Several studies have recently confirmed what we already knew, smoking causes significant damage and premature aging of the skin. Smokers generally have more wrinkles and lines and a more dull appearance to the skin. Nicotine, it is hypothesized, may play a role because it constricts blood vessels and therefore decreases oxygen and nutrients from getting to the skin. This seems oversimplified to me. If nicotine were the main cause, the worst skin damage and accelerated aging should occur at the sites where nicotine patches have been applied. We should see a lot of old-looking, wrinkly squares on women’s shoulders and abdomens where the patches used to be, but that is not happening.
It seems to me that the carbon monoxide produced by smoking tobacco would play a far greater role in decreasing oxygen delivery, and in fact, that is another proposed mechanism. Carbon monoxide is the stuff in car exhaust that helps you fall asleep, forever. Carbon monoxide binds to hemoglobin (the oxygen carrying protein in the blood) more strongly than does oxygen. It literally suffocates you without you even knowing it. At lower doses, it suffocates your tissues just a little bit at a time, causing progressive damage, and the appearance of more rapid aging.
But in looking at the skin, it is apparent that it’s not just decreased oxygen. There is actual damage going on. In fact, cigarette smoke affects the skin in a similar way that the sun’s ultra-violet (UV) rays do. By damaging the collagen and elastin in the skin, and by interfering with the repair, the multiple chemicals in cigarette smoke cause the increased wrinkles and older appearing skin. The hot smoke itself may even play a role too in drying out the skin.
The accelerated aging that we see in the skin is also happening on the inside. Cigarette smoke damages blood vessels throughout the body, most notably in the heart. We all know the risks of smoking and that cigarettes take years off one’s life, but we now know that smoking tobacco actually promotes aging at the cellular level. Telomeres are like little caps on the ends of DNA. It has been noted that telomere length is correlated with how long the cell can live. With each division of a cell, the telomeres get a little shorter, and once the telomeres get too short—the cell dies. Smoking tobacco has been shown to actually decrease the length of telomeres, and therefore, shorten the lifespan of the cell.
There is a lot of talk about “anti-aging” these days. Though so far, there isn’t anything out there that actually reverses the clock, smoking tobacco certainly makes it tick faster. Therefore, quitting smoking is the most anti-aging thing you can do.
The real goal of any “anti-aging” program should be to reduce the risks of age related diseases—namely, heart disease, cancer, stroke, diabetes, hypertension, COPD or chronic obstructive pulmonary disease (emphysema and chronic bronchitis), and pneumonia. Guess what? Smoking increases the risk for all of these problems. It is estimated that that smoking decreases one’s life by an average of 14 years, mostly by developing one or more of these diseases. And that’s the average. For every smoker that you know that lives to 80, there are many more that had their lives shortened by 20 or more years! There may not be any way of putting the brakes on when it comes to aging, but smoking tobacco is like putting your foot on the accelerator.
Nicotine replacement therapy (NRT) has not been associated with the same level of risks as smoking tobacco directly. This is presumed to be because nicotine replacement eliminates the 60 known carcinogens and 4,000 other chemicals, including carbon monoxide, tar, pesticides, etc. that are found in tobacco. For example, NRT has been shown to be safe for patients who have had heart attacks. Many doctors feel that the small potential risks involved in using NRT, are far outweighed by the benefits of quitting tobacco. Unfortunately, NRT smoking cessation programs are only about 20% successful. Even less so if you follow people beyond 2 years. So what are we supposed to tell the other 80%? Sorry, I guess you’ll be dying young?
If nicotine replacement therapies such as gums and patches have been shown to be a safer alternative to smoking tobacco, it stands to reason that other alternative nicotine replacement devices would also be preferable to smoking tobacco. Informed consent is one of the basic tenets of practicing good medicine. People must be made aware of the indications, the risks, and the benefits of all of their reasonable alternatives. People should be made aware of their choices and allowed to make their own decisions.
