Naltrexone May Have a Role in Reducing Weight Gain Caused by Nicotine Withdrawal

Smoking is the leading cause of disease and death in the US. It accounts for 480,000 deaths annually. It is a major risk factor for coronary heart disease. Although the number of smokers has considerably decreased from 20.9% in 2005 to 14.0% in 2019, a huge proportion of the US population still smokes and many try to quit and are unsuccessful. According to the FDA, nearly 70% of smokers in the US said they wanted to quit and in 2018, about 55% of adult smokers tried to quit but only 8% were successful.

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It is known from medical research that smokers who try to quit smoking experience an increase in body weight. And it is a subject of medical research investigation to study linkages between cessation of smoking and increase in body weight and also, to study the underlying biochemical mechanisms that regulate this shift.

Recently, researchers at the University of Minnesota Medical School published a paper based on their study investigating the link between poor eating habits and nicotine withdrawal. They demonstrated that the opioid system in the brain plays a key role in driving the poor eating habits of smokers during the cessation process.

The team of researchers studied two groups of people aged between 18 and 75 during two laboratory sessions. They studied one group of smokers and one group of non-smokers and they were randomly assigned to stop using nicotine products for 24 hours. Researchers also randomly gave a placebo or naltrexone (50mg) to members of the two groups. After each laboratory session, participants in both groups were provided snack items containing low and high calories and having different tastes like sweet, salty, and fat.

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Findings of the study

Smokers who were experiencing nicotine withdrawal ate more calories as compared to nonsmokers. But when naltrexone was administered, participants became less likely to eat high calories snack items. According to researchers, these findings were related to the use of high calories to counter the negative effects experienced by smokers during nicotine withdrawal. Also, these findings were supported by other research pointing towards increased proclivity for high sugar and high-fat food while experiencing withdrawal symptoms.

Secondly, researchers found out that naltrexone, an opiate antagonist, decreased calorie intake to a level as that of non-smokers. This finding suggested that the opioid system may be an underlying mechanism influencing this increase in high-calorie food.

The current focus of researchers

The researchers are now focusing on studying the impact of changes in appetite on weight gain after quitting smoking and how much these changes hinder the process of successful smoking cessation and enhance the risk of relapse.

According to the authors of this paper, the findings of the current study build on the findings of earlier research that indicated the effect of nicotine use on appetite. Moreover, researchers believe that the current findings demonstrate a link in the biochemical system of the brain.

Implications for treatment and alleviating barriers and fears of smokers

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Understanding the underlying biological mechanism for proclivity for high-calorie food consumption during nicotine withdrawal is an important step towards understanding the biochemical targets for researching new treatment options for nicotine withdrawal. The findings will also help develop new approaches to help smokers understand their behavior during nicotine withdrawal and develop recovery approaches targeting the specific changes in eating habits.

Furthermore, smokers often fear that nicotine withdrawal will lead to weight gain and the findings of this study will help understand the specific underlying mechanisms that enhance the proclivity for high-calorie food during smoking cessation. These understandings will also help alleviate the fears of people who smoke and address poor eating habits associated with nicotine withdrawal.

Given the finding of the study about the role of the opioid system in enhancing proclivity for junk food consumption, it is possible to research opioid antagonists to counter this effect. In the above-mentioned study, scientists demonstrated this effect by using naltrexone. Considering this finding, it may have a role in controlling weight gain in smokers who are experiencing nicotine withdrawal symptoms including a proclivity for junk food consumption. Naltrexone, an opioid antagonist, is already FDA approved for weight loss in obesity (only in combination with bupropion), and its beneficial effects during nicotine withdrawal need to be further investigated.

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Authors

Mustafa al Absi Ph.D. is the main researcher and lead author of this study. He is a psychologist and a professor in the Department of Family medicine and Biobehavioral Health at the University of Minnesota Medical School. The co-authors for this paper include Justin J. Anker, Nakajima Motohiro from the same medical school, and Susan Raatz from the Department of Food Science and Nutrition at U and M.

Funding

The funding for this study came partly from grants awarded to the lead author by National Institute on Alcohol Abuse and Alcoholism and from the Stress and Resilience Research Laboratory by the national institute on Drug Abuse.

References

Tobacco withdrawal increases junk food intake: The role of the endogenous opioid system, ScienceDirect, Accessed October 3, 2021, https://www.sciencedirect.com/science/article/abs/pii/S0376871621003148

Weight gain following smoking cessation, APA PsycNet, Accessed October 3, 2021, https://psycnet.apa.org/record/1994-07255-001

Smoking cessation and weight gain, Obesity reviews, Willey online library, Accessed October 3, 2021, Tobacco withdrawal increases junk food intake: The role of the endogenous opioid system https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-789X.2004.00131.x

Current Cigarette Smoking Among Adults in the United States, Centers for Disease Control and Prevention, Accessed October 3, 2021, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/

What It’s Like to Quit Smoking, U.S Food and Drug Administration, Accessed October 3, 2021, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/

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