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AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action
AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action

AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action

The Peter Attia DriveGo to Podcast Page

Bob Kaplan, Peter Attia
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May 10, 2021
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Episode Transcript
Hey everyone, welcome to a sneak peek. Ask me, anything or am a episode of the drive podcast? I'm your host Peter attea. At the end of this short episode. I'll explain how you can access the AMA episodes in full along with a ton of other membership benefits. We've created or you can learn more now by going to Peter attea m.com.
R / subscribe. So without further delay, here's today's sneak peek of the ask me. Anything episode. Welcome to ask me anything AMA episode number. 23, I'm joined once again by Bob Kaplan.
In today's episode, we discuss nicotine and all things related to nicotine. We talk about smoking, of course, and we talked about how nicotine Works turns out, nicotine is a super complicated and very
Molecule. It has effects in the brain, it has effects in the body, we talked about how nicotine works and we talked about what the studies say about its benefits to people, that might sound like a contradictory term, given that we know, tobacco is so harmful, but in this episode, we distill all of that into something that I hope is digestible, if you're a subscriber and you want to watch the full video of this podcast, you can find it in the show notes. And if you're not a subscriber, you can watch a sneak peek of the video on YouTube. So,
Without further delay, I hope you'll enjoy am a number
23. Hey, Peter. Hey, man. How are
you? I'm doing, well, how are you good? Except for the fact that my shin is on fire, it is killing me at the moment. I think, you know, I've discovered recently the use of long high socks for Sumo deadlifts, which has been a game changer. And then today, when I was doing my,
I'm upset. I just forgot to put the socks on so I literally had a hundred thirty-five pounds on the bar and two reps into it. Ripped a hole in my shins. That by the time I put the bar down, there was blood down to the floor. And I was like dude how could you forget to put your socks on like your magic favorite socks? So anyway I'm lamenting my Badness there but other than that I'm good that's good. I don't think we have any questions around that but I do have a question.
Do you do you do Sumo deadlift, you do a standard as well and you still using your X bar. I go back and forth so I used to love to deadlift twice a week. Alternating two of the three between a Sumo a standard and a hex bar. And I go in phases. Like right now, I'm really loving Sumo and I've fallen out of love with trap bar. I don't know why. I just was having trouble, kind of finding it again, and whereas I feel really good in the sumo
And I actually haven't done straight bar in probably like six months. I mean, like a traditional narrow narrow stand straight bar, but I like mixing them up. I mean, I just I sort of think deadlift is if you could only assume this they're sort of silly unrealistic question. If you'd only do one exercise, what would it be? It would definitely be variations of deadlifts for me. Hey, that rhymed, it's very nice. Yes, poetic, I'm good like that. So we have, we have an interesting episode today. We do, we do.
We Consolidated a bunch of questions around nicotine. We Street a bunch of questions and typically, people will just, I think would say that, I don't think people would ask, you know, it's smoking bad for you but there actually are a lot of things, a lot of questions around nicotine and are there benefits to nicotine? And in particular, we got questions around the people have heard about it, improving cognition. And if that's possible, is there any literature on that? There's also a question about nicotine improving fat oxidation.
Ation and can it actually help with weight loss and another one, which is really interesting that I think will get to is, is it possible that smoking is protective against covid-19? Yeah. This is where I think the amas are fun because that turned into a really interesting Deep dive and I would have never even thought of that. So it was nice to see a whole bunch of people had asked that question. And then of course, we got to, we got to look into it. You know, I say before we jump into this, I will just say from a personal standpoint.
When I became interested in nicotine about maybe 11 years ago and realized that if you could strip away, the addictive nature of nicotine and we'll get into that a little bit more. The actual molecule was quite interesting and started chewing nicotine gum intermittently. And obviously the, if anybody's ever chewed nicotine gum, who's not a smoker, you realize, you got to go really easy because it can make you quite nauseous and things like that.
So I would, you know, for the next three or four years, I was on and off nicotine gum, you know, somewhere between four and eight milligrams a day and found it to be quite beneficial as far as sort of sharpening my sword. So to speak and just got me a little focused and I was fortunate in that I never really felt even this slightest semblance of addiction to it so I could chew it for 10 days in a row and then stop it for a month and didn't even really notice I was not taking it so I don't know that. That's necessarily something.
Everyone can experience recently. I have discovered, these little pouches nicotine containing pouches which you can sort of put in your ear mouth. They also have lozenges and things like that, that I much prefer because then you don't get the there was always some I was at the gum taste it kind of grows it. Also had a little sugar in it was little too sweet and these pouches are mostly flavorless. They have a bit of an aroma and to be clear they're not they're not like dip or chew, you know, and we'll get into what that difference is. So you're just basically just getting a
Pretty high dose of nicotine and it's bypassing the liver. So it actually hits you quicker. Yeah, I've tried the gum in the, in the lozenges, and I found with a gum same as you. And also, I think on the instructions, that part of it is you chewed a little bit, get a little bit of nicotine out of it and then you're supposed to park it which sounds like what you're probably doing with that pouch or what you do with the laws inch. Because otherwise I think it if you're just chewing it like regular gum and chewing it a lot at it made me nauseous. Yeah, let's help people understand a little bit. Why?
A nicotine isn't dangerous. Let's start with that, right? Because I as you alluded to at the outset, you would not be blamed for having a knee-jerk reaction to the notion that nicotine is a bad thing. So you want to talk for a second? Bob about the difference between nicotine and tobacco. Yes. So when you're looking at nicotine and tobacco and you're looking at, well, when you're looking at tobacco, obviously cigarettes contain leaves from tobacco plants and tobacco also,
As nicotine. So you've got that connection there and something that I didn't realize is that tobacco is actually, it's in the nightshade family of plants. And so when you look at potatoes and tomatoes and eggplants, there's actually there's nicotine in there but the Nick at the level of nicotine and those plants are nowhere near tobacco. So nicotine makes up this is about one to three percent of the dry weight of tobacco. Whereas these nightshades it's like millions of a percent very Trace Amounts but interestingly even though
The Surgeon General said, there's there's not enough evidence or inadequate evidence to infer a causal relationship between nicotine, exposure, and risk for cancer. So I think like a lot of other people. So I have you beat Peter by maybe a decade or two as far as my interest in nicotine, but it was more about I smoked in high school, a little bit smoke cigarettes, and I can certainly speak to the, The Addictive nature of cigarettes, but at that time, in probably years after that, I would just think, you know, when people would talk about nicotine being bad for you, I'd say sure that that's it.
It's in cigarettes, and it's probably one of the many carcinogens and tobacco smoke. And if you go to the, I think it's like they got the who where they've got their long list of potential and known carcinogens, and I think they, it says, they have at least 69 chemicals that that are contained in tobacco, smoke that are carcinogens, but nicotine is actually not one of them. That's an important point, right? This is something really worth reiterating, right? So the the US Department of Health and Human Services,
They've identified at least 69. Chemicals, contained within the tobacco plant. IE things that make it into cigarettes that are carcinogens and nicotine is not one of those things. So it's interesting in that nicotine is the thing that I think we're going to talk about, has some benefits. It also, unfortunately has that addictive part of it, so it brings you back to the tobacco but in and of itself, it doesn't cause cancer, right? And if you look at the who this could be a, you don't entirely different podcast.
But red meat and processed meat, processed meat is a Class 1 and then there's the next class down which is red meat. So I figured I'd go to the list on The Who and if there's anything you know on nicotine being carcinogenic I would think that the who would have it listed there but it's not. So I think that's what you're basically saying is the who will go so far as to claim that red meat is a carcinogen and we've written so much about this topic and basically said be evidence
That red meat is carcinogenic is so weak that it's very difficult to take it. Seriously. And if there's any carcinogenic properties of meat, it's really low signal. And you're saying, if they, if they can't even recognize. Nicotine has carcinogenic given their sensitivity for identifying carcinogens, the likelihood that it has any cancer-causing properties is approaching Epsilon, if not zero. Yeah, that's right. Okay, so, where do all these nicotine replacement products? Come from this?
Safe to say that this entire industry of gums and patches and lozenges inhalers and nasal sprays little pouch that I'm sucking on right now. These are basically tools to get people to stop smoking, right? Yeah. So if you yeah, you look at the literature and there's this nrt they call it nicotine replacement therapy. So you've got nicotine, which is addictive. And so you could implicate that and getting people to smoke and stay smoking and make it hard for them to stop, but they're actually exploiting.
Teen, in fact to help people quit smoking. So you've got all these products that some of them, most the ones that we've talked about. For the most part I think are FDA approved for nicotine replacement therapy to get people to help quit smoking and there's some reviews and probably by a lot of people are familiar with the Cochrane collaboration. They put together a review and found high-quality evidence that this NR T increases the chances of successfully quitting smoking by about 50 to 60 percent and I think anybody who smokes knows
How how hard it is to quit, but hang on. Bob, we're going to have to make sure, we make sure people know, we're talking relative success increase. Can you put that in absolute terms please? Yes. So the for the six months, the absolute quit rate, this is just in general at six months. So you try to quit and they look at people after six months and see if there are, if they've gone back to smoking in the people who have quit for six months and haven't returned to smoking. The absolute rate is about 325.
Percent, which is pretty depressing. And so, in that case, that means that nrt may increase the rate from an absolute perspective by a couple of percentage points. Maybe two to three percent. Yeah. So another great teaching Point here, which is you could read the headline and say wow, nicotine replacement therapy increases your odds, acquitting by 50 to 60 percent and that sounds like an awfully big number. But you have to always ask the question. What does that mean at Absolute level? And if the absolute rate, the absolute success rate of people quitting,
Ting tobacco. At six months is two to three percent and you increase that by 50 to 60 percent. Well look. It's you know, it's an improvement but in the big picture it tells us that it is very hard to quit smoking using nrt and I got to be honest with you I don't know why it's not hire Bob like I don't know why the relative Improvement within our tea, isn't like a thousand percent or you know like five hundred percent like what
Do you have do you have a sense of why it may be as a former smoker? Why when you if you if you take someone who smokes and you give them nrt you can't get 50%, absolute quit rate at six months. It's hard for me to say it's been so long since I smoked. I think it'd be interesting to look into. I wonder if people think that like they, you know, they go to a lozenger, they go and and the lozenges that I've tried in the gun that I've tried. I usually just try the small stoves so the the lozenges that I have. I think, are they come in for the most part 2 milligram and for
Milligram and I take the two milligram one and I think we'll get to this but a cigarette, supposedly has about one milligram of nicotine contained within the cigarette. But I think it's a different route of administration. And I think that people might think that it's they probably say something to the effect of it's just not the same and they go back to the smoking. And I think some people think it's like, well, maybe it's the oral fixation or things like that. Or do you think it's just that that when you're smoking, the inhalation is the fastest route.
Administration. So the rush and the buzz from the nicotine. When you inhale it and, you know, across that entire alveolar, surface area, nothing can compete with that. And so, all of these little piddly nrt therapies are just insufficient to reach the same level. I think that plays a role. I think that they're working on, if that if they haven't already developed as but patches and maybe some of the sprays, the nasal sprays and things like that, that they're part of why they're, you know, you have these different routes of administration as they're trying.
Going to mimic getting speedier delivery to it. So maybe those will be more efficacious in the future. Well, it'd be interesting actually to at some point do a podcast on smoking cessation because we take this for granted that gosh, I think at its peak which would have been about 1964, 1965 I believe up to 59, if not sixty percent of Americans, over the age of 18, Smoked Cigarettes, which you know, I don't know how to qualify that.
Don't know what constituted smoking, you know, did that include people who just smoked socially, like at a bar or, you know, a couple cigarettes, a week versus the pack a day smoker. But, but nevertheless, that's a pretty astonishing quantity. I think the most recent numbers are about 18 to 19 percent of people over 18, is that sound about directionally, right? Yeah, I think so. I think we'll get to it with covid that they are. They look at some prevalence numbers to because they're comparing rates of hospital admission compared to the general population and I think it it
Depends, but I think Americans might be like around 13% to 15%. It's definitely gone down and it reminded me too. I think the podcast with nir barzilai and he was talking about a centenarians and talking about is it the genes or the environment? And he would talk about a lot of the centenarians that he was studying and saying that it doesn't look so much like its environment in one of his, you know, one of the things that he pointed out was a lot of the centenarians had smoked and I don't know if that was never smokers, but if you look at, if you look historically, you would think almost like
How is it possible that these people never smoked in their lifetime? It was so prevalent. It was kind of amazing. Yeah. I mean, we haven't had a lot of current smokers enter our practice, a few that have obviously, that's literally the first thing we address. If you're a smoker and you're interested in longevity, there's harder to find a lower hanging piece of fruit than smoking cessation, As you move to improve someone's Health. We've used Wellbutrin, which is an antidepressant I used to know the
Numbers. In fact, I think we have a little white paper somewhere in the practice that gave us a bit of an assessment on how to combine nrt with Wellbutrin. But this might be an interesting topic. But okay, so what can we say about the cognitive benefits of nicotine? So here I am a few minutes. After ingesting, my little nicotine, little patch, it sitting in here. It's again, it's bypassing my liver. It's getting into my system much quicker because it's being directly absorbed
Maybe it's Placebo, but I got to tell you Bob, I'm feeling pretty sharp right now. I don't have to say, I'm just feeling sharp. Yeah, you got a differential equation for me to solve or not offhand, but yeah, just I could recite Stokes theorem like that. I'm, I'm ready to go. It's going to go entirely different am a podcast. You looked into this. So how many Studies have tried to
ask this question? Directionally, thank you for listening to today's sneak peek. Am a episode of the
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