Image Retrieved from: https://vaping360.com
Vincent Li, Class of 2022
A quick breath in. Hold, then release. A ring of smoke followed by a puff of vapor. The ubiquity of cigarettes in the 20th century has been replaced with a piece of metal reminiscent of a USB flash drive, or a pen, that fits easily into one’s palm: a vape. But this device doesn’t insert into your computer or transfer files; it’s a medium by which people can inhale a fine aerosol vapor that frequently contains nicotine, chemical additives, and eye-catching flavors like mango or cinnamon (NIDA, 2019).
Vaping, however, has recently been the topic of controversy due to a string of lung ailments, chest pains, and even deaths linked to e-cigarette use. The Centers for Disease Control and Prevention (CDC) recently reported that there were 34 deaths and 1,604 cases of lung injury due to vaping or e-cigarettes (EVALI) “as of October 22, 2019” within the U.S. (“New CDC,” 2019). According to the CDC, the likely culprit is due to Vitamin E acetate, which was found in the “samples of lung fluid collected from 29 patients” (Aubrey and Kennedy, 2019) and similarly in the THC cartridges that were used by those affected. Thirteen of the cartridges contained liquid composed of as much as “50 percent” Vitamin E, which according to Howard Zucker, New York’s state health Commissioner, is an unapproved additive (Neel, 2019). This means that the cartridges were laced with vitamin E and were not officially sponsored by a medical dispensary within the state of New York.
Still, the evidence is insufficient to conclude that there is a causative relationship between vitamin E and the symptoms expressed by the patients. According to FDA adviser Michael Felberbaum, “no one substance, including Vitamin E acetate, has been identified in all of the [additional] samples” obtained separately (Neel, 2019).
But how exactly would this fat-soluble vitamin be introduced to the lungs? Vapes and e-cigarettes are comprised of four main sections: a mouthpiece for vapor inhalation, a battery, a heat source, and a container of the liquid solution (coined “e-liquid” or “e-juice”) that is turned into the aerosol (NIDA, 2019). When either a button is pressed, or an intake of breath occurs at the mouthpiece, the heating component of the e-cigarette vaporizes the liquid, turning it into a vaporized mist that is then inhaled (NIDA, 2019).
However, this does not answer the question as to why excess Vitamin E vapor, whose function is primarily that of an antioxidant and anti-inflammatory supplement, would cause significant lung damage and possible death (“Office”). Because the vitamin is fat-soluble, rather than its water-soluble counterparts like Vitamin C, any excess is not disposed of by means of urination, but is stored instead in the fat cells of the liver (“Fat-Soluble”). As such, there are health risks associated with too much intake; excessive supplement usage “can cause hemorrhage and interrupt blood coagulation” by means of platelet recruitment (“Office”). While lethal in its own right, there is not a definitive link that can be supported by scientific research, which rightfully warrants further analysis of the aforementioned samples to see if there are any other additives that may be responsible. It would also be prudent to gauge how Vitamin E differs in its potency when in aerosol form versus in topical creams of the foods that we eat.
As a precautionary measure, the Trump administration mentioned a plan that would ban the aforementioned flavors except for tobacco (“Ban”). The extent of the controversy is reactionary in nature and stems from the belief that e-cigarette use should not fall under the same realm of regulations as other tobacco and nicotine products, nor should it be under scrutiny considering they do not cause a largely disproportionate number of deaths.
But perhaps these first e-cigarette linked deaths were the tipping point for those that disagreed with the marketing and advertisement of vapes. Originally designed as an alternative device that would pose less deleterious consequences to those suffering from excessive cigarette use, e-cigarettes, and subsequently vapes, have grown in popularity so much so that they have betrayed their intended function. According to a cohort study performed by Berry et al. (2019), juveniles who begin using e-cigarettes are more likely to begin using cigarettes within the next two years. Berry et al. (2019) finds that the percentage of high school aged youths that use e-cigarettes within the past 30 days jumped from 1.5% when recorded in 2011 to 20.8% in 2018.
Rather than serving as a (debatably) healthier substitute for cigarettes, for which there is an “established list of 93 HPHCs [harmful and potentially harmful constituents]” ranging from carcinogens and other addictive toxicants (“Established”), there are theories that vapes--and their enticing advertising methods--are causing far more non-using youths to consistently expose themselves to nicotine and other tobacco products.
References
Aubrey, A., & Kennedy, M. (2019, November 8). CDC Finds Possible Culprit In Outbreak
Of Vaping-Related Lung Injuries. Retrieved from https://www.npr.org/sections/health-shots/2019/11/08/777646890/cdc-finds-possible-culprit-in-outbreak-of-vaping-related-lung-injuries.
Ban on flavored vapes could lead to loss of 150,000 jobs, $8.4 billion sales hit: report.
(2019, November 22). Retrieved from https://www.reuters.com/article/us-health-vaping/ban-on-flavored-vapes-could-lead-to-loss-of-150000-jobs-84-billion-sales-hit-report-idUSKBN1XW20K.
Berry KM, Fetterman JL, Benjamin EJ, et al. Association of Electronic Cigarette Use
With Subsequent Initiation of Tobacco Cigarettes in US Youths. JAMA Netw Open. 2019;2(2):e187794. doi:https://doi.org/10.1001/jamanetworkopen.2018.7794
Established List of HPHCs in Tobacco Products and Tobacco Smoke. (n.d.). Retrieved
from https://www.fda.gov/tobacco-products/rules-regulations-and-guidance/harmful-and-potentially-harmful-constituents-tobacco-products-and-tobacco-smoke-established-list.
Fat-Soluble Vitamins: A, D, E, and K - 9.315. (n.d.). Retrieved from
https://extension.colostate.edu/topic-areas/nutrition-food-safety-health/fat-soluble-vitamins-a-d-e-and-k-9-315/.
Joe Neel, A. A. (2019, September 5). Vitamin E Suspected In Serious Lung Problems
Among People Who Vaped Cannabis. Retrieved from https://www.npr.org/sections/health-shots/2019/09/05/758005409/vitamin-e-suspected-in-serious-lung-problems-among-people-who-vaped-cannabis.
New CDC Report Provides First Analysis of Lung Injury Deaths Associated with Use of
E-cigarette, or Vaping, Products. (2019, October 28). Retrieved from https://www.cdc.gov/media/releases/2019/p1028-first-analysis-lung-injury-deaths.html.
NIDA. (2019, November 22). Vaping Devices (Electronic Cigarettes). Retrieved from
https://www.drugabuse.gov/publications/drugfacts/vaping-devices-electronic-cigarettes on 2019, November 24
Office of Dietary Supplements - Vitamin E. (n.d.). Retrieved from
https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/.
Vaping, however, has recently been the topic of controversy due to a string of lung ailments, chest pains, and even deaths linked to e-cigarette use. The Centers for Disease Control and Prevention (CDC) recently reported that there were 34 deaths and 1,604 cases of lung injury due to vaping or e-cigarettes (EVALI) “as of October 22, 2019” within the U.S. (“New CDC,” 2019). According to the CDC, the likely culprit is due to Vitamin E acetate, which was found in the “samples of lung fluid collected from 29 patients” (Aubrey and Kennedy, 2019) and similarly in the THC cartridges that were used by those affected. Thirteen of the cartridges contained liquid composed of as much as “50 percent” Vitamin E, which according to Howard Zucker, New York’s state health Commissioner, is an unapproved additive (Neel, 2019). This means that the cartridges were laced with vitamin E and were not officially sponsored by a medical dispensary within the state of New York.
Still, the evidence is insufficient to conclude that there is a causative relationship between vitamin E and the symptoms expressed by the patients. According to FDA adviser Michael Felberbaum, “no one substance, including Vitamin E acetate, has been identified in all of the [additional] samples” obtained separately (Neel, 2019).
But how exactly would this fat-soluble vitamin be introduced to the lungs? Vapes and e-cigarettes are comprised of four main sections: a mouthpiece for vapor inhalation, a battery, a heat source, and a container of the liquid solution (coined “e-liquid” or “e-juice”) that is turned into the aerosol (NIDA, 2019). When either a button is pressed, or an intake of breath occurs at the mouthpiece, the heating component of the e-cigarette vaporizes the liquid, turning it into a vaporized mist that is then inhaled (NIDA, 2019).
However, this does not answer the question as to why excess Vitamin E vapor, whose function is primarily that of an antioxidant and anti-inflammatory supplement, would cause significant lung damage and possible death (“Office”). Because the vitamin is fat-soluble, rather than its water-soluble counterparts like Vitamin C, any excess is not disposed of by means of urination, but is stored instead in the fat cells of the liver (“Fat-Soluble”). As such, there are health risks associated with too much intake; excessive supplement usage “can cause hemorrhage and interrupt blood coagulation” by means of platelet recruitment (“Office”). While lethal in its own right, there is not a definitive link that can be supported by scientific research, which rightfully warrants further analysis of the aforementioned samples to see if there are any other additives that may be responsible. It would also be prudent to gauge how Vitamin E differs in its potency when in aerosol form versus in topical creams of the foods that we eat.
As a precautionary measure, the Trump administration mentioned a plan that would ban the aforementioned flavors except for tobacco (“Ban”). The extent of the controversy is reactionary in nature and stems from the belief that e-cigarette use should not fall under the same realm of regulations as other tobacco and nicotine products, nor should it be under scrutiny considering they do not cause a largely disproportionate number of deaths.
But perhaps these first e-cigarette linked deaths were the tipping point for those that disagreed with the marketing and advertisement of vapes. Originally designed as an alternative device that would pose less deleterious consequences to those suffering from excessive cigarette use, e-cigarettes, and subsequently vapes, have grown in popularity so much so that they have betrayed their intended function. According to a cohort study performed by Berry et al. (2019), juveniles who begin using e-cigarettes are more likely to begin using cigarettes within the next two years. Berry et al. (2019) finds that the percentage of high school aged youths that use e-cigarettes within the past 30 days jumped from 1.5% when recorded in 2011 to 20.8% in 2018.
Rather than serving as a (debatably) healthier substitute for cigarettes, for which there is an “established list of 93 HPHCs [harmful and potentially harmful constituents]” ranging from carcinogens and other addictive toxicants (“Established”), there are theories that vapes--and their enticing advertising methods--are causing far more non-using youths to consistently expose themselves to nicotine and other tobacco products.
References
Aubrey, A., & Kennedy, M. (2019, November 8). CDC Finds Possible Culprit In Outbreak
Of Vaping-Related Lung Injuries. Retrieved from https://www.npr.org/sections/health-shots/2019/11/08/777646890/cdc-finds-possible-culprit-in-outbreak-of-vaping-related-lung-injuries.
Ban on flavored vapes could lead to loss of 150,000 jobs, $8.4 billion sales hit: report.
(2019, November 22). Retrieved from https://www.reuters.com/article/us-health-vaping/ban-on-flavored-vapes-could-lead-to-loss-of-150000-jobs-84-billion-sales-hit-report-idUSKBN1XW20K.
Berry KM, Fetterman JL, Benjamin EJ, et al. Association of Electronic Cigarette Use
With Subsequent Initiation of Tobacco Cigarettes in US Youths. JAMA Netw Open. 2019;2(2):e187794. doi:https://doi.org/10.1001/jamanetworkopen.2018.7794
Established List of HPHCs in Tobacco Products and Tobacco Smoke. (n.d.). Retrieved
from https://www.fda.gov/tobacco-products/rules-regulations-and-guidance/harmful-and-potentially-harmful-constituents-tobacco-products-and-tobacco-smoke-established-list.
Fat-Soluble Vitamins: A, D, E, and K - 9.315. (n.d.). Retrieved from
https://extension.colostate.edu/topic-areas/nutrition-food-safety-health/fat-soluble-vitamins-a-d-e-and-k-9-315/.
Joe Neel, A. A. (2019, September 5). Vitamin E Suspected In Serious Lung Problems
Among People Who Vaped Cannabis. Retrieved from https://www.npr.org/sections/health-shots/2019/09/05/758005409/vitamin-e-suspected-in-serious-lung-problems-among-people-who-vaped-cannabis.
New CDC Report Provides First Analysis of Lung Injury Deaths Associated with Use of
E-cigarette, or Vaping, Products. (2019, October 28). Retrieved from https://www.cdc.gov/media/releases/2019/p1028-first-analysis-lung-injury-deaths.html.
NIDA. (2019, November 22). Vaping Devices (Electronic Cigarettes). Retrieved from
https://www.drugabuse.gov/publications/drugfacts/vaping-devices-electronic-cigarettes on 2019, November 24
Office of Dietary Supplements - Vitamin E. (n.d.). Retrieved from
https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/.
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