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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The Body Is Not an Apology – by Sonya Renee Taylor
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First, a couple of things that this book is not about:
- Self-confidence (it’s about more than merely thinking highly of oneself)
- Self-acceptance (it’s about more than merely settling for “good enough”)
In contrast, it’s about loving and celebrating what is, while striving for better, for oneself and for others.
You may be wondering: whence this “radical” in the title?
The author argues that often, the problem with our bodies is not actually our bodies. If we have cancer, or diabetes, then sure, that’s a problem with the body. But most of the time, the “problem with our bodies” is simply society’s rejection of our “imperfect” bodies as somehow “less than”, and something we must invest time and money to correct. Hence, the need for a radical uprooting of ideas, to fix the real problem.
Bottom line: if, like most of us, you have a body that would not entirely pass for that of a Marvel Comics superhero, this is a book for you. And if you do have a MCU body? This is also a book for you, because we have bad news for you about what happens with age.
Click here to check out The Body Is Not An Apology, and appreciate more about yours!
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Rebuilding Milo – by Dr. Aaron Horschig
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The author, a doctor of physical therapy, also wrote another book that we reviewed a while ago, “The Squat Bible” (which is also excellent, by the way). This time, it’s all about resistance training in the context of fixing a damaged body.
Resistance training is, of course, very important for general health, especially as we get older. However, it’s easy to do it wrongly and injure oneself, and indeed, if one is carrying some injury and/or chronic pain, it becomes necessary to know how to fix that before continuing—without just giving up on training, because that would be a road to ruin in terms of muscle and bone maintenance.
The book explains all the necessary anatomy, with clear illustrations too. He talks equipment, keeping things simple and practical, letting the reader know which things actually matter in terms of quality, and what things are just unnecessary fanciness and/or counterproductive.
Most of the book is divided into chapters per body part, e.g. back pain, shoulder pain, ankle pain, hip pain, knee pain, etc; what’s going on, and how to fix it to rebuild it stronger.
The style is straightforward and simple, neither overly clinical nor embellished with overly casual fluff. Just, clear simple explanations and instructions.
Bottom line: if you’d like to get stronger and/or level up your resistance training, but are worried about an injury or chronic condition, this book can set you in good order.
Click here to check out Rebuilding Milo, and rebuild yourself!
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Demystifying Cholesterol
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All About Cholesterol
When it comes to cholesterol, the most common lay understanding (especially under a certain age) is “it’s bad”.
A more informed view (and more common after a certain age) is “LDL cholesterol is bad; HDL cholesterol is good”.
A more nuanced view is “LDL cholesterol is established as significantly associated with (and almost certainly a causal factor of) atherosclerotic cardiovascular disease and related mortality in men; in women it is less strongly associated and may or may not be a causal factor”
You can read more about that here:
Statins: His & Hers? ← we highly recommend reading this, especially if you are a woman and/or considering/taking statins. To be clear, we’re not saying “don’t take statins!”, because they might be the right medical choice for you and we’re not your doctors. But we are saying: here’s something to at least know about and consider.
Beyond HDL & LDL
There is also VLDL cholesterol, which as you might have guessed, stands for “very low-density lipoprotein”. It has a high, unhealthy triglyceride content, and it increases atherosclerotic plaque. In other words, it hardens your arteries more quickly.
The term “hardening the arteries” is an insufficient descriptor of what’s happening though, because while yes it is hardening the arteries, it’s also narrowing them. Because minerals and detritus passing through in the blood (the latter sounds bad, but there is supposed to be detritus passing through in the blood; it’s got to get out of the body somehow, and it’s off to get filtered and excreted) get stuck in the cholesterol (which itself is a waxy substance, by the way) and before you know it, those minerals and other things have become a solid part of the interior of your artery wall, like a little plastering team came and slapped plaster on the inside of the walls, then when it hardened, slapped more plaster on, and so on. Macrophages (normally the body’s best interior clean-up team) can’t eat things much bigger than themselves, so that means they can’t tackle the build-up of plaque.
Impact on the heart
Narrower less flexible arteries means very poor circulation, which means that organs can start having problems, which obviously includes your heart itself as it is not only having to do a harder job to keep the blood circulating through the narrower blood vessels, but also, it is not immune to also being starved of oxygen and nutrients along with the rest of the body when the circulation isn’t good enough. It’s a catch 22.
What if LDL is low and someone is getting heart disease anyway?
That’s often a case of apolipoprotein B, and unlike lipoprotein A, which is bound to LDL so usually* isn’t a problem if LDL is in “safe” ranges, Apo-B can more often cause problems even when LDL is low. Neither of these are tested for in most standard cholesterol tests by the way, so you might have to ask for them.
*Some people, around 1 in 20 people, have hereditary extra risk factors for this.
What to do about it?
Well, get those lipids tests! Including asking for the LpA and Apo-B tests, especially if you have a history of heart disease in your family, or otherwise know you have a genetic risk factor.
With or without extra genetic risks, it’s good to get lipids tests done annually from 40 onwards (earlier, if you have extra risk factors).
See also: Understanding your cholesterol numbers
Wondering whether you have an increased genetic risk or not?
Genetic Testing: Health Benefits & Methods ← we think this is worth doing; it’s a “one-off test tells many useful things”. Usually done from a saliva sample, but some companies arrange a blood draw instead. Cost is usually quite affordable; do shop around, though.
Additionally, talk to your pharmacist to check whether any of your meds have contraindications or interactions you should be aware of in this regard. Pharmacists usually know contraindications/interactions stuff better than doctors, and/but unlike doctors, they don’t have social pressure on them to know everything, which means that if they’re not sure, instead of just guessing and reassuring you in a confident voice, they’ll actually check.
Lastly, shocking nobody, all the usual lifestyle medicine advice applies here, especially get plenty of moderate exercise and eat a good diet, preferably mostly if not entirely plant-based, and go easy on the saturated fat.
Note: while a vegan diet contains zero dietary cholesterol (because plants don’t make it), vegans can still get unhealthy blood lipid levels, because we are animals and—like most animals—our body is perfectly capable of making its own cholesterol (indeed, we do need some cholesterol to function), and it can make its own in the wrong balance, if for example we go too heavy on certain kinds of (yes, even some plant-based) saturated fat.
Read more: Can Saturated Fats Be Healthy? ← see for example how palm oil and coconut oil are both plant-based, and both high in saturated fat, but palm oil’s is heart-unhealthy on balance, while coconut oil’s is heart-healthy on balance (in moderation).
Want to know more about your personal risk?
Try the American College of Cardiology’s ASCVD risk estimator (it’s free)
Take care!
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Age & Aging: What Can (And Can’t) We Do About It?
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How old do you want to be?
We asked you how old you are, and got an interesting spread of answers. This wasn’t too surprising; of course we have a general idea of who our readership is and we write accordingly.
What’s interesting is the gap for “40s”.
And, this wasn’t the case of a broken poll button, it’s something that crops up a lot in health-related sociological research. People who are most interested in taking extra care of their body are often:
- Younger people full of optimism about maintaining this perfectly healthy body forever
- Older people realizing “if I don’t want to suffer avoidable parts of age-related decline, now is the time to address these things”
In between, we often have a gap whereby people no longer have the optimism of youth, but do not yet feel the pressure of older age.
Which is not to say there aren’t 40-somethings who do care! Indeed, we know for a fact we have some subscribers in their 40s (and some in their 90s, too), just, they evidently didn’t vote in this poll.
Anyway, let’s bust some myths…
Aging is inevitable: True or False?
False, probably. That seems like a bold (and fortune-telling) claim, so let’s flip it to deconstruct it more logically:
Aging is, and always will be, unstoppable: True or False?
That has to be “False, probably”. To say “true” now sounds like an even bolder claim. Just like “the moon will always be out of reach”.
- When CPR was first developed, first-aiders were arrested for “interfering with a corpse”.
- Many diseases used to be death sentences that are now “take one of these in the morning”
- If you think this is an appeal to distant history, HIV+ status was a death sentence in the 90s. Now it’s “take one of these in the morning”.
But, this is an appeal to the past, and that’s not always a guarantee of the future. Where does the science stand currently? How is the research and development doing on slowing, halting, reversing aging?
We can slow aging: True or False?
True! There’s a difference between chronological age (i.e., how much time has passed while we’ve been alive) and biological age (i.e., what our diverse markers of aging look like).
Biological age often gets talked about as a simplified number, but it’s more complex than that, as we can age in different ways at different rates, for example:
- Visual markers of aging (e.g. wrinkles, graying hair)
- Performative markers of aging (e.g. mobility tests)
- Internal functional markers of aging (e.g. tests for cognitive decline, eyesight, hearing, etc)
- Cellular markers or aging (e.g. telomere length)
- …and more, but we only have so much room here
There are things we can do to slow most of those, including:
- Good nutrition (e.g. collagen and lutein, to keep specific parts of the body functioning “like those of a younger person” ranging from the joints to the eyes and brain)
- Anti-oxidant activity (e.g. eating anti-oxidant foods, supplementing with anti-oxidants or other things that mitigate oxidative stress, and avoiding foods that hasten oxidative stress which causes many kinds of aging)
- Getting good sleep (not to be underestimated for its restorative importance)
- Taking care of our cognitive health
- Taking care of our mental health (especially: reducing stress)
- Taking care of our mobility (prevention is better than cure!)
In the case of cognitive decline particularly, check out our previous article:
How To Reduce Your Alzheimer’s Risk
It’s too early to worry about… / It’s too late to do anything about… True or False?
False and False!
Many things that affect our health later in life are based on early-life choices and events. So it’s important for young people to take advantage of that. The earlier one adopts a healthy lifestyle, the better, because, and hold onto your hats for the shocker here: aging is cumulative.
However, that doesn’t mean that taking up healthy practices (or dropping unhealthy ones) is pointless later in life, even in one’s 70s and beyond!
Read about this and more from the National Institute of Aging:
What Do We Know About Healthy Aging?
We can halt aging: True or False?
False, for now at least. Our bodies are not statues; they are living organisms, constantly rebuilding themselves, constantly changing, every second of every day, for better or for worse. Every healthy or unhealthy choice you make, every beneficial or adverse experience you encounter, affects your body on a cellular level.
Your body never, ever, stops changing for as long as you live.
But…
We can reverse aging: True or False?
True! Contingently and with limitations, for now at least.
Remember what we said about your body constantly rebuilding itself? That goes for making itself better as well as making itself worse.
- If yesterday you couldn’t touch your toes and today you can, congratulations, you just got younger by a biological marker of aging.
- If you stopped drinking/smoking/eating a certain way last year, and this year your skin has fewer wrinkles, congratulations, you got younger by a biological marker of aging.
- If you’ve been exercising and now your heart rate variability and VO2 max are better than last month, congratulations, you got younger by a biological marker aging.
- If you took supplements that reduce and/or mitigate oxidative stress (e.g. resveratrol, CoQ10, l-theanine, etc), and you took up intermittent fasting, and now your telomeres are longer than they were six months ago, congratulations, you got younger by a biological marker of aging.
But those aren’t really being younger, we’ll still die when our time is up: True or False?
False and True, respectively.
Those kinds of things are really being younger, biologically. What else do you think being biologically younger is?
We may indeed die when our time is up, but (unless we suffer fatal accident or incident first) “when our time is up” is something that is decided mostly by the above factors.
Genetics—the closest thing we have to biological “fate”—accounts for only about 25% of our longevity-related health*.
Genes predispose, but they don’t predetermine.
*Read more: Human longevity: Genetics or Lifestyle? It takes two to tango
(from the Journal of Immunity and Ageing)
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Mental Health Courts Can Struggle to Fulfill Decades-Old Promise
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GAINESVILLE, Ga. — In early December, Donald Brown stood nervously in the Hall County Courthouse, concerned he’d be sent back to jail.
The 55-year-old struggles with depression, addiction, and suicidal thoughts. He worried a judge would terminate him from a special diversion program meant to keep people with mental illness from being incarcerated. He was failing to keep up with the program’s onerous work and community service requirements.
“I’m kind of scared. I feel kind of defeated,” Brown said.
Last year, Brown threatened to take his life with a gun and his family called 911 seeking help, he said. The police arrived, and Brown was arrested and charged with a felony of firearm possession.
After months in jail, Brown was offered access to the Health Empowerment Linkage and Possibilities, or HELP, Court. If he pleaded guilty, he’d be connected to services and avoid prison time. But if he didn’t complete the program, he’d possibly face incarceration.
“It’s almost like coercion,” Brown said. “‘Here, sign these papers and get out of jail.’ I feel like I could have been dealt with a lot better.”
Advocates, attorneys, clinicians, and researchers said courts such as the one Brown is navigating can struggle to live up to their promise. The diversion programs, they said, are often expensive and resource-intensive, and serve fewer than 1% of the more than 2 million people who have a serious mental illness and are booked into U.S. jails each year.
People can feel pressured to take plea deals and enter the courts, seeing the programs as the only route to get care or avoid prison time. The courts are selective, due in part to political pressures on elected judges and prosecutors. Participants must often meet strict requirements that critics say aren’t treatment-focused, such as regular hearings and drug screenings.
And there is a lack of conclusive evidence on whether the courts help participants long-term. Some legal experts, like Lea Johnston, a professor of law at the University of Florida, worry the programs distract from more meaningful investments in mental health resources.
Jails and prisons are not the place for individuals with mental disorders, she said. “But I’m also not sure that mental health court is the solution.”
The country’s first mental health court was established in Broward County, Florida, in 1997, “as a way to promote recovery and mental health wellness and avoid criminalizing mental health problems.” The model was replicated with millions in funding from such federal agencies as the Substance Abuse and Mental Health Services Administration and the Department of Justice.
More than 650 adult and juvenile mental health courts were operational as of 2022, according to the National Treatment Court Resource Center. There’s no set way to run them. Generally, participants receive treatment plans and get linked to services. Judges and mental health clinicians oversee their progress.
Researchers from the center found little evidence that the courts improve participants’ mental health or keep them out of the criminal justice system. “Few studies … assess longer-term impacts” of the programs “beyond one year after program exit,” said a 2022 policy brief on mental health courts.
The courts work best when paired with investments in services such as clinical treatment, recovery programs, and housing and employment opportunities, said Kristen DeVall, the center’s co-director.
“If all of these other supports aren’t invested in, then it’s kind of a wash,” she said.
The courts should be seen as “one intervention in that larger system,” DeVall said, not “the only resource to serve folks with mental health needs” who get caught up in the criminal justice system.
Resource limitations can also increase the pressures to apply for mental health court programs, said Lisa M. Wayne, executive director of the National Association of Criminal Defense Lawyers. People seeking help might not feel they have alternatives.
“It’s not going to be people who can afford mental health intervention. It’s poor people, marginalized folks,” she said.
Other court skeptics wonder about the larger costs of the programs.
In a study of a mental health court in Pennsylvania, Johnston and a University of Florida colleague found participants were sentenced to longer time under government supervision than if they’d gone through the regular criminal justice system.
“The bigger problem is they’re taking attention away from more important solutions that we should be investing in, like community mental health care,” Johnston said.
When Melissa Vergara’s oldest son, Mychael Difrancisco, was arrested on felony gun charges in Queens in May 2021, she thought he would be an ideal candidate for the New York City borough’s mental health court because of his diagnosis of autism spectrum disorder and other behavioral health conditions.
She estimated she spent tens of thousands of dollars to prepare Difrancisco’s case for consideration. Meanwhile, her son sat in jail on Rikers Island, where she said he was assaulted multiple times and had to get half a finger amputated after it was caught in a cell door.
In the end, his case was denied diversion into mental health court. Difrancisco, 22, is serving a prison sentence that could be as long as four years and six months.
“There’s no real urgency to help people with mental health struggles,” Vergara said.
Critics worry such high bars to entry can lead the programs to exclude people who could benefit the most. Some courts don’t allow those accused of violent or sexual crimes to participate. Prosecutors and judges can face pressure from constituents that may lead them to block individuals accused of high-profile offenses.
And judges often aren’t trained to make decisions about participants’ care, said Raji Edayathumangalam, senior policy social worker with New York County Defender Services.
“It’s inappropriate,” she said. “We’re all licensed to practice in our different professions for a reason. I can’t show up to do a hernia operation just because I read about it or sat next to a hernia surgeon.”
Mental health courts can be overly focused on requirements such as drug testing, medication compliance, and completing workbook assignments, rather than progress toward recovery and clinical improvement, Edayathumangalam said.
Completing the programs can leave some participants with clean criminal records. But failing to meet a program’s requirements can trigger penalties — including incarceration.
During a recent hearing in the Clayton County Behavioral Health Accountability Court in suburban Atlanta, one woman left the courtroom in tears when Judge Shana Rooks Malone ordered her to report to jail for a seven-day stay for “being dishonest” about whether she was taking court-required medication.
It was her sixth infraction in the program — previous consequences included written assignments and “bench duty,” in which participants must sit and think about their participation in the program.
“I don’t like to incarcerate,” Malone said. “That particular participant has had some challenges. I’m rooting for her. But all the smaller penalties haven’t worked.”
Still, other participants praised Malone and her program. And, in general, some say such diversion programs provide a much-needed lifeline.
Michael Hobby, 32, of Gainesville was addicted to heroin and fentanyl when he was arrested for drug possession in August 2021. After entry into the HELP Court program, he got sober, started taking medication for anxiety and depression, and built a stable life.
“I didn’t know where to reach out for help,” he said. “I got put in handcuffs, and it saved my life.”
Even as Donald Brown awaited his fate, he said he had started taking medication to manage his depression and has stayed sober because of HELP Court.
“I’ve learned a new way of life. Instead of getting high, I’m learning to feel things now,” he said.
Brown avoided jail that early December day. A hearing to decide his fate could happen in the next few weeks. But even if he’s allowed to remain in the program, Brown said, he’s worried it’s only a matter of time before he falls out of compliance.
“To try to improve myself and get locked up for it is just a kick in the gut,” he said. “I tried really hard.”
KFF Health News senior correspondent Fred Clasen-Kelly contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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How To Lower Your Blood Pressure (Cardiologists Explain)
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Today we enjoy the benefit of input from Dr. Zalzal, Dr. Weeing, and Dr. Hefferman!
If the thought of being in an operating room with three cardiologists in scrubs doesn’t raise your blood pressure too much, the doctors in question have a lot to offer for bringing those numbers down and keeping them down! They recommend…
150 mins of Exercise
This isn’t exactly controversial, but: move your body!
See also: Exercise Less; Move More
Reduce salt
Most people eating the Standard American Diet (SAD) are getting far too much—mostly because it’s in so many processed foods already.
See also: How Too Much Salt May Lead To Organ Failure
Eating habits
There’s a lot more to eating healthily for the heart than just reducing salt, and over all, the Mediterranean diet comes out scoring highest:
- What Is The Mediterranean Diet Anyway? ← a primer for the uncertain
- Four Ways To Upgrade The Mediterranean ← includes a heart-specialized version!
Reduce alcohol
According to the WHO, the only healthy amount of alcohol is zero. According to these cardiologists: at the very least cut down. However much or little you’re drinking right now, less is better.
See also: How To Reduce Or Quit Alcohol
Maintain healthy weight
While the doctors agree that BMI isn’t a great method of measuring metabolic health, it is clear that carrying excessive weight isn’t good for the heart.
See also: Lose Weight (Healthily!)
No smoking
This one’s pretty straight forward: just don’t.
See also: Addiction Myths That Are Hard To Quit
Reduce stress
Chronic stress has a big impact on chronic health in general and that includes its effect on blood pressure. So, improving one improves the other.
See also: Lower Your Cortisol! (Here’s Why & How)
Good sleep
Quality matters as much as quantity, and that goes for its effect on your blood pressure too, so take the time to invest in your good health!
See also: The 6 Dimensions Of Sleep (And Why They Matter)
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