Obama's gum-chewing in India called 'ungainly sight' 
 
 President Barack Obama became the first president honored as chief guest for India’s Republic Day parade with an old habit: gum chewing. 
 
 Obama popped in a piece of chewing gum during Monday’s parade, according to pool reports and local press. 
 
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 The president could be seen “at certain points” chewing gum while watching the procession, which celebrates that day the Constitution of India came into force in 1950, one pool report said. 
 
 Obama was also spotted chewing upon his arrival as he greeted Indian Prime Minister Narendra Modi in video posted by The Times of India. The outlet called it an “ungainly sight.” 
 
 This wasn’t the first time Obama has received criticism for chewing gum at public events. 
 
 The president, who has been known to use nicotine chewing gum, chewed gum during a trip to China in November, at a ceremony in France for the 70th anniversary of D-Day and during his inauguration in 2013. ||||| President Obama as he walks with China’s President Xi Jinping on Tuesday. This clip has been slowed down. (Source: AP) 
 
 In June, President Obama’s physician dispatched the results of his third physical examination of the commander in chief. The doctor noted Obama was in “excellent” health except for one minor problem: his history of smoking. But Obama, the report found, was now “tobacco free,” buoyed by the “occasional use” of “Nicotine Gum.” 
 
 It’s difficult to find a larger advocate of gum-chewing than the president. Obama chews gum while ensconced in Air Force One watching football. He chews gum while in the throes of a campaign. He chews gum when presiding over World War II commemorations. And to the horror of conservatives, he chewed gum this week at an Asia-Pacific Economic Cooperation conference in Beijing. Amid the gallantry of Vladimir Putin and the accusations of Australian Prime Minister Tony Abbott, there was Obama, chewing away. 
 
 President Obama arrived in Burma, the country which the junta renamed Myanmar, on Wednesday but is still being chewed out in China for chomping on Nicorette gum during APEC summit ceremonies in Beijing. (Reuters) 
 
 It’s kind of his thing. And regardless of the criticism facing Obama over the habit, he’s obviously hooked. 
 
 For Obama, gum isn’t about vanity. His aides described his quest to kick cigarettes as a “lifelong struggle.” “I was one of these teenagers” who smoked, he said in 2009. “And so I know how difficult it can be to break this habit when it’s been with you for a long time.” And even as late as mid-2010, his medical team reported he was still smoking. Navy Capt. Jeffrey Kuhlman, the White House physician, recommended Obama stick with “smoking cessation efforts,” such as “the use of nicotine gum.” 
 
 
 
 In 2010, Obama chewed gum en route to Gulfport, Miss., for a tour of areas of the Gulf Coast affected by the BP Deepwater Horizon oil spill. (AP Photo/Charles Dharapak) 
 
 Of course, not everyone is sympathetic — certainly not the French. “One thing: OBAMA was chewing gum almost uninterrupted,” one Twitter user bleated after Obama was caught chewing gum at a World War II ceremony. “How disrespectful!” Another added, “And #Obama welcomed the Queen with chewing gum in his mouth… #shocking #boor.” 
 
 The Chinese, too, weren’t so keen on the president’s jaw workouts. “This is the American manner and humor, but in traditional Chinese culture, it is immature and not serious behavior!” the Wall Street Journal quoted one blogger saying. Another said it spoke to something bigger: “No wonder he doesn’t get any support.” 
 
 Republicans seized on the gum-chewing as another example of Obama’s fecklessness. On Fox News, columnist Charles Krauthammer was particularly unforgiving, castigating Obama for chewing gum at this pivotal moment in history: “My mother used to say, ‘Don’t chew gum.’ And that was just in class. Look, the Chinese of all people have been extremely sensitive to the rituals, the decorum, the subtleties, the deference of diplomacy. This goes back 3,000 years! In China, chewing gum is a sign of disrespect.” 
 
 There is cause to dispute that assertion, given the wild popularity and eclectic nature of gum in China. (Taijixing Double-Deck Lunch Box Chewing Gum, anyone?) The economic gods have been kind to gum in the Middle Kingdom, where industry behemoth Wrigley controls 45 percent of the gum market. In 2005, the Asia Times even ran a graphic of Mao Zedong blowing a giant bubble above a Tiananmen Square covered in gum. Today, gum in China enjoys “dynamic growth,” the Wall Street journal found earlier this year. 
 
 
 
 Obama at the East Asia Summit plenary session in Bali on Nov. 19, 2011. (SAUL LOEB/AFP/Getty Images) 
 
 If the East chews this much gum, China and the president have found more common ground than just controlling greenhouse gases. Basketball diplomacy, meet gum-chewing diplomacy. 
 
 “Since 1999, China has become Wrigley’s second-largest market, behind only the United States,” the Asia Times reported. “If ever there was an American company that has actually cashed in on the mythic slogan, ‘If every one of China’s billion people bought just one …’ it is Wrigley’s. As a matter of fact, they buy more than one: Chinese, on average, buy 10 sticks of gum a year.” That means the Chinese consume a whopping 14 billion sticks of gum per annum. 
 
 “Chinese food has so much garlic,” one man confessed in an interview with the Journal following the purchase of a 40-piece container of chewing gum. “I need to freshen my breath after eating.” 
 
 Obama may have separate gum ambitions, but that hasn’t stopped others from finding it odd. Like when he met with David Remnick of the New Yorker, who found the president’s jaws working away on Air Force One. “Obama chewed furtively on a piece of Nicorette,” Remnick wrote. “His carriage and the cadence of his conversation are usually so measured that I was thrown by the lingering habit, the trace of indiscipline. ‘I’m not a purist,’ he said.” 
 
 Indeed, he’s not. 
 
 Related: ||||| Bob Berens poses with his last box of remaining Nicorette lozenges in Los Angeles on Feb. 3. (Jonathan Alcorn/For The Washington Post) 
 
 Bob Berens, a television writer in Los Angeles, first noticed back in July that it was getting hard to find the Nicorette lozenges he’d been consuming religiously ever since he quit smoking seven years ago. Neighborhood stores were tapped out. Soon, he was driving across the city to locate even a single box of the elusive product. Berens couldn’t figure it out. Stores still carried Nicorette gum and Nicoderm patches. Only the brand’s lozenges were gone. 
 
 And Berens, 36, was hooked. There were generic versions, but Berens and many others swore the small, white Nicorette lozenges tasted better, packed a distinct kick and took the edge off in a way no other smoking-cessation product could. Maybe it was some secret flavoring. Maybe it was just psychological. But he was as loyal to Nicorette lozenges as he had once been to his favorite cigarettes, Marlboro Reds. 
 
 “Those lozenges,” Berens says, “are magic.” 
 
 Berens and many other ex-smokers today are at the mercy of a mysterious nationwide nicotine-lozenge shortage. GlaxoSmithKline, maker of Nicorette, quietly stopped making its lozenges early last year because of quality control problems and initiated a recall, assuring curious visitors to its Web site, “you aren’t alone and we apologize.” But the pharmaceutical giant was silent about whether it would make the lozenges again. 
 
 Now, as the Nicorette lozenge threatens to disappear entirely, Berens and others are hunkering down and stocking up. They are left looking not only for lozenges but also for answers. What happens when a product that is supposed to ease addiction vanishes? And really, just how hard is it to make a lozenge? 
 
 Austin Rodrigues, 34, walks into a pharmacy in Brooklyn in search of Nicorette lozenges on Feb. 5. (Yana Paskova/For The Washington Post) 
 
 “I wonder how many people have gone back to smoking because of the lozenge problems,” says Austin Rodrigues, a Nicorette lozenge devotee living in New York City. 
 
 Quitting smoking today is almost a rite of passage, the result of broad societal changes and laws that discourage the habit. Each year, an estimated 21 million people — about 45 percent of U.S. smokers — attempt to stop smoking. They might try electronic cigarettes or medication or the cold turkey approach. At some point, many end up turning to nicotine-replacement therapies such as the gum, lozenge or patch. 
 
 The gum accounts for slightly more than half of the $1 billion U.S. market. President Obama is one longtime nicotine gum chewer. And then there’s the lozenge, which makes up nearly a third of U.S. sales, according to Euromonitor. 
 
 Glaxo’s Nicorette brand dominates the market for nicotine gum and lozenges. The company alerted federal regulators on Feb. 20 that it was voluntarily recalling its lozenges and mini lozenges from warehouses and distributors because of quality-control problems. The company described the recalled lozenges as “overly thick, overly soft, and sub and superpotent,” according to U.S. Food and Drug Administration records. 
 
 But, the company said, the lozenges were still safe to use. So retailers could sell the remaining supply. 
 
 Nicorette introduced the nicotine lozenge to the United States in 2002, almost two decades after the gum. The gum was the original nicotine-replacement therapy, invented in the early 1970s by a Swedish chemical engineer named Ove Ferno. Swedish submariners were going stir-crazy because they couldn’t smoke on their subs. Ferno was a smoker, too. He was convinced it was nicotine, not tobacco, that drove his addiction. He first tried a nicotine aerosol spray. It tasted terrible. After much trial and error, his lab produced a palatable nicotine gum. 
 
 Ferno used his invention to break his own habit. 
 
 But not everyone likes the gum. It can stick to your teeth. And it requires work — Obama has been criticized for noticeably chewing gum during recent high-profile visits to China and India. 
 
 The nicotine lozenge just sits in your mouth, said Saul Shiffman, a University of Pittsburgh psychology professor who led the study showing U.S. regulators that the Nicorette lozenge worked at least as well as the gum. And the lozenge provides 25 percent more nicotine because it is completely absorbed, he said. 
 
 Nicotine content aside, the preference for gum or lozenge can run deep. 
 
 “Some patients complain bitterly about the taste of one or the other,” said J. Taylor Hays at the Mayo Clinic’s Nicotine Dependence Center. 
 
 But nicotine-replacement products are intended to be short-term fixes. Package inserts for nicotine gum and lozenges warn that the product shouldn’t be used for more than 12 weeks. But 6 to 10 percent of the products’ consumers use them for more than six months — in some cases, for years. Doctors generally think this is safe, especially when the other option is going back to smoking. 
 
 Berens started smoking when he was 12. He sneaked cigarettes at first, eventually developing a two-pack-a-day habit. He grew up in Oyster Bay, N.Y., the second-oldest of four children. They all smoked. His parents smoked, too. And one by one, they all quit. His mother and sister went cold turkey. His father, a lawyer, chewed the gum for years — so much that Berens swears he could see his father’s jaw muscles become more defined. Two of his brothers also chew the gum. 
 
 He was 29 when he decided to quit. Berens went with the Nicorette lozenge. “I had an epiphany,” he says. 
 
 He walked across the street to a drugstore and bought a box of lozenges, original flavor. Today, he goes through about eight lozenges a day. He might consume twice as many when he’s facing a script deadline for the CW show “Supernatural.” 
 
 As the lozenges got harder to find, Berens started buying more online. He used to shop on Amazon to save money. But the online price skyrocketed as the shortage deepened. Recently, he sat at his computer and considered an offer of a 108-count box of lozenges for $122 — almost triple the retail price. His finger hovered above his keyboard as he weighed clicking the “buy” button. 
 
 To him, this felt like smoking cigarettes. “It’s the same level of powerlessness,” he says. 
 
 And the thought of running out of lozenges has led to a few panicky moments. 
 
 “It’s dawning on me this might be a permanent situation,” he says, laughing a bit at his predicament. 
 
 Rodrigues, 34, knows the feeling. Last year, when he noticed that Nicorette lozenges were suddenly scarce in his New York City neighborhood, he called his brother in Massachusetts. They both were ex-smokers who loved the lozenges. His brother confirmed the supply problem wasn’t just local. 
 
 Rodrigues, who had been using the lozenges for three years, wanted to know more. Like any modern consumer, he took to social media, tweeting at Nicorette: “I can’t find your brand of lozenges anywhere in NYC. It’s all generic. Sup with that.” 
 
 He didn’t hear back. So he called the company. A year earlier, he’d bought $100 worth of Glaxo stock, believing that any company making a product as good as the lozenges was a solid investment. Now, he hoped the stock would earn him some traction. 
 
 “I’d never before called any company as a stockholder to demand answers,” says Rodrigues, a comedian and writer for the comedy group Upright Citizens Brigade. 
 
 He left a message. He never heard back. 
 
 “I feel like there’s a big controversy here. Something’s going on,” Rodrigues says. “Why haven’t they restarted production?” 
 
 A reporter recently called Glaxo to ask about the lozenge shortage. The company responded with a statement, explaining the lozenge-sizing problems it had at its plant in Aiken, S.C. Glaxo said it always planned to resume production, but “we did not compromise on the somewhat lengthy corrective actions.” 
 
 So it’s taken awhile. Glaxo had to change how the lozenges are made and the equipment it uses. But it expects Nicorette Mini Lozenges to return to store shelves in April. Its full-size lozenges should be back later this year. 
 
 “Oh, my God. That’s fantastic,” Rodrigues said upon hearing the news. 
 
 He just hopes he can make it until then. Already, he has resorted to visiting small, independent pharmacies in New York to hunt for lingering lozenge boxes. And he recently bought a giant bag of hard candy — like something a grandmother might stock. It wasn’t the same. 
 
 In Los Angeles, Berens counted his remaining lozenge stockpile. He had about 170 left, with many more script deadlines to go. Maybe he could stretch it out. Maybe he could just overpay online. Eventually the Nicorette lozenge would be for sale again. 
 
 But, after thinking about all he’s been through with the lozenge, he was considering one more option. 
 
 “The reality is,” he said, “I probably should get off these.” ||||| WASHINGTON — President Barack Obama hasn't kicked the smoking habit, takes anti-inflammatory medication to relieve chronic tendinitis in his left knee and should eat better to lower his cholesterol, his team of doctors concluded Sunday after the 48-year-old's first medical checkup as commander in chief. 
 
 The hoops-happy chief executive, who has endured an exhausting White House run and yearlong battles with congressional Republicans, was otherwise declared in excellent health and fit for duty. 
 
 The White House physician, Navy Capt. Jeffrey Kuhlman, said Obama should stick with "smoking cessation efforts," the use of nicotine gum, and come back in August 2011 after he turns 50. 
 
 Obama cholesterol levels have crept up to borderline high and he should alter his diet accordingly, according to a report the White House released after the 90-minute examination at National Naval Medical Center in Bethesda, Md. While at the facility, he visited 12 military service members receiving treatment and rehabilitation for injuries suffered in Iraq and Afghanistan. 
 
 The president is the picture of health, eats modest portions and exercises regularly. He is an avid basketball player and golfer. The slightly elevated cholesterol levels, tendinitis in his left knee and occasional smoking were the only negatives noted. 
 
 Obama said at a June news conference that he still had an occasional cigarette. It was his first public acknowledgment that he hadn't kicked the habit. He chews nicotine gum to avoid regular smoking, and his doctor said that should continue. 
 
 Kuhlman also said the president should modify his diet to bring his LDL, or bad cholesterol, below 130. At the time of his last exam, Obama's total cholesterol was 173, while his LDL was 96 and HDL, or good cholesterol, was 68. 
 
 This time, total cholesterol was up to 209, with HDL down slightly at 62. LDL was up to 138. Borderline high cholesterol starts at 200, with LDL considered in the same category at 130. 
 
 Kuhlman said Obama last checkup was in July 2008 when he was seen by the attending physician to Congress when Obama was an Illinois senator. During the 2008 White House race, his campaign released a statement from his longtime Chicago doctor saying Obama was in excellent health when examined January 2007. 
 
 Sunday's report said Obama is 6-foot-1 and weighs 180 pounds in shoes and exercise clothing. His pulse rate is 56, which is very good, as is his blood pressure – 105 over 62. The doctor said Obama's vision was 20/20 in both eyes for both distance and near vision. 
 
 The president was checked for and found free of colon cancer with a virtual colonoscopy, a scan that avoids the more invasive visual inspection with a camera device that is passed into the large intestine. 
 
 The tendinitis that Obama suffers in his left leg could be the result of his regular basketball playing. 
 
 Kuhlman said that there was mild popping and grinding in Obama's left knee and "some weakness" in his left hip, also possibly a result of rigorous and extended periods on the basketball court. 
 
 The doctor said Obama should: 
 
 _Have another exam for colon cancer in five years 
 
 _Continue smoking cessation efforts, a daily exercise program, a healthy diet, moderation in alcohol intake, periodic dental care, and remain up to date with recommended immunizations. 
 
 _Keep up a modified exercise regimen to strengthen his legs to ward off more difficulties with his knee. 
 
 _Modify his diet to lower his LDL cholesterol below 130.
– It's got to be better than smoking in public, but President Obama's gum-chewing habit keeps getting him in trouble. The latest kerfuffle came in India, where Obama was watching a parade; reports noted his chewing of what was likely Nicorette. That incident has now made a number of headlines, with Politico reporting that the chewing occurred multiple times during the event as well as when Obama greeted PM Narendra Modi; the Times of India called it an "ungainly sight." The gum prompted some commentary on Twitter, noted by the Times. "Seriously—gum during a formal parade?" asked author Shobhaa De, while filmmaker Shekhar Kapur posted: "Glad to see @BarackObama is so human." Previous such moments have occurred in France and China, Vocativ reports, pointing to a Washington Post article from last year which noted, per earlier reports, that it was a doctor-recommended activity. Amid Obama's "lifelong struggle" to get off cigarettes, his physician recommended he stick with the chewing.