Tag Archive for: nicotine

The Bottom Line on Vaping Today

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Recent reports indicate that in addition to fruit juices and flavors such as menthol and bubble gum, two natural products may be contributing to the issues with vaping: vitamin E and CBD oil. Vitamin E has been found in some vaping cartridges that contain CBD oil. CBD, short for cannabidiol, is the second most abundant cannabinoid found in the cannabis plant. It has levels of THC (tetrahydrocannabinol) below the legal limit and is often used for pain relief and psychological distress such as anxiety. I can’t comment on CBD oil; it’s not my area of expertise.

What I do know is that while cannabis is typically inhaled, CBD oil can be administered orally or topically and that’s probably a better delivery system. When any oil is produced, vitamin E is typically added so the oil doesn’t go rancid. In addition, there may be other additives so the CBD doesn’t break down. There’s no research to suggest that the oil or the vitamin E are safe when incinerated. Even if a cold aerosolized process is used, the ingredients are not designed to be administered that way.

Lung tissue is very sensitive. Think of the aerosolized droplets thousands of times larger than individual molecules of vitamin E or omega-3 fatty acids that would be found in blood. Those droplets would create a barrier, making it tough to breathe, whether natural or not. The benefit relies on the absorption and while some would be absorbed quickly, how long would the residue remain? Could it even be removed?

The Bottom Line Today

As I said in the Tuesday Memo, the governor of Michigan banned the sale of flavored vaping products; I think she made the right decision even though she is taking political heat for it. Business interests have interfered in public health initiatives for too long. Do I even have to mention the tobacco industry? And that it has heavily invested in the vaping industry? With the health of a generation at stake, I think taking time to examine the safety and marketing of these products is warranted.

I wish I could say this is the last word on vaping, but this is a rapidly changing health topic. The only vaping that should be allowed is as a method for quitting smoking—not to replace smoking, but as part of a strategy to quit smoking. It should be regulated by the Food and Drug Administration because nicotine is a drug.

As for the rest of what’s being used in vaping products, I think everyone should take a pass. If the industry actually conducts safety testing to discover any health issues for vapers, maybe, but I just don’t see that happening. The burden shouldn’t be on the health industry to prove vaping is bad; the burden should be on the vaping industry to prove it’s safe. We do enough to ourselves already to impair our health. We don’t need to add any more habits that we’ll need to break in the future. If you smoke, there’s no question you should quit. Talk with your doctor about the best way to accomplish that before you start vaping.

What are you prepared to do today?

        Dr. Chet

Is Vaping Healthy?

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Two years ago, I wrote this about vaping’s potential negative effects: “We won’t know how harmful it is for years, possibly decades, when those who began vaping years ago are tested and found to have higher rates of lung disorders.”

I was wrong; we’re seeing serious lung issues now and even a few deaths. Reports of respiratory illnesses include pneumonia and asthma-like symptoms that impede breathing. Another issue appears to be seizures in some cases. The problem is that no one can identify what’s causing the problem.

One cause might be heavy metals that are aerosolized from the vaping devices as well as metal juice cartridges such as chromium, nickel, and lead. They may be irritants to lung tissue. Lead could also explain seizures in some vapers.

I think that the juices targeting young vapers could be a major source of contaminants. Juices may be natural or synthetically produced, and we might point the finger at synthetic flavors. However, there’s no research on what incinerating natural juices would produce. Phytonutrients are meant to be eaten; what could happen to them when they’re burned? They may end up being toxic due to the change in chemical structure caused by exceeding normal cooking temperatures.

There are still other possibilities so I’ll finish this up on Saturday.

What are you prepared to do today?

        Dr. Chet

Flavored E-cigs Banned in Michigan

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If you’ve been paying attention to the health news at all, you know that there have been some serious respiratory issues and deaths related to vaping. Because the majority of patients were young and were using flavored juices in the vaping products, Michigan Governor Gretchen Whitmer placed a temporary ban on the sale of all flavored e-cigarette products in the state. I applaud the governor’s action. It gives the legislature six months to come up with reasonable legislation governing vaping and vaping products.

This is not a simple issue. Health is the primary concern, especially the health of teenagers and young adults. But because of the prior lack of regulation, the vaping industry has grown to be a multi-billion dollar industry. They’re firmly entrenched, much as the tobacco industry was. They’re not going to go quietly.

The products are being pitched as healthier alternatives to cigarettes. They contain nicotine but none of the other noxious chemicals in cigarettes. They may be useful in helping adults quit smoking, but I’m skeptical of that one. Why create a billion-dollar industry that’s sole purpose is to lose customers? But the operative word was adult.

The concerns are that vaping devices use flavored juices that make them appealing to teens. Even those sold to kids without nicotine set the stage for taking the next step to a nicotine product. But are juices or flavored liquids safe to vape? I’ll update what I wrote two years ago on Thursday.

What are you prepared to do today?

        Dr. Chet

Vaping: Better Than Tobacco

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Today’s final look at vaping and quitting smoking considers the following question: Does the use of vaping to quit smoking result in eliminating the dependence on nicotine? Based on the research, the answer is no, because there’s no research that attempts to answer that question that I could find. Knowing the powerful addictive qualities of nicotine, the only assumption we can make is that vaping does not result in breaking away from nicotine. Therefore when it comes to that question, vaping transfers the nicotine addiction from one delivery system, tobacco, to another delivery system, electronic nicotine-delivery devices. The addiction remains.

But we can still say vaping is better than smoking or chewing tobacco simply for the reduction in chemical exposure.

Maybe the assumption is that nicotine is benign. It isn’t. It has powerful effects on the cardiovascular and nervous systems as well as the adrenal and pancreatic glands. But that isn’t the only issue.

Research Questions

Besides the long-term effects of vaping on the body as well as the question I posed above, there are still several questions that have to be answered.

  • What is the effect of the incineration of the flavors used in vaping juices? The assumption is that because they come from fruit and other juices, they’re natural and won’t have any negative effect on the teeth, the trachea, and the lungs. We know that cooking changes the chemicals in the fruits and vegetables we eat; we also know that when eaten, they have no negative impact on the digestive system, but there’s concern that some of the by-products may be harmful to the lungs. We have no idea what incineration of the juices at high temperature will create. Remember that tobacco is a plant, too—it’s not that different.
  • What is the effect of the smoke or vapors on other people? Vaping generates second-hand smoke just as smoking does, but there’s no research on that.
  • Will childhood vaping lead to nicotine experimentation and addiction? Vaping devices have been marketed like candy to children for their taste. Nicotine cannot be advertised to children, hence the warning in the television ad that began this series, but the concern is that once using the same type of e-cigarette delivery system with fruit juices, it will be a small step for the kids to try the nicotine forms when they’re old enough, if not before.

The Bottom Line

At this time, vaping is better than smoking or chewing tobacco due to the reduction in exposure to toxic chemicals. However, it’s not correct to suggest that vaping is safe until the above research has been done. Until research demonstrates that vaping will lead to helping smokers break their addiction to nicotine, it’s the best route available to help people quit smoking and probably to quit chewing tobacco, although that’s not been tested. But that still doesn’t make it healthy.

If you want to know more about nicotine, the business of vaping and my personal experience with cigarette smoking become a Member or Insider at drchet.com. I cover those issues in the latest episode of Straight Talk on Health.

What are you prepared to do today?

        Dr. Chet

Reference: Ther Adv Respir Dis. 2018 .doi: 10.1177/1753465817744960.

Do Vapes Help People Quit Smoking?

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The only answer at this point is maybe. In the most recent review of the literature, population-based studies that rely on surveys and questionnaires suggest that vaping helps; the problem is that while they tells us something about the population as a whole, it tells us nothing about an individual. We’re still missing randomized placebo-controlled trials. The placebos wouldn’t have to have zero nicotine but should have a variety of doses to assess the best dose of nicotine for quitting; after all, nicotine patches and nicotine gum have been available for decades and have proven to be only 7% effective over a year.

The premise of vaping is that it’s healthier than smoking cigarettes. Is it? When you consider the hundreds if not thousands of chemicals released from tobacco cigarettes, the answer would be yes. Switching from cigarettes to vapes is better from that perspective. But does vaping really help people quit smoking?

One of the characteristics of recent electronic nicotine-delivery systems is the use of liquids with higher doses of nicotine, close to what is found in cigarettes. It may take these higher doses to help people quit smoking.

What are you prepared to do today?

After they quit smoking cigarettes, how long does it last? Research from the United Kingdom suggests that vaping help smokers quit with the use of traditional quit-smoking programs. The long-term effectiveness remains unknown. Which raises the second question: are people able to get off nicotine altogether? I’ll talk about that on Saturday.

        Dr. Chet

References:

1. Ther Adv Respir Dis. 2018 .doi: 10.1177/1753465817744960.
2. Cochrane Database Syst Rev. 2016. doi: 10.1002/14651858.CD010216.pub3.

Warning: Vaping Update

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A couple of months ago, I happened to read a story about a couple of graduate students who came up with a business plan to replace cigarettes with vapes; they wanted the nicotine from the vapes but none of the harmful chemicals in tobacco products. Turns out, the company in the commercial was their company 15 years later after a major investment by a tobacco company.

With a DVR, you can pretty much skip all commercials if you want to. But as I hit the fast-forward recently, I saw something that made me rewind. It said something like “Warning: the following product contains nicotine.” The bulk of the commercial was a testimonial from someone who quit smoking cigarettes by switching to an electronic nicotine delivery system or vaping, for short. The commercial ended with the name of the product found in many vaping stores.

The health questions that vaping presents haven’t been answered, especially the question implied by the commercial: does vaping help people quit smoking cigarettes? Further, do people who smoked tobacco and switch to vaping ultimately quit nicotine all together?

I’ll answer the first question on Thursday. What are you prepared to do today?

        Dr. Chet

The Bottom Line on E-Cigarettes

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Vaping e-cigarettes is supposed to be better than smoking cigarettes because the toxic chemicals will be gone. That may be true for the chemicals released from tobacco and paper, but the third area of concern is the e-liquids that make up the flavor component of e-cigarettes. The marketing tactic often focuses on the variety of flavors available. The question is this: are they safe or do they contain chemicals that could negatively impact the lungs?

Researchers obtained a random sample of e-cigarette liquids from the most popular brands on sale in Greece, Spain, Germany, the Netherlands, the UK, Hungary, Romania, Poland, and France. The samples included a variety of different flavors and nicotine strengths. They analyzed each sample to find out exactly which chemicals were present and in what quantities.

Every liquid container that they tested contained at least one substance that has some level of health risk according to the United Nations classification system. The chemicals, with long complex names, can cause respiratory irritation, allergy or asthma symptoms, or breathing difficulties if inhaled. What they might do when heated is still to be determined.

There were several more research papers presented that also illustrated that e-cigarettes are not problem free. The belief is that they are not as harmful as conventional cigarettes, but the fact is we really don’t know because the components haven’t been tested.
 

Meanwhile There’s the FDA

And they probably never will be tested, at least in the U.S. This past July, the new head of the FDA Dr. Scott Gottlieb announced that he was suspending laws that govern e-cigarettes for five years. In the last administration, the governance over e-cigarettes was turned over to the FDA where they enacted restrictions that insisted the products be tested for safety before being brought to market. Those rules have been suspended so the industry could have time to set standards and comply with tobacco regulations.

I read Dr. Gottlieb’s ruling. As a physician who has treated cancer patients, he has seen what cigarettes do first hand. His belief is that nicotine addiction is the primary issue and that vaping, while not as good as not smoking, may help people quit smoking by using these products to help reduce reliance on nicotine. Gottlieb seems to believe that nicotine, while still addictive, does not kill people; it’s the 5,000 other chemicals in cigarettes that do.

I simply do not understand his reasoning. There are hazards to nicotine, as the research this week has shown. There are chemicals in the e-liquids that have not been identified, have not been tested, and we have no history with their use to investigate. How do we know what health issues we’re facing without finding answers to those questions?

One more thing. Dr. Gottlieb is an investor in a vaping products company called Kure. He has said that he will divest his interest and recuse himself from decisions on vaping for one year. I guess physician years are like dog years; he seems to have made a big decision on vaping after being in office just a few months.
 

The Bottom Line

As a former smoker, I understand the addiction. If vaping products had been available when I quit, maybe I would have used them. As a healthcare professional today, there is not a chance. We’re talking about inhaling substances that have never been subjected to any form of safety or toxicity testing. It’s unreasonable to do that. The studies I reviewed this week clearly show there is doubt. We know how long it took the tobacco industry to finally admit that tobacco was addictive when they had the data all along. The e-cigarette industry has no data at all.

You are a free-living human being. It’s your body, and what you choose to put in it is your choice. I just hope none of it comes from tobacco or e-cigarette products.

What are you prepared to do today?

Dr. Chet

 

Reference: European Respiratory Society. 2017. Abstract OA1978.

 

Update: E-Cigarettes Put Lungs at Risk

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The second study presented at the European Respiratory Conference on e-cigarettes that caught my attention was a study done in Sweden. Researchers questioned over 30,000 people, randomly selected from the Swedish population. The purpose was to ask the subjects about smoking: did they smoke, what did they smoke, and what type of respiratory symptoms did they have? Here’s what they found.

Only 12.6% of those surveyed said they smoked, and the numbers broke down this way: 11% smoked only conventional cigarettes, 0.6% vaped only, and 1.2% said they used both. Researchers speculated they smoked cigarettes when allowed and vaped in public or other settings.

What about respiratory conditions? As you might expect, the highest percentage of respiratory issues came from those subjects who smoked both conventional and e-cigarettes at 56%; 46% of those who smoked only cigarettes had respiratory issues, and 34% of those who exclusively used e-cigarettes. How many non-smokers had respiratory conditions? Only 24%. The results clearly show that vaping causes the same respiratory issues such as wheezing or productive coughs as might be found in tobacco cigarettes.

What might be contributing to the issues with e-cigarettes? I’ll cover that on Saturday. One thing is clear so far: vaping is not innocuous as has been sold to consumers.

What are you prepared to do today?

Dr. Chet

 

Reference: ERS 2017. Abstract PA4485

 

Update: E-Cigarette Safety

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As the European Respiratory Society held their annual convention, several research studies made the health news, including e-cigarettes and vaping. The appeal of e-cigarettes is that they seem to be safe–you’re not actually burning tobacco with its associated chemicals and inhaling that into your lungs. E-cigarettes remove all that bad stuff and associated negative health effects. Or do they?

In the first study, researchers recruited 15 subjects who had smoked cigarettes occasionally, fewer then 10 per month; subjects had also never used e-cigarettes. They were asked to smoke e-cigarettes for 30 minutes in a random order on different days; once with nicotine, the other without. The researchers measured blood pressure, heart rate, and arterial stiffness immediately after smoking the e-cigarettes and then two and four hours later.

In the first 30 minutes after smoking e-cigarettes with nicotine, there was a significant increase in blood pressure, heart rate, and arterial stiffness. That didn’t happen after the e-cigarettes without nicotine. While this is a small pilot study, it seems that vaping nicotine can impact the cardiovascular system in the same way regular cigarettes do.

What are you prepared to do today?

Dr. Chet

 

Reference: ERS 2017; Abstract OA1979.

 

The Bottom Line on E-Cigarettes

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The logic behind the use of e-cigarettes is that they’re better than traditional cigarettes and that vaping will help people quit smoking. Let’s take a look.

The major benefit attributed to e-cigarettes is less exposure to toxic chemicals resulting in fewer harmful effects. In a few of the studies on chemicals found in the nicotine liquid, some metals such as cadmium, aluminum, and nickel were identified as well as the expected ingredients such as glycol and polyethylene glycol from glycerin usually found in e-cigarette liquid as a propellant (1). We don’t know whether they . . .

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