Fact Checked

This Dr. Axe content is medically reviewed or fact checked to ensure factually accurate information.

With strict editorial sourcing guidelines, we only link to academic research institutions, reputable media sites and, when research is available, medically peer-reviewed studies. Note that the numbers in parentheses (1, 2, etc.) are clickable links to these studies.

The information in our articles is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

This article is based on scientific evidence, written by experts and fact checked by our trained editorial staff. Note that the numbers in parentheses (1, 2, etc.) are clickable links to medically peer-reviewed studies.

Our team includes licensed nutritionists and dietitians, certified health education specialists, as well as certified strength and conditioning specialists, personal trainers and corrective exercise specialists. Our team aims to be not only thorough with its research, but also objective and unbiased.

The information in our articles is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

FDA Cracks Down on the E-Cigarette


Electronic cigarette - Dr. Axe

The electronic cigarette is becoming more and more popular, and much of the appeal is based on ideas that it causes no harm to your health. As science catches up with the trend, though, it’s clear e-cigarettes don’t come without risk.

As more studies link e-cigarettes to issues like MRSA and carcinogenic and asthmatic aerosols, the Food and Drug Administration (FDA) decided to step in and take major action. In May 2016, the FDA made an unprecedented move to crack down on the largely unregulated vaping industry, banning the sale of them to children under 18. The agency’s Center for Tobacco Products released its final rule giving the FDA authority over all tobacco products, including not only e-cigarettes, but also cigars, little cigars, hookah and pipe tobacco.

The American Lung Association hails the decision as a long-awaited step to protect public health, particularly since e-cigarette use is skyrocketing among middle school and high school students. The ruling gives FDA authority over the sales, marketing and manufacturing of all tobacco products.

The FDA will now have authority over all e-cigarettes, meaning the agency can halt e-cigarette manufacturers from making unproven health claims and marketing to kids. The rule sets the nationwide minimum age of sale 18 years of age and prohibits distribution of free samples of e-cigarettes and all other tobacco products. (1)

While this is undoubtedly a good thing, it should be interesting to see what the FDA decides given the results of a recent study out of England. According to the research results of a 10-year smoking study, “The increasing prevalence of electronic cigarette use in England has paralleled an increasing successful quit rate, a study in the British Medical Journal shows. An editorialist says causation ‘remains unclear,’ however.”

In addition, the results show “quit rates went from roughly 11 percent to 19 percent as the prevalence of e-cigarette use among smokers increased from negligible amounts to 21 percent by the end of the study. Over that time, the use of prescription-based nicotine-replacement therapy dropped significantly.” (2)

Another British Medical Journal study highlighted that 49.3 percent of recent quitters previously used e-cigarettes. That 2017 study also indicated that 65.1 percent of e-cigarette users were more likely to attempt to quit, versus the 40.1 percent of non-users. (3)

Is the Electronic Cigarette Flavoring Really Harmless?

There are thousands of varieties of flavored electronic cigarettes in the United Sates. In order to create these flavors, manufacturers use flavoring compounds such as diacetyl, acetoin and 2,3-pentanedione, which can wreak havoc on the respiratory system.

Here’s a quick explanation of the three most commonly used flavoring compounds in the electronic cigarette:

Diacetyl — Diacetyl is a yellow/green liquid chemical that is used to achieve a buttery flavor. Many studies have found that industrial exposure to diacetyl has been associated with bronchiolitis obliterans, a severe respiratory illness producing fibrosis and obstruction of the small airways. Spirometry abnormalities (fixed airflow obstruction) and respiratory symptoms have also been linked to diacetyl exposure. (4)

Acetoin — Acetoin is another compound that is used for its buttery flavor. It is one of the 599 additives used in cigarettes, and it is present in the electronic cigarette, too. Acetoin is an irritant to the eyes, skin, mucous membrane and lungs; it is toxic when inhaled over time, even in small amounts. It is one of the compounds that is under review by the National Toxicology Program, which states that acetoin metabolizes similarly to diacetyl and increases the risk of oxidative stress and lung damage. (5)

2,3-Pentanedione — This is a controversial flavoring agent used in electronic cigarettes because the National Institute for Occupational Safety and Health reported that inhaling the compound causes respiratory tract epithelial damage and fibrosis to lungs in animal studies. It also causes genetic changes in the animal’s brain. (6)

In the past, food industries that expose their employees to flavoring chemicals have received a lot of attention because of the increased risk of developing lung disease in some workers. A popcorn production plant in Missouri, for example, used diacetyl to give popcorn its buttery taste. Workers routinely handled or were exposed to open vessels containing flavorings or chemical ingredients. Workers mixed several chemical ingredients, including diacetyl, in large pots and then applied heat in the production process, which increased the amount of flavoring chemicals that got into the air.

Studies conducted by the National Institute for Occupational Safety and Health found that working as a mixer of butter flavorings and heated soybean oil was associated with higher diacetyl vapor and had a lower level of forced expiratory volume in one second (an important measure of lung function) than those who did not work with butter flavorings. Employees who worked as mixers for more than 12 months displayed more shortness of breath, showed more chest symptoms and poorer lung function (this is why eating microwavable popcorn can be problematic for your health, too).  So many workers developed severe lung disease at the facility that exposure to flavoring chemicals like diacetyl became known as “popcorn lung.”

According to the Centers for Disease Control and Prevention, the flavoring industry has actually estimated that over 1,000 flavoring ingredients have the potential to be respiratory hazards due to possible volatility and irritant properties. (7)

In 2015, Environmental Health Perspectives published a study that evaluated 51 types of flavored electronic cigarettes that were sold by leading brands and were appealing the youth, including Cupcake, Cotton Candy and Fruit Squirts. Of the three most common flavoring chemicals, diacetyl, acetoin and 2,3-pentanedione, at least one was detected in 47 of the 51 unique flavors tested. Diacetyl was detected above the laboratory limit, being present in 39 on the 51 flavors. Acetoin was present in 23 and 2,3-pentanedione in 46 flavors. Researchers concluded by stating that urgent action is recommended to further evaluate this potentially widespread exposure to respiratory disease-inducing compounds through flavored electronic cigarettes. (8)

So here’s the point, don’t be enticed by the fancy and fun flavors of electronic cigarettes, especially if you were never a smoker. Although it seems harmless, you are not inhaling fresh air — you are inhaling chemicals that can affect your respiratory system and lung capacity … and it’s just not worth it.

Is the Electronic Cigarette a Safer Way to Quit Smoking?

Reaching for an e-cigarette to quit smoking isn’t necessarily a healthier option, especially considering vaping often produces carcinogenic compounds like benzene and formaldehyde. And the research is mixed when it looks at how effective the devices are in aiding people quit smoking traditional cigarettes.

Researchers found that almost all of the 2.6 million adults using the electronic cigarette in Great Britain are current ex-smokers who are using the device to help them quit or to prevent them from going back to cigarettes. The Director of Health and Wellbeing at Public Health England, Professor Kevin Fenton, said “e-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm.” (9)

On the flip-side, a study in The Lancet found using an e-cigarette only helped about 7 percent of people quit smoking. (10)

There have been few studies that investigate the biological effects of smoking electronic cigarettes. We know that some flavoring chemicals can increase the risk of developing respiratory conditions, but what about the other ingredients? If the e-cigarette contains nicotine, you are still at risk of experiencing high blood pressure and an elevated heart rate. Components of the vapor can also become embedded in the lungs, causing inflammation and leaving the lungs vulnerable to infection.

A 2017 article suggests “a single exposure to e-cigarette (e-cig) vapor may be enough to impair vascular function.” An hour of five-minute e-cigarette exposure narrows arteries by 30 percent and decreases the blood vessel’s ability to widen. In other words, exposure to the vapor in e-cigarettes in the long-run causes your blood vessels to age twice as fast compared to the blood vessels of those who are not exposed to the vapor. The negative effects of chronic use of e-cigarettes also include aortic stiffness, which plays a pivotal role in strokes. (11)

One main ingredient used in electronic cigarettes is propylene glycol, a synthetic liquid that is also used to make antifreeze and artificial smoke and fog used for fire-fighting trainings and theatrical productions. (12) Propylene glycol may be deemed safe for use in food, but who knows what effect it has when vaporized and inhaled into the lungs.

It’s true that the electronic cigarette serves as an alternative habit for people who are trying to quit smoking. But electronic cigarettes are not harmless — they contain chemicals that come with a host of health issues, especially when heated and inhaled. Consider other proven methods to quit smoking. Some of these include mindfulness meditation and group relaxation training. (13, 14)  Consider joining the American Lung Association’s Freedom From Smoking program.

Read Next: Phthalates — Dangerous Chemical Toxins That Must Be Avoided

Josh Axe

Get FREE Access!

Dr. Josh Axe is on a mission to provide you and your family with the highest quality nutrition tips and healthy recipes in the world...Sign up to get VIP access to his eBooks and valuable weekly health tips for FREE!

Free eBook to boost
metabolism & healing

30 Gluten-Free Recipes
& detox juicing guide

Shopping Guide &
premium newsletter

More Health