E-Liquid: Safer Than Tobacco?

Are E-cigarettes Safer Than Tobacco?

Over the last couple of years in the UK, vaping devices (electronic cigarettes, e-cig and I’m guessing other names) have become a much more popular alternatives to tobacco. Obviously there is a multitude of evidence to prove tobacco is harmful and is strongly linked to lung cancer amongst other diseases of the respiratory system. As this week we have an announcement of possible regulation around the use of electronic cigarettes, we find ourselves asking; are they safe? Unless, of course, you are The Guardian, in which case the question is: 'will e-cigarettes ever look cool on screen'. Clearly they’re not worried, should we be?

What is an E-Cigarette?

Basically, what you are operating is a battery-operated vaporiser, consisting of a chamber and a heating element. A user will inhale; the airflow from inhalation passes a sensor allowing the heating element to turn on, heating up to around 55^oC. This heat vaporises the liquid, which is inhaled. Simple.

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The part that is called into question is the liquid in itself. The liquid is made up of four principle components:

• Propylene Glycol: This is a clear organic compound, commonly used as an E-number and the production of polymers. The FDA has approved propylene glycol for use in different medications, but as it is an e-number, it is commonly used in food also. Hazards include S24 and S25: Meaning avoid direct contact of a pure solution with eyes and skin. This acts as a base, essentially carrying the nicotine and flavouring into a vapour.

• Glycerine: Also referred to as glycerol. This product is far more vaporising than propylene glycol. Thus, it is added in order to create more vapour, lowering the amount of propylene glycol. Commonly, glycerine is referred to as sugar alcohol and is very widely used in the food and pharmaceutical industry. This product is ridiculously not at all toxic.

• Flavourings: This is pretty much where it becomes questionable. We all know what food flavourings do, but what are they? They can be natural; those obtained from plants or artificial; distillates and manipulates of the natural sources. As in food, not all of these are safe for use in e-liquid. In artificial butter type flavours we have the use of diacetyl, acetoin and acetylpropionyl, which has been linked to severe cases of lung disease. So really, what is being added at this point is the source of all-evil with an e-cigarette. However, that said, when properly researched and created in a regulated laboratory, these will be just as safe as adding them to your food.

• Nicotine: Really the golden nugget of the e-liquid. The nicotine intentionally varies between e-liquids, so you can have a little (around 0.6%) or a lot (around 2.5%).

Why are they used?

The common belief is mostly, that they are much safer than that of tobacco, but they don’t contain the by products of tobacco. Meaning that they are less likely to cause cancer and lung problems. They are cheaper and much more pleasant for the users and bystanders in terms of smell. However, there are very few studies either way showing that they are good for you or bad for you. This is a very new market, so there is going to be very little in the way of reviews and long-term studies. A review I found published in the Journal of Public Health compares six longitudinal studies and four studies to state that there is a reduced desire to smoke amongst the population. Which may well be true, but they are still consuming the nicotine, although you can purchase e-liquid with 0.0mg/ml of nicotine. This is what the studies appear to be looking at, the reduction and cessation of traditional tobacco smoking, not really the health effects.

Formaldehyde

Whilst researching all this, I keep coming across the popular belief that there is a high level of formaldehyde contained in the vapour. Formaldehyde is a Group one compound, carcinogenic within humans. A study published in the New England Journal of Medicine states that high voltage discharge in an e-cigarette causes up to an inhalation of 14.4 (±3.3 mg) of formaldehyde hemiacetyl per day. This is likely to be due to the combustion of the propylene glycol, which is something that you do not want to happen. When complete combustion happens, you are essentially creating hydrocarbon and other by-products, one of which will be formaldehyde products, as stated in the study. However, complete combustion is not the aim in vaping. You want vapour, not smoke. What is ignored in this study is the fact that it is comparing the processes of heating elements ability to create the products. Thus, at low voltages we get vapour consisting of the nicotine-y goodness that people crave and, from this study, no detectable limit of formaldehyde. At the high voltages you will get breakdown products that are not wanted and I imagine would smell and taste like burning wood or tyres. There would be no benefit, a case of cherry-picking data and applying it as incorrectly as is humanly possible. The researches calculate (albeit inaccurately on practically falsified information) that there is a 5x risk of developing cancer from the use of 3ml of the liquid. But this is one study, using a worst-case scenario; if you vape at high voltage, you would get a breakdown product of formaldehyde. It was sad to see that some respectable skeptical blogs had jumped on this themselves to criticise e-cigarettes due to the level of formaldehyde produced from the high voltage.

Is there a chance that this could happen, and people are ingesting formaldehyde? Yes, I suppose. This is a highly unregulated market, and there are a lot of people out there making money off of this and not really knowing what they are doing. But If you think about what is being inhaled to get the formaldehyde, the taste of it, surely they wont use them again or they will use a better quality brand. There are companies out there that do test their liquids for quality control, although, as it is unregulated, they don’t necessarily have to.

So, are they safe?

There is no long term health study that gives that impression, nor is there any health study that states they are not safe:- there is nothing either way. Despite that, vaping is promoted to be a harm reduction aid, its healthier than smoking, its better for you, there are less long term-health effects. Is any of this true? It’s pretty premature to say. As it emerges to be more regulated, this market is booming. More studies will be released to denote its safety or harm. In terms of decreasing tobacco related deaths or weaning people off of cigarettes, it appears to work very well.

One study published in the Biomedical Journal states that ‘little evidence about their health effects suggests that vaping is probably safer than smoking’. Well, we have zero evidence that there is a god, but that is still debated in every city in the world. What a ridiculously stupid sentence to close a study with, 'the absence of evidence means no evidence in an area that isn't overly studied' perfect. This is a good time to point out that the studies that are out there include obsolete studies such as this one. If you look there are a fair few studies, only a handful of which are scientifically sound. Which is something that is seen all the time, but in the case of a new emerging area, it is very frustrating, albeit, a little gelastic. Properly created a e-cigarette will vaporise (not burn) pharmaceutical and food grade, FDA approved glycerine, propylene glycol, nicotine and flavourings. Avoiding the more buttery flavours to assure there is little chance of lung disease from diacetyl, acetoin and acetyl propionyl. Can we be assured this is what is happening? Not at all. There is no regulation around this market as of yet. You can do research and look at the backgrounds behind the companies manufacturing them, such as EL-Science to assure you have a quality assurance. However, it must be stressed that the long-term effects of vaping are not at all apparent. It does appear that they are healthier and a good way to help with reducing cigarette consumption, but this isn’t 100%. It is pretty much impossible in medical science to say that something is ‘risk free’. I’ve discussed this before, everything carries a risk, and hopefully this one is minimal.

 

Conclusion

In regards to regulation; yes, it should be regulated in order for it to be so widely sold and widely available. Should they be prescribed on the NHS? In my opinion; not at all. We have a crippled NHS in the UK, adding a prescription service for something that is costly, and millions of people will be prescribed will cripple us further. Until more studies are conducted, I can’t really comment on the safety overall. All I can say is; they appear safe, there are no adverse health benefits that have been reported over the last year and half of them being widely used and, when properly manufactured, the e-liquids are safe and are vaporised safely with a properly, well manufactured e-cigarette device. People who have opinions appear to have strong opinions either side, but the fact is; the science is being pushed aside and ignored. It would be wise to wait for hard evidence before making any judgement call on their use and proficiency.

Of course, you get the reports of the e-cigarette batteries blowing up. I recall last year receiving multiple e-mails from my university about how they are banned because a battery exploded in the dining hall. Again, inferior manufacturing products have been bought. There are a lot of cheaper, subsidiary products out there that are insufficient for use and unsafe in every aspect, for any product ever made. E-cigarettes and e-liquids are no exception. If you are going to use these products, pick a researched brand, not a high-street market.