Cigarette smoking-nutritional implications.

Although the effects of cigarette smoking on a variety of diseases, from cancer through emphysema and cardiovascular illness are well documented, direct effects on the levels of macro- and micronutrients in the body are reported less frequently. In fact, imbalances in these nutrients may have a role in many of the pathological conditions attributed to smoking. Tobacco smoke contains numerous compounds emitted as gases and condensed tar particles, many of them being oxidants and prooxidants, capable of producing free radicals thus enhancing lipid peroxidation in biological membranes. Vitamin E, vitamin C, B-carotene and selenium are involved in the overall cellular anti-oxidant defense against deleterious effects of reactive oxygen species. Smoking has been shown to lower the level of vitamin C and B-carotene in plasma. Cadmium, naturally found in tobacco, decreases the bioavailability of selenium and acts antagonistically to zinc, a cofactor for the antioxidant enzyme, superoxide dismutase. Vitamin E, the principle lipid-soluble antioxidant, may be at suboptimal levels in tissues of smokers. In addition, tobacco constituents have been shown to reduce levels of several vitamins of the B-complex. Nutritional status in smokers may be further compromised by an inadequate diet. Data from the Second National Health and Nutrition Examination Survey indicates that smokers are less likely to consume fruits and vegetables, particularly those high in vitamin C and carotenes. Cessation of smoking is the obvious solution to ending cigarette-related problems. In the world as it is, however, the medical community should be responsible for making recommendations to lower the risk in smokers to tobacco related diseases. Nutritionists could have a role in this process. There exists a lively debate as to where levels of nutrients should be set. Additional vitamin C has already been recommended for smokers. Should other antioxidants also be increased? Arguments for the against are considered.