What's in nicotine pouches? Ingredients, chemicals and health risks

Short answer:a pouch is nicotine plus plant-based fillers, pH adjusters, sweeteners and flavorings in a synthetic fiber pouch. Lab tests find far fewer harmful chemicals than in cigarettes or snus, but not zero. The main risk is the nicotine itself: it's addictive, raises heart rate, can irritate your gums, and is dangerous to children who swallow a pouch. Long-term effects are still unknown.

What's in a pouch

FDA describes authorized Zyn pouches as tobacco-derived nicotine, flavor ingredients, an artificial sweetener, stabilizers, fillers and pH adjusters,^[1] and on! PLUS the same way.^[2] A lab analysis of Zyn names the specific ingredients:^[3]

Independent testing of US products found the sweetener acesulfame K in Zyn, on! and Velo, even in pouches labeled “unflavored”, and sucralose in Velo, with more sucralose in stronger products.^[4] The pouch itself is a small synthetic fiber pouch.^[5]Note that the Zyn ingredient analysis was done by the maker's own scientists.

Why the pH adjusters matter

Nicotine absorbs through the lining of your mouth more easily in its uncharged, “free” form, and raising the pH shifts more of it into that form. In German testing of 44 pouches, the median pH was 8.8 and 86% of the nicotine was in the free form.^[6] CDC testing of 37 US brands found free nicotine anywhere from 7.7% to 99.2%, so two pouches with the same mg on the can can hit very differently.^[7]

What “tobacco-free” means

It means there's no tobacco leaf. The nicotine comes either from tobacco plants or from a lab, and the CDC says there is little chemical difference between the two.^[8]Since April 2022, FDA has regulated nicotine products whatever the nicotine's source.^[9]

What lab tests found

This is where pouch claims online get exaggerated in both directions. Here's what was actually measured.

• FDA's review of Zyn: of 42 harmful and potentially harmful constituents tested, 36 were too low to measure. Six were found: acetaldehyde, coumarin (cinnamon flavor only), formaldehyde, naphthalene (citrus flavor only), nicotine and nornicotine. No tobacco-specific nitrosamines (NNN, NNK), the main cancer-linked chemicals in tobacco, were measurable.^[1]
• Formaldehyde: Zyn had 24–52% more formaldehyde than a snus comparison product. FDA judged the exposure to be below lifetime daily-intake limits and similar to moist snuff.^[1] on! PLUS had less formaldehyde than every comparison product and no measurable nitrosamines or metals.^[2]
• Metals and ammonia:in the manufacturer's analysis (µg per gram), Zyn had less chromium, nickel and ammonia than snus, and less chromium and nickel than nicotine gum:^[3]

• Independent European testing:Germany's BfR tested 44 pouches from 20 makers and found trace nitrosamines in 26, up to 13 ng of NNN per pouch.^[10] For scale, BfR cites snus at up to 1,930 ng of NNN per gram.^[6] Nicotine ranged from 1.79 to 47.5 mg per pouch, and 29 products had unclear nicotine labeling.^[10]
• Flavor chemicals:a screen of 48 pouches found 186 substances. Three are classed as “possibly carcinogenic”, each in no more than four products, and the researchers estimate some safe-intake levels could be exceeded with moderate use.^[12]
• Industry testing:Velo's maker reported pouches lower than snus for 10 harmful compounds and comparable or undetectable for 13 more.^[11]

The health risks

Addiction

Nicotine is highly addictive.^[8] In a survey of 118 pouch users, the average score on a smokeless tobacco dependence scale indicated significant dependence, though most also smoked.^[14]

Young people

Nicotine can harm brain development, which continues until about age 25; the CDC says young people and pregnant women should not use pouches.^[8] WHO warns that adolescent nicotine exposure can affect attention and learning.^[13]

Heart

Nicotine raises heart rate and blood pressure.^[16]In a small study of smokers using strong European pouches (20 and 30 mg, far above typical US strengths), heart rate rose by about 12 and 25 beats per minute, close to a cigarette's 27, and arterial stiffness increased.^[15] BfR cites a median rise of about 8.5 bpm with 3 mg pouches.^[6] Nicotine without smoke carries much lower heart risk than smoking but is still a concern for people with heart disease.^[16] WHO says nicotine use increases cardiovascular risk.^[13]

Mouth and gums

Irritation where the pouch sits is common; gum irritation and burning were among the consumer complaints in FDA's Zyn review.^[1] In a Swedish study, 79% of 126 pouch users had oral lesions (vs 89% of snus users), though there was no increase in cavities or gum disease after up to six years of use.^[17] A small US study linked pouch use to worse gum attachment,^[18] and case reports describe gum recession and white patches where the pouch was placed.^[19][20] These are early, small studies.

Pregnancy

Nicotine is toxic to a developing fetus,^[8] and increases the risk of stillbirth.^[6]

What's still unknown

Pouches are new. FDA says long-term health data are not yet available,^[2] the CDC says more research is needed on short- and long-term effects,^[8]and BfR says long-term effects can't yet be assessed.^[6]

Compared with cigarettes

FDA said the Zyn products it authorized have substantially lower amounts of harmful constituents than cigarettes and most smokeless tobacco, and pose a lower risk of cancer and other serious conditions, for adults who switch completely. In the same announcement FDA said there is no safe tobacco product, and that authorization doesn't mean the products are safe or “FDA approved”.^[5]Lower risk than smoking isn't the same as no risk, and for someone who doesn't smoke it's an added risk, not a reduced one.

Myths that don't hold up

If you want to stop

You don't have to quit all at once. See how to quit nicotine pouches, build a free step-down plan, and know what to expect from withdrawal. The free US quitline, 1-800-QUIT-NOW, helps people using pouches too.