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Smokeless Tobacco Kills More Than 250,000 Yearly, Worldwide

smokeless tobacco

Story at-a-glance -

  • Worldwide, smokeless tobacco causes 250,000 deaths a year
  • This number may be underestimated, and researchers believe the true health impacts of smokeless tobacco are even more significant
  • In 2010, smokeless tobacco caused more than 200,000 deaths from heart disease compared to more than 62,000 deaths due to cancers of the mouth, pharynx, and esophagus

By Dr. Mercola

The risks of smoking cigarettes are well established. Smoking is the leading cause of preventable death, leading to nearly 6 million deaths a year worldwide.1 Far less talked about is smokeless tobacco, also known as chewing tobacco and snuff, even though it’s consumed in most countries of the world.

The first global estimates of the burden of disease due to use of smokeless tobacco by adults was recently revealed, based on data from 115 countries.2 Worldwide, smokeless tobacco was found to cause 250,000 deaths a year, with the majority (74 percent) occurring in India.

The lead researcher noted, however, that the actual number of deaths may be even higher:3 “It is possible that these figures are underestimated, and future studies may reveal that the impact is even bigger.”

Heart Disease Accounts for Most Smokeless Tobacco-Related Deaths

Many people associate tobacco products with cancer, and they are a leading cause of cancer deaths. However, in the case of smokeless tobacco, most people are dying from heart disease, not cancer.

In 2010, the study found smokeless tobacco caused more than 200,000 deaths from heart disease compared to more than 62,000 deaths due to cancers of the mouth, pharynx, and esophagus.4

For cigarette smoking, deaths from cancer and heart disease are similar; about 163,700 die from smoking-related cancer each year compared to 161,000 from smoking-related heart disease.5

While smokeless tobacco is often marketed as a less toxic alternative to smoking cigarettes, it is clearly not safe or risk-free. According to the American Cancer Society (ACS):6

The snuff and chewing tobacco products most widely used in the United States have very high levels of cancer-causing agents (carcinogens) called tobacco-specific nitrosamines. These carcinogens cause lung cancer in animals, even when injected into their blood.

There are other cancer-causing agents in smokeless tobacco, too, such as benzo[a]pyrene and other polycyclic aromatic carcinogens.

These carcinogens may be why several types of cancer are linked to use of smokeless tobacco… Smokeless tobacco may also play a role in heart disease and high blood pressure.

Results from a large American Cancer Society study showed that men who switched from cigarettes to snuff or chewing tobacco had higher death rates from heart disease, stroke, cancer of the mouth and lung, and all causes of death combined than former smokers who stopped using all tobacco products.”

Smokeless Tobacco May Cause Cancerous Mouth Lesions, Gum Disease, and More

Smokeless tobacco comes in the form of long strands of loose leaves, plugs, or twists of tobacco, which are typically placed between the lower lip or cheek and gum. High rates of leukoplakia are common at the site where the tobacco is usually placed in the mouth.

Leukoplakia is a white patch in the mouth that’s typically painless but may become cancerous. Research suggests three out of four daily users of smokeless tobacco had non-cancerous or pre-cancerous lesions in their mouth.7

Smokeless tobacco is also devastating to tooth and gum health, not only due to the tobacco itself but also because many also have a high sugar content, which is left to sit against your teeth and gums. ACS explained:8

“Tobacco can irritate or destroy gum tissue. Many regular smokeless tobacco users have receding gums, gum disease, tooth decay (from the high sugar content in the tobacco), and bone loss around the teeth.

The surface of the tooth root may be exposed where gums have shrunken. All this can cause teeth to loosen and fall out.”

These are but a sampling of the health risks linked to smokeless tobacco. Other health conditions include:9

Mouth, tongue, cheek, gum, and throat cancer Cancer in the esophagus Stomach cancer
Pancreatic cancer Possible increase in risk of heart disease, heart attacks, and stroke Addiction to nicotine (which can lead to smoking)
Leukoplakia (white sores in the mouth that can become cancer) Receding gums (gums slowly shrink from around the teeth) and gum disease (gingivitis) Bone loss around the roots of the teeth
Abrasion (scratching and wearing down) of teeth Cavities and tooth decay Tooth loss
Stained and discolored teeth Bad breath
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More Americans Use E-Cigs Than Smokeless Tobacco

Although smokeless tobacco has been around in some form or another for hundreds of years, only about 3.5 percent of Americans currently use it.10 E-cigarettes, which have only been around for less than a decade, have already amassed a larger following, with an estimated 10 percent of US adults and 13 percent of high school students currently “vaping.”11

The devices may soon overtake smokeless tobacco in terms of risk to public health for a couple of reasons. First, they’re available in fruit and candy flavors that entice young users. This is similar to some types of flavored smokeless tobacco, except that e-cigs don’t have the same negative stigma attached.

And this is the second major “red flag.” E-cigs are widely believed to be a “safe” alternative to smoking (or smokeless tobacco), when in fact accumulating research shows they, too, contain health-harming additives and ingredients that are inhaled and absorbed by your body (and those around you).

Currently, e-cigarettes are unregulated, which means the more than 450 brands on the market (touting more than 7,700 flavors) are sold with no labeling or testing requirements. The US Food and Drug Administration (FDA) is currently considering extending its regulatory powers over cigarettes to include e-cigarette devices.12

Most Sweet E-Cigs Contain Lung-Damaging Artificial Butter Flavor, Diacetyl

The artificial flavoring called diacetyl is often used as a butter flavoring in microwave popcorn. It’s also used to flavor dairy products, including yogurt and cheese, and exists in some “brown flavorings,” including maple, strawberry, and raspberry flavors.

Diacetyl, or a chemically similar alternative called propionyl, was also found in 74 percent of the sweet e-cig liquids tested.13 Among those that contained diacetyl, close to half would expose e-cig users to levels that exceed workplace limits designed to protect workers from the chemical’s hazardous effects.14

Research shows diacetyl has several concerning properties for brain health and may trigger Alzheimer’s disease. Diacetyl has also been linked to respiratory damage, including inflammation and permanent scarring of the airways, in workers at a microwave popcorn plant.15 And it’s not only diacetyl that’s a concern…

E-Cig Flavorings May Be Respiratory Toxins That Are Hazardous When Inhaled

Many of the flavorings used in e-cigs were never intended to be inhaled, yet are able to get deep into users’ lungs with each puff. The Washington Post reported:16

“Jessica Barrington-Trimis, an epidemiologist at the University of Southern California who studies tobacco’s health effects, said that flavorings are particularly worrisome because they ‘have a history of being known respiratory toxins.’ 

Barrington-Trimis, who spoke at an FDA panel looking into e-cigs in March, said that because the devices produce an ultrafine aerosol that goes deep into the lungs, their flavorings ‘are a natural target’ for further investigation. 
‘We need to research this more to understand what chemicals are in these things and what these chemicals may be doing to the lungs of the user,’ she said.”

Among the other concerning flavors in e-cigs are:17

  • Aldehydes, which are found in many flavors, including almond, cherry, cotton candy, bubble gum, and French vanilla; the compounds may lead to respiratory irritation, airway constriction, and other effects
  • Cinnamaldehyde, which is found in cinnamon flavors and has been shown to be toxic to human cells in lab tests

Vaping Likely Puts Your Health at Risk (and Secondhand E-Cig Aerosol Is Risky Too)

As more smokers turn to vaping (the “new” word used to describe e-cigarette use), the industry is expected to reach $3.5 billion in 2015 (more than twice the $1.7 billion estimated for 2013).18 Yet, vaping is likely dangerous to your health, just like smoking. Separate research has shown e-cigarettes emitted higher levels of certain metals, including nickel, zinc, and silver, than tobacco cigarettes.19 “Some of these metals are extremely toxic even in very low amounts,” the study’s lead researcher noted,20 adding in a statement:21

The metal particles likely come from the cartridge of the e-cigarette devices themselves – which opens up the possibility that better manufacturing standards for the devices could reduce the quantity of metals in the smoke. Studies of this kind are necessary for implementing effective regulatory measures. E-cigarettes are so new, there just isn’t much research available on them yet.”

Even the US Food and Drug Administration (FDA) has detected a potentially deadly antifreeze chemical called diethylene glycol in an electronic cigarette cartridge,22 along with tobacco-specific nitrosamines, which are linked to cancer. According to Americans for Nonsmokers' Rights (ANR), secondhand e-cigarette aerosol also contains at least 10 chemicals identified on California's Proposition 65 list of carcinogens and reproductive toxins, listed in the table below.23

Acetaldehyde Benzene
Cadmium Formaldehyde
Isoprene Lead
Nickel Nicotine
N-Nitrosonornicotine Toluene

E-Cigarettes May Serve as a Gateway to Tobacco

A National Institute on Drug Abuse survey showed that nearly 9 percent of 8th graders, 16 percent of 10th graders, and 17 percent of 12th graders had used e-cigarettes during the previous month.24 In youth, e-cigarette use now tops smoking tobacco cigarettes,25 which some may regard as a good thing.

However, aside from the health risks of the e-cigarettes themselves is the risk that they may serve as a gateway to tobacco products. A study recently published in JAMA Pediatrics revealed that young people who use e-cigarettes are more likely to start using conventional cigarettes than their peers who do not.26 The authors noted:

Electronic cigarettes (e-cigarettes) may help smokers reduce the use of traditional combustible cigarettes. However, adolescents and young adults who have never smoked traditional cigarettes are now using e-cigarettes, and these individuals may be at risk for subsequent progression to traditional cigarette smoking.”

Even the assertion that e-cigarettes are useful for smoking cessation is debatable, however. A study published in late 2014 showed that smokers who used e-cigarettes daily were more likely to quit tobacco, but those who used them intermittently were six times less likely to quit smoking tobacco in the following year.27 There’s also data showing that ex-smokers, some of whom hadn’t smoked for five years, were taking up (or relapsing) with e-cigarettes,28 which means they’re being exposed to a new set of health risks.

Do You Want to Quit Smoking, E-Cigs, or Smokeless Tobacco?

If your goal is to reach optimal health, you’ll want to avoid smoking cigarettes and e-cigarettes, as well as using other tobacco products, including smokeless tobacco. That being said, my mother smoked for all of her adult life. When she decided to give up smoking, she used a rechargeable, electronic cigarette in the process and found it helpful. So I encourage you to do your own research if you’re thinking of using e-cigarettes to help you quit and continue in your effort to fully quit.

However, I believe the "secret" to quitting smoking is to get healthy first, which will make quitting much easier. Exercising is part and parcel of this plan, as research shows people who engage in regular strength training double their success rate at quitting smoking compared to those who don't exercise.29 Healthy eating is another crucial aspect that can't be ignored. In short, if you want to quit, here are the three basic tips to get you started:

  1. Read through my comprehensive free nutrition plan to get started eating right.
  2. Develop a well-rounded exercise regimen. It is your ally to fighting disease and to quitting smoking. Strength training is an important part, but also remember to incorporate high-intensity interval exercises like Peak Fitness, core-strengthening exercises, and stretching.
  3. Find a healthy emotional outlet. Many people use exercise, meditation, or relaxation techniques for this, and these are all great. I also recommend incorporating the Emotional Freedom Techniques (EFT), as this can help clear out emotional blockages from your system (some of which you might not even realize are there), thus restoring your mind and body's balance and helping you break the addiction and avoid cravings.

Once you are regularly doing these three things, then you can begin to think about quitting smoking and at this point many are ready to try quitting “cold turkey.” Finally, if you’re a parent, talk with your children about the risks of smoking, smokeless tobacco, and e-cigarettes. The easiest pathway to not smoking is to avoid starting in the first place.