E-cigarettes don’t need nicotine to harm your health. Here’s why vaping your favorite flavor may be a bigger cancer risk than you think.
There are around 8,000 known e-liquid flavors available on the market today.
Banana Pudding, Caramel Corn Crunch, Rainbow Candy, Glazed Donut, Sub Zero Watermelon, Hawaiian Punch — the list goes on and on; names like treats from some imaginary dessert menu.
Electronic cigarettes owe much of their appeal to a continually growing list of flavored e-liquids, the nicotine-containing solution that is electronically vaporized and inhaled through the devices.
Flavored e-liquids, or e-juices, have also proved to be one of the most contentious concerns about electronic cigarettes. They also may be more hazardous to our health than previously thought.
Even the Food and Drug Administration (FDA) has pointed out that the variety of flavors that makes vaping appealing from a cessation perspective — getting a long-time smoker to stop traditional cigarettes — are the same reason why teens and adolescents are now using electronic cigarettes in record numbers.
How to regulate these flavored e-liquids has been a sticking point between the FDA and advocacy groups including the American Lung Association and the American Heart Association.
On multiple occasions these groups have rebuked the federal government for its apparent lethargy in taking action to stem a growing tide of young tobacco users.
However, on Thursday, the FDA unveiled a new plan to fight underage tobacco use, targeting electronic cigarettes, flavored cigars, and menthol cigarettes.
The agency is moving to limit the sale of flavored e-cigarettes to brick-and-mortar locations that are age-restricted retailers, such as smoke shops, or areas within stores that can only be accessed by individuals 18 or older.
The FDA is also increasing scrutiny on online sales of flavored e-cigarettes by seeking “heightened age verification processes.”
Yet, these steps only address the issue of adolescent e-cigarette-use and not the larger health risks e-juice flavors may cause.
“From the beginning the e-cigarette industry has been trying to peddle that their products are safe, that they don’t contain the nasty chemicals that you find in cigarettes,” Erika Sward, assistant vice president of national advocacy for the American Lung Association told Healthline. “As more and more research comes out, I think that we’re not surprised to find that the e-cigarette industry has not been truthful and forthcoming about the chemicals that their products do contain.”
Sward is referring to a growing body of evidence that the supposedly safe chemicals used regularly to make e-liquids are likely unhealthy.
New research further suggests the chemical components in e-liquids are toxic and harmful to the body.
Also, it’s unlikely that manufacturers of these products are even fully aware of their chemical properties and their potential for harm.
The selling points of the “safety” of e-liquids have been that the products contain relatively few ingredients and, of the ingredients used, many are on the FDA’s Generally Recognized As Safe (GRAS) list.
E-liquids are generally made from a combination of propylene glycol and vegetable glycerin. This forms the liquid base to which additional additives such as flavorings and nicotine are added.
And the proof is in the pudding, or in this case, the pudding-flavored vape juice.
Aldehydes, organic components often associated with aromas (such as those of berries), and other additives used for flavoring on the GRAS list are understood to be safe for food — not smoking or vaping.
Yet e-liquids are rife with them: cinnamaldehyde imparts the sweet spicy taste of cinnamon; vanillin for vanilla notes; and benzaldehyde is the unmistakable taste of almonds. Other common flavoring elements such as diacetyl give a creamy or buttery depth to e-liquids.
Previous studies have looked at the effects of these ingredients when subjected to heat or vaporization and found that they can cause the formation of formaldehyde and other cancer-causing chemicals, in addition to causing irritation and inflammation of the lungs.
Now new research says that the chemicals could begin to react, forming unknown byproducts as soon as the e-liquid is mixed.
“It’s entirely possible that there may be tens or even potentially hundreds of compounds forming and we just don’t know much about them,” Sven-Eric Jordt, PhD, professor of anesthesiology, pharmacology, and cancer biology at Duke University School of Medicine.
Jordt is a co-author on a new study that suggests the problem of understanding the simple question of what is in e-liquids is far more complex than it seems, or at least, how it’s being marketed.
“It’s known that these flavors, especially the aldehydes there, are quite reactive. They can form adducts, reaction products, with the solvents,” Jordt told Healthline. “We found that a large proportion, sometimes forty-percent or more of the flavor, is reacting with the solvent after mixing. After a few hours, a quite large proportion of the flavor is converted into these reaction products.”
The reactivity of e-liquids not only makes clear labeling of ingredients more difficult from a regulatory perspective, it also makes it harder to know what effects the unknown byproducts will have on the lungs and body when vaporized.
Chemical reactions are occurring in these products literally as they sit in a bottle waiting to be sold.
“These liquids are unstable, you don’t even need to heat them or oxidize them or do something to them to form chemical reaction products,” said Jordt.
And these byproducts are making their way into the lungs of those who vape.
The study found that some of the byproducts formed in the e-liquid solution had a 50 to 80 percent carryover concentration when vaporized, meaning that they don’t break down during the vaporization process.
A “significant” amount of these chemicals “will reach the airways during vaping,” wrote the authors.
Another recent study published in the journal Toxics found that vaporized e-liquids expose users to dangerous levels of aldehydes.
In that small pilot study (only twelve participants), researchers did a chemical analysis of the breath of participants before and after using electronic cigarettes.
They found that the average concentration of aldehydes in the breath was ten-and-half times higher than before vaping.
Additionally, the concentration of noxious chemicals like formaldehyde in the breath was “hundreds of times lower” than in the vapor itself, leading the researchers to conclude that “a significant amount is being retained in the user’s respiratory tract.”
In some cases, formaldehyde exposure was comparable to traditional cigarettes.
“It’s unacceptable that a user of e-cigarettes is being told by the cigarette industry that its products are safe and at the same time they are breathing in these toxic chemicals,” said Sward. “It really speaks to the fact that the tobacco industry has not changed at all.”
Perhaps most puzzling about FDA’s slow response to the growing body of research about the deleterious effects of e-liquid flavorings is that many of the ingredients have been understood to be harmful when inhaled for decades.
“Some of these flavorings have a very bad track record,” Dr. Jacqueline Moline, vice president, occupational medicine, epidemiology, and prevention, Northwell Health, Manhasset, New York, told Healthline.
Studies have shown in recent years the toxic effects of cinnamaldehyde, vanillin, and diacetyl on the lungs when vaporized in e-cigarettes, but these chemicals were already on the radar of regulatory agencies like the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH).
Vanillin and cinnamaldehyde in particular have been associated with higher chemical toxicity levels in e-cigarettes.
Cinnamaldehyde has also previously been identified by OSHA as an eye, skin, and respiratory irritant.
Diacetyl, the component responsible for butter and cream flavors, caused workers in a microwave popcorn manufacturing plant in the United States to become sick and die. The cause: “popcorn lung,” or bronchiolitis obliterans, a scarring of the lung tissue that causes narrowing of the airways, leading to shortness of breath, wheezing, and symptoms similar to chronic obstructive pulmonary disease.
Inhalation exposure to another common e-cigarette flavoring component, 2,3-pentanedione, has also been shown to result in damage to the airways similar to diacetyl.
“For decades, workers have been the canaries in the coal mine. They’ve been exposed to compounds at the highest rates. We’ve typically learned from these high exposures what detrimental health effects there can be. For us to allow even higher rates in a personal consumer product is just an anathema to public health,” said Moline.