Smoking is a subject that is close to many peoples hearts in more ways than one. You may have seen my Stoptober videos in support of the NHS and governmental initiative STOPTOBER. STOPTOBER was designed to help the general public stop smoking back in October 2013, this was in response to the rising cost (in the region of £6bn a year) that smoking related illnesses was placing on the NHS. The STOPTOBER videos were designed to help people wanting to stop smoking, STOP for good!
Health risks of smoking
Smoking is best known for causing atherosclerosis (thickening of the arteries), high blood pressure and cardiovascular disease. This is in part caused by the physical damage the toxins in smoke cause to the lining of the arteries, but then exacerbated by the high fat diet many people consume these days. The exposed lining of the arteries means any bad cholesterol (caused by a high saturated and trans fat diet) in the blood (LDL) can become oxidised (OLDL) resulting in clogging of the exposed lining and thickening and inflammation of the arteries.
Smoking increases risk of Diabetes
New evidence presented in the Surgeon General suggests that smoking will increase a persons risk of type 2 Diabetes by a significant 30-40%! Smoking has long been thought to be related to impaired glucose tolerance, meaning people may find their body struggles to deal with high volumes of carbohydrate and sugar, but these new findings. The problem was singling smoking out as a causative factor in its own right i.e. how much of the Diabetes risk was smoking, or was the bulk of the cause attributed to being overweight, inactivity, or a poor diet! However, more recent studies have been more tightly controlled and factored for confounding variables such as weight, inactivity etc, meaning a direct cause and effect between smoking and Diabetes could be obtained. On the basis of such studies, the Surgeon General report concludes: "The evidence is sufficient to infer that cigarette smoking is a cause of diabetes."
Stop smoking to reduce risk of Diabetes
Dr Tonstad asserts that the lack of attention paid to stopping smoking when a patient is diagnosed with Diabetes is a major concern. As much as dietary amendments and weight loss are stressed for Diabetes management, smoking cessation should be encouraged to. As a Dietitian I would always encourage my clients/patients to stop smoking when diagnosed with Diabetes or Impaired Glucose Tolerance (IGT) because of the increased risk of heart disease linked to poor blood sugar control, but it seems that even more emphasis should be placed on smoking cessation and not just diet, weight loss and medication.
Where’s the evidence?
Some key biological mechanisms thought to cause Diabetes when smoking include the link between smoking and central obesity (stored fat around the mid-section), which is a well known factor in promoting insulin resistance (meaning insulin doesn’t enable sugar to enter the muscle and organs). It is hypothesised that this is related to increased cortisol levels and the effect smoking might have on sex hormones. As mentioned earlier, smoking also increases inflammation in the arteries resulting in oxidation of LDL (bad cholesterol) and therefore fatty deposits in the arteries (British Heart Foundation, 2013).
Perhaps most pertinently however is the apparent presence of nicotinic receptors on the islet or langerhans and beta cells of the pancreas which may interact with nicotine (from smoking), hindering the release of insulin from the pancreas.
Good enough reason to stop smoking?
So the evidence is out there, and it comes from one of the most respected types of research studies (Meta-analysis), therefore if you have a family history of Diabetes or heart disease, are overweight and have a poor diet that is high in fat and sugar, then you should really think seriously about 1.) losing weight, 2.) improving your diet, and 3.) stopping smoking! Smoking is a preventable cause of Diabetes and is something that should be banished if you want to increase your chances of avoiding Diabetes.
British Heart Foundation, (2013). Smoking. Retrieved 27th January, 2014, from bhf
Tucker, M, E, (2014). Medscape. Smoking Causes Diabetes; Doctors Should Help Patients Quit. Retrieved 27th January, 2014, from http://www.medscape.com/viewarticle/819606