Trends show that nicotine pouches are quickly rising in popularity. You can find them in work and gym bags throughout Santa Monica and Westwood, as well as in offices in areas like Century City. Unlike cigarettes or vapes, nicotine pouches produce no smoke, vapor or smell, and users claim they are a less messy way to consume nicotine. However, many users of nicotine pouches are under the impression that because there is no smoke, there is no health risk, and this is where cardiac surgeon, Dr. Maria Tehrani, begins to see a problem. Nicotine pouches are somewhat less harmful than cigarettes, however, like cigarettes, they impact the heart and blood vessels.

FDA Approved, But Not Sanctioned

Nicotine pouches do not contain tobacco. Rather, they contain nicotine and other chemicals, as well as flavorings and sweeteners. The user places the pouch between their lip and gum. Unlike other methods of nicotine consumption, the nicotine in pouches takes between twenty to sixty minutes to be fully absorbed. Similar to vapes and cigarettes, the Nicotine pouch industry is dominated by a select few, larger companies.

There is a strong positive relationship between the strength of the pouch and the amount used. An individual can become as addicted to nicotine pouches as a traditional cigarette smoker. Because there is no actual flame to nicotine consumption, the stimuli that promote smoking cessation no longer apply. It is perfectly legal to use these products at work and at school. It is not uncommon for the same individual to use these products while exercising and while consuming alcohol in the evenings.

Nicotine effects the Cardiovascular System

The cardiovascular system is the first and most quickly affected system by the introduction of a stimulant. Within minutes of introduction, the rate at which the heart beats and the pressure at which the blood is pumped increase. The body of circulating blood becomes more viscous, increasing resistance to blood flow through the circulatory system. In response to the increase in demand, the heart must work harder and faster.

Nicotine is best described as a “cardiovascular time bomb.” It has a profoundly negative effect on the inner lining of the blood vessels and makes them less flexible and more rigid. It also disrupts the regular rate at which the heart beats. In response to the effect of nicotine, the heart becomes more irregular and is less able to respond to the body’s demand for a increased rate of contractions.

Because blood is always circulating, the cardiovascular system is stressed for hours at a time, day after day, year after year, especially for an individual who is continuously using nicotine.

Pouch Products Are Not Safer than Cigarettes

Of all the hazardous substances in cigarettes, only a few are a concern in pouch products. tar and carbon monoxide are a result of burning and thus are completely absent in pouch products. Thus, the overall risk of pouch product use on cardiovascular system and other organs is likely to be lower compared to cigarettes.

This comparison is relevant only to those who smoked preexisting cigarettes. Many youth and young adults who now use pouch products are first time users of tobacco/nicotine products. For those individuals, this comparison is between pouch products and zero products, and consequently, first hand cardiovascular effects of nicotine and other constituents of pouch products.

Products containing nicotine in pouch format do not have U.S. FDA approval for cessation. Many of the individuals who intend to fully switch to pouch products from cigarettes ultimately use both products simultaneously, thus resulting in increased total nicotine exposure.

What is Not Known

Extensive research has not been done on the long term effects of the pouch product use. Consequences of long term use of other pouch products are expected to be similar to that of cigarettes and Swedish Snus.

Limited evidence suggests e-cigarette vaporizing pods (or “pouches”) may increase blood pressure and worsen cardiovascular outcomes. The evidence is not sufficient to compare the cardiovascular safety of pouches to cigarettes. There are no data to support that pouches are as harmful as cigarettes. Likewise, there are no data to support that pouches are completely safe.

Who Should be Most Cautious

There are several cardiovascular conditions for which the effects of nicotine may be particularly risky. This includes coronary heart disease, previous myocardial infarction (heart attack), heart failure, atrial fibrillation, other arrhythmias, and hypertension. Nicotine can reduce the cardiovascular benefits of medication for hypertension and may actually worsen heart failure.

Pregnant women are at risk for adverse fetal outcomes with exposure to any nicotine products.

Prior to undergoing a surgery, there are many cardiovascular and other adverse outcomes that may occur and increase with nicotine use. Nicotine slows wound healing and increases the risk of post-surgical complications. To increase post-surgical healing and decrease the risk of complications, nicotine should be discontinued. Often times, patients do not discontinue cigarette use and continue to use e-cigarettes/nicotine pouches.

If You Want to Cut Back or Stop

Nicotine pouch usage leads to physical dependence. When someone quits using pouches, they may become irritable and have difficulty concentrating. They may also have very strong cravings. Rather than quitting abruptly, it may help to step down to a lesser nicotine strength pouch. It may also help to reduce the number of pouches used daily, and to set times of the day when pouches can’t be used.

There are nicotine replacement products that are safer and have a long history of use. These products are prescribed and used by primary care physicians. Smokers should not use nicotine pouches and then return to smoking. The goal should be to stop using all nicotine products.

When to See a Cardiac Specialist

You should see a cardiac specialist if you have chest pain or pressure, an irregular or rapidly beating heart, if you have passed out, or if you have difficulty breathing. You should see a cardiac specialist even if you think these symptoms are caused by or related to your nicotine pouch use.

Cardiac evaluation is recommended if you use any form of nicotine regularly, especially if you have high blood pressure, or a family history of early heart disease. Palpitations warrant further cardiac evaluation as do known cardiac conditions. All patients undergoing a cardiac procedure should inform the surgical team of all forms of nicotine use.

Dr. Tehrani is a cardiac surgeon and recognizes the negative cardiac effects of all forms of nicotine. Nicotine substitution products (NSPs) may be better than smoking, but NSPs are not helpful in improving cardiac status.

Maria Tehrani, MD | Cardiac Surgeon

Ronald Reagan UCLA Medical Center

818-350-9899

757 Westwood Plaza

Los Angeles, CA 90095

M-F 9am-5pm

Serving the communities of Westwood, Brentwood, Santa Monica, Bel Air, Marina del Rey, Pacific Palisades, Culver City and the greater Los Angeles area.