Nutritional supplements for smoking addictions

DEFINITION: Treatment of nicotine addiction and nutritional deficiencies in smokers.

PRINCIPAL PROPOSED NATURAL TREATMENTS:

•For addiction: None

•For nutrition: Folate, multivitamin-multimineral supplements, vitamin C, vitamin E

OTHER PROPOSED NATURAL TREATMENTS: Acupuncture, alfalfa, cytisine (toxic), eucalyptus, gotu kola, hops, hypnotherapy, licorice, lobelia, melatonin, passionflower, skullcap, wild oats (Avena sativa)

HERBS AND SUPPLEMENTS TO AVOID: High-dose beta-carotene

Introduction

Nicotine is a highly addictive drug. The combination of this chemical, the flavor of tobacco smoke, and the oral satisfaction of a cigarette leads to the addiction of many smokers. Smoking is an addiction that is difficult to break.

Conventional treatment for smoking addiction focuses primarily on methods to separate nicotine addiction from the other habit-forming features of cigarettes. These treatments are called nicotine replacement therapy (NRT) and include nicotine patches, lozenges, gums, and nicotine inhalers. Also, the nicotine-free drugs bupropion (Wellbutrin), varenicline (Chantix), and bupropion (Zyban) have shown benefits.

Furthermore, cigarette smoking is one of the biggest risk factors for developing cancer and heart disease. The more cigarettes a person smokes and the longer the habit is kept, the greater the risk of dying from cancer, a heart attack, or a stroke. Probably less well-known is that smokers are also much more likely to catch colds and other infections.

Because cigarette smoking poses such a public health risk, many studies have attempted to discern whether the use of vitamin supplements by smokers might help avert cancer and other diseases. However, the results have not been promising, and one supplement, beta-carotene, may actually be dangerous for smokers.

Proposed Natural Treatments: Addiction

There are no proven natural aids for treating cigarette addiction. The herb lobelia, which comes from the Indian tobacco plant (Lobelia inflata), has been widely promoted for stopping smoking. The origin of this idea appears to be a long-standing misconception—that a constituent of lobelia (lobeline) closely resembles the drug nicotine. However, lobeline and nicotine are not biochemically similar, and though they both stimulate the central nervous system, they act very differently. Lobeline, in large doses, can decrease respiration and depress the central nervous system. Nonetheless, a small body of research suggests that lobeline might have some unusual effects on the nervous system that could make it helpful for treating addiction, especially to amphetamines. For example, lobelia reduces nicotine’s ability to trigger dopamine responses in the brain, lessening its addictive potential. However, long-term trials lack support for this assertion, and short-term studies indicate only short-term success.

The herb wild oats (Avena sativa) has also been suggested as a treatment for cigarette addiction, but the evidence is weak. Some studies found that using wild green oat extract (GOE) or wild oat supplements of between 800 and 1,600 milligrams per day increased an individual’s chances of quitting, lowered levels of anxiety, and improved overall quality of life while quitting. However, several similar studies failed to find similar evidence.

Weak evidence also supports the role of melatonin in reducing nicotine withdrawal symptoms. However, this is mainly dependent on each individual's response to melatonin. In some individuals, the supplement helps them sleep, which helps regulate emotions, reduces cravings, and lowers anxiety.

The substance cytisine is a toxic compound found in the seeds of Laburnum anagyroides and related plants. Weak evidence, mostly from studies in Eastern Europe, hints that the careful use of this substance might aid smoking cessation. Numerous other herbs are promoted for stopping smoking—alfalfa, eucalyptus, gotu kola, hops, licorice, passionflower, and skullcap—none of which have been fully evaluated scientifically.

Acupuncture, especially in the form of ear acupuncture (auriculopuncture), is widely used as a treatment for cigarette addiction. However, a late twentieth-century meta-analysis of twelve placebo-controlled trials did not find acupuncture more effective than sham (fake) acupuncture for smoking cessation. A subsequent double-blind, placebo-controlled study of 330 adolescent smokers also found no benefit. One study found that while acupuncture may not be effective for treating cigarette addiction on its own, it might (in some unknown manner) increase the effectiveness of smoking cessation education. In a placebo-controlled study of 141 adults, acupuncture with smoking dangers education was twice as effective as the placebo and four times as effective as acupuncture alone. Nonetheless, these benefits were seen only in the short term. At long-term follow-up, acupuncture’s advantage disappeared.

In the early 2020s, laser auricular acupuncture was found to be relatively effective in helping smokers quit. Sixty participants who received the treatment reported fewer cravings, headaches, irritation, fatigue, and anxiety. Those who received laser auricular acupuncture combined with counseling experienced the best results, with lower urinary cotinine levels, increased calmness, and increased concentration. Cold laser therapy, also called low-level laser therapy, has also been proposed as a treatment, rendering similar results.

While hypnotherapy benefits some individuals, it does not appear to be superior to other methods for quitting. In a review of nine studies, researchers found no consistent evidence that hypnotherapy was better than fourteen other interventions for nicotine addiction. Another randomized trial found that, when combined with a nicotine patch, hypnotherapy was no better than cognitive-behavioral therapy. Another meta-analysis of fourteen studies, including 1,926 participants, and using twenty-two control interventions confirmed these results, finding minimal or no positive improvement from hypnotherapy. Those studies that found small amounts of positive impact noted that many of them were short-lived, and smoking habits returned within six months.

Proposed Natural Treatments: Nutrition

People who smoke often have deficiencies in numerous nutrients, including zinc, calcium, folate, vitamin B₁₂, vitamin C, vitamin E, beta-carotene, lycopene, and essential fatty acids in the omega-3 and omega-6 families. There are many possible causes for this depletion, including free radicals in cigarette smoke that destroy natural antioxidants. However, the sinle most important cause of nutrient depletion might be poor diet rather than smoking itself. (Smokers have, on average, a less well-balanced diet than nonsmokers.) In addition, some evidence suggests that folate or vitamin C supplements may improve arterial function in smokers, thereby potentially helping to prevent heart disease.

High doses of vitamin E have not proven helpful in preventing heart disease or lung cancer in smokers. However, vitamin E consumption has shown some promise for reducing the risk of prostate cancer in smokers.

For these reasons, many smokers benefit from general nutritional support in the form of a multivitamin-multimineral tablet. However, high doses of the antioxidant vitamin beta-carotene may not be helpful for smokers and could even cause harm.

Beta-carotene: A supplement to avoid. Although nutritional doses of the antioxidant nutrient beta-carotene help to supply needed vitamin A, there is evidence that smokers should avoid high doses of beta-carotene. An enormous double-blind, placebo-controlled study called the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) trial enrolled 29,133 Finnish male smokers and examined the effects of vitamin E and beta-carotene supplements on lung cancer rates among them. The results showed that twenty milligrams (mg) of beta-carotene daily for five to eight years increased the risk of lung cancer by 18 percent.

In addition, a statistical analysis of the ATBC study, including 1,862 smokers with heart problems, found that persons taking either beta-carotene or a beta-carotene and vitamin E combination had a significantly increased risk of fatal heart attack compared to those taking a placebo. Another statistical review of the study analyzed the effects of beta-carotene on persons with angina pectoris, one of the first symptoms of heart disease. Results indicated that beta-carotene was associated with a slight increase in angina.

Another large, double-blind, placebo-controlled trial enrolling 18,314 smokers, former smokers, and workers exposed to asbestos studied the effects of a different combination of beta-carotene and vitamin A on lung cancer and cardiovascular disease. Evidence from the trial suggests that thirty mg of beta-carotene and 25,000 international units of vitamin A, taken together daily, have no beneficial effects and may be harmful. Persons taking the supplements had a 28 percent higher incidence of lung cancer than the placebo group, a 17 percent higher death rate from lung cancer, and a 26 percent higher death rate from cardiovascular disease. The trial was stopped twenty-one months early based on these findings. Although nutritional doses of beta-carotene (about three mg daily for adults) are probably healthful, smokers should avoid doses of beta-carotene greater than twenty to thirty mg daily.

Another study investigated the impact of diets high in micronutrients on the improvement of smoking addictions. Individuals who improved their diet overall had fewer negative repercussions during the quitting process and smoked fewer cigarettes per day than the placebo group, but the sample size was small, and the study's drop-out rate was high, skewing these results. Further research is necessary to understand this relationship.

Bibliography

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Yavagal, Puja C., and Nagesh L. “Efficacy of Laser Auricular Acupuncture for Smoking Cessation: A Randomised Controlled Trial.” Sultan Qaboos University Medical Journal, vol. 21, no. 2, 2021, p. e275-e81. doi:10.18295/squmj.2021.21.02.017.