E-cigarettes – finally some guidance…

At Northway Dental Practice we have like many people in healthcare been considering how we should advise our patients about e-cigarettes also known as vaping.

This issue has been one of common sense versus the available evidence. We felt, as I am sure most people in healthcare who have considered it also did, that e-cigs are less likely to be harmful to our health than smoking tobacco. They do not contain carcinogenic (cancer causing) chemicals, although some products have nicotine which is addictive. But the evidence was lacking to say that they were less harmful, and like many things which are new there tends to be a natural apprehension.

However when we look at the harms of smoking which are very real such as cancer, heart disease, stroke, emphysema as well as the dental implications such as gum disease, mouth cancer, stained teeth and bad breath, it seems that moving over to anything less harmful is the right thing to do on the way to quitting altogether.

It seems the government have now decided it is time to clarify the situation in a press release this week (https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review) the conclusion drawn by Public Health England is that e cigarettes are 95% less harmful than smoking tobacco. My strong suspicion is that the remaining 5% is the unknown risk since this is a new phenomenon and this 5% will become clearer in time. It might even reduce in light of new evidence. They also determined that e-cigarettes were not a gateway or enabling route to more harmful behaviours, and they were not encouraging smoking in non-smokers.

So the message seems clear, if you smoke – quit. If you cannot quit – vape (as a way of lessening the harm or a help to quit).

I have had some personal experience of this having been a tobacco smoker in the past. I first tried an early version of an e-cigarette back in the late 2000’s and was fairly unimpressed, it did not taste like a cigarette, I felt no effect from the nicotine content and it seemed fiddly to use. At that point I decided perhaps they were just a fad.

It is much later and these products have developed into the wild array of devices and gadgets now available, which do provide to smokers the same sensation (minus 95% of the harm, it now seems) as smoking tobacco did, with the added benefit of a wide range of pleasant flavours. They also provide the nicotine smokers crave. Having tried one of these devices it seems that technology might offer the smoker who has tried everything to quit a chance to get away from the harms of tobacco.

It seems 2.6 million people in the UK are already convinced.

UPDATE 10-12-2015

So it seems there is a little more information to consider. One article I recently read (Harvard Gazette Article) links the disease commonly called popcorn lung, a serious and irreversible lung disorder to a chemical called Diacetyl. It also goes on to suggest that since 74% of e-liquids tested contained Diacetyl there may be a risk which was previously unknown.

Whilst this sounds worrying there are obviously several angles from which to view any given piece of information. My objection to the article is that it is titled on-line “popcorn-lung-seen-in-e-cigarette-smokers” however the study it quotes did not find any cases of popcorn lung in e-cigarette users, to the best of my knowledge there have been no cases. Instead it found a chemical which has been linked to this disease in a different context – 8 individual industrial workers exposed to the chemical in considerably higher doses developed the disease.

Another article (The Truth about Diacetyl) suggests that the evidence that diacetyl causes this disease might be questionable and also further goes on to point out that the chemical diacetyl is present in cigarette smoke and in much higher levels, but no cases of popcorn lung have been attributed to smoking tobacco cigarettes, something the world does have a great deal of data about.

So my advice would be if you vape it might be best to buy eliquid that does not contain diacetyl, a number of brands currently advertise as definitely free from this chemical and I suspect given this is likely to be newsworthy and induce a degree of panic the majority of the remaining main brands are likely to move to remove this chemical in their products.

In other news it appears that with e-cigarettes due to be regulated in 2016 they may be available on the NHS as a aid to quitting smoking.

Update 28th April 2016

The Royal College of Physicians have released a joint statement about e-cigarettes

https://www.rcplondon.ac.uk/news/joint-statement-public-health-bodies-e-cigarettes-emerging-public-health-consensus

In which they recognize that e-cigarettes are the best choice for smokers to switch to if quitting altogether is not possible, or as a way of quitting.