Is vaping bad for you? Doctors weigh in
It’s so much more than a simple “yes” or “no.”
Juul and other e-cigarettes: What are the health risks?
Once hailed as the healthier end-all to smoking traditional cigarettes, e-cigarettes (also called vaporizers or vapes) have become a public enemy thanks to a slew of reports of lung illnesses, seizures and even death in people who use them. Even if you don't vape, you can develop health issues if you hang around people who do via secondhand vaping.
Because of the company's popularity, Juul in particular has sparked heated debate since its launch of sleek, small vapes and sweet-flavored nicotine cartridges in 2015.
In fact, the World Health Organization actually singled out Juul in its latest report on the global tobacco epidemic (on page 31), calling it one of the new industry players that "continue to subvert tobacco control." The FDA also called Juul out for marketing its vapes at healthier than cigarettes, when there's no proof of that yet.
Juul's own CEO even said the recent respiratory illness cases are "worrisome." In the midst of all this, it's no surprise that big cities are taking action and banning e-cigarette sales in an attempt to keep their residents healthy.
So is Juul and the other vapes out there bad for you or not? The evidence remains inconclusive because, unlike traditional cigarettes, e-cigarettes haven't been around long enough to make conclusive "x equals y" claims. However, there's plenty of reason to believe that some of the same perils apply and consumers should be wary of the long-term effects. Below, doctors weigh in on the most significant health risks of vaping.
Read more: Is Juuling bad for your teeth? | How to quit Juul-ing, according to addiction experts | Juul CEO says don't vape
Scientists don't know everything about e-cigarettes yet, but they do know that many of the same perils associated with conventional cigarettes still apply.
Vaping and nicotine addiction
Vaping was supposed to be the less addictive cure-all to cigarette smoking. But as it turns out, nicotine is addictive no matter what vessel people use to consume it -- and some e-cigarettes are known to contain as much nicotine as an entire pack of cigarettes in just one e-liquid pod.
So while vaping might help people quit smoking actual cigarettes and avoid some of the cancer-causing chemicals in them, vapes themselves are hard to quit. Dealing with addiction can cause a range of physical and emotional complications, from withdrawals to depression.
Effects of vaping on heart health
The Stanford School of Medicine released a study in May 2019 that suggested the e-liquids in Juuls and other vapes could increase a person's risk of heart disease. When inhaled, the e-liquid affects a certain kind of cells, called endothelial cells, that line the inside of blood vessels.
Researchers found that endothelial cells exposed to e-liquid or to blood collected from people who smoked e-cigarettes exhibited DNA damage and cellular death. Damage occurred even in the absence of nicotine, which means other compounds in the e-liquids are harmful. Interestingly, the severity of the damage varied by flavor, with cinnamon and menthol found as the most harmful.
The endothelial cells the researchers tested were grown from stem cells, an ideal method for studying cells that are usually hard to isolate from patients.
"This study clearly shows that e-cigarettes are not a safe alternative to traditional cigarettes," said Joseph Wu, director of the Stanford Cardiovascular Institute, in a press release. "... We saw significant damage. The cells were less viable in culture, and they began to exhibit multiple symptoms of dysfunction."
Another recent study found that, compared to people who don't use e-cigarettes, people who do are up to 56% more likely to have a heart attack and 30% more likely to have a stroke.
"Even after adjusting for cardiovascular risk factors, the statistics are still significant," Dr. Lawrence Weinstein, chief medical officer of American Addiction Centers, told CNET, "with e-cigarette users 34% more likely to have a heart attack and 25% more likely to develop coronary artery disease."
To get those numbers, the researchers controlled other known cardiovascular risk factors, such as age, sex, body mass index, high cholesterol, high blood pressure.
Vaping and seizures
A possible link exists between e-cigarettes and seizures, Dr. Weinstein told CNET, explaining that "nicotine in abundance induces convulsive seizures by activating particular neurons in the amygdala, the part of the brain responsible for emotions, memory and survival instincts."
Dr. Weinstein brings this risk to attention because nicotine concentration might be misstated on some products: Researchers who studied this found that some e-liquids labeled as having a concentration of 18mg/mL contained as much as 52% more than stated. Some e-liquids also contained less nicotine than stated.
This can be particularly problematic for children who come into contact with mislabeled e-liquids because they are more susceptible to nicotine poisoning, Dr. Weinstein said.
Throughout 2019, the FDA has been investigating incidents in which people -- especially teens and young adults -- who vaped suffered a seizure. In April 2019, the FDA said in a statement that it has received "35 reported cases of seizures following use of e-cigarettes between 2010 and early 2019." What's even more troubling is that the FDA says that in some cases, "Seizures have been reported as occurring after a few puffs or up to one day after use."
As of August 7, 2019, the agency has now received more than 120 total reports of seizures and other neurological issues that followed using e-cigarettes. It is still investigating the link between the two.
Nicotine and reproductive health
It's well known that smoking traditional cigarettes during pregnancy significantly increases the risk of premature delivery, low birth weight, stillbirth and birth defects. Dr. Rajy Abulhosn, medical review officer for Confirm BioSciences, told CNET that the use of e-cigarettes may present just as much risk due to the nicotine they contain.
Furthermore, Dr. Abulhosn said that the US Surgeon General has shown that "babies born to mothers who used nicotine during pregnancy show long-lasting effects to both lung and brain development and function."
A 2019 study published in the Journal of the Endocrine Society found that the nicotine and chemicals in e-cigarettes may put women's fertility at risk by making it much more difficult to harder for an embryo to implant in the uterus. Unsurprisingly, the study also found that vaping while pregnant can trigger lifelong developmental abnormalities in babies.
Many e-cigarettes, including Juul devices, are small and easy to hide from authority figures, which is likely one reason they've become so popular.
Psychological complications
The same study that found e-cigarettes to increase the risk of heart attack by 55% also found that e-cigarette use may increase a person's risk of depression by 50%. The research does not outright say that vaping causes depression, but it's likely that people who vape are more likely to already have depression and use e-cigarettes as a coping mechanism. Similar relationships have been found between smoking regular cigarettes and depression.
Young people are particularly at risk for psychological complications, because nicotine can alter the development of the prefrontal cortex, the part of the brain responsible for decision-making, personality expression and logic. The prefrontal cortex isn't fully developed until around age 25, and using nicotine before then can increase a person's risk of mood disorders, addiction and impaired impulse control.
Nicotine's effect on the brain
There's one other big concern when it comes to e-cigarettes and the brain: Research has found that a significant number of electronic nicotine devices generate vapor with potentially unsafe levels of manganese.
Manganese is an essential mineral that you need to get from food, but when inhaled, manganese "is delivered directly to the brain and can lead to hallucinations," Dr. Weinstein said.
Chronic exposure to manganese can lead to manganese toxicity, a condition that develops silently over time and begins with nonspecific symptoms like headaches and fatigue. Over time, if manganese levels become high enough, toxicity can cause organ damage, hallucinations, difficulty concentrating, memory problems, and more. Researchers don't know the actual threshold of manganese exposure at which these symptoms start to occur, but it's always worth exercising caution.
There's still more research to do, but scientists and doctors have reason to believe that many of the chemicals in e-cigarettes can cause permanent damage through multiple pathways.
Does vaping cause lung damage?
E-cigarettes don't burn tobacco or leave tar on your lungs like regular cigarettes do, but the e-liquids and aerosols in vapes do contain a number of chemicals that still harm the lungs and respiratory system, Dr. Laren Tan, a pulmonologist at Loma Linda University told CNET.
"A common misconception is that e-cigarettes are completely safe, since e-cigarettes do not appear to have the classic look, feel or smell," said Dr. Tan, "[but] the intentional inhalation of particulates can still be harmful, especially in those with chronic respiratory diseases like asthma and COPD."
Dr. Weinstein points one of those harmful compounds out as chromium. Also found in regular cigarettes, chromium appears to be present in e-cigarette emissions, and chronic inhalation of it has been shown to induce asthma, decrease lung function and cause cancer of the respiratory system.
The Centers for Disease Control and Prevention (CDC) is currently investigating more than 150 cases of severe lung issues that may be tied to e-cigarettes. The cases span nearly 20 states, and many of the victims are young adults who reported symptoms like coughing, fatigue and shortness of breath.
Read more: Secondhand vaping: The latest vaping health risk
The lasting health effects of Juul and other vapes
Scientists and medical professionals won't know for sure what kind of health complications are posed by e-cigarette use until e-cigarettes have been around long enough to establish causal relationships.
For now, health professionals can only look to the similarities between traditional cigarettes and e-cigarettes and continue to accumulate new evidence -- but the recent news about vape-related seizures, respiratory illnesses and deaths should be enough to make any consumer wary.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.