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The Truth on Vaping Dangers

10th February 2015

Many worries have been voiced about vaping since it has taken off and become a common sight in our environment.

Those that have been raised include the following, to which I have put rebuttals afterwards;

Ecig vapour is a risk to bystanders (passive vaping) by exposing them to toxins or nicotine - False. The research has been comprehensively reviewed by scientists and there is no significant exposure to bystanders.

Nicotine is toxic - It is claimed to be carcinogenic and cause other problems. Most of these claims prove to be false or greatly misleading. And this plant alkaloid may have health benefits as well, in terms of protecting against depression, psychosis and neurodegeneration. More research is needed, but the main group for whom nicotine is toxic are adolescents and children, because nicotine can interfere with the long distance wiring of growing brains - a problem that does not exist for adults, where the effect is neuroprotective.

Nicotine is a gateway drug - This claim is misleading and sensationalist. Stimulants generally do have some priming effect on addiction related pathways in the brain - however the size of the effect is roughly comparable to caffeine.

....based on the above two points, the following claim is made;

Nicotine is really the problem - False, the 'toxicity' of nicotine is very low compared to the toxins generated by cigarette combustion, and this claim should be made from a risk/benefit perspective - there are also potential benefits to nicotine for health, and the evidence for these benefits (in both the cell system and real populations) is probably currently stronger than for supposed risks.

They are a fire risk - There is a risk of electrical failure particularly from the charger, but if you are replacing burning a cigarette, one small risk has replaced a larger one, and the risk is basically the same for many other battery powered electricals)

Vaping is a gateway for teens and adults into smnoking - No evidence to support this, in fact the evidence seems to point the other way as cigarette use continues to fall impressively. Other research continues to show that if anything, e-cig use in teens is unlikely to be more than experimental, and ongoing use is generally replacing tobacco, which presents an overall harm-reduction to the teens. Usage amongst this age group is very low.

They are not effective smoking quit-aids - The evidence is growing stronger and stronger that they are very effective quit-aids, even the best available. It is not proven yet to the satisfaction of all scientists but the evidence that is meaningfully gathered is all pointing to this conclusion.

E-cigarette food flavours encourage children and adults into taking up vaping - False, so far. There is no evidence that flavours are encouraging children to take up nicotine, and in adults non-tobacco flavours are associated with greater smoking quit success or smoking reduction, perhaps by de-conditioning the brain to like the foul taste of cigarettes. Because it seems that the ecig is less addictive than tobacco (see next point), this means that reduced tobacco use also allows for greater likelihood of nicotine reduction and quitting either source of nicotine.

E-cigarettes are as addictive as tobacco cigarettes - False. No evidence exists to show this, and in fact it shows the opposite. Yes, nicotine is a weak gateway drug, but there are other components of tobacco cigarettes that make them more addictive, which are missing in e-cig vapour. If the current balance of evidence is verified, the result will be that the total 'gateway' effect, and addicting potential, is lowered when a smoker switchers from tobacco to an e-cig. This helps to explain the increased likelihood of total quit success by first switching to e-cigs, even according to some research, when tobacco smokers didn't even intend to stop, and the absence of any significant trend amongst adolescents towards full smoking despite the increase in e-cig popularity in general. In studies, there is virtually no observations of people progressing from never using nicotine to regular use due to trying vaping, nor from progression of vaping towards tobacco cigarettes. The evidence actually points in the other direction.

They produce higher or similar levels of formaldehyde than cigarettes - False, except for specific high power devices running dry. Normal usage produces much less of these compounds.

Ecigarettes are a source of heavy metals - This is misleading. Since some poor quality products may release small quantities of certain metals, this has been a common concern raised in the media. However, there are insignificant levels of the two most concerning metals- lead and mercury. Lead and mercury levels are high in cigarette tobacco, and more importantly, the level of cadmium, lead and mercury in the bloodstream of smokers is elevated (see for 1), 2, 3. The levels of any metals found in e-cig vapour are much less, and I am not aware of any research showing an elevated blood level of these in users. So the safety compared to smoking appears to be much better.

Ecigarette vapour contains 'particulates' whose toxicity is a concern - Vapour does contain particulates that are very small particles, sometimes called PM2.5 or PM1's. These tiny particles have been associated with toxicity in combustion exhaust, particularly from diesel engines. However this toxicity is not so much due to the size but the chemical composition of the particle. Diesel exhaust is very dirty, and the particles do not quickly degrade because they cannot be easily broken down by immune macrophages and lung cells, traveling around the blood stream. This is the problem. Particles produced by an e-cig are mainly water and propylene glycol, which can be readily degraded. It isn't the same kind of particle. Cigarettes also produce particulates.

Ecigarette vapour causes cell damage - The data that shows 'cell stress' effects it appears is often obtained by studying the wrong cells compared to those that would be exposed in the real world, or exposure to specific vapours produced in abnormal ways in unrealistic conditions, i.e. with high carbonyl generation, or due to certain flavourings that may be added (rarely). But there are also cell and animal studies that show no negative effects at all, and some have compared with smoking combustion products, which did show harm from smoking. There may be some irritant effects, i.e. of propylene glycol, but meaningful comparison must be made with tobacco (which also contains propylene glycol), as vaping is a Tobacco Harm Reduction activity. These comparisons either do, or would be in the future expected to show an improvement in this aspect for the average smoker. A real world test is how it affects lung function compared to smoking. Some people may also be allergic to propylene glycol, which is not surprising - people can be allergic to almost anything. Also the concerns related to PG do not appear to be relevant to vegetable glycerin based e-liquids (which also do not appear to produce carbonyls in incorrectly used high power devices.) In this research, the only effects were observed from some uncommon flavourings. Cinnamon extract also (rarely used and not present in our e-liquids) is also able to create a toxin which is an irritant.

Vaping causes cardiovascular stress - False. Certain changes are observed after vaping. However these are not in themselves negative and appear normal i.e. as a result of a stimulant. See 1, 2, 3, 4, 5, 6. There is no significant lung or cardiovascular effects observed in the real world, and generally a strong improvement compared to smoking. Potential irritant stresses on the lung need to be compared to smoking (see below and previous point). These effects can be lowered by avoiding certain flavourings such as cinnamon.

Vaping triggers viral and bacterial infections - Now this one is interesting, and misleading. Propylene glycol and the pH of vapour can have a mild irritant effect. Many existing viral or bacterial infections are primed to be more aggressive under conditions of stress. Viruses can replicate when they sense cell stress. And bacteria will form 'biofilms' under conditions when they feel threatened that makes them more resistant to antibiotics. This reflects an antibacterial and anti-microbial action of the agents in vapour, such as propylene glycol. As this effect isn't sufficient to kill these colonies altogether, they will behave more defensively, which has been interpreted as making them more dangerous. But it is possible that if you have such an infection you are treating with antibiotics, and take PG containing vapour at the same time, the antibiotic may be more effective. One study showed that in rodents, vapour caused bacterial counts in lungs to increase whilst triggering biofilm formation (antibiotics also cause this). Yet when bacteria are in a biofilm, their nutrient sources and growth potential is reduced. So a logical explanation is not that the vapour triggered a higher number of bacteria, but that the escape from colonies in the lungs, ie to the outside environment (which would in that case increase transmission to others) or internally (into the bloodstream), which would then increase the danger of infection needing antibiotics, has actually been reduced, so the numbers in the lung surface appears to be higher. These bacteria are more dangerous when they are replicating and spreading into the body, particularly in low oxygen conditions in body tissues. So these findings don't (IMO) seem to reflect a risk of dangerous infections. In any case, if this is a problem, it is caused by 'stress' in the bacteria and lung tissues/immune cells, and since this is less than for smoking, the only way to look at viral or bacterial effects is in a comparison with that, not with those who do not use either method of nicotine delivery. There are many reports and medical observations of strong improvement in pulmonary function in those who switch from smoking to vaping which are not consistent with increased rates of infections, except with a minor fraction that are allergic to PG. There are also roles to be found in (uncommon) flavourings and ingredients that can be added to e-liquids, which the industry has responded to by removing if present whenever they are flagged.

In the future, e-liquid vapours can be engineered to combat these effects, block biofilm production (i.e. with polyphenols which destroy biofilms) or synergise with antimicrobial actions of PG to kill off bacterial infections. It is possible to enhance immune function as well. There is also the same potential to engineer e-cig juices to reduce cancer risk, and enhance chemotherapy and radiotherapy, which is not presented by tobacco, as there are a number of natural compounds which are known to strongly inhibit tumour growth, sensitive tumour cells selectively to chemotherapy or radiotherapy, and even restore sensitivity in chemotherapy resistant tumour cells, whilst efficiently delivering to respiratory tract cells and to the blood stream.

Natural compounds may be added that have a multitude of anti-microbial and antiviral effects, which can include reducing the attachment and replication of respiratory viruses in respiratory tissue, for example via the ICAM-1 pathway (which the commercial product Vicks First Defense employs to reduce risk of respiratory infections).

So lets stop demonising this popular low temperature atomising technology that has helped so many people, or we will be in danger of blocking a great deal of possible progress. The future is bright!

For more comprehensive information - we recommend Dr Farsilanos's links and research here - 2013, 2014, 2015 amongst many scientific sources available, as Farsilinos has consistently been proven right, anticipated findings, and responded to all the science as it has emerged. His opinion is, in our opinion, the most balanced available (note, he does receive funding from the industry).