Snus: Smokeless Tobacco Facts and Risks

Snus—a moist, finely ground smokeless tobacco product—originated about 200 years ago in Sweden but is now used in the United States and elsewhere. Smokeless tobacco products like snus are seen by some to be a "better" alternative to cigarette smoking, and there is some evidence to support the claim.

In October 2019, the U.S. Food and Drug Administration (FDA) issued a press release stating that “using snus instead of cigarettes puts you at a lower risk of heart disease, chronic bronchitis, lung cancer, stroke, and emphysema."

The FDA announcement raised concerns among some researchers as there is evidence that snus products may increase the risk of diabetes, stillbirths, and heart attacks, particularly when used heavily.

This article discusses what snus and smokeless tobacco are, differences between types, and the health risks associated with them.

What Is Snus?

Smokeless tobacco is any type of tobacco that is not smoked or burned. It may be used as inserted between the gum and cheek as chewing tobacco, inhaled through the nose as dry snuff, or inserted between the lower lip and gum as moist snuff.

Snus is a type of smokeless tobacco that is inserted between the upper lip and gum. It is a finely ground, moist tobacco sold in the United States in sealable pouches.

Snus contains only a handful of ingredients:

• Salt
• Sodium carbonate ("soda ash")
• Water
• Moisture-preserving agents

Aromatic compounds like mint or clove are also sometimes added to enhance the flavor.

The tobacco used in snus undergoes pasteurization in the same way as milk. The process reduces the amount of tobacco-specific chemicals, called nitrosamines, that are known to be carcinogenic (cancer-causing).

Because of this, some researchers—and tobacco companies—contend that snus is a less harmful alternative to smoking cigarettes.

The pasteurization process also reduces the risk of stomach upset. Because of this, you don't have to spit when using snus (something you would have to do if you used chewing or "dipping" tobacco).

Comparing Types of Snus

Snus is available in parts of northern Europe and the United States. It is also 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 found mainly 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 made with fire-cured tobacco and sold in flavored pre-package pouches. The flavors are mainly mint-based.

In Sweden, snus products are made with air-cured tobacco and come in a variety of flavors such as lemon, clove, mint, cherry, and cinnamon. The air curing gives these products a more pronounced tobacco flavor but also higher levels of nicotine delivery.

Studies show that Swedish snus products have higher unprotonated (absorbable) nicotine than U.S. versions. Because more nicotine is absorbed with Swedish snus, the risk of nicotine addiction is greater.

Swedish snus products also have higher pH levels, which further enhances the absorption of nicotine through the tissues of the mouth.

Cancer

Snus products are linked to several different types of cancer. Even so, there remains considerable debate as to how much snus increases the risk.

Among the cancers commonly linked to snus are:

• Pancreatic cancer
• Oral (mouth) cancer
• Colorectal cancer
• Lung cancer

A 2013 review of studies in the Harm Reduction Journal concluded that any evidence of a link between snus and pancreatic cancer is "weak" and that there was no solid evidence of a link between snus and colorectal cancer either.

With respect to oral cancer, the same research team concluded that the overall "risk is small and substantially less than that associated with smoking." Moreover, the risk is far lower than that of chewing tobacco.

Myocardial Infarction

Myocardial infarction, also known as a heart attack, is just one of the cardiovascular diseases closely linked to tobacco smoking.

There is some evidence that using snus may increase the risk of heart attack death based on population-based research published in the Harm Reduction Journal.

According to a 2013 review, the heavy use of snus (50 grams or more per day) nearly doubles the risk of a fatal heart attack compared to the general population. (With that said, it only increases the risk of death and not of a heart attack itself, which remains more or less the same as the general population).

As with lung cancer, the researchers concluded that the risk of cardiovascular disease is far greater among tobacco smokers than among smokeless tobacco users.

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 for several reasons. High levels of nicotine are known to reduce the effectiveness of insulin in the body. Because of this, smokers with diabetes tend to need more insulin to regulate their blood sugar levels.

Research shows the high consumption of snus is also a risk factor for type 2 diabetes. The results further demonstrated that smokers who switch to snus neither lower their risk of type 2 diabetes nor are better able to control their blood sugar.

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 changes 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 the unborn child. Studies have shown that snus exposure increased the risk of stillbirth, neonatal apnea, preterm birth, and oral cleft malformation.

Prevention

Neither smoking nor smokeless tobacco is healthy. If you or someone you know needs help quitting the habit, there are several things you can do:

• Ask your healthcare provider about nicotine replacement gums, patches, lozenges, and sprays.
• Get a prescription for medications like Chantix (varenicline) or Zyban (bupropion) used for smoking cessation.
• Link to online or in-person smoking support groups. People using smokeless tobacco are welcome to join.
• Prepare for cravings and triggers by having substitutes to turn to, like sugar-free candies, gum, mints, or sunflower seeds.

Summary

Snus is a type of smokeless tobacco that originated in Sweden and is now used in the United States. It differs from chewing tobacco in that the tobacco in snus products is pasteurized and tucked beneath the upper lip rather than the cheek.

While snus use is considered "safer" than smoking cigarettes, it should not be considered "healthy." There is some evidence that it may increase the risk of type 2 diabetes, heart attack, stillbirth, and certain cancers.

If you are a snus user and want to quit, you would pursue the same quit strategies used by tobacco smokers, including support groups and nicotine replacement therapy.

A Word From Verywell

Because snus products have been promoted as being a "safer" alternative to cigarettes, some people have used them as a step-down tool to quit. This is probably not the best idea.

Switching from one habit to another is rarely an effective way to quit the nicotine habit. Instead, you may find yourself using more and more to treat your nicotine craving.

If you truly want to quit but find it impossible to do so, seek help from a healthcare provider. More importantly, do not be too hard on yourself. Studies show that it takes between 20 and 30 quit attempts before a person is finally able to quit smoking.

By keeping your eye on the goal and seeking support, you'll be better equipped to kick the habit once and for all.