Deadly Dependence

Chewing tobacco or smoking releases addictive substance of nicotine that negatively impacts your life. But if you regularly consume nicotine and then suddenly stop, you may experience uncomfortable symptoms of nicotine withdrawal
By Prof Dr Harvinder Popli & Deepika Arora

Nicotine is a chemical that contains nitrogen, which is made by several types of plants, including the tobacco plant. It is also produced synthetically. Nicotinetabacum, the type of nicotine found in tobacco plants, comes from the night shade family. Red peepers, egg plants, tomatoes and potatoes are example of night shade family.
Approx. 16.7 percent of adult males and 13.6 percent of adult females in the US are smokers. Smoking leads to over 480,000 deaths in the country per year and over 16 million people in US are currently living with diseases caused by smoking. While not cancer-causing or excessively harmful on its own, nicotine is highly addictive and exposes people to the extremely harmful effects of tobacco dependency. According to the Centers for Disease Control and Prevention (CDC), smoking is the most common preventable cause of death in the United States.

Fast facts on nicotine:
Chewing or snorting tobacco products usually releases more nicotine into the body than smoking.
Nicotine is at least as difficult as to give up heroin.
The side effects of nicotine can affect the heart, gastrointestinal hormones (or gut hormones).
Nicotine results in increased level of β- endorphin which reduces anxiety.
Some studies suggest that nicotine may improve memory and concentration due to an increase in acetylcholine and nor epinephrine. Nor epinephrine also increases the sensation of wakefulness and arousal.
According to WHO there are more than one billion tobacco smokers worldwide.
Signs and Symptoms of nicotine addiction include an inability to stop using tobacco products, desire to keep smoking even when health complication arise, continued use of tobacco products even if it negatively impacts your life, people who regularly consume nicotine and then suddenly stop experience withdrawal symptoms which may include cravings, anxiety, depression, moodiness, irritability, difficulty focusing and paying attention.

How nicotine affects body chemistry:
When inhaled, nicotine travels to the brain quickly within 7 to 10 seconds and attaches to receptors where the neurotransmitter acetylcholine would normally dock. This starts a chain of chemical reactions that influence numerous bodily functions.
Most smokers are familiar with the feeling of racing heart, shallow breathing when they smoke. Adrenaline, the flight or fight hormone is responsible for the same. When nicotine reaches the brain, adrenaline is released increasing heart rate, blood pressure and restricting blood flow to the heart.
Adrenaline also tells the body to move excess glucose into the bloodstream. At the same time, nicotine hinders the release of insulin from the pancreas, which would remove excess sugar from the blood. The result is that smokers are often in state of hyperglycaemia, meaning they have more sugar in their blood than in normal. High blood sugar dampens hunger and this is a contributing factor for the appetite suppressant effects of nicotine.
Dopamine is another neurotransmitter that is activated when nicotine reaches the brain. Dopamine causes feelings of euphoria and is thought to play a significant role in addiction.
Nicotine is a stimulant, but depending on the smoker’s mental and physical state, it can be perceived as energizing or relaxing.
Once the body adapts to regular nicotine intake, people find giving up smoking difficult because of the uncomfortable symptoms of nicotine withdrawal. Withdrawal symptoms usually peak after 1–3 days and then decrease over a period of 3–4 weeks. After this time, the body has expelled most of the nicotine, and the withdrawal effects are mainly psychological. Understanding certain facts explained can help people to manage while they quit smoking after long years with zero withdrawal symptoms:
Caffeine overdose: When person first quit smoking, there are certain situations that can trigger a strong urge to smoke for example, a smoker who usually drank two cups of coffee in the morning with a cigarette will feel stronger caffeine effect from the same two cups after quitting smoking. This is because smoking causes the body to metabolize caffeine more quickly. So, when person quit smoking and continue to drink coffee, metabolism rate become slow and caffeine level rises in the body. This may cause caffeine toxicity which can result in anxiety, difficulty in concentrating, impatience, insomnia and restlessness. These symptoms are often attributed to nicotine withdrawal. So, one should also reduce the amount of caffeine while quitting smoking to overcome the withdrawal symptoms of nicotine.
Hypoglycaemia: Blood sugar plummets in many people when first quitting. The most common side effects felt during the first three days can often be traced back to blood sugar issues. Symptoms such as headache, inability to concentrate, dizziness, time perception distortions, and the ubiquitous sweet tooth encountered by many, are often associated with this blood sugar drop. When a person quit smoking, oxygen levels are often better than they have been in years, but with a limited supply of sugar it can’t properly fuel your brain. It is not that cigarettes put sugar into your blood stream; it is more of a drug interaction of the stimulant effect of nicotine that affects the blood sugar levels. Cigarettes cause the body to release its own stores of sugar and fat by a drug type of interaction. That is how it basically operated as an appetite suppressant, affecting the satiety centres of your hypothalamus.
As for sugar levels, nicotine in fact works much more efficiently than food. If you use food to elevate blood sugar levels, it literally takes up to 20 minutes from the time you chew and swallow the food before it is released to the blood, and thus the brain, for its desired effect of fuelling your brain. cigarettes, by working through a drug interaction cause the body to release its own stores of sugar, but not in 20 minutes but usually in a matter of seconds.
In a sense, your body has not had to release sugar on its own in years, you have done it by using nicotine’s drug effect! This is why many people really gorge themselves on food upon cessation. To minimize some of the real low blood sugar effects of the first few days it really can help to keep drinking juice throughout the day. After the fourth day though, this should no longer be necessary as your body should be able to release sugar stores if your diet is normalized.
Dehydration: Drink at least one gallon of water every day after quitting smoking and one should continue it for at least three days. Water will help to flush out nicotine and other chemical associated with tobacco from body. Water will also help to keep the body hydrated.

(The author is Dean, School of Pharmaceutical Sciences, Delhi Pharmaceutical Science and Research University and the co-author is a PHD scholar)