The musculoskeletal effects of cigarette smoking

It has been well-established that cigarette smoking is the leading cause of preventable mortalities worldwide (Abate et al., 2013), but what is the most important implication of cigarette smoking on morbidity and quality of life? You most likely focused on the effects of smoking on the cardiovascular system, but have you looked beyond the cardiovascular dimension? A large quantity of experimental research indicates that cigarette smoking is a prominent contributor to morbidity through its effects on the musculoskeletal system. A recent review by Abate and colleagues (2013) investigated the effects of cigarette smoking on the musculoskeletal system and the musculoskeletal benefits associated with smoking cessation.

Cigarette smoking has been shown to decrease bone density through both direct and indirect pathways (Abate et al., 2013). In vitro experiments have demonstrated that at concentrations comparable to levels found in regular smokers, nicotine directly suppresses bone metabolism (Abate et al., 2013). Cigarette smoking has also been found to exhibit anti-estrogenic properties, which is relevant to bone health because estrogen is known to contribute to maintaining bone health in post-menopausal women (Abate et al., 2013). It was previously discovered that smoking patients receiving estrogen-replacement therapy required a greater dose of the hormone to achieve similar clinical results to non-smoking patients receiving the standard dose of estrogen (Abate et al., 2013).

The negative impact of cigarette smoking on bone density has numerous implications for one’s quality of life. Some of the downstream outcomes of decreased bone density include an increased risk of fractures, poorer prognosis following fractures, and an increased risk of back pain (Abate et al., 2013). Moreover, meta-analyses have suggested that up to 25% of the burden of rheumatoid arthritis in the population can be attributed to smoking (Abate et al., 2013). Finally, studies have consistently found that cigarette smoking is linked to muscle and tendon atrophy, with a dose-response relationship observed between the daily number of cigarettes smoked and the severity of tendon atrophy (Abate et al., 2013).

The good news is that smoking cessation has been linked with noticeable short- and long-term musculoskeletal benefits. In the long-term, smoking cessation has been associated with increased bone metabolism and a decreased risk of fractures (Abate et al., 2013). The short-term benefits include improved prognosis following orthopaedic surgery, reduced frequency of musculoskeletal complication, and reductions in the length of hospital stays (Abate et al., 2013).  All the evidence presented supports one of the main messages of Leave the Pack Behind, which is that it is never too late to think about smoking cessation.   

References

Abate M, Vanni D, Pantalone A, Salini V. (2013). Cigarette smoking and musculoskeletal disorders. Muscles, Ligaments and Tendons Journal, 3(2), 63-9.

Weight Gain Following Smoking Cessation: Inevitable or Not?

Weight Gain Following Smoking Cessation: Inevitable or Not?

Countless myths surrounding smoking cessation have been accurately addressed, but the one concerning smoking cessation and weight gain is not one of them. In fact, weight gain following smoking cessation may not be a myth, as there is evidence supporting the tendency to see minor increases in weight post-cessation, which is plausible when considering that cigarette smoking increases resting metabolic rate and ultimately energy expenditure at rest (Filozof et al., 2004). In one study, it was found that over the course of four years, the net weight gain on average totaled less than 2 kilograms (Clair et al., 2013). When considered in conjunction with the array of health risks that accompany sustained smoking behaviour, one ought to reconsider the significance of such a minor increase in weight.

Smoking leads to an increase in the contraction frequency of cardiac smooth muscle, increasing heart rate and blood pressure (Clair et al., 2013). These events result in damage to the endothelial lining of blood vessels, increasing susceptibility to atherosclerosis and cardiovascular disease (Clair et al., 2013). Smoking cessation, on the other hand, has been found to reduce a number of risk factors for cardiovascular disease even in spite of small increases in weight (Clair et al., 2013). 

Also noteworthy are the profound health benefits observed immediately following smoking cessation. While cigarette smoking has been shown to reduce insulin sensitivity and increase susceptibility to hyperinsulinemia (Filozof et al., 2004) and hyperglycemia, all of which are predictive of diabetes, refraining from smoking seems to abruptly return insulin sensitivity to higher levels (Clair et al., 2013). Moreover, smoking cessation contributes to improving an individual’s blood lipid profile, particularly through increasing the concentration ratio of high-density lipoprotein cholesterol (the “good cholesterol”) to low-density lipoprotein cholesterol (the “bad” cholesterol) in plasma (Clair et al., 2013). This finding is significant because high-density lipoprotein cholesterol promotes the excretion of excess cholesterol, ultimately improving cardiovascular health (Whiteney et al., 2013).

Lastly, weight gain following smoking cessation does not appear to be inevitable. When smoking cessation is accompanied by a diet intervention and nicotine replacement therapy, particularly the gum, avoidance of post-cessation weight gain seems to be a reasonable expectation (Filozof et al., 2004). A study was conducted on a group of women who attributed their unsuccessful cessation attempts to weight gain (Filozof et al., 2004). This group of women participated in a cessation intervention that included a reduction in caloric intake and assistance from nicotine replacement therapy in the form of the gum (Filozof et al., 2004). The results were promising, as the intervention was found to improve smoking cessation success rates while preventing weight gain (Filozof et al., 2004).

In summary, the health risks of sustained cigarette smoking have been shown to significantly outweigh the risks of a minor weight increase. Furthermore, it was discovered that weight gain is not an inevitable consequence of smoking cessation. The following question should be more easily addressed in light of these findings: Is weight gain a plausible reason for the continuation of cigarette smoking?

Resources & References

More information about quitting and quit aids can be found on the Leave The Pack Behind website.

The QuitRunChill website provides an online program that can increase your success at quitting while avoiding weight gain.

Clair, C., Rigotti, N., Porneala, P., Fox, C.S., D’Agostino, R.B., Pencina, M.J. Meigs, J.B. (2013). Association of Smoking Cessation and Weight Change With Cardiovascular Disease Among Adults With and Without Diabetes. Journal of the American Medical Association, 309(10), 1014-1021. doi: 10.1001/jama.2013.1644.

Filozof, C,. Fernández Pinilla, M.C., Fernández-Cruz A. (2004). Smoking cessation and weight gain. Obesity Reviews, 5(2), 95-103. doi: 10.1111/j.1467-789X.2004.00131

Whitney, E., Rolfes, S, Hammond, G., & Piché, L. (2013). Understanding Nutrition (1st Canadian ed.). Toronto: Nelson