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0:00 - Intro with Joanna Junak
0:31 - Dr Fredrik Nyström talks to us about snus and nicotine pouches
1:21 - Snus replaces cigarettes as the most popular nicotine product in Sweden
2:52 - Snus use increases amongst Swedish youth
3:27 - Study examines the effects of nicotine on human body
7:30 - Effects of alcohol on human body also examined in study
9:39 - Nicotine not associated with an increased risk of oral cancers
11:24 - Closing remarks


Hello and welcome. I'm Joanna Junak and this is GFN News on GFN.TV. In today's program

Fredrik Nyström, Doctor of Medicine, Professor at the Faculty of Medicine and Health Sciences,

Linköping University, will tell us more about using snus and nicotine pouches. Thank you

Fredrik for joining us today. First, can you tell us what is snus? And is snus the same

as nicotine pouches? It's pretty much the same when it comes to

the effect. Swedish snus, which is sort of a moist snuff, it's sometimes called, but

we usually prefer to call it just, as you said, snus. That's basically putting tobacco

under the lip. And this particular tobacco has not been fermented, so it's very pure

tobacco, and it's sort of nothing particular that's dangerous to you that comes out of

this compared to nicotine pouches. I would consider it the same agent, the same thing

really when it comes to metabolic effects, to use pure nicotine or to use Swedish tobacco

under the lip. Snus wasn't always popular. What has happened

that now in Scandinavia snus is more popular than other nicotine products?

I mean, my science is about the metabolic effects of nicotine in snus, but I could try

to explain what I think. I mean, basically, it's been very banned to smoke and people

want the nicotine. And as you said, there is a tradition to use snus. So what we can

see from an epidemiological perspective is that pretty much the same amount of tobacco

is consumed now in Sweden as when we once were about 20% smokers. But now we have something

like that, nicotine uses by snus instead, and smoking has gone down to about something

like 5%. So sort of these are inverse appearances of using tobacco. We pretty much swapped smoking

tobacco to using tobacco in snus instead to get the nicotine. That's how it looks from

an epidemiological perspective. And again, then in the last couple of years, also the

more white snus has become very popular, which is pretty much just pure nicotine in pouches.

But to me, as I said, I think that's pretty much the same thing when it comes to potential

metabolics effects, whether it's from tobacco or if it's more purified nicotine.

Are there any specific groups of people with a very high prevalence of snus use and a very

low prevalence of smoking? Yeah, basically in younger people, it's become

very popular to use even the newer version, which is the white snus, as we call it, pure

nicotine with some tastes and not really any tobacco at all. That's become very popular.

And in particular, if I'm correctly informed about the epidemiology, that's up to date.

So among young women, it's become very popular. Snus contains nicotine, and the mass media

tend to depict nicotine as something that is harmful in and of itself. What does the

science have to say about that? Actually, there hasn't been that very much

experimental and well-designed trials on nicotine. Most of it is epidemiology to this day, and

that's not very trustworthy since epidemiology on snus usually means studying people that

are former smokers. And it's very difficult to discern which effects that are which when

it comes to cardiovascular disease and cancer. I mean, you can still get cancer from having

smoked a couple of years ago and then switch to snus, for example.

So I did a trial on my own on that topic, which is the one I'm going to present at the

conference in Bishek. And we randomized people to use nicotine-free or nicotine-containing

snus during a couple of hours while they were also trying a big meal. So they had a standardized

meal with lots of calories and sugar during these four hours that the trial took place.

And we measured all the metabolic important variables like insulin and glucose. And also

we measured blood pressure every hour and even measured cortisol and specific satiety

hormones and so on. We draw blood tests every hour. And to make the story short, there were

56 experiments done and people served in this setting as their own controls. They tested

all the four conditions of the trial. And to summarize, there was very small effects

on any of the parameters. Glucose was not affected. Insulin levels were not affected

by the nicotine in snus. And there was a small increase, I don't know, perhaps 15% or so

in cortisol during these four hours. And I think that could perhaps be linked to the

fact that people do feel a bit more peppy and aroused and experience an increased focus

and so on due to nicotine, which is why you use it because cortisol is a hormone with

such effects. I don't think that was of very much importance. And again, cortisol increase

did not in this trial lead to any increase in glucose or insulin. So I mean, it had no

metabolics effect that I could see in my trial. And there was a slight increase in blood pressure

of something like three to five millimeters of mercury, which is pretty much the same

you get from drinking coffee and coffee is still allowed. So my conclusion of this trial

was that there was surprisingly small metabolic effects in this statistically high power trial

of nicotine. So my agenda nowadays seems to be to explain to my colleagues and peers,

I'm also sort of head of pulmonary medicine, actually, at my university, not only internal

medicine to explain that you mustn't mix up the dangers with the smoke. When you smoke

tobacco, you get particles and all sorts of dangerous stuff in your lungs. If you use

nicotine, either in snus or more pure forms, nicotine has very little effects. And it even

is good in some disorders for people. I mean, that's why people tend to use nicotine. Some

people feel relief, there are randomized trials showing that you can reduce pain in some circumstances

when you actually use nicotine patches. And so my favorite paper, which I like to cite,

it's not my own, is that archers shooting bows, semi-professional archers, they hit

better scores when they have nicotine in the blood. So I mean, there are potentially very

good effects on nicotine, and that's probably why people like to use it. And in Sweden,

they swapped from using cigarettes to using snus in different forms instead. And I think

that's a perfect example of harm reduction.

You have also included alcohol in your research. So in your research, you tested both alcohol

and nicotine. Can you tell us more about that?

That's why there were four different conditions in my trial, together with Emil. So each subject

tested four conditions. So the conditions were the snus with or without nicotine, so

there's two conditions. And there was also combined with drinking two deciliters of red

wine to the hamburger that they ate with or without alcohol in it. So that's why it was

four conditions, as you said. So in the same trial, we tested the effects of the alcohol

in red wine, which is also my interest. And as you said, it's often combined with nicotine

alcohol. And the effects of the alcohol was actually, to some extent, more impressive

on metabolism than the nicotine effects were. And we could show, which was in line with

what I supposed, that the glucose levels post meal, two hours after the meal, were actually

lowered when you had alcohol in the blood. And that suits with the effect that alcohol

actually has a glucose lowering effect in many trials. And we could show that that was

even under these circumstances, that was the case. So I mean, I have to disclose that I'm

pretty much pro-moderate drinking of alcohol is also something that could be good for cardiovascular

disease and reduce cardiovascular disease, lower glucose levels, lower cholesterol, and

which are also shown in the randomized trials, the trial I did once, and also lower blood

pressure because it's vasodilating. It makes you warm on the hands and so on. So I agree.

I don't think it's harm reduction to ask people to stop drinking any alcohol. I mean, it should

be okay to drink alcohol to meals like red wine to the dinner, for example. And nicotine

is good as well in combination with this. It doesn't ruin the effects of the nicotine

that might be potentially good.

And final question. Can you tell us what the science and statistics say about the relative

safety of snus compared with smoking?

That's again back to epidemiological data, but the ones that I've got hold of, which

is two, three years old, the latest data, it, for example, shows no increase whatsoever

in lip or oral cavity cancer, which some have claimed to be a consequence of using snus.

That's not confirmed by the latest data. And we also have the, I think the lowest prevalence

of pulmonary disease linked to smoking, at least in Europe nowadays, according to last

data in many age groups. So it is, it's a delay, I guess, in those effects since you

can still get ruined by having been a smoker for 30 years and then quitting in a couple

of years, the last couple of years. But the trend is going down. So it makes perfect sense.

You still can get pulmonary disease from, for example, unhealthy environments. I mean,

like cars and we have the studded tires that tend to put lots of dangerous particles still

in the air from the cars, even though the cars have become much better and so on. So

there are still other things that can make you end up with end stage pulmonary disease,

but it is going down very clearly since we've changed from smoking to snus use instead,

in parallel. It makes perfect sense, but it's going to take a longer time to get rid of

almost all such diseases because still people smoked a lot, say 20 years ago or even 10

years ago here also.

Thank you, Fredrik. That's all for today. Tune in next time here on GFN TV or on our

GFN TV podcast. And don't forget to book your place at GFN23 to join in the discussion

yourself. Thanks for watching or listening. See you next time.