Recently the Food and Drug Administration approved the sale of a tobacco product, based on the premise that “it is less harmful to the population as a whole.” It was felt that this product category was a less toxic option for tobacco users. The approval process was at the behest of a Swedish company called Swedish Match who presented a total of eight new products known as Snus (all of which fall under the general category of Snuff) for approval. Since then, Snus has become the most popular tobacco product in Sweden.
Most people assume that smokeless tobacco is a good alternative to cigarettes—especially for individuals those who want to wean themselves from smoking.
Results from a new study done by the U.S. government actually showed, that users of smokeless tobacco are actually exposed to higher levels of nicotine, as well as other cancer-causing chemicals.
In order to appreciate these specific research findings, you have to understand the nature of what was measured in the study. Nicotine is the compound delivered and providing pleasure when one uses smokeless tobacco, but this is not the carcinogen that is being evaluated. The carcinogen being evaluated is nicotine-derived nitrosamine ketone (NNK).
NNKs are the end product of nicotine that the person is exposed to, through a series of possible chemical reactions. It forms when the tobacco leaves are exposed to a light, or during the synthetic process that occurs when an individual uses smokeless tobacco, or NNKs can form internally in certain people, due to predetermined enzymes that metabolize nicotine in a very specific way. NNKs cause cancer by activating signaling pathways in certain individuals, which then stimulate uncontrolled growth of cells. This results in tumor formation. These signaling pathways have been the subject of extensive research in cancer, in an effort to try to identify individuals who might be susceptible to some types of cancerous tumors, particularly breast cancer and colon cancer.
A study out of The University of Minnesota published in the journal Cancer Prevention, analyzed data from 391 individuals who used different smokeless tobacco brands. The researchers measured urine levels of biomarkers of NNKs and nitroso nicotine (NNNs), another type of carcinogen. The levels found correlated with the number of years of daily use, number of tins used per day, and mean dip duration. There was a significant increase in levels of these markers in the study participants. At a later date, the principal investigator actually went on to be an expert witness during FDA hearings, testifying in opposition to allowing smokeless tobacco to have labels suggesting that they are less harmful than standard nicotine products.
Other substances that should be of concern
Propylene glycol and flavoring chemicals have been known to produce irritation in the airways of the lungs that differs from the type of irritation caused by regular cigarette smoke. In the case of these other irritants, the ongoing inflammation persists after cessation of exposure and that can lead to permanent scarring in the airways.
The dangers of using smokeless products
Among individuals who use tobacco products, the dangers come from more than just the effects of smoke exposure. As snus products demonstrate, it is the nicotine and the by-products from nicotine that are of great cause for concern as well. It’s also important to realize that the cancer-causing chemicals are just one aspect of concern. Of equal concern are the addictive properties of these smokeless snus products. Those addictions come in the form of inhaling the smoke, inhaling the vapor, putting snuff in the upper lip and holding it there for hours at a time, or chewing the leaves. All these addictive behaviors result in the chemical being absorbed and NNKs or NNNs being absorbed. Consumers need to be aware of the dangers of these so-called “safer” products.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.