March 8th is National No Smoking Day

With a smoking ban coming to England in 2007, kicking the habit is something that will play on every smoker’s mind in the coming months. 8th March 2006 is National No Smoking Day and 1.5 million smokers are expected to use this as a reason to quit. Maggie McDonaugh, a smoker of 22 years, gave up smoking with NiQuitin CQ on national TV in December 2005. 10 weeks into her televised quitting journey, Maggie’s body has undergone dramatic changes, some of which took place just minutes after she first quit back in December. According to Dr Mark Porter, giving up when she did at the age of 38, Maggie’s life expectancy is now unlikely to be affected and her overall well being has dramatically improved.

Host: Mark Ryes (MR)

Guests: Dr Mark Porter (MP) Maggie McDonaugh (MM)

MR: Welcome to today's show, hello, I'm Mark Ryes. Have you ever tried to give up smoking? Difficult, isn't it. Well, we're dealing with that difficult subject today, with National No Smoking Day on the 8th of March and the imminent smoking ban, they say there's never been a better time to give up. I'm joined in the studio today by a face you'll recognise, I'm sure, Dr Mark Porter, here to talk not only about the medical aspects of giving up smoking and how much healthier you will be but also about how difficult it can be to give up as well. And a face that I hope that you'll recognise, Maggie, who has given up with the help of Niquitin CQ Patches. Maggie, it's been a while now, is it actually seven months now since you gave up?

MM: It is, yeah, seven months ago.

MR: If you don't recognise Maggie, let's just have a look at the commercial and remind you.

 

Advertisement Dialogue :
MM: confession to make, don't feel good about it, stole a cigarette off my son without him knowing, lit the cigarette up, had two puffs, it doesn't mean that I'm giving up giving up. It's made me even more determined to give up. I told Jessie because I don't want to feel as if I'm cheating on her. She turned around and said, "Don't worry mum" she said, "You can do it." So not very proud of myself at the moment. Bit of a silly cow, aren't I.
Narrator: Be strong and quit with Niquitin."
Advertisement Ends.

MP: Very good.

MM: Thank you.

MR: Well, there it is, that was very good, yeah exactly, you were cringing while you were watching yourself there. Seven months on, how easy or difficult have you found it, Maggie?

MM: There have been difficult times, ...

MR: Have there?

MM: ... it hasn't all been plain sailing. I was smoking for twenty five years, thirty a day, quite a severe habit, plenty of willpower and patches, patches really worked for me.

MR: Could you have done it without the patches?

MM: No way, no. I've tried about eight or nine times before and I think eight hours is the longest that I've ever lasted.

MR: Well, we'll come back to that in a moment. So if you want to submit your questions to either Maggie or Dr Mark Porter, you can if you take a look underneath our little box that you're watching us on your screen at the moment, you can submit your question. We'd love to hear from you in the studio and the questions will come up on my screen here so I can ask them. First one, Mark, Oliver wants to know, "Is it true every time I smoke I take five minutes off my life?"

MP: Yeah, well this is one of those statistics that we use to try and quantify the damage that smoking does and what we do know is that smokers who've continued the habit life-long, one in three of them will die of a smoking-related illness and that might be lung cancer, it might be heart disease, it might be a stroke. There's a long list of them. Whether one cigarette takes five minutes, that's a bit inaccurate but that's a good indicator of the way that you are shortening your life. If you think how many cigarettes you smoke it gives you a fair idea of how dangerous they are for you.

MR: Although there's new research out this week that shows if you give up when you're about thirty five, about half way through your life, actually you can reverse the negative effects.

MP: Yeah, I mean that's a relatively new finding and what they've done is they've said if you give up before the age of thirty five that your total life expectancy is pretty unaffected, in other words you should live as long as somebody who's never touched a cigarette in their life. Now the immediate response from smokers to that is, 'Oooh, I can smoke until I'm thirty five and get away with it'.

MR: Well, yeah but I guess the health implications are far more subtle than that.

MP: Well I like to look at it in two ways. First of all, it doesn't mean just because you live as long that you're going to live as healthy so you will be more prone to get disease even if you do stop and you might well not have the lungs of ... you know, out of puff and all sorts of other problems that go with it. But the key message is that it's reversible and there's this perception among smokers that, you know, 'I smoked for twenty years', as Maggie did, 'What's the point of giving up', you know, 'I've done the damage, the damage is already done', but it's never too late to give up and in fact, the benefits of giving up smoking start from about twenty minutes after you give up. Even in people and, in fact, indeed sometimes more in people who are in their seventies and eighties who've smoked all of their life.

MR: Does that mean you feel it straight away, do you feel the benefits straight away?

MR: Yeah, you get changes in your circulation, in your blood pressure, stickiness of your blood and your pulse rate can happen within twenty minutes or thirty minutes after your last cigarette. The sort of things that you're going to notice more of in terms of breathing, would be more like six to nine months by the time your lungs get back to normal and for someone of Maggie's age, that can be a ten percent increase in their lung capacity. Ten percent might not sound very much but it's the difference between being out of breath when you're jogging along or ...

MR: Well, let's find out, do you feel healthier, do you feel better, can you do more, can you taste more?

MM: I definitely, definitely taste a lot more; I used to be really out of breath if I ran up the stairs which wasn't good, so when you get into bed it's uuuuh!

MR: And as a smoker did you just put that down to being unfit because you didn't want to blame the fags?

MM: Yeah, I didn't put it down to cigarettes at all. Yeah, it was just like a lifestyle thing, nothing to do with the smoking.

MR: So overall you've made the right decision and it's good for you at this point?

MM: Absolutely fantastic, yep, I've just got to convince my son now.

(Laughter)
MR: Well, you're a great example to him and a great example to all of us as well. Mark, I've got another question in from Sarah, that's just come in, "What will happen to my body if I stop smoking, but more to the point, what will happen if I continue smoking?"

MP: Well, I would hope, you know, Sarah now at this stage, I don't have to spell out the dangers of smoking but essentially what happens if you carry on smoking, the main damage is done to the lining of your arteries, that's the bit that we worry about most. There's a saying in medicine that 'You're only as old as your arteries' and smoking accelerates the natural furring up process that occurs and that's the underlying problem that leads to heart attacks.

MR: So stroke and heart failure.

MP: Yeah, and those are the two biggest killers of us so, you know, anything that increases the risk of those is significant. The other worrying thing, and this is related to how long you've been smoking for and how many cigarettes you've smoked, is lung cancer. Lung cancer, forty thousand deaths in the UK, it's the most common form of cancer in the UK, and it's almost ... I mean it can happen to people who are non-smokers but they're nearly always smokers and that risk increases each decade that you smoke so the sooner you stop, the better from that point of view.

MR: Another question, this has just come in from Alex. Alex thank you very much indeed for your question, "If I stop smoking how much will it reduce my chances of getting lung cancer and what are the benefits that I see in the first six months to try and pers ...", he quite rightly says, "... to try and persuade me to stay off them?"

MP: Okay, alright, well, I mean, looking at lung cancer and heart disease, if you stop your chances of getting a heart attack or stroke diminish within twenty four hours. But over a ten year period they settle back down to what they would have been, almost what they would have been if you'd been a lifetime non-smoker and much the same happens with lung cancer although lung cancer never quite gets back to normal. But an area that I think that people are often more interested in is the short term effects in terms of the way you look. You know, you tend to have better teeth, better gums, you don't smell as bad and your complexion can be transformed. I don't know if you've ever noticed but if you look at a group of people in a room, particularly if they're thirty plus, it's quite easy to spot the smoker in terms of complexion, ...

MR: Indeed, absolutely.

MP: ... particularly amongst women. A woman who's thirty five and smokes very heavily can often have the complexion of a forty five year old and that's because of circulation changes and the effect that smoking has on collagen, the structural protein in your face. So stopping that, that's reversible.

MR: Bottom line, Mark, is smokers know it's bad for them.

MP: Yeah.

MR: They already know that, it's not a question of, 'I need to give up because it's bad for me'. We all know that and I'm speaking as a smoker ...

MP: Yeah.

MR: ... I did give up for five years then I went back, you know, it's difficult and the whole message to go 'Don't give up giving up' presumably is the really important one.

MP: Well I mean, it's never too ... the key message I would say is it's never too late, you can do it at any time and it doesn't matter if you've failed numerous times and you go back on them, just keep trying to give up and actually we know we don't have to persuade smokers to give up. We know that seven out of ten of them want to give up, these aren't people who are saying, 'I'm not listening to a thing my doctor says'. Seven out of ten people want to give up. They just find it very difficult, they haven't had the right guidance and, you know, some of them are just looking for the right opportunity and that's our job is to make it easy for them. It's never going to be easy, we can make it easier.

MR: We'll come onto the various different methods that there are and talk about them in some depth and if you want to ask a question please do. Remember you can submit your question at the bottom of the screen, just underneath the box that we're at. You mentioned lots of smokers give up several times or try and give up several times and that was your situation, Maggie, wasn't it, ...

MM: Yeah.

MR: ... because you tried to give up a number of times.

MM: Oh, I've done loads of things to try and give up, absolutely loads but just never succeeded, never got past the first day.

MR: I think you're like Roy from Lancaster who says, "I've tried to stop time after time, I just can't quit, what should I do?" What would you tell him to do?

MM: Well, speak to your doctor, they do help an awful lot. There are lots of different things, there's gum, there's lozenges, there's patches, twenty four hour Niquitin patches helped me, that's what I needed.

MR: So ones that you actually have on while you sleep as well so you don't wake up with the craving.

MM: Yeah, all the way through the day and night. I was smoking thirty a day so I needed something strong, heavy duty.

MR: Mark, isn't nicotine itself so addictive that if you're on patches you're still a nicotine addict though?

MP: Yes, I mean that's effectively how nicotine replacement therapy works, whether it's a patch, a nasal spray, a lozenge or however you take it, chewing gum, however you take it. And the idea of it is that, really there are two challenges when you're trying to stop smoking. The first is that you've got to wean yourself off nicotine and coming off nicotine, one of the early withdrawal effects that you get is that irritability, you know, aggressiveness, you get the munchies, you feel hungry, you can't sit still, you're fidgeting all the time. Now nicotine replacement therapy will help you with that while you deal with the other problem which is that of habit. You know, I pick the phone up, I have a cigarette; I sit at my keyboard, I have a cigarette; I go to the pub, I'll have a pint and a I'll have a cigarette. You have to tackle both of those and there's no way that we can help the habit other than abstinence. You just have to go without it and learn to understand that there's a ...

MR: So without a shadow of doubt there's a difficulty to this.

MP: Yes, of course there is, now the nicotine replacement therapy just makes the habit bit a bit easier during those first crucial weeks and then what you do is you wean the dose of that nicotine replacement therapy down over a twelve week period normally. It can go on for longer but normally, and that just makes the whole process easier. In fact we know it doubles your chances of quitting and that's the key. Willpower alone will not be enough for most people.

MR: We'll come onto the various different therapies. You're right in saying that it's only about what ... one to three percent of people ever give up with willpower alone.

MP: Yeah, I mean the way I say it to my patients is that if there are thirty of you stopping on willpower alone, twenty nine of you will be back on the cigarettes within a year and that's the acid test of whether you've given up smoking, are you smoking in a year after you've stopped.

MR: Now a lot of people think it's about being weak-willed and indeed, we've got a question in from Sarah, thanks for your question, Sarah. "My mum's tried to quit like eight times," she says, "What can I do to help her or is she just too weak-willed, is it her fault?"

MP: Well I'd say ... because it's difficult, I mean she may be weak-willed, I don't know her, but I mean, it's quite normal. As I said, if I took thirty people like your mother, who's doing it on willpower alone, then we would expect twenty nine of those people to be back on the cigarettes within a year and certainly it's not unusual for me to see people who've given up smoking successfully, who've got a track record like Maggie's, they've said, 'I've done it ten times before'. You know, what's different about this time, maybe the motivation, maybe the use of nicotine replacement therapy, maybe the support and advice of a doctor or a partner who last time wouldn't give up with you. So there's lots of different reasons why it changes.

MR: Interesting, it's very difficult of course, if you live with the smoker still ...

MP: Yes.

MR: To actually give up because you've still got the smell in the house and everything else.

MP: But I would say there's far more to willpower than ... it's not simply a matter of you know, you're weak-willed. You know, I think that there's quite good evidence that it's easier to get people off some of the nastiest illegal drugs that we use in society, than it is to get people off tobacco.

MR: Well, you know, that's the question. So not necessarily weak-willed so there isn't blame to be put on anyone.

MP: No, there's no point in blaming anyone, it doesn't help anything.

MR: Exactly.

MP: It's recognising the fact that it's difficult.

MR: Terry's got a challenge, Terry's sent in a question, he says, "I'm one of those reformed smokers that everybody hates. I smoked forty a day, gave up on my fortieth birthday and haven't had one for eight years." Well, well done for a start! He said, "It was tough but I didn't use any aids or help, just willpower." He says, "That's all it takes, isn't it?"

MP: Terry, that's all it took you. And that's all we can say and great, I mean if it works, it works. And actually it is interesting, I do come across patients who just give up and have no problem at all and these are people who are highly motivated and they're often not people who give up on New Year's Day or National No Smoking Day. These are people who just suddenly, for some reason, they could be at a family wedding and they've just had enough or ... just something clicks and they come in and go, 'I'm going to give up' and they do and they never, ever look back but they are the exception rather than the rule.

MR: Talking of clicks there's a great website, isn't there, that we can go to.

MP: www.Click2Quit.co.uk, yeah, the details should be below us somewhere.

MR: Yeah, and of course yes, you can find the link at the bottom of our page as well. But did you ever try to give up, Maggie, just on willpower alone?

MM: Quite a few times, yes, as I said earlier, eight hours was the most I could do.

MR: That wasn't that good, was it. I mean, do you think ...

MM: I felt really good at the time I done eight hours, I couldn't go an hour without a cigarette!

MP: You got to about four o'clock in the afternoon or something?

MM: Yeah and then I thought, 'Oh God, I really, really need one.'

MR: Let's hear from Phil, thank you for your question Phil. He says, "I've cut down from forty a day to five a day." Well that's a great start, isn't it.

MP: Yeah.

MR: He says, "Is that any better for my health or do I have to quite altogether?"

MP: Phil, it's a lot better for your health. The risks for most of the hazards associated with smoking are directly proportional to the number that you smoke so the fewer you smoke, the better. Unfortunately, there's been some new data out recently looking at social smokers, people who smoke less than five a day.

MR: And people that just smoke at weekends, for instance?

MP: Yeah, who're saying, 'Well, I can't be ... there's no risk from that' and actually, worryingly, the rise of lung cancer was marked even in that group. So it appears that smoking between one and four cigarettes a day is still bad for you. Not as bad for you as smoking twenty so you're heading in the right direction but there's no such thing as risk-free smoking.

MR: That's bad news for Jules, he's sent in a question, he's said, "I gave up smoking twenty to thirty a day fifteen years ago but still can't go without just one cigarette after my evening meal each day. I don't get urges any other time other than that last ciggie of the day, after dinner." Is it so bad?

MP: Well, if that's his way of controlling a habit that, unleashed would be twenty to thirty a day, then yes. I mean, it would be better if he didn't smoke anything at all and the risks from smoking one cigarette a day are minimal. I'm not going to blow them out of proportion because they are small.

MR: But you are still a nicotine addict.

MP: Yeah, you are and the thing that worries me about people who continue to smoke is it's a bit like an alcoholic who has a problem with alcohol. Some people can go back to controlled drinking, most can't and most smokers, I've heard it so many times. I manage ... you know, just have one on a Friday night or just have one after dinner in the evening, you know, two years down the line they're back on their habit again. I've seen it so many times. Now, if you can control just one a night and you're happy with that then I don't think your doctor's going to go knocking on your door too hard. But just watch you don't slip back, many people do.

MR: It's interesting what you say about habit because habit is the major thing that you have to break as well and I'm sure you had that difficulty, Maggie, didn't you?

MM: Yeah.

MR: Louise wants to know, she says, "I've got a very social, active social life but I really want to give up smoking. How do you suggest I manage it and deal with difficult situations ... " that we've all been in, " ... like going to a pub or a club?"

MP: Well, there are two schools of thought on this. I mean, I don't know what Maggie did but a lot ... did you avoid situations where you ... ?

MM: I could cope with going to the cigarette ... to the cigarette? ... to the pub, I could cope with the pub, but I always had some lozenges in my handbag, even though I used the patches. If I had such a great urge to have one then instead I'd have a lozenge, which I don't know if it's any good but ...

MP: Well, no, yeah, I mean my advice would normally be to people like Maggie would be to avoid situations like pubs and clubs and things where you find it very difficult not to smoke. But sometimes you've got to tackle these things head on and actually the important step, and this is the real key between moving from being someone who's trying to give up smoking to becoming a non-smoker, is to learn that there's far more to being in a pub or a club than having a cigarette.

MR: Yes!

MP: And actually this is where the legislation's on our side because, as of next year, you're not going to be able to. You're not going to be able to smoke at home, you're not going to be able to smoke on public transport, in your office, at home, at work, and you're not going to be able to smoke when you go out. So this pressure, this pressure to social smoke will mean that you're literally going to have to take your packet of cigarettes, walk outside the club and have one in the rain outside and I think that's going to become less attractive, that's my hope.

MR: You're saying the legislation says we can't smoke at home?

MP: Well no, no! You can smoke at home, sorry not the legislation, but I mean there is pressure now on most smokers, one would hope, so you're not smoking in front of your ... I mean, if your husband doesn't smoke and particularly, you'll know, your children, you shouldn't be smoking in front of them. And I think that's one of the main drives we have in the last two or three years is that smokers are beginning to become much more socially aware.

MR: And lawyers are now saying of course that when the ban is implemented, if you have a workman who comes to your home who isn't a smoker, they could sue you if you smoke around them.

MP: Yes, I mean, I'm not a great fan of all this compensation-itis and the legalese that goes around it. I just think that what's really been rewarding is the social responsibility that the smokers have had slightly thrust upon them but have also taken on. People don't walk into my house now and light up in the same way they would have done twenty years ago without even asking. I was telling Maggie earlier about how I went on holiday with my family to Majorca. The first time I ever went on a plane and I was the eldest of four, my parents were sitting at the front of the plane. We were the last to check in; we were in the back amongst the smokers and there were four kids there. And there must have been thirty people smoking in the back of an old Boeing 737!

MR: The twenty five year olds in the audience won't even recognise that because smoking's been banned on planes for a long time, but in the old days yeah ... and cinemas as well.

MP: You couldn't see ... you couldn't see the front of the plane!

MP: And that's all ... now that's all changed so we're heading in the right direction and all I would say to people who do have this pressure, you know, they feel that they like to enjoy a social smoke, is that's going to become more difficult. And what I don't want people to do is be beholden to a habit that drives them outside, looking stupid really and ruining their evening. It's taking them away from what's going on.

MR: Well, we're half way through the programme. We're still welcoming your questions, you can just go to the little box underneath where we are, right on your screen that you see and submit your question. We'd love to hear from you. Let's talk about the various different types of therapy.

MP: Yeah.

MR: We've talked a little bit about patches and Pat wants to know, she's keen to use patches but she says, "Aren't they addictive?"

MP: Well, they contain nicotine which is addictive, of course and basically, one way of thinking of them is looking at them as cigarettes without all the other harmful things in. Cigarettes contain at least four hundred different types of chemical.

MR: so you cut out 399 ...

MP: 399, go onto one for twelve weeks and wean yourself off it and that's the idea of using patches. They're not something we'd put people on for life, although there's some people who use them long term. We prefer if they use them over a three month period as they were designed to be used, as a way of weaning yourself off naturally.

MR: When my mum gave up smoking a year and a half ago now, she found it quite difficult to wean herself off the nicotine replacement.

MP: Yeah, and ... but this is where you need to seek expert guidance because it depends on what sort of nicotine replacement you go for. For instance, Maggie was a heavy smoker and when she started she went onto the high strength patch I would imagine.

MM: Yeah, twenty one micrograms.

MR: Yes, you were using ones like these, weren't you, that come in boxes like this and they're all separated out and literally you just stick it on and it's clear so people can't really see that you've got it on.

MP: And that lasts ... that particular one lasts for twenty four hours but there are a couple of things. There are different types of patches, there are different strengths of patches. For instance, if you are a smoker who's smoking five cigarettes in the evening you would not really want to be on a twenty four hour high dose patch. That's inappropriate and that's where you're actually getting more nicotine than you normally get through your habit and you can end up then becoming ...

MR: Oh really, so you've got to be very careful when you start.

MP: Oh yeah. You need to tailor it. Now most packs have instructions on them to help you get the right dose but your pharmacist or your GP or health visitor or district nurse or practice nurse, whoever runs the smoking cessation in your area, that's their skill. And also, I mean it's a twenty four hour patch versus ... you can get sixteen hour patches as well and the thing about twenty four hour patches is that they're great for people who have a fag first thing in the morning and what time would you have yours, how quickly out of bed?

MM: I would be out of bed and it would probably be two minutes later.

MP: So she would be somebody that I would say, 'You need to sleep in a patch and wake up with it so it's there the whole time.'

MR: I've got a question from Nina, Mark, who says, "Is it safe to use patches though, and what other methods should I consider apart from patches?"

MP: Well, you know, what you've got to think about, remember this is nicotine replacement therapy. There's nothing in the patch that you're not getting from the cigarette smoke in terms of nicotine and you're not getting all the other horrible chemicals that go with it so it's much safer.

MR: Like arsenic's in ...

MP: Yeah, in cigarettes, yeah and you know, we get this ... there is this problem with pregnancy. One in four women continue to smoke during pregnancy, unbelievably, even though they know it's harmful because it's so difficult for them to give up.

MR: Of course

MP: And we have a problem about whether to use nicotine patches or not in pregnancy because they're not ... manufacturers don't advise using them during pregnancy. But actually, from a medical point of view we say, 'Well it's safer to use patches at the right dose than it is to be getting your nicotine from cigarettes' because cigarettes are harmful for lots of other reasons. So it's always a balance, ideally you'd be off neither!

MR: Well, you talk about 'neither', one of the other things that's been talked about a lot is hypnotism, the kind of Paul McKenna school of giving up smoking, does that work, have you seen that work on people?

MP: I have, I've often seen it on people who've tried everything else and one of the ... I don't have any experience of Paul McKenna's school; one of the characteristics that I see in my patients who come into 'stop smoking' clinics, who've had success from it, is they're the sort of patient who's tried everything else. Fifteen different techniques they've tried and actually, they're a bit like patients who've had problems with dieting, they've tried fifteen different types of diet and every time, the diet was at fault. It was the wrong diet, it was the wrong 'stop smoking' technique. And actually, what they're looking for is a technique that's right for them and what they don't see is actually, they're the consistent theme in all of this. It's their approach to the problem that's wrong, either their motivation or something else that they need to address.

MR: It can be about motivation of course because the Alan Carr school which is just 'Give up, be happy about giving up and don't look back' works for some people and not others.

MP: Exactly and I think that the great thing about hypnotherapy is that sometimes it's a chance for some people who've gone round the houses to try a technique that actually ... where they consider that it's actually them that's at fault and it gives them a little insight into what's going on and takes a bit of time.

MR: Interesting. I've got a couple of questions for Maggie now. Claire wants to know, "Do you think it would have been easier to give up when you were younger?"

MM: No, I think whenever you give up it's going to be hard. I tried so many times when I was younger. I tried before I had kids to give up smoking, when I was very young, you know what I mean. It's one of those things when ... You've just ... you've got to be in the right frame of mind. Doesn't matter how old you are.

MR: And that's the motivation we were just talking about. Annie also wants to know, Maggie, "I've seen your clips on the television and you've mentioned that your son's also a smoker. Has he given up now?"

MM: No, I wish to God he had. No, still working on that one, definitely.

MR: And Kate wants to know, "I remember Lorraine, who gave up smoking with Niquitin a few years ago on TV. How's she getting on, is it difficult to keep up and do you have to keep using the patches?" I'm not sure we necessarily know about Lorraine.

MP: No.

MM: I don't know anything but I've heard that she isn't smoking. I haven't spoken to her myself but as far as I know she's not smoking.

MR: But the rest of the question stands. Do you have to keep using the patches still or are you now off them?

MM: Twelve weeks.

MR: So that's it, after three months.

MM: You bring yourself down three levels. Every four weeks you come down from twenty one micrograms, fourteen, seven and then come off.

MR: And how difficult was it for you, that final day of that final patch?

MM: I think I was on a real high actually. I think I just felt really good about everything. Just one of those things and by the time you get down to seven micrograms the patches are so small, they're tiny little things anyway.

MR: You're seven months on. How much money do you think you've saved?

MM: Oh!

MR: Because that's a big thing as well, isn't it, you save a lot of ...

MM: Over a thousand pounds.

MR: Wow! Just in seven months. Have you got plans for it?

MP: Sharing it with her doctor!

(Laughter)
MR: Oh, I think you wish!

MR: I've got another health question that's just come in, Mark, and this is one that we were chatting about before the programme. Michael wants to know, he says, "It may sound stupid ...", I don't think it does sound stupid, Michael actually, "Are certain brands of cigarettes healthier than others?" like low tar or high tar because some people move to low tar because they think it is better for them.

MP: Yeah, I mean this is something, Michael, that's happened over the last twenty years. There's been a move towards low tar cigarettes. Understandable belief that it had less nicotine in it and less tar that, you know, you'd be doing your lungs better so each puff contains less toxins if you like. Unfortunately, smokers aren't easily fooled and this is all down to the nicotine habit. Smoking is a very good way of delivering nicotine to the body, it's rapidly absorbed by the lungs and it's self-dosing. So you'll see a smoker who hasn't had a cigarette for a while will have their cigarette and it's rapid, fast, long drags, it's a sort of (sucking noise) ... they can really adjust their dose.

MR: Yes.

MP: And if you watch people in a pub who've had ten in a row and they don't really want one, they've lit one out of habit; they've just had a few puffs and it just sits in the ashtray so you're very good at controlling the dose and that's exactly what you do with low tar cigarettes.

MR: So your body tells you what you need, or what it thinks it needs.

MP: Yeah and basically you just take bigger drags on low tar cigarettes.

MR: So it's no better for you?

MP: Well the evidence ... I mean there is some controversy about it but the evidence essentially suggests that they're just as bad as normal cigarettes. In fact, in women, who tend to smoke more low tar cigarettes, there is some evidence that the change in the way that you breathe in that you tend to take bigger inhalations with weaker cigarettes to get the same hit means that we're getting a different type of lung cancer in the outside of the lungs, it's becoming more common in women. Now that may be related to low tar cigarettes, we don't know but certainly, they're no safer. You're kidding yourself.

MR: It's quite scary as well, isn't it. Jake's sent us a question, thank you for that, Jake. He says, "I've been suffering from lots of chest infections in the last year. I've been a smoker for five years. Is it related? Just as I seem to get over one, I get another."

MP: Funny that, isn't it, yes. I mean, it's a classic story of a smoker, 'I get a cold, then it goes down onto my chest' and they come along to the doctor and they need help getting rid of it. Now that's either because they have a slight tendency to asthma, which smoking can make worse and normally they wouldn't notice it because the smoking's there; it's irritating the lungs or they've got ... they're starting to get the signs of smoking damage which is where the lung becomes inflamed and doesn't operate properly. They start to cough up phlegm on a regular basis and, you know, if you're getting that at your age, you need to stop. Yeah I mean, well, I've seen patients who, you know, in their twenties have got lungs of a forty or fifty year old and by the time they've got to forty or fifty years old they've got no lungs. They're on oxygen.

MR: So the research is showing if they gave up then, they could reduce and reverse a lot of those defects.

MP: Yeah, you will not notice that you've lost your lung capacity until you've roughly lost ... I mean it varies from person to person, but anywhere between half and three quarters of your ... half of your lung, up to as much as half of your lung can be destroyed before you notice it in day-to-day life.

MR: Wow, that's scary!

MM: God, that is very scary!

MP: So when you say, 'Oh, I've become breathless' and actually by then already you've permanently and irreversibly damaged your lung. You do not want ...

MR: And that's the running up and down the stairs thing that you were talking about.

MM: Yeah.

MP: I mean yours is reversible because you haven't lost that much function but once you get to that stage you can ... and (to Maggie) I bet you will have some permanent damage but you just probably don't know.

MM: Yeah. I said earlier on, going on about chest infections, I haven't had one in seven months since giving up and I was always getting them. Always, always.

MR: Well that's great for you.

MP: There you go.

MR: Absolutely. Another question in from Cedric and this is one that you hear time and time again.

MP: Yeah.

MR: "Do you automatically put on weight after giving up smoking?" Did you, did you Maggie? Because I did when I gave up.

MM: Haha, I've always been quite sort of chubby anyway. Probably a few pounds, yeah and well, I haven't tried to lose it, I didn't try to lose it.

MR: Is it because you get the munchies, Mark and because you're giving up the habit of doing things in your fingers you're putting things in your mouth instead.

MP: Cigarettes actually contain calories. You get about two to four possibly calories from a cigarette, so, which someone's worked out. All these scientists work all sorts of strange things out. So actually giving up twenty a day should save you eighty calories and you should lose weight but of course it doesn't work out that way. Nicotine's a very potent appetite suppressant and when you come off the cigarettes you tend to want to do things with your hands and cram things.

MR: We've just had a question from Steve Best, He's just ... he's on his fifth day of patches, well done Steve, keep it up! He says, "The urge to smoke is getting worse." What else can he do to take away from the craving apart from eating crisps and sweets?

MP: Well, I mean, he needs to make sure he's on the right strength of the patches, first thing. He shouldn't be getting such a strong feeling of craving on the patches. I mean I know Maggie had a couple of days where she'd have gone out and mugged somebody for a cigarette.

MM: Definitely!

MR: Really?

MP: But are you on the right dose of patches? But going back to the weight gain quickly, nicotine replacement can reduce some of that weight gain. But the average weight gain's not that much, it's about four to six pounds, in the studies that I've looked at, at a year. Now the problem with that is that's an average effect, some people lose weight when they give up smoking so ...

MR: Really?

MP: Well, they often combine giving up smoking with going to the gym and eating healthily and transforming their lives. Some people, it doesn't affect their weight at all and other people pile it on. But there's nothing inherently fattening about giving up smoking; you have to put the calories into your mouth so if you can control that and watch your snacking ...

MR: It's also making one set of willpower go into another set of willpower, I guess.

MP: Yeah and the craving thing, I guess, is ... you know, are you on the right dose of nicotine replacement therapy, is it the right form for you? If you get your cravings in bursts are patches right for you? Might you be better on gum or ...

MR: There a little inhalers as well, aren't there.

MP: Or inhalers, yeah and they give different hits, you know, there's lots of ... you can tailor it to the individual need.

MR: I found it ... but when I did give up I found it very easy to give up on the inhaler because it was so disgusting I just stopped using it.

MP: Yeah, I mean that's what people say about the gum. The gum and the inhalers actually do ... (to Maggie) I don't know if you've actually used either of them but they actually taste like ... you know, they taste like ashtray.

MR: Oh it's ... absolutely, it does! And that's the thing, that if you've not tried it you don't seem to realise that.

MP: And that's the nicotine you're tasting

MR: Yeah, exactly.

MM: That's enough to put you off though, isn't it.

MR: It can be. Helen wants to know, "I gave up smoking a year ago ..." and I'm just rattling through it because we're coming towards the end of the programme. She says she recently started worrying that she might start up again. What can she do to make sure she stays a non-smoker?

MP: Well she is a non-smoker now and you need to think of yourself as a non-smoker, it's as simple as that. And one of the big problems that a lot of smokers fall into, and it's not a year stage, it tends to be at the two to three month stage is, 'Haven't I been good!' You know, 'I can have one now' or 'I can have a cigar' ... men, men and cigars, 'I'll just have one cigar at the family wedding'.

MR: So just 'no'.

MP: No. Just say no.

MR: Don't be tempted. I've had loads of questions in, this has to be the last question, I'm afraid. Tim, Chris, Jenny, Peter, so many more people as well. All have said, 'If today's the day, how do I go about starting giving up?'

MP: Right, key thing, you make the decision that you're going to do it. Seek professional help, remember willpower alone can work but it's not good enough. You need to consider nicotine replacement therapy and/or joining an NHS smoking cessation clinic and your GP surgery will have details; particularly today, they'll be plastered all over the place.

MR: Excellent, National No Smoking Day on March 8th. How did you avoid the temptation of going back, Maggie?

MM: It's the willpower. I don't want to die of lung cancer at the end of the day. I want to be around for my children. So I think about them and just sort of plod along, keep busy, you've got to keep busy.

MP: I'll be keeping an eye on her as well now she's on telly.

MR: I'll bet you are, I'll bet you are! Can you just give us that web link again if people want more advice.

MP: It's www.click2quit.co.uk.

MR: And you can get the link at the bottom of our page as well. Thank you so much for joining us, Dr Mark Porter. Maggie, thank you very much and if you're quitting smoking coming up to National No Smoking Day, the very best of luck. We'll see you soon.

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