Understanding the health risks associated with e-cigarettes

In the past month, nearly 400 people have been hospitalized and 6 people have died from a severe lung disease linked to the use of electronic cigarettes. According to the Centers for Disease Control (CDC), those hospitalized experienced respiratory symptoms which included a dry, non-productive cough, shortness of breath, and chest pain. Some of these people also reported symptoms of nausea, vomiting, diarrhea, fever and fatigue that preceded the development of respiratory symptoms. Their symptoms began within a few days to several weeks after using electronic cigarette devices to vape nicotine- and marijuana-containing liquids.

Electronic cigarettes differ from traditional cigarettes in that they do not contain tobacco. They draw and heat liquid (e-liquid or vape juice ) over a battery-powered metal coil which is aerosolized into fine particles.

This aerosol is inhaled and deposited deep into the lungs where nicotine and chemical by-products can be absorbed into the bloodstream and transported to interact with the circulatory system and receptors in the brain. Electronic cigarette devices have been marketed to be a safer alternative to traditional cigarettes because they were alleged not to contain the toxic by-products of tobacco combustion. However, vaped e-liquids also undergo heat-catalyzed chemical reactions that produce cell damage from the formation of toxic compounds and exposure to heavy metals; research has demonstrated this to occur in e-liquids with and without nicotine.

While electronic cigarettes were intended to be used by adults to stop smoking, their popularity has grown at an alarming rate with adolescents. The CDC reports that in 2018, 3.6 million kids in the United States reported regular use of electronic cigarettes. That number is further analyzed to the statistics of 1 in 5 high school students and 1 in 20 middle school students. Some makers of these devices seem to targeting kids with their products. They have designed discrete devices that fit into the palm of your hand, some of which resemble a USB flash drive. The liquids or “juices” for these devices are available in various sweet flavors and some of the packaging is made to resemble candy packaging. Juul, one of the best selling electronic cigarettes, is under investigation by the FDA and Federal Trade Commission for its marketing practices directed at youth. Their devices contain pods that hold as much nicotine as a pack of cigarettes. Juul has also gained notoriety for creating a product known as a nicotine salt in which benzoic acid is used to make higher concentrations of nicotine consumable without causing throat irritation, this in turn increases the addictive potential nicotine.

Liquids used in e-cigarettes commonly contain propylene glycol, vegetable glycerin, nicotine and various chemical additives used as flavoring agents. There are close to 8,000 e-liquid flavors available on the market. Many flavoring agents used in e-cigarette juice fall into the category of the Federal Drug Administration (FDA’s) generally regarded as safe (GRAS) substances when used in food. However, there is no data to support these same agents to be GRAS when heated and inhaled into the lungs.

A March 2018 study employed high-throughput screening to assess and validate the toxicity of multiple e-liquids. The findings revealed the greater number of chemicals the e-liquid contained the greater the toxicity potential. The presence of vanillin — vanilla flavoring — and cinnamaldehyde — cinnamon flavoring — were associated with increased toxicity rates. The research has generated a searchable public database of e-cigarette ingredients at www.eliquidinfo.org. While the amount of data thus far is limited, this database is a start to offer research that can help determine the health effects of e-liquids and their toxicity potential from transition to cancer causing chemicals and cell damaging ability when heated and inhaled. 

Until more is known about the origins of the severe lung disease, the CDC recommends refraining from the use of electronic cigarette devices. It is becoming clear that vaping is a multi-system chemical assault on the body, and not a safer alternative to cigarettes. Research has shown the chemical by-products produced by vaping to have negative effects on circulation, lung health and brain health.

Dr. Stacie Wells, ND, FAAEM is a Naturopathic Doctor & Fellow of the American Academy of Environmental Medicine. She practices at the Northwest Center for Optimal Health in  Marysville, WA. Contact her at 360-651-9355 or [email protected].