Research on health effects of e-cigarette juice flavorings surveyed by JAMA

[ozmotion]

The Journal of the American Medical Association put out an article last week summarizing some of the more recent research into the content and health effects of e-juice flavorings:

JAMA Network | JAMA | Flavorings in Electronic Cigarettes:  An Unrecognized Respiratory Health Hazard? (free article)

It'd be nice if juice flavoring components were listed the way that food ingredients are on packaged food products, so users can make informed choices.

 

[AndriaD]

The Journal of the American Medical Association put out an article last week summarizing some of the more recent research into the content and health effects of e-juice flavorings:

JAMA Network | JAMA | Flavorings in Electronic Cigarettes: .An Unrecognized Respiratory Health Hazard? (free article)

It'd be nice if juice flavoring components were listed the way that food ingredients are on packaged food products, so users can make informed choices.

I agree that it would be nice, but that article is just another ANTZ hatchet job -- "... there is concern that their availability may both lead to dual product use (ie, ENDS and cigarettes) and reduce cessation. Additionally, there is concern that ENDS may be used by nonsmoking adolescents and young adults who might not otherwise have used nicotine-delivering products, and that dual use may follow." and "...which are designed to create an ultrafine aerosol that penetrates deeply into the lungs." The first is the standard ANTZ rant "oh the CHEEEEELDREN!" along with that totally ludicrous idea that using e-cigs would lead someone to smoke real ones, along with the idea that using e-cigs does not equal cessation, when in fact it DOES, if one is not smoking cigarettes. The 2nd is just plain wrong, since inhaling vapor deep into your lungs is the LEAST effective way to vape -- the so-called "ultrafine aerosol" is NOWHERE NEAR as fine as cigarette smoke, which actually deposits SOLID TOXIC PARTICLES into the lungs, as tar.

I'm really disappointed in the AMA, who are apparently doing all they can to protect the tobacco industry and BP's totally ineffective NRT products -- so they're prostitutes just like the CDC and the WHO, and probably the FDA as well.

Andria

 

[ozmotion]

I agree that it would be nice, but that article is just another ANTZ hatchet job -- "... there is concern that their availability may both lead to dual product use (ie, ENDS and cigarettes) and reduce cessation. Additionally, there is concern that ENDS may be used by nonsmoking adolescents and young adults who might not otherwise have used nicotine-delivering products, and that dual use may follow." and "...which are designed to create an ultrafine aerosol that penetrates deeply into the lungs." The first is the standard ANTZ rant "oh the CHEEEEELDREN!" along with that totally ludicrous idea that using e-cigs would lead someone to smoke real ones, along with the idea that using e-cigs does not equal cessation, when in fact it DOES, if one is not smoking cigarettes. The 2nd is just plain wrong, since inhaling vapor deep into your lungs is the LEAST effective way to vape -- the so-called "ultrafine aerosol" is NOWHERE NEAR as fine as cigarette smoke, which actually deposits SOLID TOXIC PARTICLES into the lungs, as tar.

I'm really disappointed in the AMA, who are apparently doing all they can to protect the tobacco industry and BP's totally ineffective NRT products -- so they're prostitutes just like the CDC and the WHO, and probably the FDA as well.

Andria

I'd hesitate to equate the pursuit of research into ecig-related health impacts with some kind of subversive, ulterior motive. The largest study cited in this article (the first one), for example, is funded by National Cancer Institute of the National Institutes of Health - hardly a big-tobacco proponent.

There's not much research into whether e-cig use leads to real tobacco use, in children. Until there is, I'd prefer to avoid jumping to conclusions. History shows that logic and 'common sense' does not always bear out in reality.

These studies do not have the goal of suggesting that traditional cigarettes are preferable to electronic cigarettes. Instead, they recognize that independent of the choice between traditional and electronic, ecigs may have their own health effects, and we're just beginning to understand them.

I didn't understand what you said about how "inhaling vapor deep into your lungs is the LEAST effective way to vape", though. What is an effective way to vape?

 

[bigdancehawk]

I'd hesitate to equate the pursuit of research into ecig-related health impacts with some kind of subversive, ulterior motive. The largest study cited in this article (the first one), for example, is funded by National Cancer Institute of the National Institutes of Health - hardly a big-tobacco proponent.

There's not much research into whether e-cig use leads to real tobacco use, in children. Until there is, I'd prefer to avoid jumping to conclusions. History shows that logic and 'common sense' does not always bear out in reality.

These studies do not have the goal of suggesting that traditional cigarettes are preferable to electronic cigarettes. Instead, they recognize that independent of the choice between traditional and electronic, ecigs may have their own health effects, and we're just beginning to understand them.

I didn't understand what you said about how "inhaling vapor deep into your lungs is the LEAST effective way to vape", though. What is an effective way to vape?

The first cited study reached the astonishing conclusion, "Gee, there sure are a lot of these products!"
"Concerns" are not evidence.
There have been a number of studies to determine who uses e-cigs, both here and abroad. The vast majority are former or current cigarette smokers. No study has been able to identify a single person who was induced to become a regular analog cig smoker via e-cigs.
If we're "just beginning to understand" the health effects of e-cigs, exactly what is it we have now begun to understand?

 

[AndriaD]

I'd hesitate to equate the pursuit of research into ecig-related health impacts with some kind of subversive, ulterior motive. The largest study cited in this article (the first one), for example, is funded by National Cancer Institute of the National Institutes of Health - hardly a big-tobacco proponent.

There's not much research into whether e-cig use leads to real tobacco use, in children. Until there is, I'd prefer to avoid jumping to conclusions. History shows that logic and 'common sense' does not always bear out in reality.

These studies do not have the goal of suggesting that traditional cigarettes are preferable to electronic cigarettes. Instead, they recognize that independent of the choice between traditional and electronic, ecigs may have their own health effects, and we're just beginning to understand them.

I didn't understand what you said about how "inhaling vapor deep into your lungs is the LEAST effective way to vape", though. What is an effective way to vape?

The most effective way to vape is to inhale mouth-to-throat, and then to lung if one feels it's really necessary, although it really isn't, in terms of absorption; the nicotine in vapor absorbs FAR better in the soft tissues of the mouth, throat, and sinuses/nasal tissues than from the lungs; nicotine in smoke, on the other hand, DOES absorb better when inhaled "deeply into the lungs." The tissues of the different locations are simply different.

I have proven this to myself, when I first reached the point of being able to quit cigarettes -- the first smoke of the day, shortly after waking, proved the most difficult for me to dispense with; no matter how much I vaped, I simply could not get satisfied, so I'd end up going on out for a smoke. Then, I realized I was trying, early in the morning when still half-asleep, to vape as if I was smoking -- short, fast, deep inhales. So, that night, while watching TV, I consciously tried to practice the slow mouth-to-throat, slow exhale thru nose, way to vape -- and even though at that time I was using 6mg nicotine, I was able to absorb enough using that modified technique that I gave myself the sharp stomach-pains of nic OD. The next morning, I kept all this in mind as I tried, once again, to substitute vaping for the morning smoke -- and within about 10-15 minutes, I reached complete satisfaction, and so didn't have to go out and smoke at all: that was my first smoke-free day.

There does not need to be research to know that vaping will not lead to smoking; it's like saying that eating filet mignon will lead to eating TV dinners. Like breathing air will lead to drowning. It simply does not follow. Vaping leads to ABSTAINING from smoking. If a never-smoker becomes accustomed to vaping, then tries a cigarette, there is simply no way they will enjoy the bitterness, the burning in the mouth, the STINK -- never-smokers do NOT find the smell of burning tobacco appealing in ANY way, and the taste? It's on the order of deciding to lick a dirty ashtray because you like ice cream sundaes -- complete non sequitur.

The National Cancer Institute of the National Institutes of Health may not be tobacco fans, but they are CERTAINLY ANTZ, who think it is somehow preferable for someone to wait, perhaps for YEARS, to quit smoking completely via some magical, as-yet-unknown method, than to engage in harm reduction with vaping. Which is completely asinine, and totally stupid, and shows their ideologically-driven game plan very clearly, essentially that anyone who does not QUIT COMPLETELY RIGHT NOW ought to just die -- because a very large proportion of those who don't engage in harm reduction most likely WILL die years or decades earlier than they ought. Their "perfect" is absolutely the enemy of the "good". And even besides all that... they are a *cancer* institute -- why would they want anything that might help to put them out of a job? They only SAY they want 'an end to cancer,' but an end to cancer -- or even a significant decline -- would endanger their usefulness, and thus, their job. An 'end to cancer' is the very LAST thing they want.

Andria

 

[misu]

I'm a RN. I don't say this to boast or to give my opinions greater merit. I say this because I wish I had a dollar for every time someone has posed the question "You're a nurse, right? I have this ... . What can I use for this ...? What to you think of ... ?" I'm also fairly discerning, or so I've been told.
Is JAMA in someone's back pocket? I'm sure they are. Do they have an agenda? I'm sure they do. However, just because they wrote an article doesn't mean that we should dismiss the whole because they may be catering to someone's political agenda. When you go fishing, you don't eat the bones and scales. Usually these things get discarded. Unless you're making soup. Then they get used, then discarded. The same thought should be given to research articles. My point is, there are some interesting things about this article that I can use when someone asks me "You're a nurse, right? What do you know about e-cigs? Should I use them? Are they harmful?"

1)

Although exclusive use of ENDS is generally considered to be less risky for individuals than smoking combustible tobacco products, there is concern that their availability may both lead to dual product use (ie, ENDS and cigarettes) and reduce cessation.

There should be concern. To me, what's the point of using an e-cig to heal your lungs if you're gonna smoke, even one cigarette a day? There are some, I'm sure, will say that one is better than twenty. Not when you have COPD. To me that like saying to an abuse victim "One punch is better than twenty." While the damage may be less, inflicting damage on top of damage prevents healing and causes more damage.

2)

Additionally, there is concern that ENDS may be used by nonsmoking adolescents and young adults who might not otherwise have used nicotine-delivering products, and that dual use may follow.

I call BS on this one. If a non-smoking adolescent wants to do something, they're gonna do it. My kids are grown. One of them smokes. I think I would have rather this child smoked an e-cig from the get go than cigarettes. Although, the juice chemical compounds and sources have me, somewhat, concerned.

3)

Given the limited timespan over which these products have been in the marketplace, the long-term safety of ENDS is uncertain.

I can't agrue with this. We just don't know the long term safety. Personally, and I have no facts to back this up and this is just opinion, I thing cigarettes are more dangerous now, and more cancer causing, because of all the chemicals that have been added in recent decades.

4)

One concern that has received little attention is the potential for toxic effects from inhaled flavorings.

There should be concern. The phrase "Popcorn Lung" comes to mind. While this is mainly from diacetyl, I was at a B&M that sold Buttered Popcorn flavored juice. Maybe they used diacetyl as a flavorant in this juice. Because there are no ingredients listed, we just can't know.

5)

Recent in vitro studies found that the cytotoxic effects of e-liquids were largely restricted to flavoring components.

I have read that a lot of flavorants come from China. I am not a xenophobe. I'm not an any type of person phobe. But I do not trust food products that come from China. Too much lead and other heavy metals tainted products come from China. Don't believe me? That's okay. I'm not offended. Google it for yourself

6)

High doses of diacetyl, deemed safe for ingestion by the Flavor and Extract Manufacturers Association and the US Food and Drug Administration (FDA), have been shown to cause acute-onset bronchiolitis obliterans, a severe and irreversible obstructive lung disease, when inhaled by workers exposed to particulate aerosolized flavorings containing diacetyl.

Most people don't know this. I didn't know this until recently. This could have devastating results in someone who already has COPD.

7)

At present, there is no jurisdiction to regulate the composition of e-liquids, no regulatory program to assess the hazards of the flavorings in ENDS products, and no surveillance system in place to identify ENDS users with severe respiratory disease.

I'm not a fan of many regulations. Some is good, like how we know that our dog died fro heavy metal poisoning from the food made in China. Without regulation, there would be no way to know. However, I think this article serves as a catalyst to start regulating this industry. I don't like that. I do think that we should have access to a list of ingredients and/or the MSDS.

8)

The proposed Deeming Regulations of the FDA, which would extend the agency’s authority to regulate products meeting the statutory definition of “tobacco products” (including ENDS), only propose to restrict the sale of flavored ENDS to minors.

Again, I call BS. It's the beginning of the money grab. A way to collect a tax.

The above is just my 2¢. I did not write this to offend or make you hate me. Feel free to disagree with me. Just don't call me names

 

[xtwosm0kesx]

References Dr. F's study on Diacetyl but makes no mention of the fact the the study results are ridiculously high due to the fact that (AFIAK) Dr. F intentionally selected juices that were highly likely to positive for diacetyl (specifically custards).

Seems about right.

 

[AndriaD]

I agree with most of what you wrote, especially the part about the money grab -- that's very obvious, since they do need to recoup some of the lost tobacco-tax money, and I don't actually dispute a *reasonable* tax; to me that is far more acceptable than them trying to "regulate" something they very obviously know diddly about.

However there was one part with which I do disagree...

1)
There should be concern. To me, what's the point of using an e-cig to heal your lungs if you're gonna smoke, even one cigarette a day? There are some, I'm sure, will say that one is better than twenty. Not when you have COPD. To me that like saying to an abuse victim "One punch is better than twenty." While the damage may be less, inflicting damage on top of damage prevents healing and causes more damage.

First of all, most people (at least around here) have used e-cigs as the WAY to cessation! I don't care what the ANTZ say -- if you are not smoking, then THAT IS CESSATION! no matter how you make that happen, if there is no smoking, then cessation has occurred.

Secondly, yes, smoking 1 cigarette a day is FAR better than smoking 10, 20, 30, 40, or however many someone might be inclined to smoke if they did not vape -- that is the VERY ESSENCE of harm reduction -- they have not ELIMINATED harm, and in fact, neither have those of us who've quit completely -- the risk is still there for some years, because of previous smoking. But if getting down to having 1 a day is the best you can do, then that's the best you can do -- and it's not up to anyone else to say, well you're not doing it right, or you're not REALLY doing yourself any good, because OF COURSE YOU ARE! You are forgoing all those other cigarettes you would have smoked! Those who smoke but would rather not have a hard enough time, they don't need criticism, they need support, they need understanding, and they need other people to stop trying to mind their business for them -- they may be doing the best they can, or they may not be, but it's up to THEM to decide for themselves, not some group of self-righteous we'll-make-you-healthy-despite-your-wishes ANTZ or medical personnel or anyone else. Until a person is adjudged by a court to be legally incompetent, then it is THEIR decision, and no one else's, and if e-cigs allow them to smoke 1 or 5 instead of 10 or 40, then that is BETTER. That is HARM REDUCTION.

Andria

 

[Rossum]

It'd be nice if juice flavoring components were listed the way that food ingredients are on packaged food products, so users can make informed choices.

Then the list would look like this:

• Vegetable Glycerin
• Propylene Glycol
• Natural and Artificial Flavors
• Nicotine

Seriously, foods labeling does not require itemization of the flavorings.

 

[misu]

References Dr. F's study on Diacetyl but makes no mention of the fact the the study results are ridiculously high due to the fact that (AFIAK) Dr. F intentionally selected juices that were highly likely to positive for diacetyl (specifically custards).

Seems about right.

Well ... that's not very scientific. :/

 

[misu]

Then the list would look like this:

• Vegetable Glycerin
• Propylene Glycol
• Natural and Artificial Flavors
• Nicotine

Seriously, foods labeling does not require itemization of the flavorings.

But, don't flavorings have to have their ingredients listed? From what I'm reading, you can go to a cake supply place, or craft store with cake making supplies, and buy flavorings that can be used in flavoring DIY e-fluids. Now, I'm curious. The next time I go to Micheal's, I'll go to the cake isle and scope out the flavoring labels. I'll especially look for a butter flavor to see what they list.

 

[Rossum]

Dunno what's listed in the labels for flavorings, but I do know what's listed on the labels for the foods I can buy, and the individual chemicals making up the flavors aren't there.

 

[misu]

Dunno what's listed in the labels for flavorings, but I do know what's listed on the labels for the foods I can buy, and the individual chemicals making up the flavors aren't there.

Right.
But you can buy flavorings at craft stores and in the craft section at Walmart to use in food prep. I think that I read somewhere that the ingredients are listed on those, including the chemicals because they're for food. Which is why I want to go and see for myself. But, not today. There's a travel ban

 

[Frenchfry1942]

Packaged foods do not list all of the additives. To my knowledge, only if the ingredient (chemical) is more than 2% of the product and approved by the FDA. I just read that banana flavoring is over 300 sub-ingredients and Strawberry is also high. People don't think about those things.

I read awhile back that Doritos have 124 ingredients (chemicals), I don't know anyone that doesn't like a Dorito...or 30. Reading about flavorings, I realized that their is a whole industry to create additives to make foods taste better. Ever drink chocolate milk? (gasp!)

So much is not listed on packages.

 

[AndriaD]

Right.
But you can buy flavorings at craft stores and in the craft section at Walmart to use in food prep. I think that I read somewhere that the ingredients are listed on those, including the chemicals because they're for food. Which is why I want to go and see for myself. But, not today. There's a travel ban

Lake effect snow? Sympathies! It's cold as a welldigger's hindparts here today, more like January than November, but at least there's none of that awful white stuff to deal with.

Andria

 

[misu]

Right, packaged foods don't. And maybe even the individual flavors, sold separately, don't. I'm saying that I don't know this for sure because I've read that they are labeled. So, when I can clear the driveway and am allowed to drive, I may venture out to see for myself. They do sell flavorings in the craft section at Walmart. I'm told that they sell glycerin too.

 

[misu]

Lake effect snow? Sympathies! It's cold as a welldigger's hindparts here today, more like January than November, but at least there's none of that awful white stuff to deal with.

Andria

I heard that your neck of the woods would be colder than normal this year. I hope this passes and gets back to normal for you. Stay warm
I have no use for snow! I've grown up here and, with few exceptions, have lived here all of my life. I don't play in it. I don't drive in it, not because I fear my own driving skills but because most people nowadays drive like idiots on 70 and sunny days. You should see them trying to navigate themselves in the snow. I don't even want to "Just have a white Christmas" as some people around here say. Okay, I'm turning into Miss Cranky Pants, so I'm gonna vape and sip coffee now

 

[Frenchfry1942]

So what exactly is in Red #5? The flavorings in e-juice, to me, are the most questionable part. The FDA has a classification called Generally Regarded as Safe (GRAS).

Things that make you go, "hmmm".

I really wish e-juice vendors better identified the parts in e-juice.

 

[AndriaD]

I heard that your neck of the woods would be colder than normal this year. I hope this passes and gets back to normal for you. Stay warm
I have no use for snow! I've grown up here and, with few exceptions, have lived here all of my life. I don't play in it. I don't drive in it, not because I fear my own driving skills but because most people nowadays drive like idiots on 70 and sunny days. You should see them trying to navigate themselves in the snow. I don't even want to "Just have a white Christmas" as some people around here say. Okay, I'm turning into Miss Cranky Pants, so I'm gonna vape and sip coffee now

Yeah it's barely over freezing today, down here, and weather this cold is rare even in January -- usually even in the middle of winter, we can have 40-50 degree days, and then get cold at night. My cat is just beside herself; she's normally a mostly-outdoor cat, but I did some reading to try and find out how well cats tolerate extreme weather in either direction. Seems that since domestic cats are all descended from African wildcats, they tolerate extreme heat MUCH better than cold, so I don't let her out unless it's over 40. She's going nuts, driving me nuts with her constant yowling, so I put her out in the garage (we have a space-heater out there). She's still yowling but at least it's more muffled. Nothing I can do for her, till the weather warms up a little.

I loved snow when I was a kid -- it's so rare down here, to get any accumulation. And even after I was grown, and lived for 5 yrs in Michigan, I didn't mind it all that much. But now, back here in GA, I positively LOATHE it, because the idjits down here just lose their minds when it snows a half-inch -- seriously, they close down pretty much EVERYTHING, and pre-empt TV so they can yammer endlessly about "snowpocalype," and I-75/I-85 look like parking lots. If these fools ever saw a REAL snowpocalypse, they'd run and hide and probably start blathering about The End of Times. Once in Lake Orion, MI ('bout halfway between Flint and Detroit), I saw it snow 21 inches in less than 90 minutes. That was fascinating -- and it didn't close down the whole dang city, either. But by far the best snow I ever saw was in Milwaukee -- probably sorta like Buffalo? If you blunder off the shoveled paths, they won't find your body till spring!

Andria

 

[misu]

Yup. 3 feet of snow in my driveway. I'm looking out of my kitchen window and watching it accumulate on the overhang off of my gutter. The window is halfway covered. Luckily, my roof is new It will all melt by Saturday.