back to indexNicotine’s Effects on the Brain & Body & How to Quit Smoking or Vaping | Huberman Lab Podcast #90
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Welcome to the Huberman Lab Podcast,
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where we discuss science and science-based tools
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for everyday life.
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I'm Andrew Huberman,
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and I'm a professor of neurobiology and ophthalmology
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at Stanford School of Medicine.
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Today, we are discussing nicotine.
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Nicotine is one of the most commonly consumed substances
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on the entire planet.
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There are literally billions of people
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that ingest nicotine on a daily basis.
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Most of those people consume nicotine via smoking
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and in particular, smoking tobacco.
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Tobacco contains nicotine
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and it contains a bunch of other things as well,
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which we will talk about.
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And the burning of tobacco liberates nicotine
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and makes it accessible to the various cells
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and tissues of the body.
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But of course, there are other sources of nicotine as well.
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Some people consume nicotine through dip,
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that is placing tobacco on the inside of the lip
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Some people consume nicotine via snuff,
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which is literally the shoving of tobacco leaves
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up the nostrils and allowing the tobacco
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to access the nervous system and other areas of the body
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by permeating into the mucosal membranes,
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as is the lining, the soft lining of the nasal passages.
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And of course, there are nicotine patches, nicotine gum,
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there's nicotine in pill form,
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there are toothpicks dipped in nicotine, et cetera.
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Today, we are going to separate our discussion of nicotine
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from a discussion of smoking and vaping
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and the other forms of delivery for nicotine.
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We will be talking about smoking and vaping
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and other routes of nicotine administration,
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both for sake of highlighting their detriments to health
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and believe it or not, in certain cases,
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keep in mind, very specific certain cases,
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the possible health benefits of delivering nicotine
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through specific modalities.
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It turns out those modalities
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do not include smoking cigarettes or vaping.
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And we are going to pay particular attention to vaping today
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because vaping use is on the rise,
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in particular in young people,
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and vaping use and the fact that most tobacco
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that's consumed through vaping
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includes quite amount of nicotine
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has created a scenario where nicotine,
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because of its ability to change certain chemicals
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in the brain, can actually lead to addiction
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for a number of other substances
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related to vaping and vaping-associated behaviors.
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If all of that seems like a lot to get your arms
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and your mind around right here at the outset,
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don't worry, I'll walk you through this,
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regardless of whether or not
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you have a background in biology or not,
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I promise that you'll come through
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at the end of this episode with a deep understanding
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of how nicotine works in the brain and body,
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some of its benefits, some of its potential drawbacks,
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and you will have clear optics
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as to why smoking and vaping
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and other forms of nicotine delivery
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have the effects that they do
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on your biology and psychology.
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I'm pleased to announce that the Huberman Lab Podcast
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is now partnered with Momentus Supplements.
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We partnered with Momentus for several important reasons.
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First of all, they ship internationally
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because we know that many of you are located
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outside of the United States.
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Second of all, and perhaps most important,
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the quality of their supplements is second to none,
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both in terms of purity and precision
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of the amounts of the ingredients.
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Third, we've really emphasized supplements
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that are single ingredient supplements
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and that are supplied in dosages
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that allow you to build a supplementation protocol
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that's optimized for cost,
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that's optimized for effectiveness,
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and that you can add things and remove things
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from your protocol in a way
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that's really systematic and scientific.
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If you'd like to see the supplements
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that we've partnered with Momentus on,
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you can go to livemomentus.com slash Huberman.
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There you'll see those supplements,
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and just keep in mind that we are constantly expanding
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the library of supplements available through Momentus
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on a regular basis.
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Again, that's livemomentus.com slash Huberman.
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Before we go any further,
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I just want to highlight a key takeaway
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from a previous episode,
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which is our episode on focus,
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and in fact was a toolkit for focus.
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So during the toolkit for focus episode,
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we talked about a large number of behavioral pharmacologic
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and other interventions that you can use
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to increase your level of concentration and focus
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for whatever purpose, cognitive endeavors,
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learning languages, focusing in school,
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on work, et cetera, or physical pursuits.
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Now, one of the key takeaways
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is that there are really two key protocols
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that I believe everyone should understand and know about
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and why they work, because they are so effective
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and also because they dovetail nicely
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with some of the information
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that we're going to talk about today,
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which will explain why nicotine
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is so effective in increasing focus.
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And these two protocols are as follows.
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Data based on studies done in Wendy Suzuki's lab
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at New York University.
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Of course, Wendy was a guest on this podcast,
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so you can check out that episode if you like,
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but studies done in her laboratory
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point to the fact that a daily, very brief,
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in fact, only 13 minute meditation
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can vastly increase focus and focus ability,
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not just immediately after the meditation practice,
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but at all other times as well.
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So again, this is a meditation practice done daily
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for just 13 minutes.
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It's a very simple meditation practice
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where one sits or lies down, closes your eyes,
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and directs your attention to a place
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just between your two eyes and right above it,
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so on your forehead, but just inside of that.
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And please understand that your brain
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does not have sensory receptors.
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So unlike focusing on your fingertips
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and the sensations there, if you focus on your brain,
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you can't actually sense anything in your brain
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except your thoughts.
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So the idea then is that you continually bring your focus
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back to that location just about an inch
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behind your forehead over and over again.
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And it's the refocusing of your attention to that location
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after it drifts that succeeds
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in increasing your focus ability,
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again, not just during the meditation and afterward,
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but at other times as well.
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So this 13 minute a day meditation is exceedingly simple
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and exceedingly effective.
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It should be performed every day,
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but if you miss a day, just go back to doing it,
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don't despair too much,
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and you will see these positive effects save the data,
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also increase effects on mood
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and other positive aspects of mental health and performance.
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So that's the first tool in protocol.
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The second tool in protocol relates to the general,
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what I call the aero model of focus.
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This was a model that I created in order to simplify
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the vast amounts of data on focus and concentration
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and how they are created by the various chemical systems
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within your brain.
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We're going to hear a lot about these chemical systems
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again today in the context of nicotine,
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and they are as follows.
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You can think about focus on any goal or any endeavor
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So just imagine an aero which has an aero head and a shaft,
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and we'll add a third component to it in a moment.
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The head of the aero, meaning the direction of your focus
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is largely set by acetylcholine,
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which is a chemical in the brain.
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The shaft of the aero is set by a chemical called adrenaline,
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also called epinephrine.
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Those are the same thing.
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In the brain, typically, it's referred to as epinephrine,
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and in the body, it's more commonly referred to
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as adrenaline, but those are the same neurochemical.
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Epinephrine slash adrenaline represents the shaft
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of the aero, and it's providing the energy
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for which to focus.
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And then we can put behind that aero a little propeller
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or a motor, if you like.
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And the propeller or motor in the context
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of this neurochemistry model is dopamine,
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which provides ongoing motivation.
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It pushes that aero forward continually
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as you strive to focus on a particular thing.
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This particular aero model,
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that is your ability to increase your focus,
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can be enhanced, therefore,
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by increasing acetylcholine, epinephrine,
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and dopamine simultaneously.
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And there are a lot of different ways to do that,
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but one of the more effective ways to do that
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via supplement protocols is so-called alpha-GPC.
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Alpha-GPC taken in 300 milligram form,
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10 to 30 minutes before a bout of cognitive work
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or a bout of physical work will increase your focus
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by way of increasing acetylcholine and to some extent,
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increasing epinephrine as well.
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The dopamine increase will have to be achieved
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either through cognitive processing,
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that is telling yourself you're doing a good job
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and moving forward because thoughts really do impact
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your levels of dopamine, or some other sort of pro-dopamine
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or dopamine increasing protocol,
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also discussed in the toolkit for focus
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and our episode on dopamine for motivation and drive.
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So the key thing here to understand
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is that the 13 minute a day meditation
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is a very effective way to increase focus capacity.
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And then in the short term,
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if you want to provide a boost now and again to focus,
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300 milligrams of alpha-GPC can be very effective.
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There are various sources for that,
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then we'll link to one of them in the show note captions.
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By no means am I saying that you need to take alpha-GPC,
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a number of people will certainly opt not to,
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and a number of people might be saying,
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well, I've heard that alpha-GPC can increase focus
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by way of increasing acetylcholine and norepinephrine
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or epinephrine, but it can also increase TMAO,
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which is a kind of a negative marker of cardiac health
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and cardiovascular health.
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For that reason, I and many others will take 600 milligrams
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of a garlic capsule, which can offset that TMAO increase.
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It remains uncertain as to how much alpha-GPC
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one needs to take before increasing TMAO levels
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to a point where it's of concern
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that you would even need to take the garlic capsule.
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But I just mention it in any case
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because it's a pretty simple fix.
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Garlic has other health benefits too, of course.
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And for most people, 300 milligrams of alpha-GPC
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taken every once in a while.
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I certainly don't encourage people to take alpha-GPC
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every time they want to focus.
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I always emphasize behavioral tools first,
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then focusing on nutritional tools,
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and on occasion using supplement-based tools
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to encourage increased levels of focus.
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And then of course,
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there are a number of different prescription compounds
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that if you're working with a board certified physician,
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they could prescribe you if you need additional tools
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for focus, things like Ritalin, Adderall,
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Modafinil, Armodafinil, Vyvanse, et cetera,
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for many people are going to be important
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and maybe even necessary for people with ADHD, et cetera.
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But that's a category into itself.
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And as I always say, I'm not a physician,
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so I don't prescribe anything.
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I'm a professor, so I profess many things.
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And today, I just wanted to pass along
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or redirect your attention to that episode on focus
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and highlight those two tools,
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the 13-minute-a-day meditation
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and 300-milligram Alpha-GPC for increasing focus capacity
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and for acutely, that is temporarily,
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giving an additional boost for about a focus.
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And of course, if you choose not to use those protocols,
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that's perfectly fine too.
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There's certainly no obligation.
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They are simply available to you
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should you choose to try them.
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And if nothing else, you now have in mind
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the neurochemistry of acetylcholine,
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epinephrine slash adrenaline, and dopamine,
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and that will really set the stage for understanding
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just how effective and why nicotine is so effective
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at increasing focus, motivation,
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and even, as you'll soon hear,
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working memory and cognitive capacity.
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Before we begin, I'd like to emphasize
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that this podcast is separate
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from my teaching and research roles at Stanford.
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It is, however, part of my desire and effort
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to bring zero cost to consumer information
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about science and science-related tools
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to the general public.
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In keeping with that theme,
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I'd like to thank the sponsors of today's podcast.
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Our first sponsor is Thesis.
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Thesis makes custom nootropics.
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And to be quite direct, I do not like the word nootropics
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because it translates to smart drugs.
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And to be direct, again,
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there is no such thing as a smart drug.
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That is, there's no such thing as a drug
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that can make you smarter
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because there is no circuit in the brain for being smart.
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There are circuits in the brain for focus.
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There are circuits in the brain for task switching.
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There are circuits in the brain related to creativity
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and so on and so forth.
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So the idea that there would be a single smart drug
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or nootropic is simply foolish.
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And fortunately, Thesis understands this
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and therefore has created custom nootropics
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that are designed to get you into the states of mind
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and body that are optimal for your goals.
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I've been taking thesis nootropics for quite a while now,
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and I've been extremely pleased with the results.
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I take a clarity formula that's specifically designed
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for me prior to long bouts of cognitive work.
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And I take an energy formula prior
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to particularly challenging physical workouts.
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To get your own personalized nootropic starter kit,
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you can go online to takethesis.com slash Huberman,
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take a three minute quiz,
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and Thesis will send you four different formulas
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to try in your first month.
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Again, that's takethesis.com slash Huberman
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and use the code Huberman at checkout
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to get 10% off your first box.
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Today's episode is also brought to us by InsideTracker.
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InsideTracker is a personalized nutrition platform
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that analyzes data from your blood and DNA
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to help you better reach your health goals.
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I've long been a believer
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in getting regular blood work done
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for the simple reason that many of the factors
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that impact your immediate and long-term health
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can only be analyzed with a quality blood test.
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One of the major issues with blood tests or DNA tests,
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however, is that typically you'll get your data back
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and you won't know what to do with those data.
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InsideTracker has solved this problem
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where when you get numbers back
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about your hormones, metabolic factors, et cetera,
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it will direct you to specific protocols
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in the realms of nutrition, exercise, supplementation,
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and that includes things to do, things to consider,
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and things not to do in order to bring those numbers
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into the ranges that are optimal
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for your immediate and long-term goals.
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If you'd like to try InsideTracker,
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you can visit insidetracker.com slash Huberman
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to get 20% off any of InsideTracker's plans.
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Again, that's insidetracker.com slash Huberman
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Today's episode is also brought to us by Roka.
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Roka makes eyeglasses and sunglasses
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that are of the absolute highest quality.
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The company was founded by two All-American swimmers
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from Stanford and everything about Roka eyeglasses
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and sunglasses were designed with performance in mind.
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I've spent a lifetime working on the biology
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of the visual system,
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and I can tell you that your visual system
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has to contend with a number of important challenges
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in order for you to be able to see clearly.
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Now, Roka understands this,
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and everything about their eyeglasses were designed
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in order for you to see with optimal clarity
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regardless of activities.
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Roka eyeglasses and sunglasses are superb
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In fact, they were originally designed for that purpose.
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They're extremely lightweight.
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In fact, most of the time I can't even remember
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that they're on my face,
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and they won't fall off if you get sweaty.
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In addition, Roka eyeglasses and sunglasses
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So while a lot of so-called performance eyeglasses out there
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and they do have those varieties,
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they also have varieties of aesthetic choices
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that you would be very comfortable wearing to work
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or to school or just out and about.
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And that's one of the reasons I like them.
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I don't really have to think about having too many pairs
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of sunglasses or eyeglasses.
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I can just have one or two of each pair,
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and I'm good to go no matter where I go.
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If you'd like to try Roka eyeglasses and sunglasses,
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you can go to Roka, that's R-O-K-A.com,
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on your first order.
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Again, that's Roka, R-O-K-A.com,
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and enter the code Huberman at checkout.
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Let's talk about nicotine
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and how nicotine impacts our brains, our bodies,
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our mental performance, our mental health,
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our physical performance, and our physical health.
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And once again, I want to remind everybody
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that we really need to separate out
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a discussion about nicotine
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from the discussion about the delivery device for nicotine.
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In other words, when we're talking about nicotine,
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we are not necessarily talking about smoking,
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although we might be.
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There are things associated with smoking and with vaping
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and other means of getting nicotine into our system
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that have their own effects,
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both negative and in some cases, positive.
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Indeed, later we will talk about
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how you can actually use nicotine
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to get over smoking addiction.
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This won't come as a surprise to many people,
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but what perhaps will come as a surprise
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is the fact that many people
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actually use nicotine-like substances or nicotine itself
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in order to relieve nicotine addiction.
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So we'll talk about that and what that looks like
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and offer various protocols for you later in the episode.
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I also want to mention here at the outset
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that I have a longstanding interest in nicotine.
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In fact, early in my scientific career,
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I did research on nicotine and its role in brain development
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and I've had a longstanding interest in neuroplasticity,
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the brain's ability to change in response to experience.
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And so experiments that have been done by close colleagues
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and friends of mine have really emphasized the fact
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that acetylcholine and in particular,
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when acetylcholine activates so-called nicotinic receptors,
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something you'll learn more about in a little bit,
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that can actually serve as a gateway or a trigger
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for directed rewiring of the brain.
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So this is fascinating.
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We think of nicotine as something that we take,
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but actually we have receptors,
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that is locations in the brain
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to which nicotine binds and can exert its effects.
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And those receptors did not come about
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because of the existence of tobacco
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or the existence of vaping pens
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or because of the existence of anything in the outside world.
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The fact that there are nicotinic receptors
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in our brain and body tells you that acetylcholine
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and nicotine themselves have very important roles
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in normal brain and body function.
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So much so that I often like to point to an anecdote
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of a very well-known Nobel prize-winning neuroscientist.
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I won't reveal who they are.
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They're not a faculty member at Stanford,
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but many neuroscientists know of this person
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and many people in the outside world know of this person.
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And they are also well-known for their love of nicotine.
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I once sat in this person's office and he,
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I will reveal that as a he,
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consumed no fewer than three pieces of nicotine gum
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during that relatively short conversation
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of about 45 minutes.
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And that was surprising to me.
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And I asked him why he was taking so much nicotine
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through nicotine gum.
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And he replied that for years he had been a chronic smoker,
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which on the one hand had greatly impaired
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his cardiovascular health and his fitness,
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no surprise there.
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And we'll talk a little bit more about
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what the underlying reasons are.
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But most everyone, if not everyone knows
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that smoking cigarettes or smoking in general
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really impairs lung health.
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There's just simply no question about it.
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There are some more or less unhealthy ways to smoke,
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but the quite honest message is that smoking of any kind
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is going to disrupt lung endothelial function,
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lung function, blood vessels, and so forth.
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It's going to make it harder to breathe with vigor,
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take deep breaths, deliver oxygen to tissues, et cetera.
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That said, he also pointed out
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that the data on nicotine specifically
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are pointing to the fact that nicotine can be,
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can be protective against certain forms
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of cognitive impairment.
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And that is why he continued to chew
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nicotine containing gum.
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And he swore by the focus enhancing
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and motivation enhancing effects
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of nicotine containing gum.
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Now that is not a call to arms for you to run out
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and start chewing or consuming nicotine containing products.
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We will talk about those products later in the episode,
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some of their potential advantages,
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some of their potential disadvantages.
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Now I share this anecdote because it nicely separates
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nicotine from the delivery device
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through which nicotine arrives.
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Now, I haven't talked to this individual in a few years
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to see whether or not the nicotine is working
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to stave off any kind of Alzheimer's or neurodegenerative
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or cognitive impairment that would come with age.
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This gentleman is getting up in the years
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and seems quite sharp nonetheless,
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but then again was always exceedingly sharp.
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The point is nicotine is a substance
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that can both promote cognitive function
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and under some conditions if taken to inappropriate
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or I should say to extreme dosages
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can also impair cognitive function.
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So today we really need to have a nuanced conversation
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One that includes some of the benefits,
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some of the drawbacks in particular for children,
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certainly for people that are pregnant,
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for people that have addictive tendencies
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and for people that have depression
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and any other kind of mood disorders.
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What I will tell you soon is that nicotine
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can be very powerful as a mood modulator
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and many people who have tried to quit nicotine,
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mainly through the form of smoking,
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will find that their mood can drop substantially.
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So nicotine does a lot of things in the brain and body
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and so I'd like to begin by talking about
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what exactly nicotine is
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and how it impacts your brain and body.
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So what is nicotine and where is it found?
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Obviously nicotine is found in the tobacco plant,
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but nicotine is also found in nightshades,
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that is tomatoes, eggplants and sweet peppers.
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Although the concentrations of nicotine
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in tomatoes, eggplants and sweet peppers
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is vastly lower than it is in the tobacco plant.
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You actually can also find nicotine in potatoes.
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Now, why is nicotine present in potatoes and tomatoes
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and in the tobacco plant at all?
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Well, nicotine is a plant alkaloid,
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we'll get into alkaloids a little bit later,
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but it is thought that these alkaloids evolved in plants
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as a way to prevent insects from eating them.
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And without going into a lot of insect biology,
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the reason or the rationale behind this explanation
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is that nicotine is not only a substance in tobacco
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that people use or in the various medications
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that people use, but it's also used as a pesticide
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because it can dramatically disrupt
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the nervous system of insects.
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It can render them infertile,
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which is not to say that it renders humans infertile.
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I want to say again, it is not the case
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that nicotine renders humans infertile,
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but it can make certain insects infertile.
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It can actually disrupt their motor function
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and their brain function.
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And the reasons that it has such different effects
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on insects, in other words, it can kill them
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or prevent them from reproducing
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and therefore explains why plants probably evolved
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to have this plant alkaloid, nicotine.
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In humans, because of the differences
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in receptors for nicotine,
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where they're located in the types of receptors,
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the effects of nicotine on humans is quite a bit different.
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And again, it does not cause infertility in humans.
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Although I will talk a little bit later
link |
about some double-blind peer-reviewed studies
link |
conducted in humans that indicate that, for instance,
link |
nicotine can reduce penile girth,
link |
that is the girth of the penis,
link |
and can lead to certain forms of sexual dysfunction.
link |
And those changes are largely downstream
link |
of changes in blood flow and endothelial cell function.
link |
Endothelial cells are the cells
link |
that make up blood vessels and other vascular-type tissues
link |
within the brain and body.
link |
So nicotine is found in these plants.
link |
And what we can know for sure
link |
is that at some point in human evolution,
link |
somebody or some group of people,
link |
either, and here I'm completely guessing,
link |
it's a just-so story,
link |
but someone or some group must have inhaled the smoke
link |
from the tobacco plant
link |
or put the dried leaves of the tobacco plant
link |
against some mucosal tissue,
link |
any of the different mucosal linings of their body
link |
by which substances can pass through, that's right.
link |
Any of the mucosal soft-lining tissues of the body
link |
will allow certain substances,
link |
not all certain substances, to pass in.
link |
That's why people can put tobacco in their mouth
link |
and a certain amount of nicotine
link |
makes it into the bloodstream,
link |
put tobacco up their nose,
link |
certain amount of nicotine gets into the bloodstream.
link |
I haven't heard of people putting tobacco
link |
in other orifices of their body,
link |
containing mucosal tissue,
link |
and I'm certainly not suggesting people do that,
link |
but you get the idea
link |
and how nicotine gets from these plants,
link |
these dried leaves, into the bloodstream.
link |
Burning tobacco leads to a heat-induced change
link |
in the availability of nicotine,
link |
and this is why smoking tobacco or vaping tobacco
link |
simply by heating it up allows the nicotine to be liberated
link |
and go into the bloodstream
link |
simply by inhaling it into the lungs.
link |
We will get back to smoking of various kinds later,
link |
but right now let's just keep our attention
link |
on how nicotine is pulled from these plants
link |
and into the human body.
link |
Now, whether by inhalation
link |
or whether or not by placing it in contact
link |
with the mucosal tissue of the mouth
link |
or other mucosal-containing orifice of the body,
link |
the nicotine then gets into the bloodstream.
link |
And once it's in the bloodstream,
link |
it only exerts its effects
link |
because it binds to certain so-called nicotinic receptors.
link |
Okay, so the nicotinic receptors
link |
are of the acetylcholinergic variety.
link |
I know this is a lot to think about and a lot to hear
link |
if you haven't heard about this,
link |
but it's actually quite simple.
link |
Anyone can understand this.
link |
Acetylcholin is a molecule, a chemical that is,
link |
that's released in the brain and body,
link |
and when it binds to receptors,
link |
that is little parking spots on cells,
link |
it changes the way those cells behave.
link |
Those cells can increase their activity
link |
and release other chemicals.
link |
They can become electrically active.
link |
They can do any number of different things.
link |
When we ingest nicotine, it gets into the bloodstream,
link |
and eventually some of that will get into the brain
link |
and some of it gets into the body.
link |
And in both the brain and body,
link |
there are these so-called nicotinic acetylcholine receptors.
link |
Now the so-called family, and indeed they are a family,
link |
this is how we refer to groups of receptors
link |
of related design and genetic background, just like humans.
link |
You have a family of these acetylcholine receptors
link |
that are of the nicotinic variety.
link |
So, you know, maybe on one street in your neighborhood,
link |
you know the Joneses on another street,
link |
you know the Chows on another street.
link |
Well, in your body,
link |
you have the nicotinic acetylcholine receptors,
link |
and then you have the so-called
link |
muscarinic acetylcholine receptors.
link |
Today it's really simple.
link |
Nicotine only binds to the nicotinic acetylcholine receptors
link |
and there are a bunch of different ones
link |
on a bunch of different tissues.
link |
And the differences in those receptors
link |
dictate what sorts of effects
link |
the nicotine will have on those tissues.
link |
So let's talk about what those effects are
link |
and let's do that by dividing the effects of nicotine
link |
into effects on the brain,
link |
so everything from the neck up and on the body,
link |
the so-called central nervous system and the periphery.
link |
Although I want to point out that your spinal cord
link |
is part of the central nervous system,
link |
so in fairness to the reality,
link |
your brain and spinal cord are all central nervous system,
link |
everything else is considered the periphery.
link |
Now, there are a lot of different
link |
nicotinic acetylcholine receptors,
link |
but for those of you that want to know,
link |
you have aficionados,
link |
or if you're ultra curious about this,
link |
the main effects of nicotine in the brain
link |
are mediated by nicotine binding
link |
to the so-called alpha-4 beta-2 receptor,
link |
alpha-4 beta-2 receptor.
link |
Even if you don't care about receptor subtypes,
link |
that's going to come up later when we discuss
link |
why nicotine suppresses appetite.
link |
In fact, one of the major reasons
link |
why people don't want to quit smoking
link |
or they quit smoking or another form of ingesting nicotine
link |
and then they relapse, they go back to smoking
link |
or ingesting nicotine in some other way
link |
is because indeed nicotine will increase metabolism
link |
and reduce hunger in large part
link |
by binding to this alpha-4 beta-2 receptor
link |
in a particular area of the brain.
link |
We're going to return to that in a little bit,
link |
but if you've ever heard that nicotine kills the appetite,
link |
It's not the behavior of smoking itself,
link |
it's not because you always have a cigarette in your mouth
link |
that you're not eating more food,
link |
although I suppose that might be a minor effect.
link |
There are direct effects of nicotine on both appetite,
link |
that is it reduces appetite,
link |
and direct effects on metabolism,
link |
that is it increases metabolism
link |
through its effects on some other areas
link |
of the brain and body we'll talk about in a moment.
link |
And within the brain,
link |
nicotine binds to this alpha-4 beta-2 receptor
link |
in various locations in the brain.
link |
And there are three and maybe a fourth
link |
that we'll talk about neurochemical effects of nicotine
link |
after you ingest it.
link |
First things first, when you ingest nicotine
link |
by smoking nicotine containing tobacco,
link |
or if you place tobacco in contact with the mucosal lining
link |
of the nasal passages of the mouth,
link |
it takes about two to 15 minutes
link |
for that nicotine to enter the bloodstream.
link |
Smoking hits the bloodstream faster,
link |
vaping even faster, I should mention,
link |
for a variety of reasons,
link |
and placing tobacco directly in contact
link |
with the mucosal lining is going to be the slowest.
link |
Now, as I mentioned before,
link |
nicotine gets into the bloodstream,
link |
and then because nicotine can pass
link |
through the so-called blood-brain barrier, the BBB,
link |
which is basically a fence around the brain,
link |
because it can pass through the blood-brain barrier,
link |
it's going to have very rapid effects on the brain
link |
in these four major categories of neurochemicals
link |
and neural circuits.
link |
The first of those categories,
link |
and this is a very important one,
link |
this is one that was brought up in the episode
link |
on dopamine motivation and drive,
link |
and I think not just all scientists,
link |
but all human beings should know that within their brain,
link |
they have what is called the mesolimbic reward pathway.
link |
The mesolimbic reward pathway,
link |
if you just want to call it the dopamine reward pathway,
link |
is, as the name suggests,
link |
a set of connections between a brain area
link |
called the ventral tegmental area.
link |
You don't have to remember the names of these things,
link |
of course, but if you want to, that's fine too.
link |
The ventral tegmental area, or VTA,
link |
connects to another area called the nucleus accumbens.
link |
Now, here's what's very important.
link |
Nicotine triggers the release of dopamine
link |
from the nucleus accumbens.
link |
This is what gives nicotine its rewarding properties.
link |
It increases motivation.
link |
It tends to give a not so subtle,
link |
but very transient increase in feelings of wellbeing
link |
and alertness and motivation,
link |
and that's because of the increase in dopamine
link |
caused by nicotine directly within the nucleus accumbens.
link |
Nicotine also triggers the release of certain neurochemicals
link |
from the ventral tegmental area itself,
link |
and those impinge on nucleus accumbens
link |
and increase dopamine levels further.
link |
This is what makes the rewarding properties,
link |
or sometimes referred to as the reinforcing properties
link |
of nicotine, so powerful.
link |
This is why so many billions of people ingest nicotine
link |
in one form or another.
link |
It's also why nicotine is so hard to quit,
link |
because there's a potent increase in dopamine
link |
from multiple neural circuit pathways
link |
within this mesolimbic reward circuitry.
link |
Now, within the mesolimbic reward circuitry,
link |
there's an interesting feature.
link |
There are accelerators that essentially
link |
push out more dopamine, get more dopamine released,
link |
and there are breaks of the so-called GABAergic variety.
link |
GABA is an inhibitory neurotransmitter.
link |
You don't need to know too much about it
link |
to just understand that nicotine both increases dopamine,
link |
but also decreases the activity of GABA,
link |
and so this is like pushing on the accelerator for dopamine,
link |
but also removing the break.
link |
So there's a two-pronged effect of nicotine
link |
on reinforcement reward dopamine-related pathways,
link |
the feel-good motivation pathways,
link |
and that is an increase in dopamine
link |
and a decrease in GABA,
link |
and again, that's all mediated
link |
through this mesolimbic reward pathway
link |
involving the ventral tegmental area
link |
and the nucleus accumbens.
link |
So if you can conceptualize
link |
even just 5% of what I just told you,
link |
or even if you can just remember,
link |
nicotine increases dopamine,
link |
and that's why it feels so good.
link |
It makes you want more of it.
link |
You will have everything you need to know in mind
link |
in order to understand both why nicotine is so highly used
link |
and indeed abused, why it's so hard to quit,
link |
and that will point to avenues
link |
as to how to quit or reduce intake,
link |
and it also points to how nicotine can actually be used
link |
in an antidepressant way should you choose,
link |
and we will talk about what the various criteria are
link |
for choosing that,
link |
but just understand nicotine increases motivation,
link |
it decreases negative feelings of mood,
link |
it increases positive feelings of mood and motivation.
link |
Before we continue with today's discussion,
link |
I'd like to just briefly acknowledge our sponsor,
link |
Athletic Greens, now called AG1.
link |
Athletic Greens, AKA AG1,
link |
is an all-in-one vitamin mineral probiotic drink
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that also has adaptogens and digestive enzymes.
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I've been taking Athletic Greens since way back in 2012,
link |
so I'm delighted that they're sponsoring the podcast.
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The reason I started taking Athletic Greens
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and the reason I still drink Athletic Greens twice a day
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is that it supplies total foundational coverage
link |
of my vitamin mineral needs,
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and it supplies important nutrients
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that I need to support my gut microbiome.
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The gut microbiome, as many of you know,
link |
supports the immune system.
link |
It also supports the so-called gut-brain axis,
link |
which is vital for mood,
link |
for energy levels, for regulating focus,
link |
and many other features of our mental health
link |
and physical health that impact our daily performance
link |
and high performance in any endeavors
link |
we might be involved in.
link |
If you'd like to try Athletic Greens,
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you can go to athleticgreens.com slash Huberman
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They're giving away five free travel packs
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plus a year supply of vitamin D3K2 with every order,
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and of course, vitamin D3K2 are vital
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for all sorts of things like hormone health
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and metabolic health and K2 for cardiovascular health
link |
and calcium regulation.
link |
Again, you can go to athleticgreens.com slash Huberman
link |
to claim that special offer.
link |
The second major effect that nicotine has in the brain
link |
is that it increases acetylcholine.
link |
Acetylcholine is a neuromodulator
link |
that exists in you and me.
link |
It is released from multiple sites in the brain,
link |
and the two major sites are the nucleus basalis.
link |
So these are a collection of neurons
link |
in the front and base of your brain
link |
and from some brain stem areas,
link |
and there are a bunch of different ones back there
link |
in your brain stem, which is indeed in the back,
link |
that release acetylcholine.
link |
That include the locus coeruleus as kind of a minor site,
link |
the pedunculopontine nucleus.
link |
There are a bunch of these different areas,
link |
the parabigeminal nucleus.
link |
There are a bunch of these things back there.
link |
We don't have to go into all the names,
link |
but just understand that there are little pockets
link |
of neurons, nerve cells, located in the front and the back
link |
and to some extent in the middle of your brain,
link |
but really in the front and the back of your brain
link |
that can serve two major roles.
link |
Acetylcholine released from nucleus basalis
link |
leads to a sort of spotlighting or highlighting
link |
of particular neural circuits in the brain.
link |
What do I mean by this?
link |
Well, let's say you're working on a puzzle.
link |
Let's say it's a cognitive puzzle.
link |
Maybe you're doing a word puzzle,
link |
or nowadays I've heard of this wordle thing.
link |
I'm on Twitter and people are always posting
link |
their wordle thing, and I have no idea what it is,
link |
but I'm guessing it's some sort of puzzle.
link |
I'm guessing it's like a crossword puzzle,
link |
and here, if I'm wrong, I don't know, educate me.
link |
Tell me what wordle is.
link |
Somebody put it in the comments
link |
and tell me if I should play it or not.
link |
When acetylcholine is released from nucleus basalis,
link |
the neurons are there in the base of the brain,
link |
but they extend axons,
link |
which are like little wires elsewhere in the brain,
link |
and when acetylcholine is released,
link |
it tends to be released at particular locations in the brain
link |
that are associated with whatever activity
link |
we happen to be doing.
link |
So if I'm doing wordle,
link |
here I'm talking about it as if I've ever done it,
link |
doing a crossword puzzle or wordle,
link |
well, the neurons that we're involved in
link |
trying to figure out the solution to that wordle
link |
or crossword puzzle are active,
link |
and then acetylcholine is released from the little wires,
link |
the little endings of these cells in nucleus basalis,
link |
and all of a sudden, those neural circuits get a boost.
link |
They become more active, and believe it or not,
link |
our ability to perform that crossword puzzle,
link |
or at least focus on that wordle or crossword puzzle,
link |
It literally increases.
link |
Our attention for that and not anything else is enhanced.
link |
So it's literally like a neurochemical attentional spotlight.
link |
Nicotine increases acetylcholine and thereby
link |
focus and concentration and mental performance,
link |
not by changing the neural circuits
link |
that are activated per se,
link |
but rather by making more acetylcholine available
link |
at those release sites.
link |
So it's as if the spotlighter got more intense.
link |
The highlighter is more intense than it would be otherwise.
link |
And I should also mention
link |
because of the so-called pharmacokinetics,
link |
the time course in which nicotine has its effects,
link |
which are pretty short-lived,
link |
talk about those in a moment,
link |
this enhancement in cognitive performance and attention
link |
is going to be very transient,
link |
probably on the order of about 30, maybe 45 minutes.
link |
The half-life of nicotine,
link |
depending on how it's ingested
link |
and whether or not you have food in the gut
link |
and what else is in the bloodstream, et cetera,
link |
it's going to be anywhere from one to two hours.
link |
But typically the effects of nicotine will come on
link |
in about two to 15 minutes, as I mentioned before,
link |
and then will last anywhere from about 30 to 45 minutes.
link |
This is why in the old days,
link |
and still to some extent in certain areas of the world,
link |
but less so in the United States
link |
and certainly in Europe as well,
link |
we don't see quite as many people smoking cigarettes
link |
for reasons we can discuss later,
link |
but you would see these chain smokers
link |
who are trying to maintain constant levels
link |
of nicotine in their brain and bloodstream.
link |
Now, perhaps they didn't know
link |
that nicotine has this one to two hour half-life,
link |
but they could sense, no doubt,
link |
the cognitive and the physical effects of nicotine,
link |
including this cognitive enhancement effect
link |
and highlighting of the neural circuits effect.
link |
And they would notice, they would smoke a cigarette,
link |
and then for the next five to 45 minutes
link |
have heightened focus,
link |
and then it would start to drop off,
link |
so they smoke another cigarette.
link |
So in other words, they're trying to maintain
link |
a constant level of nicotine
link |
for whatever activities they needed to perform.
link |
Obviously chain smoking,
link |
because of the terrible effects of smoking,
link |
I'll talk about those terrible effects,
link |
but I'm sure you've heard of them before,
link |
cancer, depletion of just about every organ and body tissue
link |
to the point that it can actually be measured
link |
how many years of your life you're peeling off
link |
in terms of lifespan and healthspan by smoking.
link |
Well, the terrible effects of smoking are indisputable,
link |
but the positive effects of nicotine on this circuitry
link |
are part of the reason why people would chain smoke
link |
in the first place,
link |
rather than get one big peak of concentration and focus
link |
and then just let it disappear after 45 minutes.
link |
Okay, so what we have is a scenario
link |
where dopamine is going up in the mesolimbic pathway.
link |
That's why smoking or ingesting nicotine in any other way
link |
feels good and makes us feel motivated.
link |
And then the increase in acetylcholine,
link |
especially from nucleus basalis in the front of the brain
link |
is the reason why it can increase our ability
link |
to focus on particular types of endeavors,
link |
particular mental work that we're doing,
link |
or maybe even particular physical work.
link |
Although I should mention anytime I'm pairing
link |
the words nicotine and physical work,
link |
it's obvious that because of the ways
link |
that smoking impairs lung function,
link |
those two things really run counter to one another.
link |
In other words, if you are thinking about ingesting nicotine
link |
through smoking or vaping
link |
in order to improve physical performance,
link |
that's a terrible idea.
link |
The logic isn't there
link |
and the health detriments are certainly there.
link |
The third neurochemical pathway that's strongly activated
link |
when nicotine is brought into the central nervous system,
link |
into the brain is epinephrine or in particular norepinephrine
link |
which is related to epinephrine.
link |
Now, earlier I said epinephrine is the same as adrenaline.
link |
That's still true.
link |
Norepinephrine is closely related to epinephrine.
link |
And for today's discussion,
link |
we're going to use them interchangeably.
link |
Although I realize as I say that,
link |
that the medical students and some biology students
link |
are probably going to have a minor seizure
link |
when I lump norepinephrine and epinephrine.
link |
I don't do that to be too much of a lumper.
link |
In science, we talk about lumpers and splitters.
link |
Lumpers are people that like to oversimplify a little bit.
link |
Splitters are people that really like to detail.
link |
You'll see a lot of splitters on social media
link |
from time to time.
link |
They'll say, wait, you know,
link |
you didn't mention the alpha-2 beta-6 receptor subunit.
link |
Okay, look, I get it.
link |
And I am all for having splitters in the room.
link |
But for sake of today's discussion
link |
and for ease of digestibility of some of this,
link |
just want to point out that norepinephrine, epinephrine,
link |
and adrenaline, I'm going to treat as a common pool
link |
of similar, in fact, very similar molecules
link |
that all have the same net effect,
link |
at least in the context of this discussion.
link |
And that's to increase levels of alertness,
link |
energy, and arousal.
link |
And the way that nicotine accomplishes those increases
link |
in alertness and arousal and energy within the brain
link |
is by triggering the release of norepinephrine
link |
from a little cluster of neurons in the back of the brain
link |
called locus coeruleus, tiny cluster of neurons
link |
that offers up, or I should say has,
link |
because they're always there from birth,
link |
has these little wires, these axons that extend many,
link |
many places in the brain, not every place,
link |
but virtually every place and can sprinkler the brain
link |
with norepinephrine and essentially serve
link |
as a wake-up signal, elevating levels of energy.
link |
And when that combines with the acetylcholine
link |
from nucleus basalis,
link |
which causes attentional spotlighting,
link |
increases in concentration and focus,
link |
and with the feel-good properties of dopamine
link |
and the motivating properties of dopamine released
link |
from the mesolimbic reward pathway,
link |
now you can start to get a picture
link |
of why nicotine is such a powerful molecule.
link |
It's making people feel motivated and good.
link |
It's making people feel focused
link |
and it makes people feel alert
link |
when they would otherwise feel a little bit sleepy.
link |
So this is a really powerful compound.
link |
In fact, going back to our earlier discussion
link |
about focus and some tools for focus,
link |
and I encourage you, if you're interested,
link |
to please check out the episode on focus.
link |
There are a number of different tools
link |
and protocols there to increase focus,
link |
but here we're talking about one molecule, nicotine,
link |
found in plants like tomatoes and potatoes
link |
and the tobacco plant,
link |
and it can be synthesized in a laboratory
link |
and ingested through a patch or a gum or even a pill
link |
or a toothpick dipped in nicotine.
link |
One molecule that can trigger activation
link |
of all the circuits for focus and motivation
link |
in one fell swoop.
link |
That is remarkable.
link |
That is absolutely remarkable.
link |
And here we haven't even touched
link |
on some of the psychological components of focus, right?
link |
Whether or not we're interested in something,
link |
whether or not we're excited about it or not.
link |
This is a very, very powerful system.
link |
So powerful, in fact,
link |
that I think we can really place nicotine right up there
link |
at the top, right next to caffeine
link |
as the molecule that has fundamentally changed
link |
human evolution, human consciousness, and human experience.
link |
Even if you're somebody who's never ingested nicotine,
link |
this absolutely has to be true
link |
because you have these nicotinic receptors,
link |
which is to say that acetylcholine that's naturally released
link |
without any external trigger within your brain and body,
link |
or I should say without any trigger from nicotine
link |
is binding these nicotinic acetylcholine receptors
link |
and is creating these effects in your brain and body.
link |
It's just absolutely staggering.
link |
Now, earlier I mentioned the appetite suppressing
link |
and indeed metabolism increasing effects of nicotine.
link |
And while that's a fairly niche component
link |
of what nicotine does, I mean, it's an important one,
link |
but it's not the major reason
link |
why most people consume nicotine.
link |
I'd like to take a moment and talk about that now
link |
because we are in the brain
link |
and we're talking about the effects of nicotine in the brain
link |
and so it seems to me the appropriate time
link |
to talk about this.
link |
Now, we can have this conversation about nicotine
link |
and appetite and metabolism
link |
in a very simple and straightforward way.
link |
If you'd like to learn more about the biology of metabolism
link |
and appetite and how those things are mediated
link |
by neural components,
link |
so not just stuff like your liver, et cetera,
link |
we have episodes on that,
link |
but really the neural components of hunger and appetite.
link |
I encourage you to check out our episode
link |
on hunger and appetite.
link |
But in that episode, we had a discussion
link |
and it's one that I'll just briefly summarize now
link |
that you have a collection of neurons
link |
that sits right above the roof of your mouth or so
link |
called the hypothalamus.
link |
Hypo means below and thalamus is right above it,
link |
So the small collection of neurons in the hypothalamus
link |
do a number of different things related to sex behavior,
link |
aggression, mediating the temperature of your body, et cetera,
link |
but also appetite and suppressing appetite.
link |
And within the hypothalamus,
link |
there's a compact collection of these little neurons,
link |
which are referred to as the POMC, P-O-M-C neurons.
link |
And the name comes from the fact
link |
that they express certain peptides
link |
and we won't get into that now,
link |
but the POMC neurons have a very profound impact
link |
on whether or not you feel hungry
link |
or whether or not you do not feel hungry,
link |
whether or not your appetite is suppressed.
link |
It turns out that when nicotine gets into the bloodstream
link |
and then into the brain,
link |
some of that nicotine binds to nicotinic alpha-4 beta-2
link |
containing nicotinic receptors.
link |
Again, these subunits are receptors,
link |
but basically the nicotine binds
link |
to one of those parking spots, parks there.
link |
And as a consequence, these POMC, P-O-M-C neurons
link |
increase their electrical activity
link |
and appetite is suppressed.
link |
And that's because the POMC neurons have outputs
link |
to various areas of the brain and body
link |
controlling everything from how full we feel
link |
to whether or not our blood sugar goes up or down,
link |
which can impact our hunger.
link |
And believe it or not,
link |
whether or not we have a tendency
link |
to want to move the jaw of our mouth in order to chew food.
link |
Yes, believe it or not,
link |
the neural circuitry associated with appetite
link |
and suppression of appetite
link |
actually dictates whether or not you prefer to,
link |
or I should say are more biased or less biased
link |
to moving your mouth, that is chewing,
link |
which makes perfect sense when you hear it, right?
link |
One way to suppress appetite is to sew the jaw shut neurally
link |
or at least make it less likely to open your mouth
link |
and put food in it.
link |
Actually, that reminds me of a story.
link |
I'll just interrupt myself to tell a brief story,
link |
that there's a famous Nobel Laureate
link |
who won the Nobel Prize
link |
for something totally distant from appetite,
link |
but once turned to a friend of mine at a meeting and said,
link |
I discovered the biological mechanism for losing weight.
link |
And my friend said, well, of course,
link |
it's a ingest fewer calories than you burn, right?
link |
Calories in, calories out,
link |
fundamental rule of thermodynamics
link |
and basically the fundamental rule
link |
of weight loss, weight gain, or weight maintenance.
link |
And he said, no, it's actually the gene
link |
that controls whether or not you open your mouth.
link |
Now he was making a very nerdy joke.
link |
So if you didn't register that as a joke,
link |
that's about as funny as neuroscience or biology jokes get.
link |
There are a couple of funnier ones,
link |
but that one's kind of considered on the funnier side.
link |
So this is why we're not considered comedians.
link |
But the point of the matter is that
link |
whether or not you crave or desire
link |
or impulsively want to put things in your mouth and chew it
link |
will actually dictate how many calories that you eat.
link |
And so I find it remarkable and indeed important to know
link |
that these POMC neurons are actually inhibiting
link |
the opening and the movement of the mouth for chewing.
link |
So when we smoke or when we ingest nicotine
link |
in any other way, you activate these POMC neurons,
link |
you suppress appetite, but in part,
link |
you do that by actually limiting the impulse to chew.
link |
Incredible, at least to me.
link |
Now, in addition to limiting appetite
link |
by changing one's desire to ingest food and chew it
link |
and actual craving of food
link |
by regulation of blood sugar, et cetera,
link |
there do seem to be some quite direct effects
link |
of nicotine on metabolism.
link |
And the effects on metabolism aren't enormous.
link |
These are increases in metabolism
link |
that are about 2% up to about 5%.
link |
But I want to emphasize that those are transient increases
link |
Nonetheless, people that quit smoking often find
link |
that their appetite goes up.
link |
They sometimes gain weight.
link |
They sometimes do not, depending on whether or not
link |
they offset that increase in appetite
link |
with increased physical exercise
link |
or with decreased food intake in other ways.
link |
But there does seem to be this direct effect
link |
of ingesting nicotine on metabolism,
link |
which I find is interesting
link |
because if you look in the literature,
link |
one of the reasons why people are reluctant
link |
to quit ingesting nicotine,
link |
if for instance, they want to quit using the delivery device
link |
to nicotine that's causing such problems for their health,
link |
like smoking or vaping,
link |
or whether or not they find themselves quote unquote
link |
addicted to or have the habit of ingesting nicotine,
link |
in part that's likely due to be the dopamine effects, right?
link |
Because dopamine is highly reinforcing and rewarding.
link |
It feels good, so people want to do more of it.
link |
But it's also that for many people,
link |
and here the data really points to the fact
link |
that a lot of the younger female smokers
link |
or younger female vapers,
link |
or when I say that, of course,
link |
I mean younger females that vape are doing that
link |
because they like the appetite suppressing effects,
link |
which of course opens up an entire conversation
link |
about the sociology of body imagery, et cetera,
link |
a topic for a future podcast.
link |
Okay, so nicotine has certain effects on the brain
link |
by virtue of the fact that nicotine binds
link |
these nicotinic acetylcholine receptors,
link |
and those receptors are found on some,
link |
but not all neural circuits within the brain.
link |
And we talked about some of them already,
link |
mesolimbic, the POMC neurons, et cetera.
link |
Now, when we ingest nicotine,
link |
it goes from the bloodstream
link |
to all the tissues and organs of the body.
link |
How does it do that?
link |
It can pass to everything, the brain, the body.
link |
It does that because nicotine is fat soluble.
link |
And now when anytime people hear the word fat,
link |
they tend to think about body fat, subcutaneous fat,
link |
or maybe they think about dietary fat.
link |
What I mean by fat soluble in the context
link |
of nicotine being fat soluble is that the cells
link |
of your body have an outer layer, so-called outer membrane,
link |
and it's made up of lipid, of fat,
link |
very particular types of lipids in fact.
link |
Nicotine has this remarkable ability
link |
to move through that fatty tissue.
link |
Not all molecules have that ability, but nicotine does.
link |
So it can move relatively freely through the brain and body
link |
and relatively freely from outside of cells,
link |
extracellular space to intracellular space.
link |
So it can get into cells.
link |
It can do that with the brain.
link |
We talked about those effects
link |
and it can do that within the body.
link |
Now, anytime we're talking about the body,
link |
we can be talking about any number of things,
link |
but today I'm going to refer to the periphery and the body
link |
in more or less the same way,
link |
but keep in mind in the back of your head, pun intended,
link |
you have your brain, your eyes, and the spinal cord,
link |
and those three things make up your central nervous system.
link |
The peripheral nervous system and the periphery,
link |
which is the rest of your body,
link |
that contain your organs and so forth
link |
outside of the nervous system,
link |
things like your liver and your stomach, et cetera,
link |
that's what we're going to talk about now,
link |
because nicotine has profound effects
link |
on the organs of the body that are separate from,
link |
but that occur in parallel at the same time
link |
as the effects of nicotine on the brain.
link |
So let's talk about what some of those effects are.
link |
When nicotine makes it into the bloodstream,
link |
again, within two to 15 minutes of ingesting it,
link |
depending on the delivery device,
link |
your heart rate will increase,
link |
blood pressure will increase,
link |
and the contractibility of the heart tissue
link |
will actually increase.
link |
So what that essentially speaks to
link |
is an increase in so-called sympathetic tone.
link |
And when I say that, I don't mean an increase in sympathy
link |
for others of the emotional sort.
link |
What I mean is an increase in the sympathetic activity
link |
of the sympathetic arm of the autonomic nervous system,
link |
which is a real mouthful and mindful of ideas,
link |
but all you need to know is that it's a generalized system
link |
that increases levels of alertness and physical readiness.
link |
So it makes you ready for action,
link |
makes you ready for thought.
link |
It's balanced by a whole other system
link |
called the parasympathetic nervous system,
link |
which is basically the so-called rest and digest system,
link |
which is a system of neurons and organs, et cetera,
link |
that put your body and your brain into a state
link |
of not being able to think clearly,
link |
to digest and to fall asleep.
link |
Okay, so nicotine increases heart rate, blood pressure,
link |
and contractibility of the heart.
link |
So it's going to cause more blood flow in theory,
link |
although it also tends to constrict blood vessels
link |
in many locations in the body.
link |
This explains the decrease in penile girth effect
link |
of nicotine, in particular,
link |
nicotine ingested by smoking or vaping.
link |
That's right, smoking and vaping reduces penis size,
link |
and also will have damaging effects
link |
on the bloodlining endothelial tissue.
link |
So over time, it actually is impairing blood's ability
link |
to get to the penis chronically,
link |
as well as to other organs of the body.
link |
But when people ingest nicotine acutely,
link |
and let's say they do that by Nicorette patch
link |
or by toothpick dipped in nicotine,
link |
it will have some of these same effects.
link |
But when not smoking tobacco,
link |
when bringing nicotine into the bloodstream
link |
through other mechanisms,
link |
many, if not all of the disruption
link |
of the endothelial cell function can be bypassed.
link |
But the effects on penile girth,
link |
the effects on reducing blood flow to various tissues
link |
is still present during the effects of nicotine,
link |
which as I mentioned, last about one to two hours.
link |
The half-life is about one to two hours,
link |
depending on the number of factors.
link |
Not interesting for today's discussion.
link |
So when nicotine gets into the bloodstream,
link |
it's making us more alert.
link |
It's preparing our body for readiness.
link |
The heart is pumping harder.
link |
Epinephrine, that is adrenaline,
link |
is released from the adrenal glands,
link |
which ride atop our kidneys.
link |
So everything is pointed toward creating more readiness
link |
to move, more readiness to think.
link |
And again, this is happening in parallel
link |
with all the effects of neurochemistry
link |
that are happening with the brain
link |
that we talked about a few minutes ago.
link |
And what's interesting about nicotine
link |
is that while it causes this global increase in readiness
link |
and alertness and attention and mood, et cetera,
link |
it also has the effect of somewhat relaxing skeletal muscle.
link |
Now that might seem counterintuitive
link |
to those of you out there that already know,
link |
what I'm about to tell the rest of you
link |
who didn't know it previously,
link |
that your muscles are able to contract
link |
because of the effects of acetylcholine
link |
released from neurons in your spinal cord
link |
that spit out acetylcholine onto the muscle
link |
Nicotinic acetylcholine receptors, put into plain English,
link |
nicotinic receptors are also the ways
link |
in which your muscles can get activated.
link |
So therefore, why would it be that increasing nicotine
link |
would cause relaxation of the muscles?
link |
And that has to do with some of the neural circuits
link |
that are upstream of the muscles.
link |
And it has to do with a little bit
link |
of how the autonomic nervous system
link |
is arranged in terms of which receptors go where.
link |
A topic and kind of rabbit hole of conversation,
link |
far too deep for right now,
link |
at least in the context of this already
link |
somewhat detailed discussion of the effects of nicotine.
link |
But if we were to zoom out
link |
and just think about the effects of nicotine,
link |
we now have a very clear picture.
link |
Reward pathways are turned on, attention is turned on,
link |
alertness is turned on.
link |
You feel better than you felt a few minutes ago.
link |
Your blood pressure is up.
link |
Your heart rate is up.
link |
Your preparedness for thinking is elevated as well.
link |
And yet your body is somewhat relaxed.
link |
That's a very interesting state of mind and body.
link |
Interesting because it's somewhat ideal for cognitive work.
link |
If you were going to sit down and work on a book,
link |
or you're going to sit down
link |
and try and figure out a hard math problem,
link |
or you're going to write a letter
link |
that's been really challenging for you to write,
link |
or maybe that you're really excited to write,
link |
but that you've been slow to get out the door
link |
for whatever reason.
link |
Here I'm talking about my own habits of procrastination.
link |
Well, that state of being very alert
link |
but your body being relaxed
link |
is almost if not the optimal state
link |
for getting mental work done.
link |
Because if you're feeling agitated in your body
link |
and you want to physically move your body,
link |
it's very hard to do cognitive work,
link |
at least the sorts of cognitive work
link |
that involve typing or writing or these sorts of things.
link |
It's also the exact opposite of the optimal state
link |
for physical performance,
link |
which is one of, yes, also alertness.
link |
Yes, also motivation and elevated mood.
link |
That's all wonderful stuff to have in mind, literally,
link |
when you are exercising or competing in sport
link |
or something of that sort.
link |
But under those conditions,
link |
you really also want to have a fast reaction time,
link |
a low latency for muscle activation
link |
so that you can make coordinated muscle movements
link |
in the ways that you need to,
link |
which is of course what's required of physical endeavors.
link |
That tells us a few things.
link |
First of all, it tells us that nicotine
link |
is going to be generally a bad idea
link |
for a pre-workout tool
link |
or for enhancing physical performance.
link |
However, it's apt to be, and in fact is,
link |
an excellent tool for enhancing cognitive ability.
link |
And of course, that triggers my mind
link |
to return to the anecdote
link |
about my Nobel Prize-winning colleague
link |
who ingests nicotine by way of nicotine-containing gum
link |
in order to increase levels of cognitive focus,
link |
certainly not for going out and playing sport.
link |
In fact, despite the fact that he is very, very tall,
link |
he often points to himself in an appropriately funny way
link |
that despite being on the basketball team of his high school
link |
he's probably the worst player that ever existed
link |
and they only positioned him there because of his height.
link |
And I guess his head was designed
link |
to prevent balls from entering the basket.
link |
In any event, nicotine does seem to be very good
link |
at enhancing cognitive function, at least in the short term,
link |
which is not to say that it isn't without its side effects,
link |
which we will talk about.
link |
And again, those are side effects
link |
that are independent of smoking or vaping
link |
or other forms of ingesting nicotine.
link |
For instance, dipping or chewing tobacco
link |
is known to cause a 50-fold, yes, five zero,
link |
50-fold increase in mouth cancers, things like leukoplakia
link |
and just generally is terrible for your health.
link |
I'm sorry to break it to you, but if you're dipping
link |
or you're using snuff or things of that sort,
link |
certainly I'm not going to tell people what to do.
link |
That's not my role in life,
link |
but you are dramatically increasing the probability
link |
of an oral cancer or of a mucosal lining cancer
link |
So it's not just that smoking and vaping
link |
are bad for your health.
link |
These other forms of delivery from nicotine
link |
can be bad for your health as well.
link |
And whether or not ingesting nicotine
link |
by way of nicotine containing gum or patch or toothpick
link |
or other method is dangerous.
link |
For other reasons is a discussion that's important.
link |
Right now, it appears that provided the dosages
link |
are kept reasonable,
link |
and we'll talk about what reasonable means a little later,
link |
and the frequency is kept relatively low,
link |
so not relying on these things constantly,
link |
there may in fact be some benefit to ingesting nicotine
link |
from time to time,
link |
provided that you are not still developing your brain.
link |
neuroplasticity goes on throughout the lifetime.
link |
Your life is actually one long developmental arc.
link |
It's not only development occurs and then stops,
link |
but certainly for people before puberty, during puberty,
link |
and probably for the next 15 to 20 years after puberty,
link |
avoiding nicotine is probably a good idea.
link |
Now, of course, development is your entire life.
link |
It's not like development starts and then ends,
link |
but certainly for people that are 25 years old or younger,
link |
ingesting nicotine as a way to enhance cognitive function
link |
is probably not the best idea.
link |
And certainly, please,
link |
for those of you that are 15 years old or younger,
link |
ingesting nicotine in any form,
link |
unless it's prescribed by your doctor
link |
for a very specific clinical reason,
link |
to me seems just like a terrible idea
link |
based on all the data that I've read.
link |
And the reason for that is it's going to create a scenario
link |
of nicotine dependence in order to achieve heightened levels
link |
of mood and alertness, et cetera, and that's bad.
link |
And what we're effectively talking about
link |
is an addiction for nicotine directly,
link |
not necessarily the delivery device method
link |
like smoking or vaping, although it could pull that in
link |
as an addictive or habit-forming behavior as well.
link |
But you want to let your neural circuits develop
link |
to the point where, again,
link |
unless there's a clinical need for a prescribed drug
link |
from a licensed physician or psychiatrist, et cetera,
link |
that you're not relying on chemical enhancement
link |
of these circuits.
link |
For people who are 25 years or older,
link |
and again, that's not a strict cutoff,
link |
but roughly 25 years or older,
link |
but for those of you that are thinking about using nicotine
link |
to enhance cognitive function as adults
link |
and your brain development is slowing down, right?
link |
Never ceases, but it's slowing down
link |
or has slowed down to the point
link |
where we would say developmental plasticity is largely over
link |
and you're now operating
link |
in the context of adult neuroplasticity.
link |
Well, in that case, there may be instances
link |
in which increasing acetylcholine, dopamine, et cetera,
link |
by way of nicotine ingestion might be a good idea,
link |
but certainly not by smoking, vaping,
link |
or by direct contact of tobacco
link |
to the mucosal lining tissue of the mouth or nose,
link |
so-called dipping or snuffing.
link |
For the last 20 minutes or so,
link |
we've been talking about the biology
link |
of nicotine specifically, how it impacts the brain,
link |
how it impacts the body, why it feels so good,
link |
why it can enhance focus.
link |
And we've largely set aside smoking, vaping,
link |
dipping tobacco, and snuffing,
link |
and the negative effects that those all have
link |
on mental and physical health.
link |
Working down from the top of the head
link |
to the bottom of the feet,
link |
we can say that smoking, vaping, dipping, and snuffing
link |
negatively impact every organ and tissue system
link |
and cell of the body by virtue of the fact
link |
that they all damage the endothelial cells.
link |
Again, the endothelial cells are the cells
link |
that make up the vasculature,
link |
which delivers blood and other nutrients
link |
to all the cells and organs and tissues of the body.
link |
And those endothelial cells are strongly
link |
and negatively impacted by all of the practices
link |
that I just described.
link |
Now, the way that that happens varies a little bit
link |
from each one to the next.
link |
For instance, it has been estimated
link |
that cigarettes contain anywhere
link |
from 4,000 to 7,000 toxins.
link |
Now, the word toxins is a real buzzword these days.
link |
You hear about detoxes and toxins,
link |
but more specifically, we know that it contains carcinogens.
link |
These are cancer promoting compounds.
link |
For instance, we know that the tar in cigarettes,
link |
even low tar cigarettes,
link |
as well as the ammonia within cigarettes,
link |
as well as the formaldehyde contained within cigarettes,
link |
as well as the carbon dioxide that's generated
link |
from smoking those cigarettes are all carcinogens.
link |
Carbon dioxide also has the negative effect
link |
of depleting the amount of oxygen that's delivered
link |
to any and all of our tissues
link |
by way of the impact of carbon dioxide,
link |
binding hemoglobin and preventing hemoglobin
link |
from delivering oxygen to the tissues of the body.
link |
So while there may be 4,000 or 4,500 or 7,000 toxins,
link |
depending on which cigarette,
link |
which papers they happen to be rolled in,
link |
whether or not they're filtered or non-filtered,
link |
the type of tobacco, et cetera, et cetera,
link |
there are a tremendous number of toxins
link |
and there are some very potent carcinogens
link |
within that long list of toxins.
link |
Again, ammonia, tar, formaldehyde and carbon dioxide
link |
being the most potent of those carcinogens.
link |
Now, the fact that there are carcinogens in cigarettes
link |
sometimes leads cigarette smokers
link |
and particularly the cigarette smokers
link |
that have the hardest time quitting
link |
or that enjoy their cigarettes the most from saying,
link |
well, listen, everything is a carcinogen
link |
or everything kills you.
link |
Well, certainly that's not a true statement.
link |
And while there are other carcinogens in the environment,
link |
so environmental hazards like solvents
link |
and even if you work in a laboratory, for instance,
link |
we use in the laboratory DNA intercalating dyes.
link |
These are literally dyes that allow us
link |
to see the DNA structure of cells
link |
and see the proteins they make
link |
and see the RNAs they make.
link |
And it's very important to wear gloves
link |
when you work with those things
link |
because as the name suggests, they intercalate,
link |
they actually get in between the strands of DNA
link |
and separate them.
link |
They are mutagens, they mutate DNA.
link |
They are often carcinogens as well.
link |
So we have them in our laboratory,
link |
but we take certain precautions
link |
to not have them negatively impact our health,
link |
safety protocols and so on.
link |
We hear that there are carcinogens in car exhaust
link |
and bus exhaust and in all sorts of things like pesticides.
link |
And that's all true.
link |
So in the argument of probabilities, one would say,
link |
well, if there are all these other carcinogens
link |
in the environment,
link |
why would you compound their carcinogenic effect
link |
by smoking or vaping or dipping or snuffing?
link |
But that usually doesn't get people to quit smoking
link |
or doing those things
link |
because of the powerful reinforcing effects
link |
of nicotine itself.
link |
So again, nicotine is the reinforcing element
link |
by way of triggering that dopamine reinforcement pathway,
link |
the mesolimbic reward pathway.
link |
And of course there are all the other additional effects
link |
of increased focus,
link |
such as increased ability to pay attention to work
link |
or to others that lead to other rewards.
link |
And so then it becomes a situation of compounding reward.
link |
So it's not really about the cigarette,
link |
it's about the nicotine.
link |
And it's not really about the nicotine,
link |
it's about the dopamine that the nicotine evokes.
link |
And then it's not really about the dopamine
link |
that the nicotine evokes directly per se,
link |
but also about all the positive effects
link |
that that increased dopamine results in.
link |
So we can easily circle back to the negative effects
link |
of smoking, vaping, dipping, and snuffing
link |
and say the endothelial cells are disrupted.
link |
The endothelial cells are involved in delivery of blood
link |
and other nutrients to every tissue of the body
link |
and smoking, vaping, dipping, and snuffing
link |
contain carcinogens, which are cancer promoting.
link |
And because the epidemiological studies are out there,
link |
we can actually arrive at some very clear numbers
link |
as to how much life one will lose
link |
from ingesting nicotine by way of those four delivery
link |
devices, or I should say any one
link |
of those four delivery devices.
link |
Although I should also mention that many people
link |
who are vaping are also smoking cigarettes,
link |
this is becoming increasingly common.
link |
A lot of people are using vaping in one context
link |
and cigarettes in another,
link |
dipping in one context, vaping in another.
link |
But even for those that only smoke or only vape
link |
or only dip or only snuff,
link |
the negative effects are dramatic and calculable.
link |
So it is thought that for every pack of cigarettes
link |
consumed per day, so you could average that out
link |
if you're a two a day cigarette smoker
link |
or a pack a day cigarette smoker or two pack a day,
link |
for every pack of cigarettes smoked per day,
link |
we can reliably estimate a 14 year reduction in lifespan.
link |
So cigarettes are literally peeling years off your life.
link |
Now, because of the way that the brain works
link |
and the way that human beings anticipate the future
link |
and can be grounded both in the present and the future
link |
or the present and the past,
link |
that's just how the mind works, right?
link |
That's why we can think about the future,
link |
but also realize where we are in time and space today.
link |
Because of that, many people will say,
link |
well, I enjoy cigarettes or I enjoy vaping.
link |
And so at least while I'm here, I'm enjoying it.
link |
And that's because the dopamine system is not very good
link |
at understanding opportunity costs.
link |
That is what we would be doing in those 14 years
link |
and what we would be enjoying.
link |
And the enrichment that we would get
link |
if we were to live into those 14 years.
link |
So at some level, the smoker, the vapor is being rational
link |
when they say, yeah, but I enjoy this.
link |
And so the years lost, I can't really register that
link |
because it's hard to register what you don't have
link |
and what you've never had, right?
link |
On the other hand, we can also point to the statistic
link |
that there is this 50 fold increase in mouth cancers
link |
from dipping and there are nasal cancers as well
link |
that are greatly increased by snuffing.
link |
And from smoking, and now we know based on data from vaping
link |
that the endothelial cell damage and the direct effects
link |
of damage to the lungs from TARS.
link |
And even if people are vaping,
link |
which tends to have lower TARS than do cigarettes,
link |
even for people that are vaping,
link |
greatly increased probability of stroke,
link |
of peripheral vascular disease.
link |
So this is peripheral pain because remember,
link |
blood is delivering not just blood, but other nutrients
link |
and it's clearing things out from tissues.
link |
So there's an accumulation of literally toxins and debris
link |
that cells generate all the time, which is healthy,
link |
but then normally is cleared away by the endothelial cells
link |
and by other cell types of the immune system.
link |
That's all increased in people that engage
link |
in these nicotine delivery device behaviors.
link |
Rates of heart attack, rates of stroke,
link |
rates of cognitive decline are all increased.
link |
Now you might say cognitive decline,
link |
I thought that nicotine increases the likelihood
link |
that we can maintain healthy neuronal function
link |
and cognitive capacity.
link |
It might even increase cognitive capacity in a potent way
link |
in the short term, and indeed it does.
link |
However, cigarette smoking and vaping are now known
link |
to dramatically decrease cognitive function
link |
because one of the key things about the brain
link |
is that it is the most metabolically demanding organ,
link |
which means it consumes a lot of glucose.
link |
Or even if you're ketogenic, you need ketones,
link |
you need nutrients getting to the neurons
link |
and other cell types of the brain and nervous system
link |
in order for it to function properly.
link |
And when you disrupt the vasculature
link |
through this endothelial cell dysfunction,
link |
you got things like interstitial,
link |
which just means in the spaces between dysfunction.
link |
So it's not just beating up the endothelial cells themselves
link |
but the spaces between the cells is being disrupted.
link |
There's a lot of debris that accumulates there.
link |
And as a consequence,
link |
the brain just simply will not function as well.
link |
So you start getting short-term memory lapses,
link |
you start getting working memory lapses.
link |
Working memory is a sort of memory
link |
if someone tells you their seven digit phone number,
link |
typically nowadays people just share their info,
link |
but seven digit phone number or a sequence of numbers
link |
or an address and your inability to remember that.
link |
So you're walking back to the kitchen sink
link |
and you can't remember what you were trying to remember
link |
just a short moment ago, that's working memory.
link |
Working memory suffers long-term memory,
link |
projective or interrogate memories into the future.
link |
How can you remember things in the future
link |
that haven't occurred yet?
link |
Well, this is more of a memory for future plans
link |
or ideas and planning for things that are to come.
link |
So what we can very reliably say is that currently
link |
more than 1 billion, billion,
link |
more than 1 billion people consume tobacco
link |
in order to get their nicotine,
link |
because that's really the reinforcing element within tobacco.
link |
More than 1 billion people consume tobacco
link |
in the form of cigarettes every day.
link |
A growing number of people,
link |
more than half a billion people now are starting to vape.
link |
The estimates range from 200 million to 500 million.
link |
And there's a lot of debate about this
link |
because a lot of people are hybrid smokers and vapers,
link |
meaning they do one or both,
link |
depending on time of day and location,
link |
as I mentioned before.
link |
But now you start to see how you can get to the number
link |
that billions of people are consuming tobacco,
link |
because of course you also have your people
link |
that are dipping and your people that are snuffing.
link |
And as I mentioned before,
link |
you have people that are engaging
link |
in multiple of these behaviors.
link |
So billions of people on planet earth,
link |
anywhere from one eighth to a quarter of human beings,
link |
incredible, right?
link |
Anywhere from one eighth to a quarter of human beings
link |
are consuming tobacco in one form or another
link |
in order to get their nicotine one way or another.
link |
And as a consequence are peeling ears off their life,
link |
dramatically increasing the probability of cancer, stroke,
link |
heart attack, peripheral neuropathies, brain dysfunction,
link |
meaning cognitive dysfunction,
link |
memory impairment, sexual dysfunction.
link |
There are a number of studies
link |
that have looked at increases in cortisol,
link |
and while minor, those increases do exist,
link |
decreases in growth hormone,
link |
and while minor, those decreases exist.
link |
But even setting aside the negative impact on endocrine,
link |
on hormone factors, it's very, very clear
link |
that smoking, vaping, dipping, and snuffing
link |
are among the worst things that we can do for our health.
link |
They are among the leading causes of preventable death
link |
and debilitating life conditions,
link |
which may lead you to the question
link |
as to why in the world would people do this?
link |
Well, it turns out most of them don't want to.
link |
In the best surveys that one can find
link |
of if you could quit smoking,
link |
if you could quit vaping, would you?
link |
What you find is that at least for cigarette smokers,
link |
70%, seven zero, want to quit.
link |
They would love to quit,
link |
and yet they find that to be exceedingly difficult.
link |
And the reason they find it to be exceedingly difficult
link |
is because of all the brain neurochemistry
link |
that we talked about before.
link |
The reason I spent close to 20 minutes
link |
talking about dopamine in the mesolimbic pathway,
link |
acetylcholine in the nucleus basalis,
link |
and epinephrine and the relaxation of muscles
link |
in the periphery and the increase in readiness
link |
in the body and brain is that all of those combined
link |
to make nicotine one of the most powerful
link |
and potent cognitive enhancers,
link |
and to some extent, physical enhancer,
link |
although, as I mentioned before,
link |
the total number of physical exercise
link |
or physical sport promoting effects of nicotine
link |
is very, very small, if not zero.
link |
There are certain conditions
link |
under which one might imagine using nicotine
link |
specifically for cognitive enhancement
link |
where performance of complex motor skills
link |
would sort of outweigh the negative effects
link |
on the neuromuscular system,
link |
our ability to generate coordinated movements.
link |
There's actually an excellent study
link |
looking at the effects of nicotine,
link |
not by smoking delivery,
link |
but by a different delivery mechanism
link |
in which they looked at performance of hitters in baseball.
link |
The experiment was kind of an interesting one.
link |
Even though these were fairly skilled baseball players,
link |
what they had them do was hit a ball off a tee.
link |
As I recall growing up, and admittedly,
link |
I didn't play much baseball,
link |
but you start off on tee ball and then you would go,
link |
I think it was to pitching machine,
link |
then they would use actual pitchers who throw the ball.
link |
it was a couple of different baseball-related tasks.
link |
They'd have people hit the ball off a tee,
link |
but they had to direct that hit
link |
toward a ball atop another tee.
link |
So it's fairly precise targeting that's required
link |
in order to knock that ball off the other tee.
link |
So this is an activity that involves not just motor output,
link |
but coordinated motor output,
link |
and not just coordinated motor output,
link |
but directed coordinated output that requires some,
link |
as we would say, top-down processing, right?
link |
This isn't the kind of thing that can be done reflexively.
link |
This is the kind of thing where the forebrain,
link |
the prefrontal cortex in particular
link |
has to be heavily involved
link |
in order to suppress certain actions
link |
and then create other actions.
link |
So the basic takeaway of the study
link |
is that nicotine delivered by way of nicotine gum,
link |
not by smoking, dipping, or snuffing,
link |
was able to increase cognitive performance and motor output.
link |
So a rare circumstance where a specific set of demands
link |
that involve both cognitive engagement
link |
and physical engagement
link |
showed a slight but significant improvement.
link |
But again, in most cases,
link |
nicotine is just simply not going to improve physical output
link |
if it's delivered through a smoked cigarette,
link |
through vaping, through dipping, or through snuffing.
link |
So if all these behaviors are terrible
link |
for essentially every aspect of our health, frankly,
link |
I mean, when you look at the literature,
link |
it's terrible for pregnant women.
link |
It's terrible for kids.
link |
It's terrible for older people.
link |
It's terrible for younger people.
link |
I mean, you really cannot find a scenario
link |
in which smoking, vaping, dipping, or snuffing
link |
And yet people like the effects on the brain
link |
and they feel quite addicted to them,
link |
even if they say they're not.
link |
Most of those people would be unwilling to give up
link |
their practice of nicotine delivery
link |
for more than a few hours.
link |
In fact, if you look at the effects of withdrawal,
link |
and we are going to talk about what withdrawal
link |
of nicotine looks like, what you find is that
link |
as soon as four hours after the last ingestion of nicotine
link |
by way of cigarette or vaping or dipping or snuffing,
link |
what people start to experience is some agitation,
link |
craving for nicotine, of course.
link |
And while craving is kind of a vague concept,
link |
it's actually a very specific biological mechanism.
link |
It's the drop in dopamine that's starting to occur,
link |
so much so that there's a drop in dopamine below baseline.
link |
That is the increase in dopamine
link |
that would normally be experienced from smoking, vaping,
link |
dipping, or snuffing is now not happening.
link |
And in fact, the levels of dopamine are dropping
link |
below where they would have been
link |
even without performing that behavior.
link |
So that's what craving is,
link |
and withdrawal is an increased sense of that craving,
link |
as well as a lot of negative stuff like stomach aches
link |
or nausea or irritability,
link |
and often collections of all of those.
link |
So because these nicotine delivery approaches
link |
are so terrible for our health,
link |
and also because as many as 70% of people who smoke
link |
would like to quit, but either feel they can't
link |
because they've tried and failed repeatedly often,
link |
or because it's just too scary,
link |
meaning the reinforcing properties are too strong
link |
and therefore they can't imagine living without them,
link |
or the withdrawal effects are too strong
link |
and they can't imagine living with those,
link |
well then is there hope for quitting smoking,
link |
vaping, snuffing, or dipping?
link |
And the short answer, fortunately, is yes.
link |
There are excellent ways to do that,
link |
and some of them are single event treatments.
link |
And we're going to talk about those shortly.
link |
But before we do that,
link |
I want to highlight one very brief point,
link |
which is that nicotine is not the cause of cancer.
link |
Nicotine is not the carcinogen.
link |
It's the other things in tobacco
link |
or associated with the nicotine delivery device
link |
that are causing cancer,
link |
and I should mention the other negative impacts
link |
on our health in particular
link |
by way of disrupted endothelial blood vessel function.
link |
Now that leads us to this issue of vaping,
link |
because as many of you know, and probably are thinking
link |
as I've been delivering this information,
link |
people don't vape tobacco.
link |
The way that vaping pens are designed
link |
is that it includes some liquid, it involves heat,
link |
and it does not involve the burning off of tobacco.
link |
In fact, there's a constant updating
link |
of the engineering of these vape pens
link |
so that they can be very low heat.
link |
In some cases, they use even non-heating approaches
link |
to vaporize the nicotine
link |
and allow it to enter the bloodstream very quickly.
link |
I must say in a lot of ways, vaping resembles crack cocaine.
link |
The reason why vaping and crack cocaine are so similar
link |
is the speed of entry of nicotine into the bloodstream.
link |
This isn't an episode about cocaine,
link |
but I just want to very briefly touch
link |
on some of the delivery routes for cocaine
link |
because they parallel a lot of the delivery routes
link |
for nicotine, and we can learn a lot
link |
about drug pharmacokinetics and dopamine
link |
if we look at the parallels between cocaine and nicotine.
link |
I'll preface this by saying cocaine is a terrible drug.
link |
It is actually a schedule II drug in the United States,
link |
which means that it has a very, very limited
link |
yet still present medical application,
link |
mainly as an anesthetic in certain laboratory
link |
and hospital conditions.
link |
But aside from that, it's very clear
link |
that cocaine is one of the most debilitating drugs
link |
that humans can use because of the way
link |
that it impacts the dopamine system.
link |
And it basically creates a loop whereby the only thing
link |
that can really trigger dopamine release is cocaine.
link |
And as I've said before, the way that I define addiction
link |
is it's a progressive narrowing of the things
link |
that bring people pleasure.
link |
Cocaine certainly falls into the category
link |
of addictive drugs, strongly addictive drugs.
link |
And in fact, it has the additionally pernicious feature
link |
that after using cocaine for some period of time,
link |
the amount of dopamine that's released
link |
becomes progressively lower and lower and lower
link |
so that people can never get back to a state
link |
in which dopamine release is ever as great
link |
as it was the first time they did cocaine
link |
or prior to doing cocaine.
link |
Now, with a long period of no cocaine use whatsoever
link |
and protecting the dopamine system
link |
in a number of different ways, people can often,
link |
not always, but often recover their dopamine system,
link |
if not completely, then near completely.
link |
So by all means, if you have a problem with cocaine, quit,
link |
find a way to quit, get treatment,
link |
get over that one way or another.
link |
We have an episode with an expert guest, Dr. Anna Lemke,
link |
who's a physician and the chief
link |
of the Stanford School of Medicine
link |
Dual Diagnosis Addiction Clinic.
link |
She's a world expert in dopamine and addictive substances
link |
and addictions of all kinds.
link |
You can find that episode at Hubermanlab.com.
link |
It's filled with information about how to get over
link |
different types of addictions, including cocaine addiction.
link |
Also check out her absolutely phenomenal
link |
and indeed important book, Dopamine Nation,
link |
which touches on some of this as well.
link |
And in the show note captions for the episode
link |
where Dr. Lemke was my guest,
link |
you can also find some additional resources related to that.
link |
So cocaine is terrible.
link |
That needs to be acknowledged.
link |
It should be avoided and you should find a way
link |
to quit it if you are currently using.
link |
With that said, the delivery mechanism for cocaine
link |
strongly parallels the delivery mechanisms for nicotine.
link |
That is people will snort cocaine,
link |
which is a lot like snuffing or dipping.
link |
That is when people snort cocaine,
link |
they're bringing cocaine into proximity or into contact
link |
really with the mucosal lining of the nasal passages,
link |
which then allows the psychoactive substances
link |
to permeate into the bloodstream.
link |
Very seldom do people eat it,
link |
although that does happen from time to time.
link |
People will inject it, then a so-called main lining,
link |
which is a very rapid entry into the bloodstream
link |
because it's direct application to the bloodstream
link |
by way of injection.
link |
And then there's crack cocaine,
link |
which is essentially like a vaporizing of the cocaine
link |
from a so-called cocaine rock
link |
that somewhat resembles vaping of nicotine.
link |
So while the vape pen involves a liquid
link |
that sold a cartridge that contains nicotine
link |
and often other flavors as well,
link |
flavorings I should say,
link |
both crack cocaine and vaping cause very rapid increases
link |
in the relative substances that are psychoactive.
link |
In the case of cocaine, that would be cocaine
link |
and the increase in dopamine in the brain and body,
link |
And in the case of vaping,
link |
there's a very rapid increase in blood concentrations
link |
of nicotine, much faster than occur with cigarette smoking
link |
or other modes of nicotine delivery.
link |
So that speed of onset turns out to be a critical parameter
link |
because the speed of onset of nicotine
link |
is going to also determine the speed of release of dopamine
link |
in the nucleus accumbens and ventral tegmental area,
link |
that mesolimbic reward pathway.
link |
And with the mesolimbic reward pathway,
link |
it's not just about the peak,
link |
meaning the maximal amount of dopamine that's released,
link |
but it's the time course, how steep the curve is,
link |
how quickly that dopamine increases,
link |
that's going to determine how reinforcing,
link |
how habit forming and indeed how addictive
link |
a particular substance is.
link |
So one of the major important differences
link |
between vaping and cigarette smoking
link |
is that the onset of dopamine release from vaping is faster.
link |
And even a subtle increase in the rate
link |
at which dopamine increases in the mesolimbic reward pathway
link |
can make a given amount of nicotine
link |
much more habit forming and addictive.
link |
This probably explains the fact that many, many more people
link |
in particular young people, age 25 and younger
link |
are vaping at phenomenal rates now.
link |
People are starting to vape in just about everywhere.
link |
You see this in restaurants, you see it on the street.
link |
Indeed, you even see it in the classroom.
link |
This has actually become sort of sport of sorts.
link |
It's certainly not something I encourage.
link |
In fact, when I learned about this from a college student,
link |
new college student,
link |
he's telling me that many college students
link |
are actually bringing vape pens into the classroom.
link |
I think this is also happening in high schools
link |
and even junior high schools.
link |
This is a really concerning practice.
link |
And here, I'm not trying to come across
link |
as the anti-vaping crusader,
link |
but I must say given the negative effects
link |
on one's health in the longterm,
link |
but also given these exceedingly powerful reward properties
link |
of nicotine entering the bloodstream quickly
link |
and dopamine being released very quickly
link |
from the mesolimbic reward pathway,
link |
what we're seeing out there makes total sense.
link |
Young people's brains are essentially getting wired
link |
to the expectation that dopamine
link |
is going to be increased dramatically and quickly
link |
under their control,
link |
except it's under their control
link |
only in a very narrow set of circumstances.
link |
Recall the definition of addiction,
link |
a progressive narrowing of the things
link |
that bring you pleasure.
link |
We can change that statement
link |
to also say a progressive narrowing and specific kinetics,
link |
that is specific time course
link |
of the things that bring you pleasure.
link |
Now that's a bit of a nerdier statement
link |
than a progressive narrowing of the things
link |
that bring you pleasure,
link |
but what we're going to see in the next few years, I believe,
link |
is an entire generation of young people
link |
for which a very large percentage of them
link |
are going to be seeking out a pattern or feeling,
link |
because to the person taking it,
link |
they're not looking at their dopamine levels
link |
rising in their blood,
link |
they're experiencing this as an increase in focus,
link |
an increase in alertness,
link |
an increase in mood and wellbeing
link |
that is very rapid, very dramatic,
link |
and that simply cannot be recreated
link |
by any other substance,
link |
and that's a very concerning scenario,
link |
concerning because that mesolimbic reward pathway
link |
is the only pathway,
link |
the only pathway by which you can achieve
link |
the rewarding properties of any kind of endeavor,
link |
not just vaping, of course,
link |
it is the way in which people achieve satisfaction
link |
from reaching a relationship goal or an athletic goal
link |
or an educational goal,
link |
any kind of goal or sense of satisfaction,
link |
and so it comes as no surprise
link |
that vaping is strongly associated
link |
with increased levels of depression,
link |
especially when vaping use drops off,
link |
why would that be?
link |
If people are getting so much more dopamine
link |
so much more quickly from vaping,
link |
shouldn't they be feeling better?
link |
That brings us back to the critical,
link |
and I should say defining feature
link |
of the dopamine reward pathway
link |
for motivation and wellbeing,
link |
which is that initially a given substance will cause,
link |
let's say an eight out of 10, again, arbitrary units,
link |
but eight out of 10 increase in dopamine,
link |
but with repeated use,
link |
what ends up happening is that even at similar
link |
or higher levels of ingestion,
link |
so not just one inhalation a minute,
link |
but maybe two inhalations a minute
link |
or inhalation every 30 seconds,
link |
now it's level four out of 10 activation of dopamine
link |
and then three and then two,
link |
and eventually it drops below baseline.
link |
Now the whole system can be recovered by abstinence
link |
from nicotine consumption,
link |
but the dopamine system is applied to everything,
link |
all sense of wellbeing, all sense of motivation.
link |
So during the period in which one is abstaining
link |
from nicotine and vaping in particular,
link |
people do not feel good, they feel miserable,
link |
that's why it's called withdrawal,
link |
it's associated with a bunch of psychological
link |
and physiological symptoms that all lead back
link |
to trying to get to the same levels of dopamine release
link |
in the same patterns that were experienced
link |
when one initially started vaping.
link |
So I'm not trying to paint a dark picture here,
link |
but frankly, the picture is very dark.
link |
I'm very concerned about a practice of ingesting something
link |
that powerfully modulates the dopamine system
link |
with the sorts of kinetics that one sees
link |
from ingestion of crack cocaine in young people
link |
that has all these other negative health effects
link |
that in the short term is very powerfully rewarding,
link |
increased focus, wellbeing, et cetera,
link |
but that over a very brief period of time
link |
leads to a state in which the entire dopamine reward system
link |
is impaired and can become permanently impaired
link |
unless one intervenes in a very deliberate way.
link |
So people are directly controlling the rate of dopamine
link |
and the frequency of dopamine release
link |
by the duration and frequency of inhalations
link |
And that's an incredible thing because what it does
link |
is it sets up the mesolimbic reward pathway
link |
for an expectation that dopamine will be delivered
link |
So that's one of the things that makes vaping in particular
link |
Vaping is actually harder to quit than cigarette smoking
link |
Now, does that mean that cigarette smoking
link |
is fairly easy to quit for most people?
link |
70% of people who smoke cigarettes report
link |
that they would like to quit if they thought they could.
link |
The success rate of quitting smoking
link |
when people try to go just cold turkey,
link |
just quit with no assistance whatsoever,
link |
they might tell their family and friends,
link |
hey, I'm quitting, that's it, is exceedingly low.
link |
So 5% of the people that say, that's it,
link |
I'm not smoking again, despite cancer diagnosis,
link |
I'm not smoking again,
link |
despite the fear of the negative health effects,
link |
I'm not going to ever smoke again,
link |
despite the financial costs, the health costs.
link |
I mean, I could list off the huge number of things
link |
that it does that are negative,
link |
but you already know these or you've heard them.
link |
It makes your skin worse.
link |
As I mentioned, it lowers libido, it disrupts hormones,
link |
it disrupts vascular function, brain function,
link |
it does all these terrible things,
link |
and yet most people who try and quit simply can't.
link |
And of the 5% that succeed in quitting,
link |
a full 65% of them relapse within a year.
link |
So that's a very depressing picture,
link |
but it's not to say that people cannot quit,
link |
and in fact, they can.
link |
There are a couple of methods that have been shown
link |
to help people quit.
link |
Some are behavioral and some are pharmacologic.
link |
I just want to touch on the behavioral ones first,
link |
because it turns out that there's a quite powerful method
link |
for quitting nicotine ingestion
link |
by way of cigarette smoking,
link |
which also carries over to vaping.
link |
This is beautiful work that's been done by my colleague,
link |
in fact, close collaborator,
link |
although I was not involved in the research
link |
that I'm about to describe, at Stanford,
link |
and his name is Dr. David Spiegel.
link |
He is our associate chair of psychiatry.
link |
He's been a guest on the Huberman Lab Podcast,
link |
and he is a world expert, if not the world expert,
link |
in the clinical applications of hypnosis.
link |
Now, when I say hypnosis,
link |
a lot of people think stage hypnosis,
link |
which is the hypnotist trying to get people
link |
to do certain things and say certain things,
link |
not necessarily against their will,
link |
because they actually have to agree,
link |
but the hypnotist is dictating
link |
what the person thinks, says, and does.
link |
Clinical hypnosis is vastly different from that.
link |
Clinical hypnosis is where the person, the patient,
link |
actually directs their own brain changes
link |
toward a specific emotional or behavioral goal.
link |
Work from Dr. David Spiegel's laboratory, done in 1993,
link |
but that now has been repeated many, many times,
link |
has carried over into some more modern studies,
link |
and I will provide links to those studies
link |
in the show note caption so that you can access them.
link |
Those studies have shown
link |
that using a specific form of hypnosis,
link |
people can achieve complete and total cessation
link |
of cigarette smoking,
link |
and there's no reason to believe
link |
this doesn't also carry over to vaping
link |
through one single hypnosis session.
link |
And the success rates are incredibly high
link |
when one considers that normally
link |
it would be only a 5% success rate.
link |
The success rate with this particular hypnosis
link |
developed at Stanford School of Medicine
link |
by Dr. David Spiegel is 23% of people
link |
who do this hypnosis one time succeed in quitting smoking.
link |
Now, in the old days, which actually wasn't that long ago,
link |
before the advent of smartphones
link |
and before the internet took off to the extent
link |
this was done by having someone come into the clinic,
link |
and Dr. Spiegel himself or one of his colleagues
link |
would take somebody through the hypnosis.
link |
Nowadays, you can access this hypnosis.
link |
There's a wonderful app
link |
that was developed by Dr. David Spiegel and others.
link |
It's called Reveri, R-E-V-E-R-I.
link |
I've talked about this app a few times on the podcast before
link |
because there are hypnosis scripts within the app
link |
for enhancing sleep, for improving ability to fall asleep
link |
if you wake up in the middle of the night,
link |
for focus and a number of other
link |
behavioral and emotional changes.
link |
There's also a function in the Reveri app
link |
for smoking cessation,
link |
which exactly parallels the sort of in laboratory
link |
and in clinic approaches that Dr. Spiegel would use
link |
for you to show up at his clinic or in his laboratory.
link |
And since that's not possible
link |
for the large number of people out there,
link |
if you or somebody else is trying to quit smoking
link |
or vaping or dipping or snuffing for that matter,
link |
I strongly encourage you to check out the Reveri app.
link |
You can find it easily by going to reveri.com.
link |
It's available in various formats.
link |
Some of it is available free,
link |
some of it is behind a paywall,
link |
but given the tremendously negative impact of smoking,
link |
vaping, dipping, and snuffing,
link |
the hypnosis for smoking cessation that Reveri has
link |
seems at least to me as a very powerful
link |
and worthwhile resource.
link |
So please check that out if you're somebody
link |
who's trying to quit ingesting nicotine
link |
by any of the four methods that I just described.
link |
Now, of course, there are other methods
link |
that people have used to successfully quit smoking
link |
or vaping or other forms of nicotine delivery.
link |
And there's actually an excellent review on this topic.
link |
So before diving into a few of the specifics
link |
about some of the pharmacology of using nicotine itself
link |
to quit smoking or nicotine itself to quit vaping,
link |
or the use of various things,
link |
even SSRIs, antidepressants, to quit smoking or vaping,
link |
I just want to point you to a review article
link |
that if you'd like to get a complete survey
link |
of all the options that are available,
link |
there's an excellent review on this.
link |
It was published just a couple of years ago in 2020.
link |
The title of the article is pharmacologic approach
link |
to smoking cessation,
link |
an updated review for daily clinical practice.
link |
And even though this is mainly focused on smoking cessation,
link |
it carries over quite nicely to vaping.
link |
And it details a number of statistics,
link |
the fact that every year 700,000 or more people die
link |
because of smoking related diseases.
link |
So there again, you have the negative health effects
link |
that younger people are smoking,
link |
that women are smoking more nowadays,
link |
and that even though you see less smoking
link |
typically in the US and Canada,
link |
and even in Northern Europe, some places,
link |
there's still many, many people are smoking
link |
who would like to quit.
link |
But that 75% of people,
link |
at least according to this review earlier, I said 70%,
link |
but estimates are as high as 75% of people
link |
who try to quit smoking relapse within the first week.
link |
The first week, they just go right back to it.
link |
That's how powerfully reinforcing the nicotine is.
link |
Remember, it's the nicotine in the cigarette
link |
that's powerfully reinforcing,
link |
but it's also the oral habit, the motor habit.
link |
There is this thing about density of sensory receptors
link |
People like bringing things to their lips,
link |
food, cigarettes, other lips in some cases, et cetera.
link |
There is a reinforcement pathway related to that
link |
for sort of obvious adaptive reasons.
link |
And as a consequence, there is a reinforcement
link |
both from the behavior
link |
and from the dopamine released from the nicotine itself.
link |
And as I mentioned earlier,
link |
from the positive reinforcement
link |
that comes from increased focus,
link |
so the money that you make through work
link |
or your attentional ability,
link |
or the fact that you're alert
link |
and people feel you present,
link |
all of that funnels back into positive reinforcement,
link |
behavioral reinforcement,
link |
and then what we would call addiction.
link |
So this review covers all of that
link |
and then steps beautifully
link |
through nicotine replacement therapy and various compounds,
link |
several of which I'm going to talk about now,
link |
which have been shown to increase that number
link |
that we talked about earlier of only 5% of people
link |
who try to quit with no other support,
link |
pharmacologic or hypnosis or otherwise,
link |
just say, that's it, I'm not going to smoke again,
link |
or I'm not going to vape again.
link |
Only 5% of people succeed in doing that.
link |
And even among those, many end up relapsing later.
link |
There are a couple of pharmacologic approaches.
link |
One of the main ones that's received a lot of attention
link |
in recent years is Bupriperone,
link |
sometimes referred to by its commercial name, Wellbutrin.
link |
Now, Bupriperone is a compound
link |
that increases the release of dopamine
link |
and to a lesser extent epinephrine
link |
and some other neurochemicals as well.
link |
It's used for the treatment of depression
link |
and for smoking cessation.
link |
Now, I want to point out again, I'm not a psychiatrist,
link |
so I'm not telling you to take Bupriperone,
link |
AKA Wellbutrin, but I'm going to give you a little bit
link |
of the contour of what's typically done
link |
in terms of Bupriperone administration
link |
to help people get relief
link |
from some of the withdrawal symptoms
link |
of trying to quit smoking or vaping
link |
or other forms of nicotine ingestion.
link |
Typically, Bupriperone is taken
link |
in 300 milligram per day doses
link |
divided into two dosages of 150 milligrams each,
link |
or sometimes there's a slow release formula.
link |
The dosages will vary from person to person.
link |
I want to really emphasize
link |
that there is an increased seizure risk with Bupriperone.
link |
It only occurs in a small fraction of the population,
link |
but nonetheless is a real concern
link |
for those members of the population.
link |
So for those of you with seizure risk,
link |
whether you know it or not,
link |
that's going to be a valid concern
link |
in terms of potential side effects.
link |
The other thing about Bupriperone is that it has to be used
link |
with caution in patients that have liver disease
link |
or renal disease that can impact
link |
the amount that anyone can take,
link |
meaning sometimes people have to take a much lower dose
link |
if they have renal disease or liver disease,
link |
and sometimes they can't take it at all.
link |
Sometimes if people are taking benzodiazepines
link |
for whatever reason or other sedatives,
link |
there are contraindications there.
link |
So Bupriperone isn't a kind of one-size-fits-all
link |
or magic bullet for quitting smoking.
link |
Nonetheless, for people that can take it safely,
link |
and again, this is a prescription drug,
link |
a board certified psychiatrist or other physician
link |
is going to have to prescribe it for you
link |
if it's appropriate for you,
link |
and it moves that number of 5% success rate
link |
to about what one sees with the clinical hypnosis
link |
to about 20% of people
link |
will successfully overcome their nicotine,
link |
or I should say their smoking or vaping addiction.
link |
Now it's important to ask why this would work, right?
link |
I mean, it's not as if Bupriperone
link |
is increasing nicotine per se.
link |
What it's doing is it's tapping
link |
on that mesolimbic reward pathway, increasing dopamine,
link |
or at least allowing dopamine levels
link |
to stay substantially elevated enough
link |
that people don't experience some of the drop in dopamine
link |
that leads to the withdrawal symptoms,
link |
the lessening of mood, et cetera,
link |
and it's no coincidence that Bupriperone
link |
is also an antidepressant.
link |
It's a common antidepressant
link |
for people that experience negative side effects
link |
with the so-called SSRIs,
link |
selective serotonin reuptake inhibitors
link |
that prevent them from taking those things
link |
like lessen libido or appetite,
link |
or in some cases increased appetite,
link |
or any number of other side effects that some people,
link |
not all, but some people experience with SSRIs.
link |
They'll be prescribed Wellbutrin, Bupriperone
link |
is the generic name.
link |
So Wellbutrin being the commercial name,
link |
again, Bupriperone is what they'll be prescribed instead.
link |
With the caveats of seizure risk, renal disease,
link |
liver disease, et cetera,
link |
the outcomes with Wellbutrin for smoking cessation
link |
I mean, if you think about an increase from 5% to 20%,
link |
that's pretty dramatic,
link |
and yet I also want to refer back to the incredible success
link |
of the clinical hypnosis approach.
link |
Again, you can find that at reverie.com.
link |
The clinical hypnosis approach has a success rate of 23%.
link |
So it's very closely aligned with,
link |
if not exceeding the success rate with Bupriperone.
link |
Of course, there are other pharmacologic approaches
link |
to quitting smoking or vaping.
link |
All of them generally circle back to increasing dopamine
link |
and or norepinephrine
link |
in order to offset some of the withdrawal symptoms
link |
of smoking sensation or vaping cessation.
link |
A very common approach for people to try and quit smoking
link |
or vaping is to use nicotine itself
link |
to try and prevent people from seeking nicotine
link |
through a cigarette or a vape pen.
link |
What I mean by that is people using a nicotine patch
link |
or nicotine gum or other nicotine delivery device
link |
that is not cigarettes and not vaping
link |
in order to maintain levels of nicotine
link |
in their bloodstream,
link |
which of course means maintain levels of nicotine
link |
in their brain and body
link |
to the same extent that they would
link |
if they were smoking or vaping,
link |
maybe even gradually taking down the total amount of nicotine
link |
in their brain and body by reducing the number
link |
or size of nicotine gum pieces that they ingest each day
link |
or keeping the patch on for a shorter amount of time
link |
or getting a lower dose patch
link |
that releases less nicotine total or over time.
link |
All of those approaches have been shown
link |
to be reasonably successful.
link |
I'll get to the numbers in a few minutes,
link |
but reasonably successful in allowing people
link |
to quit smoking or vaping.
link |
Again, most of the data is on cigarette smoking
link |
because vaping is a relatively new phenomenon,
link |
although quite troublingly,
link |
it's a very rapidly increasing behavior,
link |
especially in the young population.
link |
So that's why I'm kind of lumping these two things together
link |
because I think very soon we are going to need
link |
an all out campaign for how to counter vaping addiction.
link |
So what do we know about smoking sensation
link |
using nicotine itself?
link |
Is the patch best?
link |
Is nicotine gum best?
link |
It turns out that a combination of approaches is best.
link |
So somewhat surprising,
link |
but it was very clear from the literature
link |
that I was able to find that using nicotine patches
link |
for some period of time and then switching to a gum
link |
and then perhaps switching to a nasal spray,
link |
that's going to be the most effective.
link |
Then the question is how long to continue each of those
link |
and whether or not to overlap them.
link |
It seems as if doing one for about a week
link |
and then switching to another for about a week
link |
and then switching to another is one rational
link |
and reasonable approach
link |
that many people have used successfully.
link |
Why would that be?
link |
Well, it all has to do with the different rates
link |
of absorption of nicotine into the bloodstream
link |
and then the downstream consequences of that
link |
on the dopamine, acetylcholine, epinephrine,
link |
and other systems of the brain and body.
link |
And while there hasn't been an extremely detailed study
link |
of the exact kinetics of how the nasal sprays
link |
versus the transdermal patches versus the gums, et cetera,
link |
work, there's a logical structure to it
link |
that will immediately make sense to you.
link |
First of all, the transdermal patches
link |
provide a fairly steady state dopamine release
link |
And oftentimes people are wearing them at night as well.
link |
This is relevant because if people are ingesting nicotine
link |
by way of smoking and vaping,
link |
hopefully they're not waking up in the middle of the night
link |
just to smoke or vape, or believe it or not,
link |
some people do that.
link |
But of course, while people are asleep,
link |
they are not smoking or vaping.
link |
They always tell you don't fall asleep
link |
with a cigarette in your mouth,
link |
you burn the whole house down.
link |
But exceedingly rare to have people
link |
who are smoking in their sleep.
link |
So people wake up in the morning
link |
and because the half-life of nicotine from smoking or vaping
link |
is very short, anywhere from one to two hours,
link |
they are essentially in a state of withdrawal
link |
at the point where they wake up in the morning.
link |
How can I say that?
link |
Well, remember withdrawal sets in about four hours
link |
after the last ingestion of nicotine by cigarette
link |
or by inhalation from the vape pen.
link |
So people are waking up in nicotine withdrawal
link |
and then immediately going into
link |
the behavior of ingesting nicotine
link |
or very soon after waking for most people.
link |
So nicotine patch is going to be very effective
link |
Again, talk to your physician
link |
about the best approach for this,
link |
but then switching to a nasal spray
link |
or switching to nicotine gum for about a week,
link |
which is going to change the kinetics
link |
of that nicotine absorption to the bloodstream
link |
and change the release of dopamine
link |
and other neurochemicals within the brain.
link |
That's going to keep the system intentionally off balance
link |
so that it never comes to expect one single pattern
link |
or amplitude of dopamine release.
link |
And that is a very powerful way for a,
link |
let's just call it a quitting method to work
link |
because as I've always said,
link |
the most powerful schedule of dopamine
link |
is going to be this random intermittent reward.
link |
This is what's used in the casinos
link |
in order to take your money.
link |
And generally they do on average,
link |
they take your money more than you take theirs
link |
and they take more of it, not just more often,
link |
because they use this random intermittent schedule.
link |
The random intermittent schedule is one in which
link |
you don't really know when the peaks in dopamine
link |
are going to arrive.
link |
And so there isn't this expectation and craving.
link |
And then all of a sudden when dopamine is released,
link |
it's extremely high.
link |
That's how they get you to continue playing
link |
even though basically you're losing money
link |
and your dopamine is dropping.
link |
They elevate it every once in a while.
link |
Nicotine replacement can be used in a similar way,
link |
but in a benevolent way in order to help you get over
link |
smoking or vaping by keeping the total amounts
link |
of dopamine variable around the clock.
link |
And by changing the amount of dopamine that's released,
link |
it seems to help people behaviorally and psychologically
link |
because they don't come to expect
link |
having a particular amount of dopamine
link |
in their brain and blood at any given time.
link |
And this is an important point because it brings us
link |
to this notion of homeostasis.
link |
Homeostasis is this tendency for biological systems
link |
to try and reach equilibrium.
link |
What goes up, goes down, et cetera,
link |
and to some extent to the same degree.
link |
So I'll talk about this right now in the context
link |
of nicotine use, withdrawal,
link |
and then the period in which people
link |
no longer crave nicotine.
link |
So you can imagine that if we were to measure
link |
your heart rate, your blood pressure,
link |
and your overall levels of alertness and wellbeing and mood,
link |
let's just give that some value.
link |
Let's say it runs from zero to 10.
link |
Again, arbitrary units.
link |
Let's just take all those physiological measures
link |
and the subjective measure of your mood,
link |
and let's measure it four times an hour across the day,
link |
across the waking hours.
link |
What we would find is a line that would kind of
link |
squiggle a bit, maybe a nice text comes in
link |
that you really like, maybe you get a not so good news
link |
and your kind of autonomic arousal is all over the place.
link |
But on average, it's kind of a squiggly line
link |
where it increases in the morning
link |
because that's typically when body temperature
link |
and autonomic arousal increase.
link |
And then towards the afternoon,
link |
it's going to come sloping down.
link |
And then right before sleep, there'll be an increase again.
link |
If you've ever felt that,
link |
you kind of run around a lot before sleep,
link |
and then it goes down.
link |
That's kind of the typical contour of autonomic arousal,
link |
mood, et cetera, across the day.
link |
Removing, of course, life events
link |
and things like psychiatric illness and depression
link |
and et cetera, that's the typical arc of that.
link |
Now let's superimpose on whatever that contour is for you,
link |
So get a little bolus, as we say,
link |
a little bit of nicotine from smoking a cigarette
link |
or from taking inhalation on a vape pen.
link |
What ends up happening is there's an increase
link |
in blood pressure, increase in heart rate,
link |
increase in mood, increase in alertness,
link |
all the things we talked about earlier.
link |
Over time, the body starts to adjust
link |
so that the baseline upon which
link |
that nicotine-induced increase in arousal would occur
link |
is actually reduced, right?
link |
Why would that be?
link |
Well, the body and the brain,
link |
your physiology seeks homeostasis.
link |
So if there's a big increase in all those things
link |
like blood pressure and mood, et cetera,
link |
typically your baseline will drop a little bit
link |
to compensate for that over time
link |
after a couple of days or even weeks of ingesting nicotine.
link |
So let's say you wake up,
link |
you typically take an inhalation off your vape
link |
or you have a cigarette around nine or 10 a.m.
link |
and you do that daily.
link |
You get used to a certain level of mood and alertness
link |
and wellbeing for that time of day.
link |
And then if you smoke again in the afternoon, let's say,
link |
you also get accustomed to a certain level
link |
of mood and alertness and wellbeing for that time of day.
link |
Again, it'll vary depending on life events,
link |
but your system sort of gets used to it
link |
and your baseline will drop to compensate for those peaks
link |
so that the peaks aren't quite as high as they were
link |
when you first started using nicotine.
link |
Now you decide to quit.
link |
So now what we're talking about is transitioning
link |
from the consumption
link |
to what we're going to call the withdrawal phase.
link |
Now what happens is you say, that's it,
link |
I'm going cold turkey.
link |
I know there's only a 5% success rate,
link |
but I'm going to just go cold turkey.
link |
Or somebody will say, no,
link |
I'm going to use the Reverie app.
link |
Or somebody says, no,
link |
I'm going to use buprenorphine or another method
link |
or nicotine patch or something of that sort.
link |
Well, setting aside the nicotine patch
link |
or the nicotine delivery device,
link |
and only focusing on approaches
link |
for getting through withdrawal
link |
that have no direct effects on nicotine, okay?
link |
So not using the nicotine patch,
link |
but say the hypnosis or buprenorphine,
link |
which can increase dopamine,
link |
but it doesn't increase nicotine directly.
link |
The day that you quit,
link |
that homeostatic mechanism in your brain and body
link |
that sets your level of mood and arousal, et cetera,
link |
does not know and hasn't adjusted to the fact
link |
that you're not bringing in nicotine.
link |
You're not having that cigarette.
link |
You're not having that inhalation on the vape pen.
link |
So what ends up happening is that baseline,
link |
which has been adjusted down to offset the increases
link |
in mood and alertness, et cetera,
link |
when you smoke or vape is lower than it normally would be.
link |
So that 9 a.m. cigarette time or vape inhalation time
link |
no longer feels above baseline.
link |
It actually feels below baseline
link |
because what you're seeing is the lower amplitude of arousal
link |
that was there to offset the increase you were getting
link |
from vaping or smoking.
link |
And then in the afternoon,
link |
if normally you have a kind of phase of your afternoon
link |
you really enjoy, you go outside,
link |
you have a vape or a cigarette,
link |
you normally are feeling relaxed
link |
or you go out at night and you'd like to vape
link |
and you say, nope, I'm not going to do that anymore,
link |
you're going to feel much, much worse
link |
than you would have had you never started smoking or vaping.
link |
Now that's not much help to anyone
link |
who's already started smoking or vaping,
link |
but I say this because it's very important to understand
link |
that the reason why relapse rates
link |
are so high within the first week,
link |
75% of people relapse within one week
link |
and overall failure rates are 95%
link |
is because people don't expect to feel even worse
link |
than they did prior to ever smoking or vaping.
link |
So that first week is absolutely critical.
link |
And the beauty of understanding this
link |
is that if you can get through that first week
link |
either by sheer grit or by finding other methods
link |
to increase dopamine, healthy methods, I would hope,
link |
and certainly cold showers, ice baths
link |
have been shown to do that by the way.
link |
This was described in Dr. Anna Lemke's book,
link |
''Dopamine Nation''.
link |
Cold showers can increase dopamine exercise,
link |
positive social interactions.
link |
It's very likely that people will need to use
link |
other healthy methods to offset that reduction in dopamine
link |
if ever they stand to get through that first week.
link |
And again, if you can get through that first week,
link |
chances are quite a bit higher
link |
that you'll be able to maintain
link |
the cessation of smoking or vaping.
link |
And of course, hypnosis,
link |
things like buprenparone can also assist in that.
link |
Buprenparone by way of increasing
link |
dopamine pharmacologically,
link |
hypnosis through changes in neural circuitry
link |
that aren't completely understood,
link |
but seem to involve a remapping
link |
of some of the so-called default networks
link |
and some of the networks that are involved
link |
in kind of understanding of your own internal state.
link |
This stuff gets a little bit complicated
link |
and we're going to return to this
link |
in an upcoming episode of the Huberton Lab Podcast,
link |
but there are indeed legitimate changes
link |
in neural circuitry caused by clinical hypnosis
link |
that can at least partially explain
link |
why it is so effective in helping treat
link |
or allow people to stop smoking and vaping.
link |
So for those of you out there
link |
that either hear or are saying yourselves,
link |
I just can't seem to quit smoking or vaping
link |
or dipping or snuffing,
link |
hopefully an understanding
link |
of how that homeostasis process works
link |
and the time course of nicotine,
link |
depending on the delivery device,
link |
hopefully understanding that
link |
will allow you to develop a protocol,
link |
maybe it involves hypnosis,
link |
maybe it involves just understanding
link |
that the typical times in which you ingested nicotine
link |
through any of the different approaches
link |
of bringing it into your system
link |
are going to be particularly hard,
link |
but I don't just mean particularly hard,
link |
I mean particularly hard
link |
and you're going to need to do something specific
link |
to offset that decrease in overall autonomic arousal
link |
and dopamine, et cetera.
link |
Hopefully an understanding of that
link |
will allow you to get through that first week
link |
and if you can make it past that first week,
link |
you stand a very good chance of never going back.
link |
However, I did consult with Dr. David Spiegel
link |
in anticipation of this episode,
link |
regardless of the method that you used
link |
to quit smoking or vaping, snuffing or dipping.
link |
There's good evidence that a routine,
link |
maybe once a month or even once a week
link |
hypnosis type approach
link |
to replenish or even enhance the neural circuits
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that are allowing you to stay away from nicotine
link |
is going to be a very good idea.
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And given that it's a purely behavioral intervention,
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I can see no reason as to why
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people wouldn't want to do that.
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Go in and reinforce, tighten the bolts on that circuitry
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that are allowing you to not feel the impulse to smoke,
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not feel the impulse to vape.
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And just a very brief mention,
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there is a vast literature on the fact
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that when people have quit smoking or vaping
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or other form of consuming nicotine,
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that when they consume alcohol,
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there's a much higher probability of relapse.
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There are interactions between alcohol and nicotine
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that we'll cover in future episodes.
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But for those of you that want to quit,
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I want to assure you,
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despite the fact that 95% of people fail
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with the appropriate tools,
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and I like to think with an additional understanding
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of the underlying biology and psychology
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and what you can expect and when to really dig your heels
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and when to reinforce your system with more dopamine
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through any of the number of the different protocols
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and tools that we've offered here
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and that you can find elsewhere
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and other episodes of the Huberman Lab Podcast,
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I have a high degree of confidence
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that you can quit smoking or vaping, dipping or snuffing.
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So today, typical of, frankly,
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all episodes of the Huberman Lab Podcast,
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we've covered a lot about the biology
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of a particular system.
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We talked about the biology of nicotine in particular.
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We talked about vaping and smoking, dipping and snuffing,
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and the negative health consequences associated with those.
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I want to reemphasize that nicotine is not
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what causes cancer, it is the delivery device
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that causes cancer and the other negative health effects.
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That is not to say that people should be ingesting nicotine
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through any different methods
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simply to get a cognitive boost.
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There are certain circumstances
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where that might be appropriate,
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for the occasional work bout,
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certainly not for physical exercise,
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given what we talked about earlier.
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But of course, there are more and more approaches
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to increasing, not just nicotine,
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but acetylcholine generally,
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in order to achieve cognitive enhancement
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or physical enhancement,
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or I should say physical performance enhancement.
link |
Some of those we talked about earlier, such as alpha-GPC.
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In any event, nicotine, it should now be clear,
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is an immensely powerful substance,
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one of the most commonly ingested substances
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on the face of the earth and has been for a very long time.
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And now that you understand the underlying biology
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and the way in which it changes
link |
your psychology and physiology,
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that should come as no surprise.
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If you're learning from and are enjoying this podcast,
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please subscribe to our YouTube channel.
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That's a terrific zero cost way to support us.
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In addition, please subscribe to the podcast
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on Apple and Spotify.
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And on both Apple and Spotify,
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you can leave us up to a five-star review.
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If you have questions or comments
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or suggestions of topics you'd like us to cover
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or guests you'd like us to invite
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onto the Huberman Lab podcast,
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We do read all the comments.
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Please also check out the sponsors mentioned
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at the beginning of today's episode.
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That is the best way to support this podcast.
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During today's episode and on various previous episodes
link |
of the Huberman Lab podcast, we talk about supplements.
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While supplements aren't necessary for everybody,
link |
many people derive tremendous benefit from them
link |
for things like enhancing sleep, hormone function,
link |
The Huberman Lab podcast has partnered
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with Momentous Supplements, spelled Momentous O-U-S.
link |
You can find those supplements
link |
at livemomentous.com slash Huberman.
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If you haven't already subscribed
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to the Huberman Lab podcast neural network newsletter,
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it's a monthly newsletter.
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We provide summaries of different podcasts
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and we provide summaries of specific tools
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that you can use to enhance sleep, for instance,
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or enhance dopamine.
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We talk about deliberate cold exposure,
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deliberate heat exposure.
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It's very easy to sign up for
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Go to HubermanLab.com, go to the menu, click on newsletter,
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provide us your email.
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If you're not already following us on social media,
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we are Huberman Lab on Twitter, Huberman Lab on Instagram,
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And at all of those locations,
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I describe science and science-related tools,
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some of which overlap with the content
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of the Huberman Lab podcast,
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much of which is distinct from the content covered
link |
on the Huberman Lab podcast.
link |
So once again, I'd like to thank you for joining me today
link |
for a discussion about the biology
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and psychological effects of nicotine,
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this incredibly powerful substance.
link |
And as always, thank you for your interest in science.