From the Dietitian: Nutrition Concerns for Tobacco Users
added 05/01/08
According to the Centers for Disease Control, “Smoking harms nearly every organ of the body and causes cancers of the bladder, oral cavity, pharynx, larynx (voice box), esophagus, cervix, kidney, lung, pancreas, and stomach, and causes acute myeloid leukemia.” In addition, smoking causes coronary heart disease, doubles your risk for stroke, circulation problems, peripheral vascular disease, and abdominal aortic aneurysm.
These are excellent reasons to quit smoking, and while most smokers know them, they still have great difficulty quitting. The purpose of this article is to help smokers keep as healthy as possible while they continue to work on quitting this health-damaging habit. I know many smokers who, while they can’t yet stop smoking, still want to try to improve their health as they continue to try to quit.
Studies of U.S. dietary intake indicate that smokers have low intakes of fruits and vegetables and other nutritious foods and high intakes of meat. To move towards better health, smokers, as well as nonsmokers, would be wise to fill their daily eating plan with healthful amounts of whole grains, fruits, and vegetables while keeping animal protein portions small. Diets rich in these healthful foods are associated with lower risk of diseases such as heart disease, cancer, and diabetes, to name just a few. These foods are rich in plant compounds called phytochemicals. Phyto (“plant”) chemicals are compounds that we are just starting to understand and discover. They may have beneficial cell-protecting and disease-fighting effects.
Because of low intakes of these heath-protective foods, and because of the daily cell damage from smoking, smokers may need vitamins C and E, beta-carotene, and folate at different levels or forms than nonsmokers. In some cases, more is needed; in others, while the nutrient as found naturally in food is beneficial, high dose dietary supplement forms of the nutrient may be harmful.
The way in which smoking actually depletes the levels and health-protective actions of these important nutrients is not yet well understood, but what we do know can be used to help try to limit some of the damaging effects of tobacco smoke on the body. The best way to limit the damage, of course, is to quit smoking.
Vitamin C
Studies have shown that levels of vitamin C (a powerful antioxidant) are depleted in smokers. For that reason, the Recommended Dietary Allowance (RDA) for vitamin C is 35mg/day higher for smokers than for non-smokers: 110 mg/day for adult males who smoke and 95 mg/day for adult female smokers.
Smokers might consider boosting their vitamin C intake with foods such as oranges, tomatoes, potatoes, Brussels sprouts, broccoli, strawberries, and spinach.
Dietary supplements of recommended levels of vitamin C haven’t been found to cause health problems; however, the most recent studies have found vitamin C supplements ineffective at preventing lung cancer.
Vitamin E
In smokers, the antioxidant vitamin E is used up more quickly than in non-smokers. Researchers have also found that inadequate levels of vitamin C could deplete vitamin E levels even more. This means that smokers need adequate vitamin E and that vitamin C can help to improve vitamin E status as well.
A research review by the National Institutes of Health found that vitamin E was been associated with a trend toward increased bleeding, brain hemorrhage, and hemorrhagic stroke among male smokers. Vitamin E has been associated with a small increased risk of lung cancer. On the other hand, some studies have shown a decreased risk of prostate cancer in smokers taking vitamin E.
Overall, it seems that while high-dose vitamin E supplements may not be useful to smokers, getting enough of the vitamin from sources such as nuts, green leafy vegetables, vitamin E-fortified cereals, and in vegetable oils may be the most careful way to proceed.
For adults, the RDA for vitamin E is 15 mg (22.5 International Units-IU).
Beta-carotene
Studies of smokers have found that they have lower plasma beta-carotene levels than nonsmokers. Beta-carotene can be converted to vitamin A in the body, and may have some antioxidant activity as well as other benefits that are currently being researched.
Many smokers have already heard about the widely publicized results of the study in which male smokers who received beta-carotene supplements had a higher incidence of lung cancer compared with those who did not take the supplements. Food sources of beta-carotene are not associated with increased cancer risk.
Smokers might consider avoiding beta-carotene supplements or multivitamins that include vitamin A in the form of beta-carotene and instead choose a diet rich in beta-carotene containing foods such as: deep red, orange, and yellow fruits and vegetables; and dark leafy greens, such as spinach and kale.
Currently, there is no specific RDA level set for beta-carotene.
Folate
Studies looking at dietary intake have found that smokers often consume low amounts of folate-rich foods, resulting in poor folate levels. Low folate levels can cause anemia with symptoms such as weakness, fatigue, irritability, and difficulty with concentration. Folate is also important in heart health and in preventing serious birth defects.
Studies have not shown folate supplements to be effective at reducing the risk of lung cancer.
Food sources of folate are beans and legumes such as pinto and kidney beans, peas, and lentils; dark green vegetables, and folate-fortified grain products.
The RDA for folate is 400 micrograms/day for men and women. High doses of folate from supplements can mask the presence of vitamin B12 deficiency, resulting in increased risk of nervous system damage.
Food: The Safest and Most Delicious Way to Get Needed Nutrients
The combination of the damage from smoking and the lack of important food nutrients in a poor diet can result in a high risk of disease for smokers. While continuing to try to quit tobacco use, smokers would be wise to work on improving their intake of colorful fruits, vegetables, whole grains, and healthful nuts and oils and on decreasing their intake of fatty meats. This plan, while not a guarantee of eliminating the damage that smoking wreaks on the body, uses what we know to limit the damage a bit.
In most cases, obtaining the “smoker-specific” nutrients from foods rather than high-dose supplements seems to be the prudent way to improve nutrition without the risk of causing problems from consuming “too much of a good thing.”
Show me the Study
During the Co-op’s recent “Annual Meeting”, speaker Michael Shuman brought a laugh to the audience when he spoke about a major newspaper article that referenced an academic study. “I did something the reporter didn’t do,” Shuman said. “I actually read the study.” And in his reading, Shuman also came to different conclusions than the reporter, too. Being a critical thinker is an approach we promote at the Co-op as well, and as a result we invite you to read the studies we report on for yourself. References for the studies discussed in this article are below:
- Christopher G. Slatore, Alyson J. Littman, David H. Au, Jessie A. Satia, and Emily White
“Long-Term Use of Supplemental Multivitamins, Vitamin C, Vitamin E, and Folate Does Not Reduce the Risk of Lung Cancer” American Journal of Respiratory and Critical Care Medicine
177 (2008): 524-530
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Killdeer Farm
Spinach from Liz and Jake Guest’s Killdeer Farm is often one of the first Upper Valley-grown vegetables to arrive at the Co-op in the spring—and it keeps on coming, fresh and tender, into November. The Guests’ skill and passion for farming stems from the back-to-the-land movement of the 1970s. They sell certified-organic arugula, varieties of red and green lettuce, cilantro, carrots, and potatoes to the Co-op as part of their diversified farm operation.
The Dietitian is in!
Co-op Dietitian and Food and Nutrition Educator Mary Saucier Choate, M.S., R.D., L.D., helps Co-op customers find easy ways to meet their health and nutrition goals. For shoppers wanting to start eating more healthfully, Mary has created the popular Better Eating for Life program, a friendly step-by-step guide to improving your food choices. To get started, look here. Mary also has been known to wear odd food-related costumes and play in a bluegrass band. Takes all types.
