Forget nicotine. The flavourants in e-cigarettes could be just as toxic and dangerous, a specialist has cautioned.
Prof Richard van Zyl-Smit, head of the lung clinical research unit at the University of Cape Town (UCT) and of smoking cessation services at Groote Schuur Hospital, said while e-cigarettes had been touted by the tobacco industry as a safer alternative to cigarettes, this wasn’t necessarily true. He said vaping could even be more toxic due to the flavourants used.
He said while flavourants such as cinnamon and vanilla were safe as food, they were often toxic when inhaled and the use of different flavours was, unfortunately, used by the industry to hook teenagers into vaping and smoking.
“I personally do not think any of these harm-reduction arguments have any relevance to adolescents at all and shouldn’t be brought into the discussion around adolescence and vaping. The things that are safe to eat are not necessarily safe to breathe in.
“It’s often forgotten that the reason these cigarettes are addictive and attractive to children is because you have fantastic flavours,” he said.
Van Zyl-Smit was speaking last week at a webinar on debunking e-cigarette myths. It was part of a series of tobacco control conversations by smoking cessation bodies such as the South African Medical Research Council (SAMRC) and the Council Against Smoking, among others.
Van Zyl-Smit said while e-cigarettes were marketed as only containing nicotine and not the chemicals in cigarettes, which damage the lungs, this was also not necessarily true.
“Cinnamon, for example, when inhaled, impacts on the cilia, those little hairs in your lungs that help clear mucus. This is not nicotine, it’s not propylene glycol ... this is the flavourant that’s causing the problem. It reduces cilia beat frequency, which means you don’t clear mucus and pathogens as quickly.
“Vanilla, another fantastic flavour. Great to eat. Lovely ice cream. Not a good idea to inhale. If you look at studies ... this is endothelial cells looking at endothelial dysfunction. You get significant damage and dysfunction when exposed to vanilla.”
A 2018 study by the Marsico Lung Institute at the US’s University of North Carolina found flavourings in e-cigarettes could be the most toxic part of the vapour inhaled.
The study, published in Plos Biology, tested about 150 commercially available e-liquids and identified 143 unique chemical compounds.
To test toxicity the researchers developed a system by which lab-grown human cells were exposed to e-liquid chemicals. Many of these chemicals, used in e-liquids or vape juices, were toxic to human cells in the laboratory.
The more toxic a chemical, the more it reduced the growth rates of these cells. These chemicals include vanillin and cinnamaldehyde, which, respectively, produce the flavours of vanilla and cinnamon. While these flavourants had been approved by the US Food and Drug Administration (FDA) for consumption, researchers warned that this didn’t mean they were safe when inhaled.
“When we talk about exposure, we talk about safety and we talk about harm reduction. We should not be exposing adolescents to potentially toxic flavourings in so-called safe electronic cigarettes,” said Van Zyl-Smit.
SA doesn’t have any data on vaping, but Van Zyl-Smit said he’d been asked by principals to visit their high schools and talk about e-cigarettes.
He said teenagers were likely to become addicted to vaping due to their developing brains, which were laying down pathways and were susceptible to nicotine.
“When you smoke tobacco, you tend to cough and splutter. When you smoke flavoured vapour you don’t have that first-use aversion and may not become addicted the first time you use it, but certainly you will come back for a second and a third. And given the inherent risks with addiction in adolescence, it’s something that we are concerned about — the ability and the susceptibility of adolescents to become rapidly addicted to nicotine.
“The concerning part about teenagers getting addicted to vaping and smoking was not the issue of long-term lung cancer or emphysema. It’s the issue of what they listen to, particularly in terms of nicotine, in terms of cognitive function. I’m significantly concerned about long-term mental health and addiction.”
Dr Catherine Egbe, a specialist scientist at the SAMRC’s alcohol, tobacco and other drugs research unit, said often research that suggested e-cigarettes were a safe alternative to cigarettes was funded by the tobacco industry.
She said the World Health Organisation (WHO) was clear on vaping: it was not a smoking cessation alternative.
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