Peter Attia MD#161 - AMA #23 [sneak peek]: All Things Nicotine: benefits, risks, and mechanisms of action
CHAPTERS
- 0:02 – 2:12
Sumo Deadlifts and a Bloody Shin
Peter and Bob open with small talk about Peter's shin injury from forgetting his deadlift socks. They discuss his rotation among sumo, trap bar and straight bar deadlifts and why he would choose deadlift variations as his one exercise.
- •Peter scraped his shins on a warmup set after forgetting his high socks
- •Long socks have been a game changer for his sumo deadlifts
- •He rotates between sumo, standard and hex bar deadlifts in phases
- •He would pick deadlift variations if limited to a single exercise
- 2:12 – 6:20
Nicotine Questions and Peter's Personal Experience
Bob introduces the listener questions on nicotine: cognition, fat oxidation and weight loss, and whether smoking protects against COVID-19. Peter describes his own use of nicotine gum and pouches over about 11 years and why he prefers pouches.
- •Listener questions cover cognition, fat oxidation, weight loss and COVID-19
- •Peter began using nicotine gum about 11 years ago for focus
- •He never felt addicted and could stop for a month without noticing
- •He now prefers nicotine pouches, which bypass the liver and act quicker
- •Bob notes that gum is meant to be chewed briefly and then parked
- 6:20 – 9:49
Untangling Nicotine from Tobacco and Cancer Risk
Bob explains the difference between nicotine and tobacco, noting that nightshades contain only trace nicotine. Both hosts point out that nicotine is not on the lists of carcinogens in tobacco smoke and that the Surgeon General found inadequate evidence of a causal link to cancer.
- •Nicotine is about 1% to 3% of tobacco's dry weight, versus trace amounts in nightshades
- •The Surgeon General found inadequate evidence of a causal link between nicotine and cancer
- •At least 69 carcinogenic chemicals are in tobacco smoke, but nicotine isn't one
- •The WHO lists red meat as a carcinogen but not nicotine, which Peter uses to argue nicotine's cancer risk is near zero
- 9:49 – 14:23
Nicotine Replacement Therapy and Quit Rates
The hosts discuss NRT products as tools for quitting smoking and the Cochrane review showing a 50% to 60% relative improvement in quitting. Peter pushes for absolute numbers, which are only a few percentage points at six months, and they speculate on why NRT isn't more effective.
- •NRT products such as gum, patches, lozenges, inhalers and sprays are used to help people quit smoking
- •Cochrane found high-quality evidence of a 50% to 60% relative increase in quitting
- •Absolute six-month quit rates are about 3% to 5%, so NRT adds roughly 2% to 3 percentage points
- •Inhaled smoke may deliver nicotine faster than NRT can match
- 14:23 – 16:41
Smoking Prevalence and Cessation in Practice
Peter and Bob look at smoking prevalence, which peaked around 59 to 60% of American adults in the mid-1960s and is now much lower. They touch on Nir Barzilai's centenarians who had smoked, and Peter says smoking cessation is the first thing addressed with smokers in his practice, sometimes using Wellbutrin with NRT.
- •Peter recalls a peak of about 59 to 60% of American adults smoking in the mid-1960s
- •Current figures are about 18 to 19% by Peter's estimate, while Bob suggests 13% to 15%
- •Bob recalls Nir Barzilai noting many centenarians had smoked
- •Peter calls smoking cessation the lowest-hanging fruit for longevity
- •His practice has used Wellbutrin combined with NRT
- 16:41 – 20:29
Cognitive Benefits of Nicotine and Sneak Peek Close
Peter asks what can be said about nicotine's cognitive benefits and jokes that he feels sharp after placing a pouch in his mouth. He asks how many studies have addressed the question, then the episode ends with the membership pitch for the full AMA.
- •Peter says he feels sharp after using a pouch, while allowing it may be placebo
- •He asks how many studies have examined nicotine and cognition
- •The sneak peek ends with a pitch for the full AMA through membership
