What is Snus? Types and Health Risks

Snus—a moist, smokeless, finely ground tobacco product—originated in Sweden about 200 years ago but is now also used in the United States. Smokeless tobacco is seen by some in the tobacco industry as a better alternative to smoking. In October 2019, the FDA authorized a press release that said, “using general snus instead of cigarettes puts you at a lower risk of heart disease, chronic bronchitis, lung cancer, stroke, and emphysema.” This authorization was made after reviewing scientific evidence submitted by the company that supported this claim. Although this was authorized by the FDA, research shows that there are some health risks associated with snus such as diabetes, cardiovascular issues, cancer, and stillbirths.

Snus


Uskarp/Getty Images

What Is Snus?

Snus is a smokeless oral tobacco product that is finely ground and sold in a pouch form. Consumers place the pouch under the top of the lip. When snus is processed, it can involve tobacco pasteurization. This is when nitrate-forming microbes are removed. The process leads to lower levels of tobacco-specific nitrosamine content in the product. Due to this process, some researchers—and tobacco companies—report that snus is a less harmful alternative to smoking cigarettes. 

Better Than Cigarettes, But Not Safe

Snus is available in some areas of Northern Europe and the United States. It is gaining popularity in South Africa.  The sale of snus was banned from all European Union countries except Sweden in the early 1990s. The product is used in Sweden, Norway, and Denmark. Snus in the pouch form is banned in Denmark but loose snus is sold there. 

In the United States, snus products are sold in a flavored pre-portioned pouch format. The flavors are mint and wintergreen. In Sweden, the products have strength descriptors, portion sizes specifications, a variety of flavors such as lemon, clove, mint, cherry, and cinnamon. There are also categories of white, regular, or original. The original pouch goes through more moisturizing, so this pouch looks moist and brown.

The ingredients of snus consist of salt, water, and air-cured tobacco in Sweden and fire-cured tobacco in the United States. The processing of snus in Northern Europe is different than in the United States. Studies showed that nicotine levels overlapped between the U.S. and Swedish snus with a significant variation of pH levels and unprotonated nicotine. When a product has higher pH levels, this increases the nicotine levels which can lead to the product becoming more addictive due to the higher absorption levels in the body. In the study, researchers found that the unprotonated nicotine levels were highest in European pouch and loose tobaccos. Swedish snus was found to have higher levels of nitrates (TSNA). There were lower concentrations of pH, moisture, carcinogenic tobacco-specific nitrosamines, and unionized nicotine in the United States tobacco pouch products. There was additional research that showed that the total nicotine levels were higher in U. S. snus.

U.S. Snus vs. Swedish Snus

 

U.S. snus has smaller portion sizes. The taste tends to be sweeter to hide the flavor of tobacco. Swedish snus has larger portion sizes and a stronger tobacco flavor. “Research shows that the median pH was significantly higher among Swedish snus brands compared to American snus.

The Median pH among all Swedish brands was 8.7, compared to 6.5 for American snus.”

Cancer

Smokeless tobacco and snus use are linked to several types of cancer such as stomach, mouth, lung, and pancreatic cancer. There are some studies, however, that have shown that snus use is a risk-reducing alternative to smoking. In terms of lung cancer and snus use, reports show that there is a very small risk of lung cancer. It is due to the lack of combustion, exposure to nicotine, and the fact that there is no inhalation through the raspatory tract. More studies have to be conducted. 

Cardiovascular Disease

About 655,000 people die from heart disease each year in the U.S. Poor health habits can contribute to cardiovascular disease, but smoking is also a known cause. Sudies show that U.S. smokeless tobacco users were found to have an increased risk of heart disease and stroke.

Diabetes

There are approximately 34.2 million Americans that have diabetes. Within that number 15% are smokers. Smokers are 30 to 40% more likely to develop type 2 diabetes. High levels of nicotine are known to lessen the effectiveness of insulin in the body. Smokers tend to need more insulin to regulate blood sugar levels in the body. Research shows high consumption of snus is a risk factor for type 2 diabetes. This finding was similar to those who use cigarettes. The results support that smokers who change to snus use will not lower the risk of type 2 diabetes, and nicotine is known to increase the risk of type 2 diabetes.

Oral Health

Along with mouth cancer, snus can cause other oral health problems such as gingival disease, tooth loss, and oral mucosal lesions. Gingivitis is known as an early stage of gum disease. If it is left untreated, it is likely to become periodontal disease. This can affect the tissues that support the teeth and jawbone. Oral mucosal lesions are abnormal swelling or change on the outer lining of the mouth, lips, or gums. Studies show that snus use can increase the risk of oral mucosal lesions.

Pregnancy Complications

Smoking during pregnancy is very unhealthy for both the mother and unborn child. Studies have shown that snus exposure increased the risk of stillbirth, neonatal apnoea, preterm birth, and oral cleft malformation.

Other Risks

Other health risks of snus and smokeless tobacco overall include addiction, stroke, and respiratory diseases.

Prevention

Smoking and smokeless tobacco are not healthy. If you or someone you know need help quitting the habit, there are several ways. Get help from a healthcare professional, find a support system, and get proactive. Think about why you started, why you want to quit, make a plan, create gradual and healthy habits, and set a date on when and how you will quit.

A Word From Verywell

Regular use of tobacco can cause harm to your overall health. As some people use smokeless tobacco recreationally, it is also addictive. Regular tobacco use—including smokeless tobacco—can lead to consequences for your life, health, and loved ones. It is important to think long-term when it comes to your health. Choosing healthy habits such as diet, exercise, and avoiding habits that can cause health issues are important. If you or a loved one needs help with an addiction or substance abuse, don’t
hesitate to contact a healthcare professional or professional organization that can give adequate help.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. FDA grants first-ever modified risk orders to eight smokeless tobacco products. Updated October 22, 2019.

  2. Clarke E, Thompson K, Weaver S, Thompson J, O'Connell G. Snus: a compelling harm reduction alternative to
    cigarettes.
    Harm Reduct J. 2019;16(1):62. Published 2019 Nov 27. doi:10.1186/s12954-019-0335-1

  3. Lawler TS, Stanfill SB, Tran HT, et al. Chemical analysis of snus products from the United States and
    northern Europe
    . PLoS One. 2020;15(1):e0227837. Published 2020 Jan 15. doi:10.1371/journal.pone.0227837

  4. Andrew B Seidenberg, MPH, Olalekan A Ayo-Yusuf, BDS, MSc, MPH, PhD, Vaughan W Rees, PhD, Characteristics of “American snus” and Swedish snus products for sale in Massachusetts, USA. Nicotine & Tobacco Research, Volume 20, Issue 2, February 2018, Pages 262–266. doi: 10.1093/ntr/ntw334

  5. Wilson, K.M., Markt,S.C., Fang F., Nordenvall, C., Rider,J.R., YE,W., Adami H., Stattin P., Nyren, O. and Mucci, L.A. Snus use smoking and survival among prostate cancer patients. International Journal of Cancer.Volume 139, Issue 12. 15 December 2016 Pages 2753-2759. doi:10.1002/ijc.30411

  6. Centers for Disease Control and Prevention. Heart disease facts. Updated September 8, 2020.

  7. Rostron BL, Chang JT, Anic GM, et al. Smokeless tobacco use and circulatory disease risk: a systematic review and meta-analysis. Open Heart 2018;5:e000846. doi:10.1136/openhrt-2018-000846

  8. American Diabetes Association. Statistics about diabetes. Updated March 22, 2018.

  9. Centers for Disease Control and Prevention. National diabetes statistics report. Updated February 11, 2020.

  10. Food and Drug Administration. Cigarette smoking: A risk for type 2 diabetes. Updated May 4, 2020.

  11. Carlsson S, Andersson T, Araghi M, et al. Smokeless tobacco (Snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohortsJ Intern Med. 2017;281(4):398-406. doi:10.1111/joim.12592

  12. Kreyberg I, Hilde K, Bains KES, et al. Snus in pregnancy and infant birth size: a mother-child birth
    cohort study
    ERJ Open Res. 2019;5(4):00255-2019. Published 2019 Dec 2. doi:10.1183/23120541.00255-2019

  13. American Cancer Society. Quit using tobacco.