Episode 16: Why This Neurosurgeon Will Never Use Nicotine

Episode 16: Why This Neurosurgeon Will Never Use Nicotine

Episode Highlights

Not a Harmless Biohack

Why nicotine’s plant defense chemistry throws a monkey wrench into our biological machinery

Dopamine Hijack

How alpha-4 beta-2 receptors in the ventral tegmental area drive the addiction cycle

Blood Flow and Healing

Sympathetic activation and vasoconstriction, why wounds and fusions struggle to heal

Metabolic Stress

Appetite suppression on the surface, insulin resistance underneath

Cognition Claims

Short bumps in attention and memory, no durable global gains

Parkinson’s Myth

Epidemiology versus trials, reverse causation, not protection

Long COVID Caveat

A targeted, short term protocol with real promise for long COVID

How to Quit

Varenicline first line, combination NRT, bupropion, free quitline support

Show Notes

Nicotine is being sold as clean and even smart. Influencers praise it, companies profit from it, and many people are persuaded. In this deep dive, Dr. Ravi Kumar explains what nicotine really does inside the body, why the short burst of focus has a long biological bill, and how to step off the dependence cycle.

In this episode, you will discover:

  1. What nicotine is — a plant alkaloid that binds nicotinic acetylcholine receptors with high affinity and drives persistent signaling
  2. Addiction mechanics — receptor desensitization in the ventral tegmental area, dopamine release to the nucleus accumbens, and why “normal” starts to require nicotine
  3. Autonomic overdrive — epinephrine and norepinephrine spikes, elevated blood pressure, anxiety that rebounds when levels fall
  4. Why healing stalls — vasoconstriction and endothelial dysfunction that limit blood flow to tissues that need to repair
  5. Metabolic effects — appetite suppression on the surface, insulin resistance and lipid changes beneath the surface
  6. Cognition, clarified — small, short term attention benefits, no lasting or global improvements in longer trials
  7. Parkinson’s re-examined — population associations versus randomized trials, and how reverse causation explains the gap
  8. A narrow therapeutic window — why some long COVID protocols use a low dose patch for a brief period under medical supervision, which is not a green light for daily biohacking
  9. How to quit effectively
    • Varenicline as first line, titrated to one milligram twice daily
    • Combination NRT for steady baseline plus on-demand relief
    • Bupropion for cravings and mood, when appropriate
    • Behavioral supports like rewards and brief walks to ride out cravings
    • Free coaching via 1-800-QUIT-NOW or text QUIT-NOW to 333-888

If you have ever wondered whether nicotine can be healthy, or if you want to quit and need a plan, this episode gives you clear, practical steps.

For more health insights, subscribe to The Dr. Kumar Discovery Podcast on any major platform.

To find out more, or to see links to the scientific references used in this podcast, visit: https://drkumardiscovery.com/podcast/

Cheers!

Transcript

[00:00 –> 00:31] On this episode of the doctor Kumar discovery podcast, nicotine overstimulates the system, holding the gas pedal down. That’s exactly why the plant evolved it, to disrupt the nervous system of anything that tried to eat it. In some reports, patients experienced dramatic improvements or even complete remission of long COVID symptoms after using a low dose nicotine patch. Now in the brain, nicotine’s biggest problem is addiction. Yes, it can give you a brief boost in focus or memory, but it does that by hijacking your reward system.

[00:31 –> 00:48] And once you’re hooked, your brain rewires itself to depend on nicotine just to feel normal. So when you add it all up, nicotine doesn’t just tweak one or two systems. It undermines almost every single one. Your heart, your brain, your metabolism, your hormones, your bones, your ability to heal.

[00:48 –> 00:56] My name is Doctor. Ravi Kumar. I’m a neurosurgeon in search of the causes of human illness and the solutions that help

[00:56 –> 00:58] us heal and thrive. I want you

[00:58 –> 01:21] to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal. Let us question everything and discover our true potentials. Welcome to the Doctor. Kumar discovery.

[01:22 –> 01:37] Welcome to the Doctor. Kumar discovery podcast. My name is doctor Ravi Kumar. I’m a board certified neurosurgeon and assistant professor of neurosurgery at UNC. Today, I had originally planned to talk about male hormone optimization, but we’re gonna take a different path.

[01:38 –> 02:00] We’re gonna talk about nicotine. The reason is simple. I recently shared some posts on social media about how nicotine can impair wound healing because of its vasoactive properties. The response was overwhelming, and much of it was pushback. Many people argued that nicotine, when separated from smoking, is a clean compound, a substance that can actually be beneficial for human biology.

[02:00 –> 02:25] This belief that nicotine is healthy is spreading quickly. It’s being promoted heavily online often by companies selling nicotine products and by influencers, even big influencers who are financially incentivized to push these products. Over time, these ideas have become woven into our larger belief system in society. Now I believe strongly in autonomy. It’s your body, and you have the right to decide what you put into it.

[02:25 –> 02:53] But I also believe it’s critical to have clear, practical, and unbiased information available so those decisions can be made with real understanding. That is why I chose to make this episode today. So there’s two groups of people who may already feel certain about nicotine. The first are those who use it and have no plans to stop because they enjoy it and can’t imagine life without it. The second are those who never touch nicotine and are already convinced that all nicotine and tobacco products are harmful.

[02:53 –> 03:28] If you’re in one of those groups, this episode may not change your position, but I still believe you’ll benefit from hearing this information. It may give you a deeper understanding of what nicotine does in the body or give you clarity that you can share with someone else in your life. Where this episode can be most impactful is for those in between. Maybe you use nicotine whether it’s smoking, chewing, or other smokeless tobacco products or nicotine products. Or maybe you don’t, but you’ve heard and perhaps have even been persuaded by the influencer driven narrative that nicotine could be a net positive for your mind, your body, and your energy.

[03:28 –> 03:59] So here’s what we’ll do today. We’ll lay out the most honest information, the clearest and least dogmatic interpretation of the evidence, and then let you decide. By the end of this episode, you’ll know what nicotine is, how it works in your body, and what drives its addictive power. You’ll understand the current claims being made about its benefits, and you’ll hear about the one situation where nicotine could have a potential medical role. Like any drug, nicotine has possible benefits and possible harms, and we’ll explore both of them.

[03:59 –> 04:20] And most importantly, we’ll go through the many ways chronic nicotine use can damage your body. And finally, I’ll give you practical evidence based strategies to quit. Because for those already using it, nicotine is the third most addictive drug in the world, and breaking free from it is not easy. But it is possible. So before we go any further, a quick disclaimer.

[04:20 –> 04:43] I’m a medical doctor, but I’m not your doctor. This podcast is for informational purposes only. It’s not meant to diagnose or treat any medical condition, and it’s not a substitute for personalized medical advice. What I share here is knowledge you can take and discuss with your own health care provider. Also, I wanna make it clear that this podcast is completely independent from my role as assistant professor at UNC.

[04:43 –> 05:04] The views I share here are my own. I truly believe that knowledge is power, and my goal is to give you that power so you can make better decisions and live a healthier life. So first, what is nicotine? Nicotine is a compound derived from plants. It’s what’s called an alkaloid, a nitrogen containing compound that plants make as a defense to protect themselves from being eaten.

[05:04 –> 05:29] Tobacco is the main source, but smaller amounts are found in other nightshade plants and vegetables like eggplants, tomatoes, potatoes and peppers. For the plant, nicotine functions as an insecticide. It poisons insects that chew on its leaves by mimicking acetylcholine, one of the main neurotransmitters in the nervous system. In the body, we have two types of acetylcholine receptors. The first are muscarinic receptors, which nicotine does not affect.

[05:29 –> 06:09] The second are nicotinic receptors which normally bind acetylcholine and allow sodium and calcium to flow through into the nerve cell propagating nerve signals. Nicotine binds these receptors with unusually high affinity, more strongly and persistently than acetylcholine itself. Instead of a quick on off signal, nicotine overstimulates the system, holding the gas pedal down. That’s exactly why the plant evolved it, to disrupt the nervous system of anything that tried to eat it. Now if we step back in history, we find that Spanish explorers first encountered tobacco in the late fifteenth century from indigenous people who had already been using it for millennia in The Americas.

[06:09 –> 06:32] When tobacco was brought back to Europe, it exploded in popularity. People smoked it, felt stimulated, awake, and euphoric. Very quickly, addiction to nicotine, the active component in tobacco, took hold. Tobacco became one of the most successful global commodities in history. It fueled colonization, slavery, and entire global economies.

[06:32 –> 06:56] The word nicotine actually comes from a man named Jean Nico. He was a French diplomat who introduced tobacco to the French court in the mid sixteenth century. He promoted it as a cure for headaches and even the plague. Catherine de’ Medici, a member of the French royalty, embraced it and made tobacco fashionable in the highest circles of aristocracy. Nico would cement his place in history for championing tobacco in Europe.

[06:56 –> 07:33] The compound, nicotine, was eventually named after him. For centuries, tobacco use was considered not only acceptable, but even healthy and sophisticated. During World War two, cigarettes were given as rations to American soldiers and prisoners of war, who often valued them more than food. In the mid twentieth century, doctors themselves routinely endorsed smoking with ads proclaiming more doctors smoke Camels than any other cigarette. It wasn’t until 1964 that The US Surgeon General released a landmark report showing that cigarette smoking leads to cardiovascular disease, cancer, lung disease, and higher mortality.

[07:33 –> 07:52] Since then, awareness of the harms of smoking has steadily grown. I remember as a child that nearly every parent I knew smoked. Today smoking is far less common, often banned in public places, and broadly understood to be harmful. But as smoking declined, alternatives rushed in. E cigarettes and vape pens aerosolized nicotine into the lungs.

[07:53 –> 08:18] There are patches, gums, lozenges, pouches, sprays, and inhalers. The list keeps expanding. All are sold on the premise that smoking is dangerous because of the smoke, but nicotine itself, if taken clean, is supposedly safe or even healthy. And that’s where we are today. Moving away from smoking tobacco, which we know is devastating to health, towards smokeless nicotine products that are marketed as harmless or beneficial.

[08:18 –> 08:31] But here’s the spoiler. Nicotine is not a harmless biohack. It’s a net negative for your body in many ways. And in this podcast, we’re gonna break down exactly why. Let’s talk about the biochemistry of nicotine and why it’s so addictive.

[08:31 –> 08:59] No matter how nicotine enters the body, whether through the lungs, the skin, or the lining of the mouth, it enters the bloodstream and reaches the brain. Once inhaled, nicotine reaches the brain in ten to twenty seconds. By gum, it peaks in fifteen to forty five minutes, and by patch, six to ten hours. Once there, it binds to a class of receptors called nicotinic acetylcholine receptors. The ones most relevant to addiction are called alpha four beta two receptors located in the ventral tegmental area of the midbrain.

[08:59 –> 09:24] When nicotine binds, these receptors open channels that allow sodium and calcium to flow into the neuron, firing off a signal. These neurons then project forward into a structure called the nucleus accumbens. And when they fire, they release dopamine. The nucleus accumbens is part of the brain’s reward learning circuit. Normally, dopamine there reinforces natural activities that promote survival, like eating, bonding, or learning.

[09:24 –> 09:51] But nicotine hijacks this system creating an artificial surge of dopamine far stronger than what acetylcholine would ever produce. Over time, the receptors in the ventral tegmental area become desensitized. Your natural acetylcholine signals are no longer enough to produce the same baseline dopamine release. Without nicotine, dopamine levels fall below normal, leaving you restless, irritable, and craving. The only way to feel normal again becomes taking more nicotine.

[09:51 –> 10:16] This is why the cycle of addiction develops so rapidly and so powerfully. Nicotine’s effects are not limited to the brain. It also overstimulates the autonomic nervous system. It triggers the adrenal glands to release epinephrine and norepinephrine, driving up heart rate, blood pressure, and alertness. It stimulates cortisol release through the pituitary adrenal axis, further amplifying that wired anxious state associated with nicotine.

[10:16 –> 10:40] The result is a chronic over activation of the body’s fight or flight response. Nicotine also causes blood vessels to constrict by stimulating sympathetic nerve endings. This reduces blood flow directly impacting healing. Once, I treated a patient after removing a large brain tumor whose surgical incision refused to close despite every intervention we tried. Only when he finally quit smoking did the wound heal within a week.

[10:40 –> 11:08] The vasoconstrictive effects of nicotine had literally starved the tissue of the blood supply it needed to repair. The overstimulation continues in other systems as well. Nicotine activates neurons in the hypothalamus that suppress appetite. It also stimulates fat breakdown and raises free fatty acid levels in the blood, which interferes with insulin signaling and promotes insulin resistance. Human studies have shown that smokers become more insulin resistant, but insulin sensitivity improves within weeks of quitting.

[11:08 –> 11:36] Nicotine even acts on immune cells, dampening inflammation and subtly altering immune physiology. In certain autoimmune or hyperinflammatory conditions, that effect might seem beneficial, But compared to natural anti inflammatory compounds like omega three fatty acids, turmeric, or tart cherry, nicotine’s effect is relatively mild. And it comes with a steep price, the risk of dependence, and addiction. Finally, nicotine leaves the system quickly. Its half life is about two hours.

[11:36 –> 12:10] Within six hours, most of it’s gone and the cycle of withdrawal, craving, and redosing begins again. This rapid turnover is a major reason why the addiction cycle is so relentless. So what are the current claims about the benefits of nicotine? These are the claims that drive hundreds of millions of dollars in product sales and spread rapidly across social media, convincing people that nicotine is the next limitless drug. One of the most popular comes from an old epidemiological finding that smokers appear to have forty to sixty percent lower incidence of Parkinson’s disease.

[12:10 –> 12:44] This led to speculation that smoking, and by extension nicotine, might somehow protect the brain. But when researchers put that idea to the test in a large randomized trial of patients with early Parkinson’s disease who received transdermal nicotine for a year, the results were clear. There was no slowing of progression and in some cases people became functionally worse. What looked protective in population data turned out to be an illusion. Likely because people in the very early pre diagnosis stages of Parkinson’s disease often quit smoking on their own due to changes in brain chemistry.

[12:44 –> 13:06] So the association wasn’t protective, it was actually something called reverse causation. Another claim is that nicotine improves cognition. A small randomized trial once reported that nicotine patches modestly improved certain scores in people with mild cognitive impairment. Other lab studies have shown very short term bumps in attention and working memory. But the pattern is always the same.

[13:06 –> 13:35] The effect is acute and it fades quickly. In fact, a 2012 Vanderbilt study found that while nicotine produced short lived improvements in attention and memory, there were no global or lasting benefits after six months. When you step back and look at the larger body of research, the picture becomes even murkier. A meta analysis of 32 studies on nicotine and attention found inconsistent results. Forty one percent showed positive effects, forty one percent were mixed, and eighteen percent showed no effect at all.

[13:36 –> 14:06] Even more concerning, nearly sixty percent of the authors had prioritized to the tobacco industry and over half failed to disclose those conflicts of interest. When studies are funded by an industry that profits from nicotine, it casts doubt on the objectivity of the findings. So yes, nicotine likely can create short bursts of focus or memory recall. But it comes at the cost of overstimulating the brain’s reward system, desensitizing receptors, and setting off the cycle of addiction. Is that a valid trade off?

[14:06 –> 14:46] That’s a question you need to decide. Now there’s one area where nicotine may have a legitimate short term therapeutic role, and that’s in long COVID. A growing body of case reports and small studies suggest that one of the reasons people suffer for months or even years after infections is that fragments of the viral spike protein can persist in the body. These spike proteins are capable of binding nicotinic acetylcholine receptors, the same receptors involved in normal attention, memory and autonomic function. When those receptors are clogged or blocked by these spike proteins, acetylcholine can’t bind and signal properly and the result is widespread dysfunction.

[14:46 –> 15:27] Patients describe crushing fatigue, brain fog, dizziness, shortness of breath, chest pain, headaches, poor sleep, and a kind of post exertional collapse when they try to be active. In other words, when these receptors are blocked, it’s as if the body’s wiring short circuits. Normal cholinergic signaling that so much of our body depends on simply can’t get through. Because nicotine binds much more strongly to these receptors than acetylcholine, researchers hypothesized that short term nicotine could dislodge the spike proteins and temporarily take their place. Once the nicotine was withdrawn, receptors would then be available again for acetylcholine, restoring normal signaling.

[15:27 –> 15:56] And the results, though preliminarily, have been striking. In some reports, patients experienced dramatic improvements or even complete remission of long COVID symptoms after using a low dose nicotine patch. A PET imaging study confirmed this effect. Before treatment, the patient showed very little activity of nicotinic acetyl choline receptors. But after just ten days on a nicotine patch, those receptors were open and active again, and the patient’s symptoms resolved alongside that measurable brain change.

[15:56 –> 16:27] The key here is that this is a targeted temporary intervention. The typical protocol uses a seven milligram patch applied once a day for about two to four weeks under medical supervision. This is very different from using nicotine long term for focus and memory. If the choice is between being incapacitated by long COVID or taking nicotine briefly to reset receptor function, then yes, the benefits absolutely outweigh the risks. But that is worlds apart from the casual idea that nicotine could be used as a daily smart drug.

[16:27 –> 16:49] In that context, the fleeting effects are vastly outweighed by the long term costs. Now that we’ve covered the claims of the potential benefits of nicotine and the one possible therapeutic role it plays for long COVID, let’s talk about the consequences of chronic nicotine use. And I wanna emphasize this again. I’m not talking about smoke from cigarettes. I’m talking about nicotine itself.

[16:49 –> 17:15] The first thing nicotine does is put your cardiovascular system under stress. It keeps your sympathetic nervous system and your adrenal glands revved up, constantly pumping out adrenaline and norepinephrine. That means your body is stuck in a kind of low level fight or flight state. Your blood vessels clamp down, your blood pressure rises, and the tissue that should be healing simply can’t get the blood flow it needs to heal. I see this all the time in my practice.

[17:15 –> 17:45] Wounds that won’t heal, spinal fusions that don’t take because the body is chronically vasoconstricted from nicotine. And remember, every day your body is actually repairing tiny little injuries from exercise, stress, even just normal life. If you can’t heal those micro injuries, you end up with chronic degenerative diseases. It can be in your spine, your joints, your vessels, all over. Essentially, nicotine is like an anti rejuvenation drug because it prevents you from healing these micro injuries over time.

[17:45 –> 18:02] On top of that, nicotine disrupts the inner lining of your blood vessels. It’s called the endothelium. It reduces nitric oxide, which is what helps your arteries relax. It impairs endothelial function and promotes a prothrombotic environment. These are the types of changes that lead to cardiovascular disease.

[18:02 –> 18:25] Now in the brain, nicotine’s biggest problem is addiction. Yes, it can give you a brief boost in focus or memory, but it does that by hijacking your reward system. And once you’re hooked, your brain rewires itself to depend on nicotine just to feel normal. A major study ranked drugs by addictiveness, and nicotine came in third just behind heroin and cocaine. Think about that.

[18:25 –> 18:44] That’s crazy. And anyone who’s ever tried to quit nicotine is not surprised by this data. Nicotine doesn’t just make you crave it, it grips your physiology so tightly that stopping feels almost impossible. Another thing to think about with nicotine is anxiety. People often say they use nicotine to relax, to calm their nerves.

[18:44 –> 18:58] But the reality is over time, nicotine makes anxiety and irritability worse. You need more and more of it just to get back to baseline. And when you don’t have it, your symptoms spike. That’s not relief. That’s actually a dependent vicious cycle.

[18:58 –> 19:12] And it doesn’t stop there. Nicotine changes your metabolism. Sure. Many smokers look thinner because nicotine suppresses appetite, but beneath that, it’s making your body more insulin resistant. That raises your risk for type two diabetes.

[19:12 –> 19:31] It alters your cholesterol, raising LDL and lowering HDL. It messes with your hormones, increasing your cortisol and lowering testosterone for men, and it affects reproduction too. In men, it reduces sperm quality. In women, it disrupts menstrual cycles. And during pregnancy, nicotine’s vasoconstriction cuts off blood flow to the placenta.

[19:31 –> 20:01] That can cause growth restriction, preterm labor, and other complications even when there’s no cigarette smoke involved. It weakens your bones by impairing osteoblasts, which are the cells that make bone. It promotes tumor survival by blocking the normal cell death that prevents cancer from self destructing. And it even damages mitochondria, the little energy factories inside our cells. One study found that people with long term nicotine use had significantly lower mitochondrial DNA, which is a marker of impaired energy metabolism.

[20:01 –> 20:23] So it’s no wonder that many nicotine users feel exercise intolerance. Their cells literally can’t keep up with energy demands. So when you add it all up, nicotine doesn’t just tweak one or two systems. It undermines almost every single one. Your heart, your brain, your metabolism, your hormones, your bones, your ability to heal, and the cost is always the same.

[20:23 –> 20:47] Short term stimulation traded for wicked addiction and long term biological breakdown. I see it in my own patients all the time. Spines that degenerate faster, wounds that refuse to heal, and bodies that simply can’t recover the way they should. Now let’s say you’re using nicotine. It could be anything, smoking, vaping, patches, pouches, gum, inhalers, anything that contains nicotine and you’re addicted.

[20:47 –> 20:58] And you wanna quit. How do you actually do it? Because as we talked about, nicotine is extraordinarily addictive. Once you’re locked into it, breaking free is super hard. But here’s the good news.

[20:58 –> 21:17] People do it all the time. And with the right approach, you can too. The first thing I recommend is taking advantage of resources that already exist. The CDC has a free quit line. You can dial +1 800 or even text quit dash now to 333888.

[21:17 –> 21:38] You’ll get connected to counseling, coaching, and real time help. It’s completely free and paid for by grants and taxes on tobacco and nicotine products. Sometimes just having someone in your corner makes a huge difference in quitting. But let’s talk about the actual medical tools. The first line treatment, and the one I’ve seen help the most people, is a pill called varenicline.

[21:38 –> 22:02] It used to be called Chantix. It’s now generic and very affordable. Varenicline works by attaching to the same receptors in the brain that nicotine binds to, but it blocks nicotine from activating them. So when you smoke or vape while taking varenicline, you don’t get that same dopamine hit. Over time, your brain relearns that the habit is no longer rewarding, and those addictive pathways start to weaken.

[22:02 –> 22:35] In a large study called the EAGLES trial, people on varenicline were over three and a half times more likely to quit than those on placebo and it outperformed both patches and bupropion. The main side effect is nausea, which happens in about one in four people and sometimes vivid dreams. But overall, it’s safe and in my experience, it’s by far the most effective option. The usual dosing starts small. Half a milligram once daily for three days, then half a milligram twice daily for four days, then one milligram twice daily after that.

[22:35 –> 23:03] Treatment often lasts twelve weeks and sometimes can stretch up to twenty four weeks. Of course, this should be done with your doctor’s guidance, but it is a powerful tool and definitely worth exploring. If you can’t take varenicline, the next best approach is combination nicotine replacement therapy. The idea is to switch away from your usual delivery method because the habitual action of smoking, vaping, chewing is part of the addiction. A patch gives you a steady level background of nicotine without the ritual.

[23:03 –> 23:24] If you smoke more than 10 cigarettes a day, you should usually start with a twenty one milligram patch. Less than 10 cigarettes a day, you start with a fourteen milligram patch. Either way, you taper down over twelve weeks. On top of that, you add short acting forms like lozenges or gum for breakthrough cravings. Studies show this combination is more effective than any single product alone.

[23:25 –> 23:52] Make sure you follow the product label and clinical guidance on this one. But that number I told you about, one eight hundred quit now, can actually even give you nicotine replacement therapy for free if you qualify. If neither varenicline or nicotine replacement works for you, the third option is bupropion, also called Wellbutrin or Zyban. It works on dopamine and norepinephrine pathways, blunting cravings and improving mood. It also helps reduce the weight gain many people experience when they quit smoking or using nicotine.

[23:52 –> 24:08] The dose usually starts at a hundred and fifty milligrams once a day for three days then increases to twice a day. Again, this is something to coordinate with your own doctor. Beyond medications, there are behavioral strategies that actually really help. One is to build in rewards. Set small milestones.

[24:08 –> 24:33] For example, when you taper down to the seven milligram patch, treat yourself to dinner out or a small trip or something that you really enjoy. Rewarding yourself reactivates your brain’s reward system in a healthier way and gives you something to look forward to. Another simple but powerful trick is movement. Research shows that even a five to ten minute walk can cut down a craving in the moment. It’s not a cure, but it helps you get past that wave of craving.

[24:33 –> 24:53] So those are the main tools. Support lines, medications like varenicline, combination nicotine replacement, bupropion, and lifestyle changes like rewards and short bouts of exercise. Quitting is not easy, but it is absolutely possible. And that brings me to my closing thought. My goal with this episode has been to give you information you can act on.

[24:53 –> 25:15] Knowledge is power, and I hope what I’ve shared today empowers you to make healthier choices for yourself. Because at the end of the day, nicotine doesn’t let your body heal or thrive. Breaking free of it can truly change your health and your life. Next week, we’ll continue the tribulation series with a story that changed medicine forever. Two clinicians had a radical idea.

[25:15 –> 25:52] Maybe stomach ulcers weren’t caused by acid, but by infection. For that belief, they were dismissed, the grants were denied, and their reputations took serious hits, but they refused to back down. Convinced they were right, one of them went so far as to drink a flask of the bacteria himself just to prove to the world that ulcers were caused by bacteria and could be cured. It’s a story of conviction, persistence, and the courage to challenge dogma in the face of relentless criticism. If you love stories of people who dared to question accepted wisdom and changed lives in the process, you won’t wanna miss this one.

[25:52 –> 26:03] It’s the story of h pylori and the two scientists who transformed the treatment of ulcers worldwide. So until next time, stay curious, stay skeptical, and stay healthy. Cheers.

References & Resources

Tobacco: The Early History of a New World Crop (National Park Service)

Determination of Nicotine in Selected Edible Nightshades (Journal of Food Science, 1988)

The Nicotine Content of Common Vegetables (New England Journal of Medicine, 1993)

Physiology, Acetylcholine (StatPearls)

Nicotinic Acetylcholine Receptor–Mediated Calcium Signaling (Physiological Reviews, 2009)

Cigarette Smoking Saturates Brain α4β2 Nicotinic Acetylcholine Receptors (Arch Gen Psychiatry/JAMA Psychiatry, 2006)*

It’s not “either/or”: Activation and Desensitization of Nicotinic Receptors (Nature Reviews Neuroscience, 2007)

How to Use Nicotine Patches (CDC)

About E-Cigarettes (CDC)

World War II—Cigarettes in Military Rations (Stanford SRITA “World War II” & Ad Archive)

U.S. Army Operational Rations: Historical Background (Quartermaster Museum)

Nicotine treatment of mild cognitive impairment: a 6-month double-blind, placebo-controlled trial

Nicotine treatment of mild cognitive impairment: a 6-month double-blind, placebo-controlled trial (Free PMC full text)

Meta-analysis of the acute effects of nicotine and smoking on human performance

Cognitive performance effects of nicotine and industry affiliation: a systematic review

Development of a rational scale to assess the harm of drugs (Lancet 2007)

Cardiovascular toxicity of nicotine: implications for electronic cigarette and tobacco cigarette use

Nicotine and sympathetic neurotransmission (review)

Acute effects of e-cigarettes vs tobacco cigarettes on hemodynamics and sympathetic activity

Electronic cigarettes and cardiovascular disease (review)

Association between smoking exposure and flow-mediated dilation: meta-analysis

Acute non-smoking nicotine: catecholamines, BP and HR

Smoking cessation and insulin resistance: systematic review/meta-analysis

Early metabolic improvements after quitting smoking (2-week clamp study)

The effect of smoking on spinal fusion (review)

Smoking status and nonunion risk after spinal fusion: systematic review

Impact of e-cigarette vapor/constituents on bone (review)

Tobacco and nicotine products: regulation of endothelial function (review)

Long COVID – a critical disruption of cholinergic neurotransmission? (review + PET case + survey)

Is the post-COVID-19 syndrome…responds to nicotine administration? (case series)

Simulations support interaction of SARS-CoV-2 spike with nAChRs

SARS-CoV-2 spike ectodomain targets α7 nAChRs (functional work)

Nicotine patch protocol (clinical guidance page)

Evaluation of the Efficacy of Nicotine Patches in SARS-CoV-2 (trial registration)

NIC-PD (transdermal nicotine, early PD): NEJM Evidence 2023

MDS Congress abstract — NIC-PD: “does not slow progression; some outcomes worse”

Change in mental health after smoking cessation (systematic review/meta-analysis)

Nicotine withdrawal (review of symptomatology)

Tobacco and Nicotine Cessation During Pregnancy (ACOG Committee Opinion No. 807, reaffirmed 2023)

Smoking induces a decline in semen quality (human)

Adverse effects of nicotine on human sperm nuclear proteins (review)

Decreased mitochondrial DNA copy number in nicotine addicts (human)

National Texting Portal — Text QUITNOW to 333888 (CDC)

How to Quit Smoking (quitline: 1-800-QUIT-NOW) — CDC

SmokefreeTXT (text QUIT to 47848) — NCI Smokefree.gov

EAGLES Trial: Neuropsychiatric safety & efficacy of varenicline, bupropion, and patch vs placebo (Lancet 2016)

CHANTIX (varenicline) Prescribing Information — FDA

Varenicline generics after Chantix recall — JAMA Netw Open (2023) analysis

How to Combine Quit-Smoking Medicines — CDC

Cochrane Review (2023): Best ways to use NRT (combination > single)

AAFP Review (2022): Smoking cessation interventions (patch starting doses)

How to Use Bupropion SR — CDC

A sustained-release form of bupropion for smoking cessation (NEJM 1997) — reduced early weight gain

Meta-analysis: acute physical activity reduces cigarette cravings (Addiction 2013)