LiveLongAgeWell

The H1N1 (swine) flu pandemic is dangerous, yes, but also fascinating as a study of how different countries are responding and how theories change quickly. Here in Brazil, where it is winter and prime flu season, the massive city São Paulo has pretty much closed down all schools for the next two weeks, affecting over 6 million students. And just a few weeks ago, public health officials were theorizing that obesity alone appeared to be a major risk factor for developing a serious case, or of dying of the influenza.

Many of the people with H1N1 in ICUs seem to be obese, and the United States—with the epidemic of obesity affecting, amazingly, about 34 percent of the population—has had a much higher death rate than Japan, for example, with less than 2% of the population obese.

Now, the U.S. Center for Disease Control has decided that obesity, on its own, doesn’t seem to be a risk factor. Still it’s worth remembering that fat cells, especially those deep in the abdomen, secrete substances that cause a chronic state of low-level of inflammation in the body, and as a result, obesity depresses your immune system making you more susceptible to most any infection, or even cancer.

So if you are living in the summer now but have worries about flu in the upcoming seasons, you would do well to get yourself in shape and try to lose as much fat as possible to keep your immune system functioning well. If you smoke, have a plan to quit before the fall. Besides that, you can markedly cut your risk of flu by three simple measures: keeping at least a meter (3 feet) away from anyone sick, washing your hands multiple times during the day (especially after you touch surfaces in public areas), and avoid touching your nose, eyes, or mouth, because that’s how you infect yourself.

Know that these influenza viruses, fortunately, don’t penetrate through your skin, and if you remember to always wash your hands well before touching your face, you are much less likely to become infected.

OK, now another way to keep healthy and fit—eat your “greens”…Here is Part II, How to eat greens! (last week was background information):

•    When you try greens and don’t love the taste right away, consider that kale, the king of the greens, contains about 10 times more of that fantastic anti-oxidant lutein as does broccoli. The high fiber content in greens will help you control your weight, your cholesterol, as well as your blood sugar. If you have a family history or particular concerns with breast, ovarian, or colon cancer, you should eat some greens every day. If you smoke, daily greens might give you some protection from the carcinogens in cigarettes. So these truly are superstar vegetables, and you can develop a taste for them.

•    Kale is probably the healthiest of the bunch, but collards are excellent as well, and the flavor tends to be a bit smoother. The plants harvested during cooler weather may taste better, and look for smaller leaves. Spinach is a green, and a good way to start, but you should venture forth and experiment with the more potent ones. You might slowly add bits of raw kale into your daily salad, or add finely-cut collards to soup. Kale comes in different colors and varieties. Mustard greens have somewhat of a spicy, racy taste. Over a few months try them all and see which you like the best.

•    When preparing, cut out any tough stems, and to make life easy, try frozen greens or find bags of pre-washed, cut greens. You can lightly sauté them in olive oil, and try adding lemon, pine nuts, and some red pepper flakes. Look at the DDD appendix for more hints on finding recipes. One note for those on blood thinning medication: the high vitamin K content in greens could interfere with your medication, but rather than avoiding greens, research suggests greens might help protect you from the bone-thinning effects of those medications, so discuss with your physician.

I have always been impressed how often a bad string of ill health starts with a fall. For many older people, a fall, especially one resulting in a broken hip, can lead to a cascade of problems: surgery, a long period of diminished mobility and further loss of bone and muscle strength, then sometimes complications like blood clots and pneumonia, and even a tendency towards mental decline if measures are not taken to reverse this course.

And falls in younger people are not great either. For the physically active, sprained ankles are the number one sports injury. In the U.S. alone, about 8 million people suffer such an injury, and, alarmingly, about 30 to 80 percent of those people will go on to re-sprain either the same ankle or the other.

One common factor leading to falls in both younger, and especially older folds, is a diminished sense of balance, so no matter what your age—whether you want to avoid a sprained ankle that would crimp your exercise routine or a broken hip that could lead to much worse problems—I recommend you look at this simple, yet elegant 3 minute video about balance training imbedded in this New York Times health blog article. While the video shows several different simple exercises you can do to strengthen your ankles and improve your sense of balance, the take-away basic exercise is this (from the article): “Stand on one leg. Try not to wobble. Hold for one minute. Repeat.”  (Try it; it might be tougher than you suspect.)

You can progress towards more difficult exercises from that basic one, such as crossing your arms while balancing on one leg, then closing your eyes, then trying it on an unstable, softer surface such as foam or a pillow. The more difficult ones will do more to strengthen your brain’s balance circuitry, which is especially important as we get into middle-age and beyond (if doesn’t apply to you, think about your parents).

Make sure you do any of these exercises close to a wall or a table or column or something to steady yourself if needed, and do it away from sharp or breakable objects. Check with your doctor especially if you have had a recent injury. You might even start a routine of doing the basic balance exercise while brushing or flossing your teeth…it’s a way to incorporate several beneficial health behaviors at the same time, and beginning a routine like that will make you much more likely to be consistent with the activity, and consistency is one key to success. Consider a Post-It reminder note on your bathroom mirror, until the activity becomes a habit!

A New Risk Factor For H1N1 (swine flu) Infection

An interesting risk factor has emerged regarding those who get severely ill or die from H1N1 flu: obesity. It seems that a large majority of those ending up in intensive care units worldwide are overweight, and the more overweight, the higher the risk of more severe complications. This story of course is still unfolding, but it’s a very curious finding so far, and may be the reason that Japan, for example, with a very low prevalence of obesity, has had ZERO deaths with over 2000 H1N1 cases confirmed. The U.S., with a huge, growing prevalence of obesity, has a much higher death rate. For more, including theories why, click here. Another good reason to keep your weight under control, and not only for this infection…excess fat cells secrete substances that impair your general immune system, leaving the obese more prone to infections, as well as cancer.

Several weeks ago I detailed some problems with the common over-the-counter pain reliever acetaminophen (otherwise known as paracetamol, and the biggest U.S. brand name is Tylenol). The issue is that this medication, even in what many consumers feel is a safe dose, can lead to permanent liver damage.

Just today there was a big FDA meeting in Maryland, and a number of  recommendations were made (likely to be accepted by the full FDA) which will soon limit your choices for OTC and prescription pain relievers. The committees voted to limit the maximum pill size from 500 to 325 milligrams for acetaminophen, and lower the accepted maximum daily dose to well under the current 4000 milligrams. Further—and significant for many people in chronic pain—it looks like Percocet and Vicodin, two exceedingly popular drugs that mix acetaminophen with a stronger narcotic, will be banned. Read more details here

Normally I publish a post on Monday or Tuesday, and again later in the week. This week has been particularly busy for me, so…sunless tanning, part III of the sunscreen series, will be posted later in the week rather than today. In the meantime, if you are lucky enough to have sun where you are, I suggest you put on a good sunscreen and get outside!

Last week I presented some of the issues surrounding sunscreens and today I’ll give some practical hints. Unfortunately, there is still no sunscreen available that is even close to perfect; they all have potential issues regarding how well they block both UVA and UVB, how long they are effective, and how safe they are (particularly regarding absorption into the bloodstream). Still, protecting yourself from excessive sunlight is critical, not only to help protect from the number one cancer of all—skin cancer—but to avoid early aging. Consider this quote from the U.S. Environmental Protection Agency’s excellent pdf fact-sheet “The Burning Facts”:

Up to 90 percent of the visible skin changes commonly attributed
to aging are caused by sun exposure.

11 Hints…What You Can Do

1. If you are very concerned about the potential toxicity of sunscreens, consult this summary from the Environmental Working Group, a non-profit consumer “watchdog” organization that has issued a list of what they consider recommended and relatively safe products. One problem is that you probably won’t find many of their recommended ones at your local drugstore, but you can probably find most online.

2.If you are not so concerned about theoretical chemical risks, you can consult this short list of American Academy of Dermatology (AAD) “recognized” products (while not as cautious as the EWG list, the AAD is still quite a careful group). One brand from their list I particularly like is Aveeno, which you will be able to find locally. Aveeno makes high-quality products that are not terribly expensive.

3. The last several years has seen release of several products that have longer-lasting, stablilized UVA protection (as well as the more standard UVB protection), and Mexoxyl and Helioplex are two components to look for. Helioplex seems to be the superior product, and of those brands with Helioplex, I like the Neutrogena brand, particularly Neutrogena Ulta-Sheer SPF 70 with Helioplex. It’s what I use. Some researchers have claimed that since these chemicals are partially absorbed into the bloodstream, that they might have an estrogen, hormonal-type effect internally. Talk to your physician if you are concerned about possible hormonal effects,  and you may not want to use one that is absorbed, on children.

4. If you want a sunscreen that is not absorbed, find a zinc oxide or titanium dioxide product (and see EWG report above), though these often leave the skin with an unattractive white cast.

5. It is probably best to avoid spray and powder sunscreens that have (ultra-small) nano-particles which might be inhaled.

6. Besides using a broad-spectrum UVA/UVB product, buy at least a SPF 30, and use enough of it! Shockingly, you need to use a “shot-glass” amount, about 1 oz. (1/3 of a typical 3 oz. tube) for your entire body, if you want to get the advertised SPF factor. Bottom line: use more than you think you should.

7. Apply 30 minutes before going in the sun to allow it to absorb.

8. Sunscreens lose potency over time. Look at the expiration date when you buy or use, and throw away any product at 3 years.

9. Reapply after going in the water, after significant sweating, and about every 2 or 3 hours. Even “waterproof” sunscreens come off after 40 minutes in the water, so if you are a water person, look for “very waterproof” which should give double water protection.

10. Don’t forget to apply to areas commonly forgotten such as: the entire surface of the ear (I can’t count how many ear skin cancers I excised and re-constructed when I was in California), any bald spots, the tops of your feet….and use a lip-sunscreen too (lip cancer is common)!

11. Avoid the sun during peak times, 10 am to 3 pm, wear a hat and don’t forget quality sunglasses to protect your eyes from cataracts! (a subject for a future post…)

Next: self-tanning products.

First, the big picture: the most important measure you can take to keep a “youthful” appearance—as much as your particular genes will allow—is to minimize exposure to UVA and UVB irradiation from the sun. Of course staying out of the sun as much as possible is the most sure way, but also it’s inconvenient, impractical, and not healthy from many aspects, including the psychological ones, so most people use sunscreens. The problem is finding a good one.

Sunscreen use is critical both to minimize wrinkles and cut the risk of skin cancer, which ranks as the most common cancer of all. But the subject has become complex in the past few years, so today let’s go over some of the current science of sunscreens, and the next post I’ll give some specific ideas on what you can use.

A few years ago it was easy to know what to do. Most people, even dermatologists, felt that if you used a SPF 15 or, then…wow…a 30, you would be highly protected and would not have to worry much, because a 30 was thought to allow you to be in the sun 30 times as long as if you didn’t use any sunscreen. But in the last few years as more products have been released, with higher and higher SPFs, the sunscreen field has become much more murky and confusing.

Some doctors have even gone so far as to state that using sunscreens will increase the risk for the deadliest form of skin cancer, melanoma, because many products will stop the burn (mostly from UVB), but will not stop UVA. This UVA irradiation doesn’t cause as much redness, but penetrates more deeply into the skin causing worse aging damage and a higher melanoma risk. So since you don’t get red, you think you are fine, while the sneaky UVA rays are causing their deep damage.

One simple way to remember the basic difference between A and B is: UVA,  a longer wavelength, is the aging radiation, and UVB causes more burning…however, both, in excess, lead to wrinkles, skin cancer, and even a diminished immune system. And if you sit by a sunny window, know that UVA radiation penetrates glass.

Here is a summary of some recent issues. But don’t get discouraged as you read this, because there are some solutions, which we’ll discuss in the next post…

1. The “SPF” rating only concerns the level of UVB protection. There are no good FDA standards or labeling or SPF ratings for UVA, and many products don’t offer, or even claim, good protection from UVA.

2. Many of the chemicals that do provide UVA protection, perhaps ironically, break down quickly in the sun, which is one reason sunscreens should be re-applied every 2 to 3 hours.

3. Toxicity: some of the chemicals used in sunscreens are absorbed into our bloodstream and may be toxic. Particular concern has been raised about two popular components, oxybenzone and avobenzone, which theoretically could alter our internal hormonal balance, and some doctors advise: don’t use these on pregnant women or children. Then there are the super-small, nano-particles used in some expensive new products. Again, while some have claimed these tiny particles might be absorbed, the super-cautious Environmental Working Group has concluded they are not. But the EWG recommends staying away from spray or powder products that might cause lung damage from the inhaled nano-particles. Finally, some sunscreen chemicals have been shown to produce free radicals when mixed with sunlight, and free radicals (which we try to neutralize with antioxidants) lead to skin aging.

4. While many of those issues are controversial, most doctors agree: very few people use enough sunscreen to provide adequate protection. A large Australian study showed that even “diligent” sunscreen users were only applying about half of what they should to get the advertised SPF protection, and most people only get about a quarter of the protection they think they are.

5. “Waterproof” sunscreens only last for about 40 minutes in the water, and for typical beach use, even these should be re-applied regularly.

6. If you read this blog often, you know I am a big fan of vitamin D, which we naturally get from sun exposure on our skin, and many people are vitamin D deficient. For some, this D vitamin shortage is rooted in excessive paranoia about sun exposure and many of these people use too much sunscreen. Like most things in life, moderation is the best route.

Next: SPFs and good sunscreens.

The U.S. Food and Drug Administration (FDA) will be considering later this month, at a meeting in Maryland, new restrictions on the labeling and strength of the pain-reliever acetaminophen (known internationally as paracetamol; the most famous brand is Tylenol). Studies show most consumers are unaware of the risks of the drug. It is not a bad medication—it can be a wonderful alternative to aspirin—but you need to be extra cautious with its use…let’s discuss why.

Drugs can be classified as to their “safety margin”, which refers to a comparison of the dose of a drug needed to be therapeutically effective compared with the amount of the drug needed to produce toxicity. Some drugs, for example, penicillin, are considered to have a rather wide safety margin because a relatively small dose of these drugs can be therapeutically effective (here, cure an infection), but normally you need a very large dose to get serious toxicity.

On the other side of the safety margin scale are drugs like acetaminophen, which have a NARROW margin of safety, meaning, the difference between a normal therapeutic dose and a dose that will produce toxicity or even death is relatively small (“narrow”).  So you need to be extra careful when taking a drug with a narrow safety margin, like Tylenol. Overdosage is common, and serious Tylenol overdosages are NOT easy to treat or reverse. Sometimes the only treatment is a liver transplant. Milder overdoses that occur over a period of time might not even be recognized by the patient, but result in chronic liver damage.

Shockingly, acetaminophen overdosage is the “leading cause of acute liver failure in the United States”. Meaning this drug is worse than alcohol for causing acute liver failure (note that “acute” in a medical sense does not mean serious, rather, acute means a condition that arises or appears over a very short period of time).

Severe liver damage from this OTC drug can occur from a dose that you might not consider excessive. A person who already has some level of liver problem—for example from chronically drinking too much alcohol—can suffer irreparable liver damage from taking only four or five 500 mg. tablets over one 24 hour period.

Currently, the maximum safe dose (as listed on the product label) is 4000 milligrams per day, meaning: a maximum of two-500 mg. “extra-strength” tablets every 6 hours for a day. But…how often do you think this dose is exceeded, if not by you, by others in pain who, rather than wait 6 hours between doses, take a new dose after only, say, 4 hours? It’s happens a lot.

So at the FDA meeting later this month, the group will consider a recommendation to lower the maximum daily dose from 4000 mg. to 2600 mg., and cut the size of the biggest allowable tablet from 500 mg. to 325 mg. No matter what they decide, take caution with this drug, especially if you already have any liver disease, have elevated “liver enzyme” blood levels, take statin drugs to lower cholesterol, or you drink a moderate or greater amount of alcohol daily. It’s not clear at what level of daily alcohol use you have to be concerned; the Tylenol label says to “ask your doctor if you drink more than 3 drinks per day”, but many experts believe if you drink less than that you should be extra careful with acetaminophen.

Your physician should be able to answer any questions about your liver function with some simple blood tests, and if you have concerns about your daily alcohol intake combined with acetaminophen.  For everyone however, even those who drink rarely, if you “binge”—drink significant alcohol at any one time—don’t use acetaminophen to try to treat a headache or hangover (however aspirin is not great either, because it can irritate the stomach).

Be aware that acetaminophen (or paracetamol or APAP as it is known in some countries), is not only found in the Tylenol brand, but is a component of many other common OTC medications… over 200 formulations contain acetaminophen but don’t carry the Tylenol label, and the presence of acetaminophen is only discovered by reading the fine print on the back. Consult this list for examples; and better, read the ingredients of every pain or anti-fever medication you take to see what’s inside. You might take Tylenol in the evening, then at bedtime take a slug of, say, Nyquil, not realizing it too contains the same drug.

I will let you know what the FDA decides after their meeting at the end of June, but for an interim FDA report, with more details about acetaminophen, click here (pdf).

In summary, acetaminophen can be a wonderful drug, but with a narrow “safety margin”, it deserves special caution.

In honor of our mothers, let’s consider some advice many of them have given—perhaps your own mother said “eat your carrots…you’ll see better at night”—now let’s just update that with the latest information. It’s a nice coincidence because a few days before Mother’s Day, the journal Ophthalmology came out with a report on the best (nutritional) advice to prevent macular degeneration, the progressive loss of function in the retina of the eye and the most common cause of adult visual loss. (Click on this link for a “macular degeneration simulator”.)

One reason macular degeneration is so worrisome is that it’s so common: 10% of people over 65 are affected, and that rises to 30% for people over 75. Your risk is higher if you have a history of smoking, and with a close relative with macular degeneration, your lifetime risk rises to 50%. So it’s good to know there is something you can do to help diminish this threat as we get older besides a carrot-a-day…

Here’s what the analysis of the diets of over 4000 people in the Age-Related Eye Disease Study suggested to keep your vision good as you get older:

1. Eat a low-glycemic index diet. The glycemic index is a rating of how foods spike your blood sugar once they are absorbed, and the less the spike, the better. Slow absorbing foods are best. Particularly bad are white bread, starchy foods such as potatoes, and sugary pastries. Best are whole-grain breads, nuts, proteins, and vegetables.

2. Try to get a wide range of antioxidants from fresh fruits, vegetables, nuts, and perhaps eggs. Especially good are green leafy vegetables, spinach, kale, broccoli, and when you buy lettuce, stick to the dark green romaine style rather than the wimpy pale “head lettuce” or “American lettuce”. Other good sources of the vision-beneficial antioxidants are eggs, beans (especially black), and again, nuts and whole grains.

3. Try to get lots of vitamin C from citrus fruits.

4. Omega-3 fatty acids are great for your eyes (as well as your brain), and you can best get those from fatty fish, such as salmon.

So go ahead and eat a carrot-a-day, it’s great advice, but if you are really concerned about keeping your vision intact as you get older, and particularly if you have a positive family history, there are plenty of other dietary measures you can take. Don’t wait…add to your shopping list: oranges, broccoli, spinach, whole-grain bread, romaine lettuce, nuts, and salmon!

To Live Long and Age Well, it’s a good idea to avoid unnecessary radiation, and for most people, that means unnecessary CT scans. A typical CT scan results in much greater radiation exposure than a regular X-ray.

One new test, the cardiac 64-slice CT scan is used to look for blockages in the arteries of the heart, which indicate heart attack or high risk of heart attack. These scans give fantastic 3-D images, like the one below. You might see this or a CT brochure and think: I want one! But don’t be mesmerized by color and hype, because medicine is also a business, subject to market forces.

Cardiac CT scanning is often used in cases when someone comes to the emergency room with chest pain, and the doctor wants to know if the pain is due to a blocked coronary artery or some other cause. The use of this scan has tripled in the past two years, and the cardiac CT commonly exposes the patient to the equivalent radiation as 600 regular chest X-rays. Still, this scan can give much useful information, but due to the radiation exposure, you only want it when it’s really needed and when other less risky tests aren’t adequate.

Doctors are trained to always balance the risk of any procedure or test with the benefits received (the risk: benefit ratio), but the companies that sell the equipment do their best to convince doctors that the benefits are high, and the risks low. And doctors—used to being pushed around and mistreated by insurance companies—can be seduced by the fawning attention of the medical device sales force.

Last week in the Journal of the American Medical Association (JAMA), a report was issued by a group of American and German researchers, who evaluated how much radiation patients were exposed to while undergoing the 64-slice cardiac CT scans, and they found the radiation exposure varied from center to center by a factor of six, meaning a patient at some X-ray facilities received six times the radiation dose as someone having the same test at another center.

One reason for this center-to-center difference is that several new radiation-lowering techniques are available, but some centers don’t use them. It’s still not clear yet which are the best methods to lower the dosage, but it would be good to know your facility was employing at least one of those methods.

Below are some basic questions you might ask if a CT is recommended for you or a loved one. (Of course in an emergency situation, you might not want—or be in a position—to question the necessity of the test.)

1. Could another test, one without radiation exposure such as MRI or ultrasound, be done instead of the CT? If the answer is: “The CT is better.” then you might ask: How much better? Does the difference between CT and the other test justify the radiation exposure?

2. If you have already had a CT scan of the same type and your doctor orders a repeat scan, question him/her carefully if another scan is truly necessary.

3. Explain you have read about the radiation dose from CT and you want to go to a facility that takes measures (or has a “protocol”) to diminish unnecessary radiation.

For more detailed questions, check this link.

If someone were to ask me to name the worst cancer, I would say cancer of the pancreas. This cancer has received much media attention recently. Patrick Swayze is now fighting it, and it killed Luciano Pavarotti and Professor Randy Pausch (author of The Last Lecture).  Even the president of the American Medical Association died of pancreatic cancer last year.

The survival statistics are grim: after diagnosis, only about 25% of the afflicted live even one year, only 5% survive five years. It is so deadly because this cancer is typically diagnosed late, after it has spread, and surgery in those cases won’t cure. While there is hope that new and experimental drugs will work better, standard chemotherapy usually gives disappointing results. It also tends to be one of the most painful cancers. Victims often quickly lose lots of weight and become yellow with jaundice.

The pancreas—which produces digestive juices and hormones involved in food metabolism—is buried deep in the abdomen below and behind the stomach, and this deep location masks symptoms until it has spread beyond the pancreas. The liver, close by, is a prime target. Clearly, it’s a disease you want to avoid, and fortunately medical researchers have identified some measures you can take to significantly cut your risk:

1.    Don’t smoke. Smokers suffer a two to five times risk of getting pancreatic cancer. But if you smoke and quit, after five to ten years of not smoking, your risk goes down to that of a non-smoker.

2.    Eat lots of fruits and vegetables, especially dark green and highly colored ones. These vegetables contain more cancer-inhibiting phytonutrients. Think tomatoes (high in lycopene), soy, broccoli, blueberries, carrots, cranberries, and many others. In general the darker, richer, more vibrant color the better!

3.    A diet high in legumes and whole grains seems to cut the risk. One reason may be because these foods help fill you up and keep you from getting obese.

4.    Avoid obesity! Especially central, or abdominal obesity is thought to be a risk factor for pancreatic cancer. If you are overweight, work on numbers 2 and 3 above, and as a minimum for exercise, start moving and walking more. For example, take the stairs rather than the elevator, and park your car farther from the store entrance so you are forced to walk more.

5.    Minimize your red meat consumption, especially processed meat. It may be the high level of iron or the fat in red meat are the carcinogenic components, and for processed meats (non-fresh meat), the high sodium and nitrates might be the problem. Also, meats cooked at high temperature, and charred or grilled meats are especially believed to be loaded with cancer-causing substances.

6.    Floss your teeth! Yes, it is thought that those with bad oral hygiene, gum inflammation, and periodontal disease have a higher level of inflammatory substances in their body, and these can spark a pancreas cancer. Men with periodontal disease have a 64% higher risk!

7.    Make sure you are getting enough vitamin D. Vitamin D deficiency is common world-wide, and studies have suggested those who get adequate vitamin D cut their risk of pancreatic cancer by 50%. For more on vitamin D, I recommend this article from the Harvard School of Public Health.

In future posts, I will discuss each of these hints in more detail, but in the meantime, the above is food for thought…and make that food highly colored vegetables!

I have some good friends who still smoke, but they’re all careful and courteous smokers (as I think most are today) in that they try to keep their secondhand smoke away from non-smokers. But a research report just published in the medical journal Pediatrics suggests that smokers are generally not aware of another hazard from their cigarettes—they may be causing even non-smokers to become “third-hand smokers”. This is the first new medical term of 2009, and it’s good to know something about it as it will be talked about and maybe used as a basis for new laws aimed at smokers.

You notice this hazard for example when you enter a hotel room (especially common in certain cities, like Las Vegas) that has recently been occupied by smokers, and you are hit with that distinctive sick smell. You know there is something foul in the room, and it’s because some smoker has been there, leaving his mark, almost like a dog marking his territory. Sometimes it’s more of a feeling you get; it might be enough to prod you to march to the front desk and demand a non-smoking room. You might encounter the same in rental cars, homes and some offices. Twenty percent of the U.S. population still smokes, so it’s a persisting issue, and this research study suggests you should be concerned if you are (not of your own making) a third-hand smoker.

Particulate matter from cigarette smoke penetrates and persists in many surfaces, slowly leaking toxins to those in contact. Most at risk are pregnant or breastfeeding women and children, but everyone suffers some risk. The National Toxicology Program has identified in cigarette smoke some 250 poisonous gases, heavy metals, and other chemicals such as cyanide, carbon monoxide, butane, lead, arsenic, and even the highly radioactive and carcinogenic polonium-210 (used to kill an ex-Russian spy in London in 2006). Ten other substances in cigarette smoke are classified as Class I carcinogens (highest level). Besides these serious issues, cigarette smoke is very bad for looking good as you get older.

The research also showed that only 43% of smokers believed third-hand smoke was dangerous, yet 65% of non-smokers thought it was harmful. The good news is that when smokers become aware of the risks to others, most will change their behavior to minimize that risk. We need to keep encouraging smokers to quit, but, in the meantime, to smoke outside so at least disperse the damage so it won’t settle into our carpets and fabrics…(I think it’s rather ironic that some righteous non-smokers—I noticed this occasionally when I lived in California—will make an absolute scandal about people smoking outside, crying that they are fouling the air, and then they drive off in a Cadillac Escalade or Range Rover, causing much more collective harm than any cigarette.)

If you find yourself in a rental car or a hotel room and you notice you are about to become a third hand smoker, get out, change the car or room. Best to remember to reserve a non-smoking environment whenever you can.