November 12, 2020

How Vaping Affects Your Health

Show Notes

On this episode, Chuck Gaidica is joined by Dr. George Kipa, medical director and chief medical officer for Blue Cross Blue Shield of Michigan. Together, they discuss the impact vaping can have on the body.

In this episode of A Healthier Michigan Podcast, we explore:

  • The attraction to e-cigarettes and reasons they’ve grown in popularity.
  • How vaping aerosols are impacting the lungs and brain.
  • If vaping is truly less harmful than cigarettes.
  • The impact of secondhand vaping.
  • Steps to take when looking to quit vaping.

Transcript

Chuck Gaidica:
This is A Healthier Michigan Podcast, episode 67. Coming up, we discuss the effects of vaping on the body.

Chuck Gaidica:
Welcome to A Healthier Michigan Podcast. This is a podcast dedicated to navigating how we can improve our health and well-being through small, healthy habits we can start implementing right now. I’m your host, Chuck Gaidica. Every other week we’ll sit down with a certified health expert from Blue Cross Blue Shield of Michigan and dive into topics that cover nutrition, fitness, and a lot more. And on this episode, we’re discussing how vaping affects your health and even others around you. With me today is medical director and assistant chief medical officer for Blue Cross Blue Shield of Michigan, Dr. George Kipa. Dr. Kipa good to have you back with us.

Dr. George Kipa:
Thank you, Chuck. Good to be with you.

Chuck Gaidica:
Now. I have a couple, I guess it’s a bias, but it’s an admission right up front. I’ve never smoked in my life. Never got it. Don’t understand it. And now I see kids that are a quarter of my age walking out of someplace and it looks like steam or vapor comes out of their mouth and their nose. They’ve got an e-cigarette or a pen or something and they’re vaping. Can you explain what vaping is so we can understand it?

Dr. George Kipa:
Sure, Chuck. Well, vaping is another term for inhaling e-cigarette aerosol or vapor. So e-cigarettes or electronic cigarettes, they’re a type of device known as electronic nicotine delivery system or ENDS. It’s usually battery operated and these devices turn the e-liquid into an aerosol for the user to inhale. So, unlike cigarettes which burn tobacco, e-cigarettes heat and extract of nicotine which is then inhaled as an aerosol.

Chuck Gaidica:
So before I get to the aerosol part that scares the daylights out of me anyway, let’s talk about this. Do all e-cigarettes have nicotine, or are some just like flavored chemicals that you’re basically going through the motions of smoking but you’re not smoking anything except maybe a mint flavor or something?

Dr. George Kipa:
Sure. I think the primary attraction of the e-cigarettes were the fact that they were supposedly capable of delivering nicotine without some of the dangers of burning the tobacco. But since then, and I think the actual invention of this technology goes back to like 1963, I believe. But in any case, the flavored e-cigarettes that do not contain nicotine have become quite popular, and unfortunately very popular in younger people.

Chuck Gaidica:
So what seems counterintuitive to me, and I guess if you get hooked on anything as a habit, it could be jelly beans, if you eat too many, it’s bad for you. But in this case, I know at the beginning, I recall at least, I say the beginning of when I became aware of these things years ago, this was supposed to help wean you off of cigarettes, right? Wasn’t that one of the pitches that we all heard?

Dr. George Kipa:
Well, yes, that was a pitch, certainly. And actually in some other countries, I think in Europe and Australia, that’s been occasionally used as a rationale. But the problem is that we don’t really know whether in the long run this is a useful alternative. It is certainly possible if we carefully select patients that it might be helpful in certain people. But the bottom line is that the standard approach toward quitting cigarettes, in terms of utilizing a smoking cessation professional, and working with your primary care physician to find a good program to help you quit using certain medications like nicotine gum or other medications, I think that is really the preferred approach to go. According to the CDC, there is no proof yet that this is a safer or a better way to go.

Chuck Gaidica:
So the stats seem to be on the side of this idea of e-cigarettes, meaning that they seem to be selling well. Right? So we continue to hear about cigarette smoking among adults, at least in the US, I know in other countries abroad and Middle Eastern places cigarette smoking is off the charts. But here in the US there’s been a steady decline. There is a social impact of anybody that smokes near you for secondhand smoke. I mean, there’s so many reasons, including good health that that’s changed. But e-cigarettes, by 2021, the numbers say an estimated 55 million users. I mean, that’s a sixth of the US population using these things.

Dr. George Kipa:
Yeah. I mean, that’s highly significant. And if we think about the fact that really tobacco smoking itself is the leading cause of preventable deaths still in the world. And if we can link that to what’s going on here, this is a very bad trend. We managed to get the tobacco trend down significantly, and now we’ve got this opposite trend working in the other direction.

Chuck Gaidica:
So, I remember during some of the trial there were lawsuits, et cetera, with tobacco companies. And I remember a stat that’s just stuck with me for the longest time, that something like 7,000 different chemicals are in a cigarette. So you light it up, obviously there’s nicotine, but it’s all this other stuff that we can have some direct correlation to bad health and cancer. Now, with the e-cigarette, when you say that you’re taking chemicals of some kind, including nicotine, even if it’s smaller amounts, and that’s now going to bubble and boil and turn into a vapor, there isn’t one thing about that that sounds healthy to me.

Dr. George Kipa:
You’re exactly correct. Even though, again, the burning of tobacco can produce more potentially toxic substances, what we don’t know is exactly what happens with the substances that are inhaled with vaping. There’s variable heat that can be applied, variable ways that the user can use the device. So it’s a whole bunch of difference. And then there’s variation in what’s in those liquids. And I think that that variation is the source of some of the big problems that occurred with the use of e-cigarettes just last year.

Chuck Gaidica:
Well, and you know what’s interesting is that, with any kind of liquid or well, here, take olive oil, I know when you cook with it, if you heat it up too much it’ll spoil. I mean, when you heat chemical liquids up, there’s a point at which they can change what they typically are used for or how they could affect the body. So, that’s the scary part to me. And it just baffles me that when you, as a doctor, who’s studying this and speaking to patients, if the studies aren’t coming your way to see what’s going on, – Katy, bar the door – how can we not know what’s coming out of this stuff? Nobody’s testing it?

Dr. George Kipa:
Well, yes, there’ve been studies on the toxicology of the various compounds that could be in these various liquids. And again, there might be over 500 manufacturers, some illicit manufacturers, so you never know what’s in there. But toxicologists have studied the various compounds and looked at them, are they respiratory irritants? Do they sensitize the various organs in any way? And so, that research does exist. And I think when you look at what happened last year, it just pointed out how much we didn’t know back then, and we still don’t know a lot. There’s still a lot to learn. But last year there was a spike in severe inflammatory lung injury or what they call EVALI, the e-cigarette or vaping acute lung injury. And so, this peaked, I think, around the end of the summer last year, and there were greater than 2000 severe cases that needed to go in the hospital.

Dr. George Kipa:
And I believe they’re looking at, it’s greater than 60 deaths have occurred to date on that. And that was likely related to the use of vitamin E acetate as an agent to thicken that e-liquid used in e-cigarettes. And they said that 80% of the deaths that occurred were related to using e-cigarettes also to inhale THC, the psychoactive component of marijuana. That led to a very severe lung inflammation and acute respiratory distress syndrome. Patients had to be intubated, and had multiple complications including, all the deaths that I mentioned. And when they studied the lung fluids from these patients, they showed inflammatory immune cells called macrophages filled with lipids. So these cells that help protect the lung were reacting to the substance being used in these preparations. Thank God that kind of epidemic of vaping severe illness and death has greatly decreased, but that shows us the potential danger of variation in what’s included in the e-liquids.

Chuck Gaidica:
Well, Dr. Kipa, can you explain a little bit more and maybe pull the covers back on this thing a minute for us and unpack it? What does this do to the brain, the heart, et cetera? What specifically are you seeing, the lungs, brain and heart?

Dr. George Kipa:
Well, there’s a lot we still don’t know, but a lot of people are studying both the short and long-term effects of the e-cigarettes on our organs. And as I mentioned earlier, that the science of toxicology helps us understand the effects of vaping at a cellular level. And starting with the lungs, if you look at what happens when the aerosol gets in, it can lead to inflammation, mucus production, airway obstruction, it could lead to the death of cells actually, and it can affect the immune system’s susceptibility to infection. And now in this age of COVID, for instance, I think there’ve been some studies that have shown that those who vape actually are at an increased risk for both contracting COVID and at an increased risk of having a more severe reaction to COVID. So, something else to think about in this day and age.

Chuck Gaidica:
Well, and you’re mentioning two words there that are jumping off. One of them is inflammation. And you’re talking about things related to cardiovascular health as well. We’ve heard of blood clots in recent time with the pandemic. So, when you’re talking about underlying conditions, who would think that vaping could also be an underlying condition?

Dr. George Kipa:
Yes, very much so. And you mentioned the blood vessels, certainly vaping may affect the endothelium or the inner lining of blood vessels. We know that tobacco smoke can lead to [inaudible 00:09:57] and increased stroke, and is very, very likely that vaping would also be shown in the long run to affect those conditions.

Chuck Gaidica:
What about the brain?

Dr. George Kipa:
Well, for the brain, I believe it’s primarily the psychoactive nicotine effect. So, we have nicotine receptors in our brain, and when nicotine gets in there and connects to those receptors it releases dopamine and makes us feel good, so to speak, and that is the start of the addictive cycle. So, that certainly is an issue in all individuals who may try vaping. And that’s not unlike smoking tobacco because of the nicotine effect, but with vaping, it’s also been found that in the development of the brain in adolescents and young people, it may cause problems with that development leading to memory issues, leading to ADHD, even perhaps leading to depression issues. So the bottom line is, there are very, very good reasons for everyone not to do this in my opinion, but especially young people in terms of the effects on the brain.

Chuck Gaidica:
So Dr. Kipa, you just talked about brain health as part of the concern here. But with young people who are vaping right now, and God-willing, they’ve got a huge lifespan ahead of them, this could really add up to a whole different kind of dangerous proposition over their lifetime. Right?

Dr. George Kipa:
Exactly. And if one in four high school students is vaping at the moment, which I have heard, and somewhere between five and 10% of middle schoolers are doing it, that’s really an epidemic that I think everyone should talk to their kids about the dangers, and just education to the public and action in that regard is extremely important in my opinion.

Chuck Gaidica:
I don’t really care for relativistic discussions, this thing is better than that bad thing. So, I’ll do this thing. But in this case, that has also been one of the pitches. And I don’t know where you come down on that from a medical standpoint, if it is truly less harmful than cigarettes smoking, is that necessarily a bad thing?

Dr. George Kipa:
Well, the way I would look at this is the following, if someone has tried to quit smoking in other ways and failed, and if they work with their primary care physician to look at what went wrong in that regard, it is possible that for the carefully selected patient with proper support, having a smoking cessation professional work together with the primary care physician on this, and perhaps also the use of some of the medications that have been shown to work well with behavioral treatment, switching completely to vaping from smoking to provide a little bit of that nicotine may help break the habit. The problem is that, there’s a danger that it could lead to concurrent use of both cigarettes and vaping, and that would be much worse than just the cigarettes alone. So if one can avoid that problem in working out how to quit smoking, that might be one scenario in which it may be helpful. But again, I think it’s extremely important to work carefully with your private care physician and smoking sensation professional to make sure that that would be achieved. And very careful patient selection I think is important.

Chuck Gaidica:
So, Dr. Kipa, if somebody is vaping near you, is there a risk to what we used to call secondhand smoke, in this case, secondhand vapors?

Dr. George Kipa:
Well Chuck, definitely exposure to secondhand vaping aerosol should be avoided much to the same kind of reasons that we avoid second-hand tobacco smoke. So, especially the very young infants, pregnant women, definitely should avoid exposure to secondhand vaping aerosol. It’s likely that with the second hand aerosol, there will be as much nicotine absorbed as with secondhand cigarette smoke. And there are other particles there, there may be carcinogens that may increase certain risks toward cancer. All of that is likely to be true with secondhand smoke. Research will give us answers more definitively down the line, but that’ll take time.

Chuck Gaidica:
So getting out of any bad habit, Dr. Kipa, is tough enough, but when you look at getting away from vaping, what is your best advice? Is it just to quit?

Dr. George Kipa:
Well, Chuck, it’s very important to have a primary care physician that you’ve worked with for a long period of time. That primary care physician will be in the best position to come up with a personalized plan for the individual to quit. It’s very important to understand what guides you to smoke to begin with. What are your trigger factors? What has caused difficulty in failure to quit smoking before? Have nicotine patches or medications been tried? Have some of the other medications been tried? So, in working with your primary care physician and bringing in a smoking cessation professional, together with that behavioral approach and the medication approach, that dual approach is best. And whether or not vaping may have any role in that really will depend on future research to guide us, but also your primary care physicians insights into whether or not there may be a role for that in your particular care.

Chuck Gaidica:
So, Dr. Kipa, as we wrap things up, what would be some take-aways we should go away with as we look at our own health relative to vaping, and those who we know and love around us?

Dr. George Kipa:
So Chuck, to summarize, if you don’t smoke, don’t start. If you smoke cigarettes, work with your primary care physician to find a method for quitting that works for you. Combination of behavioral methods and medications work best. Take advantage of the multidisciplinary specialists in smoking cessation through the various available programs, including some of those that are available at BCBSM.com. And I’ll end with advice from the CDC. So while it is possible that e-cigarettes have the potential to benefit adults who smoke and who are not pregnant if used as a complete substitute for regular cigarettes and other tobacco products, we know that e-cigarettes are not safe for youth, not safe for young adults, not safe for pregnant adults, and not safe for just adults who do not currently use tobacco products.

Dr. George Kipa:
So, while e-cigarettes have the potential to possibly benefit some people and harm others, and more so the harm from what I’ve seen, scientists still have a lot to learn about whether e-cigarettes are effective in helping adults quit smoking. So again, if you’ve never smoked or used other tobacco products or e-cigarettes, don’t start. And additional research will help us understand the long-term health effects of vaping.

Chuck Gaidica:
Well, Dr. Kipa, thank you so much for joining us today.

Dr. George Kipa:
Thank you, Chuck. Thanks for having me.

Chuck Gaidica:
Thanks for listening to A Healthier Michigan Podcast. It’s brought to you by Blue Cross Blue Shield of Michigan. If you like our show, and you want to know more, check us out at ahealthiermichigan.org/podcast, or leave us a review or rating on Apple podcasts, Spotify, or your favorite podcast app. I’m Chuck Gaidica, stay well.