The Low Down on Electronic Cigarettes

For many Canadians (and Canadian doctors), e-cigarettes are an enigma wrapped in a mystery.  Though they are not regulated or approved for sale in Canada, they seem to be finding their way across the border in increasing quantities.  The Canadian Medical Association Journal published a couple of great articles about them in a recent issue to teach Canadian doctors what e-cigarettes are all about.   Here are some key points:


1.  What are e-cigarettes?

They are canisters shaped like cigarettes, which release vapor containing flavoring agents, other chemicals, and sometimes nicotine.  They are intended to simulate smoking without exposure to as many chemicals as tobacco.


2.  Are e-cigarettes safer than smoking regular cigarettes?

Hard to say.  Some studies show that e-cigarettes contain some impurities and carcinogens; also, the ones that contain nicotine still promote the nicotine dependence that keeps people addicted to smoking.  Even worse, smoking e-cigarettes could induce an addiction in someone who was previously a nonsmoker.

3.  Are e-cigarettes useful to help someone stop smoking?

Again, hard to say, as they have not been well studied. One randomized controlled clinical trial was not able to show superiority compared to nicotine patches. Contrast this with several other medication and behavioral approaches to smoking cessation which have been proven effective in clinical trials (the list is available here).  Also, I would add to this discussion that stopping the physical behavior of smoking is an important component of stopping smoking as a habit - in other words, the action of e-smoking may be too close to actual smoking to actually help a person to break the behavior.


A concern in the US is that e-cigarette companies are free to tempt American youth with fruit flavored e-cigarettes and celebrity endorsements, effectively resurrecting marketing campaigns that the tobacco industry used to use.  Thus, there is a fear that the e-cigarette industry could lure young people (or anyone for that matter) into nicotine addiction and possibly subsequent tobacco use.

So, while e-cigarettes may seem like a good idea on the surface, they have a dark side: those that contain nicotine propagate the addiction and may not effectively help people quit smoking; and even worse, they may lure non smokers into the dangerous world of smoking addiction.

Follow me on twitter: @drsuepedersen

www.drsue.ca © 2014

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Could Cinnamon Be....Dangerous?

Cinnamon first came to my attention over a decade ago, when a randomized clinical trial was published suggesting that cinnamon improved blood sugars and cholesterol levels in people with type 2 diabetes.  Another randomized controlled trial confirmed the improvement in blood glucose as well.  However, the quantities used were quite large, up to 6 grams per day - imagine dumping that amount of powder on your cereal in the morning?!  Ick.

It turns out that taking in generous quantities of cinnamon may in fact be harmful - depending on what kind of cinnamon you consume.  The most common type of cinnamon sold is cassia cinnamon, which contains a natural but toxic component called coumarin, which has been associated with possible liver toxicity. This is contrasted with ceylon cinnamon, which is thought to contain little coumarin.

It actually doesn't take that much cinnamon to exceed the daily tolerable intake of coumarin - as little as a teaspoon (which is just under 3 grams) of cassia cinnamon per day may be too much.

This has lead to an outrage and heartbreak in Denmark, where the cinnamon bun or kanelsnegle (a staple Danish bakery product) has come under attack following the EU's recent moves to limit cinnamon consumption due to the risks noted above.

So, cinnamon is not a great treatment for patients with diabetes - cassia cinnamon must not be taken in the quantities needed to have an impact on blood sugars due to possible toxicity, and eating that amount of ceylon cinnamon every day just isn't practical.

Follow me on twitter: @drsuepedersen

www.drsue.ca © 2014

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