Hacker News Reader

Comment by Medicalidiot | Hacker News Reader

The number one controllable risk factor for stroke and heart attack is smoking. By far. Not diet, not exercise, smoking. A significant part of that is because nicotine will constrict blood vessels leading to hypertension[1], this leads to destruction of the surface of an artery, leading to atherosclerosis formation. One day the atherosclerotic plaque ruptures and then you see me.

We once thought that atherosclerosis is an old persons disease, where health habits later in life lead are what predicates plaque formation. The Army started noticing fatty streak formation(first stage of atherosclerosis)[2] in arteries of dead soldiers during autopsy, which now leads us to believe this starts in youth and progresses from there.

1) https://www.ingentaconnect.com/content/ben/vdp/2005/00000002...

2) https://media.jamanetwork.com/news-item/autopsy-based-study-...

View on HN

Smoking is one of the leading risk factors for cardiovascular disease: agreed

It starts earlier than a lot of people thought: agreed

The primary contributor to smoking's detrimental effects on the cardiovascular system is nicotine: disagree

Mind linking to something that shows this? That doesn't agree with the results from the UK study on effects of nicotine versus smoking which puts nicotine's effects at about 5% of the risk of smoking.

You can test this yourself. Test your blood pressure prior to vaping and then after. If you choose to ignore all else you could argue the rise in BP is transient and not concerning. I personally would not bet my life on it.

I don't know if identifying whether or not something transiently raise my blood pressure is a better measure than a comprehensive report by the UK equivalent of the NIH.

Jogging in place will also transiently raise your blood pressure.

Yeah, but it's supposed to. Inhaling something and then your BP goes up means you should not inhale that thing, eh?

Indeed, too much training can be counter productive. Vice versa, runners can't just stop and settle down, neither after a race nor after a carreer, or they'd risk heart failure. I cannot explain it but I think it's common knowledge.

Source?

But it then over time it lowers your resting blood pressure. Not sure nicotine would since most users constantly use it (and it may not with occasional use either, I'm not sure).

Interesting so if my BP crashes I should smoke or vape :-)

I have had a BP crash I was cooking the Christmas dinner (the full works ) and accidently forgot I had taken my bp pills that morning and took a second set.

I passed out and vomited about 10 mins after sitting down to eat

Is that 5% of the risk of cardiovascular disease or 5% of risk from any disease?

Total risk

This is definitely a point which needs more exploring. Seems to me most damage from smoking is all the crap in smoking. The chemical nicotine - by itself - transiently raises BP, feels nice, and that's about it.

It's also only a part of the addictiveness of smoking. Probably a small part, as everyone I know who has consumed nicotine in any form has no trouble without it if they vape, but often shows discomfort/restlessness if they smoke. Amazingly, this holds true for those who consume far more nicotine through vaping compared to others that get it through smoking.

I think I remember reading some research at some point that backs this up, if I remember correctly they found it was a lot easier to get rats addicted to smoking than nicotine

Yep evilterran linked to the study I was thinking about.

Is there any research on what other chemicals might be addictive?

There's research that the heat alone in some forms of abuse of smoking things can cause lung issues.

The difference I've found with vaping is both a) I use a very cool setting so it's not nearly as hot as a cigarette (which you can't control the temperature of) and b) I used far less nicotine, starting from 24mg->3mg in the course of a year.

I can easily stop vaping for days at a time now without having a strong pang of nicotine dependency which I used to have.

Here's one: https://www.jneurosci.org/content/25/38/8593

Abstract:

Nicotine is the major neuroactive compound of tobacco, which has, by itself, weak reinforcing properties. It is known that levels of the enzymes monoamine oxidase A (MAO-A) and MAO-B are reduced in the platelets and brains of smokers and that substances, other than nicotine, present in tobacco smoke have MAO-inhibitory activities. Here, we report that inhibition of MAO dramatically and specifically increases the motivation to self-administer nicotine in rats. These effects were more prominent in rats selected for high responsiveness to novelty than in rats with low responsiveness to novelty. The results suggest that the inhibition of MAO activity by compounds present in tobacco smoke may combine with nicotine to produce the intense reinforcing properties of cigarette smoking that lead to addiction.

There is evidence that some additives enhance addiction and that others suppress the side effects from smoking (coughing, burnt throat, feeling ill, etc.) so that when someone quits smoking they have essentially stopped treating themselves for all these side effects, which then appear and make the person feel miserable. Smoking instantly relieves symptoms again (for a while):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040350/

"Our findings indicated that more than 100 of 599 documented cigarette additives have pharmacological actions that camouflage the odor of environmental tobacco smoke emitted from cigarettes, enhance or maintain nicotine delivery, could increase the addictiveness of cigarettes, and mask symptoms and illnesses associated with smoking behaviors."

So it appears that although nicotine is mildly addictive, commercial tobacco was engineered to suppress the side effects of smoking which essentially made it much more (technically) addictive. Hence quitting tobacco is much more difficult than quitting nicotine because you are also quitting the additives which are suppressing cough and hiding the feeling of illness smoking causes.

>So it appears that although nicotine is mildly addictive

It's not mildly addictive

https://en.wikipedia.org/wiki/Substance_dependence#Dependenc...

Nicotine is not on that list.

There's a great PDF (British action group I believe? I read it ages ago) which goes in to depth on the various mechanisms the tobacco companies employed in order to increase the addiction potential of cigarettes.

A modern cigarette is not just a roll of tobacco. It's pretty much been 'bred', A-B tested, into being a drug delivery system.

> The chemical nicotine - by itself - transiently raises BP, feels nice, and that's about it.

This is not entirely true. I believe it can put you at risk for cardiac arrhythmia, and the risk goes up steeply the more nicotine you intake to simply cardiac arrest. I believe this is depicted in Thank You For Smoking when the protagonist is covered in nicotine patches and almost dies. It’s entirely possible that was do to BP issues but I wouldn’t dismiss it as trivial in that case.

Also if you read about the native american experience of smoking uncured tobacco, it seems like it was likely a near death shamanic experience and it did kill people occasionally.

That said, it’s rather easy to moderate your intake with the percentages, so it’s not a problem for most people (I hope).

Nicotine is a poison and will unquestionably kill you at high doses. Same thing with water. Drink enough and you'll die. The relevant question is, what are the negative effects of nicotine at common therapeutic doses?

I've been a long-time smoker, and at least for me, nicotine alone does absolutely nothing to alleviate cravings. Gum, patches, lozenges, vaping, etc. do zero to alleviate my craving for a cigarette. I'm not discounting that nicotine is addictive (I'm in no position to say), but there's got to be something else in tobacco that is part of the addiction.

Nicotine only makes me sick. I've tried gums, vapes, and nicotine salt pouches. I smoke a tobacco pipe when I want to relax.

There are MAOIs in tobacco smoke. I'm not sure that's what makes me feel calm though.

It could be the interaction between the MAOIs and the nicotine. Or more accurately, the MAOIs altering how your body handles nicotine.

There are sibling comments discussing MAOIs, and I've heard about them before in relation to smoking. It makes me wonder if MAOIs alone would be better for smoking cessation. I don't think I'm all that addicted to the nicotine itself. There are plenty of other supposedly-addictive stimulants that I can take or leave at will and with no feelings of withdrawal, and nicotine does nothing to alleviate cigarette withdrawal for me, so I'm not sure it's even a necessary component. There are some NIH studies about MAOIs and smoking, but I'm not going to link them because I find them incomprehensibly dense.

I don’t remember what family of antidepressant Bupropion (Wellbutrin/Zyban) is, but it helped me immensely the first time I quit. I literally just woke up one day (a few days before my target quit date) and had no craving at all.

It also made me a little bit manic, and weaning off it sucked, but it worked well in general.

Addiction has two components: chemical(i.e. nicotine) and psychological (i.e. the habit of the ritual).

My mom recently switched to e-cigarettes, and she said that she still occasionally gets the urge to smoke a real cigarette. But she said the urge is a lot weaker than when she used to go prolonged periods without smoking cigarettes, such as after a long plane ride.

Have you ever tried Swedish Snus? It's supposedly healthier than smoking, and no need to spit like chewing tobacco.

If you try it. make sure you get fresh stuff before you pass judgment, because it ferments inside the package if left out for too long.

That’s how you get mouth cancer.

It's still considered the safest form of tobacco out there, and the increased risk of mouth cancer is quite small to non existent.

https://www.nytimes.com/2014/11/30/business/studying-snus-a-...

Have you tried vaping using those e-cigs that look realistic, have a light up tip, and deliver a reasonable throat hit?

For me the addiction was partly psychological around the form factor. Using "light sabre" style vapes didn't work. However I was able to wean myself off smokes using realistic e-cigs (which I also eventually quit).

They do nothing for me. They're also cheaply made and don't work well or consistently (and I've tried many brands).

The only thing that got me to quit smoking is the Juul. I tried everything else, but with the Juul, I just quit without having to consciously discipline myself 20 times a day. The gum was close though, but it took too long to kill the craving, so I'd end up chewing it constantly for it to work.

I've been smoking for a little over 20 years (since a teenager). Good luck.

Could you link the study you're talking about? I found this - https://www.theguardian.com/society/2018/dec/28/vaping-is-95...

But the only "study" referenced comparing smoking and nicotine was a video experiment that didn't even use humans.

https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes

Click on "how safe are e-cigarettes" which link to two studies, one by the royal physicians and one by public health England.

The one by the PHE is 118 pages and is a summary of all the available evidence as of 2015.

And the RCP does something similar in 189 pages.

They do not exclusively focus on comparing the relative harm, but that is a large section in each.

If you just look at what a pipe looks like if not cleaned properly, and picture the lungs looking the same, maybe the blood vessels too, then nicotene seems like the least of the problems. However, confounding factors means that a simple additive measure cannot illuminate the problem.

Short breath alone, which invariably follows the exposure to aggressive gases, leads to contraction of the vessels and increased heart rate, to keep up the oxygen level in vital parts.

Even if tar should not enter the blood streem in a healthy tester, which I'm not sure, the built up tar pits so to speak are cozy breeding grounds for all kinds of pathogens. Excess water in the lungs, or vice versa dry lungs impact the imunosystem as well.

>The primary contributor to smoking's detrimental effects on the cardiovascular system is nicotine: disagree

Where did I say that?

I don't what UK study you're referring to, the ones I used are published in American and Middle Eastern journals.

I smoked for ~3 years and one of my favorite smoking memories was with a doctor in San Diego.

He was going down the standard visit questionnaire and asked if i smoked, so I said yes. He put down his pen, looked me in the eye, and loudly said "STOP". He looked back at the form, picked up his pen, and we carried on.

I don't know if your doctor or anyone in this thread is aware of the classic Bob Newhart sketch:

https://www.youtube.com/watch?v=Ow0lr63y4Mw

Or the Fry and Laurie "Dr Tobacco" sketch:

https://www.youtube.com/watch?v=XewVicFzRxw

Does that mean that caffeine is a risk too? Doesn't it have similar effects to nicotine? (I drink a loooooot of coffee).

Really disappointed there’s no comments here. I scrolled this whole thread to see if anyone had talked about coffee.

It got me thinking because I know someone who never drank coffee in their life and lived a pretty full life nonetheless otherwise ... they’re over 100 as of recently and still self mobile, super active, sharp as a tack. She even had quite a few children.

I consume like 4-5 actual brewed coffees per day. Am I doomed?

Doomed to a slightly shorter life, made richer by the enjoyment of a beverage.

Its bad for blood pressure - I switched to decaf for that reason.

How something raises BP might be important, tho.

/bargaining

The evidence is inconclusive. Some studies show slightly higher all-cause mortality for coffee drinkers, some studies show slightly lower mortality. Either way, the effect size is clinically insignificant.

https://www.ncbi.nlm.nih.gov/pubmed/24279995

Coffee's fine. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....

A nonlinear association between coffee consumption and CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups per day, and heavy coffee consumption was not associated with elevated CVD risk.

> The number one controllable risk factor for stroke and heart attack is smoking

Can you clarify? Do you mean smoking cigarettes? Or do you mean consuming nicotine? What about vaping? How about smoking marijuana?

There's an information imbalance so definitive claims can't be made about cannabis smoking in the way that they can be made about Tobacco smoking.

Imsuspect marijuana smoking is just as harmful. The bulk of the trouble from tobacco is from the smoke. And if you look at the health effects of air pollution, they’re very similar to smoking: respiratory infections, heart disease, COPD, stroke and lung cancer

Inhaling any burning thing is quite bad for the human organism.

https://en.m.wikipedia.org/wiki/Air_pollution#Health_effects

I don't know any people who smoke 20-40 joints a day

Having smoked both, tobacco seems more irritating.

Have any of your patients tried reversing the plaque with k2/d3/magnesium. It works for lowering CAC scores, just curious if it also helps with any of the other buildup beyond calcium. Or perhaps serrapeptase/natto.

Look up Linus Pauling's therapy.

I actually ran across his studies some time ago. I've always been curious if the testing to validate his work used real vitamin-C or ascorbic acid. I will dig deeper into that now that you bring it up.

https://www.quackwatch.org/01QuackeryRelatedTopics/pauling.h...

I'm not an expert, but my understanding is its not at all clear enough to make such a strong, simplistic statement. For example:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

Are there any similar studies for marijuana vapor inhalation?

Reply on news.ycombinator.com