Your consumption level defines the risk - discussion with Dr. Farsalinos

[rokyo87]

Hello fellow vapers.

Not long ago ZVS had a honest discussion via email with Dr. Farsalinos and we talked about daily consumption of e-liquids, MTL vs. D2L vaping, health risks and vape industry. I will post whole discussion here because I think is important for every vaper to read Dr. F's newest professional opinion on vaping. Maybe some vapers will not like it but it's not about liking it is about information and responsibility. Have a good reading time.

ZVS question #1:

Hello mr. Farsalinos

We in our association are debating over this article:

What do scientists think? – Konstantinos Farsalinos at Vapexpo 2016, Paris

According to an article you said on Vapexpo:

“The message I want to pass to vapers is that your consumption level defines the risk: the more you consume e-liquid, the more you will be exposed to toxicity, nicotine is no danger. Direct lung inhalation is pleasant but a risky pattern. At least you are aware about the risk”.
What this actually mean? That M2L is 95% safer than smoking cigarettes and D2L can be as harmful as smoking cigarettes? I am referring to this graph:

We have D2L vapers who vape 30ml/day low NIC, high flavoured e-liquids (30%) @ 100W (0.2 – 0.8 Ohm) and we have M2L vapers who vape 5ml/day higher NIC, unflavoured e-liquids @ 8W – 12W (above 1 Ohm) and we are constantly in “war” who is safer and how much safer is one method of vaping over another.
Can you please put us in more scientific perspective?

Thank you for your answer in advance and sorry for bothering you.

Best regards.

Rok Klobučar
ZVS

Dr. Farsalinos answer #1:

Hello Rok,
Sorry for not been able to reply previously, and now it is 3am and i need to sleep. I will get back to you tomorrow or the day after (tomorrow i return back to Greece from India). But, i will say something and give you some time to think.
Three years ago, the surveys on vapers identified an average daily consumption of 3-4ml per day.
Can you tell me of one consumer product (anything) for which a consumption 7-times higher than average would not be associated with some harmful effects? Do you think that if you drink 7 times more water than average there will be no potential risks? What about eating 7 times higher amounts of anything (fruits, meat, sweets, whatever)? Is it normal for a daily consumption of anything to be 7 times higher than the average value of just 3 years ago?

I will let you think about it, and once i get back to Greece we will discuss it further. Please send me a reminder email.

The graph you send me is absolutely accurate, but do not forget that formaldehyde is 1 of the many toxins that exist in tobacco cigarettes. So, equal or higher levels of 1 toxicant in e-cigs compared to smoking does not necessarily mean that the whole risk is equal or higher.

Thank you

Konstantinos Farsalinos, M.D.
Researcher
Onassis Cardiac Surgery Center, Athens Greece
University of Patras, Greece
Tel nr: +30 6977 45 48 37
Website: Electronic Cigarette | www.ecigarette-research.com

ZVS question #2:

Hello mr. Farsalinos and thank you for your reply.

I perfectly understand you and I agree with you. I also think that 20ml/day or 30ml/day or even 15ml/day e-liquid is too much. My opinion was ever that D2L is more dangerous than M2L but I am a person who view vaping and risks of vaping in absolute terms from health point of view but many vapers don’t. They always say that they are not smoking and that’s a good thing, right? And in my honest opinion probably is… They say that vaping is 95% safer than smoking in general and their method (D2L) is in 95% range and my method (M2L) is in 97% range… Not a big difference and who I am to say otherwise to them?

But in the same time I am also worried. Why? Because of the future of vaping industry and the current smokers which can be “saved” by vaping in the future. I am afraid that so much of daily e-liquid consumption (in my opinion this the result of D2L vaping) will lead to some diseases (maybe even deaths) in the future, maybe not so serious diseases (and as much deaths) as cigarette smoking but some diseases (I’m just speculating I am not a doctor nor any kind of scientist). And I am afraid that these hypothetical diseases can lead to an end of vaping industry. We all know how desperate are anti-smoking (now they are also anti-vaping) and public health organizations in finding the evidence which can prove harmfulness of vaping and this can be an answer to their prayers. I don’t know. What do you think?

I prefer M2L vaping because I think that this method of vaping can be pretty much close to harmless. I personally vape unflavoured (maybe I’m too cautious), 100% VG (diluted with distilled water) e-liquids at low wattages (7 – 12 Watts) and on above 1 Ohm coils, I prefer Kanthal wire because I think is the safest wire. My daily consumption is about 5ml (+- 1ml) with 0,7mg/ml NIC and I don’t want to go with higher NIC levels because then the vapour is too much peppery and bittery (there is no flavours in my e-liquid so they can’t mask a peppery taste of NIC). In our vaping association (ZVS) I am the most stubborn, cautious and sometimes paranoid vaper. We have vapers who vape @ 150 Watts all the time, they’re mixing high flavored (even 30%) low NIC juices and consuming from 15 – 30 ml/day of e-liquids but before vaping they were very heavy smokers (up to 3 packs/day) and vaping is probably the best thing that happened in their lives so I don’t judge them (vaping probably save my life too) but I silently suppose that’s not a very good way of vaping… Today one of our members asked: “Why nobody tell us what is an acceptable daily e-liquid consumption?”. I and a couple of other members said that nobody can’t tell us that but we think up to 5ml is probably not too much. Others said 10ml is OK. Third said you are not smoking so you are fine with every quantity… And then we started to argue who is right. Debates like that are in our association almost regular. Can you please give us some advice on that one?

About that graph and formaldehyde. We in our association are concerned that somebody from public health who is anti-vaping propagandanist or some reporter who loves anti-vaping sensationalism will see this graph and soon we will have new first-page hammer titles like: “Even top vaping scientist recognizes dangers of formaldehyde in e-cigarettes!” or “Vaping has the same levels of formaldehyde as smoking!” or “There is a proof that formaldehyde is dangerous in e-cigarettes!”. What is your opinion on that?

Sorry mr. Farsalinos for long email and I hope I will receive your reply soon.

Our association is very thankful for what you’ve done and what you are doing for vaping.

Best regards

Rok
ZVS

Dr. Farsalinos answer #2:

That is the main problems with vapers. They think that the 95% less risk applies similarly to them (using 20 or 30ml per day) and to those using 4-5ml per day. I doubt this will be the case.
Moreover, the vast majority of DLI users quit smoking when D2L did not even exist. And they were fine with M2L vaping and the devices of that time. However, they have just transitioned to a new pattern and this is irrelevant to smoking cessation.
If you give a smoker an EC to do DLI, they will start coughing like crazy. Do you think they will be able to quit smoking when they see such a reaction. They will mostlikely consider that e-cig is not for them and they will just abandon it. I have witnessed such cases.

This is another typicalcase showing how stupid the e-cig industry is. Instead of realizing that the biggest market (by far) is the number of smokers who have not switched, they are competing who will get the most wattage which is relevant to established vapers but totally irrelevant to smokers. To give you an example, in the EU in late 2014, the proportion of smokers who were using e-cigs daily was 2.3%. Of course now there will be more, but how many? 4%? 5%? That is nothing compared to the 95-98% of smokers who are not using e-cigs.

So, let them compete for the DLI devices and atomizers, and when the tobacco industry will prevail in the whole market, then they will start complaining… That is truly unfortunate, but they should blame themselves only.

As for the graph, i did not mention anything about danger and i did not discuss anything about harms. I just presented the levels, and it is true that the more you vape the more you will be exposed to formaldehyde (and in many case, more than what you get from cigarettes). I cannot just hide it, and there is no reason to hide it.

Thank you

Konstantinos Farsalinos, M.D.
Researcher
Onassis Cardiac Surgery Center, Athens Greece
University of Patras, Greece
Tel nr: +30 6977 45 48 37
Website: Electronic Cigarette | www.ecigarette-research.com

ZVS question #3:

Thank you mr. Farsalinos.

What do you think how much less riskier will be vaping in comparison to smoking for D2L, high consumption (lets say 20ml/day), high flavoured vapers?

Thank you for your answer in advance.

Best regards
Rok Klobučar

Dr. Farsalinos answer #3:

To be honest I have no Idea. I consider vaping 20 and 30ml per day as extreme. So, it is hard to tell. Also, flavors are currently the biggest unknown. This does not mean they are dangerous, but we have no idea about many of the flavoring compounds.
To clarify my position, my intention is not to judge anyone or force him to vape as I suggest. But the problem is that they do not make informed choices. Vapers should be informed, should understand the problem of consumption and then they should decide what to do.

ZVS question #4:

Thank you. But it’s still far less harmful than smoking isn’t? I am worried for few of my friends in association which are extreme vapers as you said.
Best regards
Rok
ZVS

Dr. Farsalinos answer #4:

Rok, let’s be honest.
Most e-cig companies are totally irresponsible, have no quality criteria in liquid production and only make liquids based on flavor perception. The majority have no idea what they are doing. I do not trust the current market.
In that perspective, i suppose it is safer but none knows what exactly these people (who use high flavors and extreme levels of consumption) are vaping.

ZVS question #5:

Hello again mr. Farsalinos.

Do you mind if I publish our conversation somewhere where everyone can see it? On public blogs, forums, etc.?

Sorry to bother you again.

Thank you.
Rok
ZVS

Dr. Farsalinos answer #5:

No problem Rok.
I am sure many vapers will not like it, but my responsibility is to inform people and not to say only things they like.
So, i am fine with this.

Best regards.

ZVS thanks:

Thank you very much.
Keep up the good work.

Best regards
Rok
ZVS

 

[Cheallaigh]

that really wasn't all that informative at all... explained and changed nothing, what was the point?

 

[rokyo87]

that really wasn't all that informative at all... explained and changed nothing, what was the point?

To inform.

 

[Cheallaigh]

of what?

 

[rokyo87]

of what?

That 30ml/day is not as harmful as smoking but it's (probably) not harmless... Many vapers think that any kind, shape and form of vaping is totally harmless (or 95% less harmful). But I think that is not the case and I just want to share mine and Dr. F's view with other vapers.

 

[Cheallaigh]

vaping is just like anything else, most know, moderation is the key... anything is harmful if excessive...

 

[Lessifer]

In my opinion, scientists should stick to facts, not opinions, but I'm no scientist.

We don't know the absolute risk of vaping 3ml a day, and we definitely don't know the relative risk of instead vaping 30ml a day. I'm not saying vaping 30ml a day is a good idea, but to suggest that we know it to be more harmful is, IMO, not warranted.

 

[kiba]

Maybe I'm wrong but I think it's kind of a non-issue, personally don't know anybody who vapes that much, who would have the time? You'd have to devote yourself to vaping ~18 hours a day.

most of the vapers I know including myself use less liquid since technology has gotten better (about 1-1.5 tanks a day for myself, ~5ml). I can take a couple puffs at 420F degrees and easily satisfy my addiction for an hour or two.

Plus, my office and the workplaces of most people I know don't allow vaping inside (which I'm glad of, bc it's annoying and unprofessional imo) so to vape that much you'd be taking constant smoke breaks.

 

[smacksy]

I've been vaping about 10mls a day for the last year..with a couple mods in rotation it satisfies my nic addition with only 2.5 mgs of nic in my juice..I don't think it's excessive as I was a 2 pack a day smoker for over 20yrs..
Vaping has helped quit smoking, and I'm feeling alot better these days.

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[Foggy Road]

 

[sofarsogood]

I agree with Dr. F's principle and even he agrees that we don't know what the limits might be. It might be simple lung irritation will be the problem if there is a problem, not toxic compounds.

My daily ml's settled down to 7 per day. I decided I wanted it to be less but wasn't getting anywhere. Then vaping was restricted on the shop floor where I work. In practice I can still vape there but it has to be very discrete so I'm vaping less. The effect effect is my daily ml decreased to 5 and that number seems to be holding even on day's off when I can vape at will. I'm happy about that. My goal is 3.5 ml per day regardless of nicotine strength.

We may find out that daily ml's is not a simple measure measure of stress. The number of puffs might also matter. More puffs with less vapor may be more stress than fewer puffs with more vapor in some situations. When a cloud chaser exhales that gigantic amount of vapor the cloud is big because he didn't absorb most of it. My hunch is simple stress from the vapor is more significant than toxic chemicals.

My response to the toxic chemical concern is to use less flavoring, like 1%. May be cloud chasers need DIY so they can control the amount of flavoring. Commercial juice is way over flavored.

It may also be that long time smokers whose lungs were injured from smoking are more vulnerable to stress from vaping while the kids lungs recuperate better.

 

[kiba]

Commercial juice is also loaded with sucralose, every so often I try stuff like teleos, Charlie noble, anml etc. when I'm over at my buddies house, I guess he's used to it but to me it's almost unvapeable. I've got no idea why they do that, it makes me wonder what the juice would be like if I could actually taste it.

 

[daviedog]

Where did the 3 to 4 ml is average come from? Until a 'baseline' can be established, we'll never know what excessive is.

A long time smoker/shorter term vaper. What caused the deterioration of ones pulmonary functions?..

 

[Jim_ MDP]

Maybe I'm wrong but I think it's kind of a non-issue, personally don't know anybody who vapes that much, who would have the time? You'd have to devote yourself to vaping ~18 hours a day.

most of the vapers I know including myself use less liquid since technology has gotten better (about 1-1.5 tanks a day for myself, ~5ml). I can take a couple puffs at 420F degrees and easily satisfy my addiction for an hour or two.

Plus, my office and the workplaces of most people I know don't allow vaping inside (which I'm glad of, bc it's annoying and unprofessional imo) so to vape that much you'd be taking constant smoke breaks.

I think you're mistaken on a couple of points.

We know there are 30, 40, 50ml a day vapers. It's predominately the cloud chasers but there are plenty of flavor chasers consuming 30ml a day.
And that's the next point... "as technology has gotten better" is actually driving higher consumption levels.
Higher wattage mods, larger atty decks to accommodate heavy metal multi-coil builds etc. The rates for established vapers are going up, not down.

Now the areas of concern...

We have a century of scientific knowledge on nicotine. While we're only just beginning to explore it's potential cognitive benefits, we know it's not the bogeyman of tobacco consumption.
Other than the overenthusiastic new vaper having a near OD, it's probably much like caffeine and like caffeine... fairly self-limiting (you know you shouldn't have ordered that second triple Espresso. ).

We have decades of data on the inhalation of PG, though not in extremely large daily amounts. I suspect we have no issue there.

VG on the other hand... we have a decade of use and only a scant few years of massive daily amounts to look at.
I'd consider heavy VG use to be a moderate question mark.

And now the bad news...
Flavoring concentrates, and I don't mean Diketones etc. or any of the potential "nasties".
I mean the liquids themselves. They're designed for ingestion... used in kitchens and candy factories worldwide.
But we have little to no knowledge of their effects as an inhalant. That to me, is a major question mark.

I DTL about 8-10ml a day (5mg) and am fairly comfortable with that amount considering it's almost all DIY using predominately higher strength/lower percentage FA flavors. I don't think I'd be so sanguine about 30ml a day of heavily flavored retail high VG juice.

Just IMO of course, as always... YMMV.

 

[tckenno]

To inform.

I read the expo article as well as your correspondence Rok and thought it was good info. Especially the mg vs. ml part of health equation and direction vaping industry is pushing consumers. Glad to see some serious research is taking place. Would like to see more US involvement.

 

[kiba]

I think you're mistaken on a couple of points.

We know there are 30, 40, 50ml a day vapers. It's predominately the cloud chasers but there are plenty of flavor chasers consuming 30ml a day.
And that's the next point... "as technology has gotten better" is actually driving higher consumption levels.
Higher wattage mods, larger atty decks to accommodate heavy metal multi-coil builds etc. The rates for established vapers are going up, not down.

Now the areas of concern...

We have a century of scientific knowledge on nicotine. While we're only just beginning to explore it's potential cognitive benefits, we know it's not the bogeyman of tobacco consumption.
Other than the overenthusiastic new vaper having a near OD, it's probably much like caffeine and like caffeine... fairly self-limiting (you know you shouldn't have ordered that second triple Espresso. ).

We have decades of data on the inhalation of PG, though not in extremely large daily amounts. I suspect we have no issue there.

VG on the other hand... we have a decade of use and only a scant few years of massive daily amounts to look at.
I'd consider heavy VG use to be a moderate question mark.

And now the bad news...
Flavoring concentrates, and I don't mean Diketones etc. or any of the potential "nasties".
I mean the liquids themselves. They're designed for ingestion... used in kitchens and candy factories worldwide.
But we have little to no knowledge of their effects as an inhalant. That to me, is a major question mark.

I DTL about 8-10ml a day (5mg) and am fairly comfortable with that amount considering it's almost all DIY using predominately higher strength/lower percentage FA flavors. I don't think I'd be so sanguine about 30ml a day of heavily flavored retail high VG juice.

Just IMO of course, as always... YMMV.

Yes, I understand that it can be done, but I just personally don't know anyone who has the time.

I realize it could go the other way but when I started the provari hadn't even come out yet, there were no regulated mods as we know them today. now I'm (and others) able to vape less and less often, and only 3% nic due to the increase in efficiency.

 

[Smoke_too_much]

I suspect someone vaping 30ml a day has most of it lost to the atmosphere whereas someone vaping only 3 ml a day probably looses a lot less. If you compared the actual consumption into and onto the lungs they would most likely look like 2ml compared to 10ml. It would be an interesting study.

I can't disagree with the concept that a little harm does increase with increased consumption but this is not new news is it.

 

[Jim_ MDP]

Yes, I understand that it can be done, but I just personally don't know anyone who has the time.

So?

I realize it could go the other way but when I started the provari hadn't even come out yet, there were no regulated mods as we know them today. now I'm (and others) able to vape less and less often, and only 3% nic due to the increase in efficiency.

I started with cartos myself in '10/'11, (horrid things), so I presume you mean the delivery end of things eg: clearos etc., as the efficiency of the mods themselves makes no difference except for battery life.

But again... so?
That we consume perhaps marginally less now* (and that's by no means the majority of experienced vapers), it says nothing about the hoards of new vapers who see it as more of a hobby/affectation than a cessation aid.

* I certainly go through more now than when I started, but a bit less than say 18 months ago. But there are tons of exotic build users consuming more than they did last year. I'm just not one of them.

 

[kiba]

So?



I started with cartos myself in '10/'11, (horrid things), so I presume you mean the delivery end of things eg: clearos etc., as the efficiency of the mods themselves makes no difference except for battery life.

But again... so?
That we consume perhaps marginally less (and that's by no means the majority of experienced vapers), it says nothing about the hoards of new vapers who see it as more of a hobby/affectation than a cessation aid.

So... by using logic we can probably deduce that most people that work in a professional environment aren't able to vape that much.

Efficiency did make a huge difference for me and most people who started back when fish filters seemed like something good to put in an atty... even at .8 ohms on a genny, I was only vaping at 16 watts.

 

[KenD]

To inform.

There's no actual information there, only speculation. Also, you're painting out d2l as dangerous in itself. While d2l:ers usually consume more liquid that needn't be the case. Also, cloud chasing d2l:ers would be more likely to vape flavorless than flavor chasing m2l:ers. And what about vapers who don't draw the vapor into their lungs at all? Shouldn't you choose that approach to vaping if you're primarily concerned about safety? Not to mention that you're really pushing Dr. Farsalinos to get the answers you want (which, again, are guesses).

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