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Smoking and oxidative stress

Department of Hematology and Genetic Pathology Flinders University of South Australia and Flinders Medical Center Bedford Park, South Australia 5042 Australia

Dear Sir:

A recent article in the Journal by Marango et al (1) and an accompanying editorial (2) on the effect of smoking on antioxidant status prompted my to make the following comment. The take-home message from the article, as well as several references cited in the article, is that cigarette smoke contains large amounts of free radicals which, in combination with a lower intake, an increased turnover rate, or both of antioxidant vitamins in smokers than in nonsmokers, leads to increased prooxidant stress in smokers. Our recent work has shown that stress can also result in an increased prooxidant state in nonsmoking humans as measured by a 50% decrease in lymphocytic 5'-ectonucleotidase activity and a 20% decrease in tissue ascorbate stores as measured by lymphocyte ascorbate (3, 4). Also, others have shown that psychologic stress can result in a heightened proinflammatory, and therefore prooxidant, state (5, 6). Thus, psychologic stress itself can cause such changes, and it has been observed that smokers generally have higher stress levels than nonsmokers (7, 8), which is thought to explain why they smoke. Also, like stress and depression, smoking results in chronic inflammatory responses that, notwithstanding direct effects of smoking, may also be related indirectly to the high stress levels in smokers (9). To conclude, psychologic stress can cause a significantly increased prooxidant state even in the absence of smoking. It remains to be ascertained whether smoking, when combined with psychologic stress, can increase the prooxidant status of humans.

REFERENCES

1. Marangon K, Herbeth B, Lecomte E, et al. Diet, antioxidant status, and smoking habits in French men. Am J Clin Nutr 1998;67:231–9.[Abstract]
2. Cross CE, Van der Vliet A, Eiserich JP. Cigarette smokers and oxidant stress: a continuing mystery. Am J Clin Nutr 1998;67:184–5.[Medline]
3. Blake-Mortimer JS, Winefield AH, Chalmers AH. Relationship between psychological stress and lymphocytic 5'-ectonucleotidase. Int J Stress Manage 1996;3:189–207.
4. Blake-Mortimer JS, Winefield AH, Chalmers AH. Evidence for free radical-mediated reduction of lymphocytic 5'-ectonucleotidase during stress. Int J Stress Manage 1998;5:57–75.
5. Joyce PR, Hawes CR, Mulder RT, Sellman JD, Wilson DA, Boswell DR. Elevated levels of acute phase proteins in major depression. Biol Psychiatry 1992;32:1035–41.[Medline]
6. Maes M, Scharpe S, Meltzer HY, et al. Relationship between interleukin-6 activity, acute phase proteins, and function of the hypothalamic-pituitary-adrenal axis in severe depression. Psychiatry Res 1993;49:11–27.[Medline]
7. Colby JP, Linsky AS, Straus MA. Social stress and state-to-state differences in smoking and smoking related mortality in the United States. Soc Sci Med 1994;38:373–81.
8. Byrne DG, Byrne AE, Reinhart MI. Personality, stress and the decision to commence cigarette smoking in adolescence. J Psychosom Res 1995;39:53–62.[Medline]
9. Anderson R. Assessment of the roles of vitamin C, vitamin E, and ß-carotene in the modulation of oxidant stress mediated by cigarette smoke–activated phagocytosis. Am J Clin Nutr 1991;53:358S–61S.[Abstract/Free Full Text]

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