Secondhand smoke is a risk factor for lung cancer

Today’s questions are among the three most commonly asked by our readers.  They concern smoking and osteoporosis, both of which are important health issues today.  Read on and learn some healthy tips to make your life longer and healthier.

Secondhand smoke

Q.  I have been smoking a pack a day since I was age 18.  When I got married at 30 and had our first child, I stopped smoking.  The problem is my office mates and friends continue to smoke and so, I am still exposed to secondhand smoke.  How dangerous is this situation?  Is it really that bad or are health officials just using it as a scare tactic so people will stop smoking?

— S.D., Sampaloc, Manila

A.  Secondhand smoke — also known as environmental tobacco smoke — includes the smoke that a smoker exhales (mainstream smoke) and the smoke that comes directly from the burning tobacco product (sidestream smoke).  Secondhand smoke contains thousands of toxic chemicals including: ammonia (used in cleaning products), butane (used in lighter fluid), carbon monoxide (found in car exhaust), chromium (used to make steel), cyanide (used in chemical weapons), and polonium (a radioactive substance).

The dangerous particles in secondhand smoke can linger in the air for hours or even longer.  Even the residue that clings to a smoker’s hair and clothing, cushions, carpeting, drapes, and other items can pose risks, especially to children.  Secondhand smoke causes or contributes to serious health problems, including: 

• Lung disease. Exposure to secondhand smoke can aggravate respiratory conditions, especially for people who have asthma or chronic obstructive pulmonary disease (COPD).

• Heart disease. Secondhand smoke damages blood vessels and interferes with circulation, which increases the risk of heart disease and heart attack.

• Cancer. Secondhand smoke is a known risk factor for lung cancer, and the benzene it contains also increases the risk of leukemia.

 Secondhand smoke poses additional risks for children, who are especially vulnerable to the effects of secondhand smoke.  Problems include:

• Low birth weight. Exposure to secondhand smoke during pregnancy increases the risk of low birth weight.

• Sudden infant death syndrome (SIDS).  Secondhand smoke increases the risk of SIDS.

• Asthma.  Secondhand smoke increases the severity of childhood asthma.

• Infections.  Children who live with smokers are more likely to develop bronchitis, pneumonia, and middle ear infections.

• Chronic health issues.  Secondhand smoke also causes chronic coughing, phlegm, and wheezing, as well as eye and nose irritation. 

Remember, it’s your right to breathe clean air.  Start with these simple steps:

• Don’t allow smoking in your home.  If family members or guests want to smoke, ask them to step outside.  Air conditioners and ventilation systems don’t effectively remove secondhand smoke from the air.

• Don’t allow smoking in your vehicle. If a passenger must smoke on the road, stop at a rest stop for a smoke break outside of the car.

• Insist that smoking restrictions be enforced at work. Many companies have laws against smoking in the workplace.  Work it out that your company has one, too.

• Only choose smoke-free care facilities. This applies to child care facilities as well as facilities for older adults.

• Patronize businesses with no-smoking policies.  Choose smoke-free restaurants, request for nonsmoking hotel rooms when you travel, and reinforce these no-smoking policies by telling the management that you appreciate healthy air.

Consider ways to protect yourself and those you love from secondhand smoke.  If you have a partner or other loved ones who smoke, offer support and encouragement for them to stop smoking.  Your entire family will reap the healthy benefits.

Calcium supplements

 Q.  My doctor said I should stop taking calcium supplements as this can increase the risk of a heart attack.  My other doctor, however, said that this is not true.  Who is correct?  I am osteoporotic and I think I need to take calcium. 

A.  This has been an area of controversy for the last three years, but the overall weight of evidence — including three more recent studies — indicates that appropriate calcium supplement use does not increase heart attack risk. The studies showed no increase in heart attack risk with calcium supplementation.  Combined, the studies looked at a pool of about 130,000 adults, most of whom were women older than 50.  Some took calcium supplements, and some didn’t.  When takers and non-takers were compared, all three studies concluded that there was no association between calcium supplementation and heart attack risk.

Bone health experts say that adequate calcium and vitamin D intake is critical to reducing the risk of bone thinning and osteoporosis.  Vitamin D helps the body absorb calcium.  They are reassured to see further evidence that there’s no association between calcium supplementation and heart attack risk.

Still, they recommend keeping consumption of calcium from diet and supplements combined to no more than 1,500 milligrams (mg) daily for those with or at risk for osteoporosis.  The recommended calcium intake for women age 51 and older is 1,200 mg.  For men ages 51 to 70, the recommendation is 1,000 mg daily.  For men ages 71 and older, the recommendation is 1,200 mg.  The recommendation for vitamin D intake is 600 international units (IU) daily for those 70 and younger, and 800 IU for those older than 70.

Vitamin D2 OR D3?

 Q.  I’m confused with the various types of vitamin D available in pharmacies and health stores.  What kind should I take and how much? 

— R.G., General Santos City

A.  You are wise to take vitamin D, but even wise men (and women) are likely to be confused with the complexities of vitamin D.

Vitamin D is essential for health.  Its most well-established role is to increase the intestinal absorption of calcium, keeping bones strong.  But important research also raises the hope that vitamin D may help protect against prostate cancer and other malignancies, muscular weakness and falling, heart disease, and other disorders. Vitamin D is the only one of the 13 vitamins that can be made by the human body.  (Small amounts of vitamin K are produced by intestinal bacteria.)  The process starts when the ultraviolet energy in sunlight acts on a form of cholesterol (7-dehydrocholesterol) in the skin.  The result is vitamin D3.  But before D3 can function, it must travel to the liver and then the kidneys to undergo further conversions.  The end product is active vitamin D, known technically as 1,25-dihydroxyvitamin D, or calcitriol. 

Many people are deficient in vitamin D because they don’t get enough sunlight to make vitamin D3 in the skin.  That’s not all bad, since excessive sun exposure leads to premature wrinkling and skin aging as well as malignant melanomas and other skin cancers.   A good diet will provide adequate amounts of all the vitamins except D.  Fish and shellfish provide some vitamin D (oily fish are best).  And egg yolks have a tiny amount.  Fortified dairy products have added vitamin D, but very few of us get the vitamin D we need from the diet.  That’s no surprise when you realize that you need to consume about 5 ounces of salmon, 7 ounces of halibut, two 8-ounce cans of tuna, or a quart of milk to get 400 international units (IU) of vitamin D, which is only about half of what many experts recommend.

 If you don’t get enough sunlight to make the vitamin D you need, and your diet can’t make up the rest, you need a supplement.  Two forms are widely available.  D2 is produced by exposing ergosterol from yeast to ultraviolet light, while D3 can be obtained from fish or by exposing lanolin from sheep’s wool to ultraviolet rays.  Both D2 and D3 have to pass through your liver and kidneys to be converted to the active form of vitamin D.  But which is best?  Vitamin D2 has been the mainstay of therapy for over 80 years and is the only form in prescription preparations.  But both D2 and D3 are available as over-the-counter supplements in health stores.

A 2004 study suggested that D3 was better, but it tested only a single 50,000 IU megadose of each preparation.  A more realistic 2008 trial evaluated a 1,000 IU daily dose of D2 or D3, a supplement that combined 500 IU each and a placebo.  The subjects were 68 healthy adults, age 18 to 84.  Interestingly, 60 percent of them were vitamin-D deficient at the start of the trial.  At the end of 11 weeks, though, D2 and D3 were equally effective at boosting blood levels of D.

Pick whichever form of D is easier to find, but be sure to get enough.  The Recommended Dietary Allowance (RDA) for adults younger than 51 is 200 IU; for 51- to 70-year-olds, it’s 400 IU; and for people over 70, it’s 600 IU.  But many experts recommend 800 to 1,000 IU a day.  Doses up to at least 2,000 IU a day are considered safe. 

All in all, the choice between D2 and D3 is less important than getting the right “D” dose.