If you are still puffing away but hoping to break the cigarette habit, you might consider using electronic cigarettes (e-cigs, for short) as a safer alternative to regular smokes while you try to quit smoking. However, recent studies looking into how well e-cigs work for smoking cessation have reached conflicting results.
A case in point: A study by scientists in the Netherlands found that vaping — the inhaling of nicotine containing vapor produced by e-cigs — appears to be just as safe and effective as using products such as nicotine inhalers to help stop smoking. The study concluded that vaping not only reduces withdrawal symptoms from nicotine, but the fact e-cigs are held in the hand and feel similar to “real” cigarettes can help smokers quit or reduce their use of regular cigarettes.
On the other hand, University of California San Francisco (UCSF) researchers analyzed dozens of studies on e-cigs and came up with a different and discouraging finding about using vaping to give up traditional cigarettes.
Adults using the devices were 28 percent less likely to stop smoking, according to the UCSF analysis. “The irony is that quitting smoking is one of the main reasons both adults and kids use e-cigarettes, but the overall effect is less, not more, quitting,” said researcher Stanton A. Glantz, PhD, director of the UCSF Center for Tobacco Control Research and Education.
Whether e-cigs can help you quit smoking, they are likely less dangerous than smoking regular cigarettes, according to Glantz and other scientists. Still, that doesn’t mean vaping doesn’t hold health risks.
For example, a research team from the Veterans Affairs San Diego Healthcare System tested two vaping products (including one that was nicotine-free) and found both damaged the DNA in cells in ways that promote cancer. Although the e-cig vapor wasn’t as harmful to cells as cigarette smoke, the researchers concluded their study strongly suggests electronic cigarettes are not as safe as they may appear.
"There have been many studies showing that nicotine can damage cells," said Jessica Wang-Rodriguez, MD, a San Diego VA and University of California pathologist who headed the study. "But we found that other variables can do damage as well. It's not that the nicotine is completely innocent in the mix, but it looks like the amount of nicotine that the cells are exposed to by e-cigarettes is not sufficient by itself to cause these changes. There must be other components in the e-cigarettes that are doing this damage. So we may be identifying other carcinogenic components that are previously undescribed."
So far, there are about 500 brands of e-cigs on the market and they come in over 7,000 flavors. And the flavors and other additives in e-cigs could result in health risks to vapers. For example, formaldehyde, a known carcinogen, is in many e-cigs, and one flavoring agent, diacetyl, has been linked to a serious lung disease.
The Occupational Safety and Health Administration issued a warning that inhaling diacetyl can cause bronchiolitis obliterans. Better known as “Popcorn Lung,” this debilitating respiratory illness was first identified in workers who inhaled diacetyl-containing artificial butter flavor in microwave popcorn processing facilities.
Now there are worries that many people inhaling e-cig vapor are sucking diacetyl into their lungs.
Researchers at Harvard T.H. Chan School of Public Health discovered more than 75 percent of flavored e-cigs and refill liquids for the devices contained diacetyl. In addition, the Harvard study found two other potentially harmful compounds in many of the tested flavors.
“Since most of the health concerns about e-cigarettes have focused on nicotine, there is still much we do not know about e-cigarettes,” said study co-author David Christiani, MD, Harvard professor of environmental genetics. “In addition to containing varying levels of the addictive substance nicotine, they also contain other cancer-causing chemicals, such as formaldehyde, and as our study shows, flavoring chemicals that can cause lung damage.”
Whether using e-cigarettes for smoking cessation has long-term benefits — and whether vaping poses significant health risks — remain unanswered questions, according to the Centers for Disease Control and Prevention.
Although the Food and Drug Administration has discussed regulating e-cigarettes as tobacco products, no proposals have been implemented yet on the federal level. So for now, using e-cigs is a “buyer beware” proposition. You simply may not know what chemicals you are vaping, whether e-cigs will help you stop smoking, or if you are inhaling potentially dangerous chemicals.
April 12, 2016
Christopher Nystuen, MD, MBA