Chapters: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.