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The safety and long-term health effects of using e-cigarettes or other vaping products still aren’t well known. In September 2019, federal and state health authorities began investigating an outbreak of a severe lung disease associated with e-cigarettes and other vaping products. We’re closely monitoring the situation and will update our content as soon as more information is available.

Vaping has side effects regardless of whether the vape fluid contains nicotine. These side effects vary depending on the base fluid, flavoring, and other ingredients used.

There’s still a lot we don’t know about vaping and e-cigarette use. Research into short- and long-term effects is ongoing.

Here’s what we currently know about the side effects of vaping fluids with and without nicotine.

We still don’t know the long-term effects of vaping traditional nicotine-free fluids. Some of the potential short-term side effects of nicotine-free vaping are described below.

Irritation

When heated, components in vape juice may irritate the mouth and airways.

One 2015 study found that one puff from a nicotine-free shisha pen contained enough propylene glycol and glycerol, two common base liquids, to cause irritation.

When vaporized, these substances may potentially form cancer-causing, or carcinogenic, compounds.

Inflammation

Nicotine-free vaping also appears to trigger an immune system response. One 2018 in-vitro study found that exposure can cause an inflammatory response in immune system cells.

An inflammatory response that may be most prominent with vaping is within the lungs or throat. Heavy use of vaping could cause an inflammatory response throughout the body.

Similarly, a different 2018 in-vitro study concluded that exposure to e-juice flavoring compounds may activate an inflammatory response in certain types of white blood cells. This can affect how these cells work within your immune system.

Toxicity

In addition, nicotine-free e-cigarette liquid may be toxic to cells.

An in-vitro study from 2018 found that exposure to e-cigarette vapor led to cell death even when nicotine wasn’t present. The affected cells reside in your lungs and defend your body against toxins, infectious particles, and allergens in the air you breath.

Another 2018 in-vitro study found that exposure to flavoring additives in e-cigarettes can harm blood vessel cells in the heart, which are known to play a role in long-term heart health. The death of these cells can lead to vascular conditions, such as high blood pressure, diabetes, and heart disease.

The Bottom Line

In-vitro results should be interpreted with caution, as they don’t replicate real-life vaping conditions. More research needs to be done in order to understand the effects of using nicotine-free e-cigarettes.

There’s a substantial amount of research documenting the harmful effects of nicotine, though most studies focus on nicotine exposure from smoking tobacco.

Health risks include an increased risk of respiratory, heart, and digestive illnesses, as well as decreased immune system and reproductive health.

Nicotine has cancer-causing properties. It’s also addictive.

In general, vaping without nicotine appears to be safer than vaping with nicotine. However, the overall long-term safety of vaping, regardless of nicotine presence, requires more research.

Although research is limited, some studies have compared the effects of nicotine-free e-cigarettes and those that contain nicotine.

For example, according to the results of one 2015 study, people who used e-cigarettes that contained nicotine reported greater dependence than people who used nicotine-free e-cigarettes.

A smaller 2015 study of 20 participants compared the 24-hour effects of using a nicotine-free e-cigarette among participants who smoke cigarettes and participants who previously abstained from cigarettes or vaping.

The researchers reported no immediate change in lung function among the participants who previously abstained.

They reported a small negative effect on lung function among participants who smoke cigarettes.

In addition, one 2018 study found that vaping fluids with nicotine caused a significant increase in blood pressure. This increase lasted for about 45 minutes after vaping.

Vaping nicotine-free fluids is associated with far fewer health risks than smoking cigarettes.

The Centers for Disease Control and Prevention (CDC) report that smoking cigarettes has wide-ranging negative effects on health, including increased risk of heart disease, stroke, and cancer.

Cigarette smoking is the number one cause of preventable deaths in the United States.

If you’re trying to quit smoking, vaping with nicotine-free solutions might be a less-risky alternative.

However, it’s important to recognize that there are risks associated with both nicotine-free and nicotine-containing e-cigarettes.

The Bottom Line

If you don’t currently smoke cigarettes, vaping might increase — rather than decrease — your overall risk of adverse effects.

Certain juice flavors are associated with harmful side effects.

In one 2016 study, researchers tested 51 different vape juice flavors for three potentially harmful chemicals:

  • diacetyl
  • acetylpropionyl (2,3-pentanedione)
  • acetoin

They found one or more of these chemicals in 92 percent of the flavors tested.

In addition, 39 of the 51 flavors tested contained a concentration of diacetyl that was over the laboratory limit.

Diacetyl is used in buttery or creamy flavors. When inhaled, it’s associated with serious respiratory illnesses.

In a 2018 study, researchers found that cinnamaldehyde, or cinnamon flavoring, had the most significant toxic effects on white blood cells.

O-vanillin (vanilla) and pentanedione (honey) also had significant toxic effects at the cellular level.

The Food and Drug Administration (FDA) regulates vaping devices and liquids, including those that don’t contain nicotine.

Manufacturers must include a warning label on all products containing nicotine.

Some potentially harmful flavoring chemicals found in vape fluids, in addition to the ones mentioned above, include:

  • acrolein
  • acrylamide
  • acrylonitrile
  • benzaldehyde
  • citral
  • crotonaldehyde
  • ethylvanillin
  • eucalyptol
  • formaldehyde
  • propylene oxide
  • pulegone
  • vanillin

Manufacturers aren’t required to provide consumers with a list of e-liquid ingredients, which can make it hard to know which products to avoid.

You may find it easier to avoid flavors that are frequently associated with respiratory irritants. This includes:

  • almond
  • bread
  • burnt
  • berry
  • camphor
  • caramel
  • chocolate
  • cinnamon
  • clove
  • coffee
  • cotton candy
  • creamy
  • fruity
  • herbal
  • jam
  • nutty
  • pineapple
  • powdery
  • red hot
  • spicy
  • sweet
  • thyme
  • tomato
  • tropical
  • vanilla
  • woody

Marijuana vaporizers don’t contain nicotine, but they can still cause side effects.

In general, these side effects are caused by tetrahydrocannabinol (THC), the active ingredient in marijuana.

The high associated with vaping marijuana might be stronger than the high that results from traditional toking.

Other potential side effects include:

  • memory impairments
  • impaired coordination
  • difficulty problem-solving
  • sensory and mood changes
  • nausea
  • vomiting
  • increased heart rate

Vaping flavored cannabis oil may also lead to side effects similar to those of nicotine-free e-cigarettes, depending on the fluid’s base and flavoring ingredients.

CBD vaporizers don’t contain nicotine, but they can still cause side effects.

CBD stands for cannabidiol, one of several active ingredients in cannabis. Unlike THC, CBD isn’t psychoactive, which means it doesn’t cause a mental “high.”

While there’s little research on the side effects of vaping CBD, some general side effects — which tend to be mild — of CBD use include:

  • irritability
  • fatigue
  • nausea
  • diarrhea

Vaping flavored CBD oil may also cause side effects similar to those of nicotine-free e-cigarettes, depending on the fluid’s base and flavoring ingredients.

Juuling is another term for vaping. It refers to the use of a particular e-cigarette that looks like a USB key and is popular among young people.

Most Juul products contain nicotine. The side effects described in this article surrounding nicotine also apply to Juuling.

Make an appointment with a doctor or other healthcare provider if you experience any of the following:

  • dry mouth
  • chronic coughing
  • persistent sore throat
  • bleeding or swollen gums
  • mouth ulcers or sores that don’t seem to heal
  • toothache or mouth pain
  • receding gums

Your provider can assess your symptoms and determine whether they’re the result of vaping or an underlying condition.

You should also talk to a healthcare provider if you’re trying to cut back on smoking cigarettes.

They can help you understand how to slowly decrease your nicotine intake and ultimately quit altogether.