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General Health & Eye Health

Published in Retina NZ Newsletter - May 2016
By Dr Emma Sandford

In this issue we will look at smoking, to extend on the reference to quitting in the February newsletter. It is a sticky subject… a difficult one to approach as a non smoker to smokers, a tricky addiction behaviour to break down and beat, a powerful chemical addiction, and a social hot potato.  Let’s start at the very beginning…

Botanically, tobacco plants are from the same family as tomato, potato and deadly night shade (Atropa belladonna) which is the original source of atropine, used pharmaceutically today in ophthalmology practice to dilate the pupil and paralyse the focusing muscle in the eye. It is a hardy perennial flowering plant growing freely in rich moist soils. Tobacco is indigenous to North and South America, Australia, south west Africa, and the South Pacific. Over 70 species are used, Nicotiana tabacum, Virginian tobacco, being of chief commercial interest.

Nicotine is common in many plants but not in such high quantities as in tobacco. It is an alkaloid which is neurotoxic to insects hence nicotine was widely used as an insecticide in the past. Nicotine is poisonous to animals and deters browsing by herbivores.  Nicotine stimulates the  ‘nicotinic receptors’ which appear in:

  • The brain and spinal cord, where it induces behavioural changes, including a feeling of relaxation and wellbeing, as well as being  a stimulant to the brain! Nicotine is unique in comparison to most drugs, as its profile changes from stimulant to sedative with increasing dosages.

  • Autonomic ganglia. These are the junctions in the part of the nervous system that regulates every function of the body organs not under conscious control. The sympathetic system prepares the body for 'fight and flight' responses, like the effect of adrenalin upon the body. The parasympathetic system is the governor of 'rest and digest'  functions. Hence the mixed stimulation-relaxation effect of smoking.

  • Release of adrenaline from the adrenal glands. Nicotine raises blood pressure, increases heart rate, constriction of blood vessels.

There are numerous other effects, too many to list here. Interestingly, smoking is also known to increase levels of liver enzymes that break down drugs and toxins. That means that drugs cleared by these enzymes are cleared more quickly in smokers, which may result in the drugs not working or higher doses being needed, including anaesthetics.

Tobacco use is the single greatest cause of preventable death globally. As many as half of people who use tobacco die from the results of this use. The World Health Organisation (WHO) estimates that each year tobacco causes about 6 million deaths (about 10% of all deaths) with 0.6 million of these occurring in non smokers due to second hand smoke. In the 20th century tobacco is estimated to have caused 100 million deaths.

The usage of tobacco can also contribute to dementia and cognitive decline, reduced memory and cognitive abilities in adolescents and brain shrinkage (cerebral atrophy). Recent studies have linked smoking to anxiety disorders.

Essentially, whatever you have, smoking will make it worse! Increasing oxidative stress, especially on fats in cell membranes and stripping the body of anti-oxidants, vitamins and minerals used by the body to detoxify the chemicals in your average cigarette, is a huge chronic drain on your resources.

In the eye, the risk of developing wet or dry macula degeneration is over 2.5 times greater if you are a smoker. This is due to many factors, including raising bad cholesterol (HDL-Ch) in the blood, increasing platelet stickiness and tendency to clot together, leading to poor blood flow and increased ‘clotability’.

So… what to do about it?

Tobacco harm reduction (THR) is a public health strategy to lower the health risks associated with using nicotine. 

The official advice is to:

Cut down, switch to non-tobacco nicotine containing products (patches), or switch to tobacco products not consumed by smoking them.  Going cold turkey is more successful that tapering. It is widely acknowledged that discontinuation of all tobacco products confers the greatest lowering of risk. Failure rates can be high, so engage extra help…

0800 778 778

And then there’s my advice!

Break down your smoking into manageable bites. The psychological addiction is very powerful, so be kind to yourself when things get tough. Smoking releases a number of brain chemicals including dopamine. Dopamine is released in the reward centres of your brain and many innocent pleasures and pastimes can release it too. Exercise will give you endorphins and other treats and rewards will keep you honest as far as the 'dopamine replacement therapy' is concerned.  So in the first stage consider using nicotine patches, while you establish these new measures. Habit breaking! Instead of focussing on just habit breaking try habit forming. Focus on making new productive and positive habits. Apparently it takes only two weeks of repetition to create a new habit. Not just when the urge is upon you.  Be patient. It's going to be a journey with ups and downs, falling off the wagon and getting back on again.

General nutrition during quitting

Taking care of your general nutrition and herbs can also make a big difference. Eat nutrient dense (fruit and veges, nuts and seeds) rather than energy dense food (grains). Nutrient dense food can make you feel incredible, as instead of all the goodness from your food going into detoxifying your system, it is at last going to your cells.

Being a smoker, you have been on an adrenalin junkies road trip, so leave it alone for a bit. Cut grains/cereals as carbohydrates cause fluctuations in adrenalin and insulin, amongst other hormones.  You might also think about knocking the coffee back a bit or switching to decaf.


Increase your anti-oxidants to help protect your liver from the breakdown by-products of the additives in cigarettes as well as the natural carcinogens released by inhaling organic burnt matter.  A major anti-oxidant in glutathione, so make sure that you eat enough sulphur as this element is necessary to generate this agent. 

Sulphur is present in: eggs, allium vegetables (garlic, onions, leeks), protein-rich foods (fish, poultry, meats, nuts, seeds, legumes, cheese - especially parmesan), cruciferous vegetables (broccoli, cauliflower, cabbage, kale, brussel sprouts, turnips, bok choy and kohlrabi)

Vitamin C

This is extremely effective in preventing Low Density Lipoprotein cholesterol from being oxidised.  High dietary intake has been shown to significantly reduce risk of stroke, heart disease (48% reduced risk in high intake group) and cancer in many population studies.  It also reduces inflammation (a feature of most of the age related chronic diseases).

Co-enzyme Q10 may also help, as cigarette smoking is known to compromise mitochondrial function, which is why it worsens cases of inherited mitochondrial diseases such as Leber’s hereditary optic neuropathy (LHON).

Herbs for detoxing

Consult a herbalist, as there are a lot of herbs that can help you.  There is no room here to run through each herb in detail, and you must seek advice regarding drug interactions and other health conditions you may have. Liver herbs (heptorestorative herbs) such as St. Mary's thistle (Sylibum marianum), Globe artichoke (Cynarum scolymus), or Bupeurum(Bupeurum falcatum). 

Rosemary (Rosmarinus officinalis) is also hepatoprotective and a circulatory stimulant, anti-oxidant, mild analgesic, and mood raiser.

Oligomeric proanthocyanidins - grape seed, grape skin (including red wine), bilberry, cranberry, green tea, cocoa beans, cinnamon, pine bark extract, apples, Acai oil etc.. OPC bind the break down products of the toxins.

Herbs for Quitting

Aerial parts means the green bit above ground, sometimes this is during flowering.

Oat straw (Avena sativa) aerial parts This is a mood lifter, anti-depressant, and nerve tonic, and has eased nicotine craving in some studies. Be careful about oat gluten sensitivity.

Passionflower (Passiflora incarnata) aerial parts during flowering.  This is a mild sedative, an anodine (to ease pain) hypnotic, anxiolytic and is indicated for nervous restlessness, anxiety and insomnia.  (CAUTION: not for use alongside anti-depressants. It will add to the effects of benzodiazepines, hypnotics, opioid analgesics and Tri-Cyclic Antidepressants - so please take advice before trying).

Skullcap (Scutellaria lateriflora) aerial parts during flowering is sedative/relaxant, nervine and anti-convulsant.  No cautions or interactions.

Hyssop (Hyssop officinalis) leafy tops prior or during flowering is a sedative and expectorant and nerve restorative, improves digestion and eases colic. Used for hysteria and anxiety states. No cautions or interactions

{Ed: There are a lot more to list! If you would like more information please email and I can put you in touch with Dr Sandford for the full list.}

Till next time!