by Hannah Hafezi - All posts, Health and Wellbeing, Nicotine Addiction & Smoking - 03/10/201814/11/2018 E-Cigarettes – a safe alternative? E-cigarettes and vapes have been seen as a safe alternative to smoking, and are continuing to increase in popularity. But are there any health concerns? Hannah and The Doctor Service go searching for answers… What are electronic cigarettes? Electronic cigarettes (E-cigarettes) are battery powered, tobacco-free smoking devices. They deliver nicotine without producing smoke or burning. Unlike traditional cigarettes, e-cigarettes contain liquid filled cartridges containing a solution of nicotine, propylene glycol or vegetable glycerine (a clear, odourless liquid that is made from plant oils) and flavourings. When this is heated this creates a vapour that is inhaled by the smoker. As e-cigarettes do not involve burning, no carbon monoxide or tar is produced. What are the dangers of e-cigarettes? Even though people who use these are not exposed to carbon monoxide they are still exposed to nicotine, the highly addictive substance in traditional cigarettes. Nicotine is able to cross the blood brain barrier which means it is taken up by ‘nicotine’ receptors in the brain. When nicotine binds to these receptors it causes the release the brain chemical dopamine, which gives us feelings of reward and pleasure. Once this feeling wears off, the brain craves further nicotine for the release of dopamine. Repeated use leads to an increase in the number of nicotine receptors and they also become tolerant to nicotine. So when nicotine levels deplete, there is less nicotine bound to the receptors. Nicotine withdrawal symptoms occur. These symptoms include anxiety, low mood and irritability. Nicotine levels in e-cigarettes depend on the type of e-liquid that you buy and when inhaled. Nicotine levels in e-cigarettes tend to be much less than traditional cigarettes. Nicotine in high levels can be poisonous, but there are no cases of nicotine poisoning that have been reported by e-cigarettes currently. There are newer products now available which do not contain any nicotine. Electronic cigarettes in pregnancy and adolescence Nicotine exposure during pregnancy has been linked with low birth weight, premature labour and still birth. Although these new products are not confirmed safe in pregnancy, it has been seen as lower risk than cigarettes. At The Doctor Service we recommend that you currently do not use any form of cigarettes or e-cigarettes while pregnant, as it’s not clear what potential effects other substances within e-cigarettes could have on your baby. You should discuss this further with a health professional if you’re not sure. Nicotine has been found to have a negative effect on the baby’s brain. It is associated with some children having lasting developmental and behavioural problems in children. Second hand exposure Unlike cigarette smoking there is no risk of second hand exposure to smoke, as no smoke is produced. There is evidence though, that the use of e-cigarettes indoors can expose a non-user to nicotine. T he extent of this exposure is not known. New dangers of E-cigarette smoking Currently little is known about the other chemicals present and chemical compositions vary between brands. However, vapour from e-cigarettes contain some of the same potentially harmful substances as found in cigarettes, often at much lower levels. Liquid should be stored away from children to avoid accidental poisoning, and there have been reports in the media about pets being poisoned from the liquid too. As an electronic device, it is important that they are charged using the correct charger, are not left unattended whilst charging and not over-charged. There have been reports of e-cigarettes exploding during use, causing facial burns, and also whilst being carried in pockets. It is not entirely clear what causes the e-cigarettes to explode but it’s likely due to over-heating of the lithium battery and e-cigarettes that have a built in USB port have been found to have a greater risk of exploding. Are there any positives of e-cigarettes? Information in the media can often be confusing and contain misinterpreted scientific results. An expert report published by Public Health England reported that e-cigarettes are 95% less harmful than traditional cigarette smoking. This figure has been highly controversial among doctors who claim that this figure is far too high and based on little evidence. There is also concern about the lack of evidence supporting the safety of the chemicals and the potentiality of a future public health disaster, as we don’t know the long term effects that e-cigarettes could cause. Some of the evidence for and against e-cigarettes are influenced by the tobacco and e-cigarette industries who may present results in their favour which means it can sometimes be difficult to know if the evidence presented is accurate. Can they be used to help smokers quit? Public Health England recommend that e-cigarettes should be used for smoking cessation but ONLY if all other methods have failed. Further research is required to fully understand the relationship between smoking cessation and e-cigarettes. This guidance is continually being updated. Nicotine free options are available and these are good alternatives but may not curb any nicotine cravings. They will help with the psychological element of having a cigarette in hand. It is clear that the evidence for and against the use of e-cigarettes is contrasting. It is important to note that even though there is exposure to fewer toxins than traditional cigarette smoking there is a need for more long term studies. This will help to build a strong evidence base around the safety of them. The Doctor Service provides a smoking cessation service to help you stop smoking, which can also be used to help you stop the use of e-cigarettes. If you’re inhaling any products in to your lungs, these are being absorbed by your body, they need to be processed and removed. Currently there is not enough evidence to clearly state whether the chemicals in e-cigarettes can 100% be safely removed from your body. Only time will tell and further research as to whether e-cigarettes are safe to use. Want to find out more? We’ve watched the BBC Horizon documentary where Dr Michael Mosley reveals more about e-cigarettes. here http://www.bbc.co.uk/programmes/b07c6ll4 If you want advice and treatment to quit smoking, and stopping the nicotine cravings visit TheDoctorService.co.uk smoking cessation page. Edited by Dr Kiran Sodha & The Doctor Service at TheDoctorService.co.uk For further stop-smoking blogs click here. References Yong, Hua-Hie, et al. “Does the regulatory environment for e-cigarettes influence the effectiveness of e-cigarettes for smoking cessation?: Longitudinal findings from the ITC Four Country Survey.” Nicotine & Tobacco Research(2017). Public Health England. “E-cigarettes: an evidence update” Public Health England (2015) Czogala, Jan, et al. “Secondhand exposure to vapors from electronic cigarettes.” nicotine & tobacco research6 (2013): 655-662. NCSCT “Smoking Cessation: A briefing for midwifery staff”, 2016 http://dogtime.com/dog-health/general/20321-e-cigarettes-are-toxic-to-pets https://info-electronic-cigarette.com/e-cigarette-explosions-an-in-depth-investigation/ Is there a common molecular pathway for addiction? Nestler EJ Nat Neurosci. 2005 Nov; 8(11):1445-9.