When e-cigarettes reach the market they seemed like a godsend to smokers( and maybe even curious non-smokers ): all the pleasure of smoking cigarettes and none, or at the least far fewer, of the health risks. Youre merely breathing in water vapor and pure nicotine, the ads said.
But have those claims held up since e-cigarettes were introduced to the U.S. and European marketplaces 10 decades ago? The science is a bit more complicated than it seems, with scientists doggedly opposing to heavily regulate e-cigarettes, and others touting them as the ultimate smoking cessation device. Who is right?
The Daily Dot dug into the science to try and answer this question. But, spoiler alerting: The science behind e-cigarettes is young and inconclusive. They currently are not regulated by the Food and Drug Administration, which essentially permits e-cigarette manufacturers to operate without much oversight on nicotine contents and other chemical components in their e-cigarette liquids. However, the FDA will begin governing e-cigarettes in August 2016.
Cancers, lung disease, and heart disease all take several years to developpeople havent been using e-cigarettes long enough to develop these illness. Also, most e-cigarette users( called vapers) are current or former smokers, so it will be hard to parse out whether smoking or vaping was the true culprit of whatever diseases do form. Researchers can study the effects of e-cigarette aerosol in cultured cells and lab animals, but those studies cant definitively tell us what real-world e-cigarette employ will look like in the long term. Lastly, several researchers are attempting to answer the question of whether or not e-cigarettes can be used to quit smoking all together. But that question has a complicated, incomplete answer too.
Lets break it down, starting with the physical differences between traditional and e-cigarettes.
Combustion vs. vaporization
Much of what stimulates traditional cigarettes so dangerous isnt the nicotinenicotine is super addictive, can cause heart disease, but theres very little evidence that it causes cancer. Cigarettes are dangerous because of the smoking itself. Illuminating up causes the tobacco leaves and cellulose newspaper theyre wrap in to combust. And combustion of plant matter releases several other chemicals: aldehydes, carbon monoxide gas, free radicals, heavy metalsa combination that can cause not only cancer but lead to heart and lung diseases as well.
E-cigarettes, on the other hand, use a battery to vaporize a mixture of nicotine, glycerol or propylene glycol, and flavourings, depending on the product. Vaporization happens at a much lower temperature than combustion, so it seems reasonable that it wouldnt cause the release of all the same nasties as cigarettes.
“The cancer risk is probably lower than a conventional cigarette, but the effects of the ultrafine particles and the aldehydes are about the same.”
But youre not just breathing in nicotine and water vapor, according to Stanton Glantz, professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.
In the process of heating up you get a lot of aldehydes and the ultrafine particles are themselves dangerous, Glantz told the Daily Dot over the phone. The cancer risk is probably lower than a conventional cigarette, but the effects of the ultrafine particles and the aldehydes are about the same.
The effects of the particulates may include inflammation in the lungs that can cause lung illnes over period. One study found that cultured white blood cell exposed to e-cigarette vapor extract released inflammation-causing compounds, suggesting that breathing e-cigarette vapor may have similar consequences within the body. Glantz also said that the particulates in both e-cigarette vapor, cigarette smoke, and air pollution can also cause the blood to get sticky, leading to clogged arteries and heart disease.
The preliminary evidence was in favour of Glantzs views. According to two reviews, e-cigarette vapor is quite harmful in animal and cell culture studies. However, detractors from e-cigarettes tend to argue that e-cigarettes also release aldehydesbut theres reason to be skeptical, according to the second review. One study found that e-cigarette vapor contained formaldehydethe same probable-cancer-causing chemical used to preserve animals for dissection. However, some argued that the temperature used to create the e-cigarette vapor in that study was too high. Vaping at too-high temperatures causes a phenomenon called a dry puffed which is very harsh and unpleasant, as anyone whos ever tried an e-cigarette can tell you.
According to a recent study in the publication Addiction , e-cigarettes only release formaldehyde in the dry puff condition.
E-cigarettes are a moving target
In the 10 years theyve been on the market, e-cigarette devices have changed rapidly. The first generation e-cigarettes looked a lot like traditional ones( theyre also known as cigalikes ), but werent as good at get nicotine into the blood as traditional cigarettes.
“Time will tell whether or not that chronic rednes will lead to disease.”
But the newer generation e-cigarettes deliver nicotine to the bloodstream at levels comparable to regular cigarettes, entailing they can give vapers the same nicotine fix as smokers. This is good news for their potential to help smokers quit smoking. But theres a catch.
Most of the data Ive insured on second and third-generation devices is that they do cause inflammation in the lungs. They do cause a measurable biological response, Robert Teran, lead writer of the second review and director of SoM Tobacco Center of Regulatory Science at the University of North Carolina, Chapel Hill said in a phone interview with the Daily Dot. Time will tell whether or not that chronic inflammation will lead to disease.
Additionally, e-cigarettes introduce a few variables that traditional cigarettes do not. Spices are common in e-cigarette liquids. While the chemicals used to create those flavors are all on the FDAs approved list of food additives, pretty much no one has studied the effect of inhaling the vapors of these chemicals, Teran said.
There is one notable exception: diacetyl. Diacetyl is the primary chemical that gives movie theatre popcorn its buttery flavor. Its also a byproduct in many other foods: it gives some Chardonnays their signature buttery undercurrents. If you pick it up in beer, that can also be a sign that your local bar needs to clean the lines in their brew taps.
Its safe to feed, but if you breathe it in it causes bronchiolitis obliterans, otherwise known as popcorn lung, Teran said. And the only reason researchers know about the harmful effects of breathing in diacetyl is because workers in popcorn factories came down with this illness.
But diacetyl isnt simply in buttery flavors. Its also in a lot of berry flavorings as well, according to one study find diacetyl in 39 of 51 e-cigarette flavors. However, diacetyl is also present in cigarette smokeat levels higher than those is currently experiencing workers in popcorn mills, according to a 2014 study. So perhaps its a washing with diacetyl.
Nonetheless, there are still many compounds in e-cigarette flavourings whose effects on the lungs are still relatively unknown. In fact, Teran believes that e-cigarettes and traditional cigarettes might have more changes than similarities, and comparing them to one another might not be the best style to assess e-cigarettes health risks. After all, being safer than smoking is a very low bar to clear.
Teran quoth a study from his laboratory that detected vaping was associated with suppression of genes related to the immune system. The researchers even procured many suppressed genes in vapers that they didnt find in smokers, suggesting vaping may have some unique impacts on the immune system.
The ultimate cessation assist ?
To say discontinuing smoking is hard is an understatement. Nicotine isnt merely highly addictive; it was able literally change the development of the brain to build people even more dependent on it if they start smoking in their teenswhich is exactly when most smokers start. Smokers looking to quit have a few alternatives: cold turkey, gradually cutting back, employing a nicotine replacement therapy, or a drug like Chantix.
Nicotine replacement therapyusing something like the patch or gumhelps smokers get their nicotine fix and taper them off of nicotine while keeping them from smoking. Many people may choose to go these therapies alone by buying the therapies over the counter at the drugstore.
According to a study from the 90 s, cease rates for people who do the patch or gum alone, without the use of their doctor, vary between around 15 percentage after six weeks, to less than 10 percentage at 24 weeks follow-up. But subsequent reviews of that study and others like it that attempted to gain real world proof for replacing therapies found their methodologies to be flawed.
Another review of nicotine replacing therapies found that people may be more successful if they had behavioral support such as a hotline to bellow or group therapy sessions. But quit rates are still low. Replacement therapy only enhances someones the possibilities of ceasing by 50 to 70 percent, according to the review. So if someone goes cold turkey without any supporting and has an 8 percent chance of success, using replacing therapy is only going to make their chances marginally greaterand thats only to smokers who are very highly motivated to quit.
Its unclear why cease rates are so low with replacement therapy. But part of the issue may be that smoking is more than only nicotine: its the ritual and social aspects too. E-cigarettes offer many of those same consolations, so some researchers believe they can be highly effective discontinuing tools.
I think someone specifically comes and seeks therapy, then I would recommend Chantix or nicotine replacement therapy, maybe supplemented by e-cigarettes, Peter Hajek, Director of Tobacco Dependence Research Unit at the Wolfson Institute of Preventive medicine in London, told the Daily Dot in a phone interview. So many smokers only manage to stop smoking when they try a few of these e-cigarette models.
Hajek was involved in a 2014 review of e-cigarettes for smoking cessation. He and his colleagues found that e-cigarettes containing nicotine were more helpful than e-cigarettes without, but they couldnt determine if they were any better than the patch. Nonetheless, Hajek and colleagues in the Royal College of Physician now urge smokers to construct the switch to e-cigarettes, citing that they are 95 percent less harmful than cigarettes.
“They get six people together, several of whom had fiscal conflicts of interest, got around a table and scratched their head and scratched their butt and got that 95 percentage number.”
How they got to that number is unclear. When the Daily Dot asked Hajek about it immediately, he cited the many known toxic chemicals in cigarette smoke that lead to heart disease, lung cancer, and cancer.
These chemicals are either altogether absent or present in only minuscule amounts in e-cigarette vapor, Hajek said Chemicals exclusive to vaping may yet be found to also pose some risks, but this is unlikely to be more than only a small fraction of the risks of smoking.
But 95 percent less harmful seems like a long shot to Glantz.
The 95 percent number was simply made up, he said. If you go back and find the paper that comes up with that number. It has exactly no actual evidence in it. They get six people together, several of whom had fiscal conflicts of interest, got around a table and scratched their head and scratched their butt and get that 95 percentage number.
Glantz thinks, if anything, e-cigarettes are about a third to a half as dangerous. Much of Glantzs work has also been to refute the idea that e-cigarettes are useful smoking cessation tools when used alone. Earlier this year, he and his colleague published an analysis of several studies in the Lancet that e-cigarette users were 28 percentage less likely to quit smoking than those who didnt employ e-cigarettes.
The most dangerous thing about e-cigarettes is that they maintain people smoking. If “youre ever” a cigarette smoker and you switched altogether from cigarettes to e-cigarettes, it would be less dangerous, Glantz said. The majority of the data suggests most people are dual users.
He added that he believes e-cigarettes have definitely helped some people cease. But he thinks that they would only work for a minority of smokers.
Taber also thinks that e-cigarettes might not be a good cessation tool, but that they are less harmful than traditional e-cigarettes.
If youre smoking cigarettes, going to e-cigarettes is probably better for your health, Taber said. And if youre not smoking anything at all, dont try e-cigarettes and think they wont have an effect on your lungs.