Smoking damages the brain. In the Whitehall II study of more than 10,000 middle-aged adults, smokers had a greater risk of poor memory and a 37% higher risk of cognitive decline, and a meta-analysis of over 26,000 elderly people tied current smoking to a 40%-80% higher risk of dementia and cognitive decline.

If you thought the only dangers of smoking were chronic obstructive pulmonary disease (COPD), emphysema and lung cancer, think again. New studies now link the expensive (financially and health-wise) habit with new concerns. One recent paper, “Smoking History and Cognitive Function in Middle Age From the Whitehall II Study,” appeared in the Archives of Internal Medicine. Head investigator, Séverine Sabia, MSc—from the Institut National de la Santé et de la Recherche Médicale in Villejuif, France—looked at recent discussions linking smoking with dementia, considered related through the effect smoking has on vascular disease. The Whitehall II study evaluated over 10,000 participants, aged 35-55 (at baseline, phase 1, 1985-1988). Assessments were made on smoking history at both phase 1 and phase 5 (1997-1999). Among the group, 25% were light smokers (≤ 5 cigarettes per day) and 25% were heavy smokers (1-2 packs per day). Smokers had an average of 14 cigarettes daily; only 27 participants smoked over two packs a day. Cognitive data (memory, reasoning, vocabulary and semantic/phonemic fluency) were available for 5,388 study subjects at phase 5—when participants were 45-68 years old/mean age 55.5. Of those, 4,659 were retested 5 years later for phase 7, when study subjects were 50-74 years old/mean age 61. • Smoking was associated with greater risk of poor memory. • After adjustments at phase 5, smokers had a 37% higher risk for cognitive decline. • Long-term ex-smokers (stopped prior to study) demonstrated a 30% lower risk for poor cognition (vocabulary decline and reduced verbal fluency)—possibly due to health behavior improvements. • Positive midlife health changes (better nutrition, exercise, alcohol consumption, etc.) and smoking cessation were linked. • Middle-aged smokers are more likely to be lost to follow-up by death or through nonparticipation in cognitive tests. Therefore, the smoking–cognitive decline link could be undervalued. • Additional research indicates that mild cognitive decline continues at an accelerated rate to clinically diagnosed dementia. • A 2007 meta-analysis of 19 studies of over 26,000 elderly (mean age 74) demonstrated that current smoking increased risk for dementia and cognitive decline by 40%-80%, depending upon measure employed. • A ten-year study of over 3,600 Australians demonstrated that smokers had a four-fold increased risk of age-related macular degeneration compared to non-smokers. • A June 2008 study showed that smokers have higher all-cause mortality, equivalent to a non-smoker 5-10 years older. The excuse of weight gain: One objection smokers often give for not quitting is weight gain. That may be true for light smokers (less than one pack per day), but heavy smokers (greater than one pack per day) tend to have other associated health habits, such as weighing more and having an increased risk for metabolic syndrome and diabetes. The bottom line: Smoking shows no benefits on any level. Smoking is counterproductive to healthy aging. You can stay active, alert, lean and healthy with established protocols, shown to improve cognitive function and physical/sexual energy as well as enhance libido and body composition (lean muscle mass, reduced body fat), strengthen your immune system and ability to manage stress.

Frequently asked questions

Does smoking lower your IQ?

The Whitehall II study did not measure IQ. It tested memory, reasoning, vocabulary and verbal fluency in more than 5,000 middle-aged adults, and smokers had a greater risk of poor memory and a 37% higher risk of cognitive decline. Because smokers were more likely to die or drop out before testing, the true link between smoking and mental decline may be even larger.

Will my brain go back to normal after quitting smoking?

Quitting helps. In the Whitehall II study, long-term ex-smokers who stopped before the study began had a 30% lower risk of poor cognition, measured as vocabulary decline and reduced verbal fluency. Quitting also traveled with other healthy midlife changes, such as better nutrition, more exercise and less alcohol. Smoking shows no benefit on any level.

What are the effects of smoking?

Beyond COPD, emphysema and lung cancer, smoking harms the brain and eyes and shortens life. Current smoking raises the risk of dementia and cognitive decline by 40% to 80%. Smokers had four times the risk of age-related macular degeneration in a ten-year Australian study, and a smoker’s death rate matches that of a nonsmoker 5 to 10 years older. Heavy smokers also carry more metabolic syndrome and diabetes risk.

A fat belly is dangerous because visceral fat inside the abdomen releases adipokines and toxic metabolites straight into the bloodstream, driving insulin resistance, type 2 diabetes, high blood pressure and cancer risk. Middle-age belly fat also nearly triples the chance of Alzheimer’s or other dementia later in life.

There are three types of fat commonly observed in the abdomen: Subcutaneous Fat, which is fat immediately below the skin but outside the abdominal cavity. Retroperitoneal or Structural Fat separating organs and providing cushioning during movement. Visceral abdominal fat (found inside the abdominal cavity). Most of that fat is found on the greater omentum—a large apron-like sheet that drapes over all the organs. Some people are prone to storing their body fat in their abdomen as part of this greater omentum. As a result, large, globule clumps of fat attach to the omentum, where they release toxic materials into the venous drainage and into the bloodstream, ultimately causing adverse effects. This kind of fat releases adipokines, harmful chemicals that can cause Alzheimer’s, type 2 diabetes, insulin resistance, high blood pressure, and increased risk of cancer. Reports have demonstrated that being overweight or obese (particularly with a centralized distribution of adiposity) puts you in a higher-risk category for chronic conditions, from insulin resistance, type 2 diabetes, high blood pressure, high cholesterol, stroke, heart attack, congestive heart failure, gallstones, gout, osteoarthritis, sleep apnea and a liver disease called nonalcoholic fatty liver disease (NAFLD). It is interesting to note that the middle-age bulge increases your chances of having Alzheimer’s or other types of dementia in your senior years by nearly three times, even though it’s not your brain that stores the fat.  This may be related to: Toxic metabolites produced by the visceral abdominal fat, such as xenoestrogens which suppress testosterone formation, leading to poor blood vessel elasticity and high blood pressure; storage of fat-soluble toxins, such as food borne pesticides and herbicides, acquired from the environment which then slowly leach out. Toxic belly fat is thought to promote amyloid accumulation by increasing chronic inflammation. Amyloid is an abnormal protein, which deposits in the body’s tissues or in more organ-specific areas, such as in the pancreas (type 2 diabetes) or central nervous system (Alzheimer’s, Parkinson’s, Huntington disease). Visceral abdominal fat (belly fat) is the last reservoir people get rid of when they’re losing body fat—and it’s the first place they store it when they gain back body fat. To date, there are no ways to specifically target that fat, but there are things you can do to work your way down to healthier body fat levels (16% for men, under 22% for women). A low-glycemic nutrition eating plan with specific nutritional supplementation can help you optimize your health potential and reduce belly fat. Consistent high intensity interval exercise can increase metabolic rates, lower heart disease risk and improve body composition, muscle endurance, flexibility, cardiovascular endurance, core strength/stability and posture.  These effects are not purely related to the energy burned due to exercise, but also due to the significant endocrine [hormonal changes] induced by resistance exercise leading to increased Growth Hormone, Thyroid Hormone, and Testosterone production. More specifically, resistance training helps you lose abdominal fat and overall body fat while lowering cholesterol: Weight training is the best way to burn fat; it’s more effective for losing weight than aerobic activity because it burns calories while you’re exercising and later at rest due to the hormonal changes and muscular regeneration.

Frequently asked questions

How do I reduce my visceral fat?

There is no way to target belly fat directly, but you can work your whole body down to healthier fat levels: about 16% for men and under 22% for women. A low-glycemic eating plan with specific nutritional supplementation, plus consistent high-intensity interval exercise and resistance training, brings down both abdominal and overall body fat. Resistance work also raises growth hormone, thyroid hormone and testosterone.

What burns the most visceral fat?

Weight training. It is more effective for losing weight than aerobic activity because it burns calories while you exercise and again at rest, driven by hormonal changes and muscle repair. Resistance training helps you lose abdominal fat and overall body fat while lowering cholesterol, and high-intensity interval work adds a higher metabolic rate and lower heart disease risk.

Will visceral fat ever go away?

Yes, but it leaves last. Visceral belly fat is the final reservoir your body gives up when you lose fat, and the first place it stores fat when you gain it back. Keep lowering your total body fat with low-glycemic eating and consistent training, and the fat inside your abdomen is the last to follow.

Carbs are addictive. Eating carbohydrates triggers insulin, which helps tryptophan into the brain and dramatically increases serotonin release, lifting mood. People learn to overeat soda, chips and pastries to feel better, and that repeated pattern hardwires cravings and withdrawal the way a drug does.

Serotonin release in the brain controls functions such as sleep onset, pain sensitivity, blood pressure regulation, and control of mood.  Serotonin-releasing neurons are unique in that the amount of neurotransmitter they release is normally controlled by food intake: Carbohydrate consumption–acting via insulin secretion and the “plasma tryptophan ratio”–increases serotonin release dramatically (by enhancing the brain uptake of its precursor, tryptophan).  Elevated serotonin causes significant mood enhancement and a generalized sense of contentedness.  Patients learn to overeat carbohydrates (particularly snack foods and drinks, like soda, potato chips or pastries, which are rich in carbohydrates) to make themselves feel better. Self-medication with carbohydrate-rich foods as though they were drugs is a frequent cause of weight gain, and is often seen:

• In patients who become fat when exposed to stress
• In women with premenstrual syndrome (PMS)
• In patients with “winter depression” (Seasonal Affective Disorder)
• In patients who are experiencing chronic pain (ingestion analgesia)
• In people who are attempting to give up smoking. (Nicotine increases brain serotonin secretion; nicotine withdrawal has the opposite effect, causing cravings.)

Chronic patterned carbohydrate consumption causes hardwired changes in neurons, such that there are cravings and feelings of withdrawal when carbohydrates are withheld. Carbohydrate load is so closely linked to addiction that the Glycemic Index (GI) of specific carbohydrates correlates closely with their relative addictive strength  and activates addiction neural pathways. The take-home message: carbohydrates are an addiction.  Carbohydrate consumption promotes neurochemical changes, which reinforce additional carbohydrate consumption.  There is now evidence that carbohydrate binging is akin to heroin addiction, with the cravings for carbohydrates reduced by opiates and more interestingly, carbohydrate cravings dramatically increased during opiate withdrawal.  Unfortunately, carbohydrate addiction will definitely make you fat.

Frequently asked questions

Is carb addiction real?

Yes. Eating carbohydrates causes neurochemical changes that push you to eat more carbohydrates. Carbohydrate bingeing is akin to heroin addiction: opiates reduce carb cravings, and carb cravings rise dramatically during opiate withdrawal. Self-medicating with carbs is often seen in people under stress, women with PMS, people with winter depression, people in chronic pain and people quitting smoking.

Can you have carb withdrawal?

Yes. Eating carbohydrates in a repeated pattern causes hardwired changes in neurons, so cravings and feelings of withdrawal appear when carbohydrates are withheld. It mirrors nicotine: nicotine raises brain serotonin, and nicotine withdrawal does the opposite and causes cravings, which is why people trying to quit smoking often reach for carbohydrate-rich snacks.

What’s the worst carb for your body?

The carbs with the highest glycemic index. A carbohydrate’s glycemic index tracks closely with its addictive strength, and high-GI carbs activate the brain’s addiction pathways. In practice that means carbohydrate-rich snack foods and drinks such as soda, potato chips and pastries, the same foods people overeat to lift their mood.

Sleep hygiene:

To sleep better, go to bed and get up at the same time every day, avoid caffeine, nicotine and alcohol for 4-6 hours before bed, and keep your bedroom quiet, cool and dark. These sleep hygiene habits fix sleep without medications, which mostly make you forget a bad night rather than restore you.

Sleep is critical in the well-being of all animals, such that animals deprived entirely of sleep lose immune function and die in just a matter of weeks. Further, many of the major restorative functions in the body like muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep. The National Highway Traffic Safety Administration conservatively estimates 100,000 police-reported crashes are the direct result of driver fatigue each year. The Institute of Medicine estimates that drowsy driving is responsible for fully 20 percent of all motor vehicle crashes. That would mean that drowsy driving causes approximately 1 million crashes, 500,000 injuries, and 8,000 deaths each year in the U.S. Lack of sleep exacts a toll on perception and judgment. In the workplace, its effects can be seen in reduced efficiency and productivity, errors, and accidents. Just one week of sleeping fewer than six hours a night resulted in changes to more than 700 genes, and even one night of sleep deprivation is linked with brain tissue loss.

‘Sleep hygiene’ is the term used to describe good sleep habits. Sleep hygiene guidelines are designed to enhance good sleeping, and provide long-term solutions to sleep difficulties, without the use of medications. Medications used to treat insomnia tend to be effective in the short-term. Ongoing use of sleeping pills may lead to dependence and interfere with developing good sleep habits, prolonging sleep difficulties. Most sleep medications simply make the patient amnestic to their poor sleep, and do not result in restful or restorative sleep. Restorative sleep is essential in hormone production, stress control, cardiometabolic health and treatment of obesity.

What are the best sleep hygiene tips?

• Have a bedtime. One of the best ways to train your body to sleep well is to go to bed and get up at more or less the same time every day, even on weekends and days off! This regular rhythm will make you feel better and will give your body something to work from.

• Sleep when sleepy. Only try to sleep when you actually feel tired or sleepy, rather than spending too much time awake in bed. Do not nap outside the sleep time.

• Get up & try again. If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming or boring until you feel sleepy, then return to bed and try again. Sit quietly on the couch with the lights off (bright light will tell your brain that it is time to wake up), or read something boring like the phone book. Avoid doing anything that is too stimulating or interesting, as this will wake you up even more. Don’t turn on the television, get on the phone or computer, or listen to the radio.

• Avoid caffeine & nicotine. It is best to avoid consuming any caffeine (in coffee, tea, cola drinks, chocolate, and some medications) or nicotine (cigarettes) for at least 4-6 hours before going to bed. These substances act as stimulants and interfere with the ability to fall asleep. Do not exercise 3 hours before bedtime.

• Avoid alcohol. It is also best to avoid alcohol for at least 4-6 hours before going to bed. Many people believe that alcohol is relaxing and helps them to get to sleep at first, but it actually interrupts the quality of sleep.

• The bed is for sleeping. Try not to use your bed for anything other than sleeping and sex, so that your body comes to associate bed with sleep. If you use bed as a place to watch TV, eat, read, work on your laptop, pay bills, and other things, your body will not learn this connection.

• No naps. It is best to avoid taking naps during the day, to make sure that you are tired at bedtime. If you can’t make it through the day without a nap, make sure it is for less than an hour and before 3pm.

• Sleep rituals. You can develop your own rituals of things to remind your body that it is time to sleep – some people find it useful to do relaxing stretches or breathing exercises for 15 minutes before bed each night, or sit calmly with a cup of caffeine-free tea.

• Having a hot bath 1-2 hours before bedtime can be useful, as it will raise your body temperature, causing you to feel sleepy as your body temperature drops again. Research shows that sleepiness is associated with a drop in body temperature.

• No clock-watching. Many people who struggle with sleep tend to watch the clock too much. Frequently checking the clock during the night can wake you up (especially if you turn on the light to read the time) and reinforces negative thoughts such as “Oh no, look how late it is, I’ll never get to sleep” or “it’s so early, I have only slept for 5 hours, this is terrible.”

• Use a sleep diary. A sleep diary can be a useful way of making sure you have the right facts about your sleep, rather than making assumptions. Because a diary involves watching the clock (see “No clock-watching” above), it is a good idea to only use it for two weeks to get an idea of what is going on and then perhaps two months later to see how you are progressing. The point of the sleep diary is NOT to create a log of complaints to share.

• Regular exercise is a good idea to help with good sleep, but try not to do strenuous exercise in the 3 hours before bedtime. Morning walks are a great way to start the day feeling refreshed!

• Eat right. A healthy, balanced diet will help you to sleep well, but timing is important. Some people find that a very empty stomach at bedtime is distracting, so it can be useful to have a light snack, but a heavy meal soon before bed can also interrupt sleep. Some people recommend a warm glass of milk, which contains tryptophan, which acts as a natural sleep inducer.

• The right space. It is very important that your bed and bedroom are quiet and comfortable for sleeping. A cooler room with enough blankets to stay warm is best, and make sure you have curtains or an eye mask to block out early morning light and earplugs if there is noise outside your room. Background noise or white noise improves the ambiance and will reduce wake cycles.

• Keep daytime routine the same. Even if you have a bad night’s sleep and are tired, it is important that you try to keep your daytime activities the same as you had planned. That is, don’t avoid activities because you feel tired. This can reinforce the insomnia.

• Get regular exposure to outdoor or bright lights, especially in the late afternoon.  Use blackout curtains in the bedroom to eliminate light in the bedroom during bedtime.   Turn off or cover all sources of light in the bedroom.

• Don’t take another person’s sleeping pills or over-the-counter pills. Taking over-the-counter sleeping pills causes rapid development of tolerance. Diphenhydramine (an ingredient commonly found in over-the-counter sleep meds) can have serious side effects for elderly patients.

• Designate another time to write down problems & possible solutions in the late afternoon or early evening, not close to bedtime. Do not dwell on any one thought or idea—merely jot something down and put the idea aside.

Frequently asked questions

What is sleep hygiene?

Sleep hygiene is the term for good sleep habits. The guidelines are built to improve sleep and give long-term solutions to sleep trouble without medications. They cover when you go to bed and get up, what you avoid before bed, such as caffeine, nicotine, alcohol and hard exercise, and how you set up your bedroom so your body links the bed with sleep.

How do you fix poor sleep hygiene?

Start with a fixed bedtime and wake time, even on weekends. Go to bed only when sleepy, and if you are still awake after about 20 minutes, get up and do something calm and boring with the lights off. Skip caffeine, nicotine and alcohol for 4-6 hours before bed, avoid naps, stop watching the clock, and keep the bedroom quiet, cool and dark.

What are the benefits of good sleep hygiene?

Sleep is when the body repairs itself. Muscle growth, tissue repair, protein synthesis and growth hormone release happen mostly, and in some cases only, during sleep. Restorative sleep also drives hormone production, stress control, cardiometabolic health and the treatment of obesity. Sleeping pills mostly make you forget a bad night instead of giving you that restorative sleep, which is why habits come first.

What time should I go to sleep?

The clock time matters less than keeping it the same. Go to bed and get up at more or less the same time every day, including weekends and days off, so your body has a regular rhythm to work from. Only lie down when you actually feel sleepy, and if you must nap, keep it under an hour and before 3pm.