The Disobedient Body
When Quitting Nicotine Doesn’t Heal: Clinical Paradoxes and Public Health Dilemmas in Snus Cessation
In the health imaginary, giving up an addictive substance is often mistaken for a kind of physiological redemption. One quits smoking, and the lungs, freed, breathe again. One gives up alcohol, and the liver, in its biochemical silence, offers thanks. But the human body— that terrain of fragile balances and complex adaptations— doesn’t always respond with immediate gratitude.
A recent study led by Professor Fredrik Nyström —from the Department of Health, Medicine and Caring Sciences at the Faculty of Medicine and Health Sciences, Linköping University, Sweden— and published in Harm Reduction Journal, unsettles this narrative by showing that individuals who quit snus —a smokeless oral form of nicotine widely used in Sweden— may experience increases in blood pressure and body weight.
Cessation, far from being a promise of relief, can become a new physiological turning point.
This finding—both unusual and clinically unsettling—challenges core pillars of preventive medicine. For the first time, a cohort study with rigorous follow-up and daily home measurements provides prospective evidence that quitting snus—whether tobacco-based or tobacco-free—does not yield immediate cardiovascular benefits.
More strikingly, it suggests that cessation may trigger transient adverse effects, as if the body, accustomed to an altering substance, responds to its absence with a new imbalance. The supposed therapeutic neutrality of quitting is thus called into question.
The study, originally designed to compare outcomes between those who successfully quit snus and those who relapsed, was upended by a statistical paradox: 89% of the 37 participants maintained abstinence throughout the 12-week follow-up.
This unexpected success—more typical of a clinical trial with intensive intervention than an observational study—left researchers without a functional control group. Yet far from undermining the design, this contingency strengthened the longitudinal analysis of those who did quit, allowing for a clear observation of the physiological fluctuations that followed cessation.
The participants—adults between 18 and 70 years old, mostly male, and not using other nicotine products—underwent thorough evaluations. The protocol combined blood tests, validated questionnaires on diet, physical activity, and sedentary behavior, and clinical measurements of blood pressure and body weight.
Participants recorded their blood pressure at home three times a day, a routine that gave the study a living, almost breathing temporality. The clinical design was meticulous, transparent, and ethically sound, further reinforcing the observed data's reliability.
Abstinence That Makes You Sick?
The initial hypothesis, grounded in well-established knowledge of nicotine’s acute effects, such as vasoconstriction, elevated blood pressure, and increased heart rate, assumed that its withdrawal would almost naturally lead to cardiovascular improvement.
But once again, the body rewrote the script. Far from showing signs of recovery, the study documented an average increase of 3.7 mmHg in home systolic blood pressure, sustained from the fifth week onward. A modest shift on the surface, but clinically significant, especially in individuals with previously regular readings. “We really didn’t expect this result,” Nyström admitted, laying bare the uncertainty that lingers even in the most carefully crafted designs.
The study also found an average weight gain of 1.8 kg and increased HbA1c levels—a key glycemic control biomarker, particularly in women. These changes were accompanied by shifts in lipid profiles, including rises in total cholesterol, HDL, and non-HDL cholesterol, and a transient spike in high-sensitivity C-reactive protein (hsCRP), a classic marker of systemic inflammation. Taken together, these changes do not point to clinical improvement, but rather to a state of homeostatic disruption—as if nicotine withdrawal, at least temporarily, unsettled the body’s finely tuned metabolic balance.
In an anecdotal aside as unexpected as it is revealing, Nyström compared these findings to those of an earlier study in which prolonged licorice consumption—that sweet, seemingly harmless root—also raised blood pressure. The parallel is no small matter: it highlights an uncomfortable truth often overlooked by conventional clinical perspectives. Some substances, even those that slip unnoticed into the everyday diet, play complex and frequently ambiguous roles in cardiovascular regulation.
Likewise, previous studies using nicotine patches have shown that complete withdrawal from the substance can trigger notable metabolic effects, particularly weight gain, possibly mediated by changes in energy expenditure, appetite regulation, hormones such as leptin, or the brain's reward system circuits.
Snus, by releasing nicotine in a sustained and combustion-free manner, may have helped maintain an artificial physiological balance, one that abrupt cessation disrupted. It was as if the body, suddenly deprived of its usual stimulus, were fumbling to reconfigure its self-regulating mechanisms.
The Lost Balance
From a harm reduction perspective, the findings of this study invite a rethinking of binary approaches that sharply oppose use and abstinence. Combustion-free nicotine products could play a strategic role as less harmful substitutes, particularly for those who cannot or do not wish to abandon the habit entirely. That quitting snus—a substance already significantly less harmful than cigarettes—might trigger initial adverse effects does not mean its use should be promoted uncritically. However, it does demand that cessation be a clinically supported process, carefully monitored and understood in its full physiological and psychosocial complexity, because not all abstinence leads immediately to health.
The absence of immediate benefits does not undermine long-term health goals, but it does call for more nuanced, gradual transitions tailored to each body's uniqueness.
In particular, for individuals with cardiovascular risk or undergoing antihypertensive treatment, nicotine cessation should not be viewed as a clinically neutral act. It requires support, attentiveness, and oversight: regularly monitoring blood pressure after quitting is not just a prudent recommendation—it is a fundamental public health responsibility.
What do we know? What do we still need to understand? The exact mechanisms behind these effects remain obscure.
Are we witnessing a response from the sympathetic nervous system, suddenly deprived of nicotine’s stimulus? An inflammatory rebound? A subtle behavioral shift with physiologically decisive consequences? The questions multiply, and the data remain insufficient. New studies are needed—including hormonal biomarkers, broadening geographic diversity, and, crucially, involving populations without explicit motivation to quit snus. Only then can we chart a more accurate map of the consequences of cessation—and escape the illusion that less harm automatically means no harm.
It is also essential to distinguish between the types of snus: the traditional version, which contains tobacco, and the white, tobacco-free variant, whose use is rapidly increasing in countries like the United Kingdom and the United States. In this cohort, 32% of participants used only the tobacco-free version. While both forms deliver nicotine orally, their chemical profiles, absorption mechanisms, and potential side effects may not be equivalent. Assuming they are interchangeable without solid evidence is, at the very least, a risky proposition.
Health Without Dogma
This study does not challenge the long-term benefits of quitting nicotine, but it does demand that we stop oversimplifying the process or overlooking its transient adverse effects. Giving up a substance with hormonal, cardiovascular, and behavioral implications is no trivial act. It requires clinical follow-up, rigorous education, and—why not?—substitution strategies that soften the physiological disruption. Because to quit is not to vanish from the equation, but to rewrite it—with more profound awareness of the body, the risk, and the time that all meaningful adaptation demands.
Ultimately, the study led by Nyström restores science to its most noble role: questioning what is taken for granted. And it reminds us that, in public health, moral shortcuts rarely lead to physiological truth. Because between what is right and what is useful, there often lies a distance that only evidence—not conviction—can cross.
af Geijerstam, P., Joelsson, A., Rådholm, K. et al. Cardiovascular and metabolic changes following 12 weeks of tobacco and nicotine pouch cessation: a Swedish cohort study. Harm Reduct J 22, 54 (2025). https://doi.org/10.1186/s12954-025-01195-y