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E-Cigarettes: A Chance to Kick the Habit Or A Health Crises in the Making?

Fifty years after the landmark Surgeon General report that exposed the lethal effects of lighting up tobacco cigarettes, U.S. health officials and nicotine addicts are grappling with a new controversy: an invention we haven’t even begun to understand.
E-Cigarettes Health Crisis
Craig Cutler

Today, the FDA rolled out plans to begin the regulation of e-cigarettes. The FDA is proposing legislation that would ban the sale of e-cigarettes to anyone under 18 (like traditional cigarettes) and, finally, establish federal oversight of what so far has been an exponentially growing market without regulation. The following article was published in the May 2014 issue of MEN'S FITNESS.

On December 17, 2014, user FFighter7231 posted a message on reddit.com’s “subreddit” message board dedicated to all things e-cigs: “6 months ago today…I smoked my last analog and will never look back…After 16 years of smoking [about one] pack a day, I’ll never touch another one. I’ve also gotten my fiancée to go vaping.”

“Vaping” refers to inhaling and exhaling nicotine-infused vapor from a small, battery-powered cylinder or similar device typically sold at pharmacies, convenience stores, and specialty shops. According to medical rules of thumb, once FFighter7232 smoked his last cigarette (or “analog”), he could expect that the carbon monoxide in his body would decrease to normal, nonsmoking levels within 12 hours. By now, six months later, the cilia in his lungs should have mostly regrown, more effectively keeping infections away. In six more months, his chances of heart disease should decrease to half that of a smoker. And in five more years, his stroke risk should decline to that of a nonsmoker.

FFighter7232, whose real name is Patrick Holdridge, lives in Herndon, VA, and is a sales manager at a swimming pool company. He’d tried to quit smoking analogs cold turkey, but nothing stopped the cravings until he found the e-cig forum and shopped around for a solid starter kit.

“The cravings and mood swings you get when you quit smoking—you become a very nasty person,” he says. “But when you quit and find you’re able to start tasting foods again, and wake up in the morning without hacking up a lung, you feel a lot better. I feel much healthier, with improved lung capacity: I can run and swim much longer than I could before, without being completely winded like I was when I was smoking cigarettes.”

With the explosion of the e-cig market—it boomed from roughly $20 million in 2008 to about $1 billion in 2013, according to trade sources,  and Citi Research estimates it will surpass $3 billion by 2015—the potential for smokers to switch to electronic forms of satisfying their nicotine addiction puts the future of tobacco cigarettes, for the first time in history, in doubt. In a June 2013 Italian study published in the journal PLOS One, 13% of participants—none of whom wanted to quit smoking—switched  from analogs to vaping exclusively.

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“We can use these products as an extraordinary tobacco-control tool,” says study author Riccardo Polosa, M.D., Ph.D. That’s what the makers, proponents, and users of e-cigarettes are hoping. And with all the buzz around e-cigs as a method to smoke “safely,” one would think public health officials would be rallying behind a device that might help save the 480,000 lives that tobacco takes in the U.S. every year.

But by and large, they aren’t. In fact, last winter, just two days after Holdridge’s Reddit post, the New York City Council voted to ban e-cigs in public places—bars, restaurants, parks—where cigarette use is already outlawed. And earlier this year, Chicago and L.A. followed suit with their own restrictions.

Just days before NYC’s vote, e-cigarette advocate and former United States Surgeon General Richard Carmona, M.D., who served under George W. Bush, wrote to the Council, saying: “I am extremely concerned…that such an effort, if successful, could do tremendous harm to what is emerging as the most promising weapon yet in the fight against tobacco-related illness and death…The Centers for Disease Control reports that adult smokers usually know they are engaged in harmful behavior and 69% would like to reduce or quit smoking. However, each year only 6% of smokers succeed in quitting…The history and data suggest we need more viable alternatives in this fight against tobacco. I believe that one such alternative is the electronic cigarette.”

Carmona now serves as chair of the Scientific Advisory Committee and on the board of  NJOY, one of the largest e-cig manufacturers in the U.S. As Surgeon General, he was vocal in his warnings on secondhand smoke, and he feels that the e-cigarette is the only way, as he says, to “make tobacco obsolete.”

But if we’re on the road to making tobacco obsolete, we might first want to look at what we’re replacing it with.

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Concern Number 1: The Particle Problem

In 2009, the FDA conducted laboratory analysis of a handful of unnamed e-cigarette brands and found toxins in the “juice,” or the liquid that’s atomized into vapor when a user drags on an e-cig. Diethylene glycol, a compound used in antifreeze, was singled out.

The Consumer Advocates for Smoke-free Alternatives Association took issue with the FDA’s findings, noting that the “FDA tested just 18 cartridges, from only two companies,” with only one testing positive for “about 1% diethylene glycol”—which is by no means a common ingredient in most electronic cigarettes, and is poisonous in large quantities. In fact, e-cigarette juice typically uses as a nicotine preservative not diethylene glycol but propylene glycol—an odorless, colorless substance that’s found in products like cosmetics and cake mix, and which the FDA considers generally safe for human consumption.

But either way, it’s one of the many particles one ingests when vaping, which makes the FDA’s larger point: that, in e-cigs, there are too many unknowns. When an e-cig user inhales vapor, he’s not only getting water and nicotine, he’s also ingesting small particles that are microscopic and hard to detect, and occasionally mysterious to researchers. The particles are becoming a major cause for concern among health professionals, because they may damage your respiratory system.

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“They get very deep into your lungs,” says Stanley Glantz, Ph.D., of the Center for Tobacco Control Research and Education. “They’re so small they get across the alveoli into your bloodstream.” This is similar to how analog cigarettes work.

“You burn the tobacco and that generates an aerosol, or smoke, of very small particles, which then carries the nicotine into your lungs where it can be absorbed,” says Glantz. “E-cigarettes generate a similar aerosol by taking glycerin, a nicotine mixture, plus whatever else is in it, and heating that up to generate the aerosol; that’s what you inhale. They have to carry the particles because that’s how they deliver the nicotine.”

Inhaling small particle matter is considered risky, healthwise; aside from the glycerin and nicotine, says Glantz, “people have measured heavy metals in them as well.” In fact, a disturbing January 2014 study by the University of California–Riverside found small amounts of tin, silver, iron, nickel, and aluminum in one brand.

Small-particle inhalation has also been traced to respiratory problems, including damaged lung tissue. Though inhaled e-cigarette vapor is estimated to contain far fewer damaging particles than tobacco smoke (and certainly none of the tobacco residue like tar that damages a smoker’s lungs), the exact amount is unknown. In 2012, Greek researchers found that short-term use of e-cigs could constrict airways, leading to concerns about their long-term effects on the lungs.

“When I look at some of the advertising materials, there are a lot of claims that this is pure water vapor” that e-cig smokers are inhaling and exhaling, says Maciej Goniewicz, Ph.D., of the Roswell Park Cancer Institute. “No, this is a mixture of the nicotine, the solvents for nicotine, and flavorings…Nicotine isn’t the worst chemical in a tobacco [cigarette] or in e-cigs,” Goniewicz says. “It’s all the other chemicals.”

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