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Can Nicotine Pouches Cause Heartburn?

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Nicotine pouches have grown tremendously in popularity in recent years as an alternative form of tobacco consumption. They offer a smoke-free and discreet way to satisfy your nicotine cravings. This surge in popularity raises questions about the potential health implications associated with these pouches. One such concern is whether the use of nicotine pouches can contribute to heartburn, a common and uncomfortable digestive issue.

In this article, we will take a closer look at the relationship between the use of nicotine pouches and the occurrence of heartburn. While nicotine itself is known to affect the digestive system, the specific impact on heartburn remains a topic of interest and concern. 

About Nicotine Pouches

Before we dig in, let’s first get a better understanding of nicotine pouches and how they work.

Nicotine pouches are small pouches containing nicotine, flavorings, and other food-grade ingredients such as plant fibers and sweeteners. The pouches are intended to be placed under the upper lip which allows the nicotine to be absorbed through the oral mucosa in a convenient, discreet, and hands-free manner.

Nicotine pouches are completely free from tobacco which makes them different from traditional smokeless tobacco products. This is a benefit that reduces the risk of exposure to harmful substances, not to mention the fact that they are completely smoke-free.

With the rising popularity of nicotine pouches, the market has consistently grown with new brands, flavors, strengths, and variants, catering to every taste and preference.

Some of the most popular brands include ZYN, Velo, On!, just to mention a few.

The key benefits of nicotine pouches involve risk reduction, convenience, and discreetness. Simply place a pouch under the upper lip and go on with your day.

Heartburn: Causes and Symptoms

Heartburn is a prevalent digestive discomfort that is characterized by a burning sensation in the chest, often accompanied by regurgitation of acidic stomach contents into the esophagus.

Heartburn is also known as acid indigestion and occurs when stomach acid flows back into the esophagus which causes irritation and the characteristic burning sensation. This discomfort is often felt behind the breastbone and can extend to the throat. Symptoms may include a sour taste in the mouth, difficulty swallowing, and an increase in saliva production.

Occasional heartburn is common and generally harmless but persistent or severe symptoms may indicate a more serious condition like gastroesophageal reflux disease (GERD). It is important to differentiate between occasional heartburn and chronic conditions that may require medical attention.

Common causes of heartburn

Relaxation of the Lower Esophageal Sphincter (LES): The LES is a muscular ring that separates the esophagus from the stomach. Its main function is to prevent the backflow of stomach contents into the esophagus. When the LES relaxes inappropriately, stomach acid can flow back into the esophagus which leads to heartburn.

Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This can weaken the LES and contribute to acid reflux.

Dietary Factors: Certain foods and beverages can trigger or exacerbate heartburn. Common ones include spicy foods, acidic fruits, caffeine, alcohol, and fatty or fried foods.

Obesity: Excess weight, in particular around the abdomen, can put pressure on the stomach and contribute to the occurrence of heartburn.

Factors that contribute to acid reflux

  • Nicotine Use: Nicotine has been associated with the relaxation of the LES which potentially allows stomach acid to flow back into the esophagus. This connection raises questions about whether nicotine pouches, which deliver nicotine in a different manner than traditional smoking, could influence the incidence of heartburn, which we will take a closer look at further on.
  • Lying Down After Meals: Lying down too soon after eating can increase the likelihood of acid reflux. Gravity helps keep stomach contents where they belong when in an upright position.
  • Pregnancy: Hormonal changes during pregnancy can relax the LES, contributing to heartburn.

Nicotine and its Effects on the Digestive System

Nicotine is the primary psychoactive component in tobacco and has some effects on the body, including the digestive system

The impact of nicotine on the cardiovascular and nervous systems is somewhat well-documented but the specific influence of nicotine on digestive functions, particularly in relation to heartburn, needs further studies to draw any definite conclusions.

Nicotine is a stimulant that belongs to the class of compounds known as alkaloids. When nicotine is consumed, it rapidly crosses the blood-brain barrier and binds to nicotinic acetylcholine receptors in the central nervous system. This interaction leads to the release of various neurotransmitters, including dopamine, which gives you a sense of satisfaction.

Nicotine’s potential to relax the lower esophageal sphincter (LES)

One aspect of nicotine’s impact on the digestive system is its ability to relax the lower esophageal sphincter (LES). The LES is a muscular ring that separates the esophagus from the stomach. It is important that this functions properly in order to prevent the backflow of stomach contents. Since nicotine may influence the relaxation of the LES, it raises some questions about its potential contribution to acid reflux and, consequently, heartburn.

Some studies suggest that nicotine can relax smooth muscle, including the muscles of the LES, which could result in a temporary weakening of the barrier between the esophagus and stomach. This relaxation may allow stomach acid to move more easily into the esophagus, which increases the likelihood of experiencing heartburn.

The relaxation of the LES is an important factor in the development of acid reflux. When the barrier between the esophagus and stomach weakens, stomach acid can flow backward into the esophagus which leads to irritation and the symptoms associated with heartburn.

It’s important to note that the relationship between nicotine and heartburn is quite complex and may be influenced by various factors, including the method of nicotine delivery as well as other lifestyle factors. For that reason, it’s impossible to give a definite answer to whether nicotine causes heartburn in every single instance.

Smoking is generally a well-established risk factor for heartburn and GERD but the use of nicotine pouches represents a different mode of administration so findings from smoking cannot be directly applied to nicotine pouch use for that reason.

According to WebMD:

”Nicotine, a key part of tobacco, is thought to relax the ring of muscle in the lower esophagus that keeps acid in the stomach, where it belongs. When that ring relaxes, acid can trickle up and cause that burning sensation.”

Moreover, they state that smoking can cause your mouth to make less spit, which ”might mean more heartburn symptoms”. (Source)

However, if anything, nicotine pouches increase saliva production during use, so the latter would certainly not apply to nicotine pouches.

Swenico Nicotine Pouches

Scientific Studies and Research

Numerous studies have investigated the effects of nicotine on the lower esophageal sphincter (LES) and its role in promoting acid reflux.

  • LES Relaxation: Some studies suggest that nicotine can induce relaxation of the LES which facilitates the reflux of stomach acid into the esophagus. This phenomenon is well-documented in the context of smoking where the combustion of tobacco releases nicotine along with numerous other compounds.
  • Limited Research on Nicotine Pouches: However, research that specifically focuses on nicotine pouches is limited. The unique delivery method of nicotine through pouches, without the inhalation of smoke, raises questions about whether the same physiological effects observed in smoking can be extrapolated to pouch use. This is why we need further investigation to establish a direct correlation between nicotine pouches and increased heartburn risk.

Findings regarding the relationship between nicotine use and acid reflux:

  • Smoking and Heartburn: Studies on smoking and heartburn have consistently shown a positive association. Smokers are more likely to experience frequent heartburn and gastroesophageal reflux disease (GERD) compared to non-smokers. This link is attributed to the combination of nicotine-induced LES relaxation and other components present in cigarette smoke.
  • Role of Nicotine Alone: When isolating the impact of nicotine alone, the evidence is not as conclusive. Some studies suggest a modest association between nicotine use and an increased risk of GERD, while others emphasize the significance of additional components found in tobacco smoke. For that reason, the most important thing is for nicotine pouch users who experience heartburn to examine whether or not they notice any difference when they use nicotine pouches and when they do not. Individual responses as well as personal usage

With this said, nicotine pouch usage may cause heartburn, however, the findings are not unanimous in the extent to which they cause it, and whether all users will experience it. The fact of the matter is that most nicotine pouch users will not experience heartburn. At the same time, for those who already experience heartburn, nicotine pouch usage may have an effect on the experienced heartburn. Ultimately, it varies from person to person as well as factors like frequency of use and nicotine strength. This is why it’s impossible to give a definite answer because frankly, there isn’t one.

Tips for Managing Heartburn

While the potential link between nicotine pouches and heartburn is being explored, our advice if you are experiencing heartburn as a nicotine pouch user is to try reducing your nicotine strength of frequency of use. That way, you’ll be able to assess whether the nicotine pouches have any impact on your heartburn,

Here are some additional tips for minimizing heartburn:

Dietary Modifications: Identify and avoid trigger foods that may exacerbate heartburn like spicy or acidic foods, caffeine, chocolate, and fatty meals. Instead, implement a well-balanced diet with smaller and more frequent meals to reduce the pressure on the lower esophageal sphincter (LES).

Maintain a Healthy Weight: Obesity is a great risk factor for heartburn. Excess weight can put pressure on the stomach and contribute to the reflux of stomach acid. This is why it is crucial to adopt a healthy lifestyle that includes regular exercise to aid in weight management and reduce the likelihood of heartburn.

Elevate the Head of the Bed: Sleeping with the upper body elevated can help prevent stomach acid from flowing back into the esophagus. A tip is to use a wedge pillow or raise the head of the bed by a few inches.

Medical Evaluation: If heartburn symptoms persist or worsen despite lifestyle changes, it is advised to seek medical evaluation is crucial. A healthcare provider can perform diagnostic tests like endoscopy or pH monitoring to assess the severity of acid reflux and determine an appropriate treatment plan.

Medication: Depending on the diagnosis, doctors may prescribe medications such as antacids, H2 blockers, or proton pump inhibitors (PPIs) to manage heartburn symptoms. These medications work by neutralizing or reducing the production of stomach acid.

Monitoring and Follow-Up: Regular follow-up with a healthcare provider is important to monitor progress and adjust treatment plans as needed.


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