How Old Is Your Heart?

Public Health England (PHE) in collaboration with the British Heart Foundation (BHF) has launched a heart check-up to identify ‘your heart age compared to your real age’.  Is it a valuable public health intervention or a waste of time and money?

It begins by asking age, gender, ethnicity and postcode.

Then: Do you have cardiovascular disease? No.

Do you smoke? No.

But I did. I quit two years, three months and thirteen days ago. Not that I’m still counting. But this does make a big difference. My heart is ‘older’ than it would be if I’d never smoked, I know that. It can take up to ten years for risk levels to return to those of a non-smoker.

Next it asks for height, weight and a few questions on medical history. Pretty standard.

Then it asks what your cholesterol level and blood pressure are. How many people know that?

And that’s it, end of test. It tells me that my heart age is four years older than my real age and says this:

 Your risk of having a heart attack or stroke within the next 10 years is 5.8%

Your heart age is an estimate because you don't know all your numbers. We've based your result on the national average.

If you have high cholesterol and blood pressure, your heart age could be as high as 69.

Make an appointment with your doctor, nurse or pharmacist to get your blood pressure and cholesterol tested.

There are no questions about alcohol and drug consumption, diet and exercise, all things which the NHS and PHE normally tell us make a big difference to heart health. I’ve lived in central London all my adult life and we keep being told how damaging pollution is to health and longevity so it might be a good idea to include a question on that.

The NHS is already struggling, does it really need a few million people making appointments to get their BP and cholesterol checked? Or do they expect people to rush out and buy self-testing kits? And then going to the GP when they get a high result. GPs have not surprisingly expressed concern about this test adding to their already extreme workload.

Is it good public health policy to frighten people with an unrealistic heart age? Who is the mythical ‘average’ person the figures are based on? I’m considerably taller, lighter and fitter than the average woman, for example (and an ex-smoker, yes, I know) so they can't use her to scare me like some sort of Baba Yaga.

There’s also the question of efficacy. NICE has already rejected the use of lifetime risk scores because of a lack of evidence, which means they will scare people, overload GPs - and not have any effect. It’s not even a case of the end justifying the means.

The people behind the project are defending it in various parts of the media by saying it will raise awareness and start a conversation. As an awareness raiser it fails because all it will do is frighten people into going to the GP, or frighten them and then they’ll carry on as normal, or make them think about making some changes and then give up after a few weeks because that’s how we operate. No imminent threat, no motivation.  Will there be any follow-up to see if people have taken action? Doubtful.

If it’s a way of collecting information about the population, then the holes in it make that information of very limited value – unless all PHE wants to know is how many of us don’t know our BP and cholesterol. This is not a compulsory test. The people doing it are self-selecting, opting in, and the reasons they do this could skew the results. Is it idle curiosity, concern, fear or some other reason? Is it mostly the group known as the ‘worried well’? People on very low incomes and many old people will be excluded because of lack of online access.

Heart disease is a serious and growing problem that takes long-term investment and lifestyle management to tackle.  According to the British Heart Foundation:

Heart and circulatory diseases cause more than a quarter (26%) of all deaths in the UK - over 150,000 deaths each year, an average of 420 people each day or one death every three minutes.

But hang on a minute… it also says:

Since the BHF was established the annual number of deaths from heart and circulatory diseases in the UK has fallen by more than half.

In 1961, more than half of all deaths in the UK were attributed to CVD (320,000 deaths).

Since 1961 the UK death rate from heart and circulatory diseases has declined by more than three quarters.

Would it not perhaps be worth looking at why rates have fallen, what else people are dying of, what interventions have worked in the past, where limited resources could be most usefully targeted? For example, obesity has risen since 1961, smoking rates have fallen and life expectancy has risen so people are more likely to have multiple comorbidities that accumulate with age – more than one potentially life-limiting condition at once.

As it happens, I did have my BP checked this week as part of an ongoing treatment for something not heart-related. I didn’t put it in the test because I wanted to see what results came up. The nursing assistant who checked it said he’d tried to take the test but it didn’t work because he was too young. He agreed with me about the flaws in the design. (My BP is great, thanks for asking).

If you do want to know about the state of your heart and its future, you’d be better off doing this:

Modern Life Is Toxic

There are two narratives we’re being fed at the moment, scare stories that are essentially about how modern life is killing us. Everything we breathe, everything we eat, can either kill us or make us fat or damage our children. There’s an underlying message of nostalgia for ye olden days when food was safe and chemicals were safely confined to the periodic chart on the classroom wall. The days before Brexit and Trump and Facebook and everything going to hell in a hand cart.

A study has found that the chemicals in cleaning products can cause serious lung function decline in women.

It says that ‘According to new research, women who work as cleaners or regularly use cleaning products at home experience a greater decline in lung function over time than women who do not clean.’

And of course the effect is being compared with smoking, because everything is these days, including sugar.

The phrasing is odd: ‘The effect of occupational cleaning was thus comparable to smoking somewhat less than 20 pack-years’. ‘Somewhat less’ is meaningless. Does it mean a bit less or a lot less? The effect of smelling a lovely flower is somewhat less than smoking.

The hydra of chemical versus natural is rearing its ugly heads again. In this vision of the world, natural (ie unprocessed) is always better even though cancer, ricin, deadly nightshade, botulism and many more things are natural. And a chemical is a chemical whether it comes from a lab or from a plant. The cleanest mountain air or spring water are made of chemicals.

The point is not whether these chemicals are harming us, it’s that the reporting is gleefully playing on our fears. At a time of national and global insecurity, people are more vulnerable to scare stories, we’re hyper-alert to yet more things that are threatening Life As We Know It.

The Evil Chemicals narrative ties in with the Ultra-processed Food narrative, the other monster that is crawling out of the night to stalk us.

The report the media has picked up on says that ‘a 10% increase in the proportion of ultra-processed foods in the diet was associated with significant increases of 12% in the risk of overall cancer and 11% in the risk of breast cancer’.

However, Professor Linda Bauld, Cancer Research UK's prevention expert, said: 'It's already known that eating a lot of these foods can lead to weight gain, and being overweight or obese can also increase your risk of cancer, so it's hard to disentangle the effects of diet and weight.'

Dr Ian Johnson, from the Quadram Institute in Norwich, said the study had ‘identified some rather weak associations. The problem is that the definition of ultra-processed foods they have used is so broad and poorly defined that it is impossible to decide exactly what, if any, causal connections have been observed.’

And Professor Tom Sanders at King's College London said that mass-produced bread would be classed as ultra-processed, but a home-made loaf or bread from a posh local bakery would not. 'This classification seems arbitrary and based on the premise that food produced industrially has a different nutritional and chemical composition from that produced in the home or by artisans. This is not the case.'

This study is highly critical of the classifications used for ultra-processed food too.

There's a significant point in Professor Sanders’ comment about bread; there's a lot of food snobbery and smuggery going on, with the foods that are identified as being mostly eaten by lower income people being demonised whereas middle class food is more 'wholesome' and 'virtuous'.

The moral high ground food police probably don't count craft ale or artisan gin as highly processed and don’t seem to have noticed that even porridge made with soya milk and honey counts as 'ultra-processed'.

The smugness is about doing things more simply or more traditionally, buying food that doesn’t come in packaging. Yes, plastics are destroying the environment but food packaging extends the shelf life of products, causing less wastage and less environmental harm from producing (even) more than we need. It’s also a great boon to people too busy to shop for fresh produce and ingredients every day. It’s a complex problem not solved by ill-informed moralising or nostalgia.

Toxins (aka chemicals) have taken the place of diphtheria, polio and smallpox as the Invisible Evil (and plague if you go back further). But never fear, you can buy a detox from a wellness guru because your fear is their marketing opportunity.

It's not like things were any better in ye olden days when people breathed in coal or wood smoke or smog, and lots more people smoked. Sitting around in the cave or wooden houses before chimneys were invented during the long winters didn’t just make people smell like kippers, it caused serious lung damage.

Employment was much more lung-unfriendly too - mining, dyeing and tanning, the cloth industry or industrial scale laundries just to name a few.

Has there ever been a time in human history when our lungs were pink and flawless since we first learnt to make fire? It’s not modern life that’s killing us, being alive has always been dangerous. We just have more media to scare us about it now.

In ye olden days food was full of germs and poo and parasites as well as adulterants – for example alum, plaster of Paris and ash in bread.

In 1872, adulterants in food were found to include ‘strychnine, cocculus inculus (both hallucinogens) and copperas in rum and beer; sulphate of copper in pickles, bottled fruit, wine, and preserves; lead chromate in mustard and snuff; sulphate of iron in tea and beer; ferric ferrocynanide, lime sulphate, and turmeric in chinese tea; copper carbonate, lead sulphate, bisulphate of mercury, and Venetian lead in sugar confectionery and chocolate; lead in wine and cider; all were extensively used and were accumulative in effect, resulting, over a long period, in chronic gastritis, and, indeed, often fatal food poisoning. Red lead gave Gloucester cheese its 'healthy' red hue.’ Ice cream was found to contain ‘cocci, bacilli, torulae, cotton fiber, lice, bed bugs, bug's legs, fleas, straw, human hair, and cat and dog hair’.

Yum. So much for hipster nostalgia.

 Of course we need to avoid harm where we can but we need to separate real harm from hysteria, conspiracy theories and marketing opportunities. Headlines about city air being as bad as smoking don’t help. We’re never going to live some bucolic idyll in the Shires like hobbits.

Fear and guilt make for good headlines and clickbait but things are not getting worse. They’ve always been bad. The history of humanity is about processing, ingesting and inhaling stuff that's bad for us. Sometimes for fun.

Quit It - Part Three

Part Three of dispatches from the front line after ONE YEAR without smoking

(Part One, Part Two)

Have I smoked in the last year? No. Not one. Do I still want to? Yes. Will I give in? The hell I will.

The addict part of my brain will always be there but it’s become a puny, mewling thing.

One of the strongest triggers now is leaving a cinema; my first thought is still to light up. Last week I dreamed I was smoking and really enjoying it; for the next couple of days I really wanted one. An ex-smoker I know said this still happens to her occasionally, even after years.

People keep saying that I must feel so much better. In theory, my immune system should now have recalibrated, the cilia and cells in my airways regrown. My risk of coronary heart disease, heart attack and stroke has dropped to less than half that of a smoker. But it’s only in the last couple of weeks that I’ve actually started feeling well after being almost constantly ill for more than eight months - not just with post-smoking coughs and colds but with non-respiratory viruses.  The GP tells me this is normal. Bloody marvellous.

I’ve just got back to my pre-quitting weight. Maintaining it is hard and means not even looking at lovely, lovely sugar more than once a week. I’m eating less overall than I was too, which is a real challenge.

My knees have adjusted to the extra cardio and my bum muscles are a bit firmer than they were.

I’ve saved myself a couple of thousand pounds (my brand, Silk Cut Silver, now sells for £10.45 in my local supermarket, of which £5.19 is tax). Am I saving the NHS money? I may not need it for smoking-related diseases but if I live longer, I will need it for other things.

Since I quit, standardized cigarette packaging has been introduced and the ten pack is no longer available. The idea is that the drab boxes with big ugly health warnings will make more people quit and put children off starting. The evidence for quitting is very slim but there is some evidence that the boxes are less attractive to teenagers. 

Most of the legislation, constant price increases and public health strategies are aimed at preventing young people from starting. They won’t put off the addicts – and certainly wouldn’t have made me stop.

You can see why vaping is becoming more popular with its pretty colours and no health warnings or gruesome images. So far. Evidence is growing of the dangers of vaping if it is not used as a short-term quitting aid. 

Some tobacco companies have started selling tins to avoid the new packaging rules and keep their branding visible. One expert said “The fact that these tins appeared almost immediately prior to the branding and size restrictions coming into force is suspicious.” It’s not suspicious, it’s predictable. They are not going to go down without a fight for a global industry currently worth $770 billion a year.

I’ve learnt a lot about quitting in the last year, some of it scientific, some of it personal. The main messages are:

• Quitting is bloody awful but if it was easy everyone would do it. I am super special sparkly
• There is no good time to stop. This last year has been a bugger for many reasons
• It’s different for everyone
• Think before you open your mouth around a quitter
• There will be consequences. Quitting is damage limitation, not resetting to zero
• There are both genetic and cultural components to addiction
• Public health information and support is very inadequate
• It’s really important to get support from anyone who will listen to you constantly whining
• Punching people won’t make you want to smoke any less

So that’s my year of quitting. Now give me that damn cake.


UPDATE APRIL 2018

Nearly two years in and I am now a much greater drain on the public purse than when I smoked. Sorry about that.

UPDATE MAY 2018

I keep dreaming I'm smoking again, possibly because it's coming up to two years since I quit and it's on my mind. Sometimes you just have to wake up and say Fuck off, brain.

We had an interesting talk at London Skeptics (which I run) about harmful behaviour. The speaker, Dr James Erskine, has done research that shows not thinking about something isn't the answer. That just increases the cravings and the likelihood of giving in. And when you do give in, you'll do way more than you used to as a kind of rebound effect (the return of the repressed). The trick is to acknowledge and observe the thought, which helps 'decouple it' (his words) from acting on it.

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.

Quit it

There’s a lot of advice about how to give up smoking but, as with many public health initiatives, much of it is one-size-fits-all and so not very helpful to anyone who isn’t a mythical average.

This is my experience after 23 days of not smoking. None of what follows is setting myself up to fail, it’s being realistic about the task ahead and preparing myself for it. As the Boy Scouts say: Be Prepared. As far as I can see, thinking it will be easy is the best way to fail. Forewarned is forearmed.

What they don’t tell you
It will be fucking awful. No one tells you quite how awful it will be because all the health advice givers want you to stop.

Mood swings. I expected to be a bit grumpy. I didn’t expect to want to punch people, to burst into tears and to be bouncing around like Tigger all in the same day. Things and people that would normally mildly irritate you will make you go postal. It’s a bit like the worst PMS - for weeks on end.

If you live in a city and/or use public transport getting your sense of smell back is not a bonus. London and Londoners do not smell good.

You may never stop wanting to smoke. People have told me that even 30 years on they would go back to it if it was safe.

Cravings feel like a monster has taken over your body. Advice says that they get weaker and less frequent after about 14 days. They should last just a few minutes and then pass. Not so far. I still want to smoke just as much and just as often. My cravings can last up to half an hour.

Most people fail. Some research shows that around a third of smokers try to quit each year and that ‘fewer than one in eight former smokers who had abstained for a month or less at baseline were continuously abstinent over the next 2 years’. Other research has varying percentages for cold turkey and assisted quitting but in all cases, the percentage who succeed is very small.

What not to say
Do not say ‘I decided to give up and just did it. It was easy’. I will slap you. Hard.

Do not say ‘It doesn’t matter if you put on a bit of weight’. It clearly does matter or it wouldn’t have been mentioned. Stick to making sympathetic noises.

Do not say ‘Think of all the money you’re saving’. If that was a reason for giving up, no one would smoke. See also comments about not smelling like an ash-tray, not dying etc etc. I gave up because I just wasn’t enjoying it any more. I didn’t want to smoke. As simple as that. This doesn’t mean I don’t want a cigarette. Because I’m an addict.

ETA: Do not say 'Try to avoid triggers'. For me these are: waking up, going to the gym, eating, drinking and, it turns out, being with one of my closest friends (a non-smoker).

Do not talk about being a chocoholic or being really grumpy before you have your morning coffee. If you haven’t been a smoker, you won’t get it.

This may sound harsh and ungrateful but I reserve the right to be Oscar the Grouch verging on She Hulk for the next few months.

Nicotine Replacement Therapy
NRT covers products like patches, nicotine gum, inhalators and e-cigarettes. In theory it helps break the habit of smoking (as opposed to the addiction) while still getting some nicotine to lessen the cravings, and it doubles the chances of success.

The problem is that it’s aimed at a theoretical average smoker of 20 full-strength cigarettes a day who would get about 15mg of nicotine. I was smoking 10-12 of what used to be called ultra-low cigarettes which meant that I was getting about 1mg of nicotine a day. So I would have to use about 6% of a nicotine patch – not exactly practical. There are products with less nicotine for phased quitting but even these would give me a lot more than I was previously getting.

You’d think this would mean quitting was easier, but no. I know this because I tried to give up about 20 years ago when I was smoking 20 full-strength a day.

I opted for an inhalator and worked out from the information given that about 15 seconds of sucking on it would give me about the same nicotine as a cigarette. But there is no precise information about how nicotine absorption from cessation products compares with smoking other than the fact that it’s slower and less effective. Advice tells you to suck until you feel satisfied but as it takes longer to feel the effect you can end up getting a lot more nicotine than you actually want or need. So I’m very probably getting more than I was - although in a safer form.
ETA Day 32: I've done a bit more research and concluded that I was possibly under-dosing with the inhalator, which is why the first few weeks were so rough. I wasn't quite going cold turkey but certainly lukewarm turkey.

Some people I know used vaping and e-cigs as a way to give up and it worked for them. But if you go into vaping shops and talk to staff (as I did), it’s clear that vaping is becoming a hobby in itself with accessories, flavourings and associated products. I did consider it but I didn’t want to look like Puff the Magic Dragon billowing out clouds of vapour. Most of the flavourings smell disgusting to me. Many places don’t allow it indoors now so I’d have to go outside to do it and I want to break that association. It’s a lot more involved than lighting a cigarette (flavoured liquids, replacing coils at regular intervals, charging batteries and so on) and I just wanted to get the nicotine into me in the simplest and least twattish way.

Weight gain
This is a big one for me. When I gave up about 20 years ago I put on about 30lbs/13.5kg. I couldn’t lose it after a year and got so miserable that I went back to smoking. At the moment, my weight is about 4.5lb/2kg above where it should be and it’s a battle royal to stop it going any higher. Nicotine is an appetite suppressant and metabolism stimulant, which is why you gain weight when you stop smoking. If you’re using NRT this shouldn’t happen. But it has.

Your digestion will get messed up and your metabolism may well slow down so even if you resist the urge to snack you’ll gain weight. It also kicked off my Irritable Bowel Syndrome. Oh joy.

The advice web sites say to exercise more. I already go to the gym four times a week and walk a lot. I’m trying to walk more but it’s killing my knees. Being atypical sucks.

Getting help
One big difference between giving up now and my failed attempt 20+ years ago is social media. It didn’t exist then. Telling everyone on Twitter and Facebook that I’d given up meant that backing down was a lot harder but, more importantly for me, it means that I can get support and encouragement, especially if I'm having a bad day.

The downside is that giving up takes months and months and people will lose interest in daily updates. I don’t blame them, I would too. So I’ve picked a couple of close friends for long-term support, people who won’t get sympathy fatigue. Lucky them.

The next step
The advice is to use NRT for at least 12 weeks as in theory this is how long it takes to break the habit or at least the psychological addiction. Again, this is a one-size-fits-all guestimate. Some people take a lot longer. I’m not expecting to get over 30 years of smoking in a couple of months. And I am not a patient person. This is the long, slow, tedious bloody haul.

Nicotine itself isn’t that bad for you so getting off the NRT isn’t such a pressure. It’s generally considered no worse than caffeine – not totally without negative effects but way safer than smoking. So I may still be using it this time next year. We’ll see.

I haven’t fallen off the wagon yet. The important thing is to take responsibility for quitting. I’ve decided that if I do have a smoke, I won’t blame anyone or anything else. I am not a victim, I have had a lapse of willpower. It happens. Get back on the wagon.

After smoking for so long I accept that there may be some damage that will never be reversed.

Someone asked me if I now see myself as a non-smoker. I see myself as someone who is not smoking right now. That’s not giving myself an escape route, that’s focussing on the present because it’s in the present that I want to smoke.

So that’s where I am now. It’s early days. Watch this space.

PART TWO IS HERE

PART THREE IS HERE