Quit Smoking, Get Diabetes?
If you love to smoke and want a reason to keep it up, here's something you can use. A new study found that quitting smoking raises your risk for diabetes. Of course, it's a lame rationale, given that smoking increases your risk for just about every other destructive health condition. And yes, smoking also raises diabetes risk, but apparently, diabetes risk goes up even more after quitting smoking (for a period of time) than it does while keeping it up.
The study, recently published in the Annals of Internal Medicine, followed 11,000 middle-aged, non-diabetics for a period of nine years. Forty-five percent of the subjects smoked. Three years into the study, those who continued smoking had a 31 percent elevated chance of developing diabetes compared to the nonsmokers. That's certainly a significant risk factor, given that smoking also multiplies the chances of getting cancer, heart disease, lung disease, osteoporosis and so on. But some of the subjects quit smoking during the study, and those who did quit raised their risk of developing diabetes a whopping 73 percent three years later compared to the nonsmokers. In the months and years right after quitting, that risk factor is even higher.
"Based on our analysis, [it's] probably 80 percent or even 90 percent [in the first few years after quitting]," says the study's lead author, Dr. Hsin-Chieh Yeh of the Johns Hopkins University School of Medicine. On the other hand, the elevated diabetes risk goes down over time. By 12 years post-quitting, the nonsmokers and the former smokers were on par.
But is the increased risk directly related to quitting smoking…or to changes in behavior that quitting may initiate?
It's no secret that smoking suppresses appetite. Those who smoke crave an oral fix after quitting, and so tend to eat more and put on weight. That's the factor the researchers blame for the spike in diabetes. Those subjects who quit smoking gained an average of 8.4 pounds and 1.25 inches around the waist, and not surprisingly, the more weight they gained and the more the waistline increase, the greater the likelihood that they developed diabetes.
The researchers wisely suggest that people avoid taking up smoking in the first place. Given that smoking kills over five million people annually in the U.S., that it's the number one leading cause of preventable death worldwide, and that current trends indicate it will take a billion lives this century, the advice certainly seems sound. But for those who already have been smoking and now see the light, the experts agree: the benefits of quitting far, far outweigh the elevated risk of diabetes.
As for those who have already quit, Dr. Yeh suggests that their physicians should monitor them closely in the years right after. "You should probably do more frequent glucose testing after quitting for early detection," she says. She and her colleagues also suggest that individuals who have quit need to be especially vigilant about doing the things that prevent diabetes in the first place -- exercising and eating well.
For instance, Dr. Richard D. Hurt, director of the Nicotine Dependence Center at the Mayo Clinic in Rochester, Minnesota, has some practical ideas. He suggests that former smokers should walk for 30 minutes daily, which "reduces the urges to smoke and reduces withdrawal symptoms. People are able to distract themselves," he says, "it makes them feel better, and it uses up some of the calories."
But Dr. Hurt has other ideas, too. Nicotine replacement products suppress appetite much like tobacco does, so he thinks using them may help. On the other hand, they work slowly and so subtly that they may not do enough to quell hunger, so he says larger doses may be required. On the other hand, given that all of these products have side effects, using high doses seems questionable. The side effects usually are minor, but there is some real risk of heart complications and at higher doses, that risk goes up. Along the same lines, he suggests that certain antidepressant drugs, such as Zyban or Wellbutrin, may do the trick. Again, though, there's the side effect issue, with problems like headaches, nausea and vomiting, neurological issues, seizures, sleeping problems, skin problems such as rashes, stomach problems and so on are all possible.
The bottom line, voiced by Natasha Marsland, of Diabetes UK, is that "The health benefits of giving up smoking far outweigh the risk of developing type-two diabetes from modest, short-term weight gain." But even that risk can be countered with exercise and diet. Of course, those who weren't disciplined enough to avoid cigarettes in the first place might have some trouble motivating themselves to hike every day -- or even simply to avoid consuming high fat, high-glycemic junk foods, which may explain why post-quitting weight gain is so prevalent. Perhaps lifestyle support programs for quitters might be needed to translate good ideas like eating well and exercising into reality. And in the meantime, instead of using drugs for appetite suppressants, you can try a natural alternative and avoid the health risks.