How the pro-nicotine ‘wellness’ movement rebranded an addictive drug

An ironic development emerging alongside the “Make America Healthy Again” movement is the portrayal of nicotine as a wellness and performance-enhancing product. Across social media, podcasts, wellness communities and tech startups, prominent wellness personalities and other influencers are portraying nicotine as a misunderstood compound whose potential benefits have been overshadowed by its negative association with cigarette smoking.

As a result, nicotine is being repositioned from an addictive substance linked to tobacco use to a natural product that can be used for everything from improving focus to protecting against cognitive decline. This trend includes use of nicotine alone in noncombustible products such as nicotine pouches, or in combination with caffeine and nootropics, which are substances marketed to enhance cognition.

As a pulmonary physician-scientist who studies nicotine addiction and the health consequences of tobacco and nicotine products, I am concerned about claims that nicotine can enhance wellness, productivity and cognitive performance.

Distinguishing between nicotine and tobacco

Some of these claims stem from the observation that nicotine is a naturally occurring plant compound found primarily in tobacco and in nightshade vegetables such as tomatoes, potatoes and eggplant in trace amounts. Proponents of nicotine use also draw on studies suggesting that nicotine can affect certain aspects of cognition and brain function.

However, extending these findings to broad claims about productivity, brain health, longevity or wellness goes well beyond what has been shown in human studies.

Nicotine is the primary driver of tobacco addiction in the form of cigarettes, vapes and most other forms of commercial tobacco.

The greatest health risks arise when tobacco is burned, which generates thousands of toxic substances, including carcinogens, carbon monoxide and fine particulate matter. Repeated exposure to these combustion products can cause cancer, chronic obstructive pulmonary disease, cardiovascular disease and numerous other smoking-related illnesses.

While many smoking-related diseases result from exposure to combustion products, nicotine itself has well-known negative effects on the brain and body. Nicotine activates the sympathetic nervous system – the body’s “fight or flight” response – which increases heart rate and blood pressure and disrupts sleep. Repeated stimulation of this system can place additional strain on the heart.

Nicotine exposure is of particular concern during critical phases of development.
Prenatal exposure to nicotine has been associated with adverse effects on fetal growth and development. Adolescent exposure can alter neural systems involved in attention, learning and reward, increasing vulnerability to addiction.

Nicotine changes the brain

Nicotine also leads to dependence through activation of brain reward pathways.

Acetylcholine is a key neurotransmitter – a chemical messenger in the brain – involved in attention, learning, memory and information processing. Nicotine acts on many of the same nicotinic acetylcholine receptors that normally respond to acetylcholine, temporarily increasing alertness, attention and arousal. Activation of these receptors also influences the release of other neurotransmitters, including dopamine, which plays an important role in reward and reinforcement.

However, nicotine does not reproduce normal acetylcholine signaling. Unlike acetylcholine, the effects of nicotine last much longer and alters activity throughout the brain. With repeated exposure, the brain adapts to nicotine’s presence. Receptors become less responsive, and the brain compensates by increasing the number of nicotine receptors, contributing to dependence.

Focus and productivity

A common claim within wellness communities is that nicotine serves as a cognitive enhancer that improves focus and productivity.

Some studies indicate that nicotine may temporarily enhance attention, vigilance, reaction time and some aspects of working memory, but results are mixed. Research suggests that nicotine may benefit people with mild cognitive impairment, but it does not appear to enhance cognition in healthy individuals and may even worsen cognitive performance in higher-performing people.

In addition, many of these studies include regular nicotine users who are dependent on nicotine. When they stop using nicotine, regular users commonly experience difficulty concentrating, irritability, anxiety, restlessness and impaired attention. Reintroducing nicotine often relieves these symptoms, making it difficult to determine whether observed improvements reflect true cognitive enhancement or simply reversal of withdrawal symptoms.

In other words, nicotine may provide short-term improvements in attention and alertness in select users, but there is little evidence that it meaningfully enhances academic achievement, intelligence, creativity, executive functioning or workplace productivity.

Stress and mood

Wellness influencers also promote nicotine as a tool for managing stress and improving mood.

Nicotine activates reward pathways in the brain, which can create a temporary sense of pleasure and well-being. However, long-term nicotine use can interfere with the body’s stress-response system, which may make stress and anxiety harder to manage.

Research consistently shows that people who quit smoking experience reductions in anxiety, depression and stress, along with improvements in mood and overall quality of life over time. In fact, long-term discontinuation of nicotine use is associated with better mental health and well-being.

So while nicotine may create a temporary subjective sense of stress relief, current evidence does not support its use to reduce stress, improve mood or treat anxiety or depression.

Healthy aging and longevity

Some of the most ambitious claims emerging from the pro-nicotine wellness movement suggest that nicotine protects against dementia, Alzheimer’s disease, Parkinson’s disease and age-related cognitive decline.

These claims are based on findings suggesting that nicotine can influence neural pathways involved in memory and attention as well as animal and laboratory studies examining whether nicotine could modify disease processes associated with cognitive decline.

However, human studies have not demonstrated that nicotine can prevent dementia, slow Alzheimer’s disease progression, preserve long-term cognitive function or improve outcomes in Parkinson’s disease.

Some wellness and longevity advocates claim that nicotine preserves cognitive function, slows biological aging or promotes longevity.

These claims are largely based on laboratory studies showing that nicotine can affect cellular pathways related to oxidative stress and animal studies suggesting effects on inflammation and other mechanisms linked to aging and disease. However, findings from laboratory and animal studies have not translated into evidence that nicotine promotes healthy aging, extends lifespan or prevents age-related disease in humans.

Treating nicotine dependence

Food and Drug Administration-approved nicotine replacement therapies including patches, gum and lozenges, have been shown to help people with nicotine dependence reduce withdrawal symptoms and cravings, making it easier for people to stop smoking. Used as directed, these medications can reduce the symptoms of nicotine withdrawal that often make it difficult for people to quit.

But this approved form of treating addiction should not be confused with claims that nicotine enhances cognition, promotes wellness or supports healthy aging. In fact, using nicotine products outside of evidence-based treatment for stopping or reducing tobacco use carries the risk of developing nicotine dependence.