I know the topic of smoking and drinking is controversial, and I hope that this post is not taken as an invitation to start puffing packs a day and downing pints of beer like water. Yet, there is something in the habits of extremely long-lived and healthy people that flies in the face of mainstream medicine and piques my curiosity. On one hand, there is strong evidence that chronic exposure to the aromatic hydrocarbons present in any smoke is carcinogenic, confirmed in many thousands of people who have worked in forest management (controlled fires), furnace/metallurgy workers, chimney sweepers, etc. On the other hand, the evidence for natural tobacco (no additives) smoking is a lot less convincing, even if we factor in the obvious ghostwriting and sponsored studies by the Big Tobacco companies questioning the dangers of smoking. There is also the curious fact that the World Health Organization (WHO) deliberately excludes countries with high tobacco consumption from its reports on cancers and longevity. For instance, not many people know that Caribbean countries, on average, have some of the highest tobacco (and alcohol) consumption per-capita in the world, yet have much lower rates of lung and other cancers, and also have some of the highest numbers of centenarians per-capita in the world. Other countries with a high number of centenarians also seem to have higher rates of smoking (and drinking). In addition, many of the world’s so-called super-centenarians were heavy smokers (and drinkers) throughout their lifetimes. Perhaps the most famous example is former UK Primer Minister Winston Churchill who was a heavy cigar smoker all his life, detested exercise, and was a heavy drinker as well, yet lived well into his nineties despite many of his relatives dying much younger (so genes were probably not a factor).
https://www.bbc.com/news/world-africa-44224484
https://www.biorxiv.org/content/10.1101/704080v3.full.pdf
“…The supposed enrichment for extreme-age survival in BZs is then subject to a host of secondary claims, each aimed at explaining the primary pattern of extraordinary longevity. Old-age survival in the BZs is supposed to result from diverse causes such as ‘moderate’ drinking at twice the NHS heavy-drinking guidelines[28], plant-based diets[25–27] and inbreeding[12,13].”
“…However, according to the national statistics bureau of Japan, only 3.9% of Japanese women and 19.3% of men over the age of 80 are smokers[56]. Tokyo centenarians therefore smoke at around twice the rate that could be expected in a younger, 80+year old cohort with an identical sex ratio. Likewise, 80% of the ‘exceptional’ health-status centenarian population were daily drinkers, followed by 49% of the ‘normal’ and less than 40% of the ‘frail or fragile’ centenarians, resulting in “a [significant] positive relationship between drinking habits and functional status”[55]. In contrast with these figures, Japanese government surveys estimate only 2.8% of women and 23% of men aged 80+ drink every day[56]. Daily drinking peaks at 36.7% in men aged 60-69, the heaviest-drinking cohort in Japan[56]. As such, Tokyo centenarians drink at higher rates than any other age group, and smoke at rates equal to a 45-year younger population[56].”
I think there is a play by Woody Allen about a man who falls in coma for decades only to wake up in a hospital at some point in the future and be presented with lit cigar/cigarette by a nurse and upon seeing his shocked face, the nurse exclaims something along the lines of “Please go ahead, it just tobacco. The healthiest remedy known to man.” On a more recent, and grim, note – we do have the extensive data from the COVID-19 pandemic demonstrating convincingly that smokers has a much lower chance of both falling ill with COVID-19, as well as deteriorating and dying from it.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10306417/
“…A case-control study from Mexico included 32,583 patients (12,304 COVID-19 positive cases and 20,279 COVID-19 negative controls) of which 2.3% of cases were smokers and 4.3% of controls had a history of smoking [65]. This study not only concluded that active smokers had a decreased likelihood of developing COVID-19 (females, adjusted OR = 0.49, 95% CI: 0.31–0.78; males, adjusted OR = 0.64, 95% CI 0.51–0.81) but also suggested that nicotine in tobacco might have a therapeutic effect.”
And finally, there is the curious example of a medical student from the UK, who had debilitating ulcerative colitis (UC) – a disease considered “incurable” by medicine – that went away for good when he started smoking a few cigarettes a day.
“…Stephen Pendry, 23, struggled with crippling pain, tiredness, shortness of breath and dehydration since he was diagnosed with ulcerative colitis four years ago. But he is now completely symptom-free, thanks to a new four-a-day cigarette habit. Doctors are divided over benefits of patients smoking to combat symptoms – some believe nicotine is the healer so patches, and not cigarettes, are way forward”.
So, how can the bioenergetic theory attempt to explain any potential benefits of smoking? Well, for a start, many of the main psychoactive tobacco ingredients (e.g. nicotine, cotinine, anabasine) are aromatase inhibitors.
https://pubmed.ncbi.nlm.nih.gov/3711333/
In addition, it seems that most of the studies that demonstrated detrimental effects from tobacco or nicotine were in-vitro, yet the effects of nicotine/tobacco seem to be the opposite in-vivo, at least in amounts that would constitute smoking a few cigarettes a day. Perhaps most importantly, nicotine seems to be able to strongly blunt the systemic inflammatory effects of endotoxin/LPS, including in humans. Assuming endotoxin/LPS is the main driver of many/most chronic diseases, the anti-estrogenic and anti-endotoxin effects of nicotine (and some other tobacco ingredients) may explain its cumulative effects on promoting longevity, despite the known and undisputed carcinogenic effects of the actual smoke from the burning tobacco.
https://channel.ersnet.org/media-52743-converse-airway-effects-of-nicotine-iin-vitroi-and-iin-vivoi
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.826889/full
https://pubmed.ncbi.nlm.nih.gov/17177960/
“…Because a prototypical ligand for this receptor is nicotine, we studied the in vivo human response to bacterial endotoxin or lipopolysaccharide (LPS) in the context of nicotine or placebo pretreatment. Twelve adult male normal subjects were studied prospectively. Six received overnight transcutaneous nicotine administration by application of a standard patch (7 mg). Six hours later, all subjects were given an intravenous dose of endotoxin (2 ng/kg) and were evaluated for an additional 24 h for circulating levels of inflammatory biomarkers, vital signs and symptoms. The nicotine subjects had elevated blood levels of the nicotine metabolite, continine, prior to and throughout the 24-h post-endotoxin exposure phase. Subjects receiving nicotine exhibited a significantly lower temperature response as well as attenuated cardiovascular responses for 2.5-6 h after LPS exposure. In addition, increased circulating interkeukin (IL)-10 and cortisol levels were also noted in nicotine subjects. These data indicate an alteration in LPS-induced systemic inflammatory responses in normal subjects exposed to transcutaneous nicotine. In this model of abbreviated inflammation, nicotine exposure attenuates the febrile response to LPS and promotes a more prominent anti-inflammatory phenotype.”
Interestingly enough, one of most renowned healers in the Amazonian region – the birthplace of tobacco – used tobacco almost exclusively to heal almost any disease known to man. A key fact to note in his work was that all the tobacco-based remedies he used were used orally and/or topically, but never through smoking.
https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2020.594591/full
“…Harmful usage of tobacco is a public health problem of global concern and, in many countries, the main risk factor for non-communicable diseases. Yet, in the Peruvian Amazon, the geographical region believed to be tobacco’s historical birthplace, this plant is associated with a strikingly different usage and repute: Tobacco (especially Nicotiana rustica L.) in this area is described as a potent medicinal plant, used topically or via ingestion to treat a variety of health conditions. The goal of this transdisciplinary field study was to investigate clinical applications of the tobacco plant as per Amazonian medicine exemplified in the practice of a reputed Maestro Tabaquero, an Amazonian traditional healer whose medical specialization focuses on tobacco-based treatments…The current study described Amazonian therapeutic uses of tobacco (N. rustica L.) in the practice of a Maestro Tabaquero, an accomplished Amazonian healer specializing in tobacco-based treatments. The informant’s descriptions revealed refined knowledge on the plant’s therapeutic scope and properties, safety profile, and application techniques. A liquid remedy taken orally was his most commonly used preparation, with reported acute/sub-acute effects involving a pronounced psychoactive component (altered state of consciousness) and physiological response (emesis, intoxication, Spanish: “mareación”). A skilled tabaquero that knows how to diagnose, dose, administer, and intervene in case of adverse effects was described as imperative for safe treatment delivery; tobacco ingestion otherwise may be dangerous. The main indications mentioned by the informant included problems of the mind, of the respiratory system, parasitic illnesses (intestinal/skin), gout, and Amazonian epistemic conditions described as spiritual-energetic in nature.”
And last, but not least, smoking has been shown to inhibit (mostly) MAO-B, which of course results in higher dopamine levels. This pro-dopamine effect of smoking may be the reason for the known lower risk of Parkinson Disease (PD) in smokers and other users of tobacco products. Furthermore, the MAO-B inhibitor selegiline (Deprenyl) is one of the few proven anti-aging agents in humans, and is known to be used by various celebrities, politicians and other social elites for lifespan extension and retarding aging. This effect of smoking/tobacco may be a major reason behind any potential life-extending effects seen in smoking super-centenarians.
https://pubmed.ncbi.nlm.nih.gov/16177026/
https://pubmed.ncbi.nlm.nih.gov/36051642/
https://doi.org/10.1371/journal.pone.0007959
So, maybe that’s the main message here – unmodified tobacco may be indeed a highly beneficial natural remedy, with the benefits present mostly in using the plant through means that do not produce carcinogenic byproducts (e.g. smoking). However, even when smoked it seems that tobacco may still be a good “doctor” (see medical student with UC story above), despite doctors uniformly condemning tobacco/smoking as one of the biggest evils of the modern lifestyle. I wonder how many of the harms of even smoking are due not so much to the undeniably carcinogenic smoke, but to the toxic additives present in the vast majority of commercially sold cigarettes/cigars. The toxic ammonia and the carcinogenic flame retardants that are now mandated in commercial tobacco products by law may very well turn out to be a much bigger villain than the humble leaf from Amazonia.
