Let's Clear the Air: E-Cigarettes, Smoking & Popcorn Lung

I have never smoked a day in my life. I won’t begin to pretend that I even remotely understand the level of complexity associated with an addiction to smoking. I do, however, understand the public health implications, yet I still believe we should not shame or stigmatize those who smoke. Shame, guilt and fear are not effective ways to encourage people along their efforts at quitting… focusing on the positive aspects that come with quitting can be far more useful at enabling change.

From knowing people who smoke, I’ve been told that while anyone can put efforts towards changing an addictive behaviour, some levels of addiction are far more complex than others. Consider someone born to a smoker or someone who grew up in a household of smokers - the chemicals in cigarette smoke have had an influence on their brain & chemistry their entire life, well before birth. The smells can be comforting and trigger memories from childhood. I’ve been told that the immediate relief one receives from smoking is not comparable to any other addiction. For these reasons, I hope to encourage you to switch your efforts from criticism (even if it comes from a loving or caring place), to support. You may be unaware of the number of attempts someone has put towards trying to quit, along with the shame or guilt that may come with each failed attempt.

Along with the foundations of improving the quality of your diet, sleep, reducing stress and physical activity in your life, quitting smoking is the best thing you can do for your health! Smoking is a risk factor in nearly every disease and impacts every organ in the body. Think about it, many people put a ton of effort into consuming healthy food (via organic, non-GMO, wild, etc.), or they invest in clean water filters and throw money into the fitness industry (via gym memberships, yoga passes, personal trainers, workout clothing, etc.), yet we rarely hear people talk about improving the quality of the air they are breathing! Respiration is one of the largest elimination “detox” mechanisms in your body, whereby breathing is the best way to alkalize your system and rid acidity! Yes, even more than lemons, juice cleanses and teas claim to alkalize the acidity in your body, respiration is more effective! If you provide your body with clean, fresh, pure air, the health outcomes are astounding, everything from reducing stress, improving digestion and anti-aging! This is one of the reasons why yoga & meditation offers a multitude of benefits as it focuses on the breath.

While most people are well aware of the negative health outcomes associated with smoking, like I said, it is important to focus on the beneficial outcomes that can be acquired when you do stop smoking!

What are the benefits to quitting smoking that you can experience today?

Stop smoking today and you will instantly decrease your risk of developing heart disease and cancer! The benefits to quitting smoking occur even 20 minutes after quitting. Our bodies are incredibly resilient and are always working their hardest to make us feel our best (we are so lucky)! It's up to us to provide it with the building blocks it needs to heal. After you quit smoking here is how your body begins to improve:

Source: The American Lung Association

20 minutes after quitting – blood pressure drops back to normal; pulse rate drops back to normal; temperature of hands and feet normalize

8 hours after quitting – carbon monoxide in blood drops to normal; oxygen level increases to normal

24 hours after quitting – chance of heart attack decreases

48 hours after quitting – nerve endings start re-growing so your ability to smell and taste is enhanced; walking & climbing stairs becomes easier

72 hours after quitting - your body will test 100% nicotine free and over 90% of nicotine metabolites will be gone (via urinary excretion)

21 days after quitting - you will have a stronger immune system, higher energy, and improvement in sleep, a relaxed body and focused mind

2 weeks to 3 months after quitting – lung function increases 30%; circulation improves

1 to 9 months after quitting – experience a decrease in coughing, sinus congestion, fatigue, shortness of breath, along with regrowth of cilia in the lungs (cilia are hair-like projections that can clean out the air we breathe), which increases the ability for your body to manage mucous and reduce infection

1 year after quitting – risk of coronary artery disease and risk of dying is reduced by 50%

5 years after quitting – your stroke risk can be reduced to that of someone who never smoked!

10 years after quitting – your risk of all smoking-related cancers (such as lung, mouth & throat) decreases by up to 50%

15 years after quitting – your risk of heart disease and smoking related death is similar to that of someone who never smoked!

What are e-cigarettes?

Electronic-cigarettes (called e-cigarettes) are battery operated vaporizers that somewhat look like a traditional cigarette and can be smoked like a traditional cigarette, however, they contain liquid cartridges that become vaporized on inhalation and do not contain tobacco. Some e-cigarettes are disposable, whereas others contain cartridges that can be re-filled when empty. Although e-cigarettes do not contain any tobacco, tar, arsenic or other toxic hydrocarbons, they do contain nicotine, which is a known carcinogen. The amount of nicotine in an e-cigarette can be just as high as a traditional cigarette, but you are able to purchase e-cigarettes at a specific nicotine concentration, much in the same way nicotine patches can be mild or high-strength. Nicotine is a neurotoxin once utilized in farming practices as a pesticide, but has been discontinued because overexposure was fatal to farmers.

Should e-cigarettes be used as a tool to quit smoking?

There is no right or wrong answer to this question. It is important to look into the research for yourself, and decide what is best for your journey to smoking cessation. E-cigarette vapors are not benign and it is important to consider the reasons why one might switch from one addiction to another. Many of the ingredients in e-cigarette liquid cartridges in addition to nicotine include: propylene glycol, diacetyl (which I will get to in a moment), acetoin, 2,3-pentanedione, formaldehyde and other flavoring agents. Even the nicotine-free products have been shown to be damaging to cells within lung tissue and promote the adherence of pathogens within your respiratory pathway. While they do come with inherent risks, it is important to look at the research and discuss with your doctor a cessation plan that might work for you.

The U.S. Preventive Services Task Force announced that there was no evidence to support the claim that e-cigarettes are a useful tool in helping people quit smoking, yet this is the main reason why many individuals choose to use e-cigarettes in the first place. As of January 1, 2016, in Ontario it is illegal to sell e-cigarettes to an individual less than 19 years of age. It is important to note that although the use of e-cigarettes comes with risk, some people have found that e-cigarettes have been an effective tool to help them quit as they gradually were able taper down on the nicotine content, despite continuing to inhale other toxic compounds in the vapor. This is a conversation you can have with your naturopathic doctor, as there are many strategies out there to help someone quit smoking and your naturopathic doctor can tailor a treatment plan specific to your lifestyle, your triggers and help you work through the mental/emotional aspects of a smoking addiction.

What is popcorn lung?

Popcorn lung is an irreversible debilitating respiratory disease called bronchiolitis obliterans. Bronchiolitis obliterans causes scarring in small airways within your lungs leading to shortness of breath, chronic coughing and hardening of lung tissue that significantly diminishes your ability to exchange air through respiration. The reason why it is called “popcorn lung” is because it was first discovered over a decade ago among workers within popcorn processing facilities. The chemical used to make the artificial buttered "flavouring" in processed popcorn is called diacetyl, which is the same agent that causes bronchiolitis obliterans. Check out your microwave popcorn packages for the term "flavouring", "buttered flavouring", or sometimes even "natural flavouring", as the word "natural" isn't a regulated term.

Please note that the hazards recognized with popcorn flavorings can be extended to many other flavors, including, alcohol or fruit flavors found in countless other processed products. With the prevalence of chronic/systemic/inflammatory diseases nowadays one can’t help but wonder about the link to the quality of our food, air and water. It is so important to provide your body with real food, clean air and pure water - start with the foundations of health!

Can e-cigarettes cause popcorn lung? Are e-cigarettes as harmful as traditional cigarettes?

Everything always comes back to my days of phytoplankton research! When I was completing part of my thesis in San Francisco, one of the protocols we performed in our experiements utilized a chemical called diacetyl monoxamine. We used diacetyl monoxamine to extract and measure the nitrogen content of our phytoplankton samples because one metric we were assessing was whether or not the level of nitrogen affected their growth and fatty acid composition. The first day we were measuring nitrates, I was walking through the foyer towards the lab and all I could smell was buttered popcorn. The ventilation system fans were spinning on high and all of the doors were open to encourage air circulation, yet the smell was just as strong as the popcorn smell at the movie theatre! When I walked in the lab to inquire about whether someone was making buttered popcorn, our lab tech proceeded to explain that it was diacetyl monoxamine, the main chemical that causes popcorn lung, which just so happens to be the same chemical that is in the “buttered flavoring” of many popcorn products on the market. Not surprising, diacetyl is also found in cigarettes including some brands of e-cigarettes. The amount is variable and sources indicate that it doesn’t compare to classic cigarettes; however, more research needs to be done to investigate the consequences even further.

If you are pregnant, should you abruptly quit smoking?

Ever hear that if you are a smoker who is pregnant you should not abruptly quit smoking because withdrawal symptoms can stress the fetus? It is time to debunk this MYTH! It is very important to quit smoking for the health of your baby. There are no studies linking the smoking withdrawal symptoms of a pregnant mother to poor birth outcomes. As a matter of fact, smoking in any amount can cause negative birth outcomes, as it increases the risk of preterm delivery, stillbirth, low birth weight, cleft palate, sudden infant death syndrome, club foot, ADD, as well as increased overall mortality! So it doesn’t matter when you quit smoking, even if it is during your pregnancy, it is always best to avoid smoking for the health of you and your unborn baby. Furthermore, in children up to 5 years old who were born to smokers, there is a higher rate of hospitalizations from respiratory complications (including death).

Source: CDC

While this post is meant to stimulate thought and inquiry, it is important to consider that research is always changing. New studies come out all the time. Guidelines, results and recommendations are always evolving, so what you read today is old news tomorrow. Please take everything you read (including this post) with a grain of salt. Think about it, in the 1920’s cigarettes were actually recommended as good for your health by physicians! It wasn’t until the 1930’s that research began to demonstrate otherwise - thank goodness!

Research aside, no one can argue about the health benefits that breathing clean air can provide. If you can manage to get outside in nature (which has additional health benefits in itself – read here), go on a walk or take a break each day doing something you enjoy, try to focus on your breath. Try the breathing exercise listed below and see how you instantly feel better!

Breathing exercise: Inhale through your nose slowly for 4 seconds (really expanding your chest and feel your ribcage move up and your belly out), then hold your breath for 4 more seconds and slowly exale, squeezing all of the air out of your lungs and your belly (really use all of your muscles of respiration to squeeze out stale air). Repeat at least 4 more times.

I hope this post stimulated some thought. If you have any questions, thoughts or comments, please don't hesitate to ask. If you are looking to improve your health, manage stress, quit smoking and simply feel better, consider booking an appointment with a naturopathic doctor to get started.

Until next time, I wish you much peace, love, health and happiness! Have a fantastic end to February 2016!