VAPING (electronic cigarettes) AND YOUR HEALTH

Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

The safety and long-term health effects of using e-cigarettes or other vaping products still aren’t well known. In September 2019, federal and state health authorities began investigating an outbreak of a severe lung disease associated with e-cigarettes and other vaping products.
Vaping has risks, regardless of what is being vaped.
Starting to use e-cigarettes, or switching from cigarettes to e-cigarettes, increases the risk of devastating health effects. The safest option, according to the American Cancer Society, is to avoid both vaping and smoking altogether.
Research is ongoing into the health effects of vaping, and it may take some time before the long-term risks are fully understood.
However, preliminary research suggests vaping poses risks to heart health. The authors of a 2019 review point out that e-liquid aerosols contain particulates, oxidising agents, aldehydes, and nicotine. When inhaled, these aerosols affect the heart and circulatory system.
A 2018 report from the National Academies Press (NAP) found significant evidence that taking a puff from a nicotine e-cigarette triggers an increase in heart rate. The authors also described moderate evidence suggesting that taking a puff from an e-cigarette increases blood pressure. Both could affect heart health over the long term.
Another 2019 study based on the same nationwide survey found that e-cigarette use was associated with an increased risk of stroke, heart attack, angina, and heart disease.
The authors of the 2018 study used data from a different national health survey to come to a similar conclusion: Daily vaping is associated with an increased risk of heart attack, even when other lifestyle factors are taken into consideration.
Finally, a 2017 review of the cardiovascular effects of vaping indicates that e-cigarettes may pose certain risks to the heart and circulatory system, notably for people who already have some form of heart disease.

VAPING AND THE LUNGS
Some studies suggest that vaping may have negative effects on the lungs, but more research is needed.
In particular, a 2015 study examined the effects of flavoured e-juices on both human lung cells and lung cells in mice. The researchers reported many adverse effects on both types of cells, including toxicity, oxidation, and inflammation. However, these results aren’t necessarily generalisable to vaping in real life.
A 2018 study assessed the lung function of 10 people who had never smoked cigarettes immediately after vaping fluids either with or without nicotine. The researchers concluded that vaping both with and without nicotine disrupts normal lung function in otherwise healthy people. However, this study had a small sample size, which means the results may not apply to everyone.
The same 2018 report from the NAP found that there’s some evidence that e-cigarette exposure has adverse effects on the respiratory system, but additional studies are required to understand the extent to which vaping contributes to respiratory diseases.
The lung health effects are not expected to be seen for 20 to 30 years. That is why it took as long as it did for the negative health effects of cigarettes to be widely recognised. Full magnitude of the effects of toxic e-cigarette ingredients may not be known for another three decades.

EFFECTS ON TEETH AND GUM
Vaping appears to have several negative effects on oral health. For instance, a 2018 study reported that exposure to e-cigarette aerosol makes tooth surfaces more prone to developing bacteria. The authors concluded that vaping may increase the risk of cavities.
Another study from 2016 suggests that vaping is associated with gum inflammation, a known factor in the development of periodontal diseases.
Similarly, a 2014 review reported that vaping may trigger irritation in the gums, mouth, and throat. The same NAP report from 2018 concluded there’s some evidence that both nicotine and nicotine-free e-cigarettes can damage oral cells and tissues in people who don’t smoke cigarettes.

OTHER IMPACT
The 2018 report from NAP found substantial evidence that vaping causes cell dysfunction, oxidative stress, and damage to DNA. Some of these cellular changes have been linked to the development of cancer over the long term, though there’s currently no evidence to suggest that vaping causes cancer.
Vaping may also have specific adverse effects on certain groups, particularly young people. The Centers for Disease Control and Prevention (CDC) report that vaping with nicotine can permanently affect brain development in people under the age of 25.
The long-term effects of smoking cigarettes are well-documented, and include an increased risk of stroke, heart disease, and lung cancer.
Vaping might appear to be a less risky choice for people who are trying to quit smoking. However, that doesn’t mean there aren’t risks involved, even if the vaped liquid is nicotine-free.
There is limited evidence to date of the long-term effects of vaping, because the lung effects of vaping will take decades to develop. But based on the experience with cigarettes, similar adverse health effects, including COPD, heart disease and cancer, can be expected.

VAPING MARIJUANA OR CBD OIL
The side effects of vaping marijuana can include:
* Impaired coordination
* Impaired memory
* Difficulties problem-solving
* Nausea and vomiting
* Increased heart rate
* Dependence in the long term.

There’s almost no research on the side effects of vaping CBD. However, some reported side effects of using CBD oil include:
* Fatigue
* Irritability
* Nausea
These side effects tend to be mild. Marijuana and CBD e-liquids usually contain other chemicals, such as base liquids or flavouring agents. They may cause side effects similar to those of nicotine-free e-cigarettes.

VAPING AND FLAVOURS
The fluid flavour does matter. A 2016 report indicated that many vape fluids contain flavouring agents at concentrations that may pose risks to users. Another study from 2016 tested more than 50 e-juice flavours. The researchers found that 92 percent of the flavours tested for one of three potentially harmful chemicals: diacetyl, acetylpropionyl, or acetoin.

Researchers in a 2018 study found that cinnamaldehyde (found in cinnamon), o-vanillin (found in vanilla), and pentanedione (found in honey) all had toxic effects on cells.
It’s difficult to know for sure which flavours contain respiratory irritants, as ingredients tend to differ from one brand to the next.

PREVENTION TIPS
In case persons are using vaping to quit smoking, they should gradually reduce their dose of nicotine. Transitioning to nicotine-free vaping can help to minimise side effects.
* Drink plenty of fluids
* Drink water right after vaping, to prevent symptoms such as dry mouth and dehydration.
* Brush teeth after
* To reduce oral side effects after vaping, brush to clean the surface of teeth.

It can’t hurt to talk to a doctor or other healthcare professional about the risks of vaping, especially if there is an already underlying chronic health condition, such as asthma.
The safety and long-term health effects of using e-cigarettes or other vaping products still aren’t well known. Think safe before using unknown products.