Ramadan is a month of cleansing: a month during which the believer is spiritually and physically cleansed from the impurities that are an inevitable fact of life on earth estranged from the Lord God. It is fitting to fast to achieve this goal. As physicians, whenever we want an accurate picture of the health and actions of the body's metabolic pathways, we ask the patient to fast before having their blood drawn. Before I do a procedure called a bronchoscopy, in which I place a small camera into the patient's lungs, I ask the patient to fast the night before. Fasting helps the body be in a state of equilibrium, which we call "homeostasis." So does the fast of Ramadan: it helps the spirit reach its state of homeostasis.

Among the myriad of spiritual benefits of the month of Ramadan, there are a number of physical benefits as well. Ramadan teaches us to do without excessive food and drink, which does not portend a healthy lifestyle. It helps us break free of the addictions and dependencies that may develop over the year, such as that to caffeine, sugar, fats, and the like. Most important to me - as a pulmonary physician - is the opportunity to break free from the powerful addiction to nicotine.

Every day in my practice, I live and breathe the devastating effects of cigarette smoking. Just this week, I diagnosed a new lung cancer - one that is likely inoperable and incurable - in a wonderful woman who was relatively healthy, except for a cough that would not go away. The next day, I had to face another patient who had a lung cancer come back with a vengeance, spreading to her liver. This is to leave aside the crippling effects of the emphysema and chronic bronchitis that is caused by smoking, which can leave patients utterly breathless, even at rest. Cigarette smoking has done so much harm to so much people, and it is truly a tragedy.

The problem is in nicotine itself: it is powerfully addicting; more addicting, in fact, than heroin. It is also an extremely lethal poison, and if a sufficiently concentrated amount of nicotine is spilled on the skin, it can result in death. The reason people become addicted to cigarette smoking is because nicotine acts on receptors in the brain which stimulate the "pleasure centers," causing a release of a chemical called dopamine. This chemical makes the person feel very good. In fact, these receptors are called "nicotinic," because they have a particular affinity for nicotine. The cigarette is a very effective delivery mechanism for nicotine to bind receptors in the brain: nicotine reaches the brain in approximately seven seconds. The problem is, the cigarette is also an extremely toxic method of delivering said nicotine.

According to the WHO, tobacco smoking kills 5.4 million people per year. It is the leading preventable cause of death in the world. Tobacco smoke causes emphysema, lung cancer, throat cancer, asthma, cardiovascular disease, and stroke. Second hand smoke can be just as harmful, as well. In addition, the smoke itself is full of harmful poisons. Among the hundreds of additives in cigarette smoke are: cyanide (a deadly poison in the tiniest of amounts), carbon monoxide (which chokes cells of life-giving oxygen), ammonia, and other deadly chemicals, dozens of which are known carcinogens, or cause of cancer.

So, why smoke at all? Because the addiction is very, very difficult to shake. I had a patient tell me straight out: "Doc, I beat crack cocaine just like that. But, I can't shake cigarettes." With each inhalation of the cigarette smoke, with each delivery of nicotine to the brain, the receptors become less sensitive to its effects, necessitating more and more cigarettes to produce the same pleasurable feeling. Couple that with the unpleasant sensation of nicotine withdrawal, and the person becomes hooked. It is a very sinister product.

Enter Ramadan. Since smoking is prohibited during the daytime fast, it is the perfect opportunity to finally break free from nicotine dependence. The half-life of nicotine is approximately 2 hours, which means that half of the nicotine in the body is broken down and eliminated in 2 hours. After approximately 10 hours, the nicotine is completely out of the system. Theoretically, someone should be able to quit after just one day's fast in Ramadan, especially during the long, long, long days of summer. Yet, we have all witnessed the mad rush of Muslims to light up a cigarette the moment the call to sunset prayer is begun (many times before they even have had something to eat or drink). Why?

Partly to reduce the irritability and discomfort of nicotine withdrawal, but also because of the powerful behavioral associations that develop with cigarette smoking. I had a friend tell me, even though he has been without a cigarette the entire day, "I just have to have a cigarette after I eat. I just have to have one." Another patient of mine had quit, but then started again after going to the gas station and seeing the packs of cigarettes lined up on the counter in front of him. This behavioral association is extremely powerful and difficult to change, and it is the most important part of why nicotine addiction is so difficult to overcome. Yet, Ramadan is all about changing our behavioral patterns; it all about changing our habits to make ourselves better.

Thus, we should take the opportunity of the fast of Ramadan to change those behavioral associations that lead to smoking. Anything that triggers an urge to smoke should either be discarded or hidden: whether it be an ashtray, Marlboro hat, favorite shirt, cigarette lighter, or even best friend. If one is in the habit of always smoking after eating, then he or she should learn to do something else: eat a sugar free snack, chew sugar free gum, get up and walk outside, whatever it may be. Use the spiritually regenerating spirit of Ramadan to garner the strength to change age-old habits that are associated with smoking.

Family and friends should help in this effort. Clinical studies have clearly shown that emotional and behavioral support are effective adjuncts to pharmacological treatments to help with smoking cessation. The person trying to quit smoking is probably going to be a bit irritable, or even a bit unpleasant. As Ramadan is the month of patience, try to be patient with your friend or loved one as they struggle to beat the monster that is nicotine dependence. Continue to encourage them during their struggle. Remind them that, if they are able to go without cigarettes for 14 hours, they can certainly go without them for the remaining 10. And if their spouse is also a smoker - which can doom the effort of someone trying to quit - then let it be a project for both husband and wife. They will both be better off because of it.

And when a person finally quits, the benefits are almost instantaneous. 12 hours after quitting smoking, the blood level of carbon monoxide, a poisonous gas found in cigarette smoke, returns to normal. Lung function may improve weeks after quitting smoking. After 1 year, the increased risk of a heart attack is reduced by half. After more than 5 years, the risk of having a stroke returns to that of someone who has never smoked. Along with all of this, you will just feel better.

And it may take a few tries, but that's OK. Many of my patients tell me they feel like failures when they fail to quit smoking after they try. I counsel them not to: this is a very difficult addiction to break, and many people try several times before finally becoming successful. But, it can be done. Despite its difficulty, somehow, some way Muslims the world over find a way to go without a cigarette when they fast during Ramadan. That is part of the miracle that is Ramadan. Well, if it can be done during the day, it can be done at night as well. All you need is a little encouragement, a little faith, and a lot of prayer. And there is no better time to start than during the holy days and nights of Ramadan.

(Photo: Poagao via flickr under a Creative Commons license)

My apologies for commenting off topic. But I dind't see anywhere else to do it. Congratulations and blessings to Zahed Amanullah for the birth of his son. How wonderful to have a Ramadan baby! My best to your wife and son. :)

As salaamu alaikum,
I quit smoking on the Friday before Ramadan began, and I am so happy that I did! I feel closer to Allah (swa) and cleaner as a human being. I have some withdrawal symptoms, but nothing that is unendurable. I thank Allah for giving me the strength to be able to do this.

I tried quitting for a couple or Ramadans but it didn't work for me. I can understand the premise though: Since smoking is a physical and behavioral addiction, the best chance you have of quitting is if you attack it on both fronts.

For the physical craving, use nicotine replacement (patches, gum, lozenges) or at the very least plain old flavored gum (try cinnamon). Personally, I used generic nicotine gum (try Target).

For the behavioral component, drastic changes in routine like Ramadan can help. But there are other opportunities that similarly change behavior as well. Moving to a new city, a new job, getting married, having your first child. The reason so many New Year's resolutions fail is because December 29th more often than not is a lot like January the 2nd.

I finally quit smoking when I started hitting the gym seriously, and I cannot tell you how much benifit you do to your body when you refuse to give in to a craving. It absolutely is worth it, and if you don't succeed, start over. Remember, failure is not an option.

What if you don't inhale??