Freedom from Nicotine - The Journey Home

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Chapter 6: Common Hazards & Pitfalls

Topics:  Alcohol | Co-Dependency | Blood Sugar | Caffeine | Crutches | NRT | Placebo Fraud | Pharma Secrets | Chantix/Champix | E-cigs | Negative Support | Second-Hand Smoke | Bad Days & Disturbing Dreams | Weight Gain | Weight Control | Menstrual Concerns | Pregnancy



Recovery Weight Gain

Escalating weight gain can gradually erode recovery motivation to the point of making the smoker's 50% odds of losing 13-14 years of life look more appealing than another pound. And let's be frank, many of us need to be concerned about weight gain.

But before going further, it's critical to note that a female smoker who is 64 inches tall (163cms) would need to gain 93 pounds (42kg) before experiencing the elevated risk of chronic heart disease generated by smoking.[1]

As Joel teaches, recovery's battle line is extremely easy to see. As a nicotine addict, "you can't administer any nicotine. There is no gray area here. Eating is more complicated. You will have to eat for the rest of your life."[2]

For many, initial weight gain associated with nicotine cessation can be frightening. It isn't unusual to see up to 5 pounds of water retention weight gain during the first week.[3] It's normally associated with physiological changes and the pounds are easily and quickly shed.[4]

Nicotine increases release of anti-diuretic hormone (ADH or vasopressin). ADH prevents us from dehydrating by increasing water retention. According to Joel, during withdrawal some people experience a rebound type effect, where the normal effect of the drug is actually exacerbated when the drug is stopped.

"That temporary increase is likely what is causing the water retention (bloating) effect that many people notice when they first stop smoking, writes Joel. "The effect can go a few days and at times, even into the second week."

Still, most experience weight gain lasting beyond the second week. But why?

It's normal to notice food starting to taste better as early as day three. And normal to reach for food as a substitute hand to mouth psychological replacement crutch. And normal to attempt to replace missing nicotine generated dopamine "aaah" sensations with "aaah"s from extra food. And normal to need time to discover how to void the onset of hunger by fueling your body early and often, now that nicotine is no longer providing instant energy via your body's fight or flight response.

It is also entirely normal to experience a minor metabolism change associated with our body no longer needing to expend energy in attempting to expel scores of tobacco toxins, and no longer feeling nicotine's stimulant effects in making our body's organs work harder (primarily our heart).

Metabolism is all the chemical processes that occur within a living cell that are necessary to keep it alive. Some substances are broken down to create food energy while other substances necessary for life are synthesized or created.[5]

These processes themselves consume energy. "Basal Metabolic Rate" or BMR is the rate at which the body expends energy while at complete rest. It is expressed as "the calories released per kilogram of body weight [1 kilogram equals 1,000 grams or 2.2 pounds] or per square meter of body surface per hour."[6]

Were we ever really at complete rest while addicted to a stimulant? Does addiction's impact upon BMR account for nicotine cessation weight gain? Most studies examine short-term weight gain with little or no attempt to determine if the gain is due to diminished BMR, extra food or less exercise.

One long-term study followed weight change and body mass index (BMI) for 36 months. It found that the "contribution of smoking cessation to the BMI increase was practically negligible with "no considerable long-term weight gain."[7]

Most shorter studies report weight change results similar to those shared by the U.S. Surgeon General in his 1990 report on "The Health Benefits of Smoking Cessation."[8]

That report examined 15 studies involving 20,000 people and although "four-fifths of smokers gained weight during recovery, the average weight gain was only 5 pounds (2.3 kg)." "The average weight gain among subjects who continued to smoke was 1 pound.

Thus, smoking cessation produced a four pound greater weight gain than that associated with continued smoking." The Surgeon General also found that less than 4% gained more than 20 pounds.

A 1991 study found slightly greater weight increases than reported by the Surgeon General (2.8 kg or 6.2 lbs in men and 3.8 kg or 8.3 lbs in women). But it also found that while smokers weighed less than never-smokers before commencing recovery, "they weighed nearly the same" at one-year follow-up.[9]

Also noteworthy is a 2009 study which found average cessation weight gain of 3 kg for women and 5 kg for men. What's really interesting is its long-term finding of "no significant differences in weight gain over the 11-year period existed between never smokers and former smokers who had stopped at least five years ago."[10]

Theories as to potential causes are many[11] including genetics,[12] hand to mouth oral gratification replacement, improved senses of smell and taste (most notably sweets and salts), diminished exercise (isolation), changes in diet, and binge eating.

It isn't easy pinpointing the cause for consuming or burning even one extra calorie, especially when our metabolism slows as we age.

Also keep in mind that study weight findings reflect averages. As seen above, up to 4% clearly go hog wild with food during recovery. Also not reflected by averages is the fact that body weight remains unchanged for many, while actually declining for some.

While natural for the rationalizing "junkie mind" in its quest for relapse justifications to want to blame cessation weight gain entirely on metabolic changes or genetics, factors totally beyond our ability to control (not increased eating or lack of activity), the math simply doesn't add up.

As a general rule, it takes 3,500 extra calories to add one pound of body weight, and burning 3,500 to shed one pound. A study of 6,569 middle-aged men who stopped smoking found that at one year they had consumed an average of 103 fewer calories per day, which the study attributed to metabolic change.[13]

Let's use that finding as our metabolic baseline. Let's assume that the average nicotine addict burns an extra 103 calories a day due to an increase in metabolism. If there is zero change in diet or activity after ending nicotine use, it would take 34 days without nicotine before a decrease in metabolism could be blamed for one pound of weight gain (34 x 103 = 3,502).

While true that minor metabolism changes mean fewer calories burned each day, if a former smoker, that change can be easily offset by taking advantage of the enhanced blood flow, greater oxygen levels and improved lung function you'll experience.

According to the Surgeon General, about half of smokers believe that smoking nicotine aids in controlling weight. The obvious question becomes, do "weight-concerned smokers endorse exaggerated beliefs in the ability of smoking to suppress body weight?"

Research suggests they do.[14] It also suggests that education may help correct exaggerated weight control beliefs, making recovery more inviting.

How to gain lots of extra weight

Recovery heralds an end to both nicotine's arrival and to the "aaah" wanting relief sensations replenishment generated. Some find themselves camping out inside the refrigerator or potato chip bags where they "aaah" themselves sick with food.

Others intentionally invite weight gain in order to justify relapse. It's a costly ploy. Having outgrown their entire wardrobe and now wearing bed sheets, visible extra pounds is a relapse excuse that's easy to see and sell to ourselves and loved ones.

Why do up the 4 percent who go hog wild continue such destructive behavior to the point of outgrowing their entire wardrobe? Few had any understanding of the dopamine pathway relationship between food and nicotine.

While normal healthy eating stimulates dopamine, during the first few days of recovery stimulation from normal eating obviously won't be sufficient to satisfy all wanting being felt.

Most of us used nicotine to satisfy subtle urges and wanting every waking hour of every single day. Over-eating cannot replace the stimulation effects of missing nicotine, at least not without leaving us as big as a house.

Still, some try. Instead of allowing the brain time to restore natural dopamine pathway receptor counts and sensitivities,[15] it's as if the up to 4 percent gaining more than 20 pounds attempt to make their brain's dependency wiring operate on taste's "aaah" influence instead of nicotine's.[16]

A 2012 study used brain-imaging studies to contrast eating food to smoking. It found that "food and smoking cues activate comparable brain networks" and "there is significant overlap in brain regions responding to conditioned cues."[17]

While compromised dopamine pathways have assigned the same use priority to nicotine as they have to eating food, there's one massive distinction. The brain does not die without nicotine, it thrives!

The sad part about attempting "aaah" relief replacement using large quantities of additional food is that, once the once the addict adopts and acts upon their demoralizing weight increase as their justification for relapse, the extra pounds are likely to remain.

That 20+ pound bag of rocks they are carrying makes daily exercise more difficult, and thus less likely.

Now, instead of the former smoker's bloodstream being filled with oxygen reserves sufficient to allow prolonged vigorous physical activity, the significantly heavier relapsed smoker feels the effects of an oxygen-starved bloodstream that is once again occupied by large quantities of toxic carbon monoxide.

Instead of extra pounds being counterbalanced by greater self-esteem and self-worth at having broken free, the relapsed addict is heavier, less healthy and likely more depressed.

Worst of all, the smoker is again engaged in slow suicide via the gradual self-destruction of their body's ability to receive and transport oxygen.

Binge eating

Binge eating reflects a loss of control, that is, being unable to stop eating or control what or how much is consumed.[18] The primary psychological binge-eating cue is waiting too long before eating and sensing the onset of hunger.[19]

Although it may feel like the only way to satisfy a hunger craving is to eat as much food as quickly as possible, repeatedly doing so could result in binge eating becoming hunger's conditioned response.

As mentioned, there is substantial overlap between eating and dependency pathways. Former smokers who relapse to smoking often report an increase in the amount smoked, over the amount smoked prior to their attempt. Akin to binge eating, it's as if their brain goes into starvation mode upon relapse and begins hoarding nicotine, resulting in a higher level of tolerance and need.

Binge eating is an attempt to satisfy hunger with a shovel. As nicotine addicts, we didn't need to eat regularly, as we used nicotine as a spoon. It pumped stored fats and sugars into our bloodstream via our body's fight or flight response. It allowed us to eat one or two larger meals each day and then use nicotine to release stored calories.

So, what happens when nicotine is no longer there? Can the addition of hunger cravings atop early nicotine withdrawal result in binge eating? Research suggests that it may be more of a concern for those having a high BMI.[20]

The root problem was that the active nicotine addict became conditioned to instantly satisfy the onset of hunger by using nicotine to release stored energy. Non-users who get hungry can't do that.

They have to eat food and then wait for digestion to turn off the body's hunger switch. Once we become non-users, when hunger strikes, whether we eat with a toothpick or shovel, we will need to wait for digestion to satisfy hunger.

It is critical that we quickly re-learn how to properly fuel our body. Yes, it takes a bit of practice to now that instant feedings from liver to bloodstream are history. And we should fully expect to confront hunger if we insist upon skipping meals.

While eating, it's beneficial to learn to chew our food longer and more slowly. Doing so allows a mouth enzyme (salivary amylase) to begin breaking down carbohydrates. This will speed digestion and aid in satisfying hunger sooner.

Research suggests that we eat slower when we turn off and tune out distractions. Maintain your focus on the act of eating and chewing and you'll actually eat less.

But what if you forget to eat and hunger arrives? If you should find yourself reaching for extra food, reach for healthy, low calorie foods such as fresh vegetables and fruits. It's best to have them washed, pre-cut and in the refrigerator in a bowl of cold water, available and ready to eat within seconds of feeling hungry.

Fear's unburned calories - Imagine being so consumed by fear of failure that you withdraw from life. How many calories are burned while hiding in a closet, lying in bed watching television or setting at a computer and clicking a mouse?

Yes, some of us take the term "quitting" literally and withdraw from life entirely.

Body weight will climb if the amount of daily energy expended substantially declines, while the number of calories consumed remains the same or increases. Also consider that 12 of 15 studies since 2006 have found that exercise reduces smoking cessation cravings.[21]

Demoralizing weight gain is fertile ground for destroying freedom's dreams. The only activity we need end during recovery is nicotine use. Don't allow fear to transform recovery into a prison.



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References:

1. Diverse Populations Collaboration, Smoking, body weight, and CHD mortality in diverse populations, Preventive Medicine June 2004, Volume 38(6), Pages 834-840.
2. Spitzer, J, Patience in weight control issues, http://www.ffn.yuku.com/topic/11636 April 24, 2003.
3. Weight Control Information Network, NIDDK, National Institute of Health, August 2006.
4. National Institutes of Health, You Can Control Your Weight as You Quit Smoking, NIDDK, Federal Citizen Information Center of the U.S. General Services Administration, web page visited August 26, 2008 - http://www.pueblo.gsa.gov/cic_text/health/w8quit-smoke/#1
5. metabolism. (n.d.). The American Heritage Dictionary of the English Language, Fourth Edition. Retrieved August 06, 2008, from Dictionary.com
6. basal metabolic rate. (n.d.). The American Heritage Dictionary of the English Language, Fourth Edition. Retrieved August 06, 2008, from Dictionary.com
7. John U, et al, No considerable long-term weight gain after smoking cessation: evidence from a prospective study, European Journal of Cancer Prevention, June 2005, Volume 14(3), Pages 289-295.
8. U.S. Surgeon General, The Health Benefits of Smoking Cessation, a report of the Surgeon General, 1990.
9. Williamson DF, et al, Smoking cessation and severity of weight gain in a national cohort, New England Journal of Medicine, March 14, 1991, Volume 324(11), Pages 739-745.
10. Reas DL, et al, Do quitters have anything to lose? Changes in body mass index for daily, never, and former smokers over an 11-year period (1990--2001), Scandinavian Journal of Public Health, September 2009, Volume 37(7), Pages 774-7777. Epub 2009 Aug 7.
11. Wack JT, et al, Smoking and its effects on body weight and the systems of caloric regulation, The American Journal of Clinical Nutrition, February 1982, Volume 35(2), Pages 366-380.
12. Pietilainen KH, et al, Physical inactivity and obesity: a vicious circle, Obesity (Silver Spring), February 2008, Volume 16(2), Pages 409-414; also see, Waller K, et al, Associations between long-term physical activity, waist circumference and weight gain: a 30-year longitudinal twin study, International Journal of Obesity, February 2008, Volume 32(2), Pages 353-361; also see, Waller K, et al, Associations between long-term physical activity, waist circumference and weight gain: a 30-year longitudinal twin study, International Journal of Obesity, February 2008, Volume 32(2), Pages 353-361.
13. Hall KD, What is the required energy deficit per unit weight loss? International Journal of Obesity, March 2008, Volume 32(3), Pages 573-576.
14. White MA, et al, Smoke and mirrors: magnified beliefs that cigarette smoking suppresses weight, Addictive Behaviors, October 2007, Volume 32(10), Pages 2200-2210.
15. Picciotto MR, et al, It is not "either/or": activation and desensitization of nicotinic acetylcholine receptors both contribute to behaviors related to nicotine addiction and mood, Progress in Neurobiology, April 2008, Volume 84(4), Pages 329-342.
16. de Araujo IE, et al, Food reward in the absence of taste receptor signaling, Neuron, March 27, 2008, Volume 57(6), Pages 930-941.
17. Tang DW, et al, Food and drug cues activate similar brain regions: A meta-analysis of functional MRI studies, Physiology and Behavior, June 6, 2012, Volume 106(3), Pages 317-324.
18. Colles SL, et al, Loss of control is central to psychological disturbance associated with binge eating disorder, Obesity, March 2008, Volume 16(3), Pages 608-614.
19. Vanderlinden J, Which factors do provoke binge-eating? An exploratory study in female students, Eating Behaviors, Spring 2001, Volume 2(1), Pages 79-83.
20. Saules KK, et al, Effects of disordered eating and obesity on weight, craving, and food intake during ad libitum smoking and abstinence, Eating Behaviors, November 2004, Volume 5(4), Pages 353-63.
21. Roberts V, et al, The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis, Psychopharmacology (Berlin), July 2012, Volume 222(1), Pages 1-15. Epub 2012 May 15.



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Page created March 29, 2016 and last updated March 26, 2016 by John R. Polito