Welcome to Q and A with Dr. K, a podcast by Mountain Pacific Quality Health, where we sit down with Dr. Doug Kuntzweiler and get your health questions answered, because on Q and A with Dr. K, the doctor is always in. Hello, everyone. This is Beth Brown, your host, and I'm pleased to announce we all get the same two for one special that we had on a previous episode. As we are joined by two
Dr Ks. Today we have Dr. Doug Kuntzweiler, who is Mountain Pacific's chief medical officer and also gives great advice, talk to us about all things medical. And joining us is Dr Tiffany Kniepkamp, who consults with Mountain Pacific and is an emergency medicine extraordinaire doc. And so we are so fortunate to have both of these experts with us today to talk about a topic that I think is big and a lot of people have confusion over, and that is vaping. So thanks so much for being here.
Thanks for having us.
Here's the short and sweet question for today. Is vaping safer than smoking? So the question is short and sweet. I don't know if the answer is short and sweet, but before we dive into that, let's talk about the definitions of those two things. So I think when we talk about smoking, everyone knows we're talking about cigarettes or pipes or whatever you're using to ingest commercial
tobacco. That is not just tobacco, it has lots of chemicals and other bad things in there that we know causes great risks to all kinds of issues with our health vaping, though, I'm not sure if everybody knows what that is, or if people have been exposed or seen vaping. So let's talk about that. What is vaping?
I can answer this one. This may be the only one I can answer. So I better jump in. Smoking means igniting some flammable product, most commonly tobacco, and so that's cigars and hookahs and cigarettes. And there are other ways to get the nicotine other than tobacco, as in gum or a patch that goes on your skin, or chewing snuff. All those are ways of using tobacco. But vaping is heating up a liquid of some sort, and it varies as to what the liquid is, and having
that create an aerosol. Aerosol is just tiny droplets that float in the air and then you inhale that into your lungs. So the liquid usually then also contains some addictive substance like nicotine, or sometimes a marijuana product, cannabis oil, of one kind or another.
So I'm glad you went back to talk about smoking, because it wasn't as simple as what I said. There is more to it than just cigarettes or pipes. So I'm glad you talked about that. And then vaping involves a liquid. And so as you already touched on, a lot of people just think, Oh, it's just, it's vapor, water, but what are we talking about? What's in that liquid?
Yeah, so that's a very common misconception. A lot of people think it's just flavored water vapor, much healthier. But in reality, what you're inhaling is actually still a mix of chemicals. The liquid in E cigarettes contains nicotine, obviously, but also chemicals like formaldehyde, which you might associate with things like smoke or wood burning, not something you necessarily want in your lungs. So it looks harmless, but it's not as simple as just water vapor.
And the other tricky part about vaping too is you don't always recognize what the devices look like that people are using to vape.
Yeah, they've they've evolved a lot. It started back in the early 2000s, I think, around 2005-2006 as an e cigarette, and it looked like a cigarette had a little battery in it, had a little bit of the juice, which was usually a propylene glycol or ethylene glycol, and then it had the nicotine, and the battery heated a little element that made that juice vaporize, and then it would kind of cool down as you inhaled it and turn into a an aerosol, little droplets of
liquid. And as I said, then that device evolved pretty rapidly, and now they look like all kinds of things. Some of them are rechargeable, some of them are disposable. Some of them are reusable. They all have some sort of a heating element that's charged by a battery, and then they have a little container or reservoir where the juice is, and then whatever they're going to add to it, typically nicotine or marijuana oils, but what they actually look like is all sorts
of different things. I'm told that one of the favorite ones of teenagers is something called the jewel, j-u-u-l, because it looks like a flash drive. So they can carry these around the school, and the teachers look at it and think, Oh, there's a very studious child taking notes and putting it on his flash drive, when, in reality, it's it's his vaping device.
Exactly, Doug. That's part of the problem. They can be really hard to spot. They're coming up with new things all the time. They can look like pens, USB drives, like you said. That's part of the thing that's become very popular with teens is that they're very easy to carry, very easy to hide, very discreet parents teachers may not even recognize what it is that they're looking at. They're designed to be very sleek and easy to carry around so they
don't stand out. And for example, recently, I got a call from our school principal because my daughter had found this blinking toy on the playground, and they sent me a picture of it, and it was the battery from a vape pen. And it was even hard for me to tell exactly what it was. I had to look up the brand, and then found out it was a battery from a vape pen. So we had a very honest discussion with my six year old of what you do and do not pick up on the playground.
Yeah, but they're very discreet and made to be that way.
Yeah, when we talk about the difference between vaping and smoking, it's what we're inhaling. Is that the major difference, regardless of the device that we use to put that into our lungs, or what is really the difference between vaping versus smoking?
Well, I think to me, one of the biggest differences is we've had a relationship with tobacco since 1600s and before, and we understand in this day and age what the components of tobacco smoke are and what the consequences of tobacco smoke are. In contrast, we have a not hardly even a decade and a half of experience with vaping, and so we don't know really what the consequences of this are. It's too soon for us to have good
information. We know that smoking is horrible for you from any number of standpoints, cancer being a prominent one, but also heart disease, stroke, vascular disease of all kinds and many other kinds of problems. It's associated with almost every kind of cancer you can think of. We don't know yet about vaping. There are studies that show that it's less harmful than smoking, but as I said, we don't have a lot of experience.
Those studies are using relatively small numbers of patients, and I don't think we fully understand it yet at this point, but I would say if it's safer than smoking, it can't be by much. And I think history will probably prove that to be true.
Exactly Doug, and I think I would say too that, so a big difference. And I know we've kind of hammered this already, but with smoking, you're burning tobacco. You're actually igniting something which creates that smoke that contains all kinds of harmful chemicals, tar, carbon monoxide, all of that. And with vaping, you're heating up a liquid. So you're never actually burning anything. You're heating it up and turning it into an
aerosol without the burning. So that means you're not getting all those combustion related toxins, but still, like Doug said, it doesn't mean it's safe. There's still harmful substances in the aerosol, and actually, the flavoring, the fruitiness, the mintiness, even that, is a chemical that your lungs are not used to inhaling, and so it
still causes a lot of issues. So people think vaping is healthier and it is technically than smoking, but it's still very far from risk free, both put bad things in your lungs that don't belong there.
So with as relatively new as vaping is, are we starting to see risks or the cons that come out of vaping? Or we honestly don't know yet?
No, we absolutely have seen risks. We've seen people who get scarring on their lungs from it.
In 2019, you may remember, there was a big outbreak of severe lung disease from people who were vaping, and it was thought that they probably got a vaping device that had a toxin in it that was related to vitamin E, and it caused severe scarring and damage to the lungs that there were about 2800 hospitalizations, and out of those people, 68 of them died that was related to one particular type of vaping device that then was taken off the
market. But there are still people who are developing a pneumonia like syndrome, where they get damage to their lungs and get scarring. So certainly is not as safe as some people maintain.
It still has nicotine. So we know a lot about nicotine, and so you're still getting the nicotine, which is one of the most addictive substances, comparable to like heroin and cocaine. It has been known to disrupt brain development, which is why this is such a huge concern, and the teens that are using it a lot now and it also it increases your heart rate and your blood pressure and nicotine also
constricts blood vessels. So when you combine your heart rate going up, your blood pressure going up, your blood vessel constricting a bit, that increases your risk of heart disease. And so, ot's the same in smoking or vaping, so you're still having those risks, as well as the respiratory illnesses that doctor cooner
talked about. It also has been shown to increase anxiety and depression and impacts your memory and cognition and your ability to form those memories and that brain development, and we know that even in pregnant women, that it affects the brain development and the oxygen flow to the fetus. And so I think that's why this is such a big concern for teens right now, because, oh, I can't remember exactly the numbers, but high amount of teenagers are using it currently, and it's going to
affect their brain. And we're already dealing with a lot of other concerns with depression and suicidal ideations and all of that, and now we add this into it, and it's just another stressor that is not good.
So you mentioned the nicotine, and that was a question that I was going to ask as well, because if there's nicotine in there, then that means vaping is addictive, just like smoking is. And if people are trying to use vaping to quit smoking, how effective is that if they're still getting the same stuff, just in a different way? So can you talk about that a little bit?
Yeah, it's pretty much a shell game. There was one small study reported to show that vaping was a good way to quit smoking, and that might be true. Some people who use vaping were able to stop smoking cigarettes, but then they were unable to stop using the vaping because, as Tiffany said, it's still nicotine, and nicotine is highly addictive. Then there are people who use it, and they wind up addicted to both. They smoke cigarettes when it's convenient to do that, and they vape when
it's not. So it's it's a shell game. We haven't really made anything that's a superior product. I've seen numbers and this kind of goes to one of the things that alarms me about it is the marketing that goes on. But I've seen numbers that up to a half a million middle schoolers are vaping, and in the high school, it's it's more, it's over a million, maybe one and a half million high school
kids are vaping. Nationwide, I've read numbers like one in 20 Americans, they but the marketing is aimed especially at young kids with all these flavors, and they have cool names and they have cool shapes, and if you're going to be one of the cool kids, you have to vape.
One other thing I was going to say about that is a big argument I hear a lot from the teenagers in the emergency department when we're talking about vaping, is nicotine is not a cancer-causing agent, it's the tobacco, it's the tar, that's the carcinogen.
But is that true? Yes, technically, nicotine is not classified as a carcinogen cancer-causing agent, but it's an indirect carcinogen because it enhances your body's response to those cancer-causing agents found in either cigarette smoke or all of the fruity smells and the formaldehyde and all of that, it increases your body's rate at turning those into
cancer cells. So while it doesn't directly cause the cancer, it makes your body more likely to develop into cancer have those cell damage, abnormal growth that just kind of escalates that.
And I recall that chewing tobacco or dipping snuff is associated with cancers of the tongue, cancers in the mouth and throat. So that's, you know, that doesn't require burning. It's the other elements in the tobacco as well as the nicotine, that are leading to those cancers. So all of this is addictive, whether teenagers want to try to talk about what's really going on in there or not.
And so how do they how do you know if you become addicted to vaping? Are there symptoms that people begin to show? Do people have withdrawals if they try to quit? Can you talk about the addictive properties there and how to handle that?
It's pretty similar to all of your other addictions. And if you find yourself craving the vape, using it more frequently, just escalating how often you're using it, or if you don't have it, frustrated, irritable, anxious, when you don't have it and you just want to go somewhere to use it. That's a big sign. You try to stop, and you just can't. Also a sign, and if you're prioritizing vaping over other activities, like, Oh, I could go to the basketball game, but I'm going to stay back
so that I can vape. That's also another sign that you could be addicted.
How soon in the morning when you wake up do you take your first vape or drink your first beer or smoke your first cigarette, that's an indicator that probably addicted, if that's the first thing you do in the morning.
So as far as getting people help if they do become addicted or they find those cravings are more than they can handle, because this is more of a teenager or tween issue. What should parents be looking for? How can they tell if their child is vaping? And then how can they get their teen or pre teen help?
Well, I think it's probably harder to detect than smoking, because the smoke tends to linger and causes an odor lingers on your clothes. I don't have a lot of experience with vaping, but my suspicion is that it's much easier for kids to hide. I mean, you can sit down and have an honest
discussion with your kids. Kind of depends on what your relationship with your kid is like to begin with, and they will probably make the argument to you that it's safer and it's not addictive and doesn't cause cancer and all those things that we have talked about, but I think where you begin is with having an honest discussion with them. And you know, if you see them vaping, you might see them in a crowd of their friends, and they're all vaping, then that would be a good point to
initiate the discussion. You've got younger kids, Tiffany. What do you - how are you approaching this?
Well, I also remember high school and college and my parents being very strict and trying to hide certain things from them, so I might have a slightly different view on some of this, but things to really look out for, and things that I'm going to look out for as my kids get older is it's a very pleasant, strong fruity smell. So if you're starting to notice kind of an unusual fruity like a fruit you can't quite place your finger on, but it smells good. That's a
good indicator. Or minty smells, but they're tending to go more towards the fruity smells. In the teens, some kids might start using like a very sweet smelling perfume or a body spray to try and hide the fact that it is on their breath and on their clothes, that that root smell is there, or lotions asking to buy, like really fruity lotions, kind of out of the blue or shifting might be a time to have a little discussion looking for those little, small, discrete devices.
I mean, if you have a very smart child who's, you know, studious, it may not be unusual, but if all of a sudden the kid who really could care less about school is carrying a pen everywhere with them, might have some questions, any changes in behavior. And just knowing who your kids are hanging out with, if all of their friends are vaping or if you smell it on them, then it would be a time to
have a discussion. And I think just having that open discussion with them about the risk that, yes, maybe they're telling you this does not cause cancer, but it's actually all of the additives in it that can cause cancer, and the nicotine is very addictive, and actually can kind of be that gateway into smoking
when you're an adult. There's a few studies, one out of Australia, that talked about it kind of being a gateway into smoking, and the likelihood that they smoke in adulthood is very high if they started vaping in their teens.
This is tough too, because in the past, when we've talked about addictions, we've said, you know, you can't stop until you make the decision you're ready to stop. And even that is hard. People tend to not be able to quit the first time they try, and it takes a couple of times before they are able to quit smoking, for example, with teens, if they're not ready, but parents are trying to intervene with this habit. I mean advice for parents, first off of okay, maybe the teen admits, yes, I
have been vaping. What are the what are the next steps?
The advice on quitting vaping is very much the same as the advice on quitting smoking. And as we mentioned, nicotine is is highly addictive, and it's not at all easy to quit. There are medications that help alternative sources of nicotine, like the skin patch and the gum, they've been shown to be pretty helpful. And then there are some new medications, Chantix being one that helps cut down on the
craving. But it's true, you do have to want to quit, and I think it that's that's very difficult to give people who know everything at that stage in their life. While we're confessing things, I smoked when I first got out of high school and I went in the military because everybody smoked. It was the first privilege they gave you in basic training. And so I smoked for the four years that I was in the military. That was a long time ago, and there really weren't any good adjunctive aids
to quitting. If you wanted to quit, you either tapered off or you quit cold turkey. And I chose to go cold turkey. Well, I grew up in a community where, pretty much if you didn't smoke, there was something odd about you. All of my parents and grandparents smoked, and so everybody in my generation grew up with secondhand smoke and didn't think a thing about it. You smoked in restaurants. You smoked on airplanes. You smoked
everywhere. When the surgeon general's report came out, people kind of poo-pooed it, but it stuck in the back of their brain. And gradually people, as they got older and they started feeling the effects of tobacco smoking, they started cutting down. And that's another thing that's kind of disconcerting
about this vaping. We have made it unsociable to smoke in public places, but vaping is sort of creeping back into being socially acceptable and publicly acceptable, and I think that's a rather alarming trend.
There are several programs specifically aimed at helping teens quit vaping, which can also go towards adult but they do have specific ones for teens, the CDC and then the American Lung Association have great support materials. They have a quit line, some online tools, talking to your doctor. You don't have one, get one, but talking with them, they can have some resources. And then, in the age of technology, there's an app
for that. There's actually a couple different apps that can help track your progress and give support for quitting. So I feel like that's a big thing that teens could utilize. You download the app on your phone. It has motivations. It has reasons to quit. You can track how many times you vaped that day, everything on it. And so I feel like that's probably the best resource. And what I would offer to a teenager who is addicted or having a hard time giving up vaping is download the
app. It's something that's very easy, and it can track their progress and give a lot of more motivational items to help them than the adult who doesn't know anything, right, right? does.
We definitely trust technology more than we trust our parents. That's very true. So I think we've answered this question, but just to be crystal clear, is vaping safer than smoking?
My answer to that is we simply don't know. There's some early evidence that shows it, it's probably less harmful. You have to remember, smoking is incredibly harmful, so there's some early evidence that vaping is somewhat less but neither one of them have a good end. It still comes with significant risks. We don't know them all as of yet, but the research is headed towards there are a lot of risks associated
with it that we don't know. So in a way, yes, it's safer than smoking, but it's like the safer of the bad. Oh, and as an added attraction, there have been reports of the batteries exploding and causing significant burns.
Oh my gosh, yeah.
Yes.
So is it pretty fair to say, unless your doctor has given it to you, maybe just don't put stuff in your lungs?
Yeah, exactly. I always thought how counterintuitive it is, and I was a smoker, but how counterintuitive it is if the house were burning down around you and you smell smoke, you get out of the house, you don't sit there and inhale deeply and enjoy the rush. You know, it just is so counterintuitive, but, but again, what that really gets to is how addictive nicotine is. Common sense would tell you this is a stupid thing to do, but nicotine would tell you, do it, do it, do it. Do it more.
Yeah, 'cause there's so many things that people think they get out of it with relaxing. I need it to wind down after the day. It helps me think there's so many things that people rely on, even behaviorally, because that addiction has them.
Yeah, and Beth, I would say too. On that note, it is often said, Right? Nicotine, it's my stress relief.
It's my stress reliever. I need this to get through my day, but it actually worsens anxiety and depression, because you're constantly going through this slight withdrawal, which increases your stress level, and then you start to adapt to the nicotine, and then you need more, and you actually have difficulty experiencing pleasure naturally anymore, because you've kind of taken that cycle away that feedback, and so in the long run, it makes things a lot worse and worsens depression
and anxiety. But we do hear that argument a lot, that it helps with it, but it's short lived.
Well, you provided some great resources. We'll make sure we get those put with this episode so folks can learn more or find some resources. Any final note or message we want to leave our listeners with today? Tiffany, you want to start?
Definitely check out the site for the app. If you are addicted to vaping, know that it does have some issues, and we're learning more and more about them. Be involved in your teen's life and in their friends and know their parents, because that'll be very helpful in those discussions with them, whether they listen or not, download the app on their phone and then they have it and they might look into it. Those are
the biggest things. Is vaping safer than smoking, kind of it is slightly safer, but it's still bad, and it still leads to a lot of long term effects. And we do see that in the medical world, and it leads to so many more effects than people realize. It affects every system in the body, highly addictive. And so it's very helpful. If you can give it up sooner than later, or better yet, don't start.
Our lungs were adapted to breathe fresh air, so stick with that.
Perfect. It's short and sweet. I like it. Dr K. Thank you very much. Thank you both for being on today. Thank you so much for listening. We'll put some resources with this episode. If you would like to learn more about vaping and how to quit, we'll have those resources for you. And if you have a question for Dr. K or Dr. K, please email us at QandAwithDrK@mpqhf.org and we'll make sure that email address is right along with this episode as well. Send us your questions.
The doctor is always in, as we like to say, and we'd love to help. Thanks. Be well.