The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
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I've ticked off something that's been on the bucket list for a while: telling Gwern off for his nicotine essay, which hooked me, and many a stupid rat, on the chemical. It is a frankly terrible nootropic, even if the harms of "pure" nicotine (or even a vape) are minimal, the dependency is remarkably inconvenient and I'm quite confident that his advice is net negative EV. If I had a time machine, I'd give my past self a light smack on the head and told him to never start, alongside inside baseball knowledge on exam questions.
I would have said it to his face if I'd actually managed to meet him at Inkhaven, but hey, sneaking it into a wider debate about LLM prose is a victory nonetheless. I can sleep easier tonight.
Didn't you go for vaping, whereas Gwern specifically distinguished between gum/patches and vaping, even in the abstract of the essay?
Yes, but I still think Gwern underestimates how debilitating any nicotine dependency is.
He is absolutely correct that vaping or gum is a massive upgrade over an existing tobacco habit. But among the examples of alternatives that he considered "safe" for the nicotine-naive included snus, which was later found to increase all-cause mortality, particularly CV mortality. His speculation about the potential benefits wrt Alzheimer's or Parkinsons proved to be wrong on the basis of RCT evidence.
TLDR: It's a shit nootropic, the dependency risk is significant enough to be concerning even for gum or pouches. He didn't see the Zyn craze coming. His claims that medicinal NRT is remarkably non-addictive held up, but were clearly not applicable to recreational use. Switching away from smoking tobacco is massively positive, for someone who doesn't have a habit, don't start.
https://www.fda.gov/tobacco-products/health-effects-tobacco-use/relative-risks-tobacco-products#NewNic
Do you have a citation for "later found"?
I'm personally a heavy user of synthetic pouches (actually homemade version which is pretty much free and difficult to ban) and have in the past dove deep into the literature on snus -- there's a lot, because the EU public health unit has been fighting with Swedish public opinion over actual snus since before vaping was even much of a thing.
My cowboy meta-analysis as of a few years ago was the there were a lot of highly motivated and well-funded studies which... pretty much failed to show significant all-cause mortality impact associated with long-term heavy usage of trad-snus; they would always find something to hang their hat on of course, but taken as a whole the literature was pretty unconvincing. And synthetic snus (in my case, unflavoured vape juice dripped onto cotton) seems unlikely to be more harmful than the tobacco kind.
I've been at this about five years; I'm sucking on the things basically all the time and it's cost me something like a couple hundred bucks and left me with entirely normal blood pressure; heart rate is a little elevated maybe? Infinitely better than vaping; not least because you don't need to go outside and look like a moron hipster pretending to smoke.
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I appreciate that you've probably reviewed the literature more closely than I have. Maybe a month or so ago, I saved a review paper, and I was wanting to go digging through the cites, but I haven't had time yet (the motivating question was concerning which/how many papers dealt with effects specifically of gum/patches). Perhaps you could help me with a few specific questions:
(1) You say, "It's a shit nootropic". Is this because you think that the worthwhile effects are, indeed, minimal? Is it worse than, say, caffeine? Or is this judgment coupled significantly with the dependency risk?
(1a) Is any of the above possibly conflated by possible interactions with, say, ADHD meds or even caffeine alone?
(2) Is there any dependency risk data you can point me to for gum/patches? I think Zyn is likely to be closer to vaping/chew tobacco than gum/patches (I can accept that perhaps Gwern got this one wrong). I've seen plenty of statements like that FDA one; note that it calls out pouches. Is there anything in the literature specifically for gum/patches?
For disclosure, I have toyed around with gum on a few occasions. I would use it for specific parts of my day that I wanted a mild stimulant and perhaps some increased habit forming, like going to the gym. When I would, for example, go on trips where I wasn't expecting to have gym access, I never experienced any withdrawal or cravings. It's more of a pain for me to buy than, say, protein/creatine, so I've also just gone long stretches without having any without any difficulty. If anything, I feel like I feel more withdrawal effects from coffee or even caffeinated tea. This may be personal variation and apart from the data, which is why I would be interested in whether you've seen any data specifically for gum/patches.
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You got nerd-sniped by ... nicotine? Keep us up to date on your efforts to kick the habit. We're rooting for you.
It's been almost 4 years, and I've found out, to my detriment, that quitting cold turkey is awful. During the periods where I am unavoidably separated from my vape, the best alternative I've found is nicotine gum, which keeps the worst of the withdrawal away. Otherwise? Brother, I'm fiending. I get angry and cranky, it's the closest I've gotten to PMSing, or what I'd imagine roid rage kinda feels like.
Quitting isn't a very high priority for me, right now. Mostly because the physical health risks of vaping are minimal, close to negligible, going off memory of my attempts to review the literature. I still resent the expense, small as it is in absolute terms, plus the dependence itself. I've found that I can cut down on total intake by opting for weaker juice, but that has little effect on the parameters I care about, which are the money spent on the habit, and the addiction itself. It's not in the top 10 things about my life that I need to fix, though I'm grateful for the words of encouragement.
(I knew the theoretical health risks were small, when I initially started. I had avoided cigarettes like the plague itself for most of my life, but I was curious about vapes, which were hard to get in India. When my ex and I landed in London several years back, we ended up locked out of our Airbnb on a cold night in October. We went to a gas station grocery store for food, where I spotted a vape. I wanted to buy it, but my ex was a cancer survivor and was scared of the risk. Being the nerd I am, I sat her down, and we went through multiple systematic reviews while eating a chicken sandwich. Eventually, we concluded that the risks were minimal, especially the carcinogenic potential, and with her assent, I ended up buying one. Still, #BlameGwern.)
Tapering off with weaker juice is the way to go. Once you go from 3mg to 0mg it's a case of a few days of habitual puffing until you think "wait, why am I doing this?" and will stop very easily because there's no longer a deficit demanding to be replenished. After that there's no more addiction and no more expense. Problem solved.
I'll keep that in mind should I try, and after all, it's the same advice I gave a good friend of mine just a day or two ago!
I've done it a couple of times before (cue quitting is easy dozens of times joke). Currently doing it again in a very drawn out manner.
Since you're a doctor I assume you're aware of nicotine's effect on blood pressure and peripheral circulation. Everyone knows that smoking = lung cancer and heart attacks, and a lot of that is because smoke of any kind is bad for you, but it's worth pointing out for the general Wellness readership that, while vaping is a lot safer than smoking, nicotine has inherent effects on health regardless of whether it's burnt in a giant sweaty cigar or administered by a sterile prescription nicotine replacement widget made in a lab by big pharma. I don't have the faintly whistling wheeze that can't be trivially coughed away when lying in bed quietly any more since stopping smoking, and my sense of taste and smell is much better, but I still get cold hands and feet from the vasoconstriction and need to start thinking more about my blood pressure.
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This was exactly how I did it. The easiest part was the way 0mg juice gurgled all wrong.
But there have been crackdowns of all stupid kinds, and AIUI, the community of home-brew stores that would make you custom blend juices are not so much a thing anymore, so it may be harder to manage a gentle decline.
Yeah it depends where you live. There's no issue here in the UK but I saw a comment online yesterday saying how difficult it is to buy (non-THC) vape stuff in California.
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