Six ways to reverse the damage from smoking, according to doctors

Smoking is the number one cause of preventable disease and premature death in the world. It increases your risk of developing cancer, heart disease, and lung disease, as well as diabetes and dementia, and it can damage your bones, eyes and teeth. Most smokers in the UK have successfully quit and are now ex-smokers, notes Sir Richard Peto, emeritus professor of medical statistics and epidemiology at the University of Oxford. “Although cigarette sales are only about a quarter of what they were in the 70s, smoking is still a cause of more than 20 per cent of all cancer deaths, and if you add up all the reliably known effects of other causes of cancer in the UK, the total risk from all of them together is still less than that from tobacco alone,” he says. “Smoking harms nearly every organ in the body as a result of toxic chemicals entering the body and passing into the bloodstream,” explains Professor Sanjay Agrawal, consultant in respiratory and intensive care medicine at the University Hospitals of Leicester NHS Trust. “The chemicals from smoking damage cells in a variety of ways, triggering inflammation.” Social or light smoking isn’t without risks, either. “The more cigarettes someone smokes and the longer they smoke for, the greater the risk, but having just one or two cigarettes a day is not harmless. Even smoking occasionally can damage the heart and blood vessels and increase the risk of cancer.” If you used to smoke when you were younger, there are ways to minimise, or even reverse, the damage. Shorts Don’t give up giving up The body begins to recover “almost immediately” after you stop smoking, says Agrawal, an Action on Smoking and Health trustee. “First, your heart rate and oxygen levels return towards normal, while carbon monoxide is cleared from your blood. Your lungs begin to clear out smoking debris, and your circulation, breathing, taste and smell improve. Over the following months, lung function can improve and coughing and wheezing can reduce. In the longer term, the risk of serious diseases such as heart disease and lung cancer falls substantially.” Smokers who stop before reaching middle age gain about an extra 10 years of life. “Ex-smokers who stopped when they were younger will always have some permanent damage,” Peto says, “but it’s only if they re-start that that damage is likely to progress to serious disease.” The key to minimising risk once you’ve stopped is to stay stopped. “If you do restart, don’t give up giving up,” he stresses. Remain completely smoke-free, including avoiding occasional social cigarettes. “People often assume that a cigarette at a wedding or on holiday no longer counts, but for the cardiovascular system, there is no safe level of smoking,” says Dr Francesco Lo Monaco, consultant and preventive cardiologist, founder and medical director of The National Heart Clinic, and author of Heart Saviour. “Avoiding second-hand smoke and vaping also reduces unnecessary exposure.” Have regular heart check ups “Blood pressure, cholesterol, fitness, diet, sleep and continued abstinence are where former smokers can regain a great deal of control,” Lo Monaco says. “Circulation, oxygen delivery, inflammation and the blood’s tendency to clot can all improve after quitting.” The NHS estimates that, after one year, the risk of a heart attack is around half that of somebody who continues to smoke. After approximately 15 years, it can fall to a similar level to that of somebody who has never smoked. In midlife, begin with a proper cardiovascular risk assessment, Lo Monaco suggests. “Tell your GP how many cigarettes you smoked, for how many years and when you stopped. Ask for your blood pressure, cholesterol – including LDL and non-HDL cholesterol – and blood glucose or HbA1c to be checked. Family history, weight, kidney health and symptoms should also form part of the assessment. Lipoprotein(a), an inherited cardiovascular risk marker, may also be worth discussing, particularly where there is premature heart disease in the family.” Keep a gentle regular exercise regimen Consistent exercise is more valuable than suddenly pushing yourself through punishing workouts, he adds. Aim for at least 150 minutes of moderate aerobic activity each week (or 30 minutes on five days), such as brisk walking, cycling or swimming at an intensity where you can still speak in sentences but would struggle to sing, alongside two resistance-training sessions. “Once somebody has built a fitness base, one or two carefully controlled sessions containing short, faster intervals may help improve cardiovascular fitness,” Lo Monaco continues. “However, a former smoker who develops chest pressure, unusual breathlessness, dizziness, palpitations or a marked reduction in exercise capacity should stop and seek medical assessment, rather than trying to train through it.” Prioritise fibre Lean towards a heart-health promoting Mediterranean-style diet of plenty of vegetables, fruit, beans, lentils, wholegrains, nuts, olive oil and fish, while reducing processed meat, heavily salted food, refined carbohydrates and excess saturated fat, he advises. “Fibre is particularly useful for cholesterol management.” Give your bones extra attention Smoking can increase your risk of developing osteoporosis and breaking bones, explains Kirsty Carne, senior osteoporosis nurse at the Royal Osteoporosis Society. “It affects bone health in several different ways, including changing the way bone cells are renewed, causing you to lose more bone than you replace. It can also affect blood flow to the bones, reduce the amount of calcium you absorb, and affect hormones and other chemicals in the body that help maintain bone health. In women, it can also cause an earlier menopause – increasing the risk of osteoporosis and breaking a bone.” Doing impact (also known as weight-bearing) exercise such as walking, stair-climbing, jogging, jumping, dancing or playing tennis, as well as strength exercise (with resistance from either your own body weight, a resistance band or weights) is crucial. Get at least 700mg of calcium each day from your diet; keep alcohol intake within guidelines (as a high intake can significantly increase your risk of osteoporosis and broken bones), and consider a vitamin D supplement from autumn to early spring. The ROS Great British Bone Check helps check your risk to see if you should discuss bone health with your GP. See the hygienist regularly The more you smoke – and the more years you do it – the higher your risk of periodontal (gum) disease and oral cancer, points out Dr Charlie Paterson cosmetic and implant dentist at Ten Dental. Smoking can hide the warning signs of gum disease, he explains, as nicotine narrows your blood vessels, stopping your gums from bleeding when they are inflamed. “Even one or two cigarettes a day, or occasional smoking on a night out alters your body’s oral immune system and lowers your body’s defenses from protecting your teeth and gums from harmful bacteria which can lead to irreversible gum disease.” Quitting smoking significantly helps to prevent gum disease progression, he adds. “Within weeks, blood flow returns to your gums. This camouflaging effect of smoking on your gums is reversed, and highlights the areas which require improved at home oral hygiene and professional cleaning from your hygienist. Bleeding is a sign of inflammation of the gums, and it can take weeks or months to stop. Long-term, your risk of oral cancer drops significantly over time after giving up.”