Food and Behaviour Research

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Nangs are popular with young people. But are they aware of the serious harms of nitrous oxide?

Allan J, Simpson H, Cameron J, Kor K

Laughing gas nitrous oxide (Canva generated)

Nitrous oxide – also known as laughing gas or nangs – is cheap, widely available and popular among young people. Yet it often flies under the radar in public health programs and education settings. Young people (aged 18 to 25) who have used nitrous oxide are often unaware of its risks – even when they reported symptoms such as “brain fog” and seizures.

FAB RESEARCH COMMENT:

So-called ‘laughing gas’ – the anaesthetic drug nitrous oxide – inactivates Vitamin B12. 

Nitrous oxide is second only to cannabis as a popular recreational drug among 16-25 year olds in the UK, US, Europe and Australila.  Commonly known as 'nangs', ‘whippets’ or ‘balloons’, it is easily available to children and young adults (supposedly for whipping cream) in canisters or tanks, and the gas inhaled from balloons. Discarded canisters are collected in tons after any major festival, but can also be seen daily in street gutters, car parks and school playgrounds.

But as this recent Australian study shows, most recreational users appear to have absolutely no idea of the serious risks of nitrous oxide - even when already reporting symptoms like 'brain fog' or seizures.

By 2023, doctors in the UK were aleardy seeing so many young people with actual spinal cord damage from B12 deficiency triggered by  nitrous oxide abuse that the Association of British Neurologists adopted new, evidence-based recommendations for its diagnosis and treatment as official clinical practice guidelines.  See:


Regulation to restrict access, and public health campaigns to raise awareness of the serious health risks from Nitrous Oxide abuse are urgently needed 


Two recent research papers call for urgent action to restrict sales of nitrous oxide, and better education to dispel the current ignorance about the serious health risks of regular use and high intakes.

 

Early warning signs often ignored untill too late

Initial B12 deficiency symptoms can include sensory problems such as tingling or numbness, blurred or distorted visionmovement or balance problems including muscle weakness, poor co-ordination and clumsiness, and a wide range of mental symptoms - all of which may of course have other causes.  

But if these symptoms are ignored, the nerve damage from a serious lack of Vitamin B12 can become irreversible - causing permanent spinal cord damage and paralysis (if not brain damage too).
 
  • B12 is needed to make myelin - a fatty substance that protects and insulates nerves, and is essential for normal brain and nerve cell signalling. So as with multiple sclerosis (which involves auto-immune damage to myelin) deficiency symptoms can be highly variable.
  • B12 is also needed to make red blood cells - leading to fatigue, and if severe, anaemia. But because these symptoms can be caused by other things too, B12 deficiency can easily be missed.
Doctors are routinely taught about 'pernicious anaemia' (PA) - the classic B12 deficiency disease, caused by auto-immune damage to cells in the stomach needed to absorb B12 (recently renamed atrophic gastritis). However, many sufferers go undiagnosed for years, becasue its onset can be so gradual, and the symptoms so varied.

See this Symptom checklist from the Pernicious Anaemia Society  


Vitamin B12 deficiency and Psychological or Psychiatric symptoms 

Importantly, B12 deficiency can 'mimic' many psychiatric as well as neurological disorders - including ADHD, anxiety, depression, schizophrenia or dementia.   

In fact for some people, psychiatric symptoms can actually be the first signs of B12 deficiency - before anaemia or any of the 'classic' neurological symptoms may become apparent - including:
  • fatigue, 'brain fog', and concentration problems
  • depression or anxiety
  • mental states of confusion and paranoia, which can mimic symptoms of schizophrenia or other forms of psychosis


Most cases of serious health problems involve excessive use, but low or 'marginal' B12 status add to the risks.  N
itrous oxide is used medically as an anaesthetic by many doctors and dentists - including during pregnancy, and for children - so screening for possible B12 deficiency would be a sensible precaution for high-risk groups.

  • Vegans and vegetarians are at particular risk of B12 deficiencies, as only animal-derived foods (or supplements) provide this vital brain nutrient.
  • Some common medications can also reduce B12 absorption - most notably drugs for 'indigestion' or acid reflux, but also metformin, widely prescribed for controlling diabetes.  

For further information, please see also:



Could It Be B12?

Sally Pacholok & Jeffrey Stuart


Could It Be B12? Pediatric Edition

Sally Pacholok & Jeffrey Stuart

Nitrous oxide – also known as laughing gas or nangs – is cheap, widely available and popular among young people. Yet it often flies under the radar in public health programs and education settings. For example, it’s not included in the drug education curriculum in Australian schools.

In our new study, we spoke to young people (aged 18 to 25) who have used nitrous oxide. We found they were are unaware of its risks – even when they reported symptoms such as “brain fog” and seizures.

What is nitrous oxide?
Nitrous oxide is regularly used for sedation and pain relief in dentistry and childbirth.

The gas, which has no colour or flavour, is also used recreationally and is known as nangs, nos, whippits and balloons.

In fact, nitrous oxide has been used to get intoxicated since its creation in 1722, and wasn’t used in surgery until 1842. It can create a feeling of dissociation from the body, changes in perception and euphoria. This lasts about one minute.

In Australia, nitrous oxide is cheap and accessible. This is because the gas is also used in baking, for example to whip cream.

So, while it’s not legal to sell nitrous oxide for recreational use, the canisters or “bulbs” are widely available online via 24-hour delivery services.

People usually discharge the gas into a balloon or a whipped cream dispenser and then inhale. Nitrous oxide is intensely cold – minus 40 degrees Celsius.

How common is it?

We still don’t have much data about who uses nitrous oxide and how often. Compared to other drugs, there is minimal research on its recreational use.

However researchers believe it is becoming more common globally, especially among young people.

For example, in 2022, nitrous oxide was the second-most used controlled substance among 16–24 year olds in the United Kingdom after cannabis.

In January 2023, the Netherlands banned the sale and possession of nitrous oxide after 1,800 road accidents, including 63 fatal crashes, were linked to the drug in a three-year period.

The Global Drug Survey reported a doubling in nitrous oxide use between 2015 and 2021, from 10% of respondents to 20%. But this voluntary survey is not representative of all people who use drugs. While it is an indication of people’s nitrous oxide use, the picture remains patchy.

What are the health risks?

Nitrous oxide is not the most harmful drug people can use but that doesn’t make it safe.

Inhaling nitrous oxide has short-term health risks, including:

  • cold burns from the gas
  • injuries from falling over
  • nausea and dizziness.

Using a lot of nitrous oxide at one time can result in passing out (from lack of oxygen) and seizures. Calling an ambulance is necessary if this happens.

Longer-term health problems may include:

  • vitamin B12 loss (causing numbness of hands and feet and eventually paralysis)
  • urinary incontinence
  • strokes
  • memory loss
  • mental health conditions, including depression and psychosis.

The availability of much larger canisters (including flavoured varieties) is also linked to an increase in significant harms. These can deliver roughly 70 times the amount of nitrous oxide as traditional small canisters.

Larger bulbs allow people to consume more of the gas at one time and they often experience health problems more quickly as a result.

However, there is still limited knowledge about nitrous oxide in the health system. This means its health risks are often compounded because it is overlooked by those assessing medical conditions and because people deny using it.

Our research

During the first stage of our 2025 Australian study, we interviewed seven young people (aged 18 to 25) who had used nitrous oxide at least ten times.

While the number of interviewees was small, the stories they told were very similar.

They were either unaware of, or unconcerned about, the drug’s potential risks. This is despite their own experiences of psychological and physical problems.

They reported becoming unconscious, getting burns from the gas on their hands and faces, sores around the mouth and even having seizures.

Of particular concern to us was use before driving because people did not recognise the lingering effects of the gas on concentration.

Our study participants also spoke about “memory zaps” or “brain fog”. Regular use of nitrous oxide affected people’s ability to participate in work and study, with some saying it was also bad for their mental health.

These thinking problems are a concerning side effect. Yet it’s one that has not been adequately investigated.

The role of social media

Videos of young people using nitrous oxide can easily be found on social media. This not only points to its popularity but suggests social media could be a good place to reach young people with information about the drug and harm reduction.

In the second stage of our research we worked with 30 young people who used nitrous oxide to co-create harm reduction resources.

As a group, we developed videos, photos and text for our nitrous oxide specific social media accounts on Tik Tok and Instagram and for posts on various sub-reddits.

These describe ways to use the drug more safely. For example the “take a breath” messaging suggests breathing the nitrous oxide in for only ten seconds at a time to ensure enough oxygen. “Take a seat” advises sitting down while using nangs, to avoid injuries from falling.