Health Concerns of Nicotine
A Poison with Enormous Health Consequences
Most people are familiar with nicotine as the addictive, stimulatory drug added to tobacco products. While tobacco’s negative impact on health parameters is well-known among the general public, many individuals still remain in the dark about nicotine’s role in their health and well-being.
Nicotine is a natural plant alkaloid, but can also be synthetically made in the lab, such as the nicotine salts added to vape juices, nicotine gum, patches, and e-cigarettes.
Found naturally in tobacco and other plants, nicotine is highly addictive, and an increasingly concerning substance given the popularity of vaping, especially among teens.
Nicotine is a natural toxic substance (Cleveland Clinic), dangerous neurotoxin (CDC), an acute hazardous waste (EPA).
Throughout the years, nicotine has been a highly debated drug, propped up by ‘big tobacco’ and associated lobbyists, while vilified by the medical and scientific community.
In this guide we explore the multitude of health concerns associated with nicotine, providing you with a comprehensive overview of how toxic nicotine really is, and the ramifications of its use in both the short and long term.
Is Nicotine Harmful?
Crude nicotine was discovered in 1571, later purified in 1828. Since then, tens of thousands of studies have investigated nicotine’s chemistry, pharmacology, potential role in medicine, and harmful side effects when consumed.
Despite the ocean of research out there, significant efforts have been made by Big Tobacco to veil or downplay the negative health impact of nicotine, leading much of the population to underestimate just how toxic this alkaloid can be.
According to Johns Hopkins Medicine, nicotine is a highly toxic substance, capable of spiking adrenaline, increasing anxiety, raising blood pressure, increasing heart rate, and increasing the chances of stroke and/or heart attack, among other negative consequences.
Health Risks of Nicotine
- May be carcinogenic, having been linked to various types of lung, pancreatic, gastrointestinal, and breast cancers when both smoked or vaped
- Contributes to the risk of developing emphysema and other chronic obstructive pulmonary diseases (in smokers)
- Is associated with the risk of developing peptic ulcer disease (PUD)
- Increases the risk of developing cardiovascular disease
- Is associated with the risk of gastroesophageal reflux disease (GERD)
- Increases the risk of high blood pressure (hypertension)
- Increases the risk of blood clots, thrombosis, and stroke
- Known to cause cardiac arrhythmia and irregular heartbeats
- Use during pregnancy is known to cause complications
- Contributes to the development of depression via overstimulation of the dopamine (feel good) pathway
Negative Side Effects of Nicotine
- Shortness of breath or difficulty breathing
- Increased heart rate (tachycardia)
- Stomach discomfort
- Agitation, irritability, nervousness
- Withdrawal symptoms if you stop use
- Psychological and physical addiction
- Difficulty falling and staying asleep
- Tingling or numbness (usually in the fingers and toes)
There are a multitude of health risks associated with both the short- and long-term use of nicotine, with risks varying depending on the mode of consumption, and the length and concentration of exposure.
Acute / Short Term Negative Health Effects of Nicotine
Some effects of nicotine pose medium to long-term risks, while others are experienced acutely after consumption. Some of these may be noticeable, while others remain a ‘hidden’ or ‘silent’ danger for consumers.
Acutely, nicotine causes a marked increase in blood pressure, cardiac contractions, and heart rate, along with a significant increase in adrenaline and gastrointestinal activity.
Short Term Cardiovascular Effects
Stimulation of the cardiovascular system results in increased stress on the heart, inhibiting its ability to function, sometimes resulting in a decrease in blood flow, oxygen, or heart attack. Nicotine constricts coronary blood vessels, causing further stress on the heart and increasing the risk for adverse cardiovascular events such as heart attack, arrhythmias (i.e. atrial fibrillation), or stroke.
Coronary Blood Flow – Nicotine acts on the smooth muscle of vascular walls, constricting the coronary arteries. This is especially troublesome for those with underlying heart conditions, causing a ‘silent’ impairment of blood supply and mimicking exercise-induced stress on the body, especially the cardiovascular system, creating an alarmingly elevated risk of negative cardiovascular events.
Arrhythmogenesis – The risk of myocardial infarction (heart attack) and sudden cardiac death are thought to be attributed to the arrhythmogenic (arrhythmia inducing) and ischemic (reducing blood flow to tissues) properties of nicotine. For example, it is theorized that nicotine may contribute to both fibrillation and fatal ventricular tachycardia. This theory has been supported by evidence in animal models and human clinical trials.
Risk of Thrombosis and Stroke
It is thought that nicotine’s influence on increasing the release of epinephrine acutely activates platelets, potentially leading to blood clots (thrombosis) or stroke. Those with underlying heart conditions and/or plaque buildup, higher blood pressure, or diabetes are at higher risk.
Systemic Vascular Effects and Damage to Organs
Nicotine is a well-known vasoconstrictor, resulting in constriction of blood vessels throughout the body, while dilating those in skeletal muscle. This can result in a decrease in skin temperature, epithelial blood flow, and directly contribute to reduced wound healing, progressive kidney disease, macular degeneration, and placental dysfunction throughout pregnancy.
Endothelial Dysfunction – Nicotine creates cause oxidative stress and chronic inflammation, resulting in reduced endothelial (blood vessel) function and health.
Nicotine causes a chronic systemic inflammatory response through several physiologic pathways. Inflammation has been shown to be a key driver and contributing factor in the development of atherosclerosis as well as in ischemic events such as heart attacks and strokes.
Can I Overdose From Nicotine?
Nicotine poisoning used to be a rare occurrence. However, with the advent of high nicotine vape juices, nicotine patches, and other nicotine products, the incidence of nicotine poisoning or overdose is on the rise.
According to the National Institute for Occupational Safety and Health, the dose of nicotine deemed to be lethal is between 50-60mg/kg of body weight for adults.
Although it is unlikely that an individual could smoke their way to an overdose, nicotine e-juices contain much more nicotine than does a cigarette, and it is possible to overindulge to the point of poisoning.
Other Circumstances Where Nicotine Poisoning Can Occur:
- Ingestion of nicotine-containing products by a child
- Smoking or vaping while also using nicotine gum or patches
Signs and Symptoms of Nicotine Poisoning Include:
- Nausea and vomiting
- Abdominal pain
- Increased saliva
- Profuse sweating
- Pale clammy skin
- Increased heart rate
- Increased blood pressure
- Loss of balance and/or control of body movement
- Inability to walk
- Rapid heavy breathing
- Muscle twitching
If Left Untreated, Nicotine Poisoning May Cause:
- Abnormal heart rhythms
- Dangerously low blood pressure
- Paralysis (temporary)
- Respiratory failure
Long Term Negative Health Effects of Nicotine
Long Term Cardiovascular Effects
Myocardial Remodeling – Nicotine can cause remodeling of heart tissues, including fibrosis (scarring) and hypertrophy, leading to cardiac diseases such as congestive heart failure, arrhythmias, and other cardiovascular complications.
Atherosclerosis – Atherosclerosis is a hardening, narrowing, and/or thickening of the arteries, associated with plaque buildup, blood flow restriction, heart attack, and stroke. As explained In the Journal of atherosclerosis (Atherosclerosis. 2011 Apr; 215(2): 281–283.), nicotine directly contributes to the development of this disease.
Nicotine has been shown to cause a chronic systemic inflammatory response through several physiologic pathways. Inflammation has been shown to be a key driver and contributing factor in the development of atherosclerosis as well as in ischemic events such as heart attacks and strokes.
Chronic Inflammation Has Been Clinically Implicated in the Development and Risk of:
- Type 2 Diabetes
- Tissue death
- Internal scaring
- Rheumatoid arthritis
- Cognitive decline and dementia
- Heart disease
- And more…
Are e-Cigs Safer Than Tobacco?
Smoking tobacco has been on a steady downtrend over the last decade. This trend, in part, has been fueled by the increased use of e-cigarette and vaping devices. But is vaping safer than tobacco?
According to the World Health Organization (WHO), tobacco kills 8 million people annually, leading many individuals to switch to vaping under the false premise that it's safe.
The Dangers of Vaping
Researchers Have Discovered the Following Harmful Chemicals in e-Cig and Vape Juices:
- A multitude of Carcinogens: including acetaldehyde and formaldehyde
- Ultrafine Particulates: capable of making their way deep into airways and lung tissue
- Benzene: a well-known VOC (volatile organic compound) and proven carcinogen
- Toxic Heavy Metals: such as lead, tin, cadmium, and nickel
- Diethylene glycol: a component of antifreeze, associated with lung disease
- Diacetyl: the chemical known for causing ‘popcorn lung’
- Acrolein: a weed killer/herbicide shown to cause permanent lung damage
- Propylene Glycol: used in antifreeze and paint solvents
- Nicotine: toxic chemical shown to contribute to or cause a myriad of health issues
The Health Concerns of Vaping
As research emerges regarding the long-term use of e-cigarettes, the medical community is learning more about the dangerous and potentially life-threatening consequences of vaping.
The Health Concerns of Vaping: An Overview
- As of Feb 2020 in the United States, vaping has resulted in over 2,800 hospitalizations resulting in serious lung injury and 68 deaths (CDC)
- In a four-year period (2013-2017) it was reported that nearly 5,000 children under the age of 5 required emergency room treatment for exposure to vape juice containing nicotine (Truth Initiative, 2019).
- Vaping has been proven to increase the risk of developing chronic obstructive pulmonary disorder (COPD), emphysema, asthma, heart disease, and other pulmonary diseases (American Journal of Preventative Health, 2020).
- Propylene glycol and glycerin, two main ingredients found in most vape juices, were shown to be toxic to cells in a North Carolina University study.
- Vaping devices such as e-cigs have been shown to produce an abundance of hazardous chemicals when heating e-juices to temperatures at which they vaporize. These chemicals include but are not limited to highly toxic acetaldehyde, formaldehyde, and acrolein. Several of these substances are linked to cardiovascular disease, cancer, lung disease, and other serious medical conditions.
- The Journal of Radiology (2019) published a study demonstrating that vaping can cause serious negative effects on vascular function with just a few pulls/puffs of a vaping device.
Is Vaping Less Addictive than Tobacco?
One common misconception regarding vaping is that the practice is less addictive than is tobacco. While this may be true for those who vape juices without nicotine, e-juices containing nicotine or nicotine salts have been proven by Johns Hopkins and other researchers to be just as addictive as smoking tobacco.
Nicotine withdrawal is a very real phenomenon, causing both mental, physical, and emotional symptoms. Typically, days 3-5 are the worst, but the symptoms of withdrawal continue long after.
Physical Symptoms of Nicotine Withdrawal Include:
- Increased appetite – especially for sweets. It is not uncommon for those seeking to quit gaining between 5-10lbs in the process.
- Nicotine Cravings – these can be a major hurdle to overcome and tend to be the longest-lasting symptom of nicotine withdrawal.
- Cough – generally lasting for a few days as your lungs work to clean out any mucus and debris that it was unable to when under the influence of nicotine.
- Headaches and Dizziness – tend to show up early on and are generally mild
- Fatigue – similar to caffeine, nicotine is a stimulant. Once you stop you may feel tired and sluggish throughout the day.
- Constipation – nicotine has been shown to increase gastrointestinal activity. Cessation may lead to mild constipation for a duration lasting around a month.
Mental, Emotional, and Behavioral Symptoms of Nicotine Withdrawal:
- Anxiety – smoking is a known stress reliever. Upon cessation, an increase in anxiety is often noted starting around day number 3 and lasting for up to a few weeks.
- Depression – tends to be mild and resolves naturally.
- Irritability – an increase in aggression, irritability, lack of patience, and knee-jerk reactions is common with nicotine withdrawal.
- Mental fog – those who stop nicotine often notice mental fog and difficulty with concentrating and mental tasks for the first two weeks.
Nicotine Withdrawal Timeline:
- 30min – 4 hours: cravings begin to set in
- 5-10 hours: physical cravings appear, restless and anxious
- 11-24 hours: irritability kicks in, as does an increase in appetite
- Day 2: headaches are common
- Day 3: cravings begin to taper slightly. Anxiety rises.
- 1 Week: low energy, brain fog, cravings, and appetite continue
- 2-4 weeks: low energy persists, brain fog begins to clear, appetite begins to level off
- 5+ weeks: cravings continue. Most other symptoms subside.