This is the final column in a series on the major causes of heart disease. For years smoking was the major preventable cause of death in the U.S. Now, unhealthy eating is, but smoking is number two.

About 14% of American men and 11% of women still smoke. Tobacco smoke contains over 5,000 identified chemicals, so it’s not surprising that it has many adverse health effects.

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Humans have been smoking for thousands of years, but it wasn’t until the 1920s that scientists in Germany found a link between smoking and lung cancer. Over subsequent decades, the evidence that smoking causes health problems became overwhelming. The percentage of people in developed countries who smoke has been dropping since the 1960s, but the percentage is increasing in developing countries.

Smoking is responsible for one in every five deaths in the U.S. — over 480,000 annually. The annual cost for cigarette-related health care is approximately $130 billion in the U.S., with another $150 billion lost in productivity. Secondhand smoke is also a problem, killing around 41,000 Americans annually, with heart disease accounting for 34,000 of these fatalities and lung cancer the rest.

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Cigarette smoke inflames the endothelium that lines our arteries, which contributes to formation of atherosclerotic plaque. Tobacco-caused inflammation also contributes to rupture of plaque, which blocks arteries, resulting in heart attacks and strokes. Smoking also affects other arteries in the body, contributing to conditions such as erectile dysfunction and peripheral vascular disease (blockage-causing plaque in arteries in the legs).

Many of the chemicals in cigarette smoke are carcinogens. Ninety percent of lung cancer in the U.S. is due to smoking, and lung cancer now causes more deaths in women than breast cancer. Smokers are also at greater risk for cancer of the bladder; blood (leukemia); cervix; colon and rectum; kidney; voice box; liver; mouth, throat, and tongue; pancreas; and stomach. If everyone in America stopped smoking, one out of three cancer deaths would be prevented.

Smoking also damages and destroys the delicate air sacs in the lungs called alveoli, resulting in emphysema, which leads to need for supplemental oxygen and a slow death. Smoking causes premature aging, affecting all our organs including our skin (“premature” wrinkling). It increases the risk of cataracts, macular degeneration, diabetes and rheumatoid arthritis. It also harms immune function and contributes to infertility. In pregnant women it contributes to premature births, low birth weight, and cleft lip and palate in the fetus. It is also one of the causes of sudden infant death syndrome (SIDS).

Smoking raises levels of dopamine and endorphins, making it very addictive. It’s certainly best not to start smoking in the first place, but if you do smoke, it is possible to quit, and many people do. Nicotine patches can be helpful, as can prescription medications such as bupropion. Smokeless tobacco (chewing tobacco) has many of the same adverse health effects as cigarettes, and e-cigarettes have their own set of problems.

There are many similarities between the fight against Big Tobacco years ago and the current fight against unhealthy food, such as:

• As the science linking tobacco and disease became more overwhelming, tobacco companies tried to deny the evidence and sow seeds of doubt on the science. Currently, food companies use the same tactics.
• Tobacco companies came up with useless gimmicks such as filters and low tar cigarettes, and “organic tobacco.” Currently, food companies tout gimmicks such as “Fruit Loops now contain fiber,” and “organic cane sugar.”
• For years doctors didn’t get that smoking was bad, and many used to smoke (there were ads like “most doctors smoke Camels”). Eventually, doctors got the message, and currently virtually no doctors smoke. Currently, it looks like it will be a while before most doctors get the connection between unhealthy food and disease and change their own eating habits. When that happens they will educate their patients.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.