Nicotine pouch users’ exposure to major toxicants closer to non-smokers’ levels, review finds

The paper, published in Toxicology Reports on 14 October, brings together chemical testing, laboratory experiments and human studies to assess the potential risks of Velo pouches sold outside the United States.

Its authors conclude that the evidence supports substantially lower health risks than smoking for people who switch completely.

They describe users’ exposure to major toxicants as “more like that of former and never smokers than current smokers”.

What showed up in users’ bodies?

A clinical study in Sweden and Denmark compared adults who exclusively used Velo with current smokers, former smokers and people who had never smoked.

Researchers used blood, urine and breath measurements to look for chemical exposure and biological changes associated with smoking.

Among pouch users, levels of NNAL, a marker of exposure to a tobacco-specific carcinogen, were 91 per cent lower than among smokers. A measure of carbon monoxide bound to haemoglobin in the blood was 46 per cent lower.

White blood cell counts were also 19 per cent lower. These cells form part of the immune system, and raised counts can indicate inflammation.

Nicotine exposure, however, was higher overall among pouch users. The findings therefore show that substantial nicotine intake can occur alongside much lower exposure to several tobacco toxicants.

Participants used their usual products during the 24-hour assessment period. This gave researchers a picture of exposure during everyday use. The study compared existing users, rather than following smokers as they switched.

Fewer chemicals without the smoke

Pouches sit between the lip and gum, releasing nicotine through the lining of the mouth. They contain no tobacco leaf and require no burning.

A chemical study published in August tested 132 substances across products including 11 commercial nicotine pouches, nine of them Velo, and two snus products.

In most tests, levels of the substances measured were more than 90 per cent lower in pouches than in the snus products. Comparisons with previously collected cigarette-smoke data also showed substantially lower levels for almost all substances compared.

The testing also found that 70 of the substances being checked could not be quantified in any of the pouch or snus samples. That means they were below the level the tests could reliably measure, rather than proof that every trace was absent.

Together, the chemical testing and measurements in users offer two ways of examining exposure: what is present in the product, and what researchers can detect in the body.

The review was written by current or former BAT employees and focuses on the company’s Velo products. BAT also funded the chemical study.

US study finds a similar pattern

Separate US research by Hongying Daisy Dai and Brian Young provides further evidence of lower exposure to certain substances.

Using national study data covering 4,527 adults across different tobacco-use groups, they found that exclusive pouch users had lower levels of lead and the tobacco alkaloids anabasine and anatabine than cigarette smokers.

The team also compared pouch users with people who used no tobacco products. Despite much higher nicotine exposure, pouch users showed no statistically significant differences in the measured metals or minor tobacco alkaloids. That finding applied to the substances tested, rather than every possible chemical or health effect.

The researchers took account of demographic differences and current cannabis use in their analysis. They reported no conflicts of interest.

Nicotine exposure remained high, with levels of nicotine breakdown products comparable to those in cigarette smokers.

Regulators have recognised the potential

The findings sit alongside a separate assessment by the US Food and Drug Administration, which authorised the sale of 20 ZYN nicotine pouch products in January 2025.

The agency concluded that those products posed a lower risk of cancer and other serious health conditions than cigarettes and most smokeless tobacco products, because they contained substantially lower amounts of harmful constituents.

Its assessment also considered evidence that a substantial proportion of adults using cigarettes or smokeless tobacco switched completely to the pouches. The decision weighed potential benefits for adults against risks across the population, including youth uptake.

That authorisation covered the specified ZYN products, rather than Velo or nicotine pouches generally. The FDA also stressed that authorisation did not mean the products were safe or that people who did not use tobacco should start.

What does this mean for smokers?

For someone who smokes, the encouraging finding is that replacing cigarettes with pouches could greatly reduce exposure to several harmful substances while still providing nicotine.

The remaining question is how far those reductions translate into fewer cases of cancer, heart disease and other illnesses over time. The review draws partly on the longer research history of Swedish snus to assess likely risks. Long-term studies of pouch users are still needed to establish the size of any health benefit.

The evidence is strongest for people who have stopped smoking completely. Someone who continues to smoke while using pouches will still be exposed to chemicals in cigarette smoke.

For smokers who make that full switch, the results offer an encouraging reason to leave cigarettes behind. Much lower exposure to several toxic substances, with measurements for major toxicants closer to those seen in people who don’t smoke.