Side Effects of Vaping

vaping

Introduction

E-cigarettes are small devices that vaporise flavoured e-juice for the user to inhale. They are designed to provide nicotine in a way that closely mimics smoking, without the carcinogenic compounds and toxic effects that we associate with tobacco smoke. More and more, people are choosing to ditch tobacco, choosing e-cigarettes as a more healthy alternative to help them stop smoking. E-cigarettes are still within a rapid development phase after a decade on the market, and we are on the brink of seeing clear, definitive research published on their safety. There are a lot of concerns about the safety of e-cigarettes, as currently very little research has been published on their long term safety, yet they are widely used as a tool to quit smoking.

At the moment, experts believe that vaping doesn’t have any substantial negative effects on your health, particularly if smoking is considered the alternative [1]. In this article, we’re going to look at the known side effects of vaping, and the potential effects that are still unclear from current research.

ecigarettes

Known Side Effects

After you take a puff from your e-cigarette, nicotine will enter your bloodstream from your lungs, similarly to when you smoke a cigarette. Nicotine inhaled from vaping or smoking alike will increase your heart rate, blood pressure, and trigger your brain to release dopamine, improving your mood. Nicotine is highly addictive, and is known to be damaging to the developing brain in children and teenagers. Nicotine is also dangerously toxic to a developing baby if someone who is pregnant ingests it in any form. Nicotine aside, what are the effects of vaping on your body, and does it have any negative effects?

Oral Health

If you choose a super-sweet e-juice flavour, you will need to consider the effects it will have on your teeth. Extra sweet tasting e-liquids are proven to damage your teeth, reducing enamel hardness up to 27% more than unflavoured e-juices. Researchers concluded that highly sweetened e-juices can have a similar effect to consuming high-sugar drinks and candy [5]. If you don’t want to worry about damaging your teeth when you vape, avoid highly sweet e-juices – apple flavour (hexyl acetate) and the flavour enhancer triacetin were the worst offenders in this study.

oral health

Lung Function

The most common short-term side effects associated with vaping, assessed in over 20,000 e-cigarette users, are mouth and throat irritation and dry cough [6, 7]. Your short term cough reflex is also inhibited after vaping, but this seems to be dependent on nicotine, as nicotine-free e-cigarettes did not cause this affect [12]. We will look further at the potential side effects on lung function in the next section.

Handling e-juice and e-cigarettes

Another side effect of using e-cigarettes is the small risk of injury that comes with handling the e-cigarette and e-juice itself. Regulation on e-cigarettes is still limited, and some early e-cigarette models were prone to overheating and battery explosion, potentially burning the user and/or leaking e-juice. E-juice also contains highly toxic quantities of nicotine if it is swallowed or comes into contact with the skin for a prolonged period of time. The risk of this is very low, but increased by improper use of an e-cigarette. To reduce the risks associated with e-juice, handle it with consideration and store it out of reach of children and animals. Use a trusted seller when purchasing an e-cigarette, and follow the instructions carefully every time on how to use, charge, and refill it.

e-juice

Dehydration

Frequent vapers report symptoms including dry mouth and tongue, headaches and dry eyes. These side effects are due to the dehydrating effects propylene glycol and vegetable glycerin, found in e-juice. These compounds are hygroscopic, meaning they absorb water. When you use an e-cigarette, the vapour you inhale will wick moisture from your lungs, drying you out and making you dehydrated more quickly than usual. The easiest way to avoid this side effect is to simply drink more water!

Potential Side Effects

Impact on Quitting

One common concern about e-cigarette usage is that people who vape do not necessarily fully quit smoking. People like this are known as ‘dual users’, and they complicate research as the known side effects of smoking can mask any new side effects that we don’t know about in vaping.

smoke

Are people who use e-cigarettes more likely to continue smoking, rather than quitting altogether, prolonging their tobacco use? Experts cannot currently agree on the answer to this question – about one third of research supports e-cigarette use as a quitting aid, with 66% of research papers finding e-cigarettes harmful or not beneficial to quitters [3]. It looks like the way people use e-cigarettes to quit smoking is very different to how people might use other nicotine replacement therapies (NRTs) such as nicotine gum or patches. This could wrongly give the impression that you take longer to quit, or are less successful, if you choose to vape. The reality may be that people simply take up vaping much earlier in their quitting attempt, as they begin to cut down their cigarettes.

ecigarettes

Policy makers in the UK also support a recent report that vaping could be up to 95% less harmful than tobacco, and encourage smokers to take up vaping to help them quit [4]. A U.S.-based study investigated the quitting success of over 2000 people between 2012-2014. 42% of long-term e-cigarette users had quit smoking by the end of the study; compared to only 14% of people who only vaped short-term or not at all [2].

Lung Function

Research into the long-term effects of vaping on lung function is difficult to undertake. This is because most users have only been vaping for a short period of time, or are dual users, so long term effects are not clear yet. Research on lung cell cultures suggests vaping could speed up the death of lung cells by 50-fold, implying the potential to trigger diseases like COPD [8]. However, the relevance of these results is questionable, as this effect is not seen in 3D-reconstructed human airway tissue, or animal models of similar experiments [9, 10]. So far, vaping also appears to have almost no long-term effects on other aspects of lung function, including carbon monoxide levels, forced vital capacity, and cough reflexivity [11, 12].

lung effects

E-juice Toxicity

The two largest components of e-juices, vegetable glycerin (sometimes called glycerol) and propylene glycol are widely considered safe to consume and also to inhale in e-cigarette vapour short-term [1]. E-juice flavourings in general are considered as having a potential to cause harm. This is due to the lack of regulation on these compounds – any food-grade flavouring can be used in an e-juice. Digestion of a food involves acid breakdown, enzyme attack, and kidney and liver processing. Vapor enters the lungs and goes directly in the bloodstream. This means we do not really know the effects that inhaled flavourings are having on our lungs and body.

Cell culture studies show that cinnamon-flavoured e-juices may have the potential to cause harm to your lungs [13]. Diacetyl, found in some e-juice flavours (at levels 700 times lower than tobacco), can have devastating effects on the lungs when inhaled in its pure form [14]. To put these risks into context, experts still conclude that these e-juice flavourings are far less toxic than cigarette smoke, and the effects they might have on your body cannot be drawn from such early research.

ejuice toxicity

Allergies

Different e-juice flavourings may contain traces of allergenic compounds. If you have a serious allergy, it’s recommended to always treat e-juice the same way you might check what foods you eat for allergenic substances.

Conclusion

The long-term side effects of vaping remain unknown. E-cigarettes have been on the market for little over 10 years, so there are no long-term studies of their effects on heart, lung, and overall health. Nobody has used an e-cigarette for 30 to 40 years, so the long-term disease-causing potential is not known. Diseases such as cancer can require many years of damage before they are triggered, so until this research is completed, we simply will not know the full repertoire of side effects caused by long-term e-cigarette use. There are many unanswered questions at the moment, but studies on vaping currently indicate a limited impact on health when used short-term. The most common reason people vape is to help nicotine withdrawal symptoms as they quit smoking [15, 16]. For a short-term purpose like this, where the user may only vape for a short period of time, the known side effects are mild, and the risk of unknown side effects is also very low.

The FDA is keeping a close eye on the vaping industry and seems to consider e-cigarettes beneficial to people quitting smoking – by 2022, all marketed devices will need FDA approval [17]. This should improve the safety of e-cigarettes. Within the UK, Public Health England have even licenced some e-cigarettes as medical devices for smoking cessation [4].

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9. PLoS One. 2015 Feb 23;10(2):e0118344. The effects of electronic cigarette emissions on systemic cotinine levels, weight and postnatal lung growth in neonatal mice. McGrath-Morrow SA1, Hayashi M2, Aherrera A2, Lopez A3, Malinina A4, Collaco JM1, Neptune E4, Klein JD5, Winickoff JP6, Breysse P7, Lazarus P8, Chen G8.
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10. Toxicol In Vitro. 2015 Oct;29(7):1952-62. doi: 10.1016/j.tiv.2015.05.018. Development of an in vitro cytotoxicity model for aerosol exposure using 3D reconstructed human airway tissue; application for assessment of e-cigarette aerosol. Neilson L1, Mankus C2, Thorne D3, Jackson G2, DeBay J2, Meredith C3.
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11. Ferrari M, Zanasi A, Nardi E, et al. Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers. BMC Pulm Med. 2015;15:120.
https://www.ncbi.nlm.nih.gov/pubmed/26459355

12. Chest. 2016 Jan;149(1):161-5.Effect of e-Cigarette Use on Cough Reflex Sensitivity.
Dicpinigaitis PV1, Lee Chang A2, Dicpinigaitis AJ2, Negassa A3.
https://www.ncbi.nlm.nih.gov/pubmed/26291648

13. Identification of toxicants in cinnamon-flavored electronic cigarette refill fluids. Behar RZ, Davis B, Wang Y, Bahl V, Lin S, Talbot P. Toxicol In Vitro. 2014 Mar; 28(2):198-208.
https://www.ncbi.nlm.nih.gov/pubmed/24516877/

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https://www.ncbi.nlm.nih.gov/pubmed/26803400/

16. Rutten LJ, Blake KD, Agunwamba AA, et al. Use of e-Cigarettes among Current Smokers: Associations among Reasons for Use, Quit Intentions, and Current Tobacco Use. Nicotine Tob Res. 2015;17(10):1228–1234.
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17. FDA News Release – FDA announces comprehensive regulatory plan to shift trajectory of tobacco-related disease, death. [Accessed 27/10/18]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm568923.htm

Image Sources

1.Photo by Tnarg from Pexels: https://www.pexels.com/photo/close-up-photography-of-man-smoking-1391465/

2. dozenist [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5 (https://creativecommons.org/licenses/by-sa/2.5)], from Wikimedia Commons https://commons.wikimedia.org/wiki/File:06-10-06smile.jpg

3. PharmacyRegulation.org: https://www.pharmacyregulation.org/regulate/article/complying-new-legislation-prohibiting-sales-e-cigarettes-under-18s

4. PNGIMAGE.net : https://pngimage.net/e-cigarette-png-4/

5. FreePNGDownload.com : http://freepngdownload.com/cigarette/cigarette-png-free-download-16

6. Icons8.com : https://icons8.com/icon/5354/lungs

7. KissPNG.com : https://www.kisspng.com/png-plastic-bottle-milliliter-glass-liquid-705969/preview.html

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