Vaping may be safer than smoking cigarettes for those trying to quit, but the shocking case of a British teenager who was highlighted the risks.
Kyla Blight. 17, from Cumbria in England, who started vaping when she was 15, had to be rushed to hospital with a collapsed lung linked to her 4,000 puffs a week on vapes (the equivalent to 400 cigarettes).
She needed a five-and-a-half hour operation to remove part of her lung – doctors found that a blister on the surface of the affected lung had burst, creating a hole in her lung wall.
Mail+ has talked to experts across the UK who say that the health problems that vaping cause are only now becoming apparent.
Vapes – electronic devices that heat e-liquids containing flavourings, thickening agents, and usually nicotine as well as many other chemicals, to produce an aerosol you then inhale – are used by 4.5million Britons.
15 per cent of young people in Britain now use vapes, up from 11.1 per cent three years ago
And, increasingly, by young people – 15 per cent of those aged between 16 to 24 in the UK now vape – up from 11.1 per cent in 2021, according to an Opinions and Lifestyle Survey. (In England, e-cigarettes that contain nicotine cannot be legally sold to under 18s.)
‘Vaping was brought in as a tool to move people to nicotine-free lives, but unfortunately there has been a rise in vaping on its own which is introducing health risks that wouldn’t have occurred otherwise,’ says Dr Gavin Nye, a senior lecturer in anatomy and physiology at the University of Chester.
The Centers for Disease Control in the US is stark: ‘If you don’t vape, don’t start.’ It points out that ‘most e-cigarettes contain nicotine, which is highly addictive and is a health danger for pregnant people, developing foetuses, and youth.
Aerosol from e-cigarettes can also contain harmful and potentially harmful substances. These include cancer-causing chemicals and tiny particles that can be inhaled deep into lungs’.
These are the are ten potential health risks – from bad breath and gum disease, to gut problems, infertility and cancer, that have been identified so far.
1 Could be bad for your lungs
The aerosol that’s released by vapes contains many chemicals that may be dangerous to the lungs.
Kyla Blight developed a blister, called a bleb, on her lung. Unlike a blister on your heel, a bleb, which is usually one to two centimetres in diameter, is full of air not fluid. When it burst, the bleb caused a hole in Kyla’s lung, releasing air into the chest cavity, causing the lung to collapse.
Anything that damages the alveoli – tiny air sacs in the lungs – can cause blebs, including smoking.
Vaping has been associated with a blister known as a bleb forming on the lung
Vaping may also lead to spontaneous collapsed lung, known as pneumothorax.
‘Pneumothoraces due to electronic cigarettes have been rarely reported so far but the body of literature illustrating an association is growing,’ according to a paper in Respiratory Medicine Case Reports in 2021.
Vaping has also been linked to lipoid pneumonia, where the alveoli fill with dead white blood cells laden with fatty material – this in turn causes inflammation and infection in the airways.
This build-up of white blood cells is believed to be due to the glycerol, which is used in e-liquids to help create thicker vapour.
Meanwhile, growing evidence suggests there may be a link between vaping and lung cancer, although this is not proven. A recent review of studies, published in the journal Cancers last September, concluded that vapes were ‘a highly potential risk factor for lung cancer and an area of significant concern for the future’.
Evidence is mounting that lung cancer is linked to glycerol in vapes, says Dr Nye. ‘In the past, it’s always been strongly suggested that vaping is not carcinogenic, unlike smoking tobacco, but now the evidence seems to finally be coming to light that toxins in vapes may be linked to cancer.
‘Glycerol is safe to consume. However, when heated in vapes, it can form the carcinogen formaldehyde, which is then inhaled into the lungs, causing cellular damage which can lead to cancer.’
According to the American Cancer Society: ‘Makers of e-cigarettes often claim the ingredients are safe. But the aerosols that these products produce can contain addictive nicotine, flavourings, and a variety of other chemicals, some known to be toxic or to cause cancer. The levels of many of these substances appear to be lower than in traditional cigarettes, but the amounts of nicotine and other substances in these products can vary widely because they are not standardised.’
‘Vaping has been linked to various types of cancer, including head and neck cancers, lung cancer and female breast cancer, as well as blood, prostate, and bladder cancers,’ says Professor Kefah Mokbel, a consultant breast surgeon based at the London Breast Institute. He points to animal and lab studies on cells that suggest that vaping may produce the kinds of DNA damage, inflammation and other biological alarm bells that are known to precede a tumour.
In one study, published in the journal Proceedings of the National Academy of Sciences, mice were exposed to vaping aerosol for 54 weeks, and were found to develop lung and bladder cancer much more often than their non-vaping counterparts.
The evidence on cancer and vaping, while based on lab studies, ‘is robust’ says Professor Mokbel – but he admits more research is needed to assess the impact of e-cigarettes on cancer rates.
2 …and for hearts
Once inhaled, the nicotine in e-liquid rapidly enters your bloodstream from your lungs, and causes your body to release adrenaline, a hormone that raises your pulse, blood pressure and breathing rate. A typical 20mg/ml disposable vape, with 40mg of nicotine, is equivalent of smoking one or two packs of 20 cigarettes.
According to Julie Ward, a senior cardiac nurse at the British Heart Foundation: ‘Nicotine is a problem for people with heart disease. It raises the heart rate, contradicting the goal of most treatments. If you have heart disease and are using nicotine replacements, such as vapes, speak to your GP first.
‘There is growing evidence that e-cigarettes can be a useful tool to help smokers to quit, and that, in the short term at least, they’re less harmful to cardiovascular health than tobacco cigarettes.
‘But this does not mean they are risk-free. They should not be used by those who have never smoked.’
Chris Pepper, a consultant cardiologist and clinical director of Cardio-Respiratory Clinical Service Unit at Leeds General Infirmary, told Mail+: ‘I always recommend that patients quit smoking and vaping nicotine for the sake of their heart health,’ adding that nicotine is associated with inflammation and damage to cells, known precursors to raised risk of cardiovascular problems.
Separately, research presented at the American Heart Association conference last October showed that e-cigarette users regularly exposed to nicotine consistently performed worse than non-vapers on treadmill tests designed to predict heart disease risk — with effects similar to those seen with cigarettes.
3 …and your brain
Our brains appear to be highly sensitive to the effects of e-cigarette chemicals, especially nicotine.
Vaping is linked to mental fog, according to two studies from the University of Rochester Medical Center in the US, published in Tobacco Induced Disease and Plos One in 2020. These studies found that both adults and children who vape were more likely to report difficulty concentrating, remembering, or making decisions than their non-vaping, non-smoking peers – with children more likely to experience mental fog if they started vaping before the age of 14. These were the first studies that showed brain effects of vaping in humans.
However, the authors pointed out that the studies only showed a link and did not prove causation – it could be that people who report mental fog are simply more likely to smoke or vape – possibly to self-medicate.
4 …and for your gut health
The gut wall prevents harmful microbes in the digestive tract migrating into the bloodstream. A study published in the journal Science in 2021 found that the chemicals in nicotine-free vape liquids could disrupt this protective barrier, leading to a problem called ‘leaky’ gut, which in turn can lead to chronic inflammation.
‘Such inflammation can contribute to a variety of diseases and conditions, including inflammatory bowel disease, dementia, certain cancers, atherosclerosis [hardening of the arteries], liver fibrosis [thickening and scarring of liver tissue], diabetes and arthritis,’ said Aditi Sharma, an immunologist at the University of California, San Francisco, involved in the research.
The findings were based on lab studies with human gut cells and then mice, with the cells exposed to vaping liquid intended to mimic the amount used by a ‘chronic’ vaper.
‘We found that vaping adversely affects the gut by causing inflammation, primarily by attacking the tight junction proteins, the guards that keep the cells of gut tight and in place – this eventually causes a leaky gut, which allows easy passage of its constituents into bloodstream. Vaping triggers something like a more severe form of IBS,’ she told Mail+.
5 …and for your immunity
Worrying findings published in 2024 in the Journal of Allergy and Clinical Immunology found that inhaling e-cigarette smoke could damage neutrophils: When bacteria or viruses enter the body, neutrophils in the blood are one of the first immune cells to respond. The findings are important as previous research has shown that damage caused to neutrophils by cigarette smoking can lead to long-term lung damage.
Researchers from the University of Birmingham took blood samples from healthy donors who had never smoked or vaped – their neutrophils were then exposed to 40 puffs of unflavoured vape vapour (an amount previous studies have shown is a low daily exposure). The neutrophils remained alive but were stuck in place, rendering them incapable of effectively tackling threats to the body such as to E.coli.
Dr Aaron Scott, associate professor in respiratory science at the University of Birmingham and lead author of the study, said: ‘We found that after short, low-level exposure to e-cigarette vapour, the cells remain alive but can no longer move as effectively and are unable to carry out their normal protective functions.
‘Interestingly, vapour from e-liquids which did not contain nicotine also had the same negative effects as vapour from e-liquids which did contain nicotine.’
6 …and for your teeth and gums
The nicotine in vapes can stain your teeth and lead to bad breath, gum disease, receding gums and even oral cancer, suggests Meryvn Druian, a dentist at the London Centre for Cosmetic Dentistry.
‘Nicotine causes vasoconstriction of blood vessels in the mouth and reduces oxygenated blood reaching the gums,’ he explains.
‘Over time, this can lead to tissue receding back, which can lead to tooth loss.’
A recent review of studies published in the journal Medicina concluded that ‘there is ample evidence establishing a connection between vaping smoke and an increased risk of developing gingivitis and periodontal disease. The use of the vape pen [ie, device] can introduce certain bacteria that contribute to the development of oral diseases in our body. In addition, there are studies that suggest that quitting vaping could be associated with an improvement in oral health’.
A selection of vapes on sale in a shop in Halifax. Some 4.5million Britons now use them
‘The mouth needs a healthy balance of bacteria – and vaping can change this,’ Dr Druain told Mail+.
And e-cigarette users experience similar DNA changes to specific cheek cells as smokers, according to a new study led by researchers at University College London and University of Innsbruck published by Cancer Research. The lead author, Dr Chiara Herzog, said: ‘This is the first study to investigate the impact of smoking and vaping on different kinds of cells – rather than just blood.
‘We cannot say that e-cigarettes cause cancer based on our study, but….[the changes the researchers observed] are associated with future lung cancer development in smokers.’
7 …and for your fertility, both in women and men
Women should give up vaping if they are hoping to become pregnant, suggests a study by University College London presented at the Fertility 2024 conference in Edinburgh in January.
Analysis of blood samples from 8,340 women revealed that those who vaped or smoked tobacco had lower levels of anti-Müllerian hormone, which indicates how many eggs women have left in their ovaries.
The study’s author, Dr Helen O’Neill, a lecturer in reproductive and molecular genetics, said women should be advised to quit to avoid undermining their chances of getting pregnant.
Dr Nye adds: ‘Nicotine disrupts the hypothalamic-pituitary-gonadal axis, which regulates reproduction and fertility, ultimately impacting on the hormones controlling the reproductive system including follicle-stimulating hormone, luteinizing hormone and cortisol.’
Also, nicotine is known to be ‘a powerful vasoconstrictor, which means it causes the blood vessels to contract, and that can impair erectile function, and disrupt the blood flow to the uterus’, he adds.
‘Although human studies are lacking currently, animal studies show impacted embryo development, damaged sperm DNA and damaged testes due to the flavouring chemicals in vapes.’
8 …and for your bladder
Studies have shown that the heated aerosols contain thousands of chemicals, including arsenic and lead, nickel, formaldehyde, and benzene (a toxic compound found in petroleum). At least 63 toxic or carcinogenic biomarkers were identified in the urine of e-cigarette users, including those linked to bladder cancer. In one study, mice exposed to e-cigarette aerosol for three months developed carcinogenic DNA changes in the bladder and lungs.
Evidence shows that around 45 per cent of all bladder cancer cases are linked to smoking but there is still no definitive evidence linking vaping to bladder cancer.
‘Effectively, the toxins from cigarette smoke and elsewhere are absorbed through the lungs and broken down in the bloodstream,’ says Hugh Mostafid, a consultant urological surgeon at the Royal Surrey County Hospital, explaining the potential mechanism. ‘If not absorbed by cells, these are eventually eliminated from the body in urine via the kidneys. Urine contains toxins in high concentrations and these CAN sit for a prolonged period of time, up to 5-6 hours in the bladder, irritating the bladder lining.
‘Over time, this can lead to mutations in the cells which then become cancerous.’
9 …and for your skin
Smoking has been linked to a number of skin conditions including acne, rosacea, hyperpigmentation, and fine lines or wrinkles. While there is less data about vaping, nicotine in vapes is the main concern, according to consultant dermatologist Justine Hextall, who is based in Arundel in West Sussex.
‘Nicotine constricts blood vessels and reduces blood flow to the skin which means that less oxygen reaches the cells and essential nutrients are in shorter supply. This all contributes to premature ageing. Nicotine also decreases collagen production, leading to decreased skin elasticity and more visible wrinkles.
‘Some people may be allergic to additives in vape e-liquid which can cause contact dermatitis,’ Dr Hextall told Mail+.
The evidence for smoking being linked to acne (thought to be because it triggers inflammation) is mixed – while a small study published in 2015 found that smokers, especially males, have a higher risk of developing acne, a larger review of studies in 2021 ‘found no significant difference in acne between people who vaped and non-vapers’, she says.
10 …and it could be bad for your muscles
Most e-cigarette products contain nicotine, which has been shown to have negative effects on muscle growth and physical performance. ‘Nicotine has been linked to an increase in myostatin, a hormone that inhibits muscle growth, reduces the strength of the muscles and prevents the toning of muscles,’ says Dr Nye.
‘It’s been known since the early 2000s that nicotine levels directly influence muscle growth and protein formation, as a result partly of the inflammation caused and it’s highly likely that vaping will follow suit.’