Smoking is never good for us — but is vaping or using nicotine pouches any better?
In recent years, the internet has been awash with conflicting evidence about the health impacts of smoking alternatives.
In 2022, UK experts reviewed the international evidence and found that "in the short and medium-term, vaping poses a small fraction of the risks of smoking.”
However, the long-term effects of nicotine alternatives like vapes and pouches are still largely unknown, and the extent of their damage is frequently debated. Which device is the worst for our health?
Cigarettes
We’ve known for decades that smoking can cause a plethora of harmful health impacts, including cardiovascular and lung disease. Smoking a cigarette creates over 7,000 chemicals, at least 69 of which are known to cause cancer.
Cancer
Smoking cigarettes increases the risk of developing cancer — almost anywhere in the body. Smokers are 20 times more likely than nonsmokers to receive a lung cancer diagnosis.
Central nervous system
Cigarettes contain nicotine, which is highly addictive. The stimulant makes people feel momentarily energized, but as the sensation wears off it can cause tiredness.
Withdrawal from nicotine can impair your ability to think and exacerbate anxiety and depression.
Cardiovascular system
Nicotine causes blood vessels to tighten, restricting blood flow and increasing blood pressure. It also weakens blood vessel walls and raises the risk of blood clots.
Respiratory system
Smoking harms the airways, alveoli (air sacs) in the lungs and cilia (tiny hair-like structures that stop dirt and mucus entering the lungs).
Lung damage
As well as damaging the respiratory system, smoking can also cause permanent lung tissue loss, a chronic cough and an increased risk of developing lung infections such as tuberculosis and pneumonia.
It can also increase inflammation throughout your body and negatively affect your immune system, making you more susceptible to infection.
Vision
Long-term smoking can impact vision, causing conditions including glaucoma (damage of the optic nerve), cataracts (clouding of the lens) and age-related macular degeneration (blurring of central vision).
Skin
Tobacco is also linked to changes in skin structure, including wrinkles, premature skin damage associated with aging and delayed wound healing.
Type 2 Diabetes
Smoking also impacts insulin, increasing the likelihood of developing insulin resistance. Smokers are 30% to 40% more likely to develop type 2 diabetes and its complications.
Periodontal disease
Another risk of smoking cigarettes is periodontal disease, otherwise known as gum disease. This is because smoking causes inflammation around the teeth, raising the risk of bacterial infection. Gums may swell and bleed (gingivitis), eventually pulling away from the teeth (periodontitis).
Vapes
Vapes (also known as e-cigarettes) usually contain nicotine, flavouring and over 30 chemicals. Studies into their long-term health effects are still ongoing.
Cardiovascular system
Research suggests that vaping may impact heart health, however, it is thought to have less of an impact than cigarettes.
One 2019 study from the University of Dundee revealed that after one month of ditching tobacco for electronic cigarettes, blood vessel health started to improve.
However, vapes still contain nicotine, which is known to increase the risk of cardiovascular disease (and other negative health impacts).
One 20mg/ml vape contains 40mg of nicotine, the equivalent of two packs of 20 cigarettes.
As well as this, experts warn that it may be even easier to become addicted to vapes.
“Vaping also has a habit-forming effect,” Dr. Naheed Ali, MD, Senior Contributor at Vera Clinic told The Standard. “It can increase your nicotine intake because it is so easy to use.”
Lung conditions
Some studies indicate that vaping harms the lungs, but more research is needed.
In 2020, the Centers for Disease Control and Prevention (CDC) confirmed 2,807 cases of e-cigarette or vaping use-associated lung injury (EVALI) and 68 deaths attributed to the condition.
However, lung health effects are not expected to be seen for around 20 to 30 years so it’s difficult to assess the full extent of damage.
Oral health
Like cigarettes, vaping can be damaging for oral health. One 2018 study found that exposure to e-cigarette aerosol made the surfaces of teeth more prone to developing bacteria, which could increase the risk of cavities.
Dr Sam Jethwa, President of the British Academy of Cosmetic Dentistry, and founder of Bespoke Smile, told The Standard that using a vape can “encourage decay in areas where it usually doesn't occur, such as the bottom edges of front teeth”.
Other studies have linked vaping to gum inflammation and gum, mouth and throat irritation.
Nicotine pouches
Nicotine pouches have recently become a popular smoking alternative among Gen Zers.
The products, which don’t contain tobacco (one of the greatest risk factors for oral cancers), are tucked under a person’s lip or cheek and nicotine is absorbed into the bloodstream through mucous membranes in the mouth.
Like vapes, the long-term health effects of nicotine pouches are not known.
Cardiovascular health
Nicotine pouches (unsurprisngly) contain nicotine which can be harmful for the cardiovascular system (and induce other negative health effects).
However, nicotine pouch users may find it easier to monitor their nicotine consumption.
“Unlike vaping, where users may unknowingly over-consume, pouches make it easier to monitor and reduce intake gradually, which supports smokers who want to taper off nicotine over time,” Chris Allen, CEO of scientific consultancy Broughton, told The Standard.
Tumour growth
Nicotine doesn’t directly cause cancer, however, research indicates that it could make cancer more aggressive.
“Recent findings suggest that nicotine itself could promote tumour growth through various mechanisms, including angiogenesis and modulation of cell proliferation. But research is still uncovering the full extent of these effects,” lung oncologist Dr James Wilson told The Standard.
Oral health
According to Professor Ama Johal, orthodontist & clinical lead at 32Co, nicotine patches such as snus are “in some ways worse” than smoking for the teeth.
As well as staining teeth, consistent use can cause gum irritation and receding, causing decay, sensitivity and gum disease. “In the worst case, snus can increase risk of oral cancer,” Johal told The Standard.
However, more research is still needed as “results are bewilderingly diverse,” Healthline reports. “Some studies find a specific cancer risk connected to snus use, and other studies find the opposite.”
The Verdict
So which is the worst for our health? Medical experts are largely in agreement that out of the three, one is the greater evil.
“Cigarettes are the worst option by far,” Dr. Naheed Ali, senior contributor at Vera Clinic told The Standard. “ Smoking damages nearly every organ in your body.”
However, research into the health effects of nicotine alternatives is ongoing, and it may take some time before we understand the long-term risks.
It comes as no surprise that the best option is to stay clear of cigarettes, vapes and nicotine pouches all together. “If you are trying to support your health, your skin, and your hair, the best choice is to avoid all three,” Ali said.
