Nicotine pouches are being marketed to young people on social media. But are they safe, or even legal?
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Flavoured nicotine pouches are being promoted to young people on social media platforms such as TikTok and Instagram.
Although some viral videos have been taken down following a series of reports in The Guardian, clips featuring Australian influencers have claimed nicotine pouches are a safe and effective way to quit vaping. A number of the videos have included links to websites selling these products.
With the rapid rise in youth vaping and the subsequent implementation of several reforms to restrict access to vaping products, it’s not entirely surprising the tobacco industry is introducing more products to maintain its future revenue stream.
The major trans-national tobacco companies, including Philip Morris International and British American Tobacco, all manufacture nicotine pouches. British American Tobacco’s brand of nicotine pouches, Velo, is a leading sponsor of the McLaren Formula 1 team.
But what are nicotine pouches, and are they even legal in Australia?
Like snus, but different
Nicotine pouches are available in many countries around the world, and their sales are increasing rapidly, especially among young people.
Nicotine pouches look a bit like small tea bags and are placed between the lip and gum. They’re typically sold in small, colourful tins of about 15 to 20 pouches. While the pouches don’t contain tobacco, they do contain nicotine that is either extracted from tobacco plants or made synthetically. The pouches come in a wide range of strengths.
As well as nicotine, the pouches commonly contain plant fibres (in place of tobacco, plant fibres serve as a filler and give the pouches shape), sweeteners and flavours. Just like for vaping products, there’s a vast array of pouch flavours available including different varieties of fruit, confectionery, spices and drinks.
The range of appealing flavours, as well as the fact they can be used discreetly, may make nicotine pouches particularity attractive to young people.
Aleksandr Yu/Shutterstock
Users absorb the nicotine in their mouths and simply replace the pouch when all the nicotine has been absorbed. Tobacco-free nicotine pouches are a relatively recent product, but similar style products that do contain tobacco, known as snus, have been popular in Scandinavian countries, particularly Sweden, for decades.
Snus and nicotine pouches are however different products. And given snus contains tobacco and nicotine pouches don’t, the products are subject to quite different regulations in Australia.
What does the law say?
Pouches that contain tobacco, like snus, have been banned in Australia since 1991, as part of a consumer product ban on all forms of smokeless tobacco products. This means other smokeless tobacco products such as chewing tobacco, snuff, and dissolvable tobacco sticks or tablets, are also banned from sale in Australia.
Tobacco-free nicotine pouches cannot legally be sold by general retailers, like tobacconists and convenience stores, in Australia either. But the reasons for this are more complex.
In Australia, under the Poisons Standard, nicotine is a prescription-only medicine, with two exceptions. Nicotine can be used in tobacco prepared and packed for smoking, such as cigarettes, roll-your-own tobacco, and cigars, as well as in preparations for therapeutic use as a smoking cessation aid, such as nicotine patches, gum, mouth spray and lozenges.
If a nicotine-containing product does not meet either of these two exceptions, it cannot be legally sold by general retailers. No nicotine pouches have currently been approved by the Therapeutic Goods Administration as a therapeutic aid in smoking cessation, so in short they’re not legal to sell in Australia.
However, nicotine pouches can be legally imported for personal use only if users have a prescription from a medical professional who can assess if the product is appropriate for individual use.
We only have anecdotal reports of nicotine pouch use, not hard data, as these products are very new in Australia. But we do know authorities are increasingly seizing these products from retailers. It’s highly unlikely any young people using nicotine pouches are accessing them through legal channels.
Health concerns
Nicotine exposure may induce effects including dizziness, headache, nausea and abdominal cramps, especially among people who don’t normally smoke or vape.
Although we don’t yet have much evidence on the long term health effects of nicotine pouches, we know nicotine is addictive and harmful to health. For example, it can cause problems in the cardiovascular system (such as heart arrhythmia), particularly at high doses. It may also have negative effects on adolescent brain development.
The nicotine contents of some of the nicotine pouches on the market is alarmingly high. Certain brands offer pouches containing more than 10mg of nicotine, which is similar to a cigarette. According to a World Health Organization (WHO) report, pouches deliver enough nicotine to induce and sustain nicotine addiction.
Pouches are also being marketed as a product to use when it’s not possible to vape or smoke, such as on a plane. So instead of helping a person quit they may be used in addition to smoking and vaping. And importantly, there’s no clear evidence pouches are an effective smoking or vaping cessation aid.
Becky Freeman
Further, some nicotine pouches, despite being tobacco-free, still contain tobacco-specific nitrosamines. These compounds can damage DNA, and with long term exposure, can cause cancer.
Overall, there’s limited data on the harms of nicotine pouches because they’ve been on the market for only a short time. But the WHO recommends a cautious approach given their similarities to smokeless tobacco products.
For anyone wanting advice and support to quit smoking or vaping, it’s best to talk to your doctor or pharmacist, or access trusted sources such as Quitline or the iCanQuit website.
Becky Freeman, Associate Professor, School of Public Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Could the shingles vaccine lower your risk of dementia?
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A recent study has suggested Shingrix, a relatively new vaccine given to protect older adults against shingles, may delay the onset of dementia.
This might seem like a bizarre link, but actually, research has previously shown an older version of the shingles vaccine, Zostavax, reduced the risk of dementia.
In this new study, published last week in the journal Nature Medicine, researchers from the United Kingdom found Shingrix delayed dementia onset by 17% compared with Zostavax.
So how did the researchers work this out, and how could a shingles vaccine affect dementia risk?
Melinda Nagy/Shutterstock From Zostavax to Shingrix
Shingles is a viral infection caused by the varicella-zoster virus. It causes painful rashes, and affects older people in particular.
Previously, Zostavax was used to vaccinate against shingles. It was administered as a single shot and provided good protection for about five years.
Shingrix has been developed based on a newer vaccine technology, and is thought to offer stronger and longer-lasting protection. Given in two doses, it’s now the preferred option for shingles vaccination in Australia and elsewhere.
In November 2023, Shingrix replaced Zostavax on the National Immunisation Program, making it available for free to those at highest risk of complications from shingles. This includes all adults aged 65 and over, First Nations people aged 50 and older, and younger adults with certain medical conditions that affect their immune systems.
What the study found
Shingrix was approved by the US Food and Drugs Administration in October 2017. The researchers in the new study used the transition from Zostavax to Shingrix in the United States as an opportunity for research.
They selected 103,837 people who received Zostavax (between October 2014 and September 2017) and compared them with 103,837 people who received Shingrix (between November 2017 and October 2020).
By analysing data from electronic health records, they found people who received Shingrix had a 17% increase in “diagnosis-free time” during the follow-up period (up to six years after vaccination) compared with those who received Zostavax. This was equivalent to an average of 164 extra days without a dementia diagnosis.
The researchers also compared the shingles vaccines to other vaccines: influenza, and a combined vaccine for tetanus, diphtheria and pertussis. Shingrix and Zostavax performed around 14–27% better in lowering the risk of a dementia diagnosis, with Shingrix associated with a greater improvement.
The benefits of Shingrix in terms of dementia risk were significant for both sexes, but more pronounced for women. This is not entirely surprising, because we know women have a higher risk of developing dementia due to interplay of biological factors. These include being more sensitive to certain genetic mutations associated with dementia and hormonal differences.
Why the link?
The idea that vaccination against viral infection can lower the risk of dementia has been around for more than two decades. Associations have been observed between vaccines, such as those for diphtheria, tetanus, polio and influenza, and subsequent dementia risk.
Research has shown Zostavax vaccination can reduce the risk of developing dementia by 20% compared with people who are unvaccinated.
But it may not be that the vaccines themselves protect against dementia. Rather, it may be the resulting lack of viral infection creating this effect. Research indicates bacterial infections in the gut, as well as viral infections, are associated with a higher risk of dementia.
Notably, untreated infections with herpes simplex (herpes) virus – closely related to the varicella-zoster virus that causes shingles – can significantly increase the risk of developing dementia. Research has also shown shingles increases the risk of a later dementia diagnosis.
This isn’t the first time research has suggested a vaccine could reduce dementia risk. ben bryant/Shutterstock The mechanism is not entirely clear. But there are two potential pathways which may help us understand why infections could increase the risk of dementia.
First, certain molecules are produced when a baby is developing in the womb to help with the body’s development. These molecules have the potential to cause inflammation and accelerate ageing, so the production of these molecules is silenced around birth. However, viral infections such as shingles can reactivate the production of these molecules in adult life which could hypothetically lead to dementia.
Second, in Alzheimer’s disease, a specific protein called Amyloid-β go rogue and kill brain cells. Certain proteins produced by viruses such as COVID and bad gut bacteria have the potential to support Amyloid-β in its toxic form. In laboratory conditions, these proteins have been shown to accelerate the onset of dementia.
What does this all mean?
With an ageing population, the burden of dementia is only likely to become greater in the years to come. There’s a lot more we have to learn about the causes of the disease and what we can potentially do to prevent and treat it.
This new study has some limitations. For example, time without a diagnosis doesn’t necessarily mean time without disease. Some people may have underlying disease with delayed diagnosis.
This research indicates Shingrix could have a silent benefit, but it’s too early to suggest we can use antiviral vaccines to prevent dementia.
Overall, we need more research exploring in greater detail how infections are linked with dementia. This will help us understand the root causes of dementia and design potential therapies.
Ibrahim Javed, Enterprise and NHMRC Emerging Leadership Fellow, UniSA Clinical & Health Sciences, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Practical Optimism – by Dr. Sue Varma
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We’ve written before about how to get your brain onto a more positive track (without toxic positivity), but there’s a lot more to be said than we can fit into an article, so here’s a whole book packed full with usable advice.
The subtitle claims “the art, science, and practice of…”, but mostly it’s the science of. If there’s art to be found here, then this reviewer missed it, and as for the practice of, well, that’s down to the reader, of course.
However, it is easy to use the contents of this book to translate science into practice without difficulty.
If you’re a fan of acronyms, initialisms, and other mnemonics (such as the rhyming “Name, Claim, Tame, and Reframe”), then you’ll love this book as they come thick and fast throughout, and they contribute to the overall ease of application of the ideas within.
The writing style is conversational but with enough clinical content that one never forgets who is speaking—not in the egotistical way that some authors do, but rather, just, she has a lot of professional experience to share and it shows.
Bottom line: if you’d like to be more optimistic without delving into the delusional, this book can really help a lot with that (in measurable ways, no less!).
Click here to check out Practical Optimism, and brighten up your life!
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A Guide to Rational Living – by Drs. Albert Ellis and Robert Harper
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We’ve talked before about the evidence-based benefits of Cognitive Behavioral Therapy (CBT), and this book is indeed about CBT. In fact, it’s in many ways the book that popularized Third Wave CBT—in other words, CBT in its modern form.
Dr. Ellis’s specific branch of CBT is Rational Emotive Behavior Therapy, (REBT). What this means is using rationality to rewire emotions so that we’re not constantly sabotaging ourselves and our lives.
This is very much a “for the masses” book and doesn’t assume any prior knowledge of psychology, therapy, or psychotherapy. Or, for that matter, philosophy, since Stoic philosopher Epictetus had a lot to say that influenced Dr. Ellis’s work, too!
This book has also been described as “a self-help book for people who don’t like self-help books”… and certainly that Stoicism we mentioned does give the work a very different feel than a lot of books on the market.
The authors kick off with an initial chapter “How far can you go with self-therapy?”, and the answer is: quite far, even if it’s not a panacea. Everything has its limitations, and this book is no exception. On the other hand…
What the book does offer is a whole stack of tools, resources, and “How to…” chapters. In fact, there are so many “How to…” items in this book that, while it can be read cover-to-cover, it can also be used simply as a dip-in reference guide to refer to in times of need.
Bottom line: this book is highly recommendable to anyone and everyone, and if you don’t have it on your bookshelf, you should.
Click here to check out “A Guide To Rational Living” on Amazon today!
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Do You Believe In Magic? – by Dr. Paul Offit
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Here at 10almonds, we like to examine and present the science wherever it leads, so this book was an interesting read.
Dr. Offit, himself a much-decorated vaccine research scientist, and longtime enemy of the anti-vax crowd, takes aim at alternative therapies in general, looking at what does work (and how), and what doesn’t (and what harm it can cause).
The style of the book is largely polemic in tone, but there’s lots of well-qualified information and stats in here too. And certainly, if there are alternative therapies you’ve left unquestioned, this book will probably prompt questions, at the very least.
And science, of course, is about asking questions, and shouldn’t be afraid of such! Open-minded skepticism is a key starting point, while being unafraid to actually reach a conclusion of “this is probably [not] so”, when and if that’s where the evidence brings us. Then, question again when and if new evidence comes along.
To that end, Dr. Offit does an enthusiastic job of looking for answers, and presenting what he finds.
If the book has downsides, they are primarily twofold:
- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
- His keenness here seems to step from a desire to ensure people don’t skip life-saving medical treatments in the hope that their diet will cure their cancer (or liver disease, or be it what it may), but in doing so, he throws out a lot of actually good science.
- He—strangely—lumps menopausal HRT in with alternative therapies, and does the exact same kind of anti-science scaremongering that he rails against in the rest of the book.
- In his defence, this book was published ten years ago, and he may have been influenced by a stack of headlines at the time, and a popular celebrity endorsement of HRT, which likely put him off it.
Bottom line: there’s something here to annoy everyone—which makes for stimulating reading.
Click here to check out Do You Believe In Magic, and expand your knowledge!
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- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
Brave – by Dr. Margie Warrell
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Whether it’s the courage to jump out of a plane or the courage to have a difficult conversation, bravery is an important quality that we often don’t go far out of our way to grow. At least, not as adults.
Rather than viewing bravery as a static attribute—you either have it or you don’t—psychologist Dr. Margie Warrell makes the case for its potential for lifelong development.
The book is divided into five sections:
- Live purposefully
- Speak bravely
- Work passionately
- Dig deep
- Dare boldly
…and each has approximately 10 chapters, each a few pages long, the kind that can easily make this a “chapter-a-day” daily reader.
As a quick clarification: that “speak bravely” section isn’t about public speaking, but is rather about speaking up when it counts. Life is too short for regrets, and our interactions with others tend to be what matters most in the long-run. It makes a huge difference to our life!
Dr. Warrell gives us tools to reframe our challenges and tackle them. Rather than just saying “Feel the fear and do it anyway”, she also delivers the how, in all aspects. This is one of the main values the book brings, as well as a sometimes-needed reminder of how and why being brave is something to which we should always aspire… and hold.
Bottom line: if you’d like to be more brave—in any context—this book can help. We only get one life; might as well live it.
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Caesar Salad, Anyone? (Ides of March Edition!)
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The Mediterranean Diet: What Is It Good For?
More to the point: what isn’t it good for?
- It’s been found to reduce all-cause mortality, which is about the best thing one can say of any diet.
- It’s especially good for heart health and against cancer.
- It’s particularly recommended for the prevention or management of diabetes.
- It’s also been found, societally, to reduce general healthcare costs—basically, people get sick less and so have fewer healthcare costs.
What brought it to the attention of the world’s scientific community?
Back in the 1950s, physiologist Ancel Keys wondered why poor people in Italian villages were healthier than wealthy New Yorkers. Upon undertaking studies, he narrowed it down to the Mediterranean diet—something he’d then take on as a public health cause for the rest of his career.
Keys himself lived to the ripe old age of 100, by the way.
When we say “Mediterranean Diet”, what image comes to mind?
We’re willing to bet that tomatoes feature (great source of lycopene, by the way), but what else?
- Salads, perhaps? Vegetables, olives? Olive oil, yea or nay?
- Bread? Pasta? Prosciutto, salami? Cheese?
- Pizza but only if it’s Romana style, not Chicago?
- Pan-seared liver, with some fava beans and a nice Chianti?
In reality, the diet is based on what was historically eaten specifically by Italian peasants. If the word “peasants” conjures an image of medieval paupers in smocks and cowls, and that’s not necessarily wrong, further back historically… but the relevant part here is that they were people who lived and worked in the countryside.
They didn’t have money for meat, which was expensive, nor the industrial setting for refined grain products to be affordable. They didn’t have big monocrops either, which meant no canola oil, for example… Olives produce much more easily extractable oil per plant, so olive oil was easier to get. Nor, of course, did they have the money (or infrastructure) for much in the way of imports.
So what foods are part of “the” Mediterranean Diet?
- Fruits. These would be fruits grown locally, but no need to sweat that, dietwise. It’s hard to go wrong with fruit.
- Tomatoes yes. So many tomatoes. (Knowledge is knowing tomato is a fruit. Wisdom is not putting it in a fruit salad)
- Non-starchy vegetables (e.g. eggplant yes, potatoes no)
- Greens (spinach, kale, lettuce, all those sorts of things)
- Beans and other legumes (whatever was grown nearby)
- Whole grain products in moderation (wholegrain bread, wholewheat pasta)
- Olives and olive oil. Special category, single largest source of fat in the Mediterranean diet, but don’t overdo it.
- Dairy products in moderation (usually hard cheeses, as these keep well)
- Fish, in moderation. Typically grilled, baked, steamed even. Not fried.
- Other meats as a rarer luxury in considerable moderation. There’s more than one reason prosciutto is so thinly sliced!
Want to super-power this already super diet?
Try: A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week
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