E-cigarettes and Vaping: What do We Know About the Risks?

While smoking in general has been decreasing, e-cigarettes have been increasing in popularity. Estimates for 2018 are 41 million e-cigarette users worldwide with that number expected to increase to 55 million by 2022 (BBC 2019). However, with recent news stories connecting vaping products and significant lung damage and death, concerns about safety have come to the forefront (Moritz 2019). 

Vape Pens

The recent spate of cases of lung damage from e-cigarette use appear to be related to vitamin E acetate (a synthetic form of vitamin E) containing products. The current hypothesis is that inhaling vitamin E acetate creates a sticky coating in the lungs which can cause severe or even fatal lung damage (NBC 2019).

While this raises concerns for a subset of vaping products, it’s worth looking at the literature to see if we should have concerns for vaping in general. Vaping has been touted as safer than smoking and an effective way to quit normal cigarettes (Rehan 2018, Liu 2018). For long-term smokers, this may be true. However, vaping does appear to act as a gateway to smoking standard cigarettes for adolescents (Chatterjee 2016). This raises obvious concerns for the health implications in teens and young adults.  

Are There Toxins in Vaping Smoke?

Standard cigarettes contain up to 600 ingredients that produce up to 7000 chemicals upon combustion including numerous toxins (Strongin 2019). These toxins include cadmium, lead, ammonia, benzene, carbon monoxide, among many others (FDA 2019). 

How do E-cigarettes Compare? 

Known toxins in e-cigarettes include carbonyls, acrolein, acetaldehyde, and formaldehyde (Bhatnagar 2016) along with heavy metals, plasticizers, and flame retardants (Oh 2015, Hutzler 2014, Gaur 2019). While levels of known toxins are generally lower than standard cigarettes, there are huge variabilities based on the design of the vape pen and evaluation methods. 

Vape pen models that use higher power will degrade the e-liquid into larger quantities of toxic compounds like benzene and toluene. Toxic carbonyl compounds are also produced based on how well the vape pen wicks the e-liquid to the heating coil. Poor wicking causes more significant degradation of the compounds and higher levels of toxic carbonyls.  Added flavors also can breakdown in the vape pen producing toxic carbonyls and aldehydes (Strongin 2019).

Unlike the recent cases of lung damage from vaping, the majority of harms from vaping will likely take many years to develop (Ratajczak 2018). While lung cancer and COPD risks may be less than traditional smoking, long-term pulmonary outcomes are still uncertain and likely not zero (Bozier 2019).

Cardiovascular Risks

There’s also concern around heart disease risk due to vaping. While it’s too early to know definitively, the emerging data suggests cardiovascular risks. Vaping appears to increase sympathetic stress levels in users and free radicals in the bloodstream (Buchanan 2019). Risk of heart attack increased 2.25 times with daily use of e-cigarettes and 1.99 times with “some day” use (Bhatta 2019). Heart disease is the number one killer in the U.S. and vaping appears to more than double your risk.  

Kidney Risks

Data is also starting to emerge indicating kidney risks. An animal study exposed mice to e-cigarettes. After 3 months of exposure, kidney function had decreased 21% (Drummond 2017). Another mouse study exposed female mice to vaping during conception, gestation and breastfeeding of their young. The offspring had higher inflammation, oxidative stress and kidney fibrosis (damage) from mother’s vaping in-utero and during breastfeeding (Li 2019). 


Vaping is not risk free and people should understand the significant potential harms with e-cigarettes. While vaping may be somewhat safer than smoking, a recent study concluded that the total harm from vaping and e-cigarettes currently outweighs the benefits in helping some smokers quit (Soneji 2018). Lung, heart and kidney risks are not insignificant and we likely still have decades before we fully understand the majority of the health risks from e-cigarettes. 

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