Dr. Keith Roach

DEAR DR. ROACH: My husband has neuropathy in his feet. He is otherwise healthy, exercises daily, maintains his weight, and eats healthy. My concern is that he uses chewing tobacco. He insists that it doesn’t have a negative influence on his condition, but I disagree. What’s your medical opinion? He is fully aware of other health complications that chewing tobacco can cause, but he doesn’t make an effort to quit. I’m frustrated and worried about his future. He is 63. — A.C.W.

ANSWER: There are many causes of neuropathy. Diabetes is a major one, but I get many letters from readers (and also have several patients) with unexplained neuropathy, which often causes pain or numbness in their feet or hands. Without a precise diagnosis, doctors often try medications to reduce nerve pain, such as gabapentin or antidepressants like amitriptyline or duloxetine, which work at the level of the nerve cell.

You’re right that chewing tobacco can make many kinds of neuropathy worse. It seems that nicotine can damage the nerves themselves. Smoking increases the risk of neuropathy in people with diabetes by about 40%. A different study in people without diabetes found an 18% increased risk for neuropathy in smokers compared to nonsmokers.

Chewing tobacco provides about the same level of nicotine as smoking. So does taking snuff, but I hardly ever see anyone who uses snuff. (Some people don’t know that snuff is powdered tobacco.) In addition to the neuropathy that is the issue here, chewing tobacco dramatically increases the risk of head and neck cancer, particularly oral cancer. If your husband saw the effects of oral cancer and its treatment, he might be more motivated to quit.

But a person’s own motivation isn’t enough sometimes. Many people who habitually use nicotine need external help. Nicotine replacement and medications like a nicotine receptor blocker (varenicline) or an antidepressant (bupropion), along with behavioral counseling, can dramatically improve a person’s ability to quit tobacco in any form.

DEAR DR. ROACH: I am 52 and have had Crohn’s disease since I was 22. I’ve been in remission for 10 years, with only mild flare-ups here and there that I’ve been able to nip in the bud as they occur, through diet and lifestyle changes. I’m on 50 mg of mercaptopurine. I also have IBS and heartburn.

I’m a good 50 pounds overweight and perimenopausal. I’m interested in trying a GLP-1 agent such as Wegovy to help me lose weight, but I’m afraid that it could trigger a full Crohn’s flare-up. I’ve read that injecting it in the thigh and titrating more slowly can minimize digestive issues. — C.M.

ANSWER: It’s true that GLP-1 agonists like semaglutide (Wegovy, Ozempic and Rybelsus) can cause gastrointestinal side effects. Part of how they work is slowing down absorption by delaying the stomach from emptying. This causes people to feel more full, but it can also cause symptoms of bloating, nausea and even vomiting.

This can be minimized by starting at very low doses and gradually increasing the dosage as the person can tolerate it — usually by waiting at least a month before increasing the dose. This effect on stomach movement isn’t related to the inflammatory process in Crohn’s disease.

A 2025 study of over 10,000 patients regarding GLP-1 agonists in people with inflammatory bowel disease didn’t find an increase in hospitalization, a need for more medication, or a need for surgery — providing strong evidence that a flare-up of Crohn’s due to a GLP-1 agent is unlikely.

Side effects such as nausea come from the medicine, not the injection site, so injecting the medicine in the thigh isn’t necessary or helpful. You can definitely talk with your gastroenterologist or regular doctor about your individual risks and benefits for GLP-1 agonists, but they seem to be safe for people with Crohn’s disease.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.