Are Snus and Nicotine Pouches a Safer Alternative to Tobacco Cigarettes?

CONTENTS:

1. Introduction

2. The Harmful Effects of Tobacco in Cigarettes

·   Health Risks of Smoking – FACTS

·   Reasons to Quit Smoking

·   Alternative Cigarette Products

3. What is Snus?

4. What are Nicotine Pouches?

5. What are the Health Benefits for Smokers Using Snus?

6. Snus Studies

·   Is Nicotine Harmful in Snus?

·   Mortality

·   Second-Hand Smoke

7. What are the Health Benefits for Smokers Using Nicotine Pouches?

8. Nicotine Pouch Studies

9. Conclusion

Introduction

While it is completely accepted that tobacco cigarettes are extremely harmful to health, most people don’t know whether there are health risks attached to snus, an oral tobacco product and nicotine pouches, which are similar oral products (but tobacco-free).  Interestingly, in many countries both of these oral products are placed in the same category as tobacco cigarettes and yet there is mounting evidence that proves neither pose any danger. Even more interestingly, nicotine pouches contain zero tobacco, raising questions as to why they need to be grouped with tobacco cigarettes.  The point is there are many misconceptions surrounding both products, mainly due to lack of publicising research. 

That research includes clinical studies to show that snus is a far healthier alternative to cigarette smoking, but there are fewer studies on nicotine pouches, mainly because these products are fairly new to market and many ongoing studies have not yet come to fruition.  Nonetheless, there is some research proving they are better alternatives to cigarettes.  Additionally, positive evidence of their safety continues to come to light, dispelling the confusion surrounding the two smokeless products.  In this article, we aim to investigate the safety of snus and nicotine pouches vs tobacco cigarettes, using reputable sources and citing research.

The Harmful Effects of Tobacco in Cigarettes

Before discussing each product, and their safety, it is important to note the harmful effects of tobacco in cigarettes.

Within every cigarette stick there are in excess of 600 ingredients, containing chemicals that activate upon combustion.  Of the 7,000 chemicals created by each cigarette, 69 of them are carcinogenic, which means they cause cancer.  These chemicals are so dangerous that some of them are used in products such as rat poison, listed on warning labels.  To emphasise just how dangerous these chemicals are, here is a list of some of the most shocking (this list is not exhaustive):

·       Arsenic

·       Ammonia

·       Formaldehyde

·       Carbon Monoxide

·       Butane

·       Benzene

·       Lead

·       Methanol

·       Tar

It is these chemicals, found mainly in the tobacco ingredient that cause 8 million premature deaths across the world every single year. Tobacco cigarettes are more deadly than HIV, drug use, alcohol abuse, car accidents and gun crime. The chemicals in cigarettes are also responsible for the most catastrophic diseases, such as heart disease, lung disease and many different cancers. Smoking alone increases the risk of heart disease and stroke by 4 times compared to non-smokers.

Health Risks of Smoking: FACTS:

·       Male smokers are at risk of developing lung cancer by 25 x more than non-smoking men.  Women, by almost 26 times.

·       Smoking thickens and narrows the blood vessels, causing blood pressure to rise and the heart to beat faster – thus leading to blood clots and heart attacks.

·       Smoking reduces blood flow in the body.

·       Smoking can cause emphysema and chronic bronchitis, two forms of lung disease.

·       In asthmatics, smoking increases attacks, accelerating the decline of lung function.

·       Smoking is NOT limited to lung cancer, in fact, smoking can cause cancer anywhere in the body, most especially mouth, throat, tongue, pancreas, stomach, bronchus, trachea, cervix, bladder, blood, oesophagus, kidney, larynx and liver.

·       Smoking increases risk of cataracts and causes macular degeneration, which can lead to blindness.

·       Smoking causes miscarriage, infertility, cot death and low birth weight.

·       It is also responsible for many cases of diabetes and rheumatoid arthritis.

Of the 8 million deaths caused by smoking, 1.2 million are the result of second-hand smoke. Despite the enormous health risks, there are still 1.3 billion smokers globally.  However, approximately 1 in 10 smokers quit every year and smoking prevalence has reduced by over 27% (male smokers) in the past 35 years, and by 38% in female smokers.

Reasons to Quit Smoking

The reasons why people quit smoking, apart from the obvious danger to health, are mainly cost/economic impact.  Cigarettes (especially in Western countries) are heavily taxed, and very expensive.  Plus there are government campaigns encouraging people to quit smoking, along with heavy legislation backed by the World Health Organisation (snus and nicotine pouches like these Nois products are far cheaper).  Furthermore, global initiatives such as World No Tobacco Day raise awareness of the risks of tobacco cigarettes.  Additionally, cigarette advertising is banned in 19 countries and many Western countries do not display cigarettes on sale, they are kept under the counter or in locked cabinets.  New Zealand has banned cigarette sales to anyone born after 1st January 2009 and the UK is planning to place the same ban, coming into effect 2027.  Most countries do not permit smoking indoors or in public spaces, to discourage smokers and to protect non-smokers from second-hand smoke.

Alternative Cigarette Products

Of course, there are other reasons why smokers are quitting, the introduction of healthier alternative cigarette products. While in the 2000’s and 2010’s, there was a significant rise in popularity of e-cigs, and these were seen as a better alternative to smoking, research has proven that vapes and e-cigs pose their own significant dangers.  E-cigs contain deadly chemicals including aldehydes, acetaldehyde, acrolein and formaldehyde.  They are associated with crippling lung disease, respiratory problems (exacerbation of asthma and bronchitis especially), cardiovascular disease (arterial stiffness, raised blood pressure, oxidative stress to name a few) and neurological issues – including depression and schizophrenia.

In recent years, other products have come to market namely snus (a more established product) and nicotine pouches (much newer to market), and available evidence proves they are better alternatives to cigarettes along  with some in-depth research.  However, as nicotine pouches are still in their infancy, most studies are ongoing, but it is encouraging to note these studies are already displaying positive findings.

Let’s talk about these products.

What is Snus?

Snus comes under the smokeless tobacco category and contrary to popular belief, snus has been around for centuries, first introduced in Sweden (hence why it is sometimes referred to as Swedish snus). Generally, snus contains tobacco, some modern snus products include a few tobacco-free versions, and these first appeared on the market in 2003. 

As the tobacco does not combust, it cannot pose the same health risks as smoking.  Moreover, snus is pasteurised and doesn’t involve fermentation.  This prevents tobacco producing bacteria that grows the carcinogenic ingredients found in cigarettes.  Snus is also refrigerated, which further inhibits toxin growth.

Currently, snus is mainly available in the Nordic countries and the USA but it is slowly progressing to more countries and is widely available to purchase online.  In Sweden, thanks to snus use, smoking is on the decline. This report states that many smokers have successfully switched to snus, thus contributing to the decrease in cigarette sales and an increase in smoking cessation.

Snus is used orally.  It is packed inside a small sachet (although snus is not a nicotine pouch!).  Mostly, snus contains water, sodium carbonate and food-grade flavourings. It also contains nicotine which is why it is often used as an appropriate smoking cessation aid.

Snus is placed inside the mouth, between the teeth and gums, releasing nicotine (and flavourings) into the mouth, thus satisfying cravings while providing a pleasant sensation.

What Are Nicotine Pouches?

Nicotine pouches first appeared on the market in 2016 and have enjoyed tremendous growth, especially as they are becoming a serious contender for smoking cessation. As a good example, Killa is one of the most established, older brands but of course, there are so many brands available now, such is the demand, with new brands (such as Lundgrens) and flavours coming to market with rapid speed. Furthermore, unlike snus they don’t contain tobacco at all – reducing any risks even further.  Currently, nicotine pouches are available in 33 countries (and widely available online)– some countries do not permit them on sale as yet, pending further studies coming to fruition and government legislation.  For example,  in Germany, nicotine pouches come under a “grey” area, as they are neither classed as food nor tobacco. 

Similar to snus, nicotine pouches involve a small sachet that contains a cellulose matrix of ingredients including mainly synthetic nicotine, flavourings and chemicals.  There is no tobacco in nicotine pouches.  The user places a pouch inside the mouth, holding it in place between the teeth and gums or cheek and gums, and much like snus, it releases nicotine into saliva and gums, satisfying cravings and creating a pleasing sensation.

The biggest difference between the two products is the tobacco content – none in pouches, ground tobacco in most snus products.  Also, nicotine pouches come in plentiful flavour choices, including menthol, like these Chapo White products.

Next, let’s talk about the health questions relating to snus and nicotine pouches, along with the evidence available.

What are the Health Benefits for Smokers Using Snus?

There are more studies surrounding the use of snus and its safety in comparison to tobacco cigarettes because the product has been used for many years.  It is also very important to look at health data coming from Sweden, the biggest market for Swedish snus, and the country that first introduced the product. Many studies of snus use in Sweden display that this smokeless tobacco product is extremely effective as a smoking cessation aid.

Snus Studies

This particular study in the National Library of Medicine, was based on nearly 61,000 Swedish people, covering a period of 8 years.  The result showed that those using snus were less likely to start smoking and smokers using snus were far more likely to quit smoking altogether (76% of men and approx. 72% of women). 

It is not only Sweden that has enjoyed a decline in smokers, in countries where snus is permitted on-sale (e.g., the Nordics), it has significantly reduced the overall smoking number – and smoking-related diseases.

Furthermore, the same study clearly states the following:

·       There are no established causes of premature death associated with using snus.

·       There are no associations with oral cancer.

·       There are no associations with pancreatic cancer.

Is Nicotine Harmful in Snus?

It also goes on to state that nicotine is non-harmful in snus (indeed there are many studies to show benefits of nicotine).  The study says that nicotine-delivery products are safe to use and do not contribute to the serious health problems of tobacco smoking, especially as the same toxins are not involved. Nicotine replacement products have been widely (and safely) used for many decades in many smoking cessation products, such as patches and sprays.

Mortality

In terms of mortality, the aforementioned reliable study also estimated that people relying on snus have a minimum of 90 to 95% less tobacco-related mortality than their tobacco-smoking counterparts.  Plus, using snus as a smoking cessation aid delivered similar health benefits to those who stopped all forms of tobacco use.

Another study (from 2017 – one year after nicotine pouches were introduced in Europe), also confirms that Sweden has the lowest use of cigarettes in the EU – at just 5%.  The country also has the lowest rate of lung cancer in men and tobacco-related deaths.  This is due to the popularity of snus.

Second-Hand Smoke

In terms of second-hand smoke causing serious disease and many deaths (mentioned above), snus (and nicotine pouches) being smokeless are perfectly safe to use and do not have any adverse health effects on other people.

It is fair to deduce then, that nicotine pouches (which are so similar to snus products) are likely even healthier than snus, because of the zero-tobacco content involved.

To quickly recap on the health benefits of snus for smokers of tobacco cigarettes:

·       Snus is proven to work as an extraordinarily effective smoking cessation product

·       The mortality rate of snus users is much the same as non-smokers

·       People choosing to use snus over cigarettes are far less likely to be affected by lung cancer

·       There is no risk of pancreatic or oral cancers

·       There is no combustion involved, so no smoke which protects others from the harmful effects of cigarette smoke

·       This study confirms that using snus poses no risk to cardiovascular health or stroke

As tobacco cigarettes have numerous health risks, and studies (as above) state that snus is perfectly safe to use, there is no reason not to promote snus as a pleasant recreational product and highly effective smoking cessation aid.

Let’s move onto nicotine pouches.

What are the Health Benefits for Smokers Using Nicotine Pouches?

Due to nicotine pouches being so new to the market (less than ten years old), there is not as much information available on their safety as there is concerning snus.  There are some completed studies and many ongoing studies that have not yet reached a conclusion.  However, based on the above research on snus, and the widely-accepted knowledge that nicotine pouches do not contain tobacco (whereas snus does), it is fair to assume that nicotine pouches pose no danger – possibly even less danger than low-risk snus. 

One informative piece from the USA Today has a very telling quote from Vaughan Rees, a Senior Lecturer on Social and Behavioral Sciences and Director of the Centre for Global Tobacco Control.  He said that “[Nicotine pouches] present significantly lower health risks than smoking, because [they] do not contain cancer-causing chemicals and other toxic substances found in cigarette smoke.”

Nicotine Pouch Studies

BAT (British American Tobacco), while a cigarette company, also makes smokeless tobacco products including nicotine pouches.  They conducted their own published research through various studies which clearly states that oral nicotine pouches produce less toxicants than tobacco cigarettes.  BAT also published evidence to state that nicotine pouches’ profile is very similar to other nicotine cessation products (sprays, patches etc.).  Furthermore, their studies display that nicotine pouches have a lower toxicant profile than snus, including their flavoured nicotine pouches (which were also under scrutiny). One of their most recent studies (2024) examined DNA changes through use of nicotine pouches and discovered there was minimal evidence. BAT concluded by indicating that nicotine pouches should reduce the risks of developing smoking-related illnesses.

Additionally, nicotine pouches, like snus, are smoke-free, and vapour-free, so there’s no risk of second-hand smoke. 

For the millions of smokers looking to quit, nicotine pouches, such as these Pablo snus, have many health benefits:

·       A snus is a proven smoking cessation product, nicotine pouches offer the same advantage

·       To date, the mortality rate amongst nicotine pouch users is unknown BUT, it is likely to be similar to that of snus users

·       As there is no tobacco involved, or combustion there’s every reason to believe that nicotine pouches will not lead to tobacco-related cancer or diseases

·       Snus poses no cardiovascular health risks, as a similar product to nicotine pouches, it is expected that there should be no dangers to the heart.

Conclusion

Studies of snus clearly show that this smokeless oral tobacco product is far safer than smoking cigarettes.  Snus is proven as a very effective smoking cessation aid and does not cause life-threatening disease, neither does it reduce life expectancy.  This is most especially displayed by the product’s huge popularity in Sweden, where it was first produced, studies in Sweden show the significant decrease of smokers in the country and the reduced rates of lung (and other smoke-related cancers) thanks to snus.

While there are some studies on the safety of nicotine pouches, as the product is still relatively new, there aren’t as many published to date. However, there is plenty of data and information available to show that nicotine pouches will be just as safe (if not safer due to their zero-tobacco content) as snus.  They already serve well as a smoking cessation aid compared to traditional no-smoking aids, especially as there are so many flavours to choose from, as a good example, these pouches from Fumi, therefore making them far more pleasurable than other non-smoking aids.

Surely any non-combustible, oral product containing nicotine (and safely administered tobacco product) has to be better than inhaling 69 burning, carcinogenic chemicals and emitting second-hand smoke to other people? Even the very small risks associated with snus, and probably also associated with nicotine pouches outweigh the enormous health implications that tobacco cigarettes pose to the global smoking (and non-smoking) population.

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