Originally published on February 1st, 2011, updated on March 17th, 2016.
Electronic cigarettes (known as e-cigarettes) are battery-operated products that look like cigarettes and provide nicotine, flavorings and other chemicals. The manufacturers claim that e-cigarettes offer the pleasures of smoking without the smoke, smell, carcinogens, tar and carbon monoxide.
Because they contain no tobacco, promoters claim that e-cigarettes can be "smoked" in non-smoking areas. (The "smoke" produced is chemically enhanced odorless water vapor.) Some also claim that substituting e-cigarettes for the real thing increases lung capacity and reduces the appearance of wrinkles due to the effects of smoking on the skin.
I do not believe most of the claims. E-cigarettes are a sophisticated delivery system for one of the most addictive of all drugs. Nicotine triggers a short-term increase in blood pressure, heart rate, and the flow of blood from the heart. It also causes arteries to narrow. You may not be getting all of the tars and other carcinogens delivered by regular cigarettes, but if you make a habit of using e-cigarettes, your cardiovascular system will still be on the receiving end of those harmful effects.
Findings from a study of e-cigarettes by researchers at the University of California, Riverside and published in the January, 2011 issue of Tobacco Control were not reassuring. The investigators tested five brands and found "design flaws, lack of adequate labeling and several concerns about quality control and health issues."
They reported that e-cigarette packages lacked adequate information on the product’s contents and proper usage, and omitted appropriate warnings. They also noted that some e-cigarette cartridges were found to leak, which could expose others to nicotine, including children and pets. In a press release, the lead researcher emphasized that there are "virtually no scientific studies on e-cigarettes and their safety."
More recently, researchers at the Harvard T.H. Chan School of Public Health reported that the flavoring chemical diacetyl was found in more than 75 percent of flavored e-cigarettes and refill liquids they tested. Diacetyl is associated with cases of the severe respiratory disease bronchiolitis obliterans, better known as "Popcorn Lung," because it first appeared more than a decade ago in workers in microwave popcorn processing facilities who inhaled artificial butter flavor. In addition to diacetyl levels above the laboratory limit of detection in 39 flavors tested, the Harvard investigators also found the chemicals acetoin and 2,3-pentanedione in 46 and 23 of the flavors respectively. These potentially harmful compounds were used in e-cigarettes with such flavors as Cotton Candy, Fruit Squirts and Cupcake designed to appeal to the youth market. Both chemicals can cause lung damage. E-cigarettes also contain formaldehyde, a carcinogen.
Unlike regular cigarettes, the more than 7,000 E-cigarette products on the market in the U.S. are not currently regulated. However, the FDA has issued a proposed rule to include them under its authority to regulate tobacco and nicotine-containing products.
If you smoke tobacco in any form, I urge you to quit now. As for e-cigarettes, based on what I’ve read, I think we need to know much more about their safety. Nicotine is nicotine. However you receive it, it isn’t good for you. And now we know that certain flavoring chemicals used in these products may also be hazardous to health.
Andrew Weil, M.D.
David C. Christiani et al, "Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 1 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes."Environmental Health Perspectives, December 8, 2015, doi: 10.1289/ehp.1510185