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A list of symptoms when quitting tobacco and changing to an ecigarette
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Admin Note
We have taken the opportunity to update and edit this post since it is very popular but not in an ideal format. At some stage it will be reformatted entirely but in the meantime it has received a facelift in order to ensure that symptoms of tobacco withdrawal are not attributed to e-cigarette use.
Above all, it is important to note that symptoms of tobacco withdrawal are wide-ranging, occasionally long-lasting, and may not occur for a month or more after quitting tobacco. Such symptoms are well-known and widely reported, and these cannot be attributed to ecigarette use since they are experienced by those who have never even seen one. Apart from dry throat and similar effects, almost all 'symptoms of ecigarette use' are the result of tobacco cessation and of course are experienced by quitters regardless of whether an ecigarette is used or not. A small number of people are intolerant to one or more ingredients in e-liquid and this is discussed below.
This article has now been reformatted and bears little relation to the original post. Thanks to the OP for starting it out - it now works as a definitive list of tobacco withdrawal symptoms and notes on intolerance to e-liquid ingredients.
For update history, please see foot of article.
Admin
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The following are all symptoms of tobacco smoking withdrawal
1. Mouth Ulcers
The Quit Ulcers are a common symptom of tobacco withdrawal, affecting many quitters. The ulcers can be very painful, but there are effective topical treatment gels. It has been suggested that high-dose vitamin therapy may also be effective.
The ulcers or gum inflammation may start a week or more after tobacco cessation. They generally clear up after a few days or weeks.
It may be possible that nicotine being absorbed through the mouth can also exacerbate this, as folks using nicotine gum have experienced these mouth sores although it would need to be shown that those using nic skin patches did not suffer so commonly.
It may be that after ecig use, at first, drinking something to rinse the mouth out may help. This will get the nic (or perhaps flavorings or other materials) out of your mouth and not give it a chance to sit there and irritate your mouth tissues and make any sore worse, if this is in fact an issue.
Admin note
Note that PG is a bactericide and used medically for that purpose, so that it is more likely to improve this type of symptom than worsen it. It is unlikely that ecig vapor from an e-liquid with PG in will affect the Quit Ulcers in any way except beneficially.
However: Cinnamon is known to cause this problem in some people.
2. The Quit Zits
A common symptom of tobacco withdrawal is skin eruption, in the form of spots through to severe acne even in those who never experienced it when young. The 'quit zits' have no relation to ecigarette use.
The bad news is that in some cases these eruptions last for months, for some who successfully stop smoking cigarettes (whether or not e-cigarettes are used). There has been some experimentation to see if various e-liquid ingredients may exacerbate the condition (such as PG or flavorings), as some e-cig users have questioned this, but without any solid results.
3. Headache, Nausea, Shakiness - but see #V4
These, together with irritability, inability to concentrate, poor sleep, depression and so on, are common nicotine withdrawal symptoms. If you are using a low-strength refill liquid and not absorbing as much nicotine as when you normally smoked, you can experience these withdrawal symptoms, which typically last only a few days to a week. Perhaps the use of a higher nic strength refill liquid might be a good idea temporarily, reducing the strength as needed. But: see V4
4. Coughing
Probably the most common symptom of tobacco smoking cessation, along with sputum / phlegm production. The severity and duration will depend on how heavy a smoker you were before switching, and how many real smokes you still have while e-smoking.
5. Sputum, Phlegm
When quitting smoking, with or without using e-cigs, people find that their body starts coughing up all the junk they've been putting in - tars and other materials coating the surface of the lungs. This material is coughed up in the form of phlegm / sputum.
Some folks find they start coughing up this junk within a week or two - some faster. The duration will vary, but most people were finding that the morning cough went away in the first week and the rest of the junk came up within the first month - but it's very common.
6. Heartburn, acid reflux
Some folks have reported heartburn / acid reflux symptoms. This reported by those quitting who don't use an ecig, so it seems to be an occasional symptom of quitting. It is reported to go away eventually. One way to live with it is to use Gaviscon liquid, an OTC (over the counter) med that coats the gullet and stops the acid burning. It's far more effective than pills for some people.
There is a possibility that swallowed nicotine may cause or worsen this condition.
Nicotine overdose is also implicated according to some reports - there is a hypothesis that nicotine causes the muscular valve at the top of the stomach to relax, in some people.
7. Muscle Cramps and Aches
Some people report increased muscle pains. One theory is that the PG in eliquid breaks down into lactic acid, which needs to be eliminated from the body.
Increasing water intake usually addresses this problem, whatever its cause. Not reported as much when using VG (vegetable glycerin) mixtures, but this is more than likely due to statistical probability since VG users are only a tiny number of total ecigarette users.
Admin note
The possibility of exacerbation due to ecig use is not only unproven, but unlikely. The problem with attributing muscle pains to lactic acid build-up caused in some way by ecigs is that all normal muscular lactic acid accumulation is topical, that is, if you work a muscle hard then that muscle alone accumulates lactic acid. Muscles are flushed out by natural processes and all lactic acid leaves via flushing, it is not possible for it to be introduced into a muscle even if that muscle is surrounded by others containing lactic acid. This is likely to be a tobacco withdrawal symptom.
8. Night Sweats
Some report night sweats, it is not known if this is a tobacco withdrawal symptom or not.
It has been reported that an intolerance to PG may be implicated but this is not proven. A change to VG only use and the immediate cessation of night sweats would confirm it but this is not reported.
9. Diarrhoea
Again, this may be a tobacco withdrawal synptom although it has been claimed that intolerance to PG might be the cause. Once again, a switch to VG accompanied by the immediate cessation of diarrhoea would confirm it.
10. Hiccups
Hiccups are reported to be a symptom of nicotine OD, for some people. Because of this, and their common occurrence, they are also known as the 'niccups'. The idea that they may result from an alternative delivery path for the nicotine, via the mouth or gullet (ie swallowing it), is attractive to some people.
Hiccups are reported to be experienced by smokers and tobacco users, and are said to be more common among those who use chewing tobacco, Snus, or dissolvable tobacco tablets. It is further suggested that they swallow tobacco juice and hiccups may result. They are not common among pipe and cigar smokers, who neither swallow nor inhale smoke, or users of nasal snuff.
11. Bleeding gums
A period of time when the gums bleed has been reported as an occasional symptom of quitting tobacco. Apparently dentists have confirmed this. It's also a symptom of vitamin C deficiency, which is not uncommon with a modern diet, so it may be wise to take vit C supplements in order to cover that possibility.
There is a modern trend to take aspirin daily for many years - decades, for some people. If you habitually take aspirin then it may be worth asking your doctor if this might be implicated. A combination of tobacco cessation and chronic aspirin ingestion seems to occur in many reports of bleeding gums. A positive note is that the bleeding apparently ceases as the tobacco cessation event recedes into the past.
12. Thyroid issues when quitting tobacco
There is discussion currently among the medical community about possible thyroid problems occurring after smoking cessation. It is not known how widespread this is or how serious. The appearance of thyroid problems soon after quitting is statistically higher than should occur, so there is a question whether smoking suppresses the symptoms of thyroid disease or whether quitting triggers it, or indeed if smoking causes or exacerbates it. This is uncommon so not a major issue for worry. Apparently weight gain or weight loss can be minor effects experienced by many, related to thyroid activity. This whole area is not fully understood so you should not read anything into our commentary, instead please ask your doctor.
Here are links for further research:
Does Quitting Smoking Trigger Thyroid Disease? - Thyroid Disease - 10/13/97
Smoking and Thyroid Disease: Exploration of the Connections / Thyroid Disease Information Source - Articles/FAQs
Some useful comments from thyroid patients who had been diagnosed before starting use of an e-cigarette:
Vaping and thyroid issues ?
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Vaping issues
V1. Dry Throat, Sore Throat
Tobacco withdrawal produces a sore throat in some people. It is unknown why this occurs but perhaps cigarette smoke ingredients have some sort of preventative or anaesthetic effect, and stop the throat becoming sore during cigarette use, which it is easy to see could cause it.
Some - but by no means all - suffer from a dry throat, or even a sore throat, when starting to use an e-cigarette due to the drying-out effect of PG.
If a person suffers from both conditions: the tobacco withdrawal sore throat, and the e-cigarette new-user sore throat, then in rare cases a fiercely sore throat can result.
PG is a humectant (attracts, ie 'sucks out' water) and when vaping the back of the throat gets coated. You can find that after sleeping, you wake up with a sore throat. Things that can help are drinking a glass of water before bed, gargling with a mouthwash to cut the PG coating before bed, drinking water throughout the day, using hard candies and drinking liquids with honey liquid through the day to keep your mouth moist - especially if you are a new user.
An alternative for those who experience more throat dryness than normal is to change to a VG-based e-liquid, which normally solves the problem.
V2. Cottonmouth
Extra-dry mouth or Xerostomia, commonly called cottonmouth, can be experienced by some. The obvious solution is to sip liquids, especially those that seem to assist the repair of dry buccal tissue such as blackcurrant juice (some acidic fruit juices may not be of much benefit). Of course, this may be problematic when travelling, so a throat lozenge may help. It appears that PG is more likely to cause this than the other two eliquid base materials (VG and PEG), so a change to all-VG liquid, or just a higher percentage of VG, may help.
V3. Light phlegm
It is not unusual for ecigarette users who ceased tobacco smoking several months previously to experience light phlegm, coughed up two or three times a day. It may be more pronounced with VG eliquids. This might be regarded as a beneficial effect since it allows the body to expel unwanted inhaled materials.
V4. Headache, racing pulse, inability to sleep
Also light-headedness, tinnitus (ringing in the ears), dizziness, slurred speech, hiccups, tingling of the extremities (fingertips, toes), jitters, teeth grinding - all these are reported as nicotine overdose symptoms.
Sometimes we overestimate just how much nicotine we were getting with regular cigarettes, and underestimate how much we are vaping, particularly at the beginning. Racing pulse is the most common, slurred speech less so. Headache can be severe. Light-headedness plus tinnitus is described as a 'just come out of a loud concert' effect. Try cutting down the nic dosage in your cartridges or liquids or vaping less frequently. The nicotine strength can be easily reduced by adding some VG (Glycerine, USP - obtained from a pharmacy), although this will also reduce the flavor.
It is said that some people experience one or other of the above symptoms even with a low nicotine liquid and find that switching to VG solves their problems, although such symptoms of PG intolerance are not widely believed to exist never mind be proven. It is more likely that such a reduction of the symptom/s (while staying at the same nic level) would be due to an intolerance to flavorings, colorings or similar used in an eliquid, and changing to a VG liquid simply removed those particular ingredients - see footnote.
Tachycardia and insomnia
A racing pulse and inability to sleep are symptoms of nicotine OD that may be experienced by those who have never before had any symptom of excess nicotine consumption. It is not clear if these symptoms are due to a batch of e-liquid that was considerably stronger than labeled, or an eventual reaction to excess nicotine. The solution might be to reduce the nic strength to a minimum sufficient to produce the required results (removal of cravings, adequate life functionality, pain relief, etc) and no more.
Note that there is a huge range of tolerance to nicotine: some people report that 12mg liquid causes these types of symptoms for them, while others consume fairly large quantities of 36mg (or even higher) with no effects whatsoever. There are cases of users with 6mg liquid who reported that over-consumption was problematic, compared with a case of one user who vaped 60mg with no effects. There are many reports of people consuming 48mg in order to successfully convert to an e-cigarette. This appears to show that there is a factor-10 variance in nicotine tolerance between individuals - that is, some can tolerate a nicotine intake ten times higher than others.
As a general policy, it is probably best to reduce the nicotine strength to the minimum needed. It will often be impossible to equate this to the amount smoked as for some reason there is no direct relationship, for many/most people. Also, the nicotine strength of the liquid can be reduced over time, for most people.
Cardiac dysrhythmia
- aka arrhythmia, irregular heartbeat, palpitations. These types of symptoms are a more serious version of the issues mentioned in the paragraph above. They are a rare occurrence and have been noted in cases of extreme long-term nicotine overuse, especially with dual use of NRTs and smoking - for example in persons who smoked and also used nicotine skin patches excessively, or who chewed large quantities of nicotine gum. This type of symptom can also occur for some people as a result of nicotine overdose.
Because it is easy to over-use an e-cigarette since there are no immediate adverse effects, unlike smoking which produces sore lungs and throat, it may be possible for people to consume too much nicotine over an extended time period of months or years. It may be wise to consider this, and cut down on the nic strength if possible.
There is a group of people who show no signs whatsoever of nicotine overdose, no matter how much they consume and for how long. It is conceivable that such people are more at risk than others, because they receive no warnings of over-use.
It is probably a good policy to gradually reduce the amount of nicotine consumed until the lowest level of acceptable efficacy is reached, instead of consuming high-strength nic without regard for the fact it may be far more than is needed for the desired results, and that it is a toxic substance when over-consumed and that perhaps cannot be taken in large quantities over time without issues. Most people experience some sort of warning that excess nicotine has been consumed, in exactly the same way excess coffee (or alcohol) affects them - the effect is not pleasant. However for some people there are no warnings at all that enough nicotine has been consumed. For this group, additional caution may be in order.
V5. Intolerance to e-liquid ingredients
A small number of people find they are intolerant to an ingredient and need to change the refill liquid they use.
a) The most common source of problems is PG, the most-used base or carrier liquid component. A large number of symptoms have been reported, from sore throat, dry skin, through to more serious symptoms - although since there has been no research on this, all statements are guesses. If you find that you are experiencing some sort of issue then the first thing to try is an all-VG liquid, to see if the problem disappears.
b) A very small number or people report the reverse: an intolerance to VG. However, it should be carefully noted that not all VG can be used for e-liquid purposes. In particular it has been reported more than once that buying a cheap brand resulted in an adverse reaction. Note that only 'Glycerin, USP' bought from a pharmacy is recommended. VG can be made for industrial purposes and a cheap brand bought in a general store is unlikely to be of the best quality. If a reaction to VG is experienced, it would be worth trying another brand.
c) Some are intolerant to other ingredients, and these are most likely flavorings or colors. The answer is to change to a different liquid or even a different supplier, and see if the problem persists.
d) If you experience a strong reaction to a new liquid then don't use it any more - change to another liquid from another supplier. Some flavorings are obviously going to cause a reaction in a percentage of people because of the type of flavor and its known issues - cinnamon is an example. Some will have a reaction to it and this must be expected.
V6. 'Menthol Mouth'
It is reported that the use of large amounts of menthol-containing e-liquids can result in the deadening of taste for a period, with the result that all refills become tasteless for a while or until menthol use is reduced or ceased. Cinnamon is also implicated.
Menthol may or may not be the cause since many report that all eliquids lose their flavor for a period. Another factor is the change in taste perception, mainly a loss of taste, caused by smoking, together with its return after tobacco cessation, and a possible period when taste goes dead for a time during the first few months off cigarettes even for those who have not used menthol.
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---- AND SOME GOOD "SYMPTOMS" ----
Since we don't want to focus on just the negatives of quitting tobacco or ecigarette use, here are some positive words from our experienced users.
First, most people adjust in the first week to symptoms. Dry throat and sore throat are easily remedied, and things like headaches or gas tend to go away quickly.
Sinuses clearing up. A wonderful thing when it starts happening. Your sense of smell starts to come back, stuffiness goes away, etc. You start noticing the smell of other people's smoke, or more subtle smells you've forgotten about as a smoker. The downside is you also start to smell the nastier smells too.
Smoker's morning cough going away. Most find that the annoying first thing in the morning coughing session goes away. Depending on how bad that was for you as a smoker, this is a definite milestone.
Deeper, clearer breathing. As your body clears all the toxins away, you start breathing deeper. Some folks report they get dizzy initially; perhaps due to taking in more oxygen and/or having no carbon monoxide intake. Many smokers actually breathe really shallow, especially if they've been smoking for a long while - so the change can be quite dramatic.
Smoke smell begone. No more stale smoke smell in your hair, your clothes, your home, your car. Downside is once your sense of smell comes back, you're prone to go on a massive cleaning spree - especially if you smoked in your home, you might find it smells unpleasant.
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Footnotes
1. Medical reports of illness
The lack of official medical reports of illness linked to e-cigarettes is extraordinary. After global use by millions of people for many years, there is not one single report of morbidity or mortality linked to e-cigarettes. Even common medications such as aspirin could not achieve this record. It indicates that e-cigarettes are best thought of as a food product like coffee, since no medication can replicate this accomplishment.
2. Tendency to assign all new symptoms to e-cigarette use
There is a strong compulsion in many people to assume that all/any new medical symptoms must be related to their new electronic cigarette usage. In 99.9% of cases these are found to be normal symptoms of tobacco withdrawal which they were unaware of - such symptoms are very wide-ranging and can occur for up to six months. In other cases, a full check-up reveals there is an unrelated medical issue.
3. Minor specific e-liquid issues
In some cases, people are intolerant to ingredients in a range of liquids from one vendor. The answer is to try some from other vendors.
It should be carefully noted that it is extremely unlikely that all materials offered by all vendors can be consumed by all users with no adverse consequences - somebody, somewhere, will be intolerant to one or more ingredients. One answer would be to try to exclude e-cigarettes or identify the e-liquid or the ingredient causing the problem, by doing the following, in order:
1. Reduce the strength of nicotine, since some symptoms may be nicotine OD.
2. Stop using flavorings that are known to have implications. Cinnamon, vanillin, capsaicin (chilli extract), diacetyl (sweet butter flavor) and dark food colorings are likely to cause problems for some (or even many) people - and this is not a complete list.
3. Cease using e-liquids with long ingredient lists. For sensitive people, the less ingredients the better.
4. Stop using any e-liquid except a type known not to cause problems, such as a low nicotine strength VG liquid with a good reputation for purity. For example, genuine Ecopure at 12mg would be a good choice. All the flavors in this range are very mild, and little has been added to the basic liquid.
5. Try a different cartridge filler material or cartomizer type, to eliminate the possibility of inhaling burnt filler/batting.
6. Change to Swedish Snus temporarily (instead of going back to smoking) and see the effect.
One or more of these actions should help you find out if the culprit is e-cigarette use, and if so, exactly which factor is the problem. Nine out of ten problems result from tobacco withdrawal or other medical issues; the remainder are normally intolerance to an ingredient or ingredients used by a particular vendor.
4. Allergic Reaction to Eliquid Ingredients
There have been a small number of cases reported where some of the symptoms were similar to #V4 but in addition there were one or more of the following: chest pains, dizziness, severe skin tingling, a feeling of electric tingling on the scalp, headache, and a general feeling of being very unwell. These symptoms may or may not be related to use of a new e-liquid.
If you think you may have experienced a reaction to an e-liquid ingredient then do not use that liquid. This is one reason to buy small, sampler pack bottles first, before buying larger amounts.
5. Specific brand VG intolerance
There are cases now being noted of severe intolerance to specific brands of VG. This may be because there are several different ways to manufacture VG, and some products may not be suitable for inhalation as a result. Or, it may be an issue with an additive of some kind.
The symptoms are shortness of breath, wheezing, congestion, bronchitis-like effects. This indicates that another brand should be used immediately. The symptoms quickly clear up after changing to another brand.
6. Pre-existing lung disease: the issues
As more smokers convert to electronic cigarettes, it will be found that more persons with pre-existing lung disease caused by smoking will take up vaping. There are a multitude of issues here and it is very likely that some high publicity incidents will occur. People will die from these diseases as many are terminal, and if they have started to use an e-cigarette in the late stages, it may be blamed on the e-cig.
If a person already has diagnosed COPD, emphysema, severe bronchitis, a history of pneumonia, or similar, then the sensible thing to do would be to use Snus and not an e-cigarette. Inhaling more materials into damaged lungs is not going to improve things.
It should be noted that emphysema sufferers have an increased risk of pneumonia, and some emphysema patients will develop pneumonia and happen to be using an e-cigarette (this has already occurred). It is highly unlikely the e-cig was in any way responsible since pneumonia is commonly seen in emphysema sufferers, but of course it will be blamed.
The sensible advice is that if you have a lung disease then don't inhale anything more. If you are diagnosed with a lung disease, then stop smoking, vaping, or any other type of inhalation of foreign materials - switch to Snus instead. Smoking damages the lungs, sometimes beyond repair, and continuing to inhale anything after diagnosis is not going to help anyone - either the person involved, or the vaping community, when people inevitably die as a result of the smoking-related diseases that sometimes present after they have stopped smoking.
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Interesting reports
Here, we'll list interesting information / reactions received that are not widely reported.
1. Violent mood swings when using cleaning materials
There have been several reports that after quitting tobacco, the use of large amounts of strong cleaners such as floor cleaner that flood a room with vapor can cause sudden mood changes, always for the worse, including depression and hostility. One theory is that ammonia vapor is the culprit, and is linked in some way with the cessation of inhalation of the ammonia in cigarettes. This is not reported in the general press but since ECF is probably the largest tobacco cessation forum in the world, with tens of thousands of visitors per day and over 100,000 posts per month, it seems reasonable to expect that newly-reported symptoms of tobacco cessation might be seen here first.
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2011-12-28
- added thyroid issues link; more info on nicotine consumption.
2011-11-17
- various edits
Latest update: 2011-09-09
- added new section on tachycardia, insomnia, cardiac dysrythmia
- added new section on VG intolerance
- added new section on COPD
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Originally Posted by Soot
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