Are E-Cigarettes a Safe Alternative to Smoking?

As a personal trainer with clients in London who want to quit smoking I’m concerned about the rise of e-cigarettes, or “vaping”. It feels like a backward step to see e-cigarette advertising in the media, when there is evidence that nicotine in this form can harm the lungs and damage your immune system.

There are over 2.6 million e-cigarette users in the UK, compared to over 8 million regular smokers. Regular smoking kills over 100,000 people every year in the UK. This is the time for new year’s resolutions, and stopping smoking is high on many people’s lists.

On 27 April 2015, a group of public health professionals wrote a joint ‘open letter’ in support of the California Department of Public Health’s campaign against e-cigarettes. The signatories included health professionals from the Prevention Institute, Americans for Nonsmokers’ Rights, the American Heart Association, the American Lung Association in California, the Los Angeles Trust for Children’s Health, and others.

“As public health professionals,” the letter states ,”we concur with the Department and believe that the time to take public health action on e-cigarettes is now.” The letter goes on to say, “The vaping industry has been blowing smoke to obscure the emerging science on the dangers e-cigarettes pose to public health.”

The letter also targets the marketing tactics being employed by the e-cigarette industry, and applauds the Department for launching a bold campaign “to combat widespread misinformation peddled by the e-cigarette marketers.” Why is there no major public health campaign against e-cigarettes in the UK? Because opinion is divided.

Johns Hopkins University research on e-cigarettes

This study was published this year in the online journal Public Library of Science ONE, and the lead author was Professor Shyam Biswai of Johns Hopkins University, Baltimore, United States.

In this study, mice were exposed to e-cigarette vapour, and developed lung damage. They were then exposed to bacterial and viral infections, and it was found that their immune response to these infections was weaker after their exposure to vaping fumes, to the extent that 20% of the mice died.

Co-author Dr Thomas Sussan said that when exposed to infection, “the harmful effects of e-cigarette exposure became more pronounced.”

The toxins in e-cigarettes are free-radicals, which damage your DNA and cell membranes, and accelerate the ageing process. The study concedes that there are only around 1% of the free-radicals as there are in regular cigarette smoke, but still enough to cause harm.

Department of Health rules out ban

The DofH ruled out a ban on e-cigarettes in enclosed public spaces in 2014, but the Welsh Assembly is still considering it, and it’s banned in some parts of Europe such as Belgium.

Public Health England supports e-cigarettes

Kevin Fenton, director of health & wellbeing at Public Health England, takes the pragmatic view that it’s not nearly as harmful as regular smoking and if it helps people quit smoking it’s a good thing. He also doubts the argument that it could be a gateway to regular smoking. He says:

“It’s very unusual for people who have not smoked to take up e-cigarettes because it’s not very addictive, and it’s not a fun thing to do.”

He says that vaping is a valid activity “as part of the smoker’s journey to quit.”

I’m not convinced by Kevin Fenton’s argument. Nicotine is addictive, and vaping is attractive to young people because many think it looks cool.

Chief Medical Officer Dame Sally Davies

Dame Sally Davies is more wary than Public Health England. She says:

“There continues to be a lack of evidence on the long term use of e-cigarettes.”

She wants e-cigarettes to be used only as licenced medicines, not for recreational use. The e-cigarette industry oppose this restriction, as the licencing process is expensive for manufacturers. As a personal trainer keen on the healthiest options, I agree with Dame Sally that vaping should be prescribed to smokers as part of a quit strategy, not as a widely available recreational product. Ideally the dose of nicotine should be reduced steadily as part of the process, until the vaping is withdrawn altogether.

Jane Ellison, Public Health Minister in England

It’s a pleasant surprise for a member of a government to take a stand against nicotine, in a government that usually sides with the free market and large companies even when they’re a threat to public health, particularly when it comes to alcohol and junk food. She says:

“The best thing is to quit altogether, including quitting nicotine.”

She continues:

“We want to protect children from the dangers of nicotine, which is why we have made it illegal for under 18’s to buy e-cigarettes.”

World Health Organisation against vaping

The WHO calls for restrictions on the health claims e-cigarette companies can make, and wants to restrict nicotine strength, as well as place restrictions on advertising and packaging.

British Medical Association against vaping

Dr Ram Moorthy (deputy chair of the BMA’s board of science) says that tighter controls on e-cigarettes are needed as vaping “reinforces the normalcy of smoking behaviour.”

Influencal voices in favour of vaping

In addition to Public Health England’s positive views on vaping, several medical experts agree that it can help reduce the harmful effects of regular smoking.

Peter Hajek of Queen Mary University, London, says:

“smokers who switch to vaping remove almost all the risks smoking poses to their health.”

Professor John Britton of the Royal College of Physicians says that vaping is:

“a massive potential public health prize.”

Can vaping lead to smoking regular cigarettes?

In the United States, over 250,000 teenagers who have never smoked normal cigarettes, have taken up vaping. Could this lead them on to smoking tobacco, just as soft drugs are often a gateway to harder drugs?

Research published in the Journal of the American Medical Association showed that high school students in Los Angeles who used e-cigarettes were more likely to go on to use tobacco.

This doesn’t prove a causal link, as it is possible that those who were attracted by e-cigarettes may have gone on to smoke regular cigarettes anyway, even if e-cigarettes didn’t exist. However, I think that becoming addicted to nicotine in one form (e-cigarettes) sets you up to be more attracted to other forms of nicotine (regular cigarettes).

Not as harmful as smoking tobacco (but still harmful)

Nobody disputes that vaping is not nearly as harmful as smoking regular cigarettes. In e-cigarettes there is no tar or arsenic or any  the hundreds of other toxic chemicals that are found in regular cigarettes. But there is nicotine, and the free-radicals found in the study above, although only around 1% of the free-radicals in normal cigarettes.

As a personal trainer with clients in London who want to quit smoking, my advice would be to simply quit altogether. The strongest weapon in the fight against smoking addiction is the desire to quit, and strong reasons to quit. The craving for nicotine wears off in a short time, and it takes a bit of willpower to overcome that craving in the short term. But once you are free from that craving, you’re totally free. Vaping does not help you quit your addiction to nicotine, it simply prolongs it.

Another problem with vaping is that it reinforces the habits associated with smoking: inhaling something, holding a cigarette-shaped object in your hand. Where’s the incentive to stop vaping once you’ve started? Many people don’t realise that nicotine itself is a toxin, and vaping simply reinforces your addiction to nicotine. This isn’t healthy.

Quitting smoking should be a lifestyle change which includes taking up regular exercise, sport, eating more healthily. Before long you’ll feel better than ever, and have no desire to smoke ever again, and millions of people do this without recourse to e-cigarettes. Remember, e-cigarettes do nothing to reduce your nicotine addiction, and nicotine is harmful in itself.

Dominic Londesborough is a personal trainer in London and author of the blog.