Vaping vs. Smoking: Is Vaping Bad for You, Too?

Jim McDonald
December 21, 2018

Vaping vs. smoking

Every discussion of the health risks of vaping should begin with a comparison to cigarette smoking. This is important for two reasons. First, vapes are designed to be reduced-harm alternatives to smoking cigarettes. Second, it’s important to weigh vaping versus smoking because the vast majority of vapers are smokers or ex-smokers.

When it comes to science though, not enough studies employ a direct comparison between vaping and smoking. That’s a missed opportunity. It’s understood that smoking is bad for you with many health risks, but is vaping bad for you? How can does vaping affect your health? Separate from understanding the absolute safety of vaping, it’s imperative to know if vaping is much safer than smoking.

Public Health England has been unequivocal in its findings: vaping is at least 95 percent safer than smoking. They understand that studying the dangers of vaping alone is only half of the subject, since vaping exists primarily as an alternative to smoking. Since there aren’t many studies that employ a direct comparison, the available information on vaping must be measured against the available information on cigarette smoking, rather than in isolation.

Is vaping bad for your lungs?

Smoking cigarettes causes well-known harm to the lungs. Long-term inhalation of burning tobacco can lead to lung and esophageal cancer, and to a variety of deadly lung conditions like emphysema, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). But what about vaping?

Cigarette smoke attacks the lungs in several ways. It contains thousands of chemicals, more than 70 of which are known carcinogens. It also contains particulate matter — fine bits of burned tobacco and paper — that is deposited deep in the lungs, where they can be buried in the tissue. Vaping doesn’t produce known carcinogens in quantities large enough to be considered real risks, and it doesn’t contain solid particles like smoke.

In fact, the things that are most dangerous in burning tobacco are largely absent from vaping. Since there is no combustion in vaping, there is no tar or carbon monoxide — two other major dangers of smoking. Vaping uses heat from a coil to turn e-liquid into an inhalable aerosol. It looks like smoke, but isn’t. That said, vaping is not without some potential risks to lung health.

There is some concern over the ingredients in e-liquid: propylene glycol, vegetable glycerin, and flavorings. There is no serious human research on the effects of inhaling PG or VG daily for an extended period of time, although extensive animal studies of PG inhalation haven’t raised any red flags. PG has been found to cause minor irritation of the airways, but this isn’t concerning in itself.

Are flavors bad for your lungs?

E-liquid flavorings are a possible source of danger that hasn’t been well-studied. Most flavorings are a mixture of many chemical compounds, and it’s likely that some are worse for lung health than others. Until recently, these flavorings were used strictly in products that were eaten, not inhaled. So toxicology studies have focused on showing that the flavorings are safe for consumption. This is an area where the science on vaping needs to catch up.

A recurring headline has been about diketones like diacetyl being found in some e-liquid. This group of flavoring chemicals is believed to be responsible for a deadly disease called popcorn lung when it is inhaled in large quantities (like in the case of workers in popcorn manufacturing facilities). Diketones are not present in all e-liquid, but a 2014 study by Dr. Konstantinos Farsalinos concluded that diacetyl and acetyl propionyl are “avoidable risks.” Following that, many manufacturers reformulated their products and eliminated them. Others began publishing testing showing the levels of the diketones in their products.

Diketones are present in cigarettes too, at 100-750 times the level of any e-liquid. Yet, even though smoking ravages the lungs in other ways, it isn’t associated with popcorn lung. Considering the much larger quantities of diketones in cigarette smoke, the comparatively small amounts in vapes are not likely to be a threat. That’s not to say diketones are safe for inhalation, but the safer choice between vaping and smoking is clear, considering the amounts present.

Is vaping bad for your oral health?

Smoking causes and contributes to a variety of oral health problems. Of course, it’s well-known that smokers are at high risk for mouth, throat and esophageal cancers. But cigarettes can also cause dental and periodontal disease, including gingival (gum) disorders. And cigarette smoke can alter the bacteria in the mouth (microbiome), making existing periodontal problems worse.

There isn’t much information available about medical side effects of vaping on oral health. A recent literature review in the Journal of Oral Pathology & Medicine summarized the state of the science, noting the “paucity of evidence.” However, the authors summarized a few interesting findings.

The authors describe a small study that suggests vapers may have increased prevalence of nicotine stomatitis (which is, oddly, not caused by nicotine), a condition caused by heat that creates lesions in the mouth. This is a minor condition that typically resolves itself when the source of heat (typically a pipe) is eliminated.

A small pilot study examined the oral microbiome of 10 vapers, 10 smokers, and 10 non-vapers/smokers. The authors found that the bacterial profile of vapers was similar to the non-vaping/smoking control group, but that the smoking group’s oral bacteria profile was very different. The researchers concluded that vapor doesn’t alter the microbiome. Again, the study was very small, so broad conclusions can’t be made. The review covers some other small studies, but questions their relevance based on their small size and lack of proper controls.

Finally, there is the issue of exploding vapes causing damage to the mouths of vapers. While it’s true that a very small number of vapers have had catastrophic accidents that caused severe facial and oral lacerations and broken teeth, this is more a matter of vape battery safety than anything else. Using modern regulated devices and quality batteries, there is virtually no chance that an atomizer will be launched from a mod into the user’s teeth.

Can vaping cause cancer?

Cancers form when toxins damage or mutate a cell’s DNA and cause it to grow out of control. A tumor can remain local, or the cancer can spread, and even move from one organ to another. Most people are familiar with cigarette smoking as a cause of lung cancer. Lung cancer kills more Americans than any other kind of cancer, and most (but not all) lung cancer victims are smokers.

Smoking can cause many other kinds of cancer too, because cancers can form not just in areas that have contact with the smoke, but also from smoke byproducts in the bloodstream and organs. According to the Centers for Disease Control and Prevention (CDC), smoking can cause cancer almost anywhere in the body.

Carcinogens have been found in vapes, but at levels that suggest the cancer risk is very low. According to a 2017 study in the journal Tobacco Control, the cancer risk of vaping is on a par with the risk of using pharmaceutical products like nicotine patches — less than one percent the cancer risk of smoking. The only byproducts of vaping that posed a real risk were carbonyls produced by overheating the vape device (as explained in the formaldehyde section of this article).

Other researchers have come to similar conclusions. A 2016 study published in the journal Mutation Research tested both e-cig vapor and cigarette smoke for their ability to cause cell mutations in bacteria. The smoke caused mutations, and was also toxic to the bacteria, while the vapor was not mutagenic or toxic.

Nicotine itself — either in cigarettes or vapes, or other nicotine products — has not been shown to cause cancer. Long-term studies of nicotine replacement therapy (NRT) and Swedish snus users show no provable link between nicotine and cancer.

The 2016 Royal College of Physicians report on e-cigarettes says that “robust evidence on the safety of long-term nicotine use in humans from the 5-year Lung Health Study, in which participants were actively encouraged to use NRT for several months and many continued to consume NRT for a much longer period, demonstrates no association between sustained NRT use and the occurrence of cancer (lung, gastrointestinal or any cancer) or cardiovascular disease.”

Is there formaldehyde in vapes?

What is formaldehyde? The EPA states that “formaldehyde is a colorless, flammable gas at room temperature and has a strong odor. Exposure to formaldehyde may cause adverse health effects.”

Portland State University researchers reported in 2015 that vapor products produced high levels of formaldehyde — even more than cigarettes. What they didn’t explain was that their experiments used unrealistically high voltages and smoking machines to produce vapor that would have been unbearable for anyone to inhale.

In fact, you can do a similar experiment by putting bread in a toaster and leaving it until the toaster emits smoke and the bread turns black with carbon. Is the result carcinogenic? Yes it is, but since no one could possibly eat it, the danger is moot. Is black toast what you think of when you think of toast? Likewise, the toxic aldehydes produced by a burning wick and atomizer are no real danger because they’re impossible to repeatedly inhale.

In a 2017 study, cardiologist Konstantinos Farsalinos replicated the Portland State experiment and showed that the vapor produced by deliberately overheating was unpalatable to human users. “The high levels of formaldehyde emissions that were reported in a previous study were caused by unrealistic use conditions that create the unpleasant taste of dry puffs to e-cigarette users and are thus avoided,” wrote the author.

In 2018, Farsalinos and Gene Gillman produced a systematic review that analyzed the evidence from 32 studies on the carbonyl compounds like formaldehyde, acetaldehyde, and acrolein that have been found in vapor. The authors found that nearly all of the high levels of carbonyls like formaldehyde produced during the studies were created by poor methodology leading to “dry puff conditions.” They proposed standards for future research that defined proper parameters for vaping experiments, including a standardized puffing regime, using current-generation atomizers and realistic power settings, and proper PG/VG ratios for the equipment tested.

The authors also explained that we inhale 1 mg of formaldehyde every day, just in our own homes. The average vaper, using 5 mg of e-liquid a day in a modern atomizer, only increases their formaldehyde intake by 0.083 mg. That’s less than a 9 percent increase above the normal exposure level, which is probably not significant.

The bottom line

Cigarettes wreak havoc on the body, damaging the smoker practically from head to toe. The harms have been proven beyond doubt. But there is no evidence pointing to similar health effects from vaping — or any health problems, for that matter — unless you count possible nicotine dependence. But nicotine isn’t directly responsible for any of the terrible results of smoking. Vaping remains a far better choice when compared to smoking.

Smokers created vaping without any help from the tobacco industry or anti-smoking crusaders, and vapers have the right to keep innovating to help themselves. My goal is to provide clear, honest information about the challenges vaping faces from lawmakers, regulators, and brokers of disinformation. I recently joined the CASAA board, but my opinions aren’t necessarily CASAA’s, and vice versa. You can find me on Twitter @whycherrywhy

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Maddie Reeze
Guest
Maddie Reeze

Vaping very well could be safe and an effective smoking cessation tool. I would agree that they are probably safer than conventional cigarettes and other tobacco products.

Dave Kriegel
Staff
Dave Kriegel

Definitely. There is something about vaping that you can’t get from the patches or gum.

ML
Guest
ML

What is the effect of the nicotine on those nearby who are not vaping

Sharon Hall
Guest
Sharon Hall

You can do that research for yourself. You might be surprised.

Sharon Hall
Guest
Sharon Hall

Nicotine is nicotine. What would you expect? Check out the science on it. Don’t depend on those who are promoting it.

Janak Raj
Guest
Janak Raj

Yeah, nicotine is nicotine .. Take it with the help of a vaporizer. No need of sticking 4000+ chemicals + tar + carbon monoxide. Thank you for enlightening all.

Dave Kriegel
Staff
Dave Kriegel

Hey ML, that is a great question that we will have to look into. As far as I have seen, so far the research points to the fact that second-hand vapor is a lot safer than second-hand smoke due to the absence of tar and carbon monoxide. However, there may still be trace amounts of nicotine in that vapor, which can be inhaled by non-vapers so I don’t really know the answer to your question, but I do agree that further research on the topic is necessary.

-Dave

Sharon Hall
Guest
Sharon Hall

Nicotine is a poison. Why don’t y’all ask the Surgeon General what the effects of nicotine are on the body of the people ingesting it first or second hand. it will kill you. My mother just died of lung cancer from smoking NICOTINE, and had end-stage COPD and emphysema. You wind up gasping for air and when you die your mouth is wide open and your head thrown back because that’s how hard you were struggling for air. My dad did that too. Do not inhale nicotine in any form, or dip or chew it, and don’t hang around with… Read more »

William Arsenault
Guest
William Arsenault

so is caffeine your more like to die from an overdose of caffeine then cocaine in its pure form nicotine is about as dangerous as coffee in the small amounts that are in E-juice

Sharon Hall
Guest
Sharon Hall

What kind of reasoning is that? Poison is poison; your science is specious. Why don’t you try out the cocaine/caffeine theory you proposed and if you live through it, get back to us on that. And, it’s “You’re” (short for you are) instead of “your” (which means, belonging to you). I don’t trust anybody’s statements that can’t distinguish between that.

Mandownunder
Guest
Mandownunder

Sunbathing causes cancer, applying sunscreen causes cancer, smoking causes cancer and I am sure there are many other things that cause cancer. I remember a statement from American ‘whisky’ makers that said Scottish Whisky caused cancer but American whisky didn’t.
If your worried about breathing in schite I assume you don’t walk down the street to often as car fumes are a lot worse for you than cigarette smoke. Try sitting in a car full of both for a prolonged time, wouldn’t fancy your chances of getting out the car full of exhaust fumes.

William Arsenault
Guest
William Arsenault

Oh yeah why don’t you look up caffeine ods and if you like I’ll even look up some links so yo can get some if you think its so safe

Sharon Hall
Guest
Sharon Hall

Honey, I am a scientist with several degrees. I know about all this. I did NOT say caffeine is completely safe. The point is that your reasoning is flawed on all these aspects, without taking into effect amounts consumed, degrees of poison, etc. But you can’t argue with those who are unable to posit reasonable theories, supported by real science, or to draw vaguely reasonable conclusions and who just argue from emotion.

William Arsenault
Guest
William Arsenault

First don’t call me honey I’m not your honey so you’re talking to someone that knows people can use coke all night but if you even attempted to do the same with caffeine you would be dead then you just contradicted yourself and said that poison is fine in small amounts then you claim that the nicotine in e-juice produces formaldehyde when the coils don’t get anywhere close to that level of heat and you know I never said weren’t any risks at all all I said is you don’t have any clue about how nicotine works and I’ll be… Read more »

William Arsenault
Guest
William Arsenault

Fluoride is more poisonous then nicotine and people drink it everyday and I don’t see everybody dropping dead

Sharon Hall
Guest
Sharon Hall

Plus, the act of heating nicotine makes it break down into components which include the same chemical makeup as embalming fluid. It’s not safe to ingest into the lungs, as more advanced scientific studies in the field are proving. There is no completely safe thing on earth, if taken to any extreme, which I think is what you have been trying to say. Now we are learning that the chemicals in the liquid affect reproductive ability as well as have deleterious effects on the lining of the lungs. You’d think you’d want to avoid that if you could, but if… Read more »

William Arsenault
Guest
William Arsenault

SOURCES

Bludlust
Guest
Bludlust

The silence is deafening!

I’m not even a smoker and I prefer vaping to cigarettes – other people doing it, that is.

I’m a winner all round. I don’t care what people’s habits do to them – the fact is, vaping is far less intrusive than cigarettes, which is a big plus for me.

Lindzy Sima
Guest
Lindzy Sima

Nicotine is no different than caffine, it’s a stimulant and it is the tar and carcinogens that are harmful to your body. The nicotine itself is no more toxic than a Starbucks latte.

Sharon Hall
Guest
Sharon Hall

The sad thing is that we are learning that is a bunch of hooey.

Seth
Guest
Seth

Sharon, even though Jorge Perez is correct in his assertion that the nicotine alone did not cause your mother’s death, my heart still goes out to you and your family. I too, have lost too many friends and loved ones from cancer and emphysema directly related to tobacco smoking. Big tobacco companies have known about the negative health effects long before it was revealed to the public. Cigarette smoking is so addicting that every time there was a crises in my life, I started smoking again. I remember I started smoking in high school to impress a crowd of older… Read more »

Sharon Hall
Guest
Sharon Hall

Bless you! I worked for the law firm that brought big tobacco down and made them pay out huge settlements for their lying, evil ways.

Jorge Antonio Pérez
Guest
Jorge Antonio Pérez

FYI, Nicotine is NOT carcinogenic, most of the illnesses/symptoms you listed are caused by all the other chemicals that the cigarettes have, like polonium, tar, phosphorus etc. Nicotine itself its only an addictive stimulant, and it’s generally considered as safe by itself (hence nicotine gum and nicotine patches) I’m really sorry about your mother, but it seems like you are assuming that Cigarette = Nicotine, when in reality is much more than only that.

Sharon Hall
Guest
Pål Basso
Guest
Pål Basso

So people should not use NRT’s according to you?

Sharon Hall
Guest
Sharon Hall

Do it or not. I could not care less if you do or don’t. Just do the real scientific research and make your own decisions.

Pål Basso
Guest
Pål Basso

So you have no valid arguments? When your “science ” is flawed, you don’t care anymore? Well, I use the science about it and I care even less about what you think. I don’t need anyone making my choices for, last of all a misguided person. Thanks for letting us all know that you don’t care or really know what you’re talking about. You are here to troll, not help. Because you comment on things you don’t even care about or seem to have any real interest in. Wish more trolls was this honest.

Seth
Guest
Seth

I used vaping to quit smoking. That was my intention from the start. Switching from cigarettes to vaping caused no withdrawal effects. When I stopped cigarettes and started vaping, I immediately was able to breath more deeply without coughing. After about a year of vaping, though, I started working out at my local health club. I definitely had trouble with deep breathing that I attribute to vaping. This was my subjective experience, of course. But I had to stop vaping in order to make progress at the gym. I felt that the smoke from vaping was irritating my lungs. My… Read more »

K Les
Guest
K Les

Has anyone ever thought of the chemicals used to process meat, vegetables, milk and water? I knew of people who did not smoke and have died of cancer. Sad thing is, cancer is all around us. Its in our everyday consumption. We jump on band wagons and the newest health craze, I.e.”gluten free” . Stop, no one truly has the answer. Just remember anything man made is just that. We “add” to what is natural. If you must smoke, smoke only raw tobbaco. Ijs.

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