For over five years I have warned readers about the dangerous effects of vaping. Electronic cigarettes, also known as e-cigarettes, vape pens and electronic nicotine delivery systems, are marketed as, and widely believed to be, safer than combustible cigarettes. But these newer options may be just as dangerous as their predecessors.
For example, e-cigarette devices contain toxic nicotine, heavy metals, fine particulate matter and formaldehyde1 and even threaten bystanders exposed to their second-hand “smoke.”2 Nicotine is always addictive, regardless of its method of delivery, and some e-cigarettes, notably Juul, deliver significantly more nicotine than other cigarettes.3
Juul has been accused of deliberately targeting and hooking young people on its “slick” products while pretending they were intended for smoking cessation for adults. Now, a former top Juul executive has filed a lawsuit alleging that Juul sold at least 1 million contaminated nicotine pods and did not recall them when made aware of the situation.4
Serious Accusations Against Juul
Siddharth Breja, formerly Juul’s senior vice president for global finance, claims in a lawsuit he recently filed in the U.S. District Court for the Northern District of California that he was fired in 2019 in retaliation for criticizing the sale of at least 1 million contaminated and expired mint-flavored nicotine pods by Juul.5 The type of contamination or its source was not revealed in the lawsuit. According to The New York Times:6
“‘ … [Juul] has jeopardized and continues to jeopardize public health and safety and the lives of millions of consumers, many of them children and teens’ …
… Mr. Breja detailed a culture of indifference to safety and quality-control issues among top executives at the company and quoted the then-chief executive Kevin Burns saying at a meeting in February: ‘Half our customers are drunk and vaping’ and wouldnʼt ‘notice the quality of our pods.’
… Juul did not recall the pods, Mr. Breja said, yet he was told to charge the supplier, Alternative Liquids Inc., $ 7 million so that Juul could recover from the contaminated batches … Mr. Breja said he urged Juulʼs chief financial officer to issue either a recall or put out product safety warnings. A week later, the complaint says, Mr. Breja was fired.”
Through a spokesperson Juul denied both the retaliation and product safety charges. The allegations are “meritless, and we already investigated the underlying manufacturing issue and determined the product met all applicable specifications,” said Ted Kwong, a Juul spokesman, in The New York Times.7
Yet the allegations increase the spotlight on a company already under investigation by the U.S. FDA, the Federal Trade Commission, five state attorneys general and several congressional committees, and named in at least 50 lawsuits brought by school districts and individuals.8
Accusations Increase Questions About Vaping Deaths
Vaping illness is becoming so common it has been given a name by the U.S. CDC: EVALI standing for “e-cigarette, or vaping, product use associated lung injury.”9 As of October 29, 2019, the CDC had reported 1,888 cases of EVALI, occurring in in all states but Alaska, Washington D.C. and a U.S. territory.10 There have been 37 deaths.
Because the popularity of vaping, widely attributed to Juul’s slick marketing,11 has happened so suddenly, health professionals are baffled by EVALI, which has also happened suddenly. Investigators are literally learning about it in “real time”12 and do not have a complete picture of causation yet.
Otherwise healthy young people continue to present themselves at the ER with severe shortness of breath and other EVALI symptoms, some requiring the use of mechanical ventilators for weeks13 and some rehospitalized after their first bout.14 The CDC’s current EVALI recommendations are concerning, to put it mildly:15
“At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of vaping products, including e-cigarettes. No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak.
We do know that THC [tetrahydrocannabinol, the psychoactive component of marijuana] is present in most of the samples tested to date, and most patients report a history of THC-containing products.
The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.
As such, we recommend that you do not use e-cigarette or vaping products that contain THC. And since the specific cause or causes of lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette and vaping products.
Adults addicted to nicotine using e-cigarettes should weigh all risks and benefits … All tobacco products, including e-cigarettes, carry a risk.”
Vaping Is Clearly Linked to Harm
The harm now seen with vaping is not entirely a surprise. A 2018 study that appeared in the journal Arteriosclerosis, Thrombosis, and Vascular Biology reported, “short-term exposure of endothelial cells to flavoring compounds used in tobacco products have adverse effects on endothelial cell phenotype that may have relevance to cardiovascular toxicity.”16
Endothelial cells form the linings of blood vessels. The study found that even lower concentrations of certain popular e-cigarette flavors like vanillin, menthol and cinnamaldehyde (cinnamon) induced inflammation and impaired nitric oxide production that indicated endothelial dysfunction.
In 2014, researchers at Japan’s National Institute for Public Health detected formaldehyde and acetaldehyde, two well known carcinogens, in vapor produced by several types of e-cigarettes, raising valid questions about e-cigarettes’ touted superior safety profile compared with traditional cigarettes.17
One e-cigarette brand generated 10 times more formaldehyde than combustible cigarettes, said the lead researcher!18 Research published in 2015 in the Journal Chemical Research in Toxicology detected highly reactive free radicals, linked to oxidative stress, in e-cigarette vapor and noted:19
“Electronic cigarette (EC) usage has increased exponentially, but limited data is available on its potential harmful effects … These results demonstrate, for the first time, the production of highly oxidizing free radicals from ECs which may present a potential toxicological risk to EC users …
… This study adds reactive free radicals to the list of potentially toxic products which have been found in EC aerosols … damage from these radicals has been implicated as an important causal factor in a variety of tobacco related diseases and disorders.”
The deleterious effect of e-cigarette vapor on the lungs may also compromise immune response, according to 2018 research published in the BMJ journal Thorax.20 The study found e-cigarette vapor is toxic to living cells and may induce an inflammatory state within the lungs while also impairing bacterial clearance, possibly leading to more serious respiratory tract infections in e-cigarette users.
Also concerning is the fact that the liquids used in e-cigarettes are highly unstable and “new compounds can form after mixing of constituents and during storage,” according to the journal Nicotine and Tobacco Research.21
Juul Ignited the E-Cigarette Boom
It is now estimated that 1 in 4 high school seniors has reported vaping nicotine in the past month, and health officials indict Juul for the exploding popularity.22 Juul is said to have hooked young people on e-cigarettes by using social media that positioned Juul as cool, providing sponsorships of high profile events23 and by offering an appealing compact, “flash drive” size,24 which enables users to hide the device and even use it in school.
The addictive potential of Juul is attributed to the use of nicotine salts. They are created by combining freebase nicotine with lactic acid. “The theory is that nicotine salts are able to travel more deeply into the lung than the freebase, where the nicotine is absorbed faster,” Grant O’Connell, head of scientific affairs at Imperial Brands, told The Verge.25
The nicotine in the salts is ionized, creating a smoother and less harsh vaping experience due to its positive charge.26 In fact, the salts in one Juul cartridge deliver roughly the amount of nicotine found in a pack of cigarettes.27
The recent lawsuit by Breja about contaminated products being released and not recalled adds to the picture of a cagey and unethical company.
Top Tips to Help You Quit Smoking
I believe the “secret” to quitting smoking and vaping is to get healthy first, which will make quitting both mentally and physically easier. Exercise is an important part of this plan, as research shows people who engage in regular strength training double their success rate at quitting smoking compared to those who don’t exercise.28,29
Healthy eating is another crucial factor to improve your health and strengthen your ability to quit. I also recommend mindfulness training (MT) to help you quit smoking or vaping addiction. MT reduces activity in the posterior cingulate cortex area of the brain, which is activated in smokers in response to smoking cues.
People who used a mindfulness app had a reduction in self-reported daily cigarette consumption by an average of 11 cigarettes per day, compared to nine cigarettes per day for those using a standard quitting-smoking app in one study.30,31
Throughout your day, when you notice you have cravings for a cigarette or e-cigarette, you don’t have to react to them — they are just thoughts. Another excellent supportive tool, especially for dealing with such cravings, is the Emotional Freedom Techniques (EFT), which can help you to break free from smoking as well as vaping.