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Ask the GP: smoking Q&A

GP Dr Michael Apple answers some of your queries about quitting and the health risks of smoking.

I smoke fewer than five a day. What’s the harm in that?

Almost a third of smokers smoke fewer than 10 a day and often don’t see the point of giving up. But most of the heart disease risk comes within the first few cigarettes of the day.

Next time you light up, feel your pulse. It will start rising within a minute. That’s extra work for your heart, which gets less blood supply because of nicotine. Your blood tends to clot more with each cigarette, and the amount of oxygen it can carry goes down. Instead of oxygen the blood cells carry carbon monoxide. All of these are risk factors for heart disease.

Smoking just one cigarette a day trebles your risk of lung cancer and raises the risk of chronic lung disease, as well as cancer of the mouth, throat, bladder, pancreas and many more.

Many studies have shown that the risks increase the more you smoke, but all risks start with just one cigarette.

I get indigestion. Could it be because I smoke?

Yes. Smoking reduces the ability of the walls of the stomach to repair themselves. Therefore it increases the chances of acid indigestion and duodenal ulcer. If you stop smoking, food may become a lot more enjoyable. You’ll taste it better and it’s less likely to give you indigestion. Some people find that their irritable bowel syndrome (IBS) improves when they quit.

What is it about diabetes and heart disease that makes smoking so dangerous?

In these conditions, the blood flow to your heart, legs, kidneys, eyes and brain is already affected, which increases the risk of strokes and heart attacks. Other risks are slow-healing ulcers and diseased legs and toes that might require amputation. When you smoke, you double or treble those risks.

Heavy smokers with diabetes have roughly double the chance of death from heart disease or stroke compared with non-smoking diabetics.

People smoking up to 15 cigarettes a day have a 50% higher chance, while ex-smokers have a 10-30% increased chance, even 10 years after quitting.

I find it so hard to stop smoking. Am I weak?

No. Having trouble stopping smoking doesn’t make you weak; it makes you human. Cigarettes are so addictive that 70% of smokers say they would like to quit, yet they still smoke. Most ex-smokers try to stop a few times before they manage to quit for good.

It’s the nicotine in cigarettes that’s physically addictive. It reaches the blood stream within a few drags, and alters various brain chemicals that change mood and concentration, which smokers find enjoyable.

Stopping smoking can lead to intense feelings of anxiety, irritability and depression, which smokers crave cigarettes to get rid of. Using nicotine replacement therapy (NRT) can help people break this physically addictive cycle.

Increasing social support while you quit by stopping with a partner or friend can also help, as can joining an NHS stop-smoking group.

Why is passive smoking such a health hazard?

Non-smokers who breathe in second-hand smoke (smoke from other people’s cigarettes known as passive smoking) inhale more than 4,000 chemicals, at least 50 of which are known to cause cancer. For non-smokers, breathing other people’s smoke means an increased risk of lung cancer, heart disease and stroke.

For children, second-hand smoke means twice the risk of chest illnesses, including pneumonia, croup (swollen airways in the lungs) and bronchitis, plus more ear infections, wheezing and asthma. They also have three times the risk of getting lung cancer in later life compared with children who live with non-smokers.

Can’t I just cut down rather than give up?

You can try but it probably won’t work. Smoking is addictive, which is why some people find it so hard to stop completely. When you cut down you tend to take more and deeper puffs on each cigarette to get your nicotine hit. It’s only by stopping completely that you can beat the addiction.

I’m worried I’ll put on weight when I stop.

Cigarettes do affect your appetite and your metabolism, and they dull your taste buds, so people often gain a few pounds when they give up. You can prevent that by doing more exercise and staying away from high calorie foods. But if you do gain a little weight, don’t worry: you can lose it again once you’ve quit the cigarettes.

Read more about how to stop smoking without putting on weight.