It’s not simple, but there is enough information to help you choose
Is vaping bad for you? Depending on what you read, you might think that vaping is as safe as breathing pure air, or that it is just as bad as smoking cigarettes. Of course, neither of these things is true. The truth is more nuanced than that, but it doesn’t lie in the middle either.
When assessing the risks of vaping, we usually look at relative risk. We compare vaping with smoking, which is usually what vapers would do before they start using e-cigarettes. It is not very reasonable to compare vaping with pure air, because most vapers would smoke instead if vaping did not exist.
That does not mean, however, that we should not try to learn about the specific risks of vaping. If there are hidden dangers in e-cigarettes, most vapers would want to know what they are. Perhaps the products could be modified to avoid potential health risks, or perhaps smokers could find an even safer source of nicotine, such as smokeless tobacco.
Let’s look at how vaping affects areas of the body that have been damaged by smoking and examine the evidence for potential disease outcomes.
Is vaping bad for your lungs?
Smoking cigarettes causes known damage to the lungs. Long-term inhalation of burning tobacco can lead to lung and esophageal cancer and to a range of deadly lung diseases such as emphysema, chronic bronchitis, and chronic obstructive pulmonary disease (COPD).
Smoke attacks the lungs in several ways. It contains thousands of chemicals, more than 70 of which are known carcinogens. It also contains particles - tiny pieces of burned tobacco - that accumulate deep in the lungs, where they can become embedded in the tissue. Vaping, on the other hand, does NOT produce known carcinogens in amounts large enough to be considered a real health risk and does not contain solid particles like smoke.
In addition, inhaled smoke causes structural and functional damage inside the lungs. The toxic combustion material affects parts of the lungs such as the cilia and bronchioles and can lead to impaired function. And a smoker’s lungs begin producing more mucus, which no longer clears properly. This is what causes emphysema and chronic bronchitis.
Popcorn lung is a frightening condition, but so far no vaper has been diagnosed with this disease.
Vapor from e-cigarettes is not smoke. At present, there is no evidence that inhaling a mixture of propylene glycol and vegetable glycerin causes any long-term damage. There may, however, be risks associated with inhaling certain flavorings. There are flavoring agents, found in some e-liquids, that have been linked to a condition called bronchiolitis obliterans or popcorn lung. These chemicals - diacetyl and acetyl propionyl - are probably the cause of several cases of popcorn lung at certain flavoring factories, where workers had inhaled large amounts of these substances in powdered form.
Popcorn lung is a frightening condition, but so far no vaper has been diagnosed with this disease. Moreover, cigarette smoke contains much more of these chemicals than e-cigarette vapor, yet there are no known cases of smokers developing bronchiolitis obliterans either.
Is vaping bad for your heart and circulatory system?
Smoking is devastating to the cardiovascular system. It causes a waxy substance called plaque to form in the walls of the arteries, which in turn hardens and causes atherosclerosis, i.e. thickening of the arterial walls. This can cause heart attacks and strokes.
Carbon monoxide in smoke impairs the blood’s ability to absorb oxygen, forcing the heart to beat harder to supply the organs. The organs, including the heart, can themselves be damaged by poor circulation. Smoke also increases the blood’s tendency to clot, which raises the risk of cardiovascular disease.
Cigarettes cause premature death in approximately half of regular smokers.
Apart from the fact that the nicotine in e-cigarettes can temporarily increase heart rate and blood pressure, it is unlikely that vaping would cause any of the damage that smoking causes to the heart and circulatory system. It contains none of the toxic constituents that make smoke so harmful to blood vessels and organs. And vapor contains no carbon monoxide.
There may be risks associated with using nicotine (discussed below) for people with heart disease. But the small risk associated with nicotine use cannot be compared with the enormous damage that smoking causes to the heart and its arteries. Vaping does not carry these risks.
Can vaping cause cancer?
A study conducted last year by researchers from British American Tobacco and published in the journal Mutation Research, examined both e-cigarette vapor and cigarette smoke to see whether they could cause cell mutations in bacteria. Smoke caused mutations and was also toxic to the bacteria, while vapor was neither mutagenic nor toxic.
This is not absolute proof, but it is a very good indication that vapor is unlikely to be carcinogenic. Despite the many news reports about small-scale studies, all the toxins found in e-cigarette vapor have also been found in very small amounts. Our bodies have some defenses against carcinogenic toxins, and it is well known that small exposures to toxins are often not dangerous.
Many people, including some doctors, have the mistaken belief that nicotine causes cancer.
The Royal College of Physicians report on e-cigarettes points out that "Under normal conditions of use, toxin levels in inhaled e-cigarette vapor are likely to be well below prescribed occupational exposure limits, in which case significant long-term harm is unlikely.”
A recent study by Cancer Research UK concluded that long-term vaping (but not vaping and smoking together) "may be associated with substantially reduced levels of measured carcinogens and toxins compared with smoking combustible cigarettes alone."
At present, there is no evidence suggesting that vaping - with or without nicotine - causes cancer.
Is vaping bad for pregnant women or teenagers?
The risks of using nicotine during pregnancy are not entirely clear. It is possible that it poses a risk to the child’s development after birth. Smoking, however, is definitely harmful to both child and mother. Although it is probably best to abstain from nicotine entirely during pregnancy, there is no doubt that vaping is a better choice if one must choose.
Teenagers, like adults, deserve honest information about the choices they make.
The risk that nicotine may affect cognitive development in the teenage brain is trumpeted by anti-vaping activists. But the truth is that the risk is based on studies of rodents and probably cannot be fully — or at all — applied to the human brain.
We do not recommend that teenagers vape - not least because it is illegal. But as in all situations, it is almost criminal to tell everyone that vaping is no better than smoking. Teenagers, like adults, deserve honest information about the choices they make. Denying them this information is no better than telling them that using condoms does not significantly reduce the risk of pregnancy and sexually transmitted diseases during sex.
Is nicotine dangerous or addictive?
Nicotine is probably harmless for most people. It temporarily causes an increased heart rate and high blood pressure because it constricts the blood vessels when absorbed by the body. This probably makes vaping – or any form of nicotine use – a poor choice for people with serious heart disease. As discussed above, pregnant women should probably also avoid using nicotine. But decades of studies of nicotine replacement therapy and Swedish snus users show that nicotine without combustion poses no noticeable risk of heart disease or stroke.
Many people, including some doctors, have the mistaken belief that nicotine causes cancer. It simply is not true. Although there is some evidence that nicotine may promote the growth of certain tumors, there is no evidence that nicotine itself causes cancer.
The current view is that nicotine itself is, at worst, weakly addictive.
Nicotine can be addictive, although this is highly questionable. Smokers get a freebase burst of nicotine in the brain, combined with other substances that increase nicotine’s addictive potential. Other forms of consumption, such as nicotine replacement therapy or smokeless tobacco, release the drug slowly into the body.
The current view is that nicotine itself is, at worst, weakly addictive. There is no reason to believe that nicotine in e-cigarettes is more addictive than nicotine patches or nicotine gum. According to Jean-Francois Etter and Thomas Eissenberg, e-cigarettes may be “as or less addictive than nicotine gum, which in turn is not particularly addictive”
Why all these horror stories about vaping?
Vaping has many fervent enemies. The devoted nicotine-hating prohibitionists in the tobacco-control movement have infected almost the entire American healthcare system, and they are not interested in hearing anything positive about a revolutionary, consumer-driven response to the dangers of smoking. When a newspaper or TV channel does a report on vaping, they usually find one of these abstinence fanatics for guidance and comments.
A group of French researchers recently found that studies drawing conclusions receive much better press coverage than follow-up studies that overturn those conclusions. The news media like studies that make loud claims. This is a problem for vaping, because the scientific literature is full of small-scale studies that "prove" things about vaping that either do not matter in real life or later turn out to be incorrect. The research is also often influenced by funding sources that want bad results.
We understand risks and benefits by looking at the overall scientific consensus
Moreover, authors tend to make loud claims about what their studies show, universities’ press releases like to exaggerate the sensational, and uncritical reporters are unwilling to seek out other opinions. Newspapers do not care about the fact that it may be irrelevant if cells, isolated in a Petri dish, become inflamed (or die) when covered with e-liquid. They do not realize - even though they should investigate and find out! - that almost everything kills cells in a Petri dish.
"Vaping may be as dangerous as smoking," the headline says. There are no facts supporting this, but no newspaper wants to publish an article with a headline like "Vaping causes inflammation in isolated cells in a Petri dish." We understand risks and benefits by looking at the overall scientific consensus, not individual studies showing a possible negative effect.
The best way to understand the science of vaping is therefore to read the thorough reviews of the subject, such as the Royal College of Physicians (RCP) report. The RCP looked at all available scientific literature on vaping and compared findings from many smaller studies by placing the information in a broader perspective than any individual study could. There are admittedly many positive small-scale studies on vaping, but the RCP report breaks down all the information and assembles it in a sensible format.
Is vaping bad for your health?
Cigarettes cause premature death in approximately half of regular smokers. The Centers for Disease Control and Prevention (CDC) states that more than 450,000 Americans die each year from smoking-related causes. Worldwide, the figure is approximately six million. Many more millions suffer from pain or even disability caused by smoking.
Since almost all vapers have belonged to the group of regular smokers, it can be difficult to distinguish any problems that may exist. But we cannot look at vaping now and point to any known health risk beyond dry mouth and the minor dangers associated with nicotine, which can be avoided.
There is no evidence that vaping causes serious health problems.
In Sweden, where many adults use snus (a moist tobacco product for oral use), we see evidence that nicotine itself has low harm potential. Sweden has the lowest number of smoking-related disease cases in the Western world. Nationwide studies show without doubt that long-term snus use poses almost no risk. Similarly, the FDA also acknowledges that long-term use of products intended for nicotine replacement therapy (NRT), such as nicotine gum and patches, is harmless - or even probably addictive.
The conclusion is that smoking is very, very bad for you, and all nicotine products that eliminate the known dangers of inhaling burned plant material can only be regarded as a major improvement. We know that smoking causes cancer, heart disease, and serious lung damage. There is no evidence that vaping causes serious health problems.
The current scientific consensus is that vaping is probably not harmful to your health. And if the alternative is smoking cigarettes, it is a much better choice.
