Smoking Cessation Makes Diabetes Worse

The following comes from Marc S. Micozzi, MD, PhD and is reprinted with permission…

Smoking Cessation Worsens Diabetes Control

For many years the government told you that the single best thing you could for your health was to quit smoking. And it is certainly true that cutting back on smoking is a positive step. But rarely do simple-minded, single-minded, government recommendations reveal the whole truth and nothing but the truth.

These are the same government experts who wrongly told us for decades to avoid dietary cholesterol, eggs, meats, and saturated fats—while giving sugars and carbs a free pass. Now it turns out that their advice was all wrong. In fact, sugars and carbs are the real culprits behind our modern epidemics of obesity, diabetes and cardio-metabolic heart disease. Some researchers have recently expressed that following the wrong diet (with sugars and carbs), and with resulting obesity, may be even worse for your health than smoking (see DD…).

I published research in the late 1980s in the American Journal of Public Health with a team of colleagues from the National Cancer Institute on the US National Health and Nutrition Examination Survey. Results showed that people who were cigar and pipe smokers only, or smoked cigarettes, half-a-pack per day or less, had better overall health profiles compared to non-smokers; and the light smokers also had healthier body weights. Metabolic effects can be profound and are important for health.

Now a new study shows that quitting smoking actually leads to worsening of blood sugar control in type 2 diabetes. The researchers controlled for the fact that quitting smoking leads to gain in body weight, and the worsening of blood sugar went beyond any effects due to weight gain.

The findings from a large primary care database in the UK were published in Lancet Diabetes & Endocrinology on April 29, 2015, on-line. The data come from the The Health Improvement Network (THIN) study which includes electronic medical records from over 35 Million patients in 546 primary care practices.

The study looked at blood levels of Hemoglobin A1C (HbA1C). This reading provides a measurement of the amount of sugar that is linked to hemoglobin in red blood cells (glycosylated hemoglobin). HbA1C provides an average reading of blood sugar levels over time (since blood sugar itself fluctuates). Lowering HbA1C is highly related to preventing the eye, heart, kidney, nerve and vascular complications of diabetes, and mortality, and it is closely monitored by doctors in patients with diabetes or pre-diabetes.

In this study, there were 10,692 diabetic patients who were current smokers as of January 1, 2005. Nearly a third of these patients (3131, or 29%) subsequently quit smoking for at least one year. In these quitters, HbA1C levels increased from an average 7.7 to 7.9 — which represented an extra 0.21 “points” on the HbA1C scale, or a 3% increase.

That may not seem like much — but doctors do everything they can, and try to get their patients to do everything they can, to keep HbA1C levels below 7.5. With an average of 7.7 HbA1C in these diabetic patients, the goal was to lower it by 0.2 points to 7.5. Instead, quitting smoking had the opposite effect, raising HbA1C by 0.2 points, in the wrong direction, and of equal magnitude.

The patients who quit smoking also gained an average of 4.8 kilograms, or 11 lbs, for their trouble. But, again, according to the analysis, the increase in HbA1C was above and beyond the effects of weight gain. It is known that the preference for sweet foods increases in people who quit smoking. But there are also direct metabolic effects behind weight gain after quitting smoking that have nothing to do with diet itself.

Controlling diabetes can be likened to football as “a game of yards, and a game of inches.” Gaining the yards involves major changes in diet (cutting out sugars, and cutting back on carbs), losing excess body weight, increasing healthy physical activity, as well as taking an effective drug like Metformin when necessary (originally derived from the ancient European herbal remedy, French lilac).

The game of inches comes down to fighting for every 0.1 point of HbA1C. Going the wrong direction by 0.2 points when you are on the goal line is like losing yards when you run a last-ditch play on fourth down on the one-yard line and end up behind the line of scrimmage (or get intercepted; Super Bowl 2015, anyone?).

Of course, despite finding that quitting smoking pushes diabetic patients over the line, in the wrong direction, researchers and editorialists were quick to continue recommending complete cessation, immediately, for anyone and everyone— including diabetics struggling to cut sweets, lose weight and lower HbA1C levels.

And, amazingly, they even got in a recommendation to keep taking statin drugs that have ultimately been proven to be toxic and ineffective. They even, “drop back and punt,” suggesting these findings may all be somehow explained by “genetics.”

It is a wonder that nobody ever counsels simply cutting back to half a pack per day or less, consistent with our US NHANES data on healthier body weight. Many people who completely quit start again at some point. For a lot of people, cutting back would be a more realistic goal than taking more dangerous drugs and other contortions to completely quit “cold turkey.” It would probably have better success rates, both long- and short-term, and equal (or perhaps better) results on overall health. As with cancer screenings, the health steps that work best are the ones that people can actually successfully achieve.

Everything with government recommendations has to be all or none— even when ignoring the science, and ultimately being proven wrong, as in the case of their dietary guidelines. Why are they afraid of the scientific truth ?

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