The First 72 Hours

The First 72 Hours

Joined: 06 Dec 2008, 16:58

13 Dec 2008, 16:54 #1

Freedom from Nicotine - The Journey Home

The First 72 hours
ImageAre you all packed with map in hand? Do you understand your chemical dependency and how the only way to arrest it is 100% obedience to the Law of Addiction? Have you developed a crave coping plan and studied the common hazards up ahead? Have you pondered your use rationalizations and how best to neutralize or destroy them?

If not, it's ok to read and learn as you go! Just remember one thing. If the going gets tough the solution is here at Freedom from Nicotine, not in a pack, tin, pouch, bag, box, tube or cartridge.

Ready for that first step? Still a bit apprehensive? It's totally understandable. We're still going to encourage you to try and relax, take some slow deep breaths and ponder this: when going cold turkey, without aid of any product or procedure, nearly everything felt during these first three days is evidence of beautiful healing. It is good not bad.

If going cold turkey, rest assured, you will not experience any quitting product side effects. Instead, you will witness the response of your body and mind as they navigate a temporary period of deep and profound healing. If a smoker, it may be your body's most intense healing ever. Picture 100 trillion cells,[1] each receiving far more oxygen and far fewer toxins.

Psychologically, the first 24 hours are usually the biggest hurdle of all. It's here, during these early magic moments that we re-discover how to breathe, move about, eat and go to sleep without introducing nicotine back into our bloodstream.

The minutes will pass whether we sit on pins and needles while intensely focusing upon each passing second, or attempt to relax, make ourselves as comfortable as possible or keep ourselves occupied. A clock or watch will soon announce the passing of an hour. When it does, celebrate! You've taken that first giant step home. Congratulations!

A new supply of the super-toxin nicotine did not arrive. Its absence likely diminished destruction of surviving brain gray matter,[2] allowed more unhealthy cells throughout the body to die natural deaths (apoptosis),[3] diminished nicotine's influence in preventing bone regeneration,[4] and permitted a decline in nicotine induced angiogenesis which causes plaque build-up within arteries to harden and accelerates tumor growth rates.[5]

Most importantly, we arrested our dependency for an entire hour. We were the jailor and it was our prisoner. Forget about forever, forget about tomorrow, and forget about two hours from now. All we control are the next few minutes, minutes during which nicotine need not enter our bloodstream.

Nicotine's Half-life

Contrary to marketing suggestions of those selling quitting chemicals that stimulate brain dopamine pathways, the only way to restore natural stimulation and sensitivities is to remove the chemicals. The speed and beauty of natural recovery can be seen within just one hour of remaining 100% nicotine-free, as the concentration of nicotine in our bloodstream declines by 25%.

"Half-life" is defined as "the time required for half the quantity of a drug or other substance deposited in a living organism to be metabolized or eliminated by normal biological processes."[6] Most older cessation literature firmly fixes nicotine's elimination half-life at about two hours.[7] But nicotine's half-life can vary based upon genetic, racial and hormonal factors.[8] Let's ignore genetic differences, as we have no idea which genes we have or don't have.

As for racial variations, a 1998 study found an average nicotine half-life of 129 minutes in Caucasians and 134 minutes in African Americans.[9] A 2002 study compared Chinese-American, Latino and Caucasian smokers. It found that Latino's had the shortest half-life (122 minutes), Chinese-Americans the longest (152 minutes), with Caucasians in the middle (134 minutes).[10]

Nicotine's half-life was found to be shorter in women (118 minutes) than men (132 minutes), and even faster in women taking oral contraceptives (96 minutes). This was thought to be associated with estrogen.[11] Its half-life has been found to be shorter during pregnancy (97 minutes) than after giving birth (111 minutes).[12] Sadly, new born babies whose mothers smoked endure a nicotine withdrawal period five times longer than what their mother's would have been. Instead of a 2-hour elimination half-life it increases to 11.2 hours.[13] If considering breast-feeding, nicotine's breast milk half-life averages 97 minutes.[14]

Interestingly, a 1993 nicotine patch study found that when nicotine was administered directly into the bloodstream (intravenously) it had a 2 hour elimination half-life but when administered through the skin via nicotine patch (transdermally), once the patch was removed nicotine's elimination half-life was 2.8 hours.[15] This finding is confirmed by a second patch study that found it to be a minimum of 3.3 hours.[16]

The liver is the primary organ in eliminating nicotine from the bloodstream, and does so by breaking it down into other chemicals, its metabolites. Although studies are limited, it makes sense that any activity which increases blood flow though the liver (exercise or eating) should tend to accelerate nicotine depletion. One study reports that liver blood flow increases by 30% after meals, with a 40% increase in the rate that nicotine is cleared from arriving blood.[17]

As suggested by the above half-life data, most of us had sufficient nicotine reserves to comfortably make it through 8 hours of sleep each night (4 half lives leaving us with 6.25% of our normal daily supply). But within 24 hours of ending all nicotine use our remaining reserves will become so small they may be difficult to detect (.02 or just 2/100ths of our normal daily level).

It is here that surgery is nearly complete and true healing begins in earnest. Within three days, with absolute certainty, we again inhabit a nicotine-free body and mind.

As for detection, we often get the question, how long will my insurance company or employer be able to detect nicotine in my system? As seen above, unless examining hair, which permanently records nicotine use, measuring nicotine in blood, urine and saliva is easy to beat and rather useless. But one of nicotine's longer-lasting metabolites (the chemicals in breaks down into) is cotinine, which has a generally recognized half-life of 17 hours.[18]

Hopefully you're not trying to tick, fool or beat the system but sample the full flavor and wonderful aroma of freedom from nicotine.

Natural Fruit Juices

If our health permits, why not devote the money we would have spent purchasing nicotine, toward purchase and use of some form of natural fruit juice for the first 72 hours. Juice will not only help stabilize blood sugar levels, it will aid in accelerating removal of nicotine from our blood. Cranberry juice is excellent.

Hypoglycemia is a fancy word for what occurs when our "blood sugar (or blood glucose) concentrations fall below a level necessary to properly support the body's need for energy and stability throughout its cells."[19]

Causes of low blood sugar in non-diabetics include skipping or delaying meals, eating too little, increased activity or exercise and excessive alcohol.[20] Warning signs include an inability to concentrate, anxiety, hunger, confusion, weakness, drowsiness, sweating, trembling, warmness, nausea, dizziness, difficulty speaking and blurred vision.[21]

We reviewed in Chapter 6 how each hit of nicotine served as our spoon pumping stored glucose into our bloodstream via our body's fight or flight pathways. It allowed us to skip breakfast and lunch without experiencing low blood sugar or hypoglycemic type symptoms. One of recovery's greatest challenges is learning to again properly feed and fuel our body. It's not a matter of consuming more calories but learning to spread them out more evenly over our entire day by eating smaller portions of healthy foods more frequently.

As an aid in blood sugar stabilization, we recommend sipping on natural fruit juices the first three days unless diabetic or inappropriate due to other health conditions (such as acid reflux). But don't over do it or go beyond three days, as juice tends to be rather fattening. Make sure it's 100% natural juice, no sugar added and avoid fruit drinks and aides.

A 2008 study examined the effects of drinking 480 milliliters or 16 ounces of unsweetened, normal-calorie cranberry juice (280 calories) upon blood sugar. Spectrometry analysis found that while low-calorie cranberry juice (38 calories) and water produced no significant changes in blood sugar levels, that normal-calorie cranberry juice resulted in significantly higher blood glucose concentrations within 30 minutes, which were no longer significant after 180 minutes.[22]

As for fruit juices accelerating nicotine removal, the heart pumps about 20% of our blood through our kidneys. Our kidneys filter approximately 50 gallons or 189 liters of blood daily. This results in removal of about two quarts of waste products and extra water, which pass to the bladder as urine.[23]

The word "renal" means "of or relating to the kidneys." "Renal clearance" is defined as the volume of blood from which a chemical such as nicotine is completely removed by the kidney in a given amount of time (usually a minute).[24] A controlling factor in determining renal clearance rate is the pH level of urine produced by our kidneys.[25] The more acidic our urine, the quicker nicotine is removed from the bloodstream.

A 2006 study found that drinking one liter of full-strength grapefruit juice (34 ounces or about 2 pints) will increase the rate by which the kidneys remove nicotine from blood plasma by 88%, as compared to when drinking 1 liter of water (231 milliliters of nicotine-free blood produced per minute using grapefruit juice vs. 123 milliliters of blood when drinking water).[26] The study found that even if the grapefruit juice was half-strength that nicotine's renal clearance rate increased by 78% (219 milliliters per minute).

The pH scale ranges from 0 to 14 with 7 being neutral. The further below 7 a substance is, the greater its acidity. The higher a substance is above 7, the greater its alkalinity. According to the FDA,[27] the below fluids have the following pH ranges:

  • · Cranberry juice 2.3 - 2.5
  • · Grapefruit juice 2.9 - 3.3
  • · Pineapple juice 3.3 - 3.6
  • · Orange juice 3.3 - 4.2
  • · Apple juice 3.4 - 4.0
  • · Prune juice 3.9 - 4.0
  • · Vegetable juice 3.9 - 4.3
  • · Tomato juice 4.1 - 4.6
  • · Milk 6.4 - 6.8
But do NOT overdo it. Remember, our primary objective is to keep blood sugar as stable as possible during the most challenging portion of recovery.

Caffeine Use

Caffeine is a mild central nervous system stimulant found in coffee beans, tea leafs and cocoa beans. The question during recovery is whether or not we can handle a doubling of our normal daily caffeine intake without experiencing "caffeine jitters" or other symptoms of over-stimulation? But why?

It's important because nicotine somehow doubles the rate by which the body depletes caffeine. What's that mean? It means that if we were drinking 2 cups of coffee while using nicotine, once nicotine use ends the stimulant effect of those two cups of coffee might now feel like 4 cups.

According to a 1997 study, "continuous caffeine consumption with smoking cessation has been associated with more than doubled caffeine plasma levels. Such concentrations may be sufficient to produce caffeine toxicity symptoms in smoking abstinence conditions." The study found "a significant linear increase in caffeine sputum levels across 3 weeks post cessation," and that "three weeks after cessation, concentrations reached 203% of baseline for the caffeine user."[28]

An earlier study found that the clearance rate of caffeine from blood plasma averaged 114 milliliters per minute in nicotine smokers and 64 milliliters per minute in non-smokers.[29]

Symptoms of caffeine intoxication have been seen with as little as 100 milligrams of caffeine daily, and may include restlessness, nervousness (anxiety), excitement, insomnia, a flushed face, increased urination and gastrointestinal complaints. Intoxication symptoms seen when more than 1 gram of caffeine is consumed per day include muscle twitching, rambling flow to thoughts and speech, irregular or rapid heartbeat, irritability and psychomotor agitation.[30]

ImageMany of us can handle a doubling of our daily caffeine intake without getting the "jitters." But how can we tell whether the anxieties we feel are related to nicotine cessation or too much caffeine? It isn't easy. Experiment with an up to 50% reduction in daily caffeine intake if at all concerned. Be careful not to reduce normal caffeine intake by more than 50% unless you want to add the symptoms of caffeine withdrawal to those of nicotine withdrawal.

Caffeine withdrawal symptoms can include headache, fatigue, decreased energy, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, and a foggy mind. Symptoms typically begin 12 to 24 hours after caffeine use ends, reach peak intensity at 20 to 51 hours, and normally last 2 to 9 days.[31]

The following is a sampling of the number of milligrams (mg) of caffeine "typical" in various substances:[32]

  • · 85mg coffee - 8 ounces drip brewed
  • · 80mg "energy drinks"
  • · 75mg coffee - 8 ounces percolated
  • · 40mg espresso - 1 ounce servings
  • · 40mg tea - 8 ounces brewed
  • · 28mg tea - 8 ounces instant
  • · 26mg baker's chocolate - 1 ounce
  • · 25mg iced tea - 8 ounces
  • · 24mg some soft drinks - 8 ounces
  • · 20mg dark chocolate - semi sweet - 1 ounce
  • · 6mg cola beverage - 8 ounces
  • · 5mg chocolate mild beverage
  • · 4mg chocolate flavored syrup
  • · 3mg coffee - decaffeinated
The stimulant effects of a 24mg soft drink before bed or a 20mg chocolate bar could now feel like two sodas or two chocolate bars. Consider a modest reduction of up to one-half if experiencing difficulty falling to sleep.

Look at it this way if we were a big caffeine user it's cheaper now. We get twice the stimulation for half the price.

Sensations Good, Not bad

I know this sounds strange, but within reason, everything we feel during our climb to withdrawal's peak is good not bad. What more honest signs of healing could we have? What sense does it make to fear healing? Why fight coming home to a place where entire days pass without once wanting to ingest nicotine into our bloodstream? Don't fight recovery, hug it. Hug it hard.

Exerpts from a free pdf book by Polito JR entitled
"Freedom from Nicotine - The Journey Home"
Copyright 2008 John R. Polito


[1] [font=&AMP]National Institutes of Health,[/font] [font=&AMP]Human Cells 101[/font][font=&AMP], NICHD, - page last updated 9/18/06.
[2] [font=&AMP]Brody, AL et al,[/font] [font=&AMP]Differences between smokers and nonsmokers in regional gray matter volumes and densities[/font][font=&AMP], Biological Psychiatry, January 1, 2004, Volume 55(1), Pages 77-84.
[3] [font=&AMP]Cucina A, et al, Nicotine Inhibits Apoptosis and Stimulates Proliferation in Aortic Smooth Muscle Cells Through a Functional Nicotinic Acetylcholine Receptor, The Journal of Surgical Research, November 26, 2007 [Epub ahead of print].
[4] Zheng LW, et al, Changes in blood perfusion and bone healing induced by nicotine during distraction osteogenesis, August 2008, Volume 43(2), Pages 355-361.
[5] Cooke JP, Angiogenesis and the role of the endothelial nicotinic acetylcholine receptor, Life Sciences, May 30, 2007, Volume 80(24-25), Pages 2347-2351; also see, Heeschen C, et al, Nicotine stimulates angiogenesis and promotes tumor growth and atherosclerosis, Nature Medicine, July 2001, Volume 7(7), Pages 833-839.

[6][font=&AMP] half-life. (n.d.). The American Heritage® Dictionary of the English Language, Fourth Edition. Retrieved August 22, 2008 from
[/font][7][font=&AMP] Benowitz NL, et al,[/font] [font=&AMP] Interindividual variability in the metabolism and cardiovascular effects of nicotine in man[/font][font=&AMP], The Journal of Pharmacology and Experimental Therapeutics, May 1982, Volume 221(2), Pages 368-372; also see Feyerabend C, et al,[/font] [font=&AMP] Nicotine pharmacokinetics and its application to intake from smoking[/font][font=&AMP], British Journal of Clinical Pharmacology, February 1985, Volume 19(2), Pages 239-247.
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[/font][10][font=&AMP] Benowitz NL, et al,[/font] [font=&AMP] Slower metabolism and reduced intake of nicotine from cigarette smoking in Chinese-Americans[/font][font=&AMP], Journal of the National Cancer Institute, January 16, 2002, Volume 94(2), Pages 108-115.
[/font] [11][font=&AMP] Benowitz NL, et al,[/font] [font=&AMP] Female sex and oral contraceptive use accelerate nicotine metabolism[/font][font=&AMP], Clinical Pharmacology & Therapeutics, May 2006, Volume 79(5), Pages 480-488.
[/font][12][font=&AMP] Dempsey D, et al,[/font] [font=&AMP] Accelerated metabolism of nicotine and cotinine in pregnant smokers[/font][font=&AMP], Journal of Pharmacology Exp Therapeautics, May 2002, Volume 301(2), Pages 594-598.
[/font][13][font=&AMP] Dempsey D, et al,[/font] [font=&AMP] Nicotine metabolism and elimination kinetics in newborns[/font][font=&AMP], Clinical Pharmacology Therapeutics, May 2000, Volume 67(5), Pages 458-465.
[/font][14][font=&AMP] Luck W,[/font] [font=&AMP] Nicotine and cotinine concentrations in serum and milk of nursing smokers[/font][font=&AMP], British Journal of Clinical Pharmacology, July 1984, Volume 18(1), Pages 9-15.
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[/font][20][font=&AMP] National Institutes of Health,[/font] [font=&AMP] Hypoglycemia[/font][font=&AMP], National Institute of Diabetes and Digestive and Kidney Diseases, NIH Publication No. 03-3926, March 2003.
[/font][21][font=&AMP] Hepburn DA, et al,[/font] [font=&AMP] Symptoms of acute insulin-induced hypoglycemia in humans with and without IDDM. Factor-analysis approach[/font][font=&AMP], Diabetes Care, November 1991, Volume 14(11), Pages 949-957.
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Last edited by FreedomNicotine on 06 Mar 2009, 19:23, edited 12 times in total.

Joined: 06 Dec 2008, 16:58

14 Mar 2010, 18:57 #2

If your diet and health permit, natural fruit juice not only helps stablize blood sugar during the first 72 hours. as shown by the below study, it aids in accelerating elimination of nicotine from the bloodstream.   But be careful in using extra juice beyond day three as they tend to be rather fattening.

Effect of grapefruit juice on cytochrome
P450 2A6 and nicotine renal clearance.
Journal: Clinical Pharmacology and Theraputics, November 2006, Volume 80(5), Pages 522-530.

Authors:  Hukkanen J, Jacob P 3rd, Benowitz NL.

Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center, and Department of Medicine, University of California, San Francisco 94143-1220, USA.

BACKGROUND AND OBJECTIVE: Grapefruit juice is an inhibitor of the cytochrome P450 (CYP) 3A4 enzyme and transporters such as P-glycoprotein and organic anion transporting polypeptides, leading to clinically important interactions. Our objective was to study the effect of grapefruit juice on the pharmacokinetics of nicotine, which is primarily metabolized by the CYP2A6 enzyme.

METHODS: Ten volunteers were given a 2-mg oral dose of deuterium-labeled nicotine on 3 occasions together with 1 L of water, full-strength grapefruit juice, or half-strength grapefruit juice. Concentrations of nicotine and its metabolites were analyzed in plasma and urine for 8 hours.

RESULTS: Grapefruit juice inhibited the formation of cotinine from nicotine (area under the plasma cotinine concentration-time curve from 0 to 8 hours of 6807, 7805, and 8007 for full-strength grapefruit juice, half-strength grapefruit juice, and water, respectively; repeated-measures ANOVA, P=.009). The time to peak plasma concentration of cotinine was delayed (216 minutes, 159 minutes, and 147 minutes, respectively; ANOVA, P=.011), and the peak plasma concentration was lower with grapefruit juice compared with water (18 ng/mL, 21 ng/mL, and 22 ng/mL, respectively; ANOVA, P=.010). Oral clearance, peak plasma concentration, and time to peak plasma concentration of nicotine were not affected. Grapefruit juice increased the renal clearance of nicotine (231 mL/min, 219 mL/min, and 123 mL/min, respectively; ANOVA, P=.045) and cotinine (19 mL/min, 14 mL/min, and 16 mL/min, respectively; ANOVA, P=.002).

CONCLUSIONS: Grapefruit juice inhibits the metabolism of nicotine to cotinine, a pathway mediated by CYP2A6, and increases the renal clearance of nicotine and cotinine. Nicotine oral clearance is not affected by grapefruit juice because the inhibition of hepatic metabolism is offset by the increase in the renal clearance of nicotine. However, other compounds metabolized by CYP2A6, as well as other drugs excreted via renal clearance mechanisms similar to those of nicotine, may be susceptible to significant pharmacokinetic grapefruit juice interactions.

PMID: 17112808 [PubMed - indexed for MEDLINE]

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