Is vaping bad for you? Depending on what you read, you might think that vaping is as harmless as breathing clean air, or that it’s just as bad as smoking cigarettes. Neither of those things is correct, of course. The truth is more nuanced, but it isn’t somewhere in the middle either.
When we judge the risks of vaping, we’re typically looking at relative risk. We’re comparing vaping to smoking, which is usually what vapers did before they began using e-cigarettes. There’s not much reason to compare vaping to clean air, since most vapers would be smoking if vaping didn’t exist.
That doesn’t mean we shouldn’t try to learn the specific dangers of vaping though. If there are dangers hidden in e-cigs, most vapers would like to know what they are. Let’s look at how vaping affects the areas of the body that are damaged by smoking, and examine the evidence about potential disease outcomes.
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).
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 — that are 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.
Additionally, inhaled smoke causes structural and operational damage inside the lungs. The toxic combustion material affects the parts of the lungs, like the cilia and bronchioles, and can lead to reduced function. And a smoker’s lungs begin to produce more mucous, which doesn’t clear properly anymore. That’s what causes emphysema and chronic bronchitis.
E-cigarette vapor isn’t smoke. There is no current evidence that inhaling a mixture of propylene glycol and vegetable glycerine causes any kind of long-term damage. However, there may be risks in inhaling some flavorings. There are flavoring agents found in some e-liquid that have been linked to a condition known as bronchiolitis obliterans, or popcorn lung. These chemicals — diacetyl and acetyl propionyl — are probably responsible for cases of popcorn lung at some flavoring factories, where workers inhaled large quantities of the substances in powdered form.
While popcorn lung is a frightening condition, there has never been a diagnosed case in a vaper. Further, cigarette smoke contains much more of these chemicals that e-cig vapor, yet there have been no known cases of smokers contracting bronchiolitis obliterans either.
Smoking wreaks havoc on the cardiovascular system. It causes the linings of the arteries to build up a waxy substance called plaque, which eventually hardens and causes atherosclerosis, a permanent hardening of the arteries. That can cause heart attacks and strokes.
Carbon monoxide in smoke reduces the blood’s ability to absorb oxygen, which forces the heart to beat harder to supply the organs. The organs themselves, including the heart, can be damaged by poor circulation. Smoke also makes blood more likely to clot, which increases the risk of negative cardiovascular events.
Aside from nicotine in e-cigs temporarily increasing heart rate and blood pressure, vaping is unlikely to cause any of the damage that smoking does to the heart and circulatory system. It contains none of the toxic constituents that makes smoke so damaging to the blood vessels and organs. And vapor contains no carbon monoxide.
There may be a risk in using nicotine (discussed below) for people with heart disease. But there is no comparison between the minor risk of nicotine and the massive damage to the heart and its arteries that smoking creates. Vaping doesn’t have those risks.
A study conducted last year by scientists from British American Tobacco, and published in the journal Mutation Research, tested both e-cig vapor with 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 neither mutagenic nor toxic.
That isn’t absolute proof, but a very good indicator that vapor isn’t likely to be carcinogenic. Additionally, despite the many news stories about small-scale studies, all of the toxins present in e-cigarette vapor are found in much smaller doses. Our bodies have defenses against cancer-causing toxins up to a point, and it’s well known that small exposures to toxins are often not a risk.
The Royal College of Physicians report on e-cigarettes said, “In normal conditions of use, toxin levels in inhaled e-cigarette vapour are probably well below prescribed threshold limit values for occupational exposure, in which case significant long-term harm is unlikely.”
Another study concluded long-term vaping (but not vaping and smoking together) “is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes.”
There is no current evidence that suggests vaping — with or without nicotine — causes cancer.
The risk of pregnant women using nicotine is not thoroughly understood. It is possible that it poses risk to the baby’s development after birth. However, smoking certainly causes harm to both baby and mother. While it’s probably best to avoid nicotine altogether during pregnancy, there is no doubt that vaping is a better choice if one must choose
The potential of nicotine to affect cognitive development in the teenage brain is trumpeted by anti-vaping activists. But the truth is that the danger is based on rodent studies and may not translate perfectly — or at all — to human brains.
We don’t recommend that teenagers vape — not least of which because it’s illegal. But, as in all situations, it borders on criminal to tell anyone that vaping is no better than smoking. Teenagers, like adults, deserve honest information about the choices they make. Denying that information is no better than telling them that using condoms doesn’t massively reduce the chances of pregnancy and sexually transmitted diseases from sex.
Nicotine is probably benign for most people. It causes a temporary increase in heart rate and high blood pressure because it constricts the blood vessels when it’s absorbed by the body. That probably makes vaping — or any nicotine use — a poor choice for people with serious heart disease. As discussed above, it’s probably best for pregnant women to avoid too. But years of study on NRT and Swedish snus users shows that nicotine without combustion poses no discernable risk for adverse heart events or stroke.
Many people, including some doctors, have the mistaken idea that nicotine causes cancer. That is simply not true. While there is some evidence that nicotine may promote the growth of some tumors, there is none that nicotine itself causes cancer.
Nicotine may be addictive, although there is a lot of doubt about that. Smokers get a freebase blast of nicotine to the brain, combined with other substances that increase nic’s addictive potential. Other forms of consumption, like NRT or smokeless tobacco, release the drug slowly into the body.
Current thinking is that nicotine by itself is at best mildly addictive. There is no reason to think that nicotine in e-cigarettes is any more addictive than nicotine patches or gum. According to Jean-Francois Etter and Thomas Eissenberg, “E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive.”
Vaping has a lot of high-powered enemies. The dedicated anti-nicotine prohibitionists of the tobacco control movement have infected just about every bastion of American public health, and they aren’t interested in hearing anything good about a revolutionary consumer-driven response to the dangers of smoking. When a newspaper or TV station does a story on vaping, they tend to find one of these abstinence-only zealots for guidance and commentary.
A group of French scientists recently found that studies making conclusions get far more coverage in the press than follow-up studies that overturn those conclusions. The news media likes studies that make broad claims. That’s a problem for vaping, because the scientific literature is full of small-scale studies that “prove” things about vaping that either don’t matter in real life, or are later shown to be false. Also, research tends to come from funding sources that want bad results.
Additionally, authors tend to make extravagant claims about what their studies show, university press releases like to magnify the sensational, and uncritical reporters don’t bother looking for other opinions. Newspapers don’t care about the fact that may not mean anything if cells isolated in a petri dish are inflamed (or killed) when covered in e-liquid. They don’t realize — although they should investigate and find out! — that just about everything kills cells in a petri dish.
“Vaping may be just as bad as smoking,” says the headline. The facts never support it, but no newspaper wants to run a story with a headline like, “Vaping causes inflammation in isolated cells in a petri dish.” We understand the risks and benefits by looking at overall scientific consensus, not lone studies that show one possible negative effect.
That’s why the best way to understand the science on vaping is to read the major reviews of the topics, like the Royal College of Physicians (RCP) report. The RCP looked at all available science on vaping, and compared findings in many smaller studies, synthesizing the information with a broader perspective than any individual study could. While there are lots of positive smaller studies about vaping, the RCP report breaks down all of the information and gathers it in a sensible format.
Cigarettes cause the premature death of about half of regular smokers. The Centers for Disease Control and Prevention (CDC) says more than 450,000 Americans die each year from smoking-related causes. Worldwide, that number is about six million. Many millions more have nagging or even debilitating health problems caused by smoking.
We’ve asked the question “is vaping safe?” before. Perhaps some day in the future, we’ll find that vaping causes some measurable health problem. Since almost all vapers come from the ranks of regular smokers, it may be difficult to separate any issues that exist. But we can’t look at vaping now and point to any known health risk beyond dry mouth and the avoidable (and minor) dangers posed by nicotine.
In Sweden, where many adults use snus (moist oral tobacco), we see evidence that nicotine itself has low harm potential. Sweden has the lowest rates of smoking-related disease in the western world. Population-level studies show beyond a doubt that long-term snus use carries almost no risk at all. Likewise, even the FDA admits that long term use of nicotine replacement therapy (NRT) products like nicotine gum and patches are not dangerous — or even likely to be addictive.
The bottom line is that smoking is very, very bad for you, and any nicotine product that eliminates the known dangers of breathing in combusted plant material can only be a vast improvement. We know that smoking causes cancer, heart disease, and severe lung damage. There is no evidence that vaping causes any serious health problems.
As of now, the scientific consensus is that vaping is probably not bad for you. And if the alternative is smoking cigarettes, it’s a much better choice.