Information

Coughing after giving up smoking is normal! 
Bouts of coughing are frequent in the days following giving up smoking. This cough is normal: it is even a good sign. It means the respiratory mucous membrane, which nicotine has anaesthetized, has become reactivated and is expelling the debris of tobacco and mucus. Hence, secretions often accompany the cough.

More breast cancers if smoking during adolescence

According to a Canadian survey, the risks of getting breast cancer vary according to the woman’s hormonal situation. So, the risk would be higher in women who began smoking in the 5 years following puberty (at the time when breasts are developing) and for childless women who smoke more than 20 cigarettes a day or more than 20 packets a year. On the other hand, a woman who starts smoking during menopause and has gone through a full term pregnancy would have fewer risks to developing cancer. Hence, there are periods in women’s lives when they are more or less sensitive to the effects of tobacco (reference: Band PR et al. Lancet 2002 ; 360 :1044-49).

Tobacco impairs fertility from one generation to the other 

It is known that women’s fertility is generally delayed two to four times longer for smokers than for those who are non-smokers and, in case of in-vitro fertilisation, the chance of conceiving is reduced by two to three times. This decrease in fertility is noticed not only for female smokers – it also has an impact on non-smokers whose mother smoked during pregnancy.

How to stop smoking without putting on weight

Putting on weight is one of the side effects of giving up smoking. To reduce it, first and foremost, a method that has an impact on the need must be used. This is the case with the Chiapi method. Nevertheless, although acupuncture suppresses the need to smoke, the average weight gain is about 4 kilos in the first 6 weeks, and then weight is stabilized and spontaneously decreases. In order to minimize this inconvenience, daily physical activity must be increased (walking, climbing stairs, cycling, gardening…) and the daily intake of calories must be reduced by about 200 calories through eating more fruit, vegetables, wholemeal cereals and less fat, cooked or cold meat, and fried food. Using the Chiapi method to stop smoking, by instantly suppressing the need for nicotine, helps avoid any over-compensation through drinking alcohol or eating sweets and fatty food that are responsible for putting on weight, sometimes in a far more catastrophic way. 

Each year without cigarettes is one more year of life

A survey carried out in England over 50 years on 34 000 smoking doctors showed that the life expectation of smokers is shortened by 10 years. However, not all hope is lost as people who give up at the age of 50 regain five extra years’ life. As a general rule, the sooner you stop smoking, the higher your chance to reach the same life expectancy as a non-smoker.

To stop smoking : more advantages than drawbacks.

According to a survey carried out in 1976 on 1353 smokers by Yves Requena, Daniel Michel and Claude Pernice, after a 3 month period without tobacco by the Chiapi method :

• Advantages : a greater sense of taste and smell for half of the cases. Breathing capacity is increased in 77.63% of the cases. Sexual desire and pleasure is increased in 29% of the cases; fewer headaches, dizziness and nausea: less coughing or even no coughing at all in 77.18% of the cases. 

• Drawbacks : more irritation in 57.75% of the cases. More appetite and weight gain (about 4 kilos) in 84.91% of the cases. Greater craving for confectionery in 38.60% of the cases. Greater alcohol consumption in 25.74% of the cases.
  

Atmospheric pollution + cigarettes: a bad cocktail for the heart.

A team of researchers in France has proved that when atmospheric pollution reaches a critical level (the public is then informed), the risk of myocardial infarction was 250% for smokers compared with 163% for non-smokers. Micro-particles, especially those emanating from less modern diesel engines together with aggressive tobacco components, act in synergy to accelerate atherogenous plates and the inflammatory process favouring the liberation of micro-emboli from atheromatous plates.

Tobacco is as dangerous as heroin for the foetus

The results of a survey published in the medical journal “Pediatrics” show that babies born to smoking mothers display the same symptoms at birth as those born to heroin addicted mothers. These babies are more anxious, less agile, more difficult to console and suffer from gastro-intestinal problems. These disorders appear once the mother smokes 6 to 7 cigarettes a day; that is to say less than half a packet, and they increase in intensity with the number of cigarettes smoked.

TOBACCO KILLS !

Mortality attributed to tobacco (10 to 12% of deaths) is equivalent to that linked to alcohol, drugs, accidents and suicides put together : in 1991, 65 000 deaths were recorded due to tobacco (of whom 7 000 were women); 32 000 due to cancer, 22 000 due to cardiovascular diseases, 6 000 due to respiratory infections, and 5 000 due to other diverse causes. Men and women who smoke are aware that they expose themselves to an increased risk of catching well over twenty infections, most of which are incurable and lethal. 

No one should be unaware of the increased frequency of respiratory tract cancers (lung, mouth, larynx, pharynx, oesophagus); cardiovascular diseases (coronary insufficiency, arteritis, high blood pressure, brain vascular accidents); of chronic respiratory diseases (bronchitis, emphysema, pneumonias); bladder cancers…
The issue is not to write yet one more general article on tobacco, but rather to specify what are the actual effects of tobacco on gynaecological organs and to suggest phytotherapy treatments to complement the usual reduction-techniques (the latter will not be developed here) and to overcome some of the side effects.

WOMEN AND TOBACCO

There is a dramatic difference between the number of male and female smokers who cut down their tobacco intake. Tobacco consumption by men has been decreasing for the past few years, while it continues to increase among women. They are the new targets of the tobacco advertising industry. It is creating special brands using colors, shapes and names suggesting that smoking will bring women success, youth and slimness… Unfortunately, the wish to stay slim and the fear of putting on weight during cutting down are important motivations for starting to smoke and for keeping on doing so.

It is true that the average weight increase on giving up smoking is 3.8 kg and that every woman wishing to stop smoking should be advised on her diet. Let’s quote some figures : 3 women in 10 smoke (with more than 50% of female smokers being aged between 15 and 25, more than 40% between 25 to 35 and less than 20% between 45 to 55. Smoking is more common among women from the most privileged social groups (smoking is highest among women executives); the higher the education, the higher the percentage of female smokers. The situation is very different among men. Female smokers are more attracted than males by the consumption of toxins such as alcohol and drugs. They say that they take medicines more often. Every year throughout the world, 500 000 women die of the effects of tobacco consumption.

When the majority of the young women who smoke today reach their fifties, it can be predicted that one in four will have been killed by tobacco. Those who will die before the age of 70 will have lost 22 years of their predicted life expectancy. Some health problems linked to smoking are particularly serious in women who, it appears, are more sensitive to tobacco toxicity than men are. When consuming the same amount of tobacco, the risks of lung cancer, osteoporosis and skin ageing seem dramatically higher in women. Specific predisposing factors could be due to morphological differences (weight, height, lung capacity), to the young age that women start smoking, to her heaviest consumption during the first 30 years of her life and to the differences in hormonal 

GYNECOLOGISTS, WOMEN AND TOBACCO 

Tthe gynecologist has an important role to play with all patients, from teenagers to menopausal women. Oral contraceptives and any other hormonal treatment should always be prescribed together with full information on the risks of smoking and the methods for giving up ; the patient should be urged to give up smoking (or to smoke less) ; equally women should be given information on colleagues who can help them give up.

TOBACCO AND ADOLESCENTS
Women start smoking at a younger age. A study carried out in 1989 showed that 20% of the girls in Year 6 smoked regularly. Cigarette smoking is more frequent amongst young girls under15 years of age than amongst boys of the same age. The majority of young girls who request oral contraceptive for the first time already smoke. In practice, one should refuse the pill to any teenage girl who smokes more than five cigarettes a day.

TOBACCO AND SEXUAL ACTIVITY
Whether women smoke or live in a smoky environment, they are equally more likely to be affected by the risk of cervix cancer. Tobacco behaves as a co-carcinogen and the nicotine increases the virulence of papilloma viruses. 88% of women who smoke 40 cigarettes or more a day have pre-cancerous lesions. Reduced smoking correlated positively with the development of the size of lesion. As a recent information tells us, the risk of having breast cancer is increased, and the risk of a tumour occurs 8 years earlier for the woman who smokes. Period pains and gynaecological disorders are more frequent, for example infections, in particular chlamydia and those affecting the fallopian tubes. This increases the risk of becoming sterile.

TOBACCO AND CONTRACEPTION
Everyone knows there is a risk of thrombosis while taking the pill (phlebitis, blood clot), and more so, if there is a risk of vascular or metabolic disorders as it is the case with diabetes or hyperlipidemia. It is strongly recommended not to smoke while taking the pill and women over the age of 40 are especially advised against it. There is a greater risk of infections for women using the coil. Complications are much more likely with abortion and with the abortive pill RU 486; thus, not only women smokers are excluded from the protocol ? but equally so are all women having stopped smoking less than 2 years previously. Shouldn’t we also exclude any woman who lives in a smoking environment?

TOBACCO AND FERTILITY
Fertility is likely to be disrupted by a number of factors. The oestrogen-lowering effect of tobacco has a negative influence on the menstruation cycle. There is a high level of nicotine concentrated in the cervical mucus and it makes the spermatozoa less mobile ; the nicotine present in the uteral liquid is ten times higher than that in the plasma. There is some evidence that ovarian follicles are reduced in women smokers. All this results in it taking longer for women smokers to get pregnant. Ectopic pregnancies are more frequent (1.3 to 2.5). There is a greater risk of miscarriage either because the implantation of the foetus is disturbed by nicotine, or because of abnormalities of the karyotype. Smoking is estimated to be responsible for a fifth of spontaneous miscarriages. There is a reduction of the number of ovocytes collected and chromosome malformations of the ovocytes - diploid and triploid - are increased. Furthermore, the chance of a successful in vitro fertilization is also reduced. According to OMS data, for 100 women who are sterile, 41% are smokers.

TOBACCO AND PREGNANCY
Pregnant women have a greater risk of high blood pressure ; where there is a medical history of high blood pressure, the foetus is also at risk of toxemia gravida. The placenta suffers from premature aging due to cadmium build-up and zinc deficiency. Scans have clearly detected this premature aging - as if the foetus was past full term – which is known to be able to cause foetal death in utero. There are greater risks of placenta praevia and retro-placental hémorrhage. Hemorrhages are more frequent during delivery. The foetus of a smoking mother or of any woman who lives in a smoky environment for a certain length of time will suffer from hypoxia and a reduced blood flow from the placenta. The blood flow in the umbilical cord is reduced because of the vaso-constrictive effect of nicotine and the existence of carbon monoxide which enters the placenta ; furthermore there is a deficit in amino acids and a decrease of factors such as prostacyclin and nitric acid, both of which have a protective and vaso-dilating effect.

With each puff of a cigarette, the heart frequency immediately speeds up, rising from 5 to 40 beats per minute – and this lasts for 20 minutes. Scans show that whilst smoking, the pregnant woman’s foetus moves less or can stop completely due to hypoxia. There is an increased risk of premature birth and rupture of membranes, with a premature birth rate of 20%. (The cause is thought to be related to the reduced activity of the inhibitor of the platelet activation factor (PAF)). The foetus development slows down and birth weight is 200 to 300 grams below average ; this hypotrophy is directly proportional to the mother’s level of smoke intoxication. The foetus is deficient in zinc and some amino acids. However, there is no increased risk of malformations but convergent strabismus is frequently observed in the children of smoking mothers, in particularly when birth weight is below 2500 grams.

The risk of perinatal mortality is increased as well as neonatal respiratory infections. Stopping smoking is strongly advised during pregnancy and breastfeeding. However, mothers should be warned against excessive intake of coffee (as smoking women often do) for excess of caffeine is also a cause of premature birth and reduced birth weight. We know that excessive coffee intake - very often related to tobacco smoking - continues for an average of 26 weeks after having given up smoking. For the first time a Finnish study has suggested that there is an increase in premature death of women who smoked during their pregnancy. One may presume that they were heavy smokers but these results are rather disturbing and should further encourage women to stop smoking when pregnant.

TOBACCO AND BREASTFEEDING
Smoking should be forbidden. Nicotine is transmitted through breast milk and is absorbed through the mucus membrane of the baby’s mouth. Due to nicotine intoxication, the breastfed baby may vomit and suffer from diarrhea if his mother smokes more than 20 cigarettes a day. There could also be a risk of convulsions and sudden death of the baby.

TOBACCO AND THE NEWBORN BABY
The effect of « passive » smoking (living in a smoky environment) on babies has been proved through the measurement of nicotine and cotinine in a baby’s hair before his third day of life. At birth, a high level of serum concentration of IgE immunoglobulins was found in the blood of the umbilical cord ; this could well explain a child’s increased susceptibility for asthma in later life. Traces of 4 aminobiphenols, a substance present in cigarette smoke, have also been found. This is a known cause of cancer of the bladder. The risk of sudden death of the newborn baby is doubled if the mother smokes. We do not know whether this is due to « passive » smoking after birth or is acquired during pregnancy, when the future mother was smoking. Hearing impairment at birth has also often been observed in nicotine-affected babies.

TOBACCO AND CHILDREN
There is no doubt that ear, nose and throat (ENT) infections occur more frequently in children whose parents smoke –be it one or both of them : otitis of the middle ear, respiratory infections, bronchiolites (an 80% risk compared to 8.5% for children who live in a smoke-free environment), asthma (more severe and frequent). Children living in a smoky environment have reduced breathing capacity of about 7%. Children who undergo adenoid surgery most often have a smoking parent. The frequency of respiratory illnesses is 14% where one parent smokes and 29%, if both smoke ; the frequency reaches 43% when the daily consumption of cigarettes smoked at home is over 45. 

Intensive care admissions of children suffering from asthma increase by 63% when parents smoke. The children of mothers who smoked during their pregnancy are estimated to have a 30% higher risk of having leukaemia or lymphoma. However, the proportion is the same where children have a non-smoking mother with a smoking partner. Researchers do not lay the blame on the « passive » tobacco consumption inhaled by the pregnant woman and her foetus but they suspect that there is a possible alteration of the genetic material carried by the spermatozoa. A recent study has shown that children run a greater risk for meningitis when in a smoky environment. Children whose parents smoke are likely to suffer more frequently from behaviour disorders such as anxiety, disruptiveness that may lead to conflict within the family.

TOBACCO AND MENOPAUSE
Smoking affects oestrogens that are reduced, thus possibly causing an earlier menopause by one or two years as well as an increased risk of osteoporosis. The loss of bone mass has been clearly identified amongst women smokers, even before menopause, and it is increased when oestrogen synthesis ceases. The continuation of smoking after menopause cancels out the protective effect of hormone replacement therapy (HRT) and so increases the risk of fractures of the neck of the thighbone. Giving up smoking is strongly recommended to menopausal women, especially when they are taking HRT.

TOBACCO, SKIN, AGING AND ESTHETICS
Tobacco is responsible for several injuries in women : deterioration of the skin with dermatoses, in particular psoriasis; rapidly ageing skin, increased risk factor for skin cancer ; allergies due to contact with smoke (such as eczema). Skin disease is linked to 4 different mechanisms : oxygenation disorders, increased production of free radicals, a hormonal effect, and a probable immuno-suppressive action. Peripheral vascular alterations caused by tobacco, (narrowing the diameter of skin vessels), reduce cellular exchanges and oxygen supply to the skin. At the cellular level, nicotine and its derivatives are responsible for an increased formation of free radicals, which have a strong oxidizing power.They have a specific action on the connective skin tissue increasing the destruction of the elastin, which causes speedy aging, and premature appearance of wrinkles. Women who smoke heavily have almost five times more wrinkles than non-smoking women. Free radicals increase with stress, air pollution, exposure to the sun, age, an unbalanced diet (consumption of cooked fat or fried foods) ... all play a role in altering the DNA and are responsible for an increased risk of skin cancer.

A third mechanism which affects the ageing process, makes women even more susceptible than men to the ill effects of tobacco ; that is to say, the anti-estrogenic effect of tobacco which increases the production of androgens, blocking their aromatisation into estrogens, and disrupting the peripheral inter-conversion of estrogens (estradiol).

One cannot exclude a possible influence of tobacco on the immune system as it affects the skins or on the immune system in general. There is some evidence that tobacco has an immuno-suppressive effect on the histiocytes. As a result, the ageing process is speeded up in women smokers : doubled for those who smoke up to 50 packets a year ; multiplied by five for over 50 packets a year, but by twelve for those women who smoke more than 50 packets a year and are regularly exposed to the sun. Tobacco enhances the ill effects of sunrays on ageing skin. Women smokers over 65 years of age have the symptoms of women who are 5 years older (skin which is dry, rough, grey, dull; wrinkled; sagging eye-lids, bags under the eyes, blotchy skin /rosacea) ; in many daily activities, essential neuromuscular functions are known to have slowed down.

DEFICIENCIES 
There are more than 200 enzymatic cellular reactions due to various deficiencies, in particular zinc and vitamin C. Zinc deficiency, frequently found during pregnancy, breast-feeding and when taking the pill, is further increased by tobacco.
Vitamin deficiencies include vitamins A, B9, B12, C and E. Vitamin C deficiency is quite significant and can be the cause of scorbut-like diseases (smoker’s pyorrhea). For the regular smoker, a minimum of 250 mg of vitamin C supplements is needed each day; the passive smoker also requires a supplement of 250 mg per day.

COMING OFF
76% of doctors recommend the use of anti-tobacco patches; 52% recommend a determined and immediate cessation ; 16% suggest psychotherapy, 15% acupuncture ; 13% would recommend progressive reduction in consumption, 7% advise nicotine chewing gum and 6% favour auricular therapy.
Relaxation techniques such as sophrology, yoga ... while stopping smoking can also be considered.
Homeopathy is also recommended with such specific strains as : tabaccum, caulophyllum, lobelia, caladium ... ; strains treating the predisposing factors, or smoke or cigarette isotherapy/isopathy. 

PHYTOTHERAPY CONTRIBUTIONS
are important ; they can help people to stop smoking by regulating the mind, stimulating the organism, allowing all body wastes to be cleaned out and by having a regenerating effect on the cells.

- Helping with cutting down : Cigarettes that contain plants other than tobacco (lobelin, derived from lobelia, which is a respiratory analeptic ; eucalyptol, derived from the eucalyptus, which acts as an antiseptic relieving congestion of the respiratory tract ; tussilago, a breathing stimulant, increases breathing capacity) are available to « ex-smokers » ; thus, it is not necessary to forego all the habits associated with smoking.
However, these cigarettes are not harmless; lobelin is toxic in itself if taken in large quantities and produces toxins (carbon monoxide and tar) when lit. Therefore, they should be used with moderation. 
Another disadvantage is smoking them in public, which is not easy as the smell given off is reminiscent of other smells such as those of certain illegal plants...
Valerian has an anxiolytic and sedative effect and is said to alter the taste of tobacco ; there is one anti-smoking product containing valerian that is available on the market. Oats are said to put one off tobacco all together.

- Coping with the neurological and psychological element
Depending on one’s psychological state, a number of plants can regulate mood, reduce anxiety, and are generally sedative. Several plants that are also spasmolytic (and can reduce spasms) can be prescribed ; for example passiflora, Californian poppy (Eschscholtzia), valerian, lemon balm (Melissa), hawthorn, camomile, lime, maillot (sweet clover), ballota nigra, poppy, birdsfoot trefoil (Lotus corniculatus). 

- Coping with body irrigation and cleaning out
All bodily tissues, organs, and cells are poisoned, so effective and thorough irrigation is important. Some plants to help this can be prescribed: artichoke, rosemary, ash tree (for irrigating the gall-bladder and kidneys), hawkheed mouse ear (Hieracium pilosella) (for the kidneys), fumeterre (for cleaning out the gall-bladder and kidneys and reducing spasms), mallow (for regulating bowel function).

- Tonic plants : Siberian Gingseng (Eleutherococcus) (whose anti-stress properties are known) such as ginseng, gentian, green tea, kola can help recover physical and psychological energy to some extent.

- Treating deficiencies
Plants containing vitamin A, C and E and molecules called pro-anthocyanidols have an anti-oxidant effect. Thanks to the action of the anti-free radicals, they start with a major cleaning out of the cells, and help regenerate all the tissues. A number of plants are rich in vitamin C: camu-camu contains the most; then there is acerola, rosa canina (fruit of the dog-rose, containing vitamin A, C and E as well as zinc), sea buckthorn, eating citrus fruits. Certain vegetables such as garlic, parsley, watercress are also recommended. 

Palm oil, carrots, dandelions, parsley contain large quantities of vitamin A (beta-carotene). Vitamin E (the vitamin that helps fertility) is found in wheat-germ oil, essentially sunflower and in all cereals. What’s more, wheat-germ contains vitamin E and vitamin A, B and C. Proanthocyanidols, extracted from pine, grape or tea are very promising molecules because of their very powerful anti-free radical effect.
Live brewer’s yeast is an excellent food supplement and is the richest source of the vitamin B group.
Zinc should be prescribed as trace elements. Such foods as meat and fish, especially oysters, are particularly rich in zinc.

TOBACCO, WEIGHT AND DIET
For women smokers, the fear of gaining weight becomes an obsession so diet is all-important when giving up smoking. Stopping tobacco, and the stress that accompanies it, often increases the feeling of hunger and, unless there is a change of diet, there is a risk of gaining an average of 3 kilos due to a change in the metabolism. It is necessary to have a balanced diet. Eating habits of smokers - men and women - are clearly different from non-smokers. This is due to the nicotine, which increases energy expenditure, and reduces energy intake. It has no effect on the quantity of calories absorbed (which in fact is increased) but it affects the absorption of food substances by speeding up passage through the gastrointestinal system. 

Smokers’ weight is often below average even though their calorie intake is proportionately greater than that of non-smokers. Their diet is poor in fibres, cereals, fruit, vegetables, dairy products and vegetable oils - mono or poly-unsaturated- but too rich in meat (especially in sauce), cooked pork, cheese, fried foods, saturated animal fat, salt. Smokers often have a strong desire for alcohol and coffee. These illogical eating habits increase the harmful effects of tobacco (cardiovascular risks in particular). When giving up smoking, it is advised to be physically more active, to drink a lot of liquids, to stop coffee and alcohol, and to have a balanced diet 3 times a day. More attention should be given to breakfast; low-calorie food should be eaten only when nibbling; complex carbohydrates and fibre-rich food should be taken. Finally, fatty foods - especially saturated - should be reduced, and vitamin C, E and beta-carotene (fruit and vegetables) should be increased.

CONCLUSION
The official campaign against smoking (Evin legislation in 1991 in France) has been badly implemented and the State interests are in real contradiction. Taxes on tobacco raise an annual income 17 times greater than the National Lottery and 9 times more than betting on horses. 
Another contradiction in financial terms is that for every 0.15 Euros collected in tax, the State spends 0.50 Euros treating illnesses caused by tobacco ... The general practitioner has a major role to play in advising all their patients who smoke (unless the GP is one of the 37% who smoke). This curse is a real addiction (nicotine is a hard drug: where a heroin addict may take a gram of heroin, only one gram of nicotine is enough to kill 30 persons); not only those who willingly and knowingly expose themselves to it are affected but also those in their close environment.

The risk of suffering from illnesses linked to « passive » smoking is multiplied 2 or 3 times as compared to non-smokers. Should we go for the American hard line approach with some form of prohibition so that at least one is not being intoxicated by the actions of others? All women, whether very young or not so young, must be concerned, and their number increases every day. At all levels, their future is at risk; women must be informed and made fully aware of the risks at stake; women should gently and patiently be guided towards giving up cigarettes.