For improving health and longevity, smoking cessation seems like a no-brainer. Smokers know their habit is detrimental and most want to shake the monkey. Doctors know they should try to help patients quit. So why is it so darned difficult?

The reality is, 70% of people who quit smoking are back on the butts within three months, regardless of the quitting methodology. It can be frustrating for patient and physician alike.

Charles Bens, PhD, a holistic nutritionist, has given much thought to this problem, and he’s come up with a radical approach to helping people quit by first improving their overall health and nutritional status. By focusing on strengthening hepatic detoxification, improving diet, increasing antioxidant intake, encouraging low-strain exercise, and imparting stress-reduction techniques, Dr. Bens’ program helps smokers increase the odds that they can get off nicotine for good.

Just as importantly, it makes it possible for those who do not quit to at least attenuate many of the physiologic ravages caused by years of smoking.

“Everyone knows someone, a family member, friend, or colleague, who smoked well into old age, and remained healthy or died of some non-smoking-related cause. Statistically, up to 40% of people who smoke all their lives never get cancer or heart disease. Conventional medical wisdom explains this away by saying it is due to “good genes.” But the truth is, no one has really looked at these people.”

Dr. Bens believes there’s much more going on than just genetics. He contends that many smokers who somehow seem to escape smoking-related diseases are doing a whole lot of other things right—they eat a healthy diet, they exercise, they find healthy ways to manage stress. Rather than dismissing these “healthy smokers” as an anomaly, physicians ought to look seriously at what makes them different from the smokers who get sick, and steer their patients who do smoke toward a healthier overall lifestyle.

Challenging Conventional Wisdom

Dr. Bens’ Healthy Smoker protocol (www.TheHealthySmoker.net) begins with the idea that by improving diet, maximizing detox capacity, and setting easily achievable healthy lifestyle goals, patients can simultaneously reduce the adverse impact of smoking and improve their chances of quitting.

To be sure, the concept of a healthy smoker flies in the face of conventional health wisdom. For decades now, physicians and patients have taken it as axiomatic that quitting is the single most important thing smokers can do, and that no other health promotion effort will really make a difference unless someone quits.

Many health professionals present this view with self-righteous overtones and scare tactics. That might motivate some people temporarily, but it rarely leads to long-term cessation; reason and morality seldom prevail over the sheer forces of addiction physiology. A careful study of the biochemistry and psychosocial dynamics of nicotine addiction bears out Dr. Bens’ argument that successful cessation is unlikely unless one first addresses other aspects of diet and lifestyle.

Four Phases of Nicotine Addiction

The first thing to understand is that nicotine enters the bloodstream and penetrates tissues faster than almost any other substance to which people are exposed. It is the ultimate quick fix, and many addiction researchers believe nicotine is considerably more addictive than crack cocaine or heroin. Dr. Bens describes four distinct physiologic phases following nicotine exposure that, combined, create the physiologic engine of the habit.

Phase One: Within seconds of a “drag,” nicotine reaches the brain, where it triggers simultaneous release of serotonin and dopamine, giving the smoker that alert but relaxed sensation they enjoy. Over time, receptors for these neurotransmitters become less sensitive to the nicotine-triggered stimulation, requiring higher and more frequent nicotine doses to get that same “buzz.” Add to this the fact that under constant stress, many people deplete stores of these neurotransmitters, and you’ve got a recipe for a strong and self-reinforcing chemical dependence.

Phase Two: Shortly after it reaches the brain, nicotine reaches the liver, where it triggers release of glucose, furthering the smoker’s sense that the cigarettes are “giving him energy.” Basically, the cigarette induces a sugar rush, which, when combined with the serotonin–dopamine surge, feels good while it lasts.

Phase Three: The glucose release in turn triggers pancreatic insulin release, which typically overcompensates for the amount of glucose released by the liver. This leads to a fairly quick drop in blood glucose to levels lower than they were before the cigarette. Shortly thereafter, the dopamine–serotonin surge runs its course, leaving the smoker with a sense of fatigue, irritability, and cravings for more cigarettes, quick-fix carb foods, caffeine (a common co-addictive drug in smokers), or various combinations of these three.

Phase Four: As blood sugar and neurotransmitter levels decline, the adrenal glands release cortisol, increasing heart rate and producing a feeling of tension, which intensifies anxiety, restlessness, and cravings.

Nicotine is nothing if not reliable; it will consistently produce this set of physiologic events. Though it may take more and more over time, cigarettes do, in fact, deliver what the smoker’s neurophysiology expects. For many smokers, that’s more than they can say for the people in their lives. It is no wonder, then, that many dyed-in-the-wool smokers see a pack of smokes as 20 friends that will never let them down.

Over time, a person’s entire physiology adapts to the periodic daily doses of nicotine. An individual who smokes 10 or more cigarettes per day on a continuous basis has radically changed many aspects of his or her basic biology. Everything from sleep cycles to appetite is affected.

Add in the psychosocial components of the smoking syndrome—the fact that smokers often socialize together, reinforcing the biochemical “rewards” with camaraderie, small but important snatches of “down” time, and associations of relaxation and good cheer—and one can begin to see how the habit is far more difficult to break than non-smokers might realize. For a long-term smoker, tobacco has affected everything from basic cellular metabolism to social life.

The Healthy Smoker Program

“When all existing smoking cessation programs are collectively analyzed, there would appear to be a less than 10% long term success rate. According to Harry Landos, MD, at the University of Minnesota, about 90% of would-be quitters are smoking again within 18 months,” said Dr. Bens.

His Healthy Smoker program, which is outlined in a well-researched but patient-friendly book, The Healthy Smoker: How to Quit Smoking by Becoming Healthier First, is built on principles first described by Joan Larson, PhD, director of the Health Recovery Center, Minneapolis. Dr. Larson, a pioneer in treating alcoholism, developed a holistic, nutrition-based therapy for recovery from alcoholism that takes into account the physiologic and biochemical changes that occur over years of chronic alcohol abuse.

Dr. Larson contends that alcoholism cannot be successfully overcome without reversing the nutrient depletions and metabolic adaptations associated with drinking. Her program boasts a 74% long-term success rate over the last 20 years, far in excess of the mean 25%–30% seen with other alcoholism recovery programs. Dr. Bens took this basic concept and developed a program that addresses the metabolic changes that result from long-term nicotine addiction.

The program brings together dietary recommendations, botanical medicines, nutritional supplementation, homeopathy, exercise recommendations, and mind-body relaxation exercises that provide a framework for healthier living.

Clearing Toxins

The process begins with detoxification. “Thousands of toxic chemicals enter your body every time you smoke, making this one of the most toxic conditions the human body can experience.” This is on top of heavy metals, pesticides, xenobiotics, and other environmental/occupational toxins to which we are all increasingly exposed. Many smokers are carrying chronic toxin loads that push their hepatic detoxification capacity to its limits.

Dr. Bens’ program includes specific strategies for supporting hepatic, renal, and respiratory detoxification. Increased intake of fruits and vegetables, reduction of refined sugar, junk foods and saturated fats are the cornerstone recommendations. But the protocol also specifies certain vegetables like beets, spinach, carrots, cabbage and cucumbers, as well as flax and olive oils, as particularly helpful for hepatic detoxification.

Nutrients like lecithin, vitamin C, vitamin E, selenium, alpha-lipoic acid, N-acetyl cysteine, taurine, methionine and calcium D-glucarate are also important for hepatic detox support. Milk thistle, dandelion, green tea and turmeric are herbal allies in the process.

Obviously, smoking beats up the lungs pretty badly, and leaves a lot of toxins behind. Dr. Bens recommends increasing intake of soy, guava, pumpkin, watercress, wheat germ oil, as well as supplements like beta-carotene, methylsulfonyl methane (MSM), B vitamins, quercetin, vitamin A, and herbs like Astragalus and Cordyceps mushrooms, all of which promote tissue repair in the lungs and clearance of accumulated toxins.

The detox protocol also recommends frequent steam baths or saunas, as well as deep-breathing exercises to improve oxygenation and elimination of toxins from the lungs.

Improving digestive health is also essential. “Almost every ‘healthy smoker’ I’ve met has a great digestive system,” said Dr. Bens. “Smokers can ill afford to have more toxins hanging around in their bodies due to constipation, or inefficient digestion and elimination.” Many nutritional guidelines in the program are aimed at detoxifying the GI tract, restoring healthy gut flora, and improving GI motility.

Dr. Bens worked with Stan Headley, MD, ND, and a development team from Vaxa, a Florida-based nutraceutical company, to design a series of formulas that match the recommendations in the book.

The line includes a comprehensive Sustaining Multiple Vitamin, emphasizing the all-important B-vitamin group (see “Don’t Worry, B Happy,” in this issue); a Detoxification Formula, including liver-support herbs like turmeric, lobelia, eleutherococcus, licorice, green tea, and echinacea, as well as L-glutamine and taurine; a Cellular Rebuilding Formula that includes nutrients like vitamin C, vitamin E, MSM, and N-acetyl cysteine which are usually depleted in long-term smokers; and a Craving Control Formula that combines several different homeopathic preparations with historical efficacy in management of irritability, overexertion, fatigue and cravings of various sorts including tobacco.

A Healthy Smoker kit, complete with the guidebook, a patient workbook, and a 3-month supply of the four supplement formulas is available from Dr. Bens’ website (www.TheHealthySmoker.net) for $159.95.

He stressed that the supplements are intended as nutritional support for people as they move toward healthier lifestyles, but they are not substitutes for dietary and lifestyle changes. He also strongly recommends that patients seek guidance from healthcare practitioners trained in nutritional medicine and experienced in the detoxification process.

Exercise: No Excuses!

Exercise is another cornerstone of the Healthy Smoker approach. Dr. Bens noted that many people who smoke fall into a mindset that they can’t exercise because they smoke, or that if they do, it somehow won’t “count” because they still smoke. Unfortunately, physicians often unwittingly reinforce that message, signaling overtly or unconsciously to their patients that unless they quit, it is pointless to talk about exercise.

But in the course of his work, Dr. Bens has met many professional dancers, athletes and performers who maintain very high levels of physical activity despite their cigarette habits. This is in no way a suggestion that smoking and exertion should go together, but simply that smoking, in and of itself, does not and in most cases should not preclude physical activity.

Granted, people who’ve been smoking for years aren’t likely to be running triathlons, nor should they even consider trying it. But walking, tai chi, gentler forms of yoga, moderate weight lifting and other low-intensity exercise are certainly appropriate so long as the patient is not severely debilitated.

Moderate exercise improves respiratory function and increases clearance of toxins. Further, people who discover an activity they enjoy often find they are less inclined to hang around the house and smoke. The social aspect of sports or exercise classes can replace the camaraderie they experienced with other smokers. For some, increased physical activity will provide direct experience of the respiratory and cardiovascular damage they’ve incurred through years of smoking, and this can be a strong motivator to quit.

Taking a Holistic View

The core principle behind the Healthy Smoker concept is that a smoker and his or her habit must be viewed holistically. Many heavy smokers also have poor diets, high sugar consumption, high interpersonal stress levels, and other concurrent addictions including alcohol, caffeine, and illicit drugs. They may also be on multiple pharmaceuticals, which can deplete important nutrients.

In encouraging patients to quit, it is essential to consider all of these aspects, and to look closely at the role that smoking plays in their lives, on a physiologic as well as on a psychosocial and emotional level. Just as nicotine abuse creates profound metabolic and neurologic changes, nicotine cessation triggers equally dramatic changes, said Dr. Bens. A long-term smoker’s physiology has made many adaptations in response to the constant intake of nicotine. Reversing these changes requires careful and comprehensive support.

Smoking cessation efforts will be more successful if the patient and the physician both understand how nicotine and the dozens of other compounds in tobacco affect the body, and how to set the stage for the transition to a cigarette-free life. Even if a patient continues to smoke, they can still obtain the myriad benefits of a healthy diet, high nutritional status, better stress management and regular exercise.