Snus: What You Need to Know

Snus is a smokeless tobacco product seen by some to be a "better" alternative to cigarette smoking. The Food and Drug Administration (FDA) issued a 2019 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."

However, the FDA noted that snus use was not approved as safe. And there is mixed research evidence on snus products that raises concern over the risk of diabetes, stillbirth, and heart attack, particularly when used heavily.

This article discusses what snus and smokeless tobacco are and the differences between types. It adds information on the health risks of snus use and research findings about it.

What Is Snus?

Snus is a moist, finely ground smokeless tobacco product used by placing it between the upper lip and gum. Snus originated in Sweden but it is now 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.

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 during 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.

What Are the Risks of Snus?

Snus use is associated with some risks, although researchers are still trying to identify the health impacts with more precision. For example, there may be an increased risk of esophageal cancer but that may not raise the risk of cancer deaths overall.

It's also unclear how other factors contribute. Alcohol consumption, for example, is associated with snus use, making it harder to understand the underlying causes that can lead to specific health issues and higher death rates.

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

However, some research evidence finds no link between snus use and oral cancer. And an analysis of nine studies that included 417,872 males in Sweden found no strong evidence for increased colorectal cancer risk overall, despite noting a higher rectal cancer risk among current users. The conclusions are similar for pancreatic and lung cancer.

Myocardial Infarction

Myocardial infarction, also known as a heart attack, is just one of the cardiovascular diseases closely linked to tobacco smoking. Less is known about the effects of smokeless tobacco, including snus.

Researchers who looked at 23 studies on heart disease, 14 on stroke, and another 14 on high blood pressure, found there was no conclusive evidence between snus use and cardiovascular disease in general, including heart attack.

Other studies indicate that snus use 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

Beyond the risk of oral 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 unhealthy for both the parent and fetus. Studies have shown that snus exposure may increase the risk of:

• Stillbirth
• Neonatal apnea (episodes where breathing stops)
• Preterm birth
• Oral cleft malformation

Will Snus Help You Quit Smoking?

The evidence for whether snus can be an effective tool in smoking cessation is mixed. A Swiss study that followed about 5,000 young males for 15 months found no benefit. In fact, the results suggest they may be more likely to start and continue smoking, though that may not be true of older people.

Other studies from Norway and Sweden have found snus use was helpful for people who successfully quit smoking.

How to Quit the Habit

Neither smoking nor smokeless tobacco is healthy. If you or someone you know needs help quitting, 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 health conditions including type 2 diabetes.

If you are a snus user and want to quit, you should pursue the same quit strategies used by tobacco smokers, including support groups and nicotine replacement therapy. Snus use is not an ideal strategy for smoking cessation, either, so seek help from a healthcare provider as you begin a journey of what may be multiple attempts to quit smoking.