Electronic Cigarettes: Perhaps a lesser evil, but an evil nonetheless

~ By Clemencia Rasquinha, MD ~

We’ve been getting many questions from our patients lately about electronic cigarettes. Specifically, they’re wondering whether e-cigarettes are a safe alternative to traditional cigarettes, and if using them is a good step toward quitting smoking. My personal opinion is that, when someone wants to quit smoking, we should pursue a permanent fix. I always tell my patients that the best way to quit smoking—and this is evidence-based—is to just quit, “cold turkey.” So, of course, e-cigarettes don’t go along with my philosophy! But let’s take a look at what they are and what we know about them.

Clemencia Rasquinha, MD

Clemencia Rasquinha, MD

E-cigarettes , also known as “e-cigs,” or “vapes,” are touted as a safer alternative to conventional cigarettes. They do not burn tobacco; instead, a battery-operated mechanism heats a liquid into vapor (hence, the term “vaping”) which is inhaled into the lungs. There are different types of e-cigs ranging from disposable packs you can pick up at the convenience store to fancy devices that can cost upwards of $100 with replaceable or refillable cartridges and USB charging devices.

Although there is no smoke, carbon monoxide, or odor, the liquid does contain nicotine, along with flavorings (anything you can imagine, including traditional tobacco flavor to bubblegum and more), a solvent called propylene glycol, vegetable glycerin, and other additives. Because the e-cigarette industry is largely unregulated (the FDA has issued a proposed rule that would allow it to regulate e-cigs), there are no standards for the amount of nicotine or other chemicals. What’s more, liquid nicotine can be extremely toxic—lethal even—if absorbed into the skin or swallowed. And some studies are showing that potentially toxic metals can be released during the vaping process.

A 2012 study at the University of Athens in Greece found that, after 10 minutes of use, e-cigarettes caused “significant airway resistance,” or breathing problems, in people with healthy lungs. And the subject of “secondhand vapor” is controversial — we really don’t know whether the exhaled vapor might cause harm to bystanders.

While some people claim to use e-cigs to quit smoking, others augment their habits by vaping in places where smoking is not allowed. And there’s grave concern that the “fun” flavors and bright colors of some vapes might lure young people who would not otherwise be smoking.

I can’t recommend that any patient use e-cigarettes for any reason. While it’s true that they may provide a somewhat less dangerous smoking experience, we just don’t know enough about the long term effects. What’s more, there is no clinical evidence that demonstrates e-cigarettes are effective in actually helping people quit smoking.

What we do know for certain is that nicotine, whether you smoke it from a tobacco cigarette or inhale a vaporized liquid, is a highly addictive substance associated with a plethora of health problems, including heart disease, cancer, stroke risk, emphysema, hormone and fertility problems, insulin resistance, type 2 diabetes, and more. It is the leading preventable cause of disease, disability, and death in the United States. Nicotine courses through the bloodstream to the brain, acting as both a stimulant and a sedative. It gives the user an initial rush of adrenaline followed by a release of dopamine which makes them feel good and takes the edge off stress. People who use nicotine regularly develop a tolerance and require increasing amounts to achieve the same effect. Hence, the pack-a-day smoker becomes a two-pack-a-day-smoker, and so on. Smoking and the need for the next nicotine “fix” begins to dominate their lives.

I’ve had a few patients over the years who insist that they enjoy smoking and have no desire to quit, but a 2011 government study revealed that 70% of adult smokers would choose to stop if they could. Many people have tried unsuccessfully in the past to quit, but have been defeated by powerful cravings during a difficult withdrawal period or other trying circumstances.

Often physicians may prescribe a nicotine patch or gum to help patients quit smoking, and that does seem to work pretty well for some people. But my philosophy is that it’s better not to shift from one nicotine addiction to another. Regardless of whether you use tobacco, e-cigarettes, patches or gum, it’s still nicotine.

Advising my patients to quit smoking “cold turkey” may seem harsh but, accompanied by the right kind of support and encouragement, I’ve found it to be a very effective technique and many people have successfully quit. Some of them had to try a few times before they made it, but I always let them know that I believed in them and was confident that they could do it.

It is never too late to quit smoking! If you want to quit:

  • Summon your willpower. You may find that you’re much stronger than you think. Knowing that it may be difficult, make up your mind that you’re never going to smoke again, and just QUIT!
  • Get clear about your motivations. Write down all of the reasons you want to quit and refer to this list when you crave a cigarette.
  • Activate your support system. Your family and friends will be happy to root for you, help you and encourage you to succeed. But you have to ask.
  • Quit with a buddy. You can motivate and inspire one another, and you’ll both feel better in the end.
  • Talk to your doctor. S/he should champion your desire for better health and support you on your path. And, you may be able to benefit from prescription drugs such as varenicline, which trick the neurotransmitters in your brain into “thinking” you’re satiated by nicotine. Your doctor can help you determine whether a prescription would be good for you.
  • Focus on all the money you’ll save! Cigarettes, as you’re well aware, are quite expensive. Keep track of how many cigarettes you have not smoked and calculate the savings. Put that money in a shoebox under the bed or move it into a savings account at the end of each week. Then buy yourself something special that you’ve really wanted, go out to a nice dinner, or even take a vacation!
  • Use your devices. There are dozens fun of apps available for your phone or tablet to help with various aspects of quitting smoking, as well as helpful programs online such as Quitline.
  • Exercise. It’s possible that you may feel slightly depressed without the nicotine giving you an artificial boost. Replace it by exercising at an appropriate level for your fitness, about 30 minutes a day if possible.
  • Explore alternatives. Although there is not much published clinical research that demonstrates results irrefutably, many people report that a meditation practice, relaxation techniques, hypnosis or acupuncture may be helpful in quitting smoking.

Your body begins to restore itself within 20 minutes of your last cigarette. While you may experience symptoms of withdrawal (especially for the first few days), you are also likely to feel an overall sense of expanded wellbeing. Over time, your senses of taste and smell will be enhanced. Your circulation and lung function will improve, coughing and shortness of breath will decrease, and your heart attack, cancer, and stroke risk will drop. You will have greatly improved the quality of your life while adding years to your life expectancy. And you’ll have the great satisfaction of having achieved an important health goal.

So don’t even consider relying on an e-cigarette crutch. Line up your support system and just QUIT SMOKING!


Dr. Rasquinha and her colleagues at IPC/Senior Care of Colorado would be delighted to help you quit smoking or achieve your other health goals. Phone 303.306.4329 to schedule an appointment.

“I practice the art of medicine. There are so many factors in caring for the elderly. It’s not just about test results, and you can’t just go by the book. So I look for the subtle things that might improve a patient’s quality of life.”
Dr. Rasquinha loves to share her passion for geriatric medicine and aging by speaking on senior health topics to various organizations. And, a big proponent of both fitness and play, she generously donates Wii video games to nursing homes. Thanks to Dr. Rasquinha, residents can enjoy playing golf, bowling, and other active games on the Wii together. Even those confined to wheelchairs and demented patients, she explains, can participate in some games and benefit.
Dr. Rasquinha graduated from Bangalore University in India, served her residency and internship at Bergen Pines County Hospital in Paramus, NJ, and completed fellowships in clinical nutrition and geriatrics. She has a diverse background in administrative medicine, long term care, and office practice. She serves her IPC/Senior Care peers as a Practice Group Leader.
Dr. Rasquinha is married to husband, Cecil; she has two young adult children and is a dog enthusiast who counts a Wiemaraner and a Puggle among her family members. She enjoys walking outdoors and always strives to keep her mind active.
Dr. Rasquinha practices at our Swedish Clinic in Englewood.

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