The Many Health Benefits of the Post p randial Cigarette .
The Many Health Benefits of the Post-Prandial Cigarette
An illustration of the importance of proper scientific interpretation
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BIOL 4X – Current Topics in Human Biology
Dr Katherine Price University of Glasgow Glasgow, Scotland November 4, 2023
“All things are poison, and nothing is without poison; only the dose permits something not to be poisonous.”
– Theophrastus von Hohenheim (c. 1493 - 1541)
1. The Dose Makes the Poison
All smokers know that delightful feeling which fills their breasts from the moment they take a puff after a satisfying meal, and yet they are often ‘reminded’ that this enchanting experience is but part of a path to an early grave! Such noxious ‘reminders’ bear no resemblance to the truth, for not only is it inconceivable that the human brain could so delight in the poisoning of the body which sustains it, but to paraphrase the words of history’s most famous toxicologist, Theophrastus von Hohenheim (a.k.a. Paracelsus), it is the dose that makes the poison. It would seem that a great many scientists have forgotten these wise words, opting instead to swallow the toxic and biased interpretations peddled by the anti-smoking lobby.
To combat this ‘anti-smoker’ sentiment, this paper shall endeavour to review, explain, and offer alternative interpretations of the very science that the vicious vipers of the anti-cigarette lobby themselves rely upon to poison public opinion, focusing chiefly on the most delightful of all smokes – the post-meal (“postprandial”) cigarette. Fear not smokers and fellow British American Tobacco employees anxious over the recent announcement of probable redundancies due to slumping sales, for it shall herein be shown that smoking after a meal (“postprandial pulmonary infumation”) offers numerous benefits, especially hormonal (“endocrine”) benefits by delaying the postprandial blood sugar (“blood glucose”) spikes associated with type 2 diabetes while shielding against low blood sugar (“hypoglycaemia”) by boosting insulin resistance. A further benefit, which applies to smoking in general, is the fortification of the vascular system via the stiffening of the arterial walls (“atherosclerosis”). Thus, the available evidence actually allows for the conclusion that cigarettes are beneficial, particularly when inhaled postprandially and at moderate doses.
2. Three Smokes a Day Keep the Endocrinologist Away
2.1 Delayed Postprandial Glucose Spikes
Perhaps the most crucial evidence of the beneficial effects of postprandial pulmonary infumation is the finding of delayed post-prandial blood glucose spikes1 and increased resistance to the hypoglycaemic effect of insulin.2,3 Typically, blood sugar rises within 10-15 minutes of consuming a meal and peaks after one to two hours before trending back down to a normal range of 3.9–5.6 mmol/L.4 More acute spikes have been implicated in the development of diabetes, and hence, there has been much scientific research on the Glycaemic Index (which represents the rate of digestibility and thus blood glucose spiking capability) of carbohydrates. Further, the addition of nutrients like fibre and fats alongside carbohydrates is widely recommended, as these further slow gastric emptying, thereby reducing the acuity of postprandial glucose spikes. These spikes have been implicated in the development of type 2 diabetes later in life.
As it so happens, cigarettes can have a rather similar effect in that they also delay postprandial glucose spikes – and without any added calories to boot! Indeed,
Several studies have found that postprandial pulmonary infumation, in particular, reduces the expected postprandial glucose spike by up to 25%.1 To some degree, this delay was generally observed among smokers as compared to non-smokers even on the days the smokers were required not to smoke, yet it was even more pronounced, and the peak glucose values were even lower, when participants consumed a cigarette immediately after a meal. To quote the researchers directly, “the peak value and overall excursions of plasma glucose were significantly lower when the smokers were smoking compared with when they were not.”1
Another study observed very similar results and even managed to isolate a cause using Doppler sonography (a machine that measures blood flow). They discovered that smoking after a meal reduced blood flow through the superior mesenteric artery,5 which supplies arterial (oxygenated) blood to the intestines and pancreas, as illustrated in Figure 1.
Reduced flow in the superior mesenteric artery not only slows gastric emptying (much like fibres or fats), but also reduces the rate of absorption, a benefit that may well mean reduced caloric absorption and thus weight loss (which has independently been correlated with reduced risk of type 2 diabetes)! It would thus appear that the postprandial cigarette is an effective way to both maintain an attractive figure and to delay postprandial blood glucose spikes, and so it follows that postprandial pulmonary infumation can delay the onset of type 2 diabetes! Moreover, the observation of at least some effect even on days that smokers did not smoke suggests that some of the benefits of postprandial pulmonary infumation are long-lasting. One is almost tempted to say, “what more can a person ask for?” Yet there are still more benefits of postprandial pulmonary infumation, including another endocrinological benefit - the boosting of insulin resistance.
Figure 1. Gut organs and Mesenteric Artery, which supplies blood to the intestines and pancreas.
2.2 Insulin Resistance
Postprandial pulmonary infumation has been found to reduce the hypoglycaemic effects of insulin.2,3,6 Hypoglycaemia is a potentially life-threatening drop in blood glucose that has been well-documented in diabetic patients who erroneously inject more than their prescribed dose,7 to name just one example. Indeed, insulin is not merely a synthetic drug injected by diabetics, it is a hormone naturally released by the pancreas in response to postprandial blood glucose spikes, which binds to proteins known as receptors found on the plasma membranes of fat cells (adipocytes), as shown in Figure 2 below.
Figure 2 Insulin Binding and Cellular Blood Glucose Uptake. The left depicts a normal fasting state, whereas the right depicts a normal fed state in which insulin binds to the receptor (dark blue) and recruits the GLUT4 channel (light blue) to allow glucose (blue-green dots) uptake.
Although insulin typically reduces elevated blood glucose back to normal range, the risks of hypoglycaemia are too much to ignore, and yet there is a way to
shield against this potentially fatal consequence of insulin that is as easy as breathing, for as one study aptly notes, “one lifestyle factor that may have direct and indirect effects on insulin resistance is cigarette smoking.”6 Insulin resistance refers to the reduced binding of insulin to the aforementioned cell membrane receptors and thus reduced glucose uptake into cells. The result is higher blood glucose and, consequently, a reduced risk of hypoglycaemia. Astute readers will recognize that this would appear to raise the alternative risk – that of overly elevated blood glucose and even greater insulin response by the pancreas, and this would indeed be the case if not for one crucial detail: the fact that there is “a dose-response relationship between quantity of cigarettes smoked per day and degree of insulin resistance.”6 It seems reasonable to conclude, then, that an excessive number of cigarettes smoked per day can beget a counterintuitively deleterious effect on one’s risk of diabetes, as with all things gluttonously consumed in excess, whereas ‘just three smokes a day keep the endocrinologist away’ by offering moderate insulin resistance without begetting an overboard compensatory response from the pancreas.
3. Three Smokes a Day Can Also Keep the Vascular Surgeon at Bay
That same magic number of cigarettes – three (based on one cigarette at the end of each meal – breakfast, lunch, and dinner) should also lead to vascular benefits in the long run. All smoking, postprandial or otherwise, has been shown to stiffen arterial walls by reinforcing them with plaque,8,9 a benefit known as atherosclerosis. Here it is best to analogise using a similar model that readers might have more experience with – plumbing. Anyone who has ever attempted to install pipes (or even ductwork) will know that there are two kinds of conduits: flexible and rigid. While flexible pipes are useful for strange or tortuous twists and curves, rigid pipes are generally more reliable – they do not kink or leak. In this way, the atherosclerosis that results from smoking can be seen as making the vascular system more resilient and reliable as illustrated in Figure 3, so long as one does not plan on contorting
their bodies in bizarre and unnatural ways. This might preclude atherosclerosis as a benefit for acrobats or circus performers, although it is worth noting there is presently no evidence showing adverse effects from atherosclerosis in acrobats or circus performers.
Figure 3. Normal versus Atherosclerotic Blood Vessel. The left is a standard non-smoker’s flimsy blood vessel, whereas the right shows a smoker’s fortified blood vessel, reinforced on both sides with plaque (yellow).
In any case, under the ‘plumbing’ theory of vascular tone, it follows that atherosclerosis is preferable to flexible yet flimsy vessels, given the importance of resilient conduits to ensure adequate transport of blood (and thus both nutrients and oxygen) to tissues throughout the entire body. Of course, severe atherosclerosis risks blocking blood flow altogether, but here again, the issue lies with severity and thus with dosage/excess, whereas it is reasonable to assume that just ‘three smokes a day can keep the vascular surgeon at bay.’
4. Conclusion: In All Things, Moderation is Best
It seems clear that three postprandial cigarettes a day, being a reasonably moderate dose, can provide numerous health benefits. Yet it is worth noting that this paper is not written from a delusional state whereby the risk of lung cancer does not exist. Indeed, it is obviously true that smoking modestly elevates the risk of lung cancer and that there is risk of increasing usage after a period of strict adherence to a routine such as three cigarettes per day, which is in fact a risk inherent to any addictive substance. Yet every decision in life involves a trade-off, as with the decision to smoke or not smoke. One can either have a reduced risk of lung cancer, or insulin
resistance, but he/she cannot have both. Suffice it to say, it seems more reasonable to opt for reduced postprandial glucose spikes, a lower risk of hypoglycaemia, and a more resilient vascular system, than to worry about the far-off possibility of lung cancer, but that is a decision every individual must make for themselves – so long as they are aware that worrying about the risks commonly associated with smoking is in fact nothing more than a bias chain of interpretations pushed by the anti-smoking lobby.
References
1. Grøndahl MF, Bagger JI, Lund A, et al. Effects of Smoking Versus Nonsmoking on Postprandial Glucose Metabolism in Heavy Smokers Compared With Nonsmokers. DiabetesCare . 2018;41(6):1260-1267. doi:10.2337/dc17-1818
2. Bergman BC, Perreault L, Hunerdosse D, et al. Novel and Reversible Mechanisms of Smoking-Induced Insulin Resistance in Humans. Diabetes . 2012;61(12):3156-3166. doi:10.2337/db12-0418
3. Cho SH, Jeong SH, Shin J, Park S, Jang SI. Short-term smoking increases the risk of insulin resistance. SciRep . 2022;12(1):3550. doi:10.1038/s41598-022-07626-1
4. Blood Glucose (Sugar) Test: Levels & What They Mean. Cleveland Clinic. Accessed December 7, 2023. https://my.clevelandclinic.org/health/diagnostics/12363-bloodglucose-test
5. Smoking Prevents the Expected Postprandial Increase in Intestinal Blood FlowUnal - 2004 - Journal of Ultrasound in Medicine - Wiley Online Library. Accessed November 30, 2023. https://onlinelibrary.wiley.com/doi/full/10.7863/jum.2004.23.5.647?sid=nlm%3Ap ubmed
6. Artese A, Stamford BA, Moffatt RJ. Cigarette Smoking: An Accessory to the Development of Insulin Resistance. Am J Lifestyle Med . 2017;13(6):602-605. doi:10.1177/1559827617726516
7. Side effects of insulin. Diabetes UK. Accessed December 7, 2023. https://www.diabetes.org.uk/guide-to-diabetes/managing-yourdiabetes/treating-your-diabetes/insulin/side-effects
8. Lee JE, Cooke JP. The role of nicotine in the pathogenesis of atherosclerosis. Atherosclerosis . 2011;215(2):281-283. doi:10.1016/j.atherosclerosis.2011.01.003
9. Messner B, Bernhard D. Smoking and Cardiovascular Disease. ArteriosclerThromb VascBiol . 2014;34(3):509-515. doi:10.1161/ATVBAHA.113.300156