Another reason why quitters gain weight when becoming smoke-free

 I've been saying for 20 years that once you quit, you may feel hungrier than when you smoke and there is a study that proves it. Nicotine binds to receptors in the brain that tell you when to stop eating.
There are other reasons why quitters will gain weight but a comprehensive quitting plan will include weight management for those concerned. Here is the chapter about avoiding weight gain from my new book: Crushing your Butts, An Effective Five Step Process to Stop Smoking and Stay Quit Forever:

Avoiding weight gain

For over 60 years smoking has been promoted as a way to stay thin and slim and many smokers are concerned about gaining weight after quitting. But not all smokers gain weight after quitting, some lose weight and others want to gain weight because they are too thin and underweight and haven’t been able to maintain a normal weight.

So whether you want to gain weight or avoid gaining, weight management should be a part of your comprehensive plan. Even if you are not concerned before quitting, any gain in weight can highlight it and bring weight to your attention.

For quitters that have gained more weight than wanted, it becomes a cause of relapse by saying, “I’ll lose the weight and then try quitting again.” But often the weight stays, and they are back to smoking. A better way is to have weight control integrated into your quit plan.

Both men and women can use smoking as way to control weight and both can worry about gaining after quitting. However, it seems in our society that women are more conscious about gaining weight than men. For some women, the fear of gaining weight is so strong, they will not even attempt to quit. These women are more likely to view their body negatively as to either their size or shape and view themselves as being heavier or less attractive when compared to non-smoking women.

Yet when quitting, women seem to control weight gain easier than men. It may be that if there is a concern, women have planned how to deal with it while making their quit plan, whereas men are often unprepared for their waist size to increase. It also could be that the actual weight gain is less than what the person perceives it is going to be. Women, who quit, often find they gain less weight than anticipated and are able to adjust. Men are more likely to relapse from gaining weight after quitting, probably because they are not prepared.

Usually the most weight is gained in the first six months after quitting and stabilizes within a year. Cessation medications can help reduce the amount of weight gained when quitting. It may be necessary for those with weight concerns to stay on medications for a longer period of time. The average weight gain is about 10 to 12 pounds but you need to gain 50 to 100 pounds of fat to do as much damage to your body as one pack of cigarettes.

What is addiction?

Have you ever thought of the perfect response to a comment later? That happened to me a few days ago when I was talking to a group of physicians. One said, "Nicotine is not an addiction. Addiction is when you hold up your mother for money to buy your drugs." I mumbled some answer and only later thought about what I wish I had said:

When I talk about nicotine being addictive, I'm talking about how nicotine hijacks the smokers brain, just as other addictive substances also do. What this man was talking about was the behavior to obtain the addict's drug of choice. It is the difference between an illegal, expensive and hard to obtain drug (such as heroin) and a legal, cheap drug that can be bought in every grocery store. If the roles were reversed between heroin and nicotine, I think you would see more heroin addicts because of increased availability but with a cheap cost, crime would drop. On the other hand, if nicotine were illegal, many smokers would quit due to lack of availability but crime would increase. There would be some smokers that would rob their own mothers to get money to buy cigarettes.

Addicts will do almost anything to get their drug of choice regardless of the drug. It is the disorder of the brain that causes this complusion. I've talked to smokers who are homeless and penniless. They will scour the street for tossed butts that they can finish off or get a pack of papers and re-roll the used tobacco. It that's not an addiction, I don't know what is.

Nicotine hijacks the survival instinct of the brain

Have you ever gone without smoking and developed an overwhelming craving that felt like, "I'M GOING TO DIE OR GO CRAZY IF I DONT' HAVE A CIGARETTE!"?
If so, nicotine has hijacked the survival part of your brain. From the very first puff of a cigarette, nicotine produced a powerful effect on the primate part of our brain that controls our survival instincts. Often people will say that smoking is just a "bad habit". Picking your nose is a bad habit, something that you have control over and you can change easily. But we don't have control over our survival instinct and quitting smoking is not easy. Willpower is not stronger than the survival instinct. This is why it's so difficult to quit smoking. Medications can help take the edge off, which allows the thinking part of our brain or our willpower, to make the decision to not give into the craving. Meds move the craving from an "I'M GOING TO DIE OR GO CRAZY"  to "I'm having a desire to smoke right now but I can do something else to take my mind off the cigarette."
A smoker does not need to take cessation medications to quit smoking, just like a dieter does not need medications to lose weight. It be successful at either, it takes a plan of how to resist temptation and overcome that strong survival instinct.

Is nicotine addiction a disease?

Addiction Box by Dirk Hanson

This is an interesting article about whether addiction is a disease or not. The case can be made that individuals that are addicted to a substance (whether it's nicotine or something else) have a powerlessness over the ability to abstain from their nicotine (or other substance). In this post, the point is made that often addiction is a change in the nervous system that can not be eliminated but can become dormant.

With smokers, the "need" to smoke can re-awake even after years of abstaining from cigarettes. It is something that the nervous system will always remember--"You're a puff away from a pack a day". Just like if you have learned to ride a bike or how to swim, you don't learn how not to swim or not to ride a bide, the only option is to stay out of the water and off of the bike. Same with smoking, you can not learn how not to smoke, only learn how to avoid smoking.

Stop Blaming Smokers

Many people want to point a finger at smokers, "Don't you know that it's bad for your health?" they ask.These self righteous individuals are making smoking a moral or ethical issue instead of what it is--a health issue, pure and simple. Smokers are not bad people because they smoke. 90% started as a teenager before they were legally able to buy cigarettes and before their brains were fully developed. Teenagers often lack the sense to make appropriate life-changing decisions. Teenagers often think that they won't become addicted or that they will quit before they do any permanent physical damage. Yet a teenager can become addicted within 6 months of the first cigarette and because their brain is still developing, smoking can cause structural changes to the brain which make it very difficult to stop smoking. So why do we still blame adults for making a stupid decision as a teenager? It's time to stop blaming the smoker for being addicted to nicotine. It's time to stop making smoking a moral issue. We don't blame individuals with diabetes, heart disease, high cholesterol, or high blood pressure for eating the wrong foods that damaged their blood vessels. Their habit of eating started as a children before they had control over their food choices. Smokers are more likely to stop once they are not blamed for smoking but are helped to address their physical problem, just as we view those with other chronic diseases that center are our lifestyle choices. Most smokers do want to quit but as long as non-smokers keep pointing a finger at smokers, their defensive mechanisms stay up and keep the smoker smoking instead of looking for solutions to try and quit.

Another Effect of Nicotine on the Brain

Nicotine is a powerful drug that enters enters the brain and attaches to receptors that release dopamine, which is a feel-good neurotransmitter. So when a smoker says that they enjoy smoking, what they are really saying is they enjoy the effect that nicotine has on their brain. One of the other things that nicotine does, is that it goes to the part of the brain that enhances external events, which means that when you pair smoking a cigarette with drinking a cup of coffee, answering the phone, driving a car or anything else, the release of dopamine makes each of these events more enjoyable than doing it without smoking. This is how "habit" cigarettes are created. so when a smoker quits, having that morning cup of coffee just doesn't seem as enjoyable, the effect that nicotine has on the brain is what is missing. This also explains why we smoke when stressed, anxious or angry, because the effect of dopamine makes us feel a little bit better. A traditional way of looking at addiction is that the substance needs to cause intoxication or euphoria, like taking a drink of alcohol or a snort of cocaine but with nicotine, the effect is much more subtle but it is still a mechanism that is used to alter our emotional state, not to the degree of other addictive substances but this is probably a reason of why so many people underestimate the power that nicotine has over a smokers brain.

It's Easy to Quit Smoking, I've Done It Hundreds of Times

Every smoker is different. I have been leading smoking cessation workshops for 20 years and some people struggle for a long time before they are successful at quitting. For others, the quitting part is easy--As Mark Twain said, "It's easy to quit smoking, I've done it hundreds of times."
I can get almost anyone to quit smoking for a period of time but there are two parts--Stop Smoking-AND-Stay Quit--it's the second part that usually grabs smokers. They under estimate how powerful nicotine is, if they slip and have a few cigarettes, even if it is several years down the road, thinking that they can control their smoking. Nicotine creates more receptors in the brain and when you quit, they go dormant but with the reintroduction of nicotine--they wake and shout--"Don't tease me with one cigarette-I want the whole pack." It takes about 6 months, the first time someone becomes addicted to nicotine but it can take only one day--the second time because the changes in the brain structure are still there. So most quitters are successful for a period of time and relapse and don't give themselves credit for the period of time that they did stop smoking. I hope you are one of the few that doesn't relapse but unfortunately over 90% of quitters will start again within a year. Just like an alcoholic can never have another drink, a smoker can never have another cigarette. That thought is often very scary, so don't think about the future but live in the moment--that is all that we can control--change your thinking to---I'm not smoking for right now. One man told me that he just told himself that when he retired, he could start smoking again, but he was scared because he was approaching retirement age and was worried that he had told himself that too much. To quit for good, we need to change our behavior and we need to change the way we think about smoking.

How Kid Nicotine Deceives Teenagers

Most smokers start as teenagers or younger and they ALWAYS think that they won't become addicted or that they will stop before they have any harmful effects from smoking but this is just another way that Kid Nicotine worms it's way into a person's life. The child starts by experimenting with one cigarette here and there but soon a pattern develops--maybe one every day after school, or one every Saturday, regardless as soon as ANY pattern shows up, that person is already showing signs of brain changes caused by the use of nicotine. The younger the person starts smoking the more likely they are to become addicted because their brain is still developing and Kid Nicotine changes that growing brain into one that NEEDS nicotine. Our brains don't fully develop until we are in our 20's (for women, about 20-21, for men 24-25). These brain changes can occur within a few months of experimenting with that first cigarette.

How theTobacco Companies are Targeting Young Men to Start Smoking

Men's Health has an excellent article of how the Tobacco Companies are targeting young men and why their marketing is working. It also explains what nicotine does to the brain which makes it much more difficult to stop smoking.


http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=other.diseases.ailments&conitem=1f662c4d88ee9110VgnVCM10000013281eac

How Nicotine is a Different Kind of Addiction

We need to find a different way of describing how individuals are attached to nicotine besides addiction, which implies the heavy withdrawals like from heroin, crack and alcohol--which hospitalization may be required. However, nicotine does change the structure of the brain--which is why it can be easy for some smokers to quit but hard to stay quit since most will relapse within a year. The nicotine is out of the body in a few days but the brain has memories attached to external events--habits, nicotine goes with coffee, talking on the phone ete..These habit cigarettes go away very quickly too. However, it can be years later when a nicotine memory is triggered in the former smokers brain and should the quitter decides to have "just one", they may find that just like potato chips, they can't stop at just one. the Nicotine locks into receptors in the brain and starts creating more of these receptors, which do dormant when quitting but can wake up with the reintroduce of nicotine---The brain is screaming--Don't tease me with one cigarette, I want the whole pack. The brain has the memory of being flooded with dopamine when Kid Nicotine locks into those receptors. So there are two parts--Stop Smoking AND Stay Quit to be successful. Understanding what nicotine does to the brain can help when Kid Nicotine comes knocking on your door out of the blue just when you think you've got kid nicotine beat.

What Nicotine does to the Brain

The reason why people smoke is to experience the effects that nicotine has on the brain. Cigarettes are a nicotine delivery system. Inhaling smoke into the lungs is the fastest way to get nicotine to the brain. The lungs have a large surface area and the capillary walls are very accessible. Up to 90% of the nicotine in mainstream smoke is absorbed and it enters the arterial system and moves fairly directly to the brain, arriving within 7 to 10 seconds. The concentration of nicotine can be three times higher than if the nicotine was injected into veins of the arm because through the venous system, first the blood is pumped to the heart, then to the lungs, back to the heart before finally going to the brain. No product reaches the brain as fast as smoking. Inhaling smoke gives higher, faster, and shorter surges of nicotine to the brain when compared to the nicotine replacement products.

Nicotine then needs to pass through the blood-brain barrier. Ammonia is added to tobacco to increase the PH of the cigarette because a higher PH allows nicotine to cross this barrier easier. Once in the brain nicotine binds to specific areas called nicotinic acetylcholine receptors. Smokers have more of these receptors than non-smokers. Smoking may increase the number of receptors or smoking may allow the receptors to live longer.

Nicotine affects the different parts of the brain in different ways depending on the dosage. Each cigarette is like getting 10 injections of nicotine. Smokers unconsciously regulate the amount of nicotine by either inhaling deeper or smoking more of the cigarette. Sometimes the smoker may use a cigarette to relax, at other times as a stimulant. Menthol cigarettes cool the smoke which causes the smoker to inhale deeper.

When nicotine occupies the receptors in the pleasure pathway, dopamine is released which causes pleasurable sensations (positive reinforcement) and removes unpleasant sensations of pain, anxiety or feelings of illness (negative reinforcement). When the brain has an increase in dopamine, it may be that this increases the attention that the individual places on external activities. These external activities become paired with the pleasurable sensations and become triggers themselves for smokers to light up. The brain becomes conditioned so that when a trigger happens, such as answering the telephone, the brain lights up and expects nicotine to occupy the receptors which the smoker experiences as “cravings”. So any event that a smoker does habitually can be paired with smoking and become a trigger to light up. The brain becomes conditioned to these pleasurable sensations and will “crave” nicotine when faced with these triggers even if they have just finished a cigarette.

Individuals smoke for a combination of both positive and negative reinforcement. When an individual starts smoking it is usually for the pleasurable effects and at some point the individual continues to smoke to avoid the unpleasant effects of withdrawals. Individuals with depression, Attention-Deficit Hyper Activity, and other mental conditions, will start smoking to relieve negative sensations, a form of self-medication. The pattern starts with the individual smoking irregularly but with each cigarette, the nicotine changes the structure of the brain until the individual increases the number of cigarettes and the frequency until addiction sets in, which can occur within three to six months of the first cigarette.

The other area of the brain that nicotine affects is the locus ceruleus which controls vigilance, arousal, concentration and stress reactions. It is also responsible for an individual’s response to stress, anxiety and panic, which may explain why smokers use tobacco in times of high stress and as a way of coping with negative emotions.

The brain structure is changed by smoking. Nicotine floods the brain with dopamine yet the body is constantly seeking balance or homeostasis. The receptor that normally accepts the dopamine is changed to lessen the effect of this flood of dopamine. This change can last five to ten years.

During the quitting process, the smoker may experience withdrawals which are physical symptoms when a drug has not been used for a period of time. Withdrawal symptoms from nicotine includes irritability, frustration, anger, anxiety, depression, difficulty concentrating, restlessness, decreased heart rate, a change in appetite, either hunger or an increase in appetite, a change in sleep habits, either insomnia or inability to fall asleep. The body is also recovering from the effects of smoking and the smoker may experience an increase in coughing, tightness in the throat, dry mouth, dizziness, lightheadedness, headaches, fatigue, difficulty in concentrating and confusion. Medications can help with these symptoms.

Cravings are not the same as withdrawals. Cravings or powerful urges to smoke happen when the brain is conditioned to want nicotine either through positive or negative reinforcement. The brain is shouting, “Where is my nicotine?” Over time cravings become less intense and less frequent. Medications can help with these cravings. Relapse occurs when a smoker will reintroduce nicotine which immediately lights up the receptors in the smoker’s brain. Often only one cigarette is all it takes for the individual to relapse back to full time smoking again because of the strong effect nicotine has on the brain. The brain has memory of how it felt with nicotine and re-addiction can happen within one day when nicotine is re-introduced. The brain has a memory and with the reintroduction of nicotine, the chemical state of the brain matches up with memories of how the individual was when he or she was addicted.

Besides nicotine there are estimated to be 4000 to 5000 chemicals in tobacco smoke. About 400 are either poisonous, cancer causing, or cancer promoting. It is unknown exactly what ingredients are in cigarettes because while the tobacco companies are required to give a list of their ingredients to the government, this information is not released to the public because it is considered a "trade secret". Additives are used to alter the pH level to make nicotine more accessible to the body and to keep the cigarettes burning longer. Nicotine delivery systems are the least regulated consumer product, yet one of the most deadly. There are a few of these chemicals:

Nicotine: A poisonous alkaloid that is the chief active principle of tobacco and is used as an insecticide.
Tar: A particulate matter made up of dozens of compounds. Some are toxic, some are cancer-causing agents. Tar cools inside the lungs, forming a sticky mass and damaging lung tissue. A quart of tar goes through the lungs of a pack a day smoker every year.
Carbon Monoxide: Deprives oxygen from the red blood cells. It stays in the blood hemoglobin for up to six hours after exposure. Is related to heart attacks and strokes. Affects non-smokers. Binds to red blood cells in the lungs 230 times faster than oxygen.
Hydrogen Cyanide: Poison used in the gas chamber. EPA standards indicate that 10 parts per million as safe however cigarette smoke produces an average 1600 parts per million.
Arsenic: A metallic substance, poisonous to all life. The human body can build up a tolerance to arsenic.
Benzene: A poison that interferes with cellular metabolism.
Cadmium: A metal which accumulates in the lungs and stays there. Has an adverse effect on the protective immune devices of the body. Used in batteries.
Ammonia: This chemical is added to tobacco to increase the pH level to make it easier for nicotine to cross the blood brain barrier. Used as a household chemical.
Acetone: Used as nail polish remover.
Toluene: Industrial solvent.
Formaldehyde: Embalming fluid.
Methanol: Rocket fuel.
Naphthalene: Mothball Chemical.
Nitrobenzene: Gasoline additive.
Mercury: Found in thermometers.
Nitrous oxide: Disinfectant.
Stearic acid: Candle wax
Butane: Cigarette lighter fuel.
Vinyl Chloride: Component of PVC pipe.
DDT: Insecticide banned by most Western industrialized nations.
Hexamine: Barbecue lighter

Stop Smoking: The Brain on Nicotine

Regardless of the reason why smokers say they smoke, the main reason is to experience the effects that nicotine has on the brain. Cigarettes are a very efficient nicotine delivery system. Inhaling smoke into the lungs is the fastest way to get nicotine to the brain. The lungs have a large surface area and the capillary walls are very accessible. Up to 90% of the nicotine in mainstream smoke is absorbed and it enters the arterial system and moves fairly directly to the brain, arriving within 7 to 10 seconds. The concentration of nicotine can be three times higher than if the nicotine was injected into the veins of a smoker because first the blood is pumped to the heart, then to the lungs, back to the heart before finally going to the brain. Even using medicinal nicotine replacement products does not give the same kick to the smokers brain because of the delivery system. Smoking or inhalation of nicotine gives higher, faster, and shorter surges of nicotine to the brain when compared to the nicotine replacement products.

Nicotine then needs to pass through the blood-brain barrier. Ammonia is added to tobacco to increase the PH of the cigarette because a higher PH allows nicotine to easier cross this barrier. Once in the brain nicotine binds to specific areas called nicotinic acetylcholine receptors. Every one is born with these receptors but when a person begins to smoke, then numbers of these specific receptors increases. We can say that nicotine is a brain disease because smoking changes the structure of the brain.Smokers have more receptors than non-smokers and smoking may allow the receptors to live longer.

Nicotine affects the different parts of the brain in different ways depending on the dosage. Smokers unconsciously regulate the amount of nicotine by either inhaling deeper or smoking more of the cigarette. Sometimes the smoker may use a cigarette to relax at other times as a stimulant depending on how deeply they inhale.

When nicotine occupies these receptors in the pleasure pathway, dopamine is released which causes pleasurable sensations (positive reinforcement) and removes unpleasant sensations of pain, anxiety or feelings of illness (negative reinforcement). When the brain has an increase in dopamine, it may be that this increases the attention that the individual places on external activities. These external activities become paired with the pleasurable sensations and become triggers themselves for smokers to light up. The brain becomes conditioned so that when a trigger such as answering the telephone, happens, the brain lights up and expects nicotine to occupy the receptors which the smoker experiences as “cravings”. So any event that a smoker does habitually can be paired with smoking and become a trigger to light up. The brain becomes conditioned to these pleasurable sensations and will “crave” nicotine when faced with these triggers even if they have just finished a cigarette.

Individuals smoke for a combination of both positive and negative reinforcement. When an individual starts smoking it is usually for the pleasurable effects and at some point the individual continues to smoke to avoid the unpleasant effects of withdrawals.

Individuals with depression, Attention-Deficit Hyper Activity, anxiety, schizophrenia and other mental conditions, will smoke to relieve negative sensations as a form of self-medication. Alcoholics and others substance abusers use nicotine in the same way also.

The other area of the brain that nicotine affects is the locus ceruleus which controls vigilance, arousal, concentration and stress reactions. It is also responsible for an individual’s response to stress, anxiety and panic, which may explain why smokers use tobacco in times of high stress and negative emotions.
During the quitting process, the smoker may experience withdrawals which are physical symptoms when a drug has not been used for a period of time. Withdrawals from nicotine includes insomnia, irritability, frustration, anger, anxiety, depression, difficulty concentrating, restlessness, decreased heart rate and a change in appetite. Medications can help with these symptoms.

Cravings are not the same as withdrawals. Cravings or powerful urges to smoke happen when the brain is conditioned to want nicotine either through positive or negative reinforcement. The brain is shouting, “Where is my nicotine?” Over time cravings become less intense and less frequent. Medications can help with these cravings. Relapse occurs when a smoker will reintroduce nicotine which immediately lights up the receptors in the smoker’s brain. Often only one cigarette is all it takes for the individual to relapse back to full time smoking again because of the strong effect nicotine has on the brain.

Just as with other addictive substance, nicotine changes the structure of the brain is is why it is so hard for a smoker to quit. As a society we need to understand that smokers smoke because they are addicted,not because they lack the willpower. They need our compassion, not nagging, and they need our support, not put-downs.

Stop Smoking: A Den of Addiction in California's Casinos

I was at the Mayo Clinic in Rochester last week for their annual Tobacco Conference. One of the presenters said that being in California is a such different world because of the laws about smoking in public areas. I guess those of us that live in California are spoiled and don't realize it. California was the first state to require that all businesses including restaurants and bars to be smoke free. It's been so long now that I don't notice that there isn't any smoke until I go to someplace where there is smoke.

Last night for Cinco de Mayo, some friends and I went to the local casino, which are exempt from California's smoking law. As soon as we walked in the door, I could smell the smoke. As I looked around, I didn't see that many people smoking and was surprised at how strong the smell was anyway. Until we walked by the bar, where almost every patron was smoking, drinking and playing video poker, what a den of addiction. When nicotine hits the brain, it activates the pleasure pathway and the release of dopamine. It heightens the external cues, which reinforces its use. The bar patrons had every sense simulated from the drinking, smoking, the noise from the slot machines, and the lights and bright colors every where. Over a quarter of all smokers are alcoholics and a heavy smoker is 10 times more likely to be an alcoholic than a nonsmoker. The reinforcement to continue addictive behavior is strong in that environment. Unfortunately these dens of addiction are more interested in the monies from the drinkers/smokers/gamblers instead of being interested in their health.

I left the casino, sick to my stomach, with a headache and my clothes stinking of stale cigarette smoke. I don't plan on returning as long as the smoke remains.

VJ Sleight, Queen of Quitting