Diabetes and Smoking

Today I read an article that was part of a continuing education program. In other words, I read the article and then took a little test to earn credits to show others that I work to keep my knowledge up to date. The research result was not one that I was pleased to review, and though the study was large, it was not the gold standard type of study so many factors could work to against the findings.
The finding of the study was that smokers who quit smoking were more likely to develop diabetes in the three years following their quit, than non smokers or former smokers in that same time period. After about 12 years of quitting, however, the extra risk is about zero. The study did take into consideration many factors that might affect ones risk of getting the disease. The increase risk stood in light of some of those confounders and was associated with more years and more packs per day, but was mediated by consideration of systemic inflammation and weight. In other words, if the quitter gained weight in the years immediately following the quit, that could and did explain why the developed. Also, smoking leads to an inflammatory response and inflammation can lead to both heart disease and diabetes.

A couple of things to say here. The first is that while reading the current study, it was noted that smoking is a "well known" risk factor for new case diabetes II. Well, I had not believed that to be the case and according to our CDC and the Surgeon General reports, the evidence is not yet strong enough to make that conclusion. However, according to the article I am currently reading by Dr. Neal Benowitz of UC and also the Cancer Council of Australia's Tobacco in Australia, smoking most definitely is a risk for the disease as it appears to cause insulin resistance.

It is clear, and supported scientifically, that diabetics who use tobacco have much worse outcomes and significant risk for fatal heart disease.

But what of the current smoker and the quitting? Should they keep smoking? They do have a 50% chance of not developing any of the 30 or so diseases associated with tobacco use (though they have a 100% chance of smelling bad). Personally, I think 50-50 odds are ridiculous when the excess risk of these diseases could be zero. So the thing to do is watch the weight gain and to counsel the smoker about this risk.

Many people will tell you these two things and I stand fiercely against both. 1)
quitting smoking will lead to some weight gain and 2) the weight gain is not as bad as the continued smoking.

First, the only thing that causes weight gain is consuming more calories than your body needs. The caloric balance may shift when quitting, but that is not a guarantee of weight gain, it is a call to action. And well, the second part has been disproved by this research study.

Remember what I said the other day. You can choose neither. The option is NOT smoke or be overweight. Smoking is a negative coping skill and more positive ways for dealing with life exist. Eating too many calories is also often a negative coping skill. Increasing physical activity and utilizing some of the valuable tenets of both Volumetrics and Weight Watchers can offset that. (so can learning positive coping skills!)