Across social media, podcasts, wellness communities and tech start-ups, prominent wellness influencers are now portraying nicotine as a misunderstood compound whose potential benefits have been overshadowed by its negative association with cigarette smoking. These advocates, many of whom support the Make America Healthy Again movement, are touting an addictive substance linked to tobacco use as a natural product that can be used for everything from improving focus to protecting against cognitive decline. This trend includes using nicotine alone in noncombustible products such as nicotine pouches or in combination with caffeine and nootropics, or “smart drugs” marketed to enhance cognition.
As a pulmonary physician-scientist who studies nicotine addiction and the health consequences of tobacco and nicotine products, I am concerned about claims that nicotine can enhance wellness, productivity and cognitive performance.
Nicotine’s impacts
Nicotine is the primary driver of tobacco addiction in the form of cigarettes, vapes, nicotine pouches, cigars, hookah tobacco, and smokeless tobacco products.
The greatest health risks arise when tobacco is burned, which generates thousands of toxic substances, including carcinogens, carbon monoxide, and fine particulate matter. Repeated exposure to these products can cause cancer, chronic obstructive pulmonary disease, cardiovascular disease and numerous other smoking-related illnesses.
While many smoking-related diseases result from exposure to combustion products, nicotine itself has well-known negative effects on the brain and body. Nicotine activates the sympathetic nervous system, the body’s “fight or flight” response, which increases heart rate and blood pressure and disrupts sleep. Repeated stimulation of this system can place additional strain on the heart.
Nicotine exposure is of particular concern during critical phases of development. Prenatal exposure to nicotine has been associated with adverse effects on fetal growth and development. Smoking during adolescence can alter the neural systems involved in attention, learning and reward, increasing a teenager’s chances of becoming addicted.
Nicotine also leads to dependence by activating of brain reward pathways.
Acetylcholine is a key neurotransmitter — a chemical messenger in the brain — involved in attention, learning, memory and information processing. Nicotine acts on many of the same receptors that normally respond to acetylcholine, temporarily increasing alertness, attention and arousal. Activation of these receptors also influences the release of other neurotransmitters, including dopamine, which plays an important role in reward and reinforcement.
However, nicotine does not operate in the same way as acetylcholine. The effects of nicotine last much longer and alters activity throughout the brain. With repeated exposure, the brain adapts to nicotine’s presence. Receptors become less responsive to nicotine, and the brain compensates by increasing the number of nicotine receptors, contributing to dependence.
Focus and productivity
Wellness influencers argue that nicotine serves as a cognitive enhancer that improves focus and productivity.
Some of these claims stem from the observation that nicotine is a naturally occurring plant compound found primarily in tobacco and in nightshade vegetables such as tomatoes, potatoes and eggplant in trace amounts. Proponents of its use point to research also draw on studies suggesting that nicotine can affect certain aspects of cognition and brain function.
However, extending these findings to broad claims about productivity, brain health, longevity or wellness goes well beyond what has been shown in human studies.
Some studies indicate that nicotine may temporarily enhance attention, vigilance, reaction time and some aspects of working memory, but results are mixed. Research suggests that nicotine may benefit people with mild cognitive impairment, but it does not appear to enhance cognition in healthy individuals and may even worsen cognitive performance in higher-performing people.
In addition, many of these studies include some regular nicotine users who are dependent on nicotine. When they stop using nicotine, regular users commonly experience difficulty concentrating, irritability, anxiety, restlessness and impaired attention. Reintroducing nicotine often relieves these symptoms, making it difficult to determine whether observed improvements reflect true cognitive enhancement or simply the reversal of withdrawal symptoms.
Managing stress
Wellness influencers also promote nicotine as a tool for managing stress and improving mood. For instance, influencer Dave Asprey said on YouTube that nicotine could “turn your mind back on without frying your nervous system.”
Nicotine activates reward pathways in the brain, which can create a temporary sense of pleasure and well-being. However, long-term nicotine use can interfere with the body’s stress-response system, which may make stress and anxiety harder to manage over time.
Among regular nicotine users, perceived improvements in mood and stress may partly reflect relief of withdrawal symptoms such as anxiety, irritability and restlessness. Research consistently shows that people who quit smoking experience reductions in anxiety, depression and stress, along with improvements in mood and overall quality of life. In fact, long-term discontinuation of nicotine use is associated with better mental health and well-being.
Healthy aging and longevity
Some of the most ambitious claims emerging from the pro-nicotine wellness movement suggest that nicotine protects against dementia, Alzheimer’s disease, Parkinson’s disease and age-related cognitive decline.
These claims are based on findings suggesting that nicotine can influence neural pathways involved in memory and attention as well as animal and laboratory studies examining whether nicotine could modify disease processes associated with cognitive decline.
However, human studies have not demonstrated that nicotine can prevent dementia, slow the progression of Alzheimer’s disease, preserve long-term cognitive function, or improve outcomes in Parkinson’s disease.
Some wellness and longevity advocates claim that nicotine preserves cognitive function, slows biological aging or promotes longevity.
These claims are largely based on laboratory studies showing that nicotine can affect cellular pathways related to oxidative stress, which has been implicated in biological aging and in the progression of neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease, and animal studies suggesting it can act as an anti-inflammatory in many cases. However, findings from laboratory and animal studies have not translated into evidence that nicotine promotes healthy aging, extends lifespan or prevents age-related disease in humans.
FDA-approved nicotine replacement therapies — including nicotine patches, gum and lozenges — can help people overcome nicotine dependence. But that sort of established therapeutic use should not be confused with these more recent, ambitious claims about nicotine’s benefits.
Hasmeena Kathuria is Professor of Medicine and Director of the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health.
This article was produced in collaboration with The Conversation, a nonprofit news organization.
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