Dr. Katrina Traikov ND

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9 things about e-cigarettes

1) Health Canada has advised Canadians NOT to purchase or use e-cigarettes, because of potential health risks, and because these products have not been fully evaluated for safety, quality or efficacy

It is currently illegal to sell, advertise or import e-cigarettes containing nicotine or making a health claim (eg. that they help people to quit smoking) in Canada. None of these products have been given market authorization by Health Canada.

Despite this e-cigarettes containing nicotine continue to be easy to obtain in Canada through various retailers or online.

In contrast, e-cigarettes without nicotine and not making health claims are not currently subject to any selling, advertising or importing restrictions in Canada.

E-cigarettes typically deliver a vapour containing nicotine, by heating a solution (called an e-liquid) containing propylene glycol (think antifreeze), glycerin and flavouring agents. While there is no smoke, tar or carbon monoxide in these vapours, making their use less conspicuous, and second hand exposure less obvious, advertising claims that you are just inhaling water vapour are a long way from the truth.

2) E-cigarettes are not regulated

This means products can contain contaminants that may be harmful to one’s health; that the way the e-cigarette is engineered can result in more or fewer contaminants being released into the air or our bodies; that these products can contain higher or lower doses of nicotine than they claim to; and that they can malfunction or deliver a dose of nicotine that is higher or lower than claimed.

In contrast, nicotine inhalers, gums, lozenges patches and sprays and gums are regulated in Canada with a DIN (Drug Identification Number), contain and deliver the dose they claim, and are tested for contaminants.

Though the levels of contaminants in E-cigarette vapour are typically much lower (1-2 orders of magnitude) than conventional cigarette smoke, there is a wide variation in the contaminants found in different e-cigarette products. In addition, contaminant levels in e-cigarette vapours are higher than those in nicotine inhalers, regulated products in Canada with a DIN.

3) Multinational cigarette companies are advertising and selling e-cigarettes and use among children and teens is rising

Wells Fargo predicts that by 2017, sales margins for e-cigarettes could surpass those of conventional cigarettes.

E-cigarettes are often marketed as healthier alternatives to smoking and as useful for quitting smoking. These claims are not supported by current scientific evidence. In fact, according to the latest research, smokers who use e-cigarettes are less likely to quit smoking than smokers who do not use them. Many smokers use e-cigarettes in addition to conventional cigarettes.

E-cigarettes are also marketed as a way to get around smoke free laws – allowing users to “smoke anywhere”. This could have a tremendously negative public health impact, undermining prevention, and cessation efforts, as well as potentially re-normalizing smoking behaviour, and exposing bystanders to aerosolized contaminants.

Advertising for conventional cigarettes has been prohibited since the 1970s

However, ads for e-cigarettes are widely available on the internet and in the U.S, and use among children and teens is rising.

According to the World Health Organization, the advertising, sale and use of e-cigarettes should be prohibited where conventional cigarettes are prohibited.

Flavoured products

E-liquids are flavoured. Flavoured tobacco products are much more popular among children and teens and people starting to smoke. Cigarettes with flavouring (except for menthol) have been banned in the U.S, and it appears Ontario is following suit, however flavoured e-cigarettes are still widely available.

Use of E-cigarettes

It appears e-cigarette use is most common among youth who also smoke or are experimenting with smoking, however, some youth who have never tried a conventional cigarette are starting to experiment with e-cigarettes.

Current smokers, young adults, people with higher education and higher income levels are more likely to use e-cigarettes and they perceive them as less harmful than conventional cigarettes.

Nicotine addiction is powerful especially among children and teens. E-cigarettes may also act as a gateway to other drugs and harmful substances for youth as well as potentially the re-initiation of smoking by former smokers.

4) It’s not just water vapour you’re inhaling

E-cigarettes can expose us to many contaminants, and the long term health effects of e-cigarette use are still unknown.

Particulate matter

Both e-cigarette vapour containing nicotine and cigarette smoke contain fine particles in similar amounts with some e-cigarettes delivering more particulate matter than conventional cigarettes. There is also strong evidence that even short term exposure to low levels of fine and ultrafine particles from tobacco smoke or air pollution can contribute to inflammation in the lungs and throughout the body and increase the risk of heart, lung and vascular disease.

In Scandinavia, a study found that discontinuation of a smokeless tobacco product after a heart attack halves the risk of death which is similar to the effect of quitting smoking.

Heavy metals

E-cigarettes can also deliver heavy metals that come from the heating element including tin, silver, cadmium, copper, lead, nickel and chromium. One study reported 2 to 100 times the nickel concentration in e-cigarette vapour compared to conventional cigarette smoke.

The type and amount of metals generated depend on the design of the e-cigarette.

Flavouring agents

Many flavouring agents used have been shown to be toxic to cells within the human body and fetuses.

In tobacco-flavoured products, trace levels of N-nitrosamines, polycyclic aromatic hydrocarbons, and volatile organic compounds have also been found. In contrast, these compounds are undetectable in regulated nicotine medications.

Propylene glycol and glycerol – the ‘base’ of the E-liquid

Propylene glycol used in the base of the e-liquid is irritating to the eyes and lungs. Concerns about the inhalation of propylene glycol in asthmatics and people with COPD (chronic obstructive pulmonary disease) have been raised.

Heating of propylene glycol can produce propylene oxide – a known carcinogen (a substance capable of causing cancer).

Heating of glycerol can produce acrolein, an irritant and oxidizing agent thought to contribute to the negative effects of cigarette smoke on the heart and lungs.

Some e-cigarettes also produce formaldehyde at levels similar to cigarettes. Formaldehyde is also a carcinogen and an irritant.

Nicotine

Nicotine is a highly addictive substance that can negatively affect human brain development – a process that is still ongoing until about the age of 25.

Nicotine can also produce dysfunction of the lining of our blood vessels and cause malformation of fetuses in pregnant women. There are also concerns about nicotine potentially promoting the development and spread of cancer.

5) Second-hand exposure is a concern

The public health of children, adults, pregnant women, the elderly, smokers, and non-smokers must be protected from exposure to nicotine, particulate matter and other contaminants from e-cigarettes.

6) E-cigarettes must not be used to circumvent smoke free laws and policies and tobacco control measures

Smoke-free laws and policies reduce consumption of cigarettes and prevalence of smoking as well as hospital admissions for heart attack, stroke, and other heart and lung emergencies. The rates of various infectious diseases and lung cancer are also decreased due to smoke-free laws and policies.

Tobacco control measures have drastically reduced the number of youths who smoke, and many lives have been saved. E-cigarettes should not be allowed to circumvent these measures.

7) E-cigarettes don’t help people quit smoking

In fact, viewing an e-cigarette commercial may trigger thoughts about smoking or cue the urge to smoke. E-cigarettes typically contain less nicotine per puff but users can learn to take more puffs to achieve similar blood levels of nicotine to those smoking conventional cigarettes.

Additionally, E-cigarettes are most commonly being used along with conventional cigarettes. Real-world use of e-cigarettes is associated with about a 30% less chance of quitting smoking compared to someone who is not using e-cigarettes.

8) Quitting smoking completely rather than decreasing one’s cigarette consumption is very important for most health benefits including staying alive

Quitting at an earlier age also decreases death rates from conventional cigarette smoking. Light smoking of even 1-4 cigarettes per day is associated with a much higher risk of cardiovascular disease compared to someone who does not smoke. Additionally, Lung cancer death rates increase more with additional years of smoking rather than amount smoked per day. Both of these factors also impact death rates from pancreatic cancer, esophageal cancer, and bladder cancer, but years smoked may be more important than number of cigarettes smoked per day – highlighting the importance of quitting for good and the potential health dangers of using a product that could delay or defer quitting.

Setting a quit date within a few weeks and measurable and achievable goals to decrease the number of cigarettes used per day over a specific period of time, as well as seeking counselling have been proven to increase one’s chances of kicking the habit for good.

Additionally, when compared with the nicotine patch, e- cigarettes had more dual use (i.e. people were still smoking e-cigarettes in addition to conventional cigarettes, but people who were using the nicotine patch were less likely to be still smoking conventional cigarettes at the same time).

9) Nicotine poisoning is a concern with e-cigarettes

Nicotine poisoning is a concern if e-liquid is ingested. Nicotine in the e-liquid can also be absorbed through the skin. A number of cases of accidental exposure in children and adults have been reported. The concentration of nicotine in e-liquids are high enough to be fatal to a child even if only a few millilitres are ingested.

Quitting smoking is one of the best things you can do for your health. Many healthcare plans include comprehensive tobacco cessation treatments. Talk to your healthcare provider about quitting smoking today.

References:
E-cigarettes – a scientific review
Electronic cigarettes: A policy statement from the American Heart Association

Originally published in the Valley Naturopath clinic newsletter September 2014.

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