Protocols
Science-based tools and supplements that push the needle.
Source
We recommend using this distillation as a supplemental resource to the source material.
Full Notes
Introduction
- Nicotine is one of the most commonly consumed substances globally
- Billions of people ingest nicotine daily, mostly through smoking tobacco
- Other sources of nicotine include dip, snuff, patches, gum, pills, and toothpicks
- This discussion will focus on nicotine, not smoking or vaping
Nicotine’s Effects on the Brain and Body
- Increases focus, motivation, working memory, and cognitive capacity
- Can lead to addiction for other substances related to vaping and vaping-associated behaviors
Tools for Focus
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13-minute daily meditation
- Increases focus ability, mood, and other positive aspects of mental health and performance
- Simple practice: sit or lie down, close eyes, direct attention to a place just between and above the eyes
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Alpha GPC
- 300mg taken 10–30 minutes before cognitive or physical work can increase focus
- Increases acetylcholine and epinephrine (adrenaline) levels
- Dopamine increase achieved through cognitive processing or other pro-dopamine protocols
- Some people take 600mg of a garlic capsule to offset potential TMAO increase related to cardiovascular health
Prescription Compounds for Focus
- Ritalin, Adderall, Modafinil, Armodafinil, and Vivance may be prescribed by a board-certified physician for individuals with ADHD or other focus-related issues
Nicotine: Overview and Effects
- Acts as a pesticide, disrupting insect nervous systems and fertility
- Cognitive function enhancement
- Mood modulation
- Potential protection against certain forms of cognitive impairment
Nicotine and the Brain
- Nicotine binds to nicotinic receptors in the brain and body
- These receptors exist for acetylcholine, not because of tobacco or other external sources of nicotine
- Acetylcholine and nicotine play important roles in normal brain and body function
- Activation of nicotinic receptors can trigger directed rewiring of the brain (neuroplasticity)
Nicotine Use and Addiction
- Separating nicotine from its delivery device (e.g., smoking, vaping) is crucial when discussing its effects
- Some people use nicotine-containing products (e.g., gum) to enhance focus and motivation
- This is not a recommendation for everyone to consume nicotine products
- Nicotine can be powerful as a mood modulator
- Quitting nicotine, especially through smoking, can cause a significant drop in mood
- Nicotine can have both positive and negative effects on cognitive function, depending on dosage and individual factors
Considerations for Nicotine Use
- Children, pregnant individuals, and those with addictive tendencies or mood disorders should be cautious with nicotine use
- Nicotine’s effects on mood and cognitive function can vary widely among individuals
- Further research and understanding of nicotine’s effects on the brain and body are needed to make informed decisions about its use
Effects of Nicotine on Humans - Nicotine does not cause infertility in humans
- Can reduce penile girth and lead to sexual dysfunction due to changes in blood flow and endothelial cell function
- Nicotine found in plants like tobacco
- Can enter the bloodstream through inhalation or contact with mucosal tissues
- Nicotine binds to nicotinic acetylcholine receptors in the brain and body
- Different receptors dictate different effects of nicotine on tissues
Nicotine’s Effects on the Brain and Body
- Ingesting nicotine takes 2–15 minutes to enter the bloodstream
- Smoking and vaping are faster than direct contact with mucosal lining
- Four major categories of neurochemical effects of nicotine:
- Mesolimbic reward pathway (dopamine reward pathway)
- Nicotine triggers the release of dopamine from the nucleus accumbens, increasing motivation, well-being, and alertness
- Also decreases activity of GABA, an inhibitory neurotransmitter
- Increase in acetylcholine
- Neuromodulator that exists in humans
- Mesolimbic reward pathway (dopamine reward pathway)
- Nicotine suppresses appetite and increases metabolism
- Binds to the alpha‑4 beta‑2 receptor in the brain
- Difficult to quit nicotine due to its potent increase in dopamine and decrease in GABA
- Nicotine can be used as an antidepressant in certain cases
Effects of Nicotine on the Brain and Body - Nicotine binds to nicotinic alpha four, beta two containing nicotinic receptors
- Increases electrical activity in POMC neurons
- Suppresses appetite and limits impulse to chew
- Direct effects of nicotine on metabolism
- Transient increases in metabolism (2% to 5%)
- Nicotine increases dopamine, reinforcing and rewarding
- Younger females may use nicotine for appetite suppressing effects
- Nicotine is fat soluble
- Can move freely through the brain and body
- Can pass through cell membranes
- Effects of nicotine on the body
- Increases heart rate, blood pressure, and contractility of the heart
- Increases sympathetic tone (alertness and physical readiness)
- Constricts blood vessels, reducing blood flow to various tissues
- Acute nicotine use can reduce penile girth
- Chronic nicotine use can impair blood flow to various organs
- Nicotine can relax skeletal muscle
- Counterintuitive due to acetylcholine’s role in muscle contraction
- Related to neural circuits upstream of muscles and autonomic nervous system arrangement
- Overall effects of nicotine
- Activates reward pathways
- Increases attention, alertness, and mood
- Raises blood pressure and heart rate
- Enhances preparedness for thinking
- Relaxes the body
- Creates an ideal state for cognitive work
Nicotine and Cognitive Enhancement
- Nicotine can enhance cognitive ability and focus
- Useful for mental work, not physical performance
- Nobel Prize-winning colleague uses nicotine gum for cognitive focus
- Negative side effects of nicotine
- Dipping or chewing tobacco increases risk of oral cancer
- Not recommended for people under 25 years old
- Can create nicotine dependence and negatively impact brain development
- Nicotine can increase acetylcholine and dopamine levels
- May be beneficial for adults with slowed brain development
- Should not be ingested through smoking, vaping, or direct contact with tobacco
Negative Effects of Smoking, Vaping, Dipping, and Snuffing
- Damages endothelial cells, which make up the vasculature
- Negatively impacts blood and nutrient delivery to all cells, organs, and tissues
- Cigarettes contain thousands of toxins and carcinogens
- Ammonia, tar, formaldehyde, and carbon dioxide are potent carcinogens
- Carbon dioxide depletes oxygen delivery to tissues
- Smoking, vaping, dipping, and snuffing all negatively impact health
- Estimated 14-year reduction in lifespan for every pack of cigarettes smoked per day
Nicotine Consumption and Effects
- Estimated 14-year reduction in lifespan for every pack of cigarettes smoked per day
- Over 1 billion people consume tobacco for nicotine
- 70% of cigarette smokers want to quit but find it difficult due to brain neurochemistry
- Negative health effects of nicotine consumption:
- Increased probability of cancer, stroke, heart attack, peripheral neuropathies
- Cognitive dysfunction, memory impairment, sexual dysfunction
- Minor increases in cortisol, decreases in growth hormone
- Nicotine is not the cause of cancer, but other substances in tobacco and nicotine delivery devices are
Withdrawal Symptoms
- Occur as soon as 4 hours after the last ingestion of nicotine
- Symptoms include agitation, craving for nicotine, stomach aches, nausea, irritability
- Craving is due to a drop in dopamine below baseline levels
Quitting Smoking, Vaping, Snuffing, or Dipping
- There are effective ways to quit, including single event treatments
- Nicotine is not the carcinogen, but other substances in tobacco and nicotine delivery devices cause negative health impacts
Vaping and Its Effects - Vaping pens designed to vaporize nicotine quickly without burning tobacco
- Constantly updated engineering for low heat or non-heating approaches
- Vaping resembles crack cocaine in terms of speed of entry of nicotine into the bloodstream
- Speed of onset determines how habit-forming and addictive a substance is
- Faster dopamine release in mesolimbic reward pathway makes vaping more addictive than cigarette smoking
- Young people’s brains getting wired to expect rapid, dramatic dopamine increases
- Leads to a progressive narrowing of the things that bring pleasure
- Vaping associated with increased levels of depression, especially when use drops off
Cocaine and Nicotine Delivery Mechanisms
- Delivery mechanisms for cocaine parallel those for nicotine
- Snorting, injecting, and vaporizing (crack cocaine) all lead to rapid increases in psychoactive substances and dopamine release
- Vaping causes a very rapid increase in blood concentrations of nicotine, faster than other modes of delivery
- This makes it more habit-forming and addictive
Dopamine and Addiction
- Dopamine reward pathway is the only pathway for achieving satisfaction from any endeavor
- Initially, a substance causes a high increase in dopamine, but with repeated use, the increase becomes lower and lower
- System can be recovered by abstinence from nicotine consumption, but withdrawal is difficult and miserable
- Vaping is harder to quit than cigarette smoking for most people
- Only 5% of people who try to quit smoking cold turkey succeed, and 65% of those relapse within a year
Behavioral and Pharmacologic Methods for Quitting Nicotine
- Only 5% of people who try to quit smoking cold turkey succeed, and 65% of those relapse within a year
- Behavioral methods:
- Clinical hypnosis
- Developed by Dr. David Spiegel at Stanford School of Medicine
- 23% success rate in quitting smoking after one session
- Available through the Reverie app (Reverie.com)
- Clinical hypnosis
- Pharmacologic methods:
- Bupropion (Wellbutrin)
- Increases dopamine release, used for depression and smoking cessation
- Typical dosage: 300 mg/day divided into two doses of 150 mg each
- Increased seizure risk, use caution in patients with liver or renal disease
- 20% success rate in overcoming smoking or vaping addiction
- Nicotine replacement therapy (NRT)
- Using nicotine patches, gum, or other delivery methods to maintain nicotine levels
- Gradually reducing nicotine intake over time
- Reasonably successful, but specific success rates
- Bupropion (Wellbutrin)
Resources
- Reverie app for clinical hypnosis: Reverie.com
- Review article on pharmacologic approaches to smoking cessation: “Pharmacologic Approach to Smoking Cessation: An updated review for daily clinical practice” (2020)
Smoking Cessation and Vaping Addiction - Vaping is a rapidly increasing behavior, especially in the young population
- Need for an all-out campaign to counter vaping addiction
- Combination of approaches for smoking cessation is most effective
- Using nicotine patches, then switching to gum, and then nasal spray
- Changing the kinetics of nicotine absorption and dopamine release
- Keeping the system intentionally off balance
- Homeostasis: the tendency for biological systems to reach equilibrium
- Baseline drops to compensate for peaks in arousal from nicotine
- Withdrawal phase: baseline is lower than normal, making quitting more difficult
- 75% of people relapse within one week; overall failure rates are 95%
- Getting through the first week is critical
- Use healthy methods to increase dopamine (e.g., cold showers, exercise, positive social interactions)
- Hypnosis and bupropion can also assist in smoking cessation
- Bupropion increases dopamine pharmacologically
- Hypnosis involves changes in neural circuitry and remapping of default networks
Clinical Hypnosis and Quitting Smoking/Vaping
- Clinical hypnosis can help treat nicotine addiction
- Understanding homeostasis process and time course of nicotine can help develop a quitting protocol
- First week of quitting is particularly hard due to decrease in autonomic arousal and dopamine
- Routine hypnosis can help reinforce neural circuits to stay away from nicotine
- Consuming alcohol increases the probability of relapse after quitting nicotine
Biology of Nicotine
- Nicotine is not what causes cancer, but the delivery device (smoking, vaping, etc.) does
- Ingesting nicotine for cognitive boost not recommended, but other methods like Alpha GPC can be used for cognitive enhancement
- Nicotine is an immensely powerful substance and understanding its biology can help in quitting
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