QUERY:
Doctor,
I have had two standard blood tests performed in the last three weeks. The results
showed elevations in some of the liver profiles, I am sorry but I can't remember which
ones. My doctor is checking for hepatitis just to be sure, but I was wondering if
nicotine from chewing tobacco could cause elevations in some liver profiles?
Thanks, C.
ANSWER:
Dear C,
Thanks for your question and for your concern for your own health. As is
often the case, when we get an abnormal test we start to think about
everything we've done wrong and get worried that one of those things is
going to catch up with us finally.
I would like to be able to tell you that chewing tobacco is the cause of
your elevated liver tests and that quitting would fix everything! However,
I can't. I can tell you that unburned tobacco contains the carcinogenic
nitrosamines NNN and NNK, which have tumor-initiating properties in animals.
Both NNN and NNK readily produce cancer in rats and hamsters in organs such
as the nose, trachea, esophagus, and liver. But you are not a rat or a
hamster.....and the studies have not been done on humans yet.
The Third National Cancer survey found that men who used smokeless tobacco
incurred a 3.9 fold increased risk of oral cancer; those women who reported
long term use (> 50 years) had approximately a 50 fold increased risk of
cancer of the gum and buccal mucosa.
Gingival (gum) recession is a common result of smokeless tobacco use. The
role of tobacco in the development and progression of gingivitis (inflammation of the
gums) and periodontitis (destruction of the teeth), however, has not been confirmed.
Studies do show that elevated blood levels of nicotine from smokeless tobacco are similar
to those produced by cigarettes. One study demonstrated that smokeless tobacco users
experienced increases in heart rate and blood pressure similar in magnitude to those
experienced by smokers. Benign oral lesions may occur after only a few years of smokeless
tobacco use. One thing that happens
fairly quickly with smokeless tobacco is a lessened sense of taste and smell, and bad
breath.
So there you have it - smokeless tobacco is bad for you, but not necessarily
the cause of your abnormal liver tests. However, do you combine chewing
with drinking alcohol? Alcohol is very likely to change your liver enzymes.
Your doctor is right to check you for hepatitis. You should probably avoid
all alcohol while you figure out what is going on with your liver, and get
some help to quit the chewing tobacco. It's a hard one to quit because the
body really misses the nicotine - sometimes you need more support than
smokers do. But you can do it and I sense that you are motivated right now
by the wake-up call of your labs!
If you are interested, here is a wonderful site that has a lot of information about tobacco, perhaps more than you ever thought you would know!