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Can Chewing Tobacco Cause Acid Reflux? Or Smoking It?

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Everyone knows that smoking tobacco is not a good thing long term term. Fewer people know that chewing tobacco is not a good thing. Probably even fewer people know that using tobacco products – whether they’re smoked or chewed – is a leading cause of acid reflux and GERD.

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Smoking – the problem

In 2016, more than 15.5% of adults smoked cigarettes in the US, compared with over 20% in 2005. (Center for Disease Control).

Despite this decline, more than 16 million Americans live with a smoking-related disease. Cigarette smoking is the leading cause of preventable disease and death in the United States, accounting for more than 480,000 deaths every year, or about 1 in 5 deaths.

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Smokeless Tobacco Products

But it’s not just smoking tobacco which is prevalent in the population. The use of smokeless tobacco products – snuff, chewing tobacco, lozenges and gum –  is on the rise.

As of 2014 3.4% of the US adult population used smokeless tobacco products and this is increasing. It’s thought that one of the reasons this is on the rise is because people think it’s a safer alternative to smoking, but it’s not.

If you think smokeless tobacco isn’t as dangerous as cigarettes, think again. Numerous studies are showing similar health problems associated with smokeless tobacco as with smoking. At least 28 cancer causing chemicals have been found in smokeless tobacco.

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Chewing Tobacco

Chewing tobacco is more addictive than smoking because the nicotine-an addictive substance-absorbed into the bloodstream from smokeless tobacco is three to four times greater than the amount of nicotine from cigarettes – and it stays in the bloodstream longer. 

Chewing on an average-size piece of smokeless tobacco for 30 minutes delivers as much nicotine as smoking three cigarettes.

The question is, can chewing tobacco cause acid reflux? No matter what form it takes, smokeless tobacco products allow tobacco to be absorbed by the digestive system or through mucous membranes and can have similar effects on the digestive system as smoking.

Can Chewing Tobacco Cause Acid Reflux?

So, can chewing tobacco cause acid reflux? Using nicotine in any of its forms has been shown to be directly associated with a rise in the incidence of reflux. This is due to a number of mechanisms:

Firstly, nicotine – from any source – relaxes the LES. This study¹ found that the cigarette smokers had significantly lower lower esophageal sphincter pressure compared with non-smokers.

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Secondly, the same study found that the combination of weaker LES and coughing associated with smoking acutely increased the rate at which acid reflux events occurred. The lack of smoke when chewing tobacco, rather than smoking it, may result in less coughing incidents, and therefore fewer reflux events, we assume.

Third, This study² has proven that smoking adversely affects salivation: long-term smoking reduces the secretion of saliva and changes its quality – it becomes thinner and less alkaline. It is therefore less protective of the cells which line the esophagus. In the case of chewing tobacco, there may be a protective effect from the additional saliva produced as a result of the action of chewing itself.

Fourth, smoking decreases gastric acid secretion according to this study³. Other studies have shown that too little stomach acid can produce acid reflux – smoking can therefore exacerbate this situation. We could find no specific information as to whether this effect would be mitigated by chewing, as opposed to smoking, tobacco.

Fifth, smoking increases bile acid reflux, according to this study. Bile acid can be just as erosive – and painful – in the esophagus as stomach acid. Again, there was no specific information about smokeless tobacco use.

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So, can chewing tobacco cause acid reflux? It would appear that all the evidence suggests yes, it can.

Whilst there may be some mitigating effects – such as the production of additional saliva in the chewing process – there is a significant body of opinion which considers nicotine intake in any of its forms to cause acid reflux and gerd.

In any event, long term, acid reflux may be the least of your problems arising from the use of tobacco products.

References 1, 2 3

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