep it off. I bloody hope not. I’ve had knee problems since I was a kid and compartment syndrome in both legs about six years ago so I don’t want to push my luck. My knees hate me right now.

Things I have learned 1: Nicotine is the third most addictive substance known, after heroine and cocaine, then alcohol and barbiturates. There is also an individual factor that makes some people more susceptible to some substances than others - I’ve used four out of those five and only become addicted to one.

Things I have learned 2: Smokers tend to have more visceral fat – the one that sits round the organs and causes serious health problems. It’s a stealth fat that even people who don’t look overweight can have. Because of chemical changes in the body, weight-gain after quitting is more likely to be subcutaneous fat (under the skin), which is less harmful, especially short-term. And it will be short term, if it kills me.

Things I have learned 3: Nicotine is not all bad. This shouldn’t be a surprise as poisonous plants like deadly nightshade have medical uses.

It has been found to protect against Parkinson’s disease. A small study has found that it may also protect against the early stages of Alzheimer’s disease.

There isn’t even much of a problem with addiction in its therapeutic use because, according to an article in Scientific American, other ingredients in tobacco smoke are necessary to amp up nicotine’s addictiveness. Those other chemical ingredients—things like acetaldehyde, anabasine, nornicotine, anatabine, cotinine, and myosmine—help to keep people hooked on tobacco. On its own, nicotine isn’t enough.

Another benefit is as a cognitive enhancer. According to Jennifer Rusted, professor of experimental psychology at Sussex University: “To my knowledge, nicotine is the most reliable cognitive enhancer that we currently have, bizarrely.” Many other studies back her up.

According to another article in Scientific American: Psychologists and tobacco-addiction specialists think it's now time to distinguish clearly between nicotine and smoking; the evidence shows smoking is the killer, not nicotine.

"We need to de-demonize nicotine," said Ann McNeill, professor of tobacco addiction at the Institute of Psychiatry, Psychology and Neuroscience at King's College London.

Things I have learned 4: There’s a lot of disagreement over whether addiction is a disease or a learned pattern of behaviour, whether addicts are helpless victims and should be treated as such or whether this view disempowers people and makes them less likely to try to take control and change. The term ‘brain plasticity’ gets bandied about a lot in terms of learning or unlearning behaviour, including addictive behaviour, but it’s pretty much empty of meaning and should be regarded with skeptical caution.

What next?
This is the point where I should think about stopping the NRT according to some guidance but I’m in no rush. One Everest at a time. And according to the research I’ve mentioned, it’s not doing me any lasting harm and may even have some benefits.

For the first time since I was a teenager I will have to deal with life’s vicissitudes without the comfort blanket of nicotine, which could be interesting. But Sparky and I will keep plodding down the long and winding road. Maybe I can train her to wear a little hat and bang cymbals.

** That's English fags, not American fags, obviously.
*** Monkey notes: the mandrill is the largest monkey, the pygmy marmoset the smallest and the vervet (not surprisingly) somewhere in between.

SIX MONTH UPDATE

Still not smoking. Still wanting to smoke or at least wanting the comfort of it. Still using the inhalator. Still haven’t lost all the weight.

For the last two months I’ve been constantly ill with colds, laryngitis, three day flu (despite having the jab), more colds. There are endless forums where quitters talk about how many times they’ve been ill since stopping. None of the public health advice sites warn you that the immune system can take a long time to recalibrate itself and, while it does, you’re vulnerable to every passing invader. Also, nerve cells in the respiratory tract are beginning to work normally again, which means you’ll feel pain and irritation that smoking damped down, and the cilia take time to regrow to help repel the invaders.

It really does feel like a kind of penance. I would very much appreciate it if everyone would just stop breathing on me.

SEVEN MONTHS

I seem to have emerged from the tunnel of germs. My knees no longer hate me and have adjusted to the extra cardio, and I've lost two of the three kilos I gained.

I've had some very difficult personal stuff to deal with, including a funeral and my first response was to reach for a cigarette. An actual physical reach for a pack that wasn't there. Someone said that it would be understandable and not a failure if I just had one, if that helped me cope. I explained that I can't just have one. Ever.

2016 was probably not the best year to quit, given what's been happening in my world. But then, there never is a best year. If not now - when?

NINE MONTHS

More colds and viruses.  I may not live any longer now but it sure as hell will feel like it. I need a way to surround myself with a cloud of smoke to keep the germs at bay without doing myself harm. Basically, I need to become a dragon.

Still haven't lost the extra weight, damn it.

And yes, I do still have nostalgia pangs for smoking, especially the lighting up part. But not nearly as often and the smugness helps keep them to a minimum, especially as the cost of a pack has now gone up to over £10.

One of my younger relatives told me that of the ten people on his course, he's the only one who doesn't vape. Not one of them were previously smokers. That's a worrying trend even if they never move onto cigarettes as there is increasing evidence of harm.  Tobacco companies are aiming to double their vaping sales  as fewer and fewer adults smoke. Profit has to come from somewhere and young people are a prime target because they think they'll live forever whatever they do.

Some smokers I know are starting to get defensive around me, which can be difficult.  "I know I should give up, but ...". I'm not making you feel bad, that's all on you. I know you'd feel better if I started again but I won't. Sorry about that.

On the upside, I’ve been keeping my hands busy.

The miracle of chocolate?

Stories about the potential health benefits of chocolate surface on a fairly regular basis. Those of us who would happily mainline chocolate may latch on to these stories but, as with most things, if it sounds too good to be true, it probably is.

Three stories picked at random:

In the latest news story, a Swedish study published in Neurology has found that chocolate may protect men against strokes. It found that men eating the most chocolate in the study group (63g/2.2oz) were 17% less likely to have a stroke.

In 2011, the BMJ published a study which found that the highest levels of chocolate consumption (more than two bars a week) were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared with the lowest levels.

This study noted that 'Recent studies (both experimental and observational) have suggested that chocolate consumption has a positive influence on human health, with antioxidant, antihypertensive, anti-inflammatory, anti-atherogenic, and anti-thrombotic effects as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. These beneficial effects have been confirmed in recent reviews and meta-analyses, supporting the positive role of cacao and cocoa products on cardiovascular risk factors such as blood pressure, cholesterol levels, atherosclerosis, and insulin resistance'.

In 2010 an American study found that older women who eat dark chocolate once or twice a week could be lowering their risk of heart failure. The study notes that one or two 19-30 gram servings of dark chocolate a week led to a 32% reduction in heart failure risk. This fell to 26% when one to three servings a month were eaten. But women who ate chocolate every day did not appear to reduce their risk of heart failure at all.

So there does appear to be some health benefit to eating chocolate. However (here comes the bad news), every study says that the fats and sugars in chocolate (even dark chocolate) have potential negative health risks. And every study suggests that it's the flavanoids in chocolate that appear to confer benefit.

Further research will probably show that a cacao-derived pill would confer the benefits and none of the risks. Which is no fun at all.

It's not just chocolate that contains flavanoids, they are also found in all citrus fruits, berries, onions (particularly red onion), parsley, pulses, tea (especially white and green tea) and red wine.

So all the articles that appear to be good news for chocolate eaters could just as well herald onions as potential lifesavers - except that wouldn't make for such good headlines.

It's unlikely that a bag of onions will replace a box of chocolates as the romantic gift of choice for men who forget their partner's birthday or their anniversary and stop off to pick something up on the way home from work. The British Onion Producers Association is not going to start paying for TV adverts modelled on the Milk Tray Man or ones with skinny women eating onions in suggestive ways.

But if you care about your loved one's health, giving them an onion would be a really romantic gesture. Shortly followed by it hitting your head.

A chocolate-covered onion. So wrong.

Oh I Do Like To Be Beside The Seaside

Does living by the coast make you healthier?

The BBC is reporting that ‘People living on the English coast are more likely than those living inland to say they are fit and well, an analysis of census data suggests.

‘The researchers said living in areas such as Skegness, St Ives or Scarborough was linked to a "small, but significant" improvement in health’.

The Telegraph has the headline 'The sea air? It really is healthy'.

Before we go any further, there is a big difference between feeling well and being healthy. Two different claims are being made, one about quality of life, the other about levels of health. The first is subjective, the second objective and therefore measureable.

People taking alternative medicine often report 'feeling better', sometimes through the operation of the placebo effect. But this doesn’t mean that they are better - and, in the case of alt med, this 'feeling' may even be dangerous if it leads to avoiding proper doctors.

A notable example of this inconsistency is a study done at Bristol Homeopathic Hospital, which 'found' that 75% of children with asthma 'felt better' after treatment. The flaws in this claim were pointed out by both the BBC and Dr Ben Goldacre. Conditions may also be self-limiting (they would have got better on their own) so external factors like treatment (or where you live) can be irrelevant. Or the condition may be periodic so the patients may be experiencing a period of less intense manifestations after a more extreme one (reversion to norm).

Then there is the problem of self-reporting, which is notoriously unreliable.

The researchers of the current study analysed data from 48.2 million people in the 2001 England census. As part of the census, people were asked ‘over the last 12 months would you say your health has on the whole been: good, fairly good or not good?’

There is a recognised psychological tendency that if people are asked to think back over a period of time, they will remember the most recent events more strongly as these memories are more salient. So if they are feeling well at the time of the census, they are less likely to focus on episodes of illness early in the year.

There is also a tendency that means a long period of illness ending in a short period of wellness will be considered more bearable (and may be reported as better health overall) than a long period of wellness ending in a short period of illness.

And how do you accommodate the 'mustn't complain, stiff upper lip' section of the population, the hypochondriacs and the ones who love a good moan?

So both self-reporting and 'feeling better' should be ringing alarm bells in the reporting of this story.

The study the media are referring to is called ''Does living by the coast improve health and wellbeing?'

It was conducted by the European Centre for Environment and Human Health at the Peninsula College of Medicine and Dentistry at the University of Exeter.

The study points out that 'robust evidence of direct, environmentally-induced salutogenic (health promoting) effects is scarce'.

The researchers investigated the relationship between people who reported their health as ‘good’ in the 2001 census and how close they lived to the coast. They found that people living under 1km from the sea were 1.13 percentage points more likely to say they were in 'good health' than than people living over 50km from the sea.

So it's a pretty small effect even if it is big enough to be statistically significant.

One interesting finding was that the effect was stronger in the most deprived areas because living by the sea 'may mitigate some effects of living in a deprived area'.

Or because wealthier people generally feel better anyway because they have better diets, living conditions and so on, so living by the sea adds less to their overall quality of life. Or because wealthier people who move to the seaside tend to be old and older people generally have poorer health. The study didn't differentiate between people who had always lived by the sea and those who had moved there or how long they need to be there for the effect to become observable.

It noted positive effects of seaside living as 'increased physical activity, stress reduction and positive emotions'. While going for walks on the beach would have a health benefit, the other two effects are subjective and harder to quantify.

Although the study says that there is an observed correlation between feeling healthy and mortality rates or the results of health surveys, its results don't definitively support this finding and the conclusion is only that 'coastal communities may have better physical health due to the stress-reducing value of greater leisure time spent near the sea' (my italics). It also concludes that more study is needed.

To be fair to the BBC and the Telegraph, the study doesn't always clearly distinguish between health benefits and a general sense of well-being. But it is certainly not the break-through study the headlines suggest.

The BBC had a related story in April, reporting that a study of 2,750 people presented to the British Psychological Society examined the effects of different types of outdoor environments on people. It found that in six different age groups the seaside was always identified as being a 'more positive experience' than inland parks or country walks.

So there does appear to be a small quality of life benefit to living by the sea, especially if you're poor, but there is still no clear evidence that it is healthier.

The answer to the study's title 'Does living by the coast improve health and wellbeing?' is 'health - maybe, wellbeing - probably' - which doesn't make for very good headlines. Living by the sea could be a kind of placebo.

Incidentally, nothing on earth would make me move to Weston-Super-Mare.