Vaping is not Cool

Do you want these chemicals in your lungs?

I recently finished watching Dr. Brian Ardis’ documentary, The Antidote. It is both interesting and fascinating, especially the section on refuting the long-held, well-published “theory” that nicotine is addictive and harmful. As Dr. Ardis explained, the tobacco industry discovered that nicotine was not addictive back in the early 1970s. They added chemicals to cigarettes to make smoking addictive to build the tobacco industry. Nicotine is found naturally in a lot of healthy foods, including eggplant, celery, and the nightshade family of vegetables. I encourage you to watch Dr Brian’s film, (yes, it’s long - 2 1/2 hours ) then research the health benefits of nicotine, and why governments want to ban nicotine gum and nicotine patches.

The intent of this substack is not to delve into the debate around nicotine. It’s to talk about the realities of e-cigarettes. Much of this information has been sourced from an extensive Surgeon General report released in 2016. The full details can be found here.

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Short History of Smoking and e-Cigarettes

In the 1880s and 1890s, many novel products were attempted to block what was thought to be poisonous components of tobacco. In 1913, the Camel brand was a new kind of cigarette that introduced high-nicotine content by using harsh burley tobacco. A few years later, In 1916, American Tobacco introduced its Lucky Strike blended cigarette, and in 1918 Liggett & Myers (L&M) reformulated its Chesterfield brand to make it more palatable to users. 

The landmark 1964 Surgeon General’s report on smoking and health concluded that cigarette smoking contributed substantially to mortality from certain specific diseases, including lung cancer. At that point, the finger-pointing at “tar and nicotine” as the cause of illness caused by smoking tobacco began.

What is never spoken much about are the chemicals approved for use in tobacco-based cigarettes. There are approximately 600 ingredients in cigarettes. When burned, cigarettes create more than 7,000 chemicals. At least 69 of these chemicals are known to cause cancer, and many others are toxic.  While the public is warned about the danger of the poisons in these products, there is no such warning for the toxins in tobacco smoke. And smoking pure, even organic, unadulterated tobacco leaves such as those smoked by native Americans are in a totally different class.

Here are a few of the chemicals in tobacco smoke as listed on the American Lung Association website: 

• Acetone—found in nail polish remover

• Acetic acid—an ingredient in hair dye

• Ammonia—a common household cleaner

• Arsenic—used in rat poison

• Benzene—found in rubber cement and gasoline

• Cadmium—active component in battery acid

• Carbon monoxide—released in car exhaust fumes

• Formaldehyde—embalming fluid

• Hexamine—found in barbecue lighter fluid

• Lead—used in batteries

• Naphthalene—an ingredient in mothballs

• Methanol—a main component in rocket fuel

• Tar—material for paving roads

• Toluene—used to manufacture paint

What about e-cigarettes?

Even though there has been a substantial decline in the amount of cigarettes smoked over the last 20 years, there has been a dramatic rise in the use of electronic cigarettes. These devices are referred to, by the companies themselves, and by consumers, as “e-cigarettes,” “e-cigs,” “cigalikes,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.” 

An early prototype of the current e-cigarette appeared in the U.S. in 1963. The application was for a “smokeless non-tobacco cigarette,” replacing burning tobacco and paper with heated, moist, flavored air. A battery-powered heating element would heat the flavor elements without combustion. The Favor cigarette, introduced in 1986, was another early noncombustible product promoted as an alternative nicotine-containing tobacco product.  

However, the first device now recognized as an e-cigarette was developed in 2003 by a Chinese pharmacist.  It became part of the US market by the mid-2000s. Sales of e-cigarettes accelerated rapidly since 2007. By 2014, an estimated 90% of the world’s production of e-cigarette technology and products came from mainland China. A report released by the CDC on June 22, 2023 found:

Overall, e-cigarette monthly unit sales increased by 46.6%—from 15.5 million units in January of 2020, to 22.7 million units in December of 2022.

During this study period, the number of brands increased by 46.2%, from 184 to 269 brands...The study showed that menthol-flavored e-cigarette sales remained stable and unit shares of tobacco-flavored and mint-flavored products decreased. Shares of other flavor sales, which include fruit, clove/spice, candy/sweets and chocolate, however, increased from 29.2% to 41.3%.

Interestingly, menthol in cigarettes has long been known to cause a detrimental effect on the lungs. In 2015, a large-scale cohort study reported that more frequent and more severe exacerbations of chronic obstructive pulmonary disease  (COPD) were observed in menthol cigarette smokers compared to non-menthol cigarette smokers.

Components in e-cigarettes

The e-liquids in e-cigarettes are most often flavored; a study estimated that 7,700 unique flavors existed in 2014 and that most were fruit or candy flavors. A content analysis of the products available via online retail websites documented that tobacco, mint, coffee, and fruit flavors were most common, followed by candy (e.g., bubble gum), unique flavors (e.g., Belgian waffle), and alcoholic drink flavors (e.g., strawberry daiquiri). Some retail stores are also manufacturers that create custom flavors, which increases the variety of flavors available. Flavors have been used for decades to attract youth and to mask the flavor and harshness of tobacco.

E-cigarettes are available through convenience stores, tobacco stores, pharmacies, “big box” retail chains such as Costco, online retailers, and shops called “vape shops.” The shops are often designed as cafes and lounges to promote socializing.  Advertising for conventional cigarettes has been prohibited from radio and television since 1971. However, e-cigarette products can be advertised and promoted on radio and television, at sporting and music events, in movie theaters, and all across social media.

Quantitative and qualitative studies have identified approximately 60 to 70 compounds (unidentified and identified) in each liquid tested, with at least 18 additional compounds generated during the vaporization process.  (Section 5) This book chapter on the toxicology of compounds within e-cigarettes is extensive. If you are interested in the detailed chemistry of these and more, you can find the details in this chapter.

Here is a partial list of substances found in e-cigarette constituents: (Section 5)

• Solvent carriers (PG and glycerol)

• Carcinogens - chemicals known to cause cancer, including acetaldehyde and formaldehyde

• Tobacco-specific nitrosamines (TSNAs) and aldehydes

• Metals such as nickel, tin, and lead

• Acrolein – herbicide to kill weeds; can cause irreversible lung damage, including asthma, COPD, and cancer.

• Tobacco alkaloids

• Carbonyl compounds

• Ultrafine particles that can be inhaled deep into the lungs have been identified in e-cigarette aerosols, cartridges, refill liquids, and environmental emissions.

In general, e-cigarettes often contain propylene glycol (PG) and glycerol, mixed with concentrated flavors and, optionally, a variable percentage of nicotine. PG is a common additive in food; it is also used to make things like antifreeze, paint solvent, and artificial smoke in fog machines.

In January 2018, the National Academies of Science, Engineering and Medicine released a consensus study report that reviewed over 800 different studies called “Public Health Consequences of E-Cigarettes.”

That report made clear: using e-cigarettes causes health risks. It concluded that e-cigarettes both contain and emit a number of potentially toxic substances. The Academies’ report also states there is moderate evidence that youth who use e-cigarettes are at increased risk for cough and wheezing and an increase in asthma exacerbation. There is conclusive evidence that in addition to nicotine, most e-cigarette products contain and emit numerous potentially toxic substances.

Legal Restrictions

Many cigarette smokers have turned to vaping because e-cigarettes have previously been marketed as a safe alternative to traditional cigarettes. The FDA rejected these claims, and in September of 2010, the US Court of Appeals decided that e-cigarettes may not be marketed as a safer alternative to cigarettes, or as a smoking cessation device, but instead must be sold as a smokeless tobacco product subject to the same rules and regulations of other tobacco products.

This ruling remains controversial because e-cigarettes contain no tobacco. Nevertheless, the potential harmful effects of vaping have led the FDA to issue Internet warnings regarding the risks of vaping  

Bottom line

Sucking chemicals, flavors, and heated solutions into the lungs – substances that don’t belong there – is not in any way good for your health. And it doesn’t look ‘cool.’