Nicotine and Its Health Implications: The Good, Bad, Unknown, and Nootropic Properties
- Samuel Falkson MD
- 3 days ago
- 9 min read
The idea for this post came during my last visit to the Navy Exchange, where I watched the sailor in front of me purchase fifty tins of nicotine pouches. The checkout attendant had to make multiple trips behind her to the display just to gather them all, and when the final total rang up, it was well into the four-figure range. It was a striking snapshot of how popular nicotine-only products have become - especially in certain social circles. As cigarette smoking thankfully continues to decline, products like nicotine-only pouches, gums, lozenges, and vapes are filling the gap at a remarkable pace. That naturally raises an important question: is nicotine itself harmful, or has it largely been guilty by association with tobacco, which contains thousands of other toxic chemicals? For the growing number of people using nicotine-only products, understanding the true health implications matters. In this blog post, I dive into what the peer-reviewed scientific literature actually shows - examining nicotine’s effects on cognition, cardiovascular health, cancer risk, reproductive outcomes, and even its potential neuroprotective properties.
What is Nicotine?
Nicotine is a naturally occurring alkaloid found in tobacco plants, but modern usage often involves tobacco‑free formulations. Unlike cigarettes, which expose the body to tar, carbon monoxide, carcinogenic nitrosamines, and thousands of combustion‑derived toxins, nicotine-only products generally contain nicotine as the sole active ingredient. Nicotine works by stimulating certain receptors on cells - nicotinic acetylcholine receptors - to trigger the release of several neurotransmitters such as dopamine, norepinephrine, and serotonin (1). These pathways explain nicotine’s measurable effects on the mind and nervous system.
Cognitive and Performance Effects
One reason nicotine remains appealing is that many users experience a noticeable boost in cognitive performance when using it. A large meta-analysis by Heishman and colleagues evaluated dozens of double‑blind, placebo‑controlled studies assessing nicotine’s acute effects on human performance (2). The findings provided evidence that nicotine improves alertness, reaction time, working memory speed, short‑term memory, and fine motor performance.
In practical terms, nicotine can make individuals feel sharper, more focused, and more responsive (it functions as a nootropic) - effects that many may experience as beneficial, which helps explain nicotine’s popularity. However, while the acute benefits are real, it’s important to assess at what cost they might come – are there risks to using nicotine, and is it safe?
Cardiovascular Effects of Nicotine
Cardiovascular disease is one of the most serious risks associated with cigarette smoking. However, consumption of nicotine separate from the tobacco product appears to paint a different picture.
Physiologically, nicotine does activate the sympathetic nervous system (the “fight or flight” regulator of the body), leading to short‑term increases in heart rate, blood pressure, and blood vessel constriction. These effects could theoretically contribute to cardiovascular disease if repeated frequently or in vulnerable individuals.
However, this theoretical risk has not translated to real-world demonstrable impacts in studies. A systematic review of randomized controlled trials by Kim et al. found no significant increase in adverse cardiovascular events – specifically arrhythmias, deadly heart attacks and strokes, or cardiovascular death among users of nicotine-only products (3).
The findings of Kim et al. broadly align with what Price & Martinez reported in their narrative review on nicotine’s health-related effects (1). After synthesizing human and animal data - they concluded that for healthy individuals without underlying cardiovascular disease, there is no evidence of increased long-term cardiovascular risk attributable to nicotine alone. They emphasized that most cardiovascular damage seen in smokers arises from combustion byproducts, oxidants, and particulate matter—not from nicotine. Acute increases in blood pressure and heart rate were consistently observed, but long-term harms attributable solely to nicotine were not demonstrated.
Overall, these findings suggest that while nicotine can place acute strain on the cardiovascular system (for example, by increasing heart rate and blood pressure), these effects have not translated into long-term poor cardiovascular outcomes, and nicotine-only use is dramatically less harmful than tobacco use. However, I would still recommend some caution regarding prolonged nicotine use, particularly in people with pre-existing risk-factors for cardiovascular disease (such as a personal or family history of cardiovascular disease, high blood pressure, diabetes, high cholesterol, or a history of tobacco use), as repeated sympathetic stimulation could theoretically add strain to the heart and blood vessels over time, even if we don’t see this signal in studies done so far.
Does Nicotine Cause Cancer?
One of the most important questions regarding nicotine is whether it causes cancer. We know that tobacco products greatly increase the risk of many types of cancers, such as those of the lung, mouth, and esophagus. Nicotine by itself, however, is not considered a human carcinogen. The narrative review by Price and Martinez, along with official statements from prominent organizations such as the United States Surgeon General and the National Academies of Science, Engineering and, Medicine all agree that nicotine has not been shown to initiate cancer in humans (1).
However, questions do still exist as to whether nicotine might play a role in affecting an already existing cancer. Laboratory and animal studies do suggest that nicotine could potentially promote tumor growth or angiogenesis (new blood vessel formation) in individuals who already have cancer (1). These findings have not been demonstrated in human clinical outcomes, but they highlight a theoretical concern for cancer progression related to nicotine exposure. In simple terms, nicotine itself doesn’t seem to cause cancer, but scientists are still studying whether it might worsen a cancer that’s already there. Given this remaining uncertainty, I would recommend caution when considering the use of nicotine, particularly for those with a personal or family history of cancer.
Does Nicotine Impact Reproductive Health and Fertility?
Many users of nicotine products—whether pouches, vapes, gum, or lozenges—are in their reproductive years (roughly teens to 40s). This makes understanding nicotine’s impact on fertility and pregnancy especially important.
Reproductive health is an area where caution is most strongly warranted, largely because nicotine is biologically active in ways that can affect reproductive cells and fetal development. Price and Martinez’s narrative review highlights that nicotine crosses the placenta, and in animal studies, it has measurable effects on fetal brain and organ development (1). Human studies are more difficult to interpret because many individuals who use nicotine during pregnancy also use tobacco products, making it challenging to isolate nicotine’s independent effects. A major systematic review of nicotine-replacement therapy by Lee et al. did identify one noteworthy human signal in a large United Kingdom cohort study, which found an increased risk of respiratory congenital abnormalities among infants born to mothers using nicotine during pregnancy (4). However, the authors did note that these women had significantly higher rates of underlying medical conditions that could explain the association, making the finding difficult to blame on nicotine alone.
Importantly, the Price & Martinez review also summarizes evidence on fertility itself, especially regarding sperm and oocyte health. In animal studies, nicotine exposure has been associated with reduced sperm count, impaired sperm motility, abnormal sperm morphology, and increased oxidative damage to sperm DNA. Similar concerns appear in studies of oocyte quality: nicotine has been shown to reduce ovarian follicle numbers, impair oocyte maturation, and negatively impact early embryonic development in rodents (1). While these effects have not yet been proven in humans, the biological plausibility suggests that nicotine could play a role in decreasing fertility potential.
Given these concerning findings related to reproductive health and fertility, in general, I would recommend anyone thinking of having a baby to avoid nicotine products. A major exception would be if one were using nicotine products to avoid using tobacco products. I do think that nicotine is significantly safer than tobacco in this (and every other) domain of health.
Addiction, Dependence, and Behavior
Separate from its physiological effects, nicotine is certainly an addictive substance. Even if the direct harms of nicotine are lower than those of tobacco smoke, its reinforcing properties can lead to increased and compulsive use, or difficulty quitting, even if one desires to. Whether one views this property as a negative or not, it is important to be aware of this fact if considering using a nicotine product.
Additionally, certain delivery methods, such as vaping, may carry additional risks (to the lungs, for example) that are independent of nicotine itself. Thus, in addition to considering the properties of nicotine, one must also consider its particular delivery method if assessing the relative risks and benefits of using a nicotine product.
A Word on Possible Neuroprotective Effects of Nicotine
An intriguing aspect of nicotine’s physiologic impact is its potential relationship with neurodegenerative diseases like Parkinson’s Disease and Alzheimer’s Disease. Several long-term epidemiologic studies have found that people who smoke have a significantly lower risk of developing Parkinson’s disease, with reductions of 30–60% reported across large cohorts and meta-analyses (5, 6). This pattern has prompted researchers to ask whether nicotine itself - not the harmful components of tobacco smoke - might offer some degree of neuroprotection. Experimental work supports this possibility: nicotine activates nicotinic acetylcholine receptors in the brain, modulating dopamine pathways and reducing neuronal injury in animal models of Parkinson’s disease (7).
While this does not prove that nicotine prevents disease in humans, it highlights a fascinating area of neuroscience. That said, I do not recommend using nicotine for the purpose of reducing neurological disease risk currently. For individuals at high risk of neurodegenerative diseases like Parkinson’s - or those already diagnosed - it may be reasonable to discuss nicotine-based therapies with their doctor, as research is ongoing. But for the average person, the potential neuroprotective properties of nicotine are interesting science at this point - not a reason to start using nicotine.
Is Nicotine Bad for You? A Balanced Summary
Nicotine exists in a gray zone. It has clear benefits, particularly in the acute setting for cognitive and mental performance. There are possible risks as well, such as potentially affecting how existing cancers behave, or negatively influencing reproductive processes. It has other effects as well, like its acute increase of blood pressure and heart rate, which are difficult to classify as either good or bad based on current data. Overall, nicotine appears substantially safer than tobacco, and is certainly a win for those that are using it in place of tobacco products.
A fair assessment is this: nicotine is a pharmacologic tool. It has benefits, risks, and uncertainties. The key is understanding the elements, and factoring them into your decision of whether or not to use it.
In an attempt to provide some clarity, I have compiled the bullet points below based on my reading of the evidence.
• In general, I don’t recommend nicotine use unless it is replacing tobacco. Important uncertainties remain - such as long-term cardiovascular implications, potential effects on existing cancers, and unclear reproductive risks.
• Nicotine-only products are far safer than tobacco. If someone uses nicotine instead of smoking, that substitution is almost certainly a net health benefit.
• Reproductive safety is unclear. If you’re planning a pregnancy, currently pregnant, or breastfeeding, it’s best to avoid nicotine - unless it is being used specifically to prevent tobacco use.
• If you choose to use nicotine, be strategic, specific, and occasional. Nicotine can acutely enhance focus and cognition – it is certainly a nootropic, so using it sparingly for specific performance-based situations when appropriate (for example, an exam, interview, or high-stakes task) makes sense. Given the many unanswered questions about long-term exposure, chronic daily use is not advisable. Think of nicotine as a tool you use deliberately - not something you rely on continuously.
Nicotine isn’t simply “good” or “bad.” Nicotine carries important health implications, yet when used strategically and sparingly, it also functions as a nootropic supporting measurable cognitive enhancement. It is a biologically active substance with numerous physiologic effects, and understanding those effects empowers better decisions.
More Questions? Reach Out!
At BlissElla Physiologic Arts, we help individuals understand their physiology to take control of their health and live with more energy and happiness through precise, personalized evaluation. Please don’t hesitate to reach out if you have further questions on this topic regarding nicotine or for other inquiries on how best to optimize your health.
Disclaimer: The information on this site is for educational purposes only and is not medical advice. It does not create a physician–patient relationship with BlissElla Physiologic Arts, PLLC and/or the medical providers working for this practice. Always consult your personal healthcare provider before making medical decisions. If you are experiencing a medical emergency, call 911.
Bibliography:
1. Price LR, Martinez J. Cardiovascular, carcinogenic and reproductive effects of nicotine exposure: A narrative review of the scientific literature. F1000Res. 2019;8:1586.
2. Heishman SJ, Kleykamp BA, Singleton EG. Meta-analysis of the acute effects of nicotine and smoking on human performance. Psychopharmacology (Berl). 2010;210(4):453-469.
3. Kim MM, Steffensen I, Miguel RTD, et al. Study title: A systematic review of RCTs to examine the risk of adverse cardiovascular events with nicotine use. Front Cardiovasc Med. 2023;10:1111673.
4. Lee PN, Fariss MW. A systematic review of possible serious adverse health effects of nicotine replacement therapy. Arch Toxicol. 2017;91(4):1565-1594.
5. Breckenridge CB, Berry C, Chang ET, Sielken RL, Mandel JS. Association between parkinson’s disease and cigarette smoking, rural living, well-water consumption, farming and pesticide use: systematic review and meta-analysis. PLoS One. 2016;11(4):e0151841.
6. Mappin-Kasirer B, Pan H, Lewington S, et al. Tobacco smoking and the risk of Parkinson disease: A 65-year follow-up of 30,000 male British doctors. Neurology. 2020;94(20):e2132-e2138.
7. Quik M, Perez XA, Bordia T. Nicotine as a potential neuroprotective agent for Parkinson’s disease. Mov Disord. 2012;27(8):947-957.