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Heart Attacks ____________________________________________

In order to understand how nicotine can cause cardiorespiratory difficulties, consider just a few more things about your heart. You know what that means…a little physiology. Don’t freak out on me! It’s going to be easy compared to what we were just through. Hey! We are doing all of this together…I am right with you…we’re bonding here. CRITICAL POINT: People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk isn't as great as that of cigarette smokers. This is probably because they're less likely to inhale the smoke. Currently there's very little scientific information on cigar and pipe smoking and cardiovascular disease, especially among young men, who represent the vast majority of cigar users. Every living cell of the body is dependent upon blood for its existence because the blood transports all substances to and from the cells. That is, it carries oxygen and nutrients to the cells and carries away waste products like carbon dioxide and carbon monoxide. Now, here is the important part. The blood is contained in a system of tubes that is connected to the heart. The contractions of the heart cause the blood to circulate continuously throughout the body. In a nutshell, the function of the heart is to increase or decrease the velocity and volume of blood in accordance with the metabolic needs of the cells. The blood can’t circulate through the body unless the heart pumps it through. In laymen’s terms, no heart, no circulation. No circulation, no blood. No blood, no oxygen and nutrients. No oxygen and nutrients, no you. Do you get the point? Of course you do because we have been over this stuff a couple thousand times…damn it! CRITICAL POINT: Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives. Okay, now you have to understand a few terms to get a real appreciation of the way all of this happens. The first term is heart rate. You probably already know what it is, but just in case you have been living in a cave for the last decade or so, I am going to explain it to you. Heart rate is the number of times the heart beats per minute. Heart rate is calculated by counting your pulse for a minute. You can also calculate it for 10 seconds and multiplying that number by six. Isn’t it amazing how that works? It’s like when students found out that 7 x 8 = 56 and that if they multiplied 8 x 7 they could get the same answer. It’s amazing!

CRITICAL POINT: Nicotine can also predispose you to arteriosclerosis, which is the occlusion of the artery. Anywho, the best place to take your heart rate is at your carotid artery. Don’t use your thumb to do this because it has a pulse and that will interfere with getting a correct count. All right, put your book down and take your heart rate. Do it now! I am doing the coaching here. Now, write down your heart rate on your sleeve with indelible ink because we are going to use that information later. The next term you will need to know is stroke volume. Stroke volume is the amount of blood pumped out of the heart per beat. When the heart contracts during the systole phase, the contraction phase of the heart, about 70 ml of blood is forced from the left ventricle to the aorta. From the aorta, it is then distributed throughout the body. Here is something else you can write on your sleeve. Stroke volume is directly proportional to the strength of the heart…the stronger your heart, the greater your stroke volume. The next term you need to know is cardiac output. Cardiac output is the product of the heart rate and the stroke volume. Again with the math! Multiply the stroke volume by the heart rate. For example, a man at rest has a pulse rate of 70 beats per minute and the amount of blood leaving the left ventricle per minute is 70 ml. His cardiac output would be 4,900…70 beats x 70 ml/min = 4,900 ml/min (4.9 liters). For this reason, cardiac output is defined as the amount of blood pumped out of the heart per minute. Cardiac output will rise proportionally to increases in either stroke volume or heart rate. If you increase one or the other, you are going to increase your cardiac output. All right, it’s time for a little quiz. Take out a piece of paper. No cheating now! Are you ready? Here we go. There are two individuals. Let’s say Jane Fonda and Richard Simmons. I picked them because they are aerobic experts, which is kind of funny in Richard Simmons case. Let’s be honest, Richard’s legs are so skinny they look like a pair of pliers in shorts and the rest of his body looks like it belongs to Rosanne Barr. That just goes to show you that you can be a fitness expert even if you look like bean dip. Anyhow, let’s assume that Jane and Richard are engaged in the same exact workload. You know, sitting around and watching Oprah on the tube. During this time, Jane’s heart rate is 50 beats per minute and her stroke volume is 60 ml. What is Jane’s cardiac output? If you said 3000ml per minute you are right! Don’t get too excited though. We’re not finished yet. Richard’s heart rate is 60 beats a minute and his stroke volume is 50ml. Accordingly, his cardiac output is also 3000 ml. Incredible how that works, huh? For a smiley face, who is in better shape…Richard or Jane? Or are they both in the same shape? If you said Richard, you are dead wrong. You can just look at him and tell that. No, just kidding. You can’t just look at someone and tell if they’re in good cardiovascular shape or not. It’s kind of like judging a book by its cover. You can do that, but you’re not always right. The same is true here. The reason Jane is in better shape has nothing to do with her being better looking than Richard either. The reason is that her heart is stronger…when Jane’s heart contracts, it pumps out more blood than Richard’s, giving her a greater stroke volume. In general, stroke volume is directly proportional to the size and strength of the heart. If you don’t believe me, look on your sleeve. It’s all written down there. A strong heart is larger and contracts more forcefully, thereby forcing a greater volume of blood. Strengthening the heart and increasing stroke volume reduces the number of times the heart must beat in order to supply the needs of the cells. In short, with a greater stroke volume, Jane’s heart does not have to beat as many times as Richard’s for the same cardiac output. In a few words, her heart does not have to work as hard as Richard’s to do the same workload. Now, there is one more thing you have to know. Heart rate is directly related to work load. In other words, the more work you do, the more times your heart will beat. The reason for this is that when you work, your muscles need oxygen. The more work they do, the more oxygen they need. What is your heart’s job…getting those muscles oxygen? You don’t believe me? I will prove it to you. Take your resting heart. Okay! Now, get out of your chair and run around the block. I will wait here because every time I feel like running, I lie down until the feeling goes away. So, I am not going with you. As soon as you get back, take your heart rate again. Do you understand? Okay, on your mark, get set, goooooo. What a dummy! Okay! What happened to your heart rate after you ran around the block? Let me guess, your heart

rate went up…right?! Now you owe me a red star. What this tells you is that your heart rate works proportionately to your workload. If you had believed me when I told you in the first place that heart rate is directly related to work load, you wouldn’t have had to run around the block. You just have to learn the hard way, don’t you? Actually, I did you a big favor by making you run around the block because when you exercise like that, your heart strengths for the reason that it is laboring against a workload. The obvious question that arises now is, “What the hell does this have to do with cigarettes?” Well, when nicotine is inhaled into the lungs, it is readily absorbed by the blood and carried throughout the body. The immediate consequence of nicotine stimulation causes the heart to be overworked. Heart rate can be elevated as much as 20 to 30 beats per minute as a result of the excitatory effects of nicotine from a single cigarette. CRITICAL POINT: The nicotine present in smoke causes heart disease by:  Decreasing oxygen to the heart.  Increasing blood pressure and heart rate.  Increasing blood clotting.  Damaging to cells that line coronary arteries and other blood vessels.

Note here that the heart rate has increased, but not proportionally to the workload. In other words, the heart is contracting 20 to 30 more times to do the same workload. Remember Jane sitting around watching Oprah on the tube. Her heart rate was 50 beats per minute and her stroke volume was 60 ml. What was Jane’s cardiac output? If you said 3000ml per minute, you are right again…just checking for reliability reasons. Now, if she lights up a cigarette and smokes it, her heart rate might increase to 80 beats, but her cardiac output will still be 3000 ml per minute, meaning that her stroke volume will be significantly decreased to 37.5 ml. (3000 / 80 = 37.5) The reason for this is that the heart is contracting too fast for the amount of blood being supplied to the heart. That stresses the heart terribly. If the heart is placed under this type of stress 25 to 35 times each day, as it is with most smokers, adverse effects are almost certain. In actual fact, this constant stress of the heart, which is not in proportion to the workload, predisposes the individual to cardiac infarction…you know, what Olivia Newton John is always singing about…HEART ATTACK!

Arteriosclerosis _______________________________________________________

Nicotine can also predispose you to arteriosclerosis, which is the occlusion of the artery. Here is how that works. By the time I am done with you, you will probably want to drop out of here and go to medical school. If you were smart, you would have done that in the first place. In case you do drop out and go to medical school, when you are a full pledged physician, let me know where you are practicing …I don’t want to go there. CRITICAL POINT: Smoking decreases HDL (good) cholesterol and increases the production of LDL (bad) cholesterol.

Anywho, your body produces two types of fat…lowdensity lipoproteins (LDL’s) and high-density lipoproteins (HDL’s). The LDL’s are the bad guys, and the HDL’s are the good guys. The LDL’s are little round balls of fat while the HDL’s are much larger and irregular in shape. Both of these fats circulate through the blood. Now, envision the walls of your arteries, as being made of Velcro and the LDL’s as little Velcro balls. You know what happens when you throw a Velcro ball against a Velcro wall? They stick to the wall, you moron! That is exactly what happens, the little LDL’s start collecting on the artery walls and start forming plaque. If this continues, the walls of the arteries are going to narrow and eventually an occlusion of the vessel will occur. CRITICAL POINT: Carbon monoxide and nicotine both appear to play a part in accelerating the deposition of cholesterol in the inner lining of arteries which over many years leads to arteriosclerosis. When that happens, you are basically screwed because the vessel will eventually burst, causing a major bleed. When that happens, there is a good chance you will be taking a new residence in either heaven or hell. This is one reason why God invented HDL’s. What the HDL’s do is go through the vascular system and knock the LDL’s off the artery walls. Actually, this system works out really well in healthy human beings, which goes to show you that God is pretty smart. One thing He didn’t consider is that human beings are…well…human and like fools, some of them smoke. The problem with that is that the nicotine in the cigarettes significantly increases the production of LDL’s and decreases the production of HDL’s. And you know what that means…heaven or hell! Why? Because you have more LDL’s to adhere to the artery walls and less HDL’s to knock them off.

Peptic Ulcers __________________________________________________

Another action of nicotine is that it inhibits pancreatic bicarbonate secretions. I talked about some of this before when I talked about the brain and when I discussed the cardiovascular system. So, go back and read it. It’s the McDonald’s restaurant crap…food, glycogen, glucose, ATP. Remember that? Okay! Go back and read it again. Where the hell have you been? I feel like I have been sitting here for hours. Either you are a damn slow reader or you didn’t read anything and just had me sitting here waiting…nice! I forgive you….we are still bonding. CRITCAL POINT: Cigarette smokers are about twice as likely to have ulcers as nonsmokers. The fact is that current research indicates an association between smoking cigarettes and peptic ulcer disease. This applies to both gastric (stomach) and duodenal ulcers and to both men and women. Also, ulcers heal slower and recur more often in cigarette smokers than in nonsmokers. Okay, what I didn’t tell you is that when the glycogen leaves the stomach, the acid is left behind. This high level of acidity is a major problem. That acid in your stomach can break down just about anything short of tempered steel. Since the lining of your stomach and upper small intestine (duodenum) is not composed of tempered steel, the acid can eat through the lining. The reason it doesn’t eat right through the walls of your stomach is because the pancreas, after the stomach is empty, secretes a type of bicarbonate soda, which buffers the acid. Well, it does if you don’t smoke. If you do smoke, the nicotine

in the cigarette inhibits the pancreas from secreting the bicarbonate soda. Consequently, the acid begins to eat through the stomach wall and the duodenum lining, thereby predisposing you to acute peptic ulcers and duodenal ulcer formation. Neat, huh? Peptic and duodenal ulcers are not a fun thing. Both conditions can be extremely dangerous, so much so that they can lead to death if not treated properly.

Carboxyhemoglobin _________________________________________________________________

After all that negative stuff, you probably want to hear something positive. Well, what if I told you that I had a solution to all your problems…would you be interested? Of course you would! Okay then, here goes. Go home tonight, pull your car into the garage and close all the windows and doors. Then, take a garden hose, put one end in your exhaust pipe and the other end in the driver’s window. Once you have everything tight and secure, start the car up. Then, put your Michael Jackson I’m Bad CD into your CD player and sit back and relax. In about twenty minutes you won’t have a care in the world because you are going to be elevated to a celestial level. Still interested? Probably not! The interesting thing is that the gas you would be taking in from the car exhaust is the same poisonous gas that you inhale when you smoke cigarettes, only in a smaller quantity. The gas, of course, is carbon monoxide. Along with tar and nicotine, it is one of the major contaminants of cigarette smoke. Although cigarette doesn’t emit enough carbon monoxide to kill you, it has more than enough to play havoc with your cardiorespiratory system. First of all, carbon monoxide has a very high affinity for adhering to hemoglobin, the oxygencarrying content of the blood. When carbon monoxide combines with hemoglobin, it actually forms an entirely new substance called carboxyhemoglobin. It is estimated that the average smoker has about 8 to 10 percent carboxyhemoglobin in his hemoglobin. This has the effect of adding approximately 5000 feet of altitude to the individual’s physiology. Needless to say, the individual’s ability for aerobic work is significantly decreased. The reason for this is that the hemoglobin that is tied up with carbon monoxide cannot carry oxygen. As a result, less oxygen will be delivered to the heart and the tissues of the body. Do I need to say that without oxygen you can’t do work because you need oxygen to break down ATP? Okay, without oxygen, you can’t do work because you need oxygen to break down ATP. How is that? CRITICAL POINT: When carbon monoxide combines with hemoglobin, it forms an entirely new substance called carboxyhemoglobin. Carboxyhemoglobin significantly decreases individual’s ability for aerobic work Now, believe it or not, that is just a few of the health problems you are going to experience if you smoke. In reality, there are a lot more physiological problems associated with smoking, but my intention here is not to write an entire book on smoking. I could do that, but you are not paying me enough, so you

will have to settle for the abbreviated version. However, I would like to address some of the social problems you may run into if you are a smoker. Let’s take a look.

Social-psychological Programs _____________________________________________________________________________________

As mentioned, there are social psychological problems, as well as medical hazards associated with smoking. Smokers are discriminated against with respect to employment, promotion and social acceptance. Furthermore, the public has developed a strong bias against smokers. Smokers are often stereotyped as being sloppy and lazy or lacking will power. CRITICAL POINT: Smokers are discriminated against with respect to employment, promotion and social acceptance. Smokers are also discriminated as far as social interaction. Smokers are required to sit in the back of buses, in the back of planes, in secluded rooms in restaurants, in the balcony of theaters and isolated work areas. There is good reason for this type of intolerance. Cigarette smoke is not only filthy, vile and disgusting, but the side stream smoke can be dangerous to non-smokers. Not surprisingly, smokers are also more likely to have low self-esteem and experience more anxiety, depression, loneliness and unhappiness than those who don’t smoke. Let’s be real, how would you feel if no one wanted you around? CRITICAL POINT: Anti-smoking legislation is largely a product of state law and varies across jurisdictions. A majority of states protect workers against unwanted smoke in the workplace. Beyond establishing smoke-free workplaces (nearly 75% of companies in America either prohibited smoking in the workplace or restricted it to designated areas), employers have a near absolute right to make employment decisions based on one's smoking habits. Research also indicates that smokers develop more facial wrinkles (and do so sooner) than people who don’t smoke. It is also common knowledge that smoking causes halitosis. Really bad halitosis! Have you ever kissed anyone who smokes? It’s like kissing a dirty ashtray. Not that I would know. It’s just what I have been told. If that is not bad enough, the tar stains the enamel of the teeth, the epithelial lining of the fingers and lips and everything else with which it comes in contact. The burning of tobacco also causes hair, clothes and surroundings to smell like the south end of a northbound dog. And here is something that will really surprise you…NOT! Recent surveys have revealed that males and females alike are generally more likely to date someone who doesn’t smoke. HELLO!

Why Rational People Do Irrational Things - Like Smoking _____________________________________________________________________________________________________________________________________________

The funny thing about all this is that smokers are well aware of the dangers and social problems associated with cigarettes. Research indicates that cigarette smokers are more aware of the hazards of smoking than non-smokers. In reality, 94 percent of the 80 million people who smoke are cognizant of the fact that they are damaging their bodies by smoking. Of course, this leads us to an important question. How can people justify endangering their health and the health of others by smoking? That’s an excellent rhetorical question, but one I can handle. In reality, it’s not that mysterious if you know a little bit about psychology. Actually, the answer is quite interesting and one that can be applied to a broad spectrum of “seemingly irrational behavior, by supposedly rational human beings.” The first thing you have to realize is that most people are motivated

to justify their own behavior. When an individual performs an act, this person will attempt to convince himself or herself and others that there is a reasonable and logical explanation for this behavior. In other words, people are not so much motivated to be right as they are motivated to believe that they are right. In this light, it is more accurate to characterize human beings as rationalizing animals rather than rational animals. This concept has been encapsulated into a theory called cognitive dissonance by a social psychologist named Leon Festinger. The theory is quite simple, but as I mentioned, the range of its application to human behavior is enormous. In actuality, there has been a great deal written on the subject of cognitive dissonance. One of the most noted writers is Dr. Elliot Arnson, a professor of psychology at the University of California, Santa Cruz. Most of the concepts I will discuss in this section are derived from his award-winning book The Social Animal. If you want a more profound understanding of cognitive dissonance, I suggest you check out his book. It’s excellent, easy to read and scientifically sophisticated. CRITICAL POINT: Cognitive dissonance is the feeling of uncomfortable tension which comes from holding two conflicting thoughts in the mind at the same time. Dissonance increases with:  The importance of the subject to us.  How strongly the dissonant thoughts conflict.  Our inability to rationalize and explain away the conflict. Basically, cognitive dissonance is the feeling and/or conflict we experience when our behavior differs markedly from our beliefs or values. Stated differently, whenever we do something that is not consistent with the way we think we should act, we face conflict and/or dissonance. Of course, the realization that our behavior is different from our beliefs and values is unpleasant. Because cognitive dissonance is unpleasant, Festinger believes that we are strongly motivated to reduce it by changing our beliefs or values, by changing our behavior, or both. For example, let’s suppose that an individual started smoking when he was fairly young. After using cigarettes for some time and experiencing considerable pleasure from their use, he is informed by a valid source that the drug is extremely dangerous to his health. Since the individual’s behavior is now inconsistent with what he now believes to be true about cigarettes (that they are dangerous), he will experience dissonance. His cognition is “I use cigarettes which are hazardous to my health.” In brief, he simultaneously holds two cognitions that are dramatically opposed to each other. One way that he could reduce this dissonance is to simply stop using cigarettes. By doing this, the individual would bring his behavior in accord with his actual beliefs. Unfortunately, for many people, this is easier said than done. CRITICAL POINT: Dissonance is most powerful when it is about our self-image. Feelings of foolishness, immorality and so on (including internal projections during decision-making) are dissonance in action. If an action has been completed and cannot be undone, then the after-the-fact dissonance compels us to change our beliefs. If beliefs are moved, then the dissonance appears during decision-making, forcing us to take actions we would not have taken before. As mentioned, the physical and mental addiction to cigarettes may make it extremely difficult to give up the drug. There is the possibility that a smoker may even try to quit using cigarettes and fail. What generally happens in these cases is that the individual will attempt to reduce dissonance by working on the other cognition, “Cigarettes are NOT hazardous to my health.” First, smokers might attempt to convince themselves that research evidence linking cigarettes with health problems is not conclusive. They will say stuff like, “I know a lot of people who smoke and they’re not sick. Besides, I smoke and I feel great. Anyway, if you listen to what the research says,

everything is dangerous. A lot of those researchers don’t know what they are doing or what they are talking about.” In addition, smokers might seek out intelligent people who either smoke or advocate such behavior. Therefore, they convince themselves, in effect, that cigarettes can’t be all that bad since a lot of reputable people use them. The dialogue goes something like this, “Dr. Williams knows more than anyone I know and he smokes. If he’s not afraid, I’m not either.” Smokers may also switch from one brand of cigarettes to another and delude themselves with the belief that the new brand is safe. “I’ve switched over to Marlboro. I’ve heard there are very few side effects with this brand.” Finally, smokers might add cognitions that are in accord with their behavior in an attempt to convince themselves that what they are doing is logical and reasonable, in spite of the danger. For instance, they might exaggerate the importance of using cigarettes. “Smoking helps me relax. If I don’t smoke, I will get fat as a pig.” Similarly, they may actually try to make a virtue out of smoking by exhibiting a “macho” type attitude while flirting with death. “You have to die of something. I’m not afraid. If I die, I die.” If your need to smoke is great enough, you may even convince yourself that they are actually healthy. “How can cigarettes be bad when they help you relax?” Then again, smokers may relinquish all responsibility for their behavior to a higher power. I really love this ploy. How many times have you heard this horse hockey? “If it’s my time to go, I’ll go whether I smoke or not. That’s God’s decision, not mine.” All of the aforementioned behaviors will reduce dissonance by reducing the inconsistency between the individual’s behavior through a minimization of the danger or an exaggeration of the significance of his action. CRITICAL POINT: Dissonance is often strong when we believe something about ourselves and then do something against that belief. If I believe I am good but do something bad, then the discomfort I feel as a result is cognitive dissonance. Cognitive dissonance is a very powerful motivator which will often lead us to change one or other of the conflicting belief or action. The discomfort often feels like a tension between the two opposing thoughts. To release the tension we can take one of three actions:  Change our behavior.  Justify our behavior by changing the conflicting cognition.  Justify our behavior by adding new cognitions. An interesting point is that once an individual justifies his action, the theory of dissonance predicts that he will begin to believe that the justification is valid. In short, a smoker will start believing his own lies. Once an individual commits to a particular action and justifies it, chances are the behavior will not change. For instance, a person will tend to ignore things or other people that conflict with his position. If by chance the smoker hears a plausible argument against his held position, the smoker will tend to forget it. However, if that person hears a plausible argument for his position or against the opposition, that person will tend to remember it. Eventually, he will no longer seek objective information

concerning the issue. Rather, the smoker will seek out information or people that support his position, thereby reassuring that his actions are appropriate. Interestingly, if the person cannot find external support to justify the position, the person will attempt to justify it internally, convincing himself that his smoking behavior is physically, mentally and morally right.

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