October 31, 2013

E-Cigarettes may not be safe

A new study by the German Cancer Research Centre raises question over the safety of e-cigarettes.  See the full report here.  Here are the key messages from the research:

Product characteristics

  • E-cigarettes cannot be rated as safe at the present time.
  • Consumers do not have reliable information on product quality.
  • Electronic cigarettes have various technical flaws (leaking cartridges,accidental intake of nicotine when replacing cartridges, possibility of unintended overdose).
  • Some manufacturers provide insufficient and partly wrong information about their liquids.

Health effects

  • The liquids contain ingredients that on short-term use irritate airways and may lead to allergic reactions and which may be harmful to health when inhaled repeatedly over a prolonged period of time.
  • The aerosol of some liquids contains harmful substances (formaldehyde, acetaldehyde, acrolein, diethylene glycol, nickel, chromium, lead).
  • The functionality of electronic cigarettes can vary considerably (aerosol production, nicotine delivery into aerosols).
  • Adverse health effects for third parties exposed cannot be excluded because the use of electronic cigarettes leads to emission of fine and ultrafine inhalable liquid particles, nicotine and cancer-causing substances into indoor air.

Now I am not a massive fan of e-cigarettes, I think they have a very acrid smell and I would like to see them covered by the same regulations as normal cigarettes i.e. use them outside and not inside public places.  My main worries are that children will see people in public places using these devices and want to emulate them and that it will normalise what is essentially nicotine addiction and Chinese medicine says any addiction is detrimental to health.

That being said I would rather an addict use an e-cigarette than a normal cigarette any day.

On the minus side I know that some people are using e-cigarettes to smoke cannabis oil and resin in public places and we will probably see this use increased as it is very difficult to identify someone doing this.

More research is needed into these devices and there also needs to be fundamental regulation of these devices so that the quality and quantity of the chemicals to be vaporised can be standardised and controlled so they can be used safely.  There are studies showing that the carcinogens that are found in normal cigarettes are also present, all be it in smaller quantities, in e-cigarettes so yes they are better but they are in no way perfectly safe.

From the Journal of Indoor Air:


The consumption of e-cigarettes causes emissions of aerosols and VOCs (volatile organic compounds), such as 1,2-propanediol, flavoring substances, and nicotine, into indoor air. During inhalation of e-cigarette vapor, the aerosol size distribution alters in the human lung and leads to an exhalation of smaller particles. This effect is caused by the evaporation of the liquid particles in the lung and also in the environment after exhalation. The quantity of the inhaled vapor could be observed to depend on the ‘liquid’ delivery system of the e-cigarette in use.

Overall, the e-cigarette is a new source of VOCs and ultrafine/fine particles in the indoor environment. Therefore, the question of ‘passive vaping’ can be answered in the affirmative. However, with regard to a health-related evaluation of e-cigarette consumption, the impact of vapor inhalation into the human lung should be of primary concern.

Now they do point out that the release of any gasses, comparative to a real cigarette, is vastly reduced and that their experiment is small scale but they do conclude that passive vaping does exist.

And next from the National Institute of Health:


And here are the good bits (well from my point of view, its a good read all round to be fair especially the bit where the FDA have to go to court.

Accessible information provides details about the presence of nicotine (including cotinine), tobacco specific impurities (anabasine, myosmine, ?-nicotyrine), propylene glycol (rarely diethylene glycol), and tobacco specific nitrosamines (which include carcinogens) in commonly available brands of electronic cigarettes

Moving on to The Journal of the American Medical Association (who also point out that impurities and carconogens have be detected in e-cigaretts):


Chemical analyses of several samples of products by FDA scientists detected tobacco-associated chemicals that may be harmful to humans, including known human carcinogens. One cartridge also contained 1% ethylene glycol, a toxic chemical. Additionally, the researchers found varying levels of nicotine, even in products sold under the same label

Again, overall I am happy that e-cigarettes are probably safer than r-cigarettes but IMHO NO cigarettes are better than either and there are lots of proven ways of giving up smoking and acupuncture can help in conjunction with other interventions but there is not much high quality evidence that it can help on its own but everyone is different and I know plenty of my clients site acupuncture as the thing that helped them kick the habit.

And I will finish with that old staple from many a written article, more research is necessary and desirable on this subject which I am sure will remain a hot topic for non-smokers and smokers.