Cigarette Smoking Cessation

On July 4, 2011, the New York Times Business section reported that a new study of the popular prescription medication used to treat cigarette smoking cessation, Chantix, revealed that an alarming cardiovascular risk was associated with this drug, and that the FDA would surely have to call for Chantix to be taken off the market. The research by the Center for Drug Evaluation and Research, with Dr. Celia Winchell lead researcher, and Dr Curt D. Furberg, a Wake Forest professor of medicine, the senior author, analyzed 14 randomized clinical trials involving 8200 patients, and found that one extra cardiovascular event could be expected per 28 patients treated, with serious cardiovascular events (serious stroke and heart attack) occurring at a rate of 1.06 percent of Chantix users, compared to a rate of 0.82 percent in the study population of smokers without cardiovascular history receiving placebo versus Chantix. Dr. Furberg stated: "We have known for many years that Chantix is one of the most harmful prescription drugs on the U.S. market, based on the number of serious adverse events reported to the FDA. It causes loss of consciousness, visual disturbances, suicides, violence, depression and worsening of diabetes. To this list we can add serious cardiovascular events." Other experts, such as Dr. J. Taylor Hays of the Mayo Clinic, who has been paid by the drug manufacturer, Pfizer, to study Chantix, stated that the benefits of quitting smoking still outweighed the risks. Many patients, now aware of these serious potential risks, are again looking to Complementary and Integrative Medicine (CM/TCM) to both provide a safer alternative to the treatment that is proven effective, and to decrease the potential for risk of serious health problems when using Chantix.

Many patients still have serious problems quitting cigarette smoking, failing even pharmaceutical treatment. Complementary Medicine has long been acknowledged, even by local, state and federal government agencies, as an effective tool to help the patient quit smoking. Acupuncture, combined with herbal and nutrient medicine, and cognitive and behavior therapies, such as group therapy for quitting addiction, has been acknowledged as a proven aid to smoking cessation for decades. Utilizing this therapy, of course, is more work than taking a pill, but is perhaps more effective, and of course, very safe.

The research cited above, analyzing 14 human clinical trials, found that only one in ten patients quit smoking with Chantix prescription over the rate of smoking cessation with placebo. This means that many patients still trying to quit have found no success with prescription drugs. Although acupuncture and herbal medicine is not highly advertised for smoking cessation, it has been mandated as part of addiction treatment in prison systems and is widely utilized in many medical clinics across the United States. The patient must understand, though, that quitting smoking successfully involves a serious and thorough effort for a few weeks, with multiple acupuncture treatments per week, and consistent use of herbal and nutrient medicines to achieve a variety of physiological and psychological goals. The cost and time have discouraged many patients, and unlike pharmaceutical treatments, the insurance is reluctant to pay for this therapy. Nevertheless, clinical success rates have been reported to be very high for patients following through with a comprehensive protocol. Many patients have utilized free drop-in acupuncture clinics to help offset the cost of this treatment, using both their primary acupuncturist and the free clinic to succeed at a more reasonable cost out of pocket.

The use and promotion of e-cigarettes as a way to quit smoking has been widely adopted, yet we are soon seeing that health experts around the world are acknowledging the harm in this approach as well. Using e-cigarettes as a temporary aid to quitting nicotine and cigarette addiction completely, or as a means of achieving a very modest use of e-cigarettes and actual cigarettes that would come with little risk, is sensible and safe. Allowing oneself to be addicted to e-cigarettes and adopt a habit of overuse comes with considerable risk and adverse health effects is very unsafe. Although this technology is new and thus not yet subjected to the extensive human clinical trials that sometime take decades to complete, we do know for a fact that 'vaping' comes with considerable health risk, despite all the industry propaganda. One should note that the tobacco industry was also able to delay the admission of harm with cigarette smoking for decades, but eventually was faced with enormous fines and criminal convictions, and enormous rulings of harm in court cases, and is doing the exact same thing with e-cigarettes. This may be profitable in the long run, just as the enormous sale of addictive cigarettes with chemical additives to increase addiction was very profitable, despite the eventual findings and payments for human harm, but individuals should see past this play for what it is. This article contains information on 'vaping' that should be read.

How acupuncture works to treat cigarette addiction

Traditional Chinese Medicine (TCM) does not promote a notion that acupuncture, or even a comprehensive approach with combination of treatment protocols, forces the patient to quit smoking, or guarantees that a patient can quit smoking without actually successfully adopting a cognitive and behavioral change in smoking desire and habit. TCM promotes acupuncture as an aid to the patient that is seriously changing their attitude, cognition, and behavior to achieve smoking cessation, and provides counseling in this regard. Nevertheless, many studies have demonstrated how various acupuncture treatment protocols are proven individually successful in this regard. Other studies, of course, have shed doubt on these individual protocols. Current studies are using an observational comparative effectiveness research (CER) model to measure the effects of acupuncture within various simple holistic and integrated treatment protocols. The intelligent patient understands that a comprehensive combination of treatment protocols, delivered by a competent Licensed Acupuncturist and herbalist, is the correct choice to utilize when they actually are motivated to adopt the cognitive and behavioral changes that are needed to finally quit smoking for good. In other words, there is usually no quick fix or magic bullet in medical treatment. It takes work on the part of the patient and often a comprehensive treatment protocol to succeed. The good thing is that a comprehensive treatment involving acupuncture has the added benefit of improving overall health. In my clinical practice, almost all patients, when informed that they will actually have to put in the work to quit, keep putting off the actual period of smoking cessation, and instead work on other health problems. We are conditioned to believe that quitting smoking should be easy, yet also conditioned to believe that cigarette addiction is perhaps impossible to overcome.

Many human clinical scientific studies have evaluated acupuncture as a treatment for cigarette smoking cessation since the early 1990s, with both positive and not-so-positive results. The not-so-positive results found that a comparison of a specific acupuncture treatment protocol applied to all patients, compared to a so-called placebo, or sham acupuncture treatment, did not show "significant" statistical benefits over the sham treatment. What these negative studies failed to express in their summaries, was that the success rates were fairly high with both the so-called "real" and "sham" acupuncture treatments, and that the study design did not reflect the actual clinical practice in reputable treatment. Such study design is often manipulated and misleading. In a skilled professional setting, a Licensed Acupuncturist and herbalist utilizes an individualized treatment approach, manipulation and stimulation with the needles, both ear and channel point selection that is not universal to all patients, and combines this aspect of the therapy with herbal and nutrient medicine, as well as advice to the patient on how to cognitively and behaviorally enhance their chances for success, perhaps even utilizing a group setting in a free clinic as well as the primary treating physician.

What these analyses of acupuncture studies have consisted of in U.S. medical journals are reviews of a small number of inadequate studies that reviewed a free clinic style of quick ear acupuncture treatments, which the acupuncture, or TCM, profession has been tricked into believing is an adequate way to approach this difficult treatment problem. While the quick free clinic ear acupuncture production line may be helpful, it is, by no means, the best way to provide comprehensive treatment for patients with difficulty trying to stop the habitual return to smoking. These analyses also failed to reveal that in all cases, the simple ear or facial acupuncture, without individualization or needle manipulation, did outperform no treatment, and consistently produced as good of results as standard therapy utilizing behavioral modification clinics that cost a lot of money. These ear acupuncture protocols were free. A 2008 meta-analysis by the esteemed Cochrane group and Wiley corporation reviewed a number of studies and found more positive results. For example, a review of 2 randomized clinical human trials comparing to no treatment, and analyzing late effects of the therapy, the outcomes with simple acupuncture protocol was 2-4 times as great as the patients with no treatment on a waiting list. For patients having a difficult time quitting, no treatment strategy has been widely effective, pharmacological, nicotine replacement, or counseling alone. TCM presents a healthy package of care that can simultaneously help with smoking cessation and work on other health problems and preventive medicine at the same time, and has none of the adverse side effects of Chantix and other drugs.

Still, the successful outcomes over time with simple standardized acupuncture alone were low, with about 10 percent succeeding to stay off cigarettes. This implies that a more comprehensive protocol is needed, and perhaps repeated attempts on the part of the patient. The patients that are "trying" to quit and superficially seeing if there is a very simple way to stop smoking without actually working at it usually fail. Reviews of late outcomes with Chantix were also poor, and short term outcomes were much more impressive. In reality, the long-term cessation of the cigarette habit for patients with a strong habituation response may be best when the patient takes a more pro-active role, incorporating a program with acupuncture, herbal medicine, and a sound cognitive and behavioral approach, and is persistent. The Mayo Clinic website promoting Chantix as the best protocol suggests as much, stating: "Therefore, the best candidate for Chantix is someone who's determined to quit smoking." These doctors state that it is extremely difficult to quit an addiction, and even more difficult to cope with the after effects, and most patients, no matter what the strategy, try to quit time and time again. The actual figures of long-term outcomes with Chantix are not presented on these websites. Short-term outcomes are described as excellent, and side effects and long-term risks are downplayed. The integration of acupuncture to treat the after effects of quitting smoking, after 12 weeks of Chantix, and to address the long-term risks posed by the drug, may also be an important consideration for many patients. Integration of short courses of acupuncture with more prolonged herbal and nutrient medicine and positive reinforcement of healthy habits may actually be the key to success.

An analysis of 12 clinical human trials of acupuncture in the treatment of smoking cessation, performed in 2011, found that subjects who received real acupuncture had more success in quitting smoking in the short-term than those receiving so-called "sham" acupuncture (Whites A, et al, Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2011;(1):CD000009). One study of 141 patients found that acupuncture combined with patient education was twice as effective as the so-called "placebo" acupuncture, and four times as effective as the use of acupuncture without the patient education. Acupuncture needs to be part of a broader treatment protocol. Acupuncture alone was found as effective as the nicotine replacement and psychological interventions, though. These studies can be seen with links in Additional Information below. The evidence indicates that a holistic and comprehensive approach, with follow-up for patients with a tendency to relapse, is the logical approach in Complementary Medicine. Many patients realize that they do not have an addiction or habituation that is easily treated, and so require a more comprehensive and persistent approach.

While many patients assume that the goal of acupuncture in cigarette or nicotine withdrawal is to turn off a switch that prompts an addictive reinforcement, this is a gross simplification of the therapeutic process. There is no switch. Acupuncture, though, is very effective to counter the somatic and psychological withdrawal symptoms, which are different from one individual to another. Typically, a patient may experience irritability, anxiety, depressed mood, unease, increased appetite, increased reactivity to external stimuli, difficulty concentrating, gastrointestinal discomfort, and a sluggishness, often with a slower heart rate due to lack of nicotine stimulation. Acupuncture may stimulate a number of systems to help adapt to these changes during a period that is crucial to achieve normalization of mood and physical well being. Of course, the patient should be aware that during this period of withdrawal, some changes in routine and behavior are very important, as well as cognitive recognition of symptoms adaptation to this stress during a period of withdrawal. TCM physicians that treat addiction instruct the patient to avoid excess personal, social and business contact for a few weeks, concentrating on adapting to a changing state of mood in a positive manner. Avoidance of external stimuli and stress is very important, and establishing an environment of calm, quiet, focused activity, and stress reduction, as well as getting enough rest, and eating a simple diet may all be important. Informing those around you that you may be irritable and moody beforehand, and may not be able to accomplish as much during this period is advisable. Family, friends and coworkers need to understand and be supportive for your health, and not be surprised and irritated by your bad mood and inability to function normally.

The most common explanation for the positive effects of acupuncture in withdrawal syndromes is the stimulation of opioid neurotransmitters, such as endorphins and dynorphins. Nicotine is shown to stimulate increased levels of these opioid neurotransmitters in the key centers of the brain associated with nicotine effects, and a repeated acupuncture stimulation may offset the sudden withdrawal of nicotine stimulation. This is one reason why a frequent acupuncture session may be more effective. Activation of the hypothalamic beta-endorphin system may also be involved in mediating the positive reinforcing effects of nicotine, and acupuncture is proven to have a significant effect on the hypothalamus with specific stimulations, especially with electroacupuncture. Acupuncture and electroacupuncture is shown to stimulate the amygdala and limbic portions of the brain in a modulatory manner as well, and this could be especially important to decrease the withdrawal symptoms and establish a more well controlled emotional state. A 2011 study at Kyung Hee University, in Seoul, South Korea, measured not only the ability to quit smoking, but the autonomic responses to patient cues or triggers that increased their desire to have a cigarette, using a heart monitor. The single acupuncture point HT7 significantly outperformed a sham acupuncture stimulation at a different location, and significantly reduced the strength of the response to smoking triggers or cues (PMID: 21195289). We see that an array of effects may be involved in explaining how acupuncture stimulation can help one to quit smoking.

How herbal and nutrient medicine works to treat cigarette addiction

An herbal chemical in the Chinese herb Lobelia chinensis (Ban bian lian), lobeline, has been touted for some years as a analog of nicotine that may fool the body and mind into believing that nicotine is being taken, thus providing an herbal nicotine replacement therapy. Chinese research made clear, though, that this herbal chemical was not a clear analog of nicotine, but worked to perhaps fool the nervous system in another way than a strict biochemical substitute. Lobeline acts mainly on the medullary system and ganglia in the central brain, as well as the adrenal medulla, and is a nicotinic receptor ligand, meaning that it binds to nicotine receptors to stimulate and block the actual nicotine effect. The herbal chemical does not stimulate the body with a nicotine-like effect whatsoever, although there is a marked decrease in the craving for nicotine observed in scientific studies, as well as the craving for methamphetamine. This research led to the study of biochemical triggers in the brain related to addiction, and may have been integral to the research that led to the discovery of Chantix as as pharmaceutical that acts like lobeline. In the U.S. lobeline was explained to patients as an herbal substitute for nicotine, though, to make the explanation easier for the patient to understand. To date, we still do not know exactly how either lobeline or Chantix works in the central nervous system. Lobelia is used as just one of several herbs in a formula that is highly utilized and studied in China for addiction, including cigarette and amphetamine addiction.

Melatonin is a nutrient chemical with evidence-based support for reducing nicotine withdrawal symptoms during treatment for cessation of smoking (Pharmacol Biochem Behav. 2001;67:131-135). Again, the central mechanisms are still not well understood, but theories abound to explain this positive effect of the neurotransmitter melatonin on reducing nicotine withdrawal symptoms. By reducing symptoms, the act of quitting smoking is made easier, and this is the principle goal in Traditional Chinese Medicine (CIM/TCM), to help make the act of quitting smoking easier. Unfortunately, melatonin is a strongly regulated chemical neurotransmitter, antioxidant, and cell signaler in the body, and a comprehensive array of herbal and nutrient chemicals may be needed to help the brain modulate an optimal melatonin balance. This array includes P5P, 5HTP, and St. Johns wort, at low dosages. Such a nutrient medicine should be utilized in the smoking cessation therapy for many patients.

Other herbal and nutrient medicines undergoing future clinical trials include passionflower, gotu kola, skullcap, beta-carotene, B12, and folate (5MTHF). The herbal chemical cysticine (cytisine), from the seeds of Laburnum anagyroides has also been studied and touted in Eastern Europe, although a mild toxicity is involved in this herb, and careful professional herbal prescription is necessary to insure safe use. As is typical, the studies cited in Western medical journals of this herbal chemical have misspelled the actual chemical name, and cytisine is the known component of Laburnum anagyroides, or Golden Chain Tree seed and flower. Cytisine is listed in the USDA phytochemical database as an antiinflammatory, psychoactive, respirastimulant and hallucinogenic with mild toxicity. The whole plant extract also contains genistein, a common beneficial isoflavone found in many plants and foods. Cytisine is also found in the safe and common Chinese herb Sophora flavescens (Ku shen), now widely used to enhance anti-arrhythmic formulas, and formulas to treat tachycardia. The psychoactive and toxicity profile of Sophora flavescens is very mild, and normal dosage has no discernable effects in this regard. The TCM physician may utilize a safe and effective formula with Sophora extract, taurine, berberine (similar to skullcap), magnesium taurinate, and ginseng (Vitamin Research Products CardioRhythm). While such herbal and nutrient protocols by themselves may not induce a sure cessation of smoking, they are proven valuable aids that are healthy and should be part of a more comprehensive protocol.

Since the mechanisms of nicotine stimulation involve stimulation of dopamine release in key centers of the brain, the use of dopaminergic herbs during withdrawal from nicotine may be helpful as well. The sudden lack of dopamine stimulation may account for a number of the symptoms of withdrawal. The USDA Dr. Duke's Phytochemical and Ethnobotanical Databases list a number of dopaminergic herbs and foods, including Uncaria tomentosa (Cat's Claw / Gou teng), Alisma plantago (Ze xie), and oats, soy, barley, Mate leaf tea, lentil, alfalfa, rice, avocado, pea, cacao, wheat, and fenugreek. Of course, some of these foods will have a small dopaminergic activity. Dopaminergic chemicals are also found in a number of Chinese and Western herbs as well, and the professional herbalist may be able to utilize specific herbs or formulas to achieve this goal. Mucuna pruriens and Muira puama are well studied dopaminergic herbs, and Rhodiola rosea (Hong jin teng) is shown to improve dopamine optimization.

A commonly used formula to help in the process of nicotine withdrawal is composed of Houttuynia Cordata (Yu xing cao), Polygala Tenuifolia (Yuan zhi), Agastaches Rugosa (Huo xiang), Ginseng (Ren shen) and Mentha haplocalyx (Bo he, or field mint). Houttuynia cordata is traditionally a heat, or inflammation clearing herb, but studies have shown that it may have anticancer properties, antitussive effects, and may promote tissue regeneration. The herb also contains the potent antioxidant glycoside quercitrin, which promoted vasodilation and diuresis, and that the essential oil in the plant easily breaks down into a complex form similar to the synthetic compound houttuynium, which is shown to mainly metabolize in the lung, and is useful to clear lung inflammation and unhealthy tissue. The combination of Houttuynia and Polygala has been the major herbal combination to treat addiction and nicotine withdrawal in China for some time. Polygala tenuifolia contains a potent expectorant and is observed to have a sedating and tranquilizing effect on the central nervous system. The other herbs, ginseng, field mint and agastaches, are supportive of lung health, calming of the nervous system, and calming of the stomach and intestinal tract. Agastaches has also been shown to stimulate clearing of toxins, increasing superoxide dismutase, glutathione peroxidase and glutathione. This simple but intelligent combination of herbs helps the patient to deal with withdrawal symptoms and restore the health of the lungs faster. These herbs are found in a number of common Chinese herbal formulas.

Other commonly used herbs included tincture extracts of Valerian and other anxiolytic, or calming, compounds, and various herbs studied in China to help detoxify and circulate the lungs to clear the accumulations of tar and nicotine. There is a theory that nicotine, while normally cleared in a few hours in the body, may accumulate in compounds attached to the tars in cigarette smoke, or in more complex molecules that combine with nicotine. One drug strategy utilizes the tendency of nicotine to bind to a protein, and stimulates this activity chemically to inhibit its crossing the brain blood barrier to counter nicotine effects and fetal neurotoxicity. Another study has found that the binding of copper and nicotine creates a potent antioxidant that may explain why nicotine use seems to decrease Alzheimer risk. All of this type of study is proving difficult, but nevertheless, drug study in a number of countries is proceeding to elucidate chronic nicotine toxicity in relation to reports of adverse events associated with e-cigarette use, where straight nicotine is consumed. The amount of scientific study concerning cigarette chemicals and effects is so large as to obscure specific information when searching. Nevertheless, scientists continue to slowly elucidate the physiology of nicotine adverse effects, as well as other chemicals found in cigarettes that create toxicity.

Pathophysiology of Nicotine Addiction

Although cigarette addiction is not completely understood, a number of aspects have been heavily researched in recent years. Both neurobiological and psychological aspects are involved in addiction, and various neurotransmitter systems, including acetycholine, dopamine, serotonin, glutamate, gamma-aminobutyrid acid (GABA), and opioid peptides have been implicated in both acute nicotine reinforcement and withdrawal from chronic use. Neuroadaptation to nicotine dependence is perhaps the key to the understanding of why one person is able to quit smoking easily and another is not. There is also a potential link between nicotine use and depression and schizophrenia that is being explored. In general, actual physical addiction has not been proven, but a negative affective state generated by nicotine abstinence with chronic dependence is proving to be a viable explanation. This type of scientific study points us to more specific remedies that may be effective, as well as an overall approach that both addresses the dopaminergic and serotonergic systems, systems of stress, and psychological or cognitive aspects creating the negative affective state that many patients get caught in. There is some hyptheses that our history of stressing the belief in actual physical addiction has programmed many patients into a strong belief in this type of addiction and diminished the capacity to change the affective state, or proceed to a positive cessation of smoking.

There are two contradictory assumptions that circulate in the population concerning cigarette or nicotine addiction. One is that nicotine is a relatively benign chemical with a short half-life clearance that cannot accumulate and cause actual physical harm. The other is that nicotine is a chemical that exerts a constant neurobiological state of addiction, and creates a chemical dependency that produces physical and neurological symptoms that make it very hard to quit chronic consumption. The fact that a nicotine or cigarette addict is not able to see the logical contradiction between these two concepts is perplexing. An estimated 25% of the U.S. population habitually smoked in 1993, according to the Substance Abuse and Mental Health Services Administration. Tobacco smoking was touted as a cause of death in over 500,000 mortalities per year in 1988, and contributed to over 40 diseases, according to the United States Department of Health and Human Services. Now, many objective scientists might dispute this fact as overblown, but the contribution of cigarette smoking to ill health and an earlier death, particularly concerning lung cancer, is unquestionable. How much nicotine contributed to this massive health problem in the population, and how much the tars and numerous other chemicals, both natural to tobacco and added by the industry, caused ill health, has not been clearly answered in a public forum. Numerous studies have documented, though, how there appears to be a limiting effect of nicotine absorption from cigarette smoke. Nicotine has a clear toxicity, yet smokers were able to consume many packs of cigarettes a day without a toxic level of nicotine being reached. On the other hand, nicotine is still the focus of the mechanism of chemical dependency with cigarettes.

Nicotine itself has been well studied since the early twentieth century. Nicotine produces positive reinforcing effects that include mild euphoria, increased energy, heightened arousal, reduced stress and anxiety, and appetite suppression, and is shown to both arouse the patient and relax him or her as well. Of course, these are considered positive aspects, and reasons why the individual chooses to smoke. Nicotine abstinence after chronic use has been shown to produce symptoms as well, in both humans and laboratory animals, and here lies the problem. This withdrawal syndrome is characterized by slower heart rate, gastrointestinal discomfort, increased appetite, depressed mood, irritability, anxiety, frustration, increased reactivity to external stimuli, difficulty concentrating, and dysphoria (generalized dissatisfaction or unease). Countering these withdrawal symptoms allows the individual to go through the period of withdrawal more successfully. This is the primary goal of treatment in TCM or Complementary Medicine.

Studies of the neurobiological reinforcing phenomena of nicotine reveal a complexity in the brain that makes a single allopathic pharmaceutical mechanism unlikely as a cure for cigarette addiction. Nicotine activates nicotinic acetylcholine receptors in the brain stem, cortex and limbic systems (mesocorticolimbic), and utilizes the dopaminergic system that projects from the nucleus accumbens and prefrontal cortex (see the article entitled Brain Function on this website to better understand). A number of non-dopaminergic pathways may be involved as well, though, according to a wide number of scientific studies. Nicotine does produce its central nervous and peripheral nervous actions primarily via the nictoinic acetylcholine receptor complex, though, especially receptors that have the Beta2 subunit, which is also linked to dopamine release. Studies of laboratory animals show that mice lacking this Beta2 subunit in the acetylcholine receptor complexes will not self-administer nicotine (Picciotto et al, 1998). Areas of the human brain with more of these types of receptors include the amygdala, prefrontal cortex, VTA and nucleus accumbens. Nicotine appears to stimulate increased dopamine release, as well as other neurotransmitters, and that this dopamine rush affects cognitive function, as well as feelings of reward, motivation, and inhibition of prolactin production, which would decrease need for sleep, and affect the attention, working memory, mood and learning. Increased dopamine with chronic stimulation may also affect the hypothalamus, a principle dopamine secreting nucleus in the brain. Sudden withdrawal of nicotine may upset a new balance reinforced by external dopamine stimulation. Because of this, gradual decrease in nicotine may be more advisable when trying to quit, rather than going "cold turkey".

Dopamine is commonly associated with the reward system in the brain. Normally, a variety of activities stimulates increased dopamine release, including laughing, sex, good food, drugs, and aggression. Amphetamines and cocaine also are found to increase dopamine release in the mesolimbic pathway, but also inhibit the re-uptake of dopamine. Dopamine is thought to be balanced with serotonin in the brain as well, and deficient bioavailability of serotonin is well known to be associated with the mechanisms of mood depression and anxiety. Stimulation of dopamine is thought to be crucial to alleviating the nicotine withdrawal symptoms. GABA systems, a primary inhibitory neurotransmitter system in the brain, and mood modulator, are thought to significantly modulate dopaminergic transmissions at the level of the VTA and nucleus accumbens, and support of the GABA system may also be helpful to moderate the withdrawal effects. Studies have demonstrated in the laboratory how GABA agonists decrease nicotine-induced dopamine increases in key nuclei of the brain.

For patients experiencing a more difficult experience with the effects of cigarette or nicotine cessation, additional herbal and nutrient medicines may be added to the overall treatment protocol. Dopaminergic herbs and GABA modulators (L-glutamine, inositol hexacotinate plus P5P) may be added to the protocol, as well as formulas to affect melatonin and serotonin metabolism (e.g. Positrol), and for some who experience anxiety with a change in heart rate, a formula with calming herbs, taurine, magnesium, and enzymes to aid metabolic conversions and reduce toxicities may be helpful. Herbal and nutrient medicines may also help reduce increased appetite and sugar cravings, aid sleep quality, and help improve cognitive functions. The experienced Licensed Acupuncturist may be able to assess and individualize this treatment more effectively. The patient may need to understand that while some patients are able to quit smoking easily, others require and more comprehensive and persistent approach, and a variety of treatment tools may be needed in the protocol. Of course, none of these treatments will be ultimately effective if the patient does not take an objective approach and utilize cognitive and behavioral changes effectively during the cessation period.

Are Electronic Cigarettes, or E-Cigarettes, or Vapes, a viable alternative?

An explosive growth in the use of electronic cigarettes, or "vapes", occurred in 2013, prompting the U.S. FDA to finally declare authority to regulate this form of nicotine delivery, but little research has been conducted so far to show potential health risks. While many experts are alarmed at surveys showing that now about 10 percent of high school students have "vaped", potentially leading to a cycle of addiction in the future, there is still little concern about the known risks of nicotine in the human body. The United States Centers for Disease Control and Prevention (CDC) states that nicotine is a naturally occurring chemical in the human body (used in the peripheral nervous system) that is toxic, and has demonstrated toxicity with exposure in tobacco product manufacturing, as well as in the manufacture and use in insecticides and fumigants. The U.S. CDC states that evidence shows that nicotine affects the nervous system and the heart negatively in higher accumulations in the body, and that direct exposure to relatively small amounts can be rapidly fatal. In February of 2014, the U.S. Poison Control Center reported that about 250 reports of nicotine poisoning with pure nicotine associated with electronic cigarettes occurred in the United States, raising some alarm. About 51 of these cases involved children opening these pure nicotine containers and either inhaling or ingesting toxic amounts. Skin contact is also a method of poisoning, prompting concern.

The U.S. CDC reports that nicotine decomposes with heat, producing nitrogen oxides, carbon monoxide, and other highly toxic fumes, reacts violently with strong oxidants in the body, is incompatible with strong acids in the body, and will degrade some forms of plastics, foam rubbers and other industrial coatings. The CDC reports that nicotine evaporation at room temperature can quickly cause hazardous air conditions in small enclosed spaces. With toxic exposure, patients will experience nervous stimulation followed by depression of inhibition of normal physiology. Vomiting is the most common sign of exposure to toxic amounts, but some patients experience symptoms 4 hours after a toxic exposure. At low concentrations, the U.S. CDC reports that nicotine causes increased heart rate and tremor, increased respiratory rate, a rise in blood pressure, and nervousness. At moderate levels one can experience some involuntary twitching or fasciculations, such as a nervous tic in the eyelid or face, abnormal heart rhythms generating a feeling of alarm, and potentially mild seizures. Aftereffects of moderate toxicity include autonomic depression, including slower heart rate, low blood pressure, and slowed breathing rate. Some symptoms associated with atrial fibrillation are caused by a depressed heart rate, and chronic overuse of vapor nicotine may lead to this depressed heart rate and symptoms, as well as trigger a rebound response with sudden rise in heart rate and fibrillation. Severe toxicity results in vomiting and a build-up of fluid in the airways or cardiovascular collapse. Exposure to the eyes results in inflammation and pain, and may result in opacity to the cornea.

We see that there is ample evidence that straight nicotine delivered in an e-cigarette has risks of adverse effects, and should at least be moderated in use. Added to this is the array of additive chemicals found in 'vape', with toxic additives such as formaldehyde studied and with researchers reporting in the New England Journal of Medicine in 2015 that lifetime risk of cancer associated with e-cigarettes is actually 5-15 times that of smoking a pack of cigarettes a day due to the common addition of formaldehyde in the vape solutions. Dr. John D. Day M.D. and cardiologist who specializes in heart rhythm pathology at Intermountain Healthcare in Murray, Utah, was quoted: "E-cigarettes have nicotine, and nicotine has dangerous cardiovascular effects. Over time, this (chronic use of straight nicotine in vapor) can cause serious harm to the cardiovascular system and lead to heart attacks, strokes, and heart failure." He explains that nicotine narrows the arteries of the heart and throughout the body. Dr. Elliot Antman M.D., the president of the American Heart Association and a professor at Harvard Medical School, was quoted: "Nicotine is known to increase heart rate and increase blood pressure. People with coronary artery blockages and people with congestive heart failure could be made worse by exposure to nicotine. they might develop chest pain or increased symptoms of heart failure." Dr. Antman stated that chronic exposure to nicotine vapor could provoke atrial fibrillation. These doctors were quoted in the medical media known as everydayhealth.com, by Dr. Jennifer J. Brown Ph.D. on 1/23/2015.

By 2016, a number of local governments in the United States proposed laws banning e-cigarette use in public spaces. For instance, the Napa County Board of Supervisors declared that it would add vaping to existing bans on indoor smoking in certain places with a unanimous decision after reviewing the accumulation of evidence of health risk. While the emphasis is on the industry using candy flavors to lure young smokers into the habit of vaping, and the creation of nicotine addiction, the board also cited evidence of harmful chemicals found in unregulated e-cigarette nicotine products, and secondary exposure that is proven to be equivalent to cigarette smoke in nicotine absorption. The American Lung Association is proposing a ban on e-cigarette use from work sites and public spaces. Despite enormous lobbying and misinformation campaigns, including fake blogs on the internet, we shall soon see such bans becoming commonplace. In March of 2016, the U.S. Department of Transportation (DOT) prohibited use of e-cigarettes on commercial flights to "protect airline passengers from unwanted exposure to aerosol fumes". The U.S. FDA proposed new regulations in 2014 to regulate the quality and content of e-cigarette nicotine products, but the enforcement of such FDA restrictions and regulations is difficult, and will not be widely enforced for years. In response, many states proposed new regulations and bans, including New Hampshire, Arizona, Maryland, New York, Pennsylvania, Kansas, Connecticut, Colorado, Oregon, Nebraska, Wyoming, Tennessee, Rhode Island, Hawaii, New Jersey, North Dakota, Maine, Louisiana, and Utah. Individuals should take from this that ample proof of harm and risk has accumulated, even if the lengthy process of large human clinical trials for such proof has not yet taken place. In 2015, California proposed a ban on e-cigarettes that would be equal to cigarettes themselves, as well as putting into law a ban on the sale of cigarettes, and eventually e-cigarettes, to anyone under the age of 21. The UK announced that a fourth of e-cigarettes on the market would be banned by initial laws in 2016, and a number of countries have taken this health threat seriously. It took half a century for the government to finally reveal cigarette dangers and health risks.

Because nicotine is a naturally occurring toxin in the body, the human organism has developed defenses. For instance, research a century ago found that when ingesting nicotine as smoke, a rate-limiting effect occurs to prevent toxic levels accumulating, with the body's immune defenses clearing toxic amounts. In the stomach, excess nicotine is quickly broken down with acids, inhibiting absorption, although contact with these strong acids produces toxic byproducts. Higher levels of nicotine in the blood circulation or tissues are well known to cause changes in the heart rate and blood pressure, and may cause first tachycardia, then bradycardia, and contribute to fibrillation and palpitations. Toxic exposure to the skin results in redness and systemic toxicity. Nicotine is also a teratogen, causing birth defects, and reports of potential reproductive toxicity and carcinogen status (causing cancer) are not yet substantiated with sufficient scientific evidence. The study of nicotine accumulation in the human body is not complete concerning ingestion of pure nicotine vapor, but we do know that this could vary from person to person depending on a variety of factors. Adverse effects of nicotine accumulation in tissues are poorly studied and understood, but industry studies revealed that nicotine accumulates to toxic levels in tissues containing melanin, a pigment found in the skin, substantia nigra of the brain, heart tissue, lung tissue, liver, lymphocytes, and the inner ear. Neuromelanin, or melanin metabolites in the brain and peripheral nervous system, are increasingly studied, and involve the triad of melanin, melatonin, and nicotine. Much scientific study reveals that chronic nicotine ingestion easily leads to an addiction cycle as well, and it is unclear which specific diseases associated with cigarette smoking are due to the nicotine, rather than other toxins in the smoke. While there has been little funding and publishing of adverse effects of nicotine and nicotine accumulation itself, and much emphasis on cigarette smoke, it can be surmised that with the popularity of e-cigarettes these studies will eventually be funded and published.

While electronic cigarettes have been hailed as a better alternative to actual cigarette smoking, avoiding the tars and toxins of the smoke, as well as being more discreet in public, the actual proof that e-cigarette ingestion of pure nicotine, and the additives in the liquid, as well as the toxic byproducts of the nicotine vapors, is benign, still does not exist. Apparently, the potential toxicity of pure nicotine delivered as a vapor in the human body is hard to analyze in terms of chronic low dosage ingestion. This would involve studies of tissue accumulation, numerous toxic metabolites, and differences in human physiology from person to person. Differences in product technology have also demonstrated that unreliabilty of listed nicotine content, differences in vaporization technology, and differences in bioavailability of nicotine due to carriers and delivery technology result in uncertainty regarding potential nicotine toxicity and accumulation. While many manufacturers have suggested that there are no toxic and carcinogenic chemicals in e-cigarettes, studies have shown that this is not true, with formaldehyde, acetaldehyde, nitrosamines, and toxic heavy metals such as cadmium, nickel and lead delivered, in lower levels than conventional cigarettes, but still accumulative. The real risk comes from poorly understood metabolites of the chemicals delivered in e-cigarettes, though, and we may not see proof and elucidation of these metabolites for many years. Studies showing safety are studying the immediate effects of a low dose. Most studies cited by the industry involve anecdotal evidence or lack of citing of harm. Health authorities around that world, though, are still skeptical that chronic pure nicotine vapor ingestion is harmless, and the lack of transparency in additives to the pure nicotine liquid products is a concern. Clearly, the public cannot view e-cigarette habits as completely harmless.

A 2014 study of electronic cigarettes in the United Kingdom, commissioned by Public Health England, and authored by John Britton and Dr. Ilze Bogdanovica of the University of Nottingham and UK Centre for Tobacco and Alcohol Studies, concluded: "Smoking kills, and millions of smokers alive today will die prematurely from their smoking unless they quit. This burden falls predominantly on the most disadvantaged in society. Preventing this death and disability requires measures that help as many of today's smokers to quit as possible. The option of switching to electronic cigarettes as an alternative and much safer source of nicotine, as a personal lifestyle choice rather than medical service, has enormous potential to reach smokers currently refractory to existing approaches. The emergence of electronic cigarettes and the likely arrival of more effective nicotine-containing devices currently in development provides an alternative to tobacco, and evidence to date suggests that smokers are willing to use these products in substantial numbers. Electronic cigarettes, and other nicotine devices, therefore offer vast potential health benefits, but maximising those benefits while minimising harms and risks to society requires appropriate regulation, careful monitoring, and risk management. However the opportunity to harness this potential into public health policy, complementing existing comprehensive tobacco control policies, should not be missed".

Detoxification after achieving cessation of cigarette addiction

More and more patients are not only looking to stop smoking, but are also now interested in improving overall health and reducing future health risks by not only clearing the accumulated tars and plaques from the lungs that accumulate with a significant and chronic smoking habit, but also the various accumulated toxins in the body and brain tissues, such as aldehydes, advanced glycation endproducts (AGEs), heavy metal ions, and plaques. In addition, our commercial industries are supplying our bodies with many environmental chemicals that are difficult to break down and store in our tissues. After seeing the health benefits from the clearing of the lungs in the months following smoking cessation, many patients are motivated to continue this process and more completely detoxify and cleanse their bodies. The results are worth the effort, and some work in this regard may prevent many of the common health problems that make life difficult as we age, and are ultimately expensive to treat. A vast amount of research in the last couple of decades guides this detoxification and clearing.

Many claims are made of simple herbal products to detox the body and this is very appealing to the public. The herbs do not directly detox the body, though, unless they are direct chelaters, able to conjugate with and transport heavy metal toxicities. Instead, the herbs useful in detoxification aid the body's own processes of detoxification, which are highly developed in the human physiology, and often need to be optimized with healthy choices in medical treatment as well as diet and lifestyle. Utilizing a professional Complementary and Integrative Medicine (CIM) physician, such as a Licensed Acupuncturist with extensive herbal knowledge as well as experience with nutrient medicine, insures that this process of detoxification is achieved.

To make the most intelligent choice of products to detox, it is best to understand what this process really is. Detoxification in the body is mostly performed by the liver, which houses Kupfer cells that contain rich quantities of macrophages to clear unwanted cells and toxins from the blood, and is also able to conjugate difficult toxins to bile salts to facilitate excretion if these chemical cannot be broken down. The other major way of clearing in the body is thus by excretion from the intestines and bowel. Excretion of toxins via the fluids, by sweating and urination is a much less effective way of elimination in the body. Health of the liver and intestinal tract is therefore of utmost importance in detoxification. The kidney plays a less potent role to excrete, ridding the body of excesses of normal chemicals that are broken down in the detoxification process, but many toxins are not able to pass the blood filters into the kidney.

Standard detox regimens include 1) aiding the liver to cleanse the blood more efficiently with diet, herbs, supplements and acupuncture, and 2) aiding the bowels in the elimination and excretion of stored toxins through fasting, colon cleanse, diet, herbs, probiotics, and acupuncture. Added to this is 3) tissue clearing through antioxidant activity and chemicals that attract and bind to heavy metals, such as EDTA (chelation). The number of ways that we might help the detoxification processes in the body are numerous, and should be tailored to the individual goals. Standard modern medical practice utilizes activated charcoal and milk thistle to detoxify the liver when acute liver toxicity threatens the health, utilizing both methods with great success, and both of these products are available and safe in standard practice. Chelation therapy using strong intravenous chemicals is also becoming a popular practice across the world, although it is still not accepted by the standard medical community in the United States except with acute threatening toxicities. For patients concerned with accumulated toxicity that is less acute, and simpler, such as toxicity from cigarette smoking, alcohol abuse, or common environmental pollutants, a course of herbs and key nutrient supplements to enhance the liver glutathione and enzyme metabolism may be the focus of therapy, and acupuncture may enhance this process greatly.

What toxins are we clearing?

Accumulations of environmental chemicals from cleaning products, flame retardants, plastics etc., air and water pollutants, and chemicals from the food are the major toxins in our bodies. Of special importance is the accumulations in our tissues, especially in the organ tissues and central nervous system, of small particle heavy metals, such as lead and mercury, that enter our bodies from the air or via the food chain and water supply. We must thank the Obama administration in 2010 for finally enacting effective EPA regulations that curtail the enormous tonnage of airborne lead and mercury toxins in the major industries creating this toxicity, coal-fired power plants, smelters, chloralkili producers, and concrete manufacture. Other heavy metal toxicities are also of concern, not the least of which is iron accumulation. This issue is more thoroughly addressed in my article on lead and mercury on this website. In some individuals, the toxins that are most damaging are composed of the chemicals resulting from breakdown of various pharmaceutical drugs. This is dependant on the types of medications and the number of medications being broken down, or catabolized, in the body. Examples of this toxicity are cited below in additional information links. The amount of toxic pesticides, chemical fertilizing agents, and other farm chemicals is growing as corporations take over more and more of our nation's farms and destroy more and more of the natural barriers to erosion and runoff into our water supply. As the rate of topsoil depletion accelerates, the need for more chemicals to maintain high crop yields increases. This toxicity also empties into our oceans and accumulates in our seafood. Mining and drilling, especially as we go deeper into the earth, with natural gas fracturing methods, and shale oil drilling, also creates massive amounts of water toxicity due to the need to use water to create pressure to break up rock and force oil and gas to the surface. Much of this "fracking" wastewater contains radioactive and heavy metal contaminants from deep in the earth, and this is dumped into our water supply. Natural toxins are also created by the body's metabolism, the most damaging and ubiquitous being the oxidant free radicals, and excesses of protein fragments, but normal healthy bodily function and diet are effective in eliminating natural toxic accumulations, unless the body is overly stressed by ill health or obesity. In addition, acetaldehyde toxicity is an area of focus in recent years, and is related to alcoholism and chronic candidiasis as well as environmental aldehydes.

As stated, synthetic medications, and the products created from the catabolism of synthetic medications, are treated as toxins in the liver and intestinal tract. The rate of chemical breakdown in the liver, or detox, usually determines the levels of prescription drugs in the body. When liver detoxification is not efficient, these levels of circulating synthetic drugs may be altered, resulting in overdosage and potential harm. Many side effects of medication occur well after starting the medication, and are the result of slow increases in circulating levels of the chemicals because of inefficient breakdown, or catabolism, of the drug. There are many published cautions or contraindications in drug combination, and these are mainly addressing the drugs that use the same metabolic methods of breaking down the drugs in the liver. Too often, these contraindications and warnings are ignored. The family of liver enzymes referred to as P450 are the most well known metabolic factors that regulate the rate of drug catabolism. Dangerous drug interactions may occur when one drug inhibits or induces a P450 enzyme activity and slows or speeds the breakdown of other drugs in the liver, resulting in altered levels of circulating dosage. By taking a number of drugs that utilize the same P450 enzymes, the chance that the circulating levels will be altered over time increases. Sometimes, the stress that this creates on the liver contributes to unhealthy liver function, which may significantly decrease the ability of the body to detoxify.

Addressing liver health is of prime importance in detoxification. It is best to decrease the stress on the liver by decreasing the amount of chemicals in the body, by adopting a more natural diet and home environment, and by decreasing medication dependency whenever possible. Most drugs are immediately broken down by a certain percentage in the liver (over 4-12 hours), although some directly deposit in the body tissues, such as muscle, fat and bone, and may accumulate, just as other chemical toxins do. The rate of immediate breakdown, or catabolism, is called the half-life, implying that half of the drug is broken down into metabolites in a short period of time. This determines the time between dosage of the drug. The more prescription drugs that are taken the more stress is placed upon the liver detoxification system, probably resulting in less efficiency in detoxifying unwanted chemicals or pollutants that we ingest by eating, drinking or breathing, as well as the other drug metabolites. When the liver is unable to clear toxins and chemicals efficiently, these environmental toxins and drug catabolites may circulate and deposit in the body tissues, often with fatty encapsulations to prevent contact with normal tissues. This type of tissue accumulation increases over time and eventually contributes to degeneration, disease and aging.

The rate, or efficiency, of toxin breakdown, or catabolism, in the liver is primarily determined by the enzyme metabolism. Enzymes are a class of molecules, mostly proteins, that regulate rates of metabolism and catabolism. When the liver is dysfunctional, the blood tests show that the liver enzyme transanimases are high in circulating blood. These are termed AST and ALT on your blood tests. High transanimases in circulation implies a problem with liver function, and/or high stress put upon the liver. Normal levels are exceeded in liver disease, but even levels in the high end of the normal range imply liver stress of a subclinical nature. More important enzymes of detoxification, such as glutathione peroxidase, are not routinely analyzed in blood tests. Enzyme metabolism may be normal on the blood test, but the liver may still have problems affecting detoxification metabolism. If the liver tissues accumulate toxic metabolites, such as oxidant free radicals, the tissues may become inflamed, and may harden (cirrhosis), and this may decrease efficiency of liver metabolism significantly. Fatty accumulation in the liver in the form of stored glycogen may also decrease the capacity of the liver to detoxify, as well as trap toxins in fatty accumulations. Excess consumption of fructose contributes greatly to this fatty liver accumulation, and poor liver function, or excess liver stress impairs the ability to the liver to catabolize glycogen stores at a fast enough rate. Therapy is directed toward clearing antioxidants and protein fragments, increasing circulation, and aiding the enzyme and glutathione metabolism in the liver. The degree of ill health of the liver is determined by the physician, who then prescribes the most tailored logical combination of herbs and supplements. Typically, a short course of herbal formula, with milk thistle, Vitamin B6, L-cysteine, L-glutamine, OptiZinc, alpha-lipoic acid, and N-acetylcysteine optimize the goals above. Proteolytic enzymes may also benefit tissue clearance in the liver. This course of nutrients optimizes various antioxdant pathways and provides the best bioavailability of glutathione, the key antioxidant.

Studies have shown that common environmental toxins, or pollutant chemicals, accumulate in the body tissues. Even a healthy person with a good diet, in an urban area, accumulates a large amount of toxic chemicals in the tissues over time. The older we are, the more difficult this detox becomes. Since true detox of our tissues is a complicated process, repeated, or habitual, detoxification help is the only real way to clear the body of toxins. Promotion of liver and intestinal health, as well as the avoidance of as many chemicals as possible is also essential, and should become a lifelong process. This involves a diet of organic foods, unpolluted water, and breathing of unpolluted air whenever possible, as well as avoidance of household chemicals such as chemical cleaning products. When this entire regimen is adopted, maximum detox is achieved. Since elimination by the GI tract is one way of detoxifying, fasting may also be a valuable aid, if you can tolerate fasting. What is most important, once again, is a healthy functioning GI and liver system. You may want to correct your digestive problems, and improve liver health with a course of treatment before adopting a detox regimen. This will insure better results. Herbal therapies may also provide stronger intestinal detoxification. Herbs with a high content of tannic acids can precipitate toxic substances in the intestinal lumen, converting them to insoluble substances, so that a high fiber diet or fast can eliminate them. Wu bei zi is an herb used in China for this purpose. Safe and effective herbal and nutrient chelating formulas may be utilized under guidance periodically. Acupuncture works in a symbiotic fashion to help the body detoxify and eliminate more efficiently.

The subject of detoxification is not as simple as many advertisers would lead you to believe. A simple change in diet with a mild herbal formula that aids the intestinal tract helps, but is only mildly effective. Once again, the medical advice presented on medical websites such as this one is more complicated than we would wish for. The idea that the human physiology is simple, and correcting problems with our health can be achieved with the magic pill or simple routine, is a fairy tale, though, that we all buy into in a consumer society. It's easier to advertise simple solutions, and so this is what we repeatedly hear. Reality is more complicated, but can be simplified by putting the process into the hands of a professional and following the professional advice.

So what about all these advertised products to detox and colon cleanse?

We see that products with a few simple herbs may help but are not the complete answer to detox. The claims are overblown. Be especially wary of products that don't list the ingredients, spend too much on advertising, and support the product with the endorsement of a single M.D. Standard medical schools provide no instruction in herbal medicine and little nutritional medicine. Trust the professional herbalist that has graduated from a medical college specializing in Traditional Chinese Medicine (acupuncture et al) or Naturopathy. To really achieve detox one should work to develop a complete program. Guidance by a professional holistic or naturopathic physician is highly recommended due to the complexity of the process. There are a number of products that can be very potent and valuable in detox, though. Let's discuss a few of these most valuable products I use and see and how they work.

Glutathione S transferase is a family of enzymes of the liver that is used by cells to detoxify and clear toxins and drugs from the body. The P450 and glucuronosyl transferase are emphasized in drug clearing metabolism, but the glutathione enzyme activity has a greater relationship to clearing toxins and cancer causing compounds. Sandalwood essential oil (most safely taken as alcohol extract or double boil water extraction), St. Johnswort and other herbs are found to be potent in increasing this enzymatic activity, as well as the combination of nutrient supplements already mentioned. St. John's Wort (Di er cao), contains a high level of quercetin and quercitrin as well, potent antioxidants, as do many Chinese herbs used to clear and protect the liver. Milk thistle has been well studied and found to benefit liver function and speed enzymatic detox, as have schisandra berries (wu wei zi), turmeric (jiang huang), and alpha lipoic acid (R-lipoic acid is the more active form). Schisandra chinensis berries have been proven to significantly increase the liver glutathione level and glutathione reductase enzyme activity. A percentage of the population lacks the 2D6 gene and has difficulty in liver detox metabolism, and these people are especially in need of herbal and nutrient aids. Studies also confirm that a percentage of the population lacks other significant genetic coding for liver detoxifying enzymes, P450, glutathione S-transferase, and N-acetyl transferase, increasing their risk for leukemia and stomach cancers significantly. The benefits of these detoxifying regimens in preventative medicine appear great in recent scientific study (see citations below).

Formulas in TCM utilize a number of herbs to work synergistically to improve liver function. I utilize such formulas as Ecliptex, Shu Gan +, Adv Chole Clear, and others, which are prescribed based on the individual's overall health diagnosis. The NIH is currently entering phase three of clinical trials of the simplest liver formula, Xiao Chai Hu Tang, called Sho-Saiko-to in the Japanese clinical trials of liver clearance of Hepatitis C. To check out the study parameters presented by the NIH, click here: http://clinicaltrials.gov/ct2/show/NCT00633230.

Activated charcoal is very effective to attract toxins from the intestinal tract. Flax, fennel and fenugreek seeds have long been used in traditional medicine to cleanse the intestinal tract. The best way is to mix the seeds, take a heaping tablespoon each day, soak in warm water, and then chew thoroughly and swallow. This tastes weird because of the mucilage, but will be very effective if taken for a week or so daily.

Most advertised herbal detox formulas use simple herbal strategies with fennel, dandelion root, etc. These herbs are beneficial but not extremely effective chemically in aiding liver function or bowel elimination, and they certainly do little to aid chelation. These herbal products are often based on the most common herbs appearing in research, are very gentle, and may have little noticeable impact, and thus generate less complaint of the common clearing effects sometimes seen when the body goes through a more vigorous detoxification, which may include itching, stomach upset, or loose bowel movements. Does the patient know that these products are working? The answer is no. These products are kept simple and achieve mild stimulation, giving the patient the impression that they are detoxing because they feel a little better when a healthy diet and herbal supplements are used. Most often these simple commercial products do not sound science and have exagerrated claims of effectiveness. Dandelion, burdock, fennel, fenugreek, and nettle can all be added to your diet, though, and give benefit in aiding the body's natural detoxifying mechanisms.

Some combinations of herbs and nutrient medicines provide intelligent formulas to achieve detoxificating goals. Acetaldehyde toxicity is common in the population, via chronic candidiasis, air pollution, excess alcohol consumption, etc. and the product AL Cofactors by Vitamin Research includes key nutrients to help the body clear this toxicity and promote increased glutathione metabolism. Such products as this provide an economical treatment product to help achieve goals. It must be noted, though, that taking even such as well formulated product does not achieve complete detoxification and clearance, and each patient is an individual, with different detox needs. This is why a professional that is knowledgeable is able to help you achieve these goals in an objective manner that is thorough and comprehensive.

To reiterate, detoxification and removal of stored heavy metals (chelation) are processes that each healthy body engages in daily. The patient may want to increase the rate of detoxification and chelation, and a variety of strategies, ranging from very gentle, to very strong, are available. Very potent chelation and detoxification needs to be supervised in a clinic, while gentle protocols can be utilized at home, or with therapy from a professional herbalist and Complementary Medicine physician utilizing nutrient medicine. Products on the grocery or drugstore shelf may not be dependable, or may be too gentle. A TCM physician with knowledge of this therapy may utilize three strategies. One, herbs and supplements that are proven to aid the liver in its natural detoxification processes, and the glutathione system in its cellular detox can be prescribed; two, intestinal clearing may be aided by herbal formulas, activated charcoal, and various specific herbs and nutrients, individually prescribed on a case-by-case protocol; and three, chelation of heavy metal and toxin accumulation in tissues can be stimulated with a variety of herbal and nutrient products. You may read more about chelation of heavy metals, and heavy metal environmental toxins on another article on this website, and you may read more about the glutathione metabolism as well.

Information Resources / Additional Information and Links to Scientific Studies

1. An example of a standard medical informational offering on acupuncture and herbal medicine in the treatment of cigarette addiction and cessation therapy is found at the New York University Langone Medical Center site, although as is typical, the presentation is more discouraging than encouraging and offers little clear information, with some misinformation. For example, Chinese researchers did not propose in their medical texts that the herbal chemical lobeline from Lobelia chinensis was an analog, or closely resembled the nicotine molecule. Every Chinese pharmacological text of merit states that lobeline or other chemicals in this herb merely has an affinity for nicotine receptors, and so has been successful in curbing the effects of nicotine in the areas of the brain that stimulate the addictive, or habituation response. By referring to less educated misconceptions that were probably found on acupuncture websites, these authors appear to denigrate the profession of Chinese herbalism and the scientific study that has been accomplished. Emphasis is placed on simple oats, or Avena sativa, as a principle herb used in smoking cessation protocol, while many actual Chinese herbs studied are not mentioned. On the other hand, most standard medical websites list Chantix as a very safe drug that has only rare side effects despite FDA warnings. The long-term success rate from Chantix is poorly measured, but small studies indicate that it has less than a 20 percent success over time, perhaps similar to an acupuncture free clinic model of ear acupuncture alone: http://www.med.nyu.edu/content?ChunkIID=35542#ref198
2. An example of analysis of scientific studies of acupuncture in the treatment of smoking cessation is presented by this review of a 1999 British Meta-analysis for the magazine Tobacco Control. Only 14 human clinical trials of poor quality were found, and techniques were limited in these studies to a short course of ear acupuncture or facial acupuncture without a comprehensive treatment protocol, and compared to a so-called "sham" acupuncture, which was not identified, but probably consisted of stimulation that resembled needle stimulation or points used other than the study points. The researchers found that the acupuncture "appears to have important non-specific effects" but was not an effective overall treatment by itself in this setting, although this limited acupuncture protocol still "as effective for smoking cessation as behavior therapy", and when compared to patients receiving no sham acupuncture (waiting list), the acupuncture protocol produced results that were significantly better than no treatment. The scientists than unscientifically concluded that acupuncture works by tricking the patient, not by stimulating actual CNS effects, which by 1999 was scientifically disproved. These types of research analysis are more revealing of the research community and goals of industry funding and publication than they are of actual measurement of acupuncture effects with the goal of finding the best way to help patients by improving and integrating specific acupuncture protocols into the overall treatment: http://acupuncturetoday.com/mpacms/at/article.php?id=27574
3. By 2012, studies such as this, from the National Taipei University of Nursing and Health Sciences, in Taiwan, showed that acupuncture combined with other protocols in treatment of smoking cessation proved to be very effective. A meta-analysis of this Integrative Medicine approach to smoking cessation here found 20 high-quality randomized controlled human clinical trials that were analyzed for long-term outcomes, with proof of effectiveness with acupuncture as part of a broader treatment protocol: http://www.ncbi.nlm.nih.gov/pubmed/22745061
4. While designing a randomized and placebo controlled human clinical trial for acupuncture to assess efficacy with smoking cessation is problematic, because there is no such thing as actual placebo needling, and because patients wishing to quit smoking are reluctant to join a treatment trial that involves a so-called placebo, many observational studies have demonstrated efficacy. This study of 1002 recruited patients wishing to quit smoking in Hong Kong, China, found that with just 6 treatments of standard acupuncture that the rate of success at 26 weeks was about 17 percent and similarly continued in a follow-up at 52 weeks. This is comparable to the claims of Chantix or any other therapeutic treatment regimen, which have been shown in follow-up studies to produce about a 10 percent success rate. The advantage of acupuncture is that other treatment modalities, such as herbal and nutrient medicine, counseling, etc. may be combined in the treatment, and that there are no side effects except improved overall health: http://www.ncbi.nlm.nih.gov/pubmed/24097937
5. A 2011 randomized controlled human clinical trial at Hyung Kee University, in Seoul, South Korea, of smoking cessation effects with acupuncture, assessed the effects of a single point HT7 in a short course of therapy, compared to a so-called sham point LI10 using a sham needling device. The HT7 group showed greater benefits with less response to normal cigarette smoking cues and better autonomic control: http://www.ncbi.nlm.nih.gov/pubmed/21195289
6. A 2005 study at the Kyung Hee University College of Oriental Medicine, in Seoul, South Korea, showed that the 28.6 percent of high responders to auricular acupuncture in treatment for cigarette smoking cessation, of 231 subjects tested, consistently tested positive more often for the genetic dopaminergic polymorphism called a DRD2 Taqi a allele, indicating that the stimulation used perhaps modulated the dopamine and dopamine receptor system: http://www.ncbi.nlm.nih.gov/pubmed/?term=dopaminergic+polymorphisms+acupuncture
7. A 2011 study at the Kyung Hee University Acupuncture adn Meridian Science Research Center, in Seoul, South Korea, also showed that stimulation at a single point, HT7, not only signficiantly outperformed a sham acupuncture stimulation in smoking cessation, but by using a heart monitor, it was seen to affect the autonomic response and reduce responses to triggers and cues: http://www.ncbi.nlm.nih.gov/pubmed/21195289
8. A study by the Dong-eui Institute of Technology in Busan, Korea, screened 21 medicinal herbs for antioxidant and nioctine degradation activity, and found that 11 such herbs were proven effective in this regard. Eugenia aromaticum (Ding xiang) and Astragalus membranaceus (Huang qi) showed the highest antioxidant capacity of these herbs. The herbal formula assembled was shown to accelerated conversion and clearing of nicotine. Smoking withdrawal symptoms were significantly reduced over a 4 week period. The classic Chinese medicinal formula used included Ban bian lian (Lobelia chinensis), Yuan zhi (Polygala tenufolia), Yu xing cao (Houttuynia cordata), Di long (Pheretima aspergillam), and Gan cao (licorice root), with Lobelia acting as the chief nicotine mimic, and the other herbs aiding nicotine clearance and repair of lung tissue. : http://www.ncbi.nlm.nih.gov/pubmed/15844840
9. Such websites as this, called Chantix Lawsuit Center, reflect the large number of patients seeking compensation from serious side effects after taking Chantix for a long time: http://chantixlawsuit-info.com/2011/04/chantix-side-effects-long-term-safety/
10. A 2011 article published in the Canadian Medical Association Journal reported that the drug Chantix (varenicline) is linked to a 72 percent greater risk of hospitalization due to serious adverse cardiovascular events such as arrhythmia or heart attack: http://www.google.com/hostednews/afp/1
11. An example of medication breakdown, or catabolism, in the liver, which produces even more harmful chemicals than the medication itself, is cited in this study of AZT catabolites: http://molpharm.aspetjournals.org/cgi/content/abstract/39/2/258
12. A conservative but informative article from the American Heart Association explains some of the pharmacodynamics of prescription drugs and the effect on the liver, with drug-drug contraindications and explanation of ill effects on the liver metabolism: http://circ.ahajournals.org/cgi/content/full/109/23_suppl_1/III-50
13. A 2000 FDA labeling approval for a synthetic estradiol oral contraceptive reveals that concentrations of drugs in the body vary considerable from person to person depending on the individual health of the liver metabolism and competition for detox pathways: http://www.fda.gov/cder/ogd/rld/19190s34.pdf
14. By 2014, a number of scientific studies showed that electronic cigarettes did present considerable health risk, delivering nanoparticles that trigger inflammation linked to heart disease, asthma, stroke and diabetes, solvents and other harmful chemicals in the vapor, and nicotine vapors that encouraged thicker biofilms linked to microbial infection that is hard for the body to counter, much less the still unknown levels of potential nicotine accumulation in tissues via pure nicotine vapor: https://www.sciencenews.org/article/health-risks-e-cigarettes-emerge
15. A 2011 study at the University of Pittsburgh, Pennsylvania, U.S.A. found that pure nicotine produced a significant rise and blood pressure and heart rate: http://www.ncbi.nlm.nih.gov/pubmed/21554897
16. A 2014 study by experts at the University of Parma School of Medicine, in Italy, noted that e-cigarettes can enhance the risk of cardiac arrhythmias and hypertension, which may predispose to future cardiovascular risk, the third leading cause of death in the United States behind iaotrogenic causes and cancers: http://www.ncbi.nlm.nih.gov/pubmed/24343348
17. A 2016 article on the web journal everydayhealth.com quotes the highest experts on cardiovascular risk in the U.S. and shows that e-cigarettes and straight nicotine in vapor poses considerable cardiovascular risk and can aggravate chronic heart pathology, such as atrial fibrillation, congestive heart failure and recovery from heart attack and stroke. In addition, the common additives in vape nicotine have been found to be very harmful with chronic use, increasing cancer risk 5-15 times that of a pack-a-day cigarette habit: http://www.everydayhealth.com/news/this-is-your-heart-on-ecigarettes/
18. In 2015, Washington State, in the U.S.A. enacted the strictest laws regulating e-cigarettes in the United States, citing much scientific information that outlines the risks and potential adverse effects of this type of nicotine delivery, which is largely unregulated and dependent on the ethics of manufacturers to insure safety. Toxic and carcinogenic chemicals in e-cigarettes would have to be listed on labels, a large tax implemented to provide for future treatment of addiction and related health problems, and harmful additives and flavorings would be prohibited by this law, the strictest of the 33 state laws now enacted in recent years to regulate electronic cigarettes: http://thinkprogress.org/health/2015/03/19/3636142/washington-state-e-cig/
19. A 2016 report on the health hazards with e-cigarettes and delivery of direct nicotine and other additives, by experts at the Pulmonary Institute in Budapest, Hungary, note that it is confirmed by a meta-review of all published scientific studies that these are harmful to the health of both the user and bystanders, that the efficacy in smoking cessation has not been justified with evidence, and that these electronic cigarettes perpetuate nicotine addiction and may increase the risk of starting conventional cigarette use: http://www.ncbi.nlm.nih.gov/pubmed/27287837
20. A 2005 meta-review of scientific study of nicotine accumulation found that many animal studies verify that toxic nicotine accumulation occurs in tissues that contain or produce melanin, a pigmented chemical found in the skin, the substantia nigra of the brain, other neural tissues, the heart, lung, liver, lymphocytes, and inner ear. In addition the triad of nicotine, melanin and melatonin comprise a neuromelanin, a molecule that is still poorly understood, but could relate to a variety of chronic symptoms and diseases: http://health-equity.pitt.edu/568/1/Yerger,_Malone_-_Melanin_Article.pdf
21. A 2010 study at Soochow University, in Suzhou, China, found that nicotine use during pregnancy produced fetal arrhythmia and tachycardia, and increased risk of adult arrhythmia in laboratory animals: http://www.ncbi.nlm.nih.gov/pubmed/19728315
22. A 2007 study at the Karolinska Institute and Karolinska University Hospital, in Sweden, found that pure nicotine, as delivered in e-cigarettes and patches, is indeed harmful to the fetus and newborn baby, interacting with acetylcholine receptors in the brain and lung to potentially create harm. In some ways, nicotine delivered more directly would present more risk of harm than cigarette smoke itself. The 2007 study preceded study of electronic cigarettes, but noted that little sound objective study had been performed that would clearly measure nicotine accumulation in the tissues of pregnant women, and thus there was no evidence that this nicotine delivery was safe: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656811/
23. A 2010 study of the effects of pure nicotine on the fetus and newborn child, funded by the Canadian Institutes of Health, and conducted by experts at McMaster University, in Ontario, Canada, concluded that there is substantial evidence by 2010 that shows widespread adverse neonatal and postnatal health consequences of pure nicotine, as is delivered in electronic cigarettes, and that epigenetic changes have been noted affecting the second generation in studies, with elevated blood pressure and blood insulin levels: http://toxsci.oxfordjournals.org/content/116/2/364.full