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Cotinine levels were categorized into three groups: cotinine 3 ng/mL were more likely to be younger, male, and non-Hispanic white, have 912 years educational attainment, married or living with a partner, have less physical activity and BMI, have higher daily dietary intakes of energy, protein, carbohydrate, sugar, fat, caffeine, alcohol, moisture, lower fiber, and dietary supplements, and have a lower incidence of diabetes, coronary heart disease, and stroke than those with a serum cotinine level 0.05) in participants with cotinine levels of 0.052.99 ng/mL

However, there are no studies to back or measure the vasoconstrictor effect of nicotine in pouches

Watts C, Burton S, Freeman B, et al

As e-cigarette use grows, more research needed on long-term effects of vaping By American Heart Association News As the number of young people using electronic nicotine delivery systems grows, so does evidence that e-cigarettes may be harmful to human health

A doctors note is advisable but not essential