According to the Surgeon General, about half of smokers believe that nicotine helps them in controlling their weight. The obvious question becomes, do weight-concerned smokers endorse exaggerated beliefs associated with nicotine suppressing bodyweight?
Research suggests they do.[1] It also suggests that education may help correct exaggerated weight control beliefs, making recovery more inviting.
Sadly, escalating weight gain can gradually erode recovery motivation to the point of making 50% odds of the average smoker losing 13-14 years of life seem more appealing than another pound.
There, 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.[2]
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."[3]
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.[4] It's normally associated with physiological changes and the pounds are easily and quickly shed.[5]
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, now that nicotine is no longer providing instant energy via your body's fight or flight response, it's normal to need time to discover how to avoid the onset of hunger by fueling the body sooner and regularly.
It is also entirely natural to experience a metabolism change associated with our body no longer needing to expend energy in attempting to expel tobacco toxins, and no longer feeling nicotine's stimulant effects in making our body's organs (primarily the heart and lungs) work harder.
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 others necessary for life are synthesized or created.[6]
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."[7]
Addicted to a fight or flight stimulant which activates hypothalamus acetylcholine receptors, nicotine prepares the body to fight to the death or run for its life.
Will arresting our addiction decrease our BMR, resulting in 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."[8]
But 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."[9]
That report examined 15 studies involving 20,000 people. It found that although "four-fifths of smokers gained weight during recovery, the average weight gain was 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.[10]
Echoing that finding, while a 2009 study found average cessation weight gain of 3 kg for women and 5 kg for men, it found "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."[11]
Theories as to potential causes are many[12] including genetics,[13], metabolic changes, hand to mouth oral gratification replacement, improved senses of smell and taste (most notably sweets and salts), diet changes, substituting food for nicotine in stimulating dopamine release, diminished exercise (isolation), and binge eating.[14]
It isn't easy pinpointing the cause for consuming or burning even one extra calorie, especially when our metabolism naturally slows a bit more, each and every year.
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 bodyweight 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 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 a pound.
A study of 6,569 middle-aged men who stopped smoking found that at one year they consumed an average of 103 fewer calories per day, which the study attributed to metabolic change.[15]
While a slower metabolism means fewer calories burned by a more relaxed body, millions of ex-smokers offset potential weight gain by putting recovery's gifts to work (their enhanced blood flow, increased oxygen levels, and improved lung function).
How to gain lots of extra weight
Recovery heralds an end to both nicotine's arrival and replenishment's "aaah" wanting relief sensations. Some find themselves camping out inside the refrigerator or potato chip bags where they "aaah" themselves sick with food.
Others intentionally invite weight gain 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 the 4 percent who go-hog wild continue such destructive behavior to the point of having nothing to wear? I suspect that 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 may not be sufficient to satisfy the wanting being felt.
Most of us used nicotine to satisfy subtle urges and wanting for more, 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,[16] 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.[17]
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."[18]
While compromised dopamine pathways may have assigned nicotine the same use priority as food, there's one massive distinction. The brain does not die without nicotine, it thrives!
The saddest part about attempting "aaah" relief replacement using large quantities of extra food is that, should the addict use their demoralizing weight increase as 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 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 food is consumed.[19] The primary psychological binge-eating cue is waiting too long before eating and sensing the onset of hunger.[20]
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 establishment 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.[21]
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. Trial and error, it may take a bit of practice. But we should expect to confront hunger if we insist on 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 speeds digestion and aids 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 may actually end up eating 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 need.
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 sitting at a computer and clicking a mouse?
Unfortunately, some of us take the term "quitting" literally and withdraw from life entirely.
Bodyweight 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.[22]
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.
References:
2. Diverse Populations Collaboration, Smoking, body weight, and CHD mortality in diverse populations, Preventive Medicine June 2004, Volume 38(6), Pages 834-840.
3. Spitzer, J, Patience in weight control issues, Freedom, April 24, 2003.
4. Weight Control Information Network, NIDDK, National Institute of Health, August 2006.
5. 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
6. metabolism. (n.d.). The American Heritage Dictionary of the English Language, Fourth Edition. Retrieved August 06, 2008, from Dictionary.com
7. basal metabolic rate. (n.d.). The American Heritage Dictionary of the English Language, Fourth Edition. Retrieved August 06, 2008, from Dictionary.com
8. 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.
9. U.S. Surgeon General, The Health Benefits of Smoking Cessation, a report of the Surgeon General, 1990.
10. 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.
11. 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.
12. 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.
13. 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.
14. Harris KK, Metabolic effects of smoking cessation, Nature Reviews Endocrinology, 2016 May; Volume 12(5), Pages 299–308.
15. Clearman DR and Jacobs DR Jr., Relationships between weight and caloric intake of men who stop smoking: the Multiple Risk Factor Intervention Trial. Addictive Behaviors, 1991, Volume 16(6), Pages 401-410.
16. 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.
17. de Araujo IE, et al, Food reward in the absence of taste receptor signaling, Neuron, March 27, 2008, Volume 57(6), Pages 930-941.
18. 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.
19. 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.
20. Vanderlinden J, Which factors do provoke binge-eating? An exploratory study in female students, Eating Behaviors, Spring 2001, Volume 2(1), Pages 79-83.
21. 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.
22. 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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