E-Cig Flavoring Harms Blood Vessels

electronic cigarette

Story at-a-glance -

  • Unlike traditional cigarettes that emit dangerous aromatic polycyclic hydrocarbons, e-cigarettes are nearly odorless and often misperceived as being safe and harmless to your health
  • Recent research shows while e-liquid burned in vaping devices contains carcinogenic chemicals, the added flavors may be damaging endothelial cells lining your blood vessels, increasing your risk of heart disease and stroke
  • In an effort to expand their consumer base to the pediatric population, e-cigarette companies have packaged e-liquid to be burned in vaping devices to look like juice boxes and candy, and are mimicking many of the powerful advertising strategies once used by big tobacco companies
  • Although odorless, bystanders are not immune from the dangerous effects of e-cigs as the vapor contains nicotine and other fine particulate pollutant matter easily absorbed through inhalation

By Dr. Mercola

Unlike traditional combustible cigarettes emitting an offensive odor, electronic cigarettes (e-cigs) are nearly odorless and usually misperceived as being harmless to your health. Tobacco companies have produced powerful advertising campaigns and print ads to forward this idea to children and adults.

Alas, even bystanders are exposed to toxic nicotine, heavy metals, fine particulate matter and formaldehyde from these devices. While the number of people smoking traditional cigarettes has been dropping, the number of teens using e-cigs, also known as vaping, has steadily risen, and research data suggests that teens who take up vaping may also be more prone to smoking.1

It is currently believed e-cigarettes do not expose you to the thousands of toxic compounds the average combustible cigarette contains, but researchers are only just beginning to understand the toxicities involved in vaping. In some ways, these man-made tobacco alternatives are just as dangerous to your health as traditional cigarettes. Recent research has found the liquid used to flavor the vape experience damages your cardiovascular system.2

Vape Flavors Damage Your Cardiovascular System

According to a study from Boston University School of Medicine, liquid used to flavor e-cigarettes may induce early signs of cardiovascular disease leading to heart attack, stroke and even death.3 The scientists found changes appeared almost immediately on the cellular level. Flavor additives are popular in the teen population, who often initially choose vaping over traditional cigarettes.

While the health effects of traditional cigarettes and hookah are well established, the dangers of e-cigarettes are only beginning to be studied. One of the key factors in this study was the direct testing of the effect of just flavoring at levels likely to be reached inside the body. According to lead author Jessica Fetterman, Ph.D., the measures evaluated during data collection were some of the first changes seen in the development of heart disease.4

The researchers used endothelial cells, which make up the lining of blood vessels, from two groups of people. One group regularly used menthol flavored traditional tobacco cigarettes and the other used unflavored tobacco cigarettes. They compared these cells against nonsmoking volunteers.5 The cells from both types of smokers were unable to perform a key function in the same way nonsmoker cells were able — the production of nitric oxide, a colorless gas the body uses to dilate blood vessels.

When the nonsmoker cells were directly exposed to menthol, the same thing happened. This gave the researchers a baseline against which they compared flavoring additives commonly used in e-cigarette. Nine chemical flavorings were tested, including:6

Menthol (mint)

Eugenol (clove)

Vanillin (vanilla)

Acetylpyridine (burnt flavor)

Cinnamaldehyde (cinnamon)

Dimethylpyrazine (strawberry)

Eucalyptol (spicy cooling)

Diacetyl (butter)

Isoamyl acetate (banana)

The researchers then exposed endothelial cells to different levels of the nine flavorings. The chemicals were heated to the same temperature a vaping device would normally create. At the highest level of exposure the chemicals triggered outright cell death. At a lower level, researchers noted impaired nitric oxide production and inflammation. Fetterman commented on the importance of the study, saying:7

"Our study suggests that the flavoring additives used in tobacco products like e-cigarettes, on their own or in the absence of the other combustion products or components, may cause cardiovascular injury. [That] could have serious implications, as flavored tobacco products are the most popularly used products, especially among youth."

She added:8

"Increased inflammation and a loss of nitric oxide are some of the first changes to occur leading up to cardiovascular disease and events like heart attacks and stroke, so they are considered early predictors of heart disease. Our findings suggest that these flavoring additives may have serious health consequences."

Children Are the Tobacco Industry's Market

In their sprint to grow a consumer base in an environment where the number of people smoking traditional cigarettes is declining, tobacco companies are selling their products to a new market — children. While scientists are proving e-cigarettes hold greater health risks than previously believed, companies are chasing profits and poisoning another generation.

The U.S. Food and Drug Administration (FDA) and Federal Trade Commission (FTC) are aiming their resources at branding using the same colors and packaging as commonly sold juices and candies. One product, Twirly Pop, is even packaged with a lollipop.9 "E-liquids," the liquid used in vaping devices, are a combination of nicotine, flavoring and other ingredients that, when ingested, can cause poisoning and death, especially in small children.10

Nearly 8,300 children under the age of 6 were poisoned by e-liquids between January 2012 and April 2017, according to the National Poison Data System.11 The number of children exposed appeared to decrease after January 2015, which researchers attributed in part to federally mandated child-resistant packaging.

Until this point, manufacturers had not voluntarily designed child-resistant packaging despite a 1,398 percent increase in poisoned children from vaping liquid between 2012 and 2015. The rising popularity of e-cigarettes increases health risks, especially in small children who are 2.5 times more likely to experience a severe outcome than children exposed to traditional, combustible cigarettes.12

The FDA and FTC are concerned this risk will rise when the product is packaged resembling candy and juices. Additionally, the agencies are cracking down on the sale of Juuls to underaged buyers. Dubbed the "iPhones of e-cigs," Juuls resemble a flash drive, have little vapor, are fruit-flavored and are easily concealed from parents and teachers.13

The FDA is also demanding Juul Labs release documentation of their marketing, focus groups, toxicology and development process in an effort to confirm the manufacturer's statement they are not intentionally marketing to children.14 An assistant superintendent for student services at a large Chicago public school hopes by making the risks associated with vaping more public, and Juul more accountable, it may make the health consequences clearer to students.15

FTC Is Requiring Immediate Action on Misbranded Products

In a press release, the FDA announced they have begun a large-scale nationwide undercover operation to find retail stores selling e-cigarettes, especially Juul products, to minors.16

In an effort to force manufacturers to change branding and labeling of e-liquids so they don't closely resemble children's products, the FTC and FDA have told companies their products' "labeling and/or advertising imitating kid-friendly foods is false or misleading."17 The FTC is citing their authority falls under the Federal Trade Commission Act, which prohibits unfair or deceptive advertising.

The manufacturers have been given 15 days to respond with their plans to change labeling or packaging of the products. The agencies warn failure to respond and take action may result in further action, including seizure of product or injunctions. Additionally, FDA commissioner Scott Gottlieb told reporters it would be difficult to imagine the products were not aimed at children as the packaging imitates items children frequently consume.

Vaping Advertisers Copy Big Tobacco Playbook

The tobacco industry used strong advertising campaigns to grow an enormous consumer base addicted to their product. Electronic cigarette companies appear to be following directly in these footsteps, using some of the same advertising tactics traditional tobacco products are now banned from using. While traditional cigarette ads were aimed at adults, these slick tactics are now being used to garner new consumers in the pediatric population.

Many old advertisements for traditional cigarettes featured celebrity spokespersons, like Gary Cooper and Marlena Dietrich, who made the habit appear trendy and cool. E-cigarette companies are using actors, TV personalities and musicians to demonstrate to children the same thing. Magazine ads feature rugged men and glamorous women, giving teenagers the impression those who are masculine, sexy or rebellious should be vaping.18

E-cigarette companies also sponsor sporting events and music festivals, much like their tobacco counterparts once did. Cigarettes sponsorships are banned, but e-cigarette brands have auto racing sponsorships of their own. In 2009 a federal law banned fruit and candy flavored cigarettes in order to help reduce the number of children who were tempted to begin smoking combustible cigarettes. Today, e-cigarette liquids pitch similar flavors to an audience enthralled by sugar.

Apollo Vapors offers Almond Joyee, "the candy bar taste without the calories!" and French Vanilla flavor that is "like biting into a deliciously sweet vanilla cupcake."19 Advertisers use cartoons and urge their customers to switch, don't quit, in much the same way True cigarette advertising urged their customers in advertisements: "Considering all I've heard, I decided to either quit or smoke True. I smoke True." Blu e-cigarette print ads say: "Why quit? Switch to Blu."

The ads build on the misconception many teenagers hold that vaping is harmless. The irony is the same companies who convinced doctors to recommend smoking to alleviate anxiety20 are now hawking similar products to a new generation with the knowledge that only the packaging has changed. While society begins shunning traditional cigarettes after decades of education about the significant hazards to health, vaping appears to be accepted.

Headlines Don't Tell the Story

The 2016 Surgeon General Report stated e-cigarettes are a major public health concern, as use from 2011 to 2015 in high school students had risen an astounding 900 percent.21 Although headlines have reported the number of people vaping is on the decline, there remains an estimated 3 million vaping adolescents.22 This represents only an 11.3 percent drop since 2015, as compared to the 900 percent increase in the previous four years.23 Reports of declining numbers are based on this slim decrease.

While considering the number of teens who are vaping, it's important to realize there is no safe level of exposure to tobacco products, smokeless or combustible. Teens who begin by using e-cigarettes are also more likely to start smoking combustible cigarettes.24

Results of several studies support this concern,25 as well as data finding students are more likely to move from vaping to traditional cigarettes than to switch from traditional to electronic.26 Research authors wrote about the risks to teens:27

"For example, adolescents may be more likely to use e-cigarettes before conventional cigarettes because of factors unique to e-cigarette products, such as perceptions that e-cigarettes are less harmful than conventional cigarettes, the widespread availability of unique e-cigarette liquid flavors that may be especially appealing to youth and limited enforcement or restrictions on youth access to e-cigarettes."

The risk of addictive behavior as teens grow into adulthood also increases when teens are exposed to nicotine. Researchers from Perelman School of Medicine at the University of Pennsylvania28 used an animal model to demonstrate that when exposed to nicotine as a teen, the animal grew up to drink more alcohol than unexposed animals. According to the researchers, exposure changed the neurological circuitry in the brain's reward pathway. Other studies have demonstrated similar results.29

Administration of nicotine during adulthood did not produce the same alteration in function of the inhibitory midbrain circuitry as did exposure during adolescence. The researchers found the alteration in transmission of neurotransmitters were responsible for signals during stress or in the recognition of reward. Long-term changes in the midbrain reward center may also be a gateway to other addictive drugs, such as cocaine, heroin and morphine.

Bystanders Are Affected by Vaping Toxins Too

The lack of offensive odor from the devices has led to a greater acceptance of the habit in public places. However, bystanders are not immune from the health risks associated with vaping. In one study, researchers found significant levels of lead, nickel, chromium and magnesium were produced by vaping devices.30

While the results were consistent with other studies,31 the researchers found larger amounts were released when liquid was exposed to the heating coils32 and nearly 50 percent of the vapor samples contained lead levels higher than limits set by the Environmental Protection Agency.33 Inhaled lead may attack your brain and nervous system, kidneys, liver and bones.

The nicotine-containing aerosol produced by the devices also contains fine particulate matter easily absorbed through inhalation by bystanders. E-cig vapor also contains acetaldehyde34 and formaldehyde,35 both known carcinogens.36 At least one brand tested had 10 times more than found in traditional cigarettes. The FDA has also detected antifreeze chemicals in e-cigarettes — another known carcinogen.37

Secondhand vapor may contain at least 10 chemicals identified on California's Proposition 65 list of reproductive toxins and carcinogens, according to Americans for Nonsmokers' Rights.38 Likely the most well-known is diacetyl, one of the flavorings tested in the feature study that demonstrated a damaging effect on your blood vessels. The chemical also causes known damage to the respiratory system and permanent scarring of the airway.39

The number of teens using vaping devices and suffering health risks is a critical public health concern and affects the future health of every community. The 2018 American Lung Association State of Tobacco Control40 report calls for significant and important action from state and federal agencies toward the elimination of tobacco use to positively impact the number of preventable deaths and to reduce the pain and suffering experienced by smokers and their families.