The Risks of "Healthy" E-Cigarettes: Unproven Claims & Lack of Regulation

The so-called "healthy" electronic cigarettes are becoming increasingly popular. Unlike regular electronic cigarettes that contain nicotine, these products contain vitamins, hormones or essential oils. However, the US Food and Drug Administration (FDA) has taken notice because many companies that sell them have made unproven health claims.

Healthy electronic cigarettes, also known as "nutritional supplement diffusers," are a range of products found within electronic cigarettes. These devices deliver nicotine to the lungs without the need for combustion or tobacco, removing harmful compounds such as tobacco tar. Rather than burning, electronic cigarettes use the energy from a battery to heat up liquid and create a vapor that can be inhaled.

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

Inhaling, rather than swallowing, these compounds allows for faster absorption into the bloodstream, and therefore, in theory, vitamins and supplements can take effect more quickly when inhaled.

Many of these additives are familiar as supplements considered safe for consumption. However, most of them lack inhalation safety testing, particularly for potential long-term harm. Because health e-cigarettes are nicotine-free, they have avoided regulatory scrutiny.

The outbreak of 2019's electronic cigarette-related acute lung injury (Evali) in the United States highlighted the importance of detecting ingestion routes. Among the initially reported 60 fatal Evali cases, vitamin E acetate was identified as the key factor causing lung injury. As vitamin E is a common food additive, this makes it clear that even well-known substances can have severe health consequences when inhaled.

These devices are relatively new to the market, and therefore research on their safety is scarce. However, we can examine specific components to look for potential effects, both beneficial and harmful.

E-cigarette components

Many benign or beneficial compounds can become harmful if administered in an untested manner or to the wrong patient group. For example, the benefits of vitamin C are well-known, but it has been shown that high doses of vitamin C can 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 individuals who are deficient. However, there is no clear evidence to support any benefits for individuals with normal B12 levels. Additionally, we lack evidence regarding the safety or efficacy of inhaling B12.

A study conducted in 1967 showed that inhaling vitamin B12 had no benefits compared to injecting supplements. The researchers also noted the potential for lung damage in the same year.

We can also examine information regarding shared components with electronic cigarettes to search for potential impacts. Some products offer vitamin B12 dissolved in common e-liquid ingredient, vegetable glycerin. Other products use propylene glycol or a mixture of two liquids. When heated, these components can break down into harmful chemicals, such as formaldehyde.

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

The health e-cigarette that offers essential oils may also encounter similar issues. They contain a mixture of compounds called terpenes and other chemicals that are similar to e-liquids.

According to reports, terpenes have a range of benefits, including anti-cancer, anti-allergic, and antibacterial properties, which suggests potential benefits of using these essential oils. However, terpenes are thermally unstable and may decompose through inhalation into harmful compounds, which can irritate the respiratory system and potentially be toxic to cells at higher doses and prolonged exposure times.

Strengthening scrutiny" or "Intensifying scrutiny

Due to similarities between electronic cigarettes and "healthy" electronic cigarettes, these companies are currently facing increasingly strict scrutiny from public health institutions. The FDA has issued a warning stating that so-called healthy electronic cigarettes are "unsafe," "ineffective," and "unproven.

We must carefully weigh the benefits and risks of using these devices. Many of the supplements in these devices may help improve our lifestyle, but there is no evidence to support inhalation as being superior to traditional delivery methods.

The existence of healthy e-cigarettes has not been long enough for researchers to determine their long-term consequences. We know that short-term exposure to their components can damage the lungs, so long-term use could bring very serious risks - indicating that the scale of evidence is firmly against the use of "healthy e-cigarettes.

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