The Peter Attia Drive
#344 - AMA #70: Nicotine: impact on cognitive function, performance, and mood, health risks, delivery modalities, and smoking cessation strategies
Mon, 14 Apr 2025
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives deep into nicotine—a topic increasingly debated both scientifically and publicly. He clarifies the critical differences between nicotine and tobacco, highlighting why nicotine alone isn't primarily responsible for smoking's severe health consequences. Peter examines the specific risks associated with nicotine use, including addiction, sleep disruption, cardiovascular concerns, and effects on mood and anxiety. He evaluates various nicotine delivery methods, from traditional cigarettes to gums, pouches, and synthetic alternatives, ranking them according to their relative safety. Additionally, Peter explores nicotine's potential positive and negative impacts on physical performance, cognitive function, fertility, and its interactions with other stimulants like caffeine. Finally, he provides practical guidance for minimizing risks with nicotine use and offers thoughtful strategies for smoking cessation and effective nicotine replacement therapies. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #70 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Revisiting the previous AMA on microplastics: low-effort, high-impact changes to significantly reduce microplastic exposure [1:45]; Overview of episode topics related to nicotine [3:30]; The current landscape of nicotine research [4:45]; Addressing the common misconception that nicotine itself is the primary cause of tobacco-related health risks [6:45]; Peter’s Marlboro-branded apparel is a nostalgic tribute to the Formula One era and not a sign of support for smoking [10:00]; The limitations of current research on the health risks of nicotine itself [12:15]; The most common side effects of nicotine [18:15]; The impact of nicotine on sleep [21:30]; Nicotine and mood: how nicotine can have both anxiety-inducing and calming effects based on genetics and dosage [25:00]; The addictive properties of nicotine: factors influencing addiction risk, and why certain people may struggle more than others [29:15]; The various nicotine products and nicotine delivery methods available: effects, absorption rates, and potential risks [33:45]; The relative risks of various nicotine products: how differences in nicotine concentration, absorption rates, and presence of contaminants impact their safety [37:00]; Potential cognitive benefits of nicotine: short-term benefits and impact of chronic use [44:45]; How nicotine exposure during adolescence can negatively impact brain development [47:45]; Nicotine's potential to prevent or slow neurodegenerative diseases [50:45]; Nicotine’s impact on memory, learning, and attention [52:45]; The interaction between nicotine and other stimulants, particularly caffeine [55:15]; Nicotine's potential impact on physical performance [57:15]; The potential effects of nicotine on fertility, and the challenges of distinguishing the impact of nicotine itself from the effects of smoking [58:30]; Considerations for people curious about using nicotine for its cognitive benefits [1:01:30]; How to think about nicotine: weighing cognitive claims, addiction risks, and personal tolerance [1:03:15]; The prevalence of smoking, the health risks it poses, and the substantial long-term benefits of quitting [1:05:45]; Effective strategies for smoking cessation, including the use of nicotine replacement therapies [1:09:00]; The reasons behind weight gain after quitting smoking, the role of nicotine in appetite suppression, and strategies to manage weight [1:15:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
Chapter 1: What is the main topic of this episode?
Hey everyone, welcome to a sneak peek, Ask Me Anything, or AMA episode of The Drive Podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com forward slash subscribe.
So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask Me Anything AMA episode number 70. For today's AMA, we're discussing a topic that has been gaining significant attention in both the scientific community and among the public, and that is nicotine.
This is a topic that we get a lot of questions about, not only from our audience, but also from my patients. In this episode, we discuss the distinction between nicotine and tobacco, understanding why nicotine itself is not the primary driver of the major health risks associated with smoking.
Chapter 2: What are the differences between nicotine and tobacco?
We discuss the risks of nicotine use, including addiction, sleep disturbances, cardiovascular effects, and its impact on mood and anxiety. We talk about the various delivery methods of nicotine, from traditional cigarettes, which I think everybody would agree are bad, to pouches, gums, and synthetic options, ranking them from least to most harmful.
the role of nicotine in physical performance, cognitive enhancement, fertility, and its interaction with other stimulants such as caffeine. We touch on the guidance for those interested in minimizing the risks while still using nicotine. And we end this podcast by looking at smoking cessation and considerations for those trying to quit smoking, which often involves using nicotine replacements.
If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. And if you're not a subscriber, you can watch the sneak peek of this video on our YouTube page. So without further delay, I hope you enjoy AMA number 70.
Chapter 3: What are the health risks associated with nicotine use?
Peter, welcome to another AMA. How are you doing? I'm doing really well. Thank you for having me back. I mean, we're always happy to have you whenever you would like. And again, it'd be very awkward if you weren't here. I think we do need to follow up based on one of our recent AMAs is, do you still have a liquid of some form in front of you? I do. What kind of cup is that in?
Chapter 4: How does nicotine affect sleep and mood?
You know, I'm actually drinking it in a glass.
Did you listen to our micro plastics AMA? And that's why you made that change?
Nick, I have made several changes following the AMA on microplastics. I believe that they are all in the spirit of 80-20. So I'm really low on the sigmoidal curve of cost and energy with one exception. And yeah, I think I'm just taking what I think are the relatively easy steps to hopefully mitigate 80% of my exposure.
Chapter 5: What are the various nicotine delivery methods?
And I'm going to spend no more time worrying about the last 20%, which A, I have no idea if it matters. And even if it does, I don't think I could live my life and be concerned with it.
That's great to hear. Two things. First is, by the time this comes out, we'll most likely have a short video on what those changes were, so we'll link to that. If we don't have that video, something terribly went wrong, so we should have it. The second is, are you just so happy that you continue to join us for these AMAs? Otherwise, you would still be living so foolishly in your microplastic life.
Chapter 6: Are there cognitive benefits of nicotine?
I am looking forward to the day when someone else hosts an AMA for me.
Maybe an avatar. That would be awesome. We could just have AI Peter and it's just an ongoing AMA that never ends. Well, today's AMA is not going to be that. It will be you live. And it is on a single topic. We get asked a lot about, there's so much more use of it. We initially did an AMA on it, I think like four years ago. And at the time, you didn't see as much use as you do now.
And that's nicotine. So we are going to talk all things nicotine today. This is going to look at benefits, short-term, long-term, around everything from cognition, exercise, whatever it may be, risks of nicotine and things that people need to be aware of. We're going to look at different ways and vehicles that people can use nicotine and what are the pros and cons.
And then we're also going to end this with something that we get asked a lot about every now and then when it comes to smoking cessation. And I think we often say a lot of people in our audience most likely are not smoking because if you are, you're probably not opting into this deep content, but some people are.
But also we hear from people where it's, hey, my parents, significant other, children, friends, whatever it may be, are still doing this. How can I talk to them about quitting? So we'll cover that as well. So all that said, anything you want to say, before we get rolling. Nope. This is a great insight that you added right there. So thank you for that. All right, start out.
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Chapter 7: What strategies can help with smoking cessation?
Chapter 8: How does nicotine impact physical performance?
And then we're also going to end this with something that we get asked a lot about every now and then when it comes to smoking cessation. And I think we often say a lot of people in our audience most likely are not smoking because if you are, you're probably not opting into this deep content, but some people are.
But also we hear from people where it's, hey, my parents, significant other, children, friends, whatever it may be, are still doing this. How can I talk to them about quitting? So we'll cover that as well. So all that said, anything you want to say, before we get rolling. Nope. This is a great insight that you added right there. So thank you for that. All right, start out.
Can you explain just where the field of nicotine research currently stands and what's new and distinct from when we talked about this four years ago?
One of the things that we appreciated, meaning the team and I as we were preparing for this, was trying to appreciate how much of the research on nicotine is based on tobacco and its first application through, obviously, cigarettes.
But then also the idea of using tobacco to extract nicotine for non-smoke, but tobacco derived nicotine versus synthetic nicotine, which is honestly what a lot of people are thinking about in that context. And so I think that's important to understand that it is not always easy to tease out the impact of nicotine.
And I'll foreshadow one example that we're going to talk about, which is infertility. You would think we would have legions of data that would explain the effect of nicotine on fertility, both for males and females. It turns out that if you want to talk about it through the lens of smoking, that's true.
But if you want to talk about it through the lens of vaping or nicotine pouches, that's not true. And so I think that's one of the issues that I think makes this difficult to talk about with complete clarity. So anyway, I guess that's the first thing I would say. I think the second thing I would say is, and you alluded to this four years ago, we did an AMA on nicotine.
Don't worry, those of you that listened to that, there's very little overlap. I spent way more time talking about how nicotine worked, mechanisms of action. Today, we're probably going to, I think, answer a lot more of the practical questions that people have. And I will also say that four years later, there's frankly more research on some of the benefits of nicotine.
And to be sure, we're going to talk about both the risks and benefits of nicotine today. So anyway, I would say that's probably a good place to start.
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