By Dr. Mercola
Conventional tobacco cigarettes contain thousands of toxic chemicals released into your lungs and the surrounding air with each puff. The Centers for Disease Control and Prevention1 calls tobacco use the "single largest preventable cause of death and disease in the United States," killing more than 480,000 Americans every year and 41,000 from exposure to secondhand smoke.
Additionally, smoking-related illnesses cost more than $300 billion, including direct and indirect costs. In 2016 an estimated 15.5 percent of adults — 76.1 million people — smoked daily.2 In response to these numbers, tobacco companies began marketing electronic cigarettes (e-cigarettes or e-cigs), claiming they were a safer alternative for both the smoker and bystanders.
However, a 2016 report by the U.S. Surgeon General,3 "E-Cigarette Use Among Youth and Young Adults," called the products unsafe and documented an alarming increase in use by young adults. The report also showed e-cigs are associated with use of other tobacco products as well as challenges with brain development affecting the health and mental health of young adults.
Despite the industry's claims to the contrary, a growing body of research data continues to demonstrate damage to the user and bystander from using e-cigs, also called vaping, as these devices produce vapor rather than smoke.
Vaping May Damage Lungs, Increasing Risk of Lung Disease
The findings prompted researchers to suggest further study is necessary as the data was acquired under laboratory conditions,6 but many of the effects were similar to those seen in people who regularly smoke and those with chronic lung disease.
Much of the previous research has concentrated on exposure to e-cig liquid prior to being heated, while this study was focused on the impact the vaporized chemicals may have on lung tissue. To accomplish this, researchers extracted alveolar macrophages from lung tissue samples provided by nonsmokers who had no history of chronic obstructive pulmonary disease (COPD) or asthma.7
The cells were broken up into three groups: One-third were exposed to e-cigarette fluid, one-third to different strengths of artificially vaped condensate and the rest were left unexposed for 24 hours. The data showed the macrophages exposed to condensate were harmed significantly more than those exposed to unheated e-cigarette fluid, and the effects appeared to worsen as the amount of condensate increased.
After 24 hours the total number of viable cells were significantly reduced and the researchers found condensate containing nicotine exaggerated the effect.8 However, with or without nicotine, vaporized chemicals from e-cigs increased the inflammatory response.
Researchers found the vapor also disabled the ability of the macrophages to engulf bacteria and protect pulmonary function. This damage increases the cells vulnerability to dust, bacteria and allergens, increasing the risk of triggering COPD.
Inflammatory Process May Increase Risk of Infection
The researchers also found when macrophages were exposed to doses of vapor too low to kill, the cells expelled 50 times higher amounts of reactive oxygen species (ROS) compared to unexposed cells. Dr. Daniel Weimer, pediatric pulmonologist at Children's Hospital of Pittsburgh, reviewed the results and commented:9
"[Macrophages] do a bunch of things. One thing they can do is eat up foreign things, whether they be bacteria or viruses or just particles that have drifted down into the lungs. They can act as scavengers that present these particles to the immune system to activate an immune response.
Many people think of COPD as an older person's disease. But we're seeing younger and younger kids vaping. And that may cause a loss of lung function at a more accelerated pattern because they're starting it in their teens."
Excessive production of ROS and inflammatory cytokines may induce an inflammatory state partly dependent on nicotine, inhibiting phagocytosis (the ability of the cells to clear bacteria), suggesting the user may have a higher risk of pulmonary infections.10 Lead researcher and professor of respiratory medicine at the University of Birmingham, David Thickett, commented:11
"There has been a lot of support for people to use e-cigarettes rather than traditional cigarettes because of the perceived safety of the e-cigarette process. There is an agenda to portray e-cigarettes as safe. We should have a cautious skepticism that [e-cigarettes] are as safe as we are being led to believe."
The American Lung Association (ALA)12 is concerned with the use of e-cigarettes, the unproven claims they may be used to help smokers quit and the potential they may be a gateway to smoking traditional cigarettes, especially considering the aggressive marketing tactics the industry has used to target youth.
Dr. David Hill, member of the ALA board of directors, reviewed the study findings and commented that while e-cigs might be safer than traditional cigarettes, "less harmful doesn't mean safe." He added:13
"We have to be careful when we promote these as safe. Would I encourage my patients to use these or should they be marketed as a safe alternative to smoking? Definitely not."
How E-Cigarettes Work and Came to Market
E-cigarettes are battery-operated devices used to inhale aerosol, which typically contains nicotine, flavorings and other chemicals. Despite a variety of appearances and design, they operate in a similar manner. In many of the products, puffing activates the battery-powered heating device, which in turn vaporizes the liquid the person inhales.
The history of the development, commercialization and distribution of the product dates back to 1965 when Herbert A. Gilbert was credited with developing the first device and receiving a patent in 1965. In 1979, Phil Ray a pioneer of computers, created the first commercialized variation, which failed. Attempts to commercialize the product were restarted in the 1990s but again failed.14
The first commercially successful e-cigarette was created in Beijing in 2003. E-cigarettes were introduced to Europe in 2006, followed shortly thereafter in America. It was two years later the World Health Organization (WHO) proclaimed e-cigarettes were not legitimate smoking cessation aids and demanded marketers remove this information from any advertising and materials.15
In March 2009 the U.S. Food and Drug Administration (FDA) directed U.S. Customs to reject product entry into the U.S. as an unapproved drug delivery device. Canada also banned the sale, advertising and import, claiming they contained a known irritant, and Hong Kong banned them with a maximum penalty of two years' imprisonment and HK$100,000 fine for possessing or selling e-cigs.16
FDA Reversed Their Opinion and Sales Skyrocketed
By 2011 the FDA had reversed their opinion and announced they would regulate the products as they do tobacco and traditional cigarettes.17 A short nine years later, the product has become ingrained into Western culture with more than 9 million American adults vaping consistently18 and having risen to epidemic proportions among high school students.19
According to Euromonitor International,20 the number vaping rose from just over 5 million in 2011 to more than 40 million in 2018, and their market research estimates usage will reach 55 million by 2021.
However, disproportionate numbers of people are vaping in the U.S. compared to other countries, spending more than six times more on vaping than Japan, the next closest country. Vaping products continue to be illegal in Brazil and Thailand.
The most common reason people give for using e-cigs is they are "less harmful than regular cigarettes," and 49 percent claim they are being used to stop smoking traditional cigarettes. The percent of other reasons are not far behind, including that the use is not banned in public and the vapor doesn't bother other people.21
Vaping May Lead to Smoking Traditional Cigarettes and Addictive Behavior
Although Big Tobacco would like you to believe vaping is harmless to you and your companions, research data does not support their claims. Data from the featured study demonstrates chemicals found in the vapor shuts down cells designed to protect your lung tissue, and other research shows e-cigs carry further risks.
From a general look, e-cigarettes appear to be a positive step in the right direction — away from combustible tobacco. However, it is critical to look deeper anytime you add something into or on your body. According to the National Institute on Drug Abuse,22 in addition to the known health effects, early evidence suggests e-cigarettes serve as an introduction to use of other tobacco products.
In one study, students who had vaped by the time they reached ninth grade were more likely than others to start smoking combustible cigarettes within the following year.23 Interestingly, the reverse was not true. In other words, students who said they smoked cigarettes were not likely to report using e-cigarettes in the following six months.
In previous studies, results suggested teenagers who vape are at an increased risk for smoking combustible cigarettes, which may actually encourage cigarette smoking in adolescents. Another study from the University of Pennsylvania,24 using an animal model, determined rats exposed to nicotine during adolescence grew up to drink more alcohol than those who were not exposed.
The exposure at a young age changed neurological circuitry in the brain within the reward center, explaining how the exposure increased the potential for addictive behavior later in life.25 Nicotine exposure during adulthood did not appear to alter the function of the midbrain circuitry as it does during adolescence.
E-Cigarettes Increase Your Risk of Heart Disease and Stroke
Many e-cigarette liquids use flavor, found to induce early signs of cardiovascular disease leading to heart attack, stroke and even death. Researchers found changes appear almost immediately on the cellular level.
According to the lead author, Jessica Fetterman, Ph.D., the measures evaluated during data collection were some of the first changes seen in the development of heart disease.26 Using endothelial cells that line blood vessels, researchers exposed one group to menthol flavored traditional tobacco cigarettes and the other to unflavored tobacco cigarettes.
They compared these against nonsmoking volunteers. The cells from both types of smokers were unable to perform a key function — the production of nitric oxide used to dilate blood vessels. This gave the researchers a baseline against which they compared flavoring additives commonly used in e-cigarettes.27
At the highest level of exposure, the chemicals triggered outright cell death. At lower levels, researchers noted impaired nitric oxide production and inflammation. Fetterman commented on the importance of the study:28
"Increased inflammation and a loss of nitric oxide are some of the first changes to occur leading up to cardiovascular disease and events like heart attacks and stroke, so they are considered early predictors of heart disease. Our findings suggest that these flavoring additives may have serious health consequences."
Bystanders Inhale as Much Nicotine From Vape as Traditional Cigarettes
Vapor from e-cigarettes also include flavor chemicals, giving the user an experience similar to traditional cigarettes without high levels of offensive polycyclic aromatic hydrocarbons. However, while there is no offensive odor, the vapor does pollute the air with nicotine and fine particulate matter that is easily inhaled by bystanders.29
Despite lower levels of nicotine pollution from vaping, data demonstrates bystanders exposed to the vapor have similar levels of cotinine, a measure of the amount of nicotine taken into the body, as those exposed to traditional secondhand cigarette smoke.30 The reason for this discrepancy is unclear.
According to the Americans for Nonsmokers Rights,33 secondhand vapor may contain at least 10 chemicals identified on California's Proposition 65 list of reproductive toxins and carcinogens. Likely the most well-known is diacetyl, an artificial flavor used to add a buttery taste and linked to respiratory damage and permanent scarring of the airway.34
How to Make Quitting Smoking Easier
Although some claim vaping helps increase the potential to quit smoking, Dr. Michael Blaha, a professor of medicine and director of clinical research at Johns Hopkins Medicine, believes:35
"When the field was originally thinking of these as cessation devices, then some toxicity could be tolerated. But now we're looking probably at a couple million users in the United States who are being exposed to e-cigarette vapors who potentially wouldn't have been exposed to any tobacco product."
I believe quitting smoking is an important step to taking control of your health and it is a significant challenge. However, I also believe the "secret" to quitting smoking is to get healthy first, making quitting mentally and physically easier.
Exercise is an important part of this plan, as research shows people who engage in regular strength training double their success rate at quitting smoking compared to those who don't exercise.36 Healthy eating is another crucial factor. If you want to quit, here are three basic tips to get started:
- Read through my comprehensive free nutrition plan to get started eating right.
- Develop a well-rounded exercise regimen. This is your ally to fighting disease and to quitting smoking. Strength training is an important part, but also remember to incorporate high-intensity interval exercises such as the Nitric Oxide Dump, core-strengthening exercises, stretching and regular nonexercise movement (like walking and cutting back on sitting).
- Find a healthy emotional outlet. Many use exercise, meditation or relaxation techniques for this, and these are all great. I also recommend incorporating the Emotional Freedom Techniques (EFT) into your new health plan. This can help clear out emotional blockages from your system (some of which you might not even realize are there), thus restoring your mind and body's balance and helping you break the addiction and avoid cravings.
Once you are regularly doing these three things, then think about quitting smoking as you have developed a foundational core on which to rely during the process. At this point many are ready to quit "cold turkey."
If you need a distraction, these six things to do instead of smoking may help. Finally, if you're a parent, talk with your children about the risks of smoking combustible cigarettes and e-cigarettes, and of the dangers of smokeless tobacco. The easiest path to not smoking is to avoid starting in the first place.
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