The Risks of Health E-Cigarettes: Safety Concerns Arise

The so-called health electronic cigarettes are becoming increasingly popular. Unlike regular electronic cigarettes that contain nicotine, these products contain vitamins or essential oils. However, they have caught the attention of the US Food and Drug Administration (FDA).

Healthy electronic cigarettes, also known as 'nutritional supplement diffusers,' encompass a range of products that share a common source found in electronic cigarettes. Unlike traditional cigarettes, electronic cigarettes deliver nicotine to the lungs without combustion or tobacco. This allows for the removal of harmful ingredients such as tobacco tar. Electronic cigarettes work by utilizing energy from a battery to heat liquid, creating an inhalable vapor.

A new line of products aims to use the same inhalation delivery system for various non-nicotine products, including popular vitamins (such as B12 and C), milk thistle, melatonin (a hormone), green tea, and various essential oils. The health e-cigarette company claims that different combinations of these additives can help improve focus, promote sleep, and even aid in weight loss.

Inhaling rather than swallowing these compounds allows for quicker absorption into the bloodstream, hence theoretically making vitamins and supplements more effective when inhaled.

Many of these additives will be familiar as supplements deemed safe for ingestion. However, most lack inhalation safety testing, particularly in regards to potential long-term harm. Because healthy e-cigarettes do not contain nicotine, they have managed to evade regulatory agencies.

The onset of the 2019 outbreak of e-cigarette or vaping product use associated lung injury (or EVALI) in the United States highlighted the importance of detecting ingestion methods. In the initial report of 60 deaths related to EVALI, vitamin E acetate was identified as a key factor causing lung damage in these individuals. Vitamin E is a common food additive, therefore this clearly emphasizes that even well-known healthy substances can have serious consequences on one's health when inhaled.

These devices are quite innovative in the market, and therefore research on their safety is scarce. Administering incorrect patient groups with untested methods could render many benign or beneficial compounds harmful. For example, the benefits of vitamin C are well-known, but using high doses of vitamin C has been shown to increase the risk of death in sepsis patients.

Vitamin B12 is also a popular additive in these devices. B12 injections are highly effective in restoring vitamin levels for those who are deficient. However, there is no evidence to support any benefits for people with normal B12 levels. Additionally, we lack evidence on the safety or efficacy of inhaling B12.

A research conducted in 1967 revealed that inhaling vitamin B12 showed no benefits compared to injecting supplements. However, even at that time, researchers pointed out the potential risk of lung damage.

We can also examine information on components commonly shared with electronic cigarettes to identify potential impacts. Some products offer Vitamin B12 dissolved in vegetable glycerin, a common ingredient in e-liquids. Other products use propylene glycol or a mixture of two liquids. When heated, these components can break down into harmful chemicals known as reactive carbonyl compounds, such as formaldehyde.

These chemicals have been found to damage alveolar macrophages, which are crucial immune cells in the lungs, in a manner that does not depend on the presence of nicotine. Similar findings have been observed in other important airway and immune cells.

Electronic cigarettes that offer essential oils as a healthier option may also be subject to similar issues. They contain a mixture of compounds known as terpenes, as well as other chemicals similar to those found in e-liquids.

According to reports, terpenes have a range of benefits, including anti-cancer, anti-allergy and antibacterial properties, indicating potential benefits of taking these essential oils. However, terpenes can be degraded by heat and may be broken down into harmful compounds when inhaled, which can irritate the respiratory tract and potentially be toxic to cells at higher doses and longer exposure times.

Due to the similarities between electronic cigarettes and health e-cigarettes, these companies are now facing increasingly strict scrutiny from public health institutions. The FDA warns that health e-cigarettes are "unsafe," "ineffective," and "unproven.

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