The Dangers of Vaping: What We Know and What We Don't

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man smoking e-cig
Photo credit: mauro_grigollo/istockphoto

Smoke-free?

When it comes to vaping, it can be hard to hear past the biased chatter from both sides to understand what the actual benefits and drawbacks of this new smoking technology are -- just as it is with any growing trend where health and safety are concerned. To help you gain a more balanced understanding of vaping, we'll explore both the positives and negatives aspects, as well as the potential long-term health effects that we're only beginning to understand.

Vaping is considered an alternative to smoking

Vaping means inhaling vapor produced by an electronic-cigarette or other vaporizer, devices which heat substances such as cannabis, tobacco, or their concentrated derivatives to extract their active ingredients far more efficiently -- and proponents argue less harmfully -- than the more traditional method of combustion, which produces smoke. In most cases, vaping refers to inhaling the vapor from uniquely-flavored "e-juice" cartridges that can contain a variable amount of nicotine, which can be used to help some cigarette smokers quit.

There are different types of vaporizers

Vaporizers are the wide variety of electronic devices used to turn dry herb or liquid concentrates into vapor. These include slender e-cigarettes made to resemble traditional cigarettes; larger vape pens -- also known as APVs (Advanced Personal Vaporizers) -- that often produce more vapor; and even bulkier, pricier vape mods that allow even more customization and can be made to vaporize a wider variety of substances beyond e-juice at a wider variety of temperatures.

Vaporizers use heat to function in different ways

Vaporizers have rechargeable battery used to generate heat in an atomizer containing the vaping substance. This works either via a convection method, which uses air or gas to heat the substance, heating it more evenly throughout; or a conduction method where the substance is heated directly, which may cause it to heat unevenly and burn, potentially worsening the effects on the user's lungs.

A variety of substances can be vaped

It depends on the vaporizer. If the user isn't vaping dry cannabis or its waxy concentrated form, they'll most likely be using e-juice sold in cartridges or bottles specially-dedicated vaping shops, made by many different companies in a wide multitude of flavors ranging from menthol to popcorn.

Vaping often uses e-juice

Aside from nicotine and food flavorings (more on those soon), the chief ingredient in almost all e-juice is either propylene glycol or glycerol, which are used as bases to generate an aerosol resembling cigarette smoke when vaped. These are approved by the FDA and have been found in some animal studies to contain little to no toxicity.

Nicotine plays a role in vaping

Though vaporizers are often equated with cigarettes in American culture and policymaking, the only ingredient in common between the two is nicotine. Nicotine is an addictive substance included in high, medium, or low concentrations in most e-juices -- though even the high concentration liquids deliver less nicotine than a conventional cigarette in the same time frame. Other carcinogenic contaminants common in cigarettes may be present in tobacco-flavored vaping liquids, but in levels deemed too low to put vapers at risk.

Nicotine can pose risks for younger users

Despite being one of the most studied drugs, the effects of nicotine are little-understood, since it's so often been inseparable from tobacco for so long. The general consensus is that nicotine itself poses limited risks outside of developmental ones for young users and pregnant women, but it has high addictive potential that has led some critics of vaping to claim it acts as a gateway to traditional cigarettes.

Vaping can be less harmful than smoking

Here's the most essential thing to understand about vaping -- we don't know enough about it yet. But even with potential risk factors still coming to light, many consider vaping to be much less harmful than smoking traditional cigarettes. One of the most promising analyses of the technology, from London's Royal College of Physicians, estimated that the health hazards from e-cigarette use are unlikely to exceed 5% of the hazards inflicted by smoking tobacco.

Public education about vaping is lacking

Given that they are considered to be less harmful than ordinary cigarettes, e-cigs still have something of a PR problem in the US. A poll by Harvard's school of public health found that 32-percent of respondents deemed vaping as dangerous as traditional tobacco products, while six-percent deemed it more dangerous. This negative public perception may be why many states are now regulating public and indoor-use of vaporizers like cigarettes.

There are fewer chemical components than cigarettes

There are roughly 7,000 constituents, or chemical components, that make up the contents of a single cigarette, and over 90 are known or potential carcinogens. The average e-liquid has very few constituents and thus far fewer carcinogens like tar, so even the harmful constituents of cigarettes that are in e-cigs as well, are present in far smaller quantities.

Aldehydes do still pose a potential risk

Aldehydes are among the few harmful components of e-cigarettes vapers must still worry about. When overheated, e-juice can release these harmful chemicals, such as formaldehyde, albeit in much lower levels than cigarettes, perhaps low enough to be negligible. Regardless, this results primarily from using a vaporizer not as intended, creating a harsher, drier puff that lets the user know something is off.

Vaping may offer benefits to the respiratory health for smokers

It's hard to tell the long-term effects of a technology barely a decade old, but much of the available evidence suggests that using a vaporizer in place of traditional smoking tobacco can lead to improved airway function and respiratory systems for former smokers who now get their nicotine fix through vaping.

Vaping may have fewer secondhand risks than smoke

Cigarettes create two kinds of secondhand smoke -- one kind exhaled by the smoker, and one, far more harmful kind released from the burning tip. Vaporizers create only one kind of secondhand vapor -- the one exhaled by the user -- regarded as containing low concentrations of nicotine and other pollutants. Though to date, there is insufficient evidence to suggest that inhaling this vapor causes any measurable negative impact on bystanders.

Vaping does have negative short-term effects

E-cigarettes eliminate the stink of traditional cigarettes, but can still cause some of the same short-term drawbacks associated with smoking. These potential drawbacks can include throat and mouth irritation, coughing, nausea, and vomiting, especially for new users or those vaping an atypically large quantity of e-juice in single sitting.

Vaping can cause compromised oral health

Though vaping may be much easier on your lungs, recent findings suggest this method may not be much better than smoking for the user's mouth. One study showed that cells lining the mouth died at a much greater rate than normal following e-cig exposure, increasing the risk of gum disease, infection and oral diseases such as xerostomia, or dry mouth, and stomatitis, an oral inflammation of ulcers.

Vaping poses other safety risks

Even when not in use, the separate components of e-cigarettes can pose a safety risk. There have been cases of vaporizers or their batteries overheating to the point of causing explosions, fires, and related bodily harm. Injuries and death have also resulted from young children coming into contact with nicotine-containing e-liquids, either by ingesting or having their skin exposed to a significant volume of it.

Vaping may lead to compromised immune responses

The immune responses to viral infection generated by one's nasal mucous membrane are known to be compromised in cigarette smokers, but it may be even worse for vapers, according to the American Association for the Advancement of Science (AAAS). They found that, with or without nicotine, e-cigarette suppressed 305 more immune-related genes in users than cigarettes, which suppressed only 53.

E-juice flavoring can compromise immune responses

Why would vaping cause more harm to the user's immune system than smoking? The most likely culprit seems to be the food flavorings of the e-liquid, a hypothesis supported by the AAAS study, which showed that the most suppressive effects to the subject's immune cells came from exposure to a single flavoring -- cinnamon.

Flavoring agents in e-juice can cause respiratory issues

The FDA classifies flavoring agents used in e-juices as "generally recognized as safe" for oral consumption, but there's little research into their effects when inhaled. The flavoring diacetyl, used to mimic popcorn, has been known to cause respiratory issues (potentially by impairing immune function) since 2000, but in 2015 was still found in as many as 39 out of 51 e-juice flavors available for consumption.

There are variations between e-juice manufacturers

The FDA ruled last year that vape manufacturers and retailers must begin registering ingredients by August 2019, but that means until then, vapers will remain mostly in the dark about the potentially harmful flavoring agents present in any e-juice. Some vaporizing liquids have also been found to under- or overestimate the amount of nicotine present.

Unexpected contaminants can pose health risks

The current lack of regulations or labeling restrictions for vaping liquids means there's always a risk of unexpected contaminants, such as the poisonous diethylene glycol produced by nonpharmaceutical-grade propylene glycol. The FDA has warned e-cig manufacturers regarding cartridges contaminated with this and other additives found in past incidences, like the weight-loss chemical rimonabant.

Specific flavors of e-juice can pose toxicology risks

The AHA reports that several toxicology studies have found that individual flavors of vaporizing liquid, like Ceylon cinnamon, are toxic to certain human cell cultures, including embryonic stem cells and fibroblasts, which are critical to wound-healing. This toxicity is correlated with flavoring levels in the liquids, lending support to the idea that the results of inhaling such flavoring agents are not yet sufficiently understood.

There are potential adverse effects of propylene glycol in e-cigarettes

Despite the positive findings of animal studies on inhalation of the substance, the American Heart Association notes that propylene glycol has been known to cause eye or respiratory when used to generate theater fog. Thus, it's possible inhaling it from e-cigarettes on a regular basis may cause unknown respiratory harm, particularly for sufferers of asthma or other lung conditions.

Vaping may produce other potential byproducts

Thermal degradation of the e-juice base from consistent heat can sometimes produce the derivative propylene oxide, a class 2B carcinogen, while degradation of glycerol can produce acrolein, an irritant tied to cardiovascular and pulmonary issues in cigarette smokers. Levels of these toxic byproducts, however, are many-fold lower in vaporizer emissions than cigarette emissions, though the levels increase when vaping at higher temperatures. The effects of exposure to low-levels of both compounds are unknown.

Nicotine from vaping could have cardiovascular effects

Most of the cardiovascular effects attributed to vaping so far correspond neatly with the known effects of nicotine. Epidemiological studies have found no increased risk of stroke or myocardial infarction (also known as a heart attack) in vapers -- only indications that they can contribute to acute cardiovascular events, especially for those already at risk from coronary heart disease.

Vaping could be considered a gateway drug

There's been a great deal of concern that vaporizers will make smoking more attractive and accessible for non-users, opening the door to traditional cigarettes and other drugs, but the research is still decidedly split. A 2016 report by World Health Organization lends credence to the idea, but it's hard to determine causation on the matter when those most likely to try e-cigs may also be likely to try traditional smoking, regardless of that would-be gateway.

There's a growing use of vaping among young people

There are also legitimate worries that this sleeker, smoother form of vaping will turn more young children and teens to smoking. The WHO report shows a rapid increase in vape-use among non-smoking youth in the US, particularly Florida, and a CDC survey found that while only 32% of high schoolers reported trying cigarettes, 45% admitted to trying vape products.

There's no consensus about whether vaping will actually help you quit smoking

Again, the research is split. While in the UK, e-cigs containing nicotine have been found to help a smoker's chances of quitting and/or lowering intake, US studies found they actually lowered one's chances of quitting by 28%. Whether the contradictory findings result from cultural differences or simply random variations between test-subjects, it's still too soon to say.

The long-term effects of vaping are still unknown

Vaporizers have only been available for a little over a decade, so it's still impossible to know the extent to which vaporizers and e-cigarettes may impact the health of long-term users. While our scientific understanding of vaporizers continues to advance on an almost-daily basis, it may still be several decades before their full effects are better understood.