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Are E-Cigarettes Bad for You?

Vaping sounds cool, almost futuristic, and thanks to Leonardo DiCaprio, Katherine Heigel, and other sexy celebs seen inhaling the vapors of e-cigarettes, it’s like the new hookah. In fact, the Centers for Disease Control and Prevention (CDC) reported that, in 2016, 15 percent of adults had used an e-cigarette and more than 2 million U.S. middle and high school students used e-cigarettes in the past 30 days.

But since there's no tobacco, these newfangled e-cigs are totally safe, right? Not exactly—the new way of lighting up may still do serious harm to your body, experts warn. (FYI: "Vaping" is the same as smoking an e-cig. Electronic cigarettes can also be called “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems," or ENDS.)

What are e-cigarettes, exactly?

Instead of inhaling smoke as with regular cigarettes, users of e-cigarettes inhale vaporized liquid (or aerosol) made up of a mixture of water and nicotine as well as other substances sometimes added for flavor and texture. There are now more than 7,000 different electronic cigarette liquid flavors, says Holly Middlekauff, M.D., a cardiologist at UCLA Health and researcher who's published several papers on the effects of electronic cigarettes. 

So are e-cigarettes bad for you?

Older models (that often looked like cigarettes and were called "cigalikes") likely dispensed the least amount of aerosol, says Middlekauff, but newer, fancier models ("mods") allow users to change the resistance and voltage of the device. This is bad news because, for one, they deliver a much larger volume of aerosol, says Middlekauff. "Second, in some instances, you can dial up the temperature at which the liquid is heated, and research shows that hotter temperatures are more likely to generate carcinogens, or cancer-causing substances."

Yes, e-cig vapor has a much lower content of carcinogens than old-fashioned combustible cigs do, but that's not where the e-cigarettes health risks end. Most e-cigarette liquids still contain nicotine—an incredibly addictive substance, says Middlekauff. 

Once the vaporized nicotine is inhaled, it enters the bloodstream through the lungs and stimulates receptors in the brain to satisfy the ongoing need for nicotine, says Jock Lawrason, M.D., a pulmonologist and chief medical officer for Nantucket Cottage Hospital in Massachusetts. “E-cigarettes don’t have the dangerous chemicals and irritants that we are exposed to from regular cigarettes such as tars and other carcinogens, but they do have nicotine in them, which addictive and not safe.”

Not only is it addictive, but Lawrason adds that nicotine is known to produce several reactions in our bodies, including rapid heartbeat, increased blood pressure, reduction in the oxygen supply of vital organs, blood clots, and reduced insulin levels, and may cause certain cancers on its own, no actual smoke required.

And when nicotine is inhaled through electronic cigarette use? It seems to cause the same cardiac abnormalities as those seen in patients with heart disease, according to a recent study published in the Journal of the American Heart Association authored by Middlekauff. That, and it's linked to increased inflammation of the aorta (the large artery in your chest) and increased levels of oxidative stress—both important markers in the development of atherosclerosis (or clogged arteries), a huge risk factor for heart disease.

Some borderline good news: several e-cigarette manufacturers make models that deliver progressively lower amounts of nicotine (including models with no nicotine at all). But that’s only one ingredient. “E-cigarette use is growing rapidly,” says CDC director Tom Frieden, M.D., M.P.H. “Yet there is still a lot we don’t know about these products.” 

The flavor of the e-cig liquid you're puffing may play a part too. With so many flavors on the market, only a small portion have been tested, says Middlekauff, but preliminary research shows that certain flavoring chemicals may have serious health consequences; for example, the flavoring chemical diacetyl can be found in high concentrations in many e-cig liquids (from butterscotch and strawberry to tequila and ranch dressing). This chemical has been strongly linked to bronchiolitis obliterans (a severe respiratory disease also called "popcorn lung" after it was observed in microwave popcorn factory workers), according to a study conducted by the Harvard T.H. Chan School of Public Health. Inhaling the vaporized version of this chemical deep into your lungs? Not a great idea. 

Ingredients aside, inhaling the chemically induced vapor may cause problems. A study out of the University of Athens in Greece found that “vaping” caused an increase in airway resistance—a  sign that your body is having a harder time breathing—in smokers and nonsmokers with healthy lungs, and at levels rivaling those of traditional cigarettes. Christina Gratziou, M.D., Ph.D., chair of the European Respiratory Society Tobacco Control Committee and an author of the study, said in a press release that the evidence strongly suggests e-cigarettes can cause immediate harm after smoking them. Other research shows that e-cig use is linked to a higher risk of bladder cancer and the presence of carcinogens in e-cig users' urine.

It's important to know that we're still lacking long-term research since e-cigs are fairly new, says Middlekauff. However, the preliminary data keeps piling up, and one thing is clear: e-cigs aren't without their own health risks.

How do e-cigs compare to traditional cigarettes?

The one area where researchers see real promise for e-cigs is helping smokers quit. In a small study of 25 smokers lead by Keith Ablow, M.D., 75 percent of patients put tobacco away when given e-cigarettes (provided by Logic, an e-cigarette manufacturer) while 50 percent of those then stopped e-cigarettes as well, leading to full smoking cessation.

"There’s almost nothing that you can do legally to yourself that’s worse than smoking tobacco cigarettes," says Middlekauff. "They’re known carcinogens, they’re known to cause heart disease, and they’re known to cause lung disease. If you’re hooked on tobacco cigarettes and you’ve been unable to quit, e-cigs are probably are a safer alternative." 

But this only seems to work if you’re replacing regular cigarettes with e-cigarettes and not using them in addition to other tobacco products, a pattern called “dual use” that Tim McAfee, M.D., M.P.H., director of the Office on Smoking and Health at CDC finds very concerning. “If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes, the net public health effect could be quite negative,” he said in a release.

So if you are trying to kick the habit, e-cigarettes may help you, but if you don’t smoke, there’s no good reason to try electronically lighting up. “People who don’t smoke and start using e-cigarettes still risk becoming addicted to the nicotine, which is of particular concern for potential young users. At the end of the day, we know that nicotine is absolutely not a safe substance to use on a chronic basis,” Dr. Lawrason says.

Your best bet? Just don't put anything in your lungs that shouldn't be there. 

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