Moms and Smoking; Apple Juice and Colon Cancer; Green Tea and Skin Cancer 

by Robert A. Wascher, M.D., F.A.C.S.


The British Medial Journal: By now, everyone knows (or should know) that nicotine is enormously addictive, and that smoking is the single greatest cause of preventable disease and death in the world. It is also common knowledge that smoking during pregnancy subjects a mother’s unborn baby to the very same genetic mutations that are known to arise in smokers. Moreover, other complications now known to be associated with smoking by pregnant mothers include abnormal development of the placenta, low birth-weight, cleft palate and cleft lip, and a doubling of the risk of babies dying from Sudden Infant Death Syndrome (SIDS). Asthma, learning disabilities and behavioral disorders are among the other long-term ailments that have also been strongly linked to smoking during pregnancy, and smoking following delivery.

In view of these seemingly incontrovertible facts, I am always stunned and, I must confess, angry when I see an obviously pregnant woman smoking (i.e., as opposed to my baseline sense of astonishment whenever I see anyone, pregnant or not, smoking…). Although I certainly understand the potent addictive qualities of nicotine, the obvious and profound conflict between maternal instinct and drug addiction (the arbitrary legality of tobacco in no way detracts from the fact that nicotine is an addictive drug that makes people “feel good”) is so stark, in my mind, that I never fail to become upset when I see a mom-to-be puffing away.

In the face of this enormous conflict between smoking and pregnancy, an interesting new study has looked at the impact of in-home motivational counseling on tobacco cessation among expectant mothers who smoke. A group of 762 pregnant smokers were randomly divided into two groups for the purposes of this study. All of the women received standard health counseling during their prenatal visits, while the 351 women in the intervention group also received regular in-home motivational counseling visits from specially trained midwives. In addition to serially interviewing all of the 762 women regarding their progress with smoking cessation, all of the women also had blood or saliva collected to measure the concentration of a metabolic breakdown product of nicotine.

In this group of smokers who, one would think, should be among the most motivated to quit, only 4.8% in the intervention group quit, while essentially the same number in the control group (4.6%) quit. Thus, in this group of pregnant women, intensive in-home motivational counseling had absolutely no discernible impact on smoking cessation. As surprising as this disappointing outcome might be to some people, the results of this study mirror my own experiences as a physician over nearly two decades now. Smokers subject not only themselves to the well-known health risks of smoking, in order to continue their nicotine addiction, but many of them also choose to subject their children (born and unborn) to the same severe health risks as well….


Carcinogenesis: There is a great deal of research underway at this time, looking at how dietary and supplemental products might help to prevent disease, including cancer. Unfortunately, most of this research has either not found significant health benefits for such products, or the apparent benefits observed in a culture dish in a lab, or in mice, have not been successfully reproduced in humans as of yet. (Indeed, this area of research is so confusing, and seemingly contradictory, to most people, that I am currently writing a book on the subject: “What You Don’t Know Can Kill You: A Clinically Proven Plan to Reduce Your Risk of Dying from Cancer!”) Because of these factors, it is wise to approach each new research paper with a healthy bit of skepticism. However, studies that look into the biochemical effects of products and substances thought to have anticancer effects are of special concern to me, as much of the clinical literature looking at cancer prevention in humans is survey-based and, consequently, the results of such studies are not very compelling, scientifically.

Unfiltered apple juice, containing more of the solid components of apple pulp than filtered, or clear, apple juice, was tested in rats in an effort to identify any anticancer properties in the colons of these animals. Rats were randomized to receive drinking water alone, clear filtered apple juice, or unfiltered cloudy apple juice, while receiving injections of a chemical known to cause colon cancer in rodents. After 7 weeks, microscopic examination of the animals’ colonic lining was undertaken. Under the microscope, specific precancerous changes in the cells of the rats’ colons were significantly less common in the animals that had consumed the unfiltered cloudy apple juice when compared to the animals that had consumed plain water or clear filtered apple juice. At the same time, other specific premalignant changes were less common in all of the animals that received apple juice, both filtered and unfiltered. This is an interesting finding, as both filtered and unfiltered apple juice are rich in compounds known as polyphenols, which are thought to have anticancer activity. The findings of this study, therefore, suggest that there may be other important compounds within the pulp of apples that, likewise, possess potential anticancer properties. Although the findings of this study are a very long way from proving that apple juice, whether filtered or unfiltered, might reduce a person’s risk of developing colon cancer, it is still a very interesting little study, and additional similar studies should be undertaken with human volunteers.


Carcinogenesis: Another dietary supplement that has garnered considerable attention within the cancer prevention community is green tea, which, like apples, is also known to be rich in polyphenols. A new study, involving mice, looked at the effects of green tea, and caffeine, on the prevention of early precancerous changes in the skin of mice subjected to intense ultraviolet light (UVL) skin exposure. Mice were treated, alternatively, with oral green tea or oral caffeine solution during the period of UVL irradiation, and their irradiated skin was then analyzed under a microscope, looking for characteristic mutations in a protein known as p53, which is an early event in the development of UVL-induced skin cancer. This study found that, compared to a group of mice that received only water, the mice that consumed either green tea or caffeine experienced a 40% reduction in the number of precancerous patches within UVL-exposed skin. Once again, this is an interesting laboratory study in nonhuman animals, and the findings of this elegant little study may not effectively translate into humans. Still, the results of this experiment raise the possibility that oral green tea or caffeine supplements might reduce the early precancerous changes in UVL-exposed skin when taken at the time of exposure. As always, however, avoidance of the sun’s rays, particularly during peak UVL periods, between 9 AM and 4 PM, is the best method of preventing UVL-induced skin cancer, especially in fair-skinned individuals.


Circulation: The so-called Metabolic Syndrome refers to a constellation of abnormalities that include obesity, abnormal cholesterol levels, high blood pressure, and elevated sugar in the blood (sometimes also referred to as “insulin resistance,” or “pre-diabetes”). Following the recent explosion in both adult and childhood obesity in the United States, the prevalence of the Metabolic Syndrome in both populations is the subject of much concern within the public health community. This syndrome is associated with a very high incidence of subsequent cardiovascular disease, to include stroke, as well as diabetes, high blood pressure, and early death.

A new study, involving 2,273 adolescent subjects ages 12 to 19, evaluated the presence or absence of household smokers, the self-reporting of smoking by the adolescent subjects, and the measured blood levels of nicotine byproducts in the blood of the adolescents. Among the adolescents with no tobacco exposure (either firsthand or secondhand), 1.2% met the criteria for Metabolic Syndrome. Among the kids exposed to secondhand smoke alone, 5.4% met the criteria for Metabolic Syndrome. Among the subjects that smoked themselves, 8.7% met the criteria for Metabolic Syndrome. Following statistical analysis to balance other risk factors (e.g., diet, level of exercise, family history of cardiovascular disease or diabetes, etc.), adolescents who were chronically exposed to secondhand smoke were found to have nearly 5 times the risk of developing Metabolic Syndrome when compared to kids who were not exposed to tobacco smoke in any form, while adolescents who actively smoked themselves were at more than 6 times the risk of developing Metabolic Syndrome.

Given that smoking and obesity are the two leading causes of preventable death in the United States, the finding that exposure to tobacco smoke, both firsthand and secondhand, is associated with an increased risk of the Metabolic Syndrome is ominous, indeed….

Dr. Robert A. Wascher

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