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Scot: We're pretty excited on today's episode because we get to celebrate something, Troy. Do you like to celebrate things?

Troy: I love to celebrate things.

Scot: You know what we're celebrating today?

Troy: I do know, yeah. But I'm not going to spoil the surprise

Scot: Okay. It's Mitch's two-year quitversary from nicotine. He once was a smoker, then he was a vaper, and now he's a quitter, and he's been a quitter for two years. This is the one time that us guys . . .

Troy: That's amazing.

Scot: . . . can say that being a quitter is a great thing. So congratulations, Mitch.

Mitch: Oh, thank you.

Troy: Congrats, Mitch. And it's amazing to think it's only been two years, but at the same time I'm thinking, "It's only been two years?" So much has happened since you quit smoking. It's beyond quitting smoking. It's been quite a ride here. And the fact that you have not started smoking again in the past two years is absolutely remarkable.

Scot: I mean, I've been close myself and I've never smoked in my life.

Troy: You and me both, man.

Scot: Mitch quit two years ago. He quit on this show. We followed his progress. He quit right before Thanksgiving, which, wow, with family stuff coming up and all that stress, we kind of questioned his sanity on that. But you've managed to make it stick, which is absolutely amazing. How do you feel two years later?

Mitch: I feel good. There are a lot of positive things that have happened. I'm not afraid at any time my chest hurts that I have lung cancer. That little peace of mind is good. I'm running again, or biking recently, but I'm able to cardiovascular stuff. That's great.

My general health seems to be doing a lot better than before, and maybe that's something that we can kind of talk about today. But it's not all sunshine and rainbows, I guess. I don't know. I guess I was expecting, "You quit and then you . . ." In the commercials, you dramatically crumple up that carton of cigarettes and toss it in the trash and walk away defiantly. I still have cravings. I still have occasional ideas of stopping at that Maverik. And it's not every day, but I'm a little surprised that that's still going on. And I just wonder, "Is that just what happens now?" So, anyway.

Scot: All right. Well, to celebrate Mitch's two-year quitversary on "Who Cares About Men's Health," we have brought in somebody that hopefully can answer some of those questions. Her name is Edlira Farka. She is the tobacco cessation program manager at the Center for HOPE at Huntsman Cancer Institute, which is a service that is provided to patients at Huntsman Cancer Institute. How're you doing today, Edlira?

Edlira: Hello, everyone. I'm so excited to be here.

Scot: Yeah, this is exciting. We hope to kind of really talk about a lot of stuff today. We'd like to talk about somebody in Mitch's position at the two-year point, how is he in better health now than he was two years ago? What are some of the reasons why he continues to crave? What are some of the challenges he might face in the future?

And then if somebody is listening that still smokes, that is one of the best things you can do. I say low-hanging fruit, but that makes it sound like it's an easy thing to do, which it is not, but that's one of the best things you can do.

Mitch: No. No, it was not easy.

Scot: It's one of the best things, though, that you can do for your health. It's one of the best investments you can make.

So this is "Who cares about Men's Health." My name is Scot Singpiel. I'm the guy that kind of tries to keep everything on track. The MD to my BS, Troy Madsen. Say hi, Troy.

Troy: That's me, yep.

Scot: And then, of course, today, the reason we're wearing our party hats, Producer Mitch.

Mitch: Hey, I'm here.

Scot: All right. Mitch, I thought maybe this first part of the show, I'm going to back off the mic and let you step up to the mic and talk to Edlira about any questions that you have at two years in on your quitversary.

Mitch: Sure. So, Edlira, one of the things that I guess I would like to talk about now that I'm kind of looking back two years on is . . . This is my seventh time quitting. I guess I don't want to sound hopeless here, but for a lot of people, they don't quit on the first time. How common is it for people to . . . After two years, am I good to go? Is it going to be a constant battle? How likely are people to slip after they've hit the two-year mark? Is there a finish line where people do a lot better or . . .

Edlira: First of all, I want to say congratulations. I think it's amazing that you have been nicotine-free for two years. It's huge. And it's true it's an everyday struggle for many people.

So I will start just by saying that nicotine dependence is a chronic disease. And as such, even though we talk about the transition period a lot, the moment that you start quitting and the withdrawals, and the first two to three days are really hard, and it tends to get easier with time, there is a part of nicotine dependence that doesn't completely disappear with time due to the fact that when most of us . . .

Most people that start smoking or vaping or using nicotine in terms of chewing, any type of tobacco really, they start when they're teenagers or young adults, and our brain is . . . We've heard of neuroplasticity. Our brain responds to those chemicals, to the nicotine, and we start creating more receptors in response to that.

And when we stop using nicotine, those receptors do not disappear. They become sleepy-like. I like to think of them as flowers that are withering, and they still stay there. And that's part of the reason why you've been vape-free or smoke-free for two years and you still think about it occasionally.

Mitch: So that's pretty common then? I don't know. Maybe it's all the PSAs I see. It just looks like you quit and then your life is amazing afterwards, like you've beat the beast and you're done. But that's not what I'm experiencing.

Edlira: Yes, exactly. And what you're experiencing is very normal. And I think we have to change the way we think about it. We have to think about this as a chronic disease. So if we were talking about hypertension and a lifestyle change that helps hypertension, like exercise, we think of that as an ongoing process. It's not something that you exercise today and then you're done with that effect. It's the same kind of idea with quitting smoking. It's an ongoing process.

And you're doing great and amazing, but it doesn't mean that you're not at risk of relapsing . . . sorry, reengaging is the correct term now . . . at any point in the future.

And so it does get easier with time and your success rate is much more higher at this point since you've been smoke-free, nicotine-free for two years, but there is no guarantee that you will never think about it, especially in moments of high emotions, whether it is a life situation, life or death, or even happy moments.

Sometimes it could be routines like going to, as you said, a gas station, places where you've been before. It could be with alcohol or it could be with people you're around who are smoking and you smell the cigarette. There are many different ways you can be reminded about it and think about it.

And I think the key to that is accepting that that thought may come, but it will pass, and you do not need to engage in that thought. We have all kinds of crazy thoughts in our heads all the time and we don't need to engage in those.

Mitch: I mean, just kind of going back to what Troy did, there were times in 2020 that I was, "This is not the time to be quitting. This is not . . ." When we were doing the 5K stuff, I was jogging. It seemed like everyone and their dog had picked up smoking and every single morning they were sitting on their stoop enjoying a cigarette while I was running past, and I'm like, "Oh, I bet I could go bum one real quick. I bet I could do that."

With the episode we had before when I quit for the first time, I just held on to some low-nicotine gum. And so when I had that really bad craving after a run, I would just chew on a piece of gum.

Edlira: Exactly, yes, and that's okay to do. That's what we recommend to use, especially when you're transitioning. We recommend to use nicotine replacement therapy, combination initially, meaning using a nicotine patch, and a short-acting, like a nicotine gum.

And we work with people to slowly use less and less nicotine. Sometimes you have to use nicotine gum long-term occasionally. This is not something you'd need to do on a regular basis, hopefully, but it's always healthier than the alternative, which is going back to smoking or vaping.

I just want to say one more thing, because you said this was the seventh attempt, and I wanted just to say that is very, very normal. On average, most people take about seven attempts to successfully be able to quit just because it is so hard to do.

And the key to that is every time you try and maybe you're not successful, you learn something about what is working and what didn't work. So it's a process, and it's not about getting it right the first time. It's just about not giving up on trying.

Mitch: Yeah. And just to double down on what you just said, the thing that worked for me was that dual system, right? I had the patch, and it was the first time I really committed to the patch, and the gum. Doing them both at the same time really kind of helped ease me off. I still had mood swings galore every time I switched to a lower dose, but it was . . .

Edlira: It is tough, right?

Mitch: Yeah, it was, I think, more tough for my . . . Maybe not more tough, but it was also tough for my partner having to deal with me.

Edlira: It's always . . . yeah, smoking affects not just you and everyone else, but quitting also affects you and everybody else. So it takes a team. It helps for a lot of people to just say, "I'm trying to quit. Please be patient with me while I'm going through this process of having to readjust to lower nicotine levels."

The brain craves that, and a lot of the symptoms that you feel are being irritable or maybe frustrated, anxious, and restless as you're trying to readjust to lower nicotine levels. But it does help in the transition to use nicotine replacement therapy, or the other options are some oral medications that we can use to help with those symptoms. And it makes it easier. I'm glad that you were using them.

Troy: And I'm wondering . . . this is interesting for me to hear this because I had kind of that same impression that Mitch had. You quit smoking and everything is good and you're great. I think Mitch's words earlier before we started the show were sunshine and unicorns, and it hasn't been sunshine and unicorns. It sounds like it's been . . . It's a challenge.

But it is interesting to hear you refer to this as a chronic disease. Like you said, hypertension, managing that, it's a daily battle. But do you ever find that there is that point where a person gets to the point where they have no more desire to smoke than a person who has never smoked? Will Mitch ever reach that point?

Edlira: It's hard to say. I think that there are variabilities, and they have done some genetic testing. So some people are more likely to be more dependent on nicotine than others. And we see that even in smokers, why there are people that have to smoke 20 cigarettes a day and then you find someone that smokes only on social situations.

And so for someone who was regularly using a pack of cigarettes, which is 20 cigarettes a day, or a really heavy vaper, then they're more likely to have these memories or these cravings occasionally. And that is very, very common. The majority of the people I talk to have some kind of memory about smoking and think about it occasionally. There are also people that don't think about it anymore, and they're the lucky ones.

Troy: But it sounds like for the most part, people 10, 20 years out are still thinking about it. There still is at least more of a craving than someone who's never smoked.

Edlira: Right. Absolutely. If you've never smoked, even though we have the receptors in our brain, we don't know how nicotine feels in our brain. And unluckily, nicotine feels great.

Mitch: It does. I'm sorry. It sounds terrible.

Troy: There's a reason it's addictive.

Edlira: Right? Exactly. I'm glad I have . . . I have tried smoking personally, but I have never inhaled and I've never felt that joyous moment from it. But I know that that's what is hard. When you give up smoking, you give up that pleasure, and there's not something that we can replace to truly give you that same euphoric feeling. Unfortunately, nicotine, that's why it's so highly addicting, is because it affects our reward mechanism in our brain.

Troy: I would like to say that running provides that, but I think now that, Mitch, you've run, maybe you can contradict that. It's like, "No. There's no comparison." I'm just joking, really.

Mitch: No, it's fine. But I really do appreciate that comment because it's so easy for everyone to be like, "Oh, smoking is bad. It's the worst thing for you, blah, blah, blah. Oh, it's a filthy habit or whatever." We don't often talk about how it also makes you feel good. That's why it's addictive, right? I would not inhale that stuff that makes my lungs kind of hurt if it didn't make me feel good. And so it feels very validating almost to hear, "No, it makes you feel good, but it's super bad for you."

Edlira: Right. Exactly. It's hard because the majority of us are not smokers, and so all we're doing is looking from the outside and just looking at these people that are smoking and thinking, "You know that's bad for you. Why are you doing that?"

Mitch: I know it's bad for me.

Edlira: Right? But the fact is, how many of us engage in activities that are bad for us that it's the majority of us who do it and we still continue to do it? We can think about unhealthy eating habits. How many of us do that even though we know it's probably not the best to do? But we enjoy it and we say, "Hey, it's okay. I'm enjoying it, even though I know that there are risks with this behavior."

We can all relate to that feeling, even though we don't understand how nicotine would really affect our brain because we haven't . . . the majority of us haven't been smoking most of our lives.

Troy: More for Mitch, what have been some of the hardest times that you've experienced in the last two years? And, Edlira, I'm curious if that's typical of what you're seeing with other people you've worked with.

Mitch: So some of the hardest times for me really were March 2020. Things were bad. There was an earthquake, there was the pandemic, and everything was really changing.

Edlira, I don't know if we prepped you too much about this, but I smoked for 10 years. I started when I was very young and in college. And every moment in my past, when things got really stressful, I would go to the gas station and buy a pack of cigarettes and sit and smoke them. That is my way of dealing with extreme stress. I have a breather. I would think.

And so when that March came and everything was different and everything was hard, and suddenly we had to be inside, I didn't have that, and that was probably the hardest thing for me. I was having a really hard time emotionally because that crutch, that habit, that decade-long habit wasn't there to help when things got tough.

Scot: Decade-long coping mechanism.

Mitch: That's a better way to put it, yes.

Edlira: Absolutely. I have to agree 100%. That is what we typically see. It's very, very hard behaviorally to manage emotions, stress, anxiety, boredom, loneliness, sadness when you've created this long-term pattern of relying on smoking to help you feel better, even though we know from science that, long term, that doesn't help anyone manage emotions better.

But in the short term, like I mentioned, the reward mechanism part, how nicotine helps us feel good in the short term, that makes it hard. In the moment, you're not thinking about, "Well, what else can I do?" You're just going back . . . Your brain likes to find easy solutions. Our brain likes to find easy solutions. And so the easiest thing is, "Hey, I know that smoking helped me in the past and that was for a very long time. So can we just go back to that?"

And so finding a different way, I think, is definitely doable. It just takes a little bit of mindful practice of, "Hey, that is one way that I felt better, but I also know that that is not the best way for me to manage my emotions. What other practices can I start practicing or utilizing or think about that can help me feel better?"

I would like to ask you, because you have had to practice those things to manage your emotions. What other things have you tried that were helpful for you, Mitch?

Mitch: Well, I did running for a while. I got into running for the first time and it took a while to get it into it, but it was getting a break, getting outside, walking, listening to a podcast. It checked off a lot of the same boxes, that break, that going outside, that stopping and not thinking about all the terrible things for 20, 30 minutes.

Scot: Yeah, disengaging for a little bit.

Mitch: Yeah.

Edlira: That's great.

Mitch: So that's kind of what I turned to. And honestly, I have since quitting, oddly enough . . . or not oddly enough. Maybe because of. I have started doing some mental health stuff. I've been working with a therapist to kind of deal with stress management and anxiety and kind of fill in the hole that this habit, this coping mechanism, that I relied on for so long . . . I've been working on coming up with new strategies.

Troy: And did you find, Mitch, that it was tough not to take on other bad habits like stress-eating or things like that?

Mitch: Oh, my God. We will need to do a series where Mitch loses 20 pounds because, yes, I did indulge a little bit the last year or two. Who's looking at me during pandemic times? I'm just going to go ahead and have a double bacon cheeseburger today because that feels good. I am a junk food lover. That's me. That's the Taquito. So yes, I did indulge a little bit into that, but I'm still working on finding my best habits.

Edlira: Most of us did it. Even though we're not smokers, most of us have done that with the pandemic.

Troy: Yeah, that's why it's called the COVID-19. There's the freshman 15, and there's the COVID-19.

Scot: Edlira, what are some of the strategies that you teach people to deal with stress or any of the emotions that they used to go to a cigarette to deal with? Mitch gave some examples. Is there a core takeaway from Mitch's examples, or are there some other examples you can give?

Edlira: Yes, absolutely. So one of the things that is helpful is to recognize triggers or cues that are associated with wanting to smoke. And so I will typically talk to someone and say, "Talk to me about your day in relation to your smoking."

So common triggers are waking up in the morning, drinking coffee, after meals, taking a break, driving, before bedtime. And then obviously, it can be things like being around someone who smokes, smelling a cigarette. It can be also an emotional trigger, so feeling stressed and anxious, like we talked about.

So depending on the trigger, then you can think about activities to do to anticipate that you're going to have that thought and what else to do. Some of the things behaviorally that are helpful . . . and it can be very different for everyone. So I'm going to generalize, and maybe some of them apply to you, Mitch, but some of them don't. And that's normal, because the approach of quitting is very different depending on the triggers and the situation for each individual.

But some of the things that are helpful are holding on a pen or a pencil or carrot stick. So having snacks that are healthy but that you can chew on is helpful. Drinking from a straw. Sometimes having a straw that's cut that you can kind of hold as a cigarette, breathe from can be helpful. Toothpicks. There are toothpicks that are flavored that are helpful. Obviously candy, but we try to say use sugar-free candy if you want to or sugar-free gum.

And then in terms of the emotions, it's helpful to really try to take a non-smoking break. For a lot of people who smoke, that is one way to escape the activity that may be too stressful or too busy or tiring.

So maybe still go outside. It's helpful to change a little bit of the routine. So I'd say if you're going out the back, maybe change and go out in the front. Someone said, "I changed the entire patio outside so I wasn't sitting in the exact same place."

But it's helpful to stay physically active. That is very, very, very helpful. And think of a project that you can do. I think this really does help to start thinking of some activity that you really maybe have wanted to start for a while, like a hobby, and haven't had time or haven't thought it was the right moment. This is a good time to do that.

A lot of people will start doing new skills. Like you mentioned, running or knitting. Anything that you would do with your hands or with your body physically helps.

And then I always like to talk about the deep breathing meditation type of activities that can be very calming. But I think it's also helpful for someone who has used smoking as a coping mechanism because it does slow down the breathing. And so in a lot of ways, it can be a positive memory and help us calm down, slow down our breathing, slow down our heart rate, and kind of gather our emotions for a few minutes before we go back to what we were doing.

Mitch: I'm glad you went through all those because those were . . . I tried a bunch of those and some of them were really helpful for me. Some of them weren't. But this was the first time quitting that I actually engaged actively in finding those habits, finding what worked for me.

I wish I had known about the sugar-free though because I went straight for the . . . Chocolate-covered cinnamon bears were the thing that I would stick in my mouth any time I wanted to smoke. And after the episode, it was very sweet, people kept buying me chocolate-covered cinnamon bears and I ended up with these giant Costco-sized bags of them. It wasn't the best for my waistline.

Edlira: What did your dentist say?

Troy: They meant well.

Scot: It's kind of funny because nobody would ever buy you a bunch of cigarettes or nicotine gum, but they're more than willing to buy you these little sugar bombs.

Edlira: I do have to say . . . You mentioned the cinnamon and it does help to have strong flavors. I mentioned cinnamon steak. And spicy stuff too also can help some people, or lemony flavors. I do have a lot of patients that do use normal candy too, like Jawbreakers, Jolly Ranchers. I don't encourage it. Not to say that it's not helpful because it's a transitionary habit, and hopefully you don't continue to do it forever, but it can help in the transition.

And I honestly think whatever works, it's okay, as long as it's not something that you continue to use and hopefully not ruin your teeth and oral health.

Scot: So, as a once-smoker and then vaper and now a two-year quitter, talk us through what Mitch's lungs and health is like two years later. How much better is it?

Edlira: So the science shows that the lung function starts to improve at between one to nine months after quitting. I'm going to kind of relate to smoking mostly, because that's what most of the research is on. Ten years after quitting smoking, lung cancer death rate is half of a smoker's. So there is a lot of benefit. However, it takes time for the lungs to heal.

So that may be why . . . I don't know if you still feel like you're not breathing as well as you wanted to. I don't know if that's what you mentioned earlier. I think I heard something about that, Mitch. But it sounds like you've stopped for two years, which is great. The lungs are constantly healing and it's always benefiting your lung health, but it's hard to measure that by year.

Scot: So, Edlira, we had talked a little bit earlier about . . . Mitch has quit for two years. Is there any research that shows after a certain point you're more likely to stick with it? Has he gone over the hump, or does he still have a hump to go over?

Edlira: No, he's definitely gone over the hump.

Mitch: Yes!

Edlira: The one-year mark is usually a great sign that you're probably less likely to go back to it. It's just that we don't want to say, "Now you're done. The race is over," because it is a journey.

And like I mentioned, the chronic dependency and the nicotine part may always be a part of your life in terms of you thinking about it occasionally. The hope is that it will happen less and less often. And once you decide, which you have in your case, you always do not think of smoking as an option, similar to someone who has never been a smoker.

For me, I will handle stressful situations, but I will never think about, "Oh, maybe I need to go and get a cigarette," because that's not an option. It's not even an alternative.

And that's the idea that I would encourage for someone who has been a smoker. It's okay to have that thought. We can't control what thoughts come into our brain, but you don't have to engage into that. And you say, "Even though I had that thought, I'm not going to follow through with it."

Troy: I was going to say this is great to hear. I've never smoked. I haven't had that experience or that dependence. But so much of what you're saying is just any change in health habits in general, or trying to do healthy things. It's never easy. I think it's always a struggle. For me, it's been a lot about trying to give up sweets and give up sugars. Mitch, similar to what you've experienced, there have been many times . . . In med school, I would buy a pack of Oreos and I would eat almost that entire thing in one sitting, and it was delicious.

Scot: I've done that.

Troy: It was amazing.

Scot: There's nothing worse. Self-checkouts are great nowadays because when you get that gallon of milk and that pack of Oreos, nobody has to see it.

Troy: Yeah, you don't get shamed for it. It's like, "I'm buying this, and I'm eating this tonight." So I think it really relates to anything we try and do. There's always that trigger, whether it's stress or anxiety or loneliness, or whatever it might be, and it's always a battle. I don't have that urge like I used to have it, but I still have that urge sometimes.

And so I can't relate certainly, Mitch, on the level I think to nicotine dependence. It's really remarkable what you've done, and especially at this time. I don't know how you've done it, but . . .

Mitch: I don't know either.

Troy: I'm incredibly proud of you. Honestly, I haven't even wanted to ask you if you were still not smoking because I was just . . . I didn't want to know the answer. I was like, "I don't know how you've done it. I just don't want to know." So I'm incredibly proud of what you've done and it's remarkable.

Edlira: I think it's great that we're celebrating this, because one of the comments that I get a lot from people who are working on quitting is the lack of awareness, and sometimes it's the elephant in the room. Like you said, it's uncomfortable to say, "Hey, are you still not smoking?" because you don't want to know the answer. But that is actually important for anyone who quits.

I'm speaking in general, and, Mitch, you can tell me if that's how you feel about this. But generally speaking, you're doing something that's so difficult and no one is recognizing it as often as it is happening, meaning that you're fighting this fight on a daily basis. And once you quit, most people say, "Okay, you quit. You're done. Good job," once. But hey, it's not a good job once. It good job always, good job for rest of your life, because it's never easy, even though it's been a long time.

Troy: See, now I feel bad. I'm sorry, Mitch. I should have been asking you.

Mitch: No, you're good. And one of the things I want to talk about is that I really appreciate that, what you just mentioned. A lot of people on the outside are just like, "Well, are you done yet? Oh, you quit. Great. High five. Oh, no, you slipped up. Oh, no." It's like, "What kind of moral failing did you have?" or, "Did you not try hard enough?" or whatever.

Kind of the thesis of our show, it was actually talking about that, right? It was talking to Scot and Troy on our first episode, where I first committed to quitting. It was that talking about, "Hey, this is hard," and having people realize that it's hard and support and to talk about the Maverik cravings, I would call it, where I'd circle the block a few times trying to debate whether or not I'd go in and grab a pack of cigarettes.

That, I think, was the biggest difference this time, and why I was able to get to the two years, was being able to talk to people about what was actually happening. A lot of times, there's so much shame wrapped up in, "You should just be strong and quit. You know it's bad for you. Just throw it away."

Edlira: "It's just willpower." And it's not just willpower. I do think it's very helpful, for whoever is still smoking and can benefit from this, that once you decide that you want to do it, it's helpful to find the reason why, why you're doing it.

And the why can be very different for many people. For some people, it could be financial. Most of the time, it has to be health-related and family, or a lot of times there's a child or a grandchild. Sometimes it could be a diagnosis of some sort that really kind of shakes us to the core and then we decide, "Hey, I'm done. I do not want to be a slave to cigarettes anymore."

But once you have the why, it helps to have a plan of how you're going to do it, anticipate that it's not going to be easy, anticipate that you're going to have the triggers and what to do with that. I think it's helpful to plan things that you think may help, like having snacks or some of the things that we talked about earlier.

And it also is helpful to talk about it and let other people know. This helps us be more accountable to ourselves. It can be a lot of pressure to do that, but I think in your case, Mitch, you mentioned that it . . . And this is the majority of the time. This was helpful for you because you felt the responsibility. You didn't want to let yourself down. You didn't want to say something and not follow through with that.

So even though it's an uncomfortable thing to do, I encourage you to do that because it makes it more likely that you will follow through with that plan.

Scot: So I think I think another round of applause is in order for Mitch. Congratulations on your two-year quitversary.

Troy: Well done.

Edlira: Yay. That's huge.

Scot: I mean, birthdays, we celebrate birthdays, but really, come on. This is bigger than that, right? A lot of effort went into it. It's a daily thing. I love the analogy that smoking is a chronic disease so it needs a solution that also is ongoing.

Quitting can be different for each person. It's hard. It can take up to seven times. You've just kind of got to find your way.

Edlira, do you have a beginning step for somebody that maybe would like to be celebrating their two-year quitversary in a couple of years on how to get started?

Edlira: I think it's great to put some small goal that you can see yourself achieving. Because this is a journey, it's a process, and it's not just an on and off light switch, I think it's helpful to think about . . . If you're smoking 20 cigarettes a day, let's say you want to say, "I want to smoke 18." It's only two fewer cigarettes. But you have to practice non-smoking when you're smoking two fewer cigarettes.

So I think it's great to think about even reducing smoking still helps reduce the harm. Even one fewer cigarette helps. So keeping cigarettes away. If you're smoking outside, just take the one cigarette that you want to smoke or two, but try to limit it. Make it harder for you just smoke.

And think about why you want to do it, because your why is what's going to help you pull through with it.

Scot: And there's no shame in getting help. You don't have to do it yourself. There are a lot of great resources out there.

Edlira: There are. Yeah.

Scot: What would be a great resource that you would drive somebody to as a beginning point?

Edlira: Anyone who's a Huntsman patient, please let us know. We would love to help you. But what normally can help is a combination of counseling and pharmacotherapy. So that is using combination nicotine replacement, like we talked about, and then the two medications that are varenicline and Zyban. Those are prescription, so I do think it's helpful to talk to your provider that you're trying to quit because they can prescribe medications and they can even give you brief counseling.

And also the quitline offers free counseling as well as some free nicotine replacement therapy.

And there are also some apps that are free, like smokefree.gov, which are really nice. You can put your goal, if you want to quit. They can send you text reminders, and that can be helpful as well.

Scot: Well, congratulations, Mitch. Edlira, thank you very much for being on the show and answering some of Mitch's questions. Should we all get together in another year and celebrate three?

Edlira: What a great idea.

Troy: Let's plan for it.

Scot: I mean, should I not have said that, Edlira? Did I just screw things up for Mitch?

Edlira: I think it's great. I think it makes it more likely for Mitch to be celebrating in a year.

Scot: All right. I wouldn't want to be the undoing, Mitch.

Edlira: Thank you for having me.

Scot: Thank you, and thanks for caring about men's health.

Super sweet episode. It's always fun to celebrate things, especially something like somebody quitting nicotine for two years. Again, congratulations to Mitch on his two-year quitversary.

If you want to reach out to Mitch and say congratulations, that would be awesome. Or if you are struggling with quitting smoking and need a little extra help, you want to reach out, that's great too. Or if you have a comment or a thought, lots of ways to get a hold of us at the podcast.

You can email us at hello@thescoperadio.com. You go to facebook.com/whocaresmenshealth. Send us a direct message, or post on our wall. You can also leave a voicemail by calling 601-55SCOPE. That's 601-55SCOPE.

And most importantly, help other men that would find this podcast useful find us. If you think there's somebody in your life that would find this episode useful, share it with them. Listen to it with them together. We'd really appreciate it.

Thanks for listening, and thanks for caring about men's health.

Interviewer: How e-cigarettes affect your heart and it's not in a good way, and it might not be better than smoking after all. We're going to find out more about that next with cardiologist, Dr. John Ryan on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Before we get into the conversation about e-cigarettes and how they affect your heart health, I think it's important that we say that cigarettes and e-cigarettes are linked to many different health problems. But today, we're just focusing on one particular and that's issues related to the heart. So, Dr. Ryan, how do e-cigarettes affect a person's heart health and are the threats real?

Dr. Ryan: I think the threats are real. I think the concerns are legitimate. One particular concern with e-cigarettes is that it's really re-normalizing cigarette smoking, nicotine consumption, and tobacco use within North America. Some of it, the science is uncertain. We are not sure of the long-term effects of e-cigarettes, either on heart or lung disease. And then legitimate concerns get raised because of this chronic exposure to nicotine, chronic and also varying exposure to nicotine. One of the particular issues there seems to be marked variation in how much nicotine is being consumed with each vape.

Interviewer: Because when you get the little vapor things, it tells you how many milligrams per whatever, but that's not regulated so we don't know if that's accurate or not.

Dr. Ryan: Exactly. And the anticipated is .05 is what's often quoted. It can really range up to 15 whereas where your cigarettes would be about two to three. So in that regard, there's variation there that's concerning. Also, some of the physiologic effects that e-cigarettes and nicotine consumption, in general, are concerning, in particular, high blood pressure, fast heart rate, endothelial dysfunction, which is the lining of the blood vessels of the heart, in particular, which can be a trigger for atherosclerosis and coronary artery disease.

And all of these things are affected by the nicotine consumption and, in particular, by the e-cigarette nicotine consumption as well as other chemicals that are in the e-cigarettes. And as you rightly pointed out, the regulation of this is difficult and not as robust as many physicians and scientists would like. And that just raises further concerns.

Interviewer: So you mentioned a lot of different bad things that can happen from e-cigarettes, and it's related to nicotine primarily, the raising your heart rate, the blood pressure, your blood vessels narrowing, high risk of hardening of the arteries. What does that do, then, that causes heart failure or heart attack or stroke?

Dr. Ryan: So a lot of it we don't know, first of all. That specifically raises concerns, but the issues, in particular, that are raised with high blood pressure, with fast heart rates, with narrowing of the blood vessels of the heart, the coronary arteries, as you mentioned, this puts extra strain on the heart. The heart obviously depends on blood flow in order to get oxygen, and in the setting of high blood pressure, fast heart rate, decreased vessel size, you do raise the risk of having a heart attack.

So the essential concern, in particular, is for heart attacks, that the use of nicotine, e-cigarettes, and cigarettes raises your risk of having a heart attack. And also, it's not necessary, and that's where I got back to the normalization of tobacco consumption and nicotine consumption within North America. This is not a necessary thing that we need to do. This distinguishes it from . . . and there's controversy of this as well, but diet consumption, fat consumption, etc. However, we do need to eat. We don't need to smoke and we don't need to vape.

Interviewer: So for sure, we know nicotine causes these negative effects to the heart.

Dr. Ryan: Exactly.

Interviewer: What about the other chemicals, like . . . I've heard the flavoring chemicals. Even if you're getting the dose without the nicotine, they've found that it can cause other diseases.

Dr. Ryan: Yeah, so the flavoring has recently been associated with what's called popcorn lung or bronchiolitis obliterans, which is a form of inflammatory and fibrotic lung disease. The reason this raises concerns is, first of all, lung disease, therefore, puts a strain on your heart. And secondly, if there's chronic inflammation, which we see in the setting of poor air quality and stress, it can result in triggering heart attacks or heart disease. So I think there are two main concerns with the chemicals that you bring up in terms of e-cigarettes.

Interviewer: If you've got a patient that's right in front of you now that smoked e-cigarettes, how would you convince them that they shouldn't? Because a lot of people get enjoyment out of it, or it's an addictive habit that they can't stop. It takes a lot of willpower to quit.

Dr. Ryan: Being sensitive enough in terms of convincing people to do things. Ultimately, I think you have to introduce the risks associated with the disease, the risks associated with the risk factors, and hope that they make an informed, educated decision about their habits. And so I try and present to them the uncertainty about e-cigarettes. I try to present them with some of the concerns that I have about e-cigarettes and nicotine consumption in general. And then, hopefully, when they leave the clinic and when they go home, they're able to access resources themselves and make good decisions themselves and be comfortable with the decisions they're making.

Interviewer: And I think, essentially, it comes down to this is something that you don't have to do to your heart.

Dr. Ryan: Exactly, yeah. You don't have to do it to your heart. You don't have to do it to your lungs.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: January 8, 2019
originally published: January 26, 2016