The harder you suck, the greater the risk

KUALA LUMPUR: In the battle against smoking or vaping-related health risks, quitting the habit is the most impactful strategy.

However, considering a change in inhalation habits could serve as a crucial initial step toward lowering the risk of developing severe smoking or vaping-related illnesses.

The Health Ministry told the New Straits Times that a higher risk is associated with deep-inhalation smoking or vaping compared to lower inhalation.

Its Disease Control Division deputy director Dr Noraryana Hassan said this when speaking on the need for public awareness regarding the potential dangers of e-cigarettes.

"Sometimes, individuals inhale deeply (while vaping), significantly increasing nicotine intake. This deep inhalation can hinder proper absorption in the lungs.

"We encountered a case a few months back involving intoxication due to inhalation. In the case of small children, their lung surface area is smaller than that of adults.

"When they inhale, they end up with more nicotine inside their system compared to adults, leading to acute side effects.

"For adults, the consequences may be chronic, affecting heart rate and other cardiovascular aspects," Dr Noraryana told the New Straits Times in an exclusive interview with "Beyond the Headlines" podcast recently.

She shared that the majority of the e-liquids on the market consist of just four ingredients: nicotine, propylene glycol (PG), vegetable glycerin (VG), and flavours.

Propylene glycol and vegetable glycerin are the two ingredients that make up the majority of any e-liquid, while liquid food flavours such as the ones found in the market from vanilla to strawberry shortcake, are concentrated in their original forms.

PG is a common additive in food; also used to make things like antifreeze, paint solvent, and artificial smoke in fog machines. While VG is a clear, odourless and sweet-tasting liquid derived from vegetable fats that is added to food, cosmetics and pharmaceuticals.

She said while PG and VG are safe for consumption, inhaling them can pose risks to the respiratory system.

"Many users are unaware that heating these substances breaks them down into various chemicals.

"Contrary to cigarettes, which clearly produce carbon monoxide and tar when burned, the issue with vaping lies in the lack of awareness regarding its chemical content and potential health implications.

"Understanding the act of vaping involves recognising the complexities of the substances involved and the chemical byproducts released during the heating process. This awareness is crucial for users to make informed decisions about their health."

Traditional smoking, she said, is combustible, whereas vaping is a distinct method that doesn't involve burning tobacco; instead, it employs heating.

"When heated, it avoids producing carbon and tar but introduces various other chemicals, known as volatile organic compounds (VOCs), posing potential health risks."

These include acrylamide, benzene, and propylene oxide. VOCs are in thousands of daily use products, including paint, varnish, wax, and various cleaning, degreasing, and cosmetic products.

She also noted higher risks of smoking- and vaping-related illnesses with an increasing duration and frequency of the habit.

"If you are an occasional smoker or vaper, you are inhaling without dependence. However, for heavy or regular smokers, the craving for nicotine intensifies.

"The difference lies in the frequency of use – occasional smokers are not considered addicted. Scientifically, when smoking, nicotine enters the brain through receptors, producing the pleasure hormone dopamine.

"Occasional smokers or vapers have fewer receptors compared to addicted individuals, whose receptors multiply with consistent use.

"Occasional smokers might have one or two cigarettes a day, taking only a few puffs, while daily smokers exceed 10 cigarettes or 20 puffs per session."

Nicotine, she said, doesn't just lead to addiction as numerous studies highlight its association with various health effects.

"Nicotine can increase heart rate, leading to cardiovascular issues and impacting overall heart health.

"When you smoke, you become addicted to nicotine, scientifically known as nicotiana tabacum. Over time, the craving for more (nicotine) intensifies. A single cigarette contains over 4,000 chemicals."

"It's crucial to recognise that the concern goes beyond nicotine's addictive nature. Simply reducing nicotine levels doesn't guarantee prevention of addiction or avoidance of nicotine's side effects. The quantity or level of nicotine is not the sole factor at play."

Dr Noraryana said vaping may also increase a person's risk of developing high blood sugar, potentially leading to prediabetes, and ultimately type 2 diabetes.

This, she said, is due to two key ingredients - propylene glycol (PG) and vegetable glycerin (VG) - containing sugar.

"At times, the sweet aroma and taste experienced during vaping can be attributed to these ingredients.

"While there is a study suggesting that vaping might increase blood sugar, there isn't currently specific research establishing a correlation between diabetes, vaping, and elevated blood sugar levels."

A 2022 study by Johns Hopkins researchers shows that e-cigarette use may increase a person's risk for high blood sugar and prediabetes. The study determined that those who vape have a 22 per cent increased risk of developing prediabetes compared to those who do not.

Dr Noraryana noted that upon hearing about new harm reduction methods, people are inclined to listen and consider making a switch.

This, she said, was a major reason why many smokers aim to transition from smoking to vaping, often unaware that vaping itself poses health risks.

"E-cigarettes are not risk-free, and they can lead to side effects like throat and mouth irritation, headaches, coughing, nausea and even cardiovascular diseases.

"Despite claims that e-cigarettes are a safer alternative, they typically contain additives, nicotine and other chemicals known to be harmful."

She also shared that the Health Ministry has to date recorded 14 cases involving of Malaysian vape users aged 30 to 35 who suffered from E-cigarette or Vaping Product Use Associated Lung Injury (EVALI).

As for another medical condition known as 'Popcorn Lung', a rare condition that results from damage of the lungs' small airways, she added that the ministry has yet to receive any information from healthcare providers.

Quitting becomes challenging due to the heightened craving for nicotine, explained Dr Noraryana.

"Excessive smoking or vaping causes a substantial growth in brain receptors, making it difficult to quit.

"To overcome this, Nicotine replacement therapy (NRT) that comes in the form of gum can help lower dopamine levels and eventually aid in quitting," she added.

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