Caitlin

Kumher
9/23/15
Literature Review

Metabolic rate and calorie expenditure are largely important in the dietetics
practice. This is because body composition and body weight are crucial components in
maintaining good health. Excess body weight can lead to increased risk of heart disease,
type two diabetes, cancer, and more. Body weight and composition can be altered through
diet and exercise. However, the way and rate at which the body metabolizes its fuel also
contributes to body weight. With a higher metabolic rate, more calories can be taken in
without gaining weight. This leads to the question of what contributes to metabolic rate. It
is known that metabolic rate can increase with exercise and increases in lean body mass,
but chemical compounds can also contribute to changes in this rate, such as nicotine. The
purpose of this paper is to evaluate how nicotine affects resting metabolic rate.
There are many obstacles that are faced when quitting cigarette smoking. One
common barrier is the fear of gaining weight after smoking cessation. While some believe
that this weight gain is due to behavioral effects of quitting smoking, it is possible that
smoking may actually lead to a change in metabolic rate. Because metabolic rate,
metabolism and body composition are imperative components of health, it is important for
dietitians to understand the ways that metabolic rate can be altered. This helps
professionals in this field to address potential changes in body weight that will affect
overall health. This paper will outline the current research regarding how nicotine
contributes to metabolic rate.
Nicotine is the addictive chemical component of tobacco products. When smoking a
cigarette, nicotine is absorbed in the body within seconds. This leads to a stimulation of the

central nervous system and a release of mood-boosting endorphins. In addition to the

relaxing stimulation of nicotine, this chemical has also been shown to impact metabolic
rate. One study by Jessen et al. researched the metabolic effects of nicotine and caffeine1. In
this randomized controlled trial, patients were given chewing gum containing caffeine,
nicotine, or a placebo. The baseline resting energy expenditure was measured for each
participant. Energy expenditure was tested again after initiation of the experimental gum.
The results of the study found that 1.0 mg of nicotine had a significant increase of 3.7% on
metabolic rate (p-value <0.05). However, an increase in dosage of nicotine did not further
increase metabolic rate. In other words, a greater number of cigarettes smoked in a day,
should theoretically, not result in a greater increase in metabolic rate. Following this
theory, weight gain after cessation of smoking should not be greater in those who were
heavier smokers. However, this study had a very small sample size. It is unknown if the
same results would be found in a larger population. Additionally, this study was only done
in men.
A further randomized crossover study by Perkins et al. also examined the effects of
nicotine on metabolic rates2. This study was also done in men and evaluated resting
metabolic rates. The participants were divided into three groups. One group received a
small dose of nicotine. A second group received a larger dose of nicotine. The third group
received a placebo. Metabolic rate was then evaluated at baseline, fifteen minutes after the
dose is received, and again thirty minutes after dosing. The researchers of this study found
that there was a significant increase, p-value <0.02, in resting metabolic rate with the
nicotine doses in comparison with the placebo group. However, there was not a significant
difference between metabolic rates in the two dosing groups. The increase in metabolic

rate occurred almost immediately after the nicotine dose was received. Additionally, the
researchers concluded that there is a 6% increase in resting metabolic rate with the use of
nicotine compared to baseline. Overall, this study found that nicotine significantly
increased metabolism.
In correlation with these results, a study by Collins et al. further researched the
effects of nicotine on metabolism and questioned if the level of nicotine contributed to
changes in resting metabolic rate3. This study was a non-randomized crossover trial. The
participants included in this study were males between the ages of 18 to 65 years who
regularly participated in cigarette smoking for at least one year. Each participant went
through three different tests and measurements. This included evaluating resting
metabolic rate at baseline, with the intake of six low-nicotine (0.8 mg) cigarettes, and with
the intake of six high-nicotine (1.74 mg) cigarettes. After statistical ANOVA testing, the
results of this study showed a 6.8% increase in resting metabolic rate compared to baseline
with both the low and high nicotine cigarette tests. However, as the number of cigarettes
increased, there was a greater peak in the metabolic rate increase in the high nicotine
cigarettes in comparison with the lower nicotine cigarettes. There was also a longer lasting
effect on metabolism with the higher nicotine intake. Therefore, the results from this study
would support that nicotine increases metabolic rate. However, contrary to the prior study,
these researchers found higher levels of nicotine may have a greater impact on metabolism
compared to lower levels of intake. It must also be considered that this study presented
some limitations. The sample size only consisted of 16 men with a mean age of 41 years. It
is also unknown how the results would change if the sample size had included females or if
the participants were monitored for dietary and exercise variables.

A separate study by Klesgres et al. looked at the metabolic effects of nicotine in only
female subjects4. The women in this study smoked a minimum of 20 cigarettes per day. For
the study design, the participants were broken into two groups. One group received gum
that contained 4mg of nicotine and the other group smoked cigarettes. After ANOVA
statistical testing, the researchers found that both the nicotine from the chewing gum and
the nicotine from the cigarettes increased resting metabolic rate (P-value <0.05). This
increase was present 10 minutes post nicotine consumption. The researchers also
evaluated the differences between the two drug administration methods. Through testing it
was determined that participants received a significantly higher level of nicotine through
the gum than the cigarettes (P-value 0.031). The mean increase in energy expenditure with
nicotine gum was 242.6 calories (P-value <0.05) and the average increase with the
cigarettes was only 155.6 calories (P-value <0.05). In addition, the researchers found that
metabolic rate spike lasted 20 minutes after chewing nicotine gum and 30 minutes after
smoking a cigarette. The spike in metabolic rate increase with cigarette smoking was
determined to be a 12.5% increase. The total time until metabolic rate was back to baseline
took 100 minutes. This study shows that nicotine increases metabolic rate for a period of
time. However, this study included limitations such as the limited sample size and sample
diversity. This study was only done in young women and it is unknown if these results
would remain true in a larger population.
Furthermore, an additional study explored the differences of nicotine effects in
other varied populations. A study by Vander Weg et al. evaluated the differences in
metabolic rates of African American and Caucasian populations5. In this cohort study, two
groups were followed as they quit smoking and assessed for height, weight, BMI, CO (ppm),

RMR (VO2, l/min), VCO2 (l/min; ml/kg/min), fat mass, fat-free mass and RMR (resting
metabolic rate). This study found that African American smokers had significantly lower
resting metabolic rate than the Caucasian participants. However, the changes in resting
metabolic rate with the cessation of smoking were not statistically different between the
two groups (p-value 0.85). Both groups experienced a significant weight gain with the
smoking cessation (p-value 0.04). Therefore, further research must be done to examine
how race contributes to the effects of nicotine on metabolic rate.
It is a common belief that smoking is associated with lower body weights and the
cessation of smoking leads to weight gain. However, the cause of this weight gain is largely
debated. Many believe that this weight gain is of behavioral origin. It is thought that people
who smoke are accustom to putting cigarettes in their mouth and struggle with this habit
when the cigarettes are removed. They replace this action with putting food in their mouth,
thus leading to weight gain6. However, this phenomenon of weight gain may be
metabolically related rather than behavioral. As the previous research shows, there are
metabolic changes in the body with nicotine along with the significant weight gain. This is
important for dietitians to understand because of the nature of the field of practice.
Generally, dietitians work to modify behaviors that lead to weight gain and poor health.
However, in the case of nicotine, the dietitian must understand the patients body is
working against them. As their metabolism slows, it will be increasingly difficult for them
to keep excess weight off. Through this understanding, dietitians will better be able to
assist smokers through the smoking cessation process.
To further investigate the cause of weight gain and smoking cessation, additional
research could be conducted regarding changes in behavior and metabolic rate. Currently,

there are few studies researching the effects of nicotine in smokeless tobacco products.
These products tend to have different behaviors associated with them. Overall, the
research shows that there is a relationship between the nicotine and an increase in
metabolic rate. Therefore, when nicotine is removed from the body, metabolism slows and
leads to weight gain.

Reflection

After reading multiple research articles discussing the effect nicotine has on

metabolism, I have developed a new perspective of smoking cessation. Nicotine is a very

powerful drug with great effects on the body. Not only is it addictive, but the research
studies reviewed suggest that nicotine increases metabolic rate. It is easy to believe that
the weight gain with smoking cessation is a result of undesirable behaviors. I thought that
cigarette smokers gained weight in part because they were used to putting cigarettes in
their mouth and then replaced that motion with putting food in their mouth. However, after
reviewing the literature, it appears that the issue of weight gain with smoking cessation is
much more complex. Much of the weight gain is contributed to a factor that is out of the
smokers control. Cigarette smokers are used to the boosted metabolism they have while
smoking and struggle to maintain their weight once nicotine is removed and metabolism
slows.

The concept that nicotine increases metabolism and metabolism will slow when

nicotine is removed is important for dietitians to understand. I now realize that weight gain
may be very difficult for this population to control. I am currently in my bariatric rotation
and am dealing with patients preparing for weight loss surgery. As a part of the program,

patients must quit smoking prior to surgery due to the risks involved. However, this poses
an issue in regards to the weight loss requirements. The goal throughout the program is for
patients to lose weight prior to surgery. Some insurance companies even require a 3%
weight loss before they will cover the cost of the surgery. It is important to understand that
smokers will have the additional challenge of overcoming their slowing metabolism as they
try to lose weight while quitting smoking. As dietitians, we must have sympathy for this
population and assist them and they must work harder than others to lose weight. To
counteract the decrease in metabolic rate, dietitians can also incorporate a decreased
allowance of energy intake into the patients meal plan. Establishing healthy eating patterns
and lifestyle changes during this time may also help prevent the patient from returning to
smoking post surgery. Overall, knowing that nicotine considerably impacts metabolic rates
will allow me to best treat patients and be sympathetic the challenges related to smoking
cessation.

Sources

1. Jessen AB, Toburo S, Astrup A. Effect of chewing gum containing nicotine and
caffeine on energy expenditure and substrate utilization. Am J Clin Nutr. 2003;
77(6): 1,442-1,447.

2. Perkins KA, Epstein LH, Stiller RL, Marks BL, Jacob RG. Acute effects of nicotine on
resting energy expenditure in cigarette smokers. Am J Clin Nutr. 1989; 50(3): 545-
550.

3. Collins LC, Walker J, Stamford BA. Smoking multiple high-versus low-nicotine
cigarettes: impact on resting energy expenditure. Metabolism. 1996;45(8):923-926.

4. Klesges RC, DePue K, Audrain J, Klesges LM, Meyers AW. Metabolic effects of
nicotine gum and cigarette smoking: potential implications for post-cessation
weight gain. J Consult Clin Psychol. 1991;59(5):749-752.

5. Vander Weg MW, Klesges RC, Ward KD. Differences in resting energy expenditure
between black and white smokers: Implications for post-cessation weight gain. Eur J
Clin Nutr. 2000;54(12):895-899.

6. Lycett, D., Munaf, M., Johnstone, E., Murphy, M. and Aveyard, P. Associations
between weight change over 8 years and baseline body mass index in a cohort of
continuing and quitting smokers. Addiction, 2011;106: 188196.