Nicotine podcast: Is there really a “continuum of harm”?

Medical Q&A [Moderated]
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Jordan and Austin, thank you for the nicotine podcast! Do you think there is sufficient evidence to suggest that nicotine itself – independent of dose and delivery route – is harmful? I.e., is there increased risk to someone who consumes nicotine only from gum or vaping?

Let’s assume a reasonable dose that is well below the threshold for poisoning.

At one point you seem to say that nicotine itself is neutral but then you seem to finish by claiming that it wouldn’t be responsible to suggest that nicotine is harmless.

If I was in your position – a doctor and founder of a health-related company – I’m sure it would be prudent to say everything that you said. You evaluated the evidence and you didn’t exaggerate or fear monger. And yet you didn’t want to cavalierly tell people that they can go cart blanche with nicotine as long as the dose and delivery route is “responsible.”

Yet I wonder if responsible use of nicotine is likely to be as harmless as responsible use of artificial sweeteners or caffeine?

Let’s consider people who only consume nic gum or vape at modest dosages. I have never smoked but I’ve been chewing nic gum for 15 years. I initially tried it to see if there may be some physical or mental benefit.

My first reaction was, “I can see why people smoke. This feels good.” I continued taking it for the “mild euphoria” and as an appetite suppressant. I don’t think it blunts hunger so much as it simply gives me something enjoyable to consume that doesn’t have calories, similar to a no-calorie beverage. I see a modest use of nicotine as another tool to help reduce calorie intake, after obviously more important tools like a healthy diet, fiber, foods that aren’t calorie-dense, etc.

I assume that I’m addicted to nic gum, though my use of it seems to be situational or recreational. I never use it during a powerlifting meet or while training or running errands. But when I’m in my office and not talking to someone, there’s a good chance that I have a piece in my mouth.

I can’t imagine how someone could overdose by accident. I once accidentally bought a 4-mg box instead of my usual 2-mg. I spent hours sucking on a single 4-mg piece. It felt so strong that I couldn’t keep it inside my cheek for more than a few seconds without taking it out. It was too stimulating. Sadly, it took only a few packs to adapt to the increased dosage.

It’s not obvious to me that I need to stop using nicotine but I may be wrong. I wouldn’t encourage others to use it, if only because of the cost. Though the cost is probably similar to soda, and definitely cheaper than alcohol or Starbucks. I absolutely enjoy my nic gum so I may be biased to see it as harmless.

Thanks as always for your entertaining and life-enhancing work!

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I think that it’s impossible to estimate the risk of something independently of the dose or route of administration. Would not be particularly useful either, as this risk estimate could not be generalized.

As mentioned in the podcast, nicotine does not appear to be health promoting at any dose or route of delivery outside of the context of harm reduction from smoking. The risk seems to be lowest in nicotine replacement and highest from smoking. We discuss this a few times in the podcast.

I.e., is there increased risk to someone who consumes nicotine only from gum or vaping?

I think so, yes, though these two things are not equivalent in risk. NRT via gum and patches are both associated with increased health risks compared to non-users, in both risky populations (former smokers) and never smokers.

At one point you seem to say that nicotine itself is neutral but then you seem to finish by claiming that it wouldn’t be responsible to suggest that nicotine is harmless.

Yes. At best, nicotine can be health promoting in some individuals for harm reduction from smoking. It can be neutral for others at low doses, less harmful route of administration, with good luck, and enjoyment with use. It can be harmful for others depending on dosing, administration, and associated behaviors.

I do not think overall that nicotine is benign, though some may experience little to no issue.

Yet I wonder if responsible use of nicotine is likely to be as harmless as responsible use of artificial sweeteners or caffeine?

I don’t think it’s even close unless you’re comparing caffeine tablets to nicotine gum. In that case, none of the health benefits associated with coffee or tea ingestion (the caffeine vehicle) are present. Still, caffeine alone doesn’t have the negative health-related outcomes that nicotine does from NRT alone. The degree of this risk depends on dose and vehicle, of course.

Let’s consider people who only consume nic gum or vape at modest dosages. I have never smoked but I’ve been chewing nic gum for 15 years. I initially tried it to see if there may be some physical or mental benefit.

I think this increases the risk of heart disease for no real benefit in performance or other aspect of health. It is enjoyable, which isn’t “nothing”, but ideally people would not use nicotine regularly.

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