Can e-cigarettes help me quit smoking and are they safe?

I have been doing a lot of research into electronic cigarettes since that is what my next book will be about. There have been many confusing headlines, some saying that they are just as harmful as tobacco cigarettes, while other headlines will tell you they will help you quit. The truth is somewhere in the middle.

The controversies that make headlines are often not the real issues, such as-cig containing formaldehyde--that chemical was only created at very high temperatures--a temperature that no vape users would realistically use.  While w-cigs do have some carcinogens, they are amounts that are 9 to 450 times less than traditional cigarettes.

1. The biggest problem is dual use long term, using electronic cigarettes while you are continue to  smoke and continuing this practice long-term instead of quitting smoking. Using an e-cig for short term while trying to quit, probably isn't a problem, but with dual use, even reducing the number of cigarettes doesn't help with the damage smoking does to your cardiovascular system. Unlike cancer where exposure to a carcinogen is linear (the more exposure, the greater the risk of developing cancer), heart disease is not linear: 50 to 80% of the damage to the cardiovascular system from smoking occurs within the first 3 to 5 cigarettes. For those who do use e-cigs to quit smoking but continue to use them long term, there are no long term studies as to the health effects. Very likely it will not be the same as smoking but e-cigs will have their own unique disease profile and associated risk.

2. The cig-a-likes don't deliver enough nicotine to really help with cessation. The mods or tanks do a better job of that. A lot has to do with the particle size in the vapor. If the particle is either too small or too large, the vapor isn't absorbed. For example, the MarkTen offers some of the highest nicotine content (44mg) but very little of that is absorbed by the smoker, so you can't count on the nicotine content. It is not what is in the liquid but what is absorbed that is important. Almost all users start with a cig-a-like and either find them unsatisfying and go back to smoking, or they switch to a tank/mod which delivers enough nicotine to satisfy.

3. While there are some health risks with nicotine, the real problem is with the flavorings. Vapor shop owners will say that the flavorings are "FDA" approved--which most are--as a food, but not as an inhalant. (Actually flavorings are not FDA approved but approved by FEMA--Flavoring and Extract Manufacturing Assoc and given a "no objection" letter by the FDA). Digestion and inhalation are two very different delivery systems. When eaten, a flavor goes through the stomach and digestive tract where it is subject to gastric juices and then is filtered by the liver where toxins are removed. When inhaled, substances go straight to your blood system with no filtration. Some flavorings are toxic when inhaled--like cinnamon, buttery flavor and cherry. There are probably more but little or no testing has been done on the over 7000 e-cig flavors available. 

4.Users like the hand to mouth use of e-cigs and when compared to the nicotine inhaler which also mimics this motion, users say that e-cigarettes give a better throat hit than the nicotine inhaler, (which is an FDA approved cessation device for cessation). A common issue with people using NRT is that they don't get enough nicotine from one delivery system, so we now suggest combination therapy, such as the patch or bupropion with either the inhaler, gum, lozenge, or nasal spray. This pairs one long acting agent with a short acting one. I have heard of many people using both chantix and bupropion together with great success but I haven't seen any research studies on it, only anecdotal.

5. Up to 90% of these devices are made in China (regardless of what the label says--no one is looking to see if the labels are true), where there are no manufacturing standards, the batteries can be defective and blow up, poorly made atomizers can leach metals into the vapor, contents of the e-liquid can be very different than the label--for example instead of using pharmaceutical grade nicotine, a less pure grade could be used or instead of propylene glycol, they could use diethylene glycol--which is cheaper but toxic. Plus there are many counterfeits on the market, so even if the manufacturer is one who is trying to create a good product, you may not know if the one you buy is real or counterfeit. This is a common problem with products made in China: Lumber liquidators, toothpaste, dog and cat treats.

Having said all that, I do believe that once some of these issues are addressed through FDA regulation, there is a place for e-cigarettes as a harm reduction device which will help a smoker quit tobacco cigarettes and hopefully will only be used for a short time instead of continuing a nicotine addiction. 

Breast Cancer and smoking

I just watched a program featuring Stanton Glanz, PhD. from the University of California in San Fransisco. He is one of my heroes. He has been a leading force in California's smoke free laws since 1978. He was talking on the relationship between smoking and breast cancer. Another subject dear to my heart since I am a breast cancer survivor. I was diagnosed when I was 32.
Glanz presents a very compelling argument linking not only smoking but exposure to secondhand smoke to breast cancer. He points out that research in the past would compare women who smoked with women who didn't smoke and there was a relative risk of 1.2, not a large difference. However, what these studies fail to look at was the percentage of non-smoking women that were exposed to secondhand smoke, either at home with a smoking husband or at work. When these same studies took this into consideration, the rates of breast cancer went up, but only in pre-menopausal women and the risks were similar. Smoking women have a double risk (or 2 times that of a non-smoking, non-secondhand smoke exposed woman), while a non-smoking woman that is exposed to secondhand smoke has a 1.7 times risk.
Animal studies have shown that about 20 of the harmful chemicals in smoke, are found in breast tissue and in breast milk. So it would only make sense that this could lead to breast cancer.
There are many known risk factors for breast cancer having to due with the exposure to estrogen: the age of puberty, age of having a child, age of menopause. Smoking lowers estrogen in a woman's body which increases the risk for osteoprosis and a lwer age for menopause. But this might also explain why the relative risk is similar between smoking and smoking exposed women. Secondhand smoke might not have the same effect of lowering estrogen but still leave chemicals in breast tissue.
A woman's breast goes through different stages from when she is born, to puberty, to full development to lacation after having a child. It appears that the effect of smoking and smoke exposure is higher for women before having a child.

While I appreciate comments, those left in other languages will be deleted. Please post in English only.

What Nicotine does to the Brain

The reason why people smoke is to experience the effects that nicotine has on the brain. Cigarettes are a nicotine delivery system. Inhaling smoke into the lungs is the fastest way to get nicotine to the brain. The lungs have a large surface area and the capillary walls are very accessible. Up to 90% of the nicotine in mainstream smoke is absorbed and it enters the arterial system and moves fairly directly to the brain, arriving within 7 to 10 seconds. The concentration of nicotine can be three times higher than if the nicotine was injected into veins of the arm because through the venous system, first the blood is pumped to the heart, then to the lungs, back to the heart before finally going to the brain. No product reaches the brain as fast as smoking. Inhaling smoke gives higher, faster, and shorter surges of nicotine to the brain when compared to the nicotine replacement products.

Nicotine then needs to pass through the blood-brain barrier. Ammonia is added to tobacco to increase the PH of the cigarette because a higher PH allows nicotine to cross this barrier easier. Once in the brain nicotine binds to specific areas called nicotinic acetylcholine receptors. Smokers have more of these receptors than non-smokers. Smoking may increase the number of receptors or smoking may allow the receptors to live longer.

Nicotine affects the different parts of the brain in different ways depending on the dosage. Each cigarette is like getting 10 injections of nicotine. Smokers unconsciously regulate the amount of nicotine by either inhaling deeper or smoking more of the cigarette. Sometimes the smoker may use a cigarette to relax, at other times as a stimulant. Menthol cigarettes cool the smoke which causes the smoker to inhale deeper.

When nicotine occupies the receptors in the pleasure pathway, dopamine is released which causes pleasurable sensations (positive reinforcement) and removes unpleasant sensations of pain, anxiety or feelings of illness (negative reinforcement). When the brain has an increase in dopamine, it may be that this increases the attention that the individual places on external activities. These external activities become paired with the pleasurable sensations and become triggers themselves for smokers to light up. The brain becomes conditioned so that when a trigger happens, such as answering the telephone, the brain lights up and expects nicotine to occupy the receptors which the smoker experiences as “cravings”. So any event that a smoker does habitually can be paired with smoking and become a trigger to light up. The brain becomes conditioned to these pleasurable sensations and will “crave” nicotine when faced with these triggers even if they have just finished a cigarette.

Individuals smoke for a combination of both positive and negative reinforcement. When an individual starts smoking it is usually for the pleasurable effects and at some point the individual continues to smoke to avoid the unpleasant effects of withdrawals. Individuals with depression, Attention-Deficit Hyper Activity, and other mental conditions, will start smoking to relieve negative sensations, a form of self-medication. The pattern starts with the individual smoking irregularly but with each cigarette, the nicotine changes the structure of the brain until the individual increases the number of cigarettes and the frequency until addiction sets in, which can occur within three to six months of the first cigarette.

The other area of the brain that nicotine affects is the locus ceruleus which controls vigilance, arousal, concentration and stress reactions. It is also responsible for an individual’s response to stress, anxiety and panic, which may explain why smokers use tobacco in times of high stress and as a way of coping with negative emotions.

The brain structure is changed by smoking. Nicotine floods the brain with dopamine yet the body is constantly seeking balance or homeostasis. The receptor that normally accepts the dopamine is changed to lessen the effect of this flood of dopamine. This change can last five to ten years.

During the quitting process, the smoker may experience withdrawals which are physical symptoms when a drug has not been used for a period of time. Withdrawal symptoms from nicotine includes irritability, frustration, anger, anxiety, depression, difficulty concentrating, restlessness, decreased heart rate, a change in appetite, either hunger or an increase in appetite, a change in sleep habits, either insomnia or inability to fall asleep. The body is also recovering from the effects of smoking and the smoker may experience an increase in coughing, tightness in the throat, dry mouth, dizziness, lightheadedness, headaches, fatigue, difficulty in concentrating and confusion. Medications can help with these symptoms.

Cravings are not the same as withdrawals. Cravings or powerful urges to smoke happen when the brain is conditioned to want nicotine either through positive or negative reinforcement. The brain is shouting, “Where is my nicotine?” Over time cravings become less intense and less frequent. Medications can help with these cravings. Relapse occurs when a smoker will reintroduce nicotine which immediately lights up the receptors in the smoker’s brain. Often only one cigarette is all it takes for the individual to relapse back to full time smoking again because of the strong effect nicotine has on the brain. The brain has memory of how it felt with nicotine and re-addiction can happen within one day when nicotine is re-introduced. The brain has a memory and with the reintroduction of nicotine, the chemical state of the brain matches up with memories of how the individual was when he or she was addicted.

Besides nicotine there are estimated to be 4000 to 5000 chemicals in tobacco smoke. About 400 are either poisonous, cancer causing, or cancer promoting. It is unknown exactly what ingredients are in cigarettes because while the tobacco companies are required to give a list of their ingredients to the government, this information is not released to the public because it is considered a "trade secret". Additives are used to alter the pH level to make nicotine more accessible to the body and to keep the cigarettes burning longer. Nicotine delivery systems are the least regulated consumer product, yet one of the most deadly. There are a few of these chemicals:

Nicotine: A poisonous alkaloid that is the chief active principle of tobacco and is used as an insecticide.
Tar: A particulate matter made up of dozens of compounds. Some are toxic, some are cancer-causing agents. Tar cools inside the lungs, forming a sticky mass and damaging lung tissue. A quart of tar goes through the lungs of a pack a day smoker every year.
Carbon Monoxide: Deprives oxygen from the red blood cells. It stays in the blood hemoglobin for up to six hours after exposure. Is related to heart attacks and strokes. Affects non-smokers. Binds to red blood cells in the lungs 230 times faster than oxygen.
Hydrogen Cyanide: Poison used in the gas chamber. EPA standards indicate that 10 parts per million as safe however cigarette smoke produces an average 1600 parts per million.
Arsenic: A metallic substance, poisonous to all life. The human body can build up a tolerance to arsenic.
Benzene: A poison that interferes with cellular metabolism.
Cadmium: A metal which accumulates in the lungs and stays there. Has an adverse effect on the protective immune devices of the body. Used in batteries.
Ammonia: This chemical is added to tobacco to increase the pH level to make it easier for nicotine to cross the blood brain barrier. Used as a household chemical.
Acetone: Used as nail polish remover.
Toluene: Industrial solvent.
Formaldehyde: Embalming fluid.
Methanol: Rocket fuel.
Naphthalene: Mothball Chemical.
Nitrobenzene: Gasoline additive.
Mercury: Found in thermometers.
Nitrous oxide: Disinfectant.
Stearic acid: Candle wax
Butane: Cigarette lighter fuel.
Vinyl Chloride: Component of PVC pipe.
DDT: Insecticide banned by most Western industrialized nations.
Hexamine: Barbecue lighter

The Best "Green" Living is to Stop Smoking

Living "Green" is the latest in healthy living. Julia Roberts and Sandra Bullock were on Oprah's show, telling us how easy and beneficial it is to go green. One evening show compared the toxins in a "green" family versus a "normal" family. Going green is big business. For a smoker, the best way to start is to stop smoking.

Besides nicotine there are estimated to be 4000 chemicals in tobacco smoke, which 400of these chemicals in smoke are either poisonous, cancer causing, or cancer promoting. We really don't know for sure because while the tobacco companies are required to give a list of their ingredients to the government, the information is not released to the public because it is considered a "trade secret". Nicotine delivery systems are the least regulated consumer product, yet one of the most deadly. Here are just a few of the chemicals that are known to be in tobacco smoke:

Nicotine: A poisonous alkaloid that is the chief active principle of tobacco and was used as an insecticide but is currently banned as an insecticide due to it's toxicity.

Tar: A particulate matter made up of dozens of compounds. Some are toxic, some are cancer-causing agents. Tar cools inside the lungs, forming a sticky mass and damaging lung tissue which can lead to emphysema. A quart of tar goes through the lungs of a pack a day smoker every year.

Carbon Monoxide: Deprives oxygen from reaching the red blood cells. It stays in the blood hemoglobin for up to six hours after exposure. It is related to heart attacks and strokes. Affects non-smokers in environment tobacco smoke AKA secondhand smoke. Binds to red blood cells in the lungs 230 times faster than oxygen.

Hydrogen Cyanide: Poison used in the gas chamber. EPA standards indicate that 10 parts per million as safe however cigarette smoke produces an average 1600 parts per million.

Arsenic: A metallic substance, poisonous to all life. The human body can build up a tolerance to arsenic.

Benzene: A poison that interferes with cellular metabolism.

Cadmium: A metal which accumulates in the lungs and stays there. Has an adverse effect on the protective immune devices of the body. Used in batteries.

Ammonia: This chemical is added to tobacco to increase the pH level to make it easier for nicotine to cross the blood brain barrier. Used as a household chemical.

Acetone: Used as nail polish remover. If you smoke, blow some smoke onto a cotton ball, then rub it on your fingernail polish.

Toluene: Industrial solvent.

Formaldehyde: Embalming fluid.

Methanol: Rocket fuel.

Naphthalene: Mothball Chemical.

Nitrobenzene: Gasoline additive.

Mercury: Found in thermometers.

Nitrous oxide: Disinfectant.

Stearic acid: Candle wax

Butane: Cigarette lighter fuel.

Vinyl Chloride: Component of PVC pipe.

DDT: Insecticide banned by most Western industrialized nations.

Hexamine: Barbecue lighter

So Go Green and Quit Smoking, the most effective way to stop introducing toxic chemicals into your body.