Flavours in e-liquids: the mass human experiment

24.01.2024  E-cigarette flavours have their own addictive potential and harbour health risks – both must be included in the harm-benefit analysis for e-cigarettes. The issues of indoor air pollution and the effects of passive vapour will also become more important for non-consumers if the number of consumers continues to rise and non-smoker protection in Germany is not consistently extended. In any case, tobacco and nicotine products are on the rise again in Germany, jeopardising what has been achieved so far in terms of non-smoker protection.

The question of whether smokers have a health benefit if they switch (completely) to e-cigarettes and, if so, how great this benefit is, has been debated for years. Retailers, manufacturers and lobby groups have been vehemently campaigning for e-cigarettes to be recognised as a means of quitting smoking. The arguments regarding ingredients are limited almost exclusively to the nicotine contained in liquids, which is not considered harmful to health. However, apart from its addictive properties, there are other health-related claims about nicotine: for example, it can (even when vaping) impair the immune system, damage palatal tissue, cause cardiac arrhythmia as well as poisoning at high doses. As far as flavours are concerned, on the other hand, interested circles only say that they are indispensable, as smokers would otherwise return to tobacco cigarettes. They should not be restricted under any circumstances.

But is that the case? Do smokers who are willing to switch and current consumers of e-cigarettes really need the 16,000 or so different flavours (mixtures) that WHO Director Rüdiger Krech estimates are available? Do adult smokers really need Sugar Daddy, Banana Ice, Wafer biscuit, Energy drink, Unicorn candy, Fairy dust and what they are all called*? Isn’t it the case that smokers are familiar with tobacco flavours from tobacco cigarettes and would continue to use them even if the many sweet flavours no longer existed?

What about transparency for consumers? E-cigarettes, including liquids and other components, merely have to be notified with their composition in the EU portal EU-CEG six months before they are placed on the market and are listed after this period. The Federal Office of Consumer Protection and Food Safety (BVL) publishes an extract from this list, which currently contains almost 350,000 entries. Anyone hoping to find information on the ingredients of e-cigarette liquids is mistaken. According to the Federal Office, this information is not available in processable form. The list does not provide information as to whether all listed products fulfil the legal requirements. It only provides information that the notification obligation has been fulfilled for these products and that the six-month standstill period between notification and market launch has already been exceeded.

If liquids and devices are checked for health safety (also by the Federal Office for Risk Assessment/BfR and the food monitoring authorities of the federal states) this can obviously only be done on a random basis; Dr Pieper from the BfR reported at the DKFZ’s Tobacco Control Conference 2023 that there is an excess of manufacturer information and that even products with banned ingredients are submitted. Problematic ingredients such as cinnamaldehyde, vanillin, sucralose and others are not even on the prohibition list but are proposed by the BfR. In addition, the flavourings can react with each other as well as with the carrier substances glycerine and propylene glycol, resulting in further harmful substances.

Neither the effect of inhaling individual flavours nor their combinations have been sufficiently researched, and certainly not in long-term studies, which also seem difficult to carry out in the constantly changing e-cigarette market. Not even mentioned here are the illegal products that enter the country en masse via online purchase, often undeclared with the intention to deceive, and are offered in a wide variety of sales outlets that do not want to miss out on the high profit margins.

The role of flavourings in the development of addiction has not or not yet been adequately investigated. Undoubtedly, they lead minors in particular to consumption in the first place, as the liquid without flavourings is tasteless and unattractive. Perhaps it is assumed that the overdosed sweet flavours will satisfy the craving for sweets without affecting body weight. In addition, the “cooling” effect which masks unpleasant irritation of the respiratory tract and which is already known from menthol cigarettes is as a powerful addiction booster.

The flavours and the shapes of disposable vapes favoured by children and young people – there are some stash-you shapes that look like pens or popsicles – show clearly that e-cigarette marketing is likewise aimed at teenagers. And definitely successful: the number of young consumers has doubled in recent years; overall, 11-24-year-olds are the largest age group of e-cigarette consumers. Minors have their chance to buy e-cigarettes at kiosks, petrol stations, late-night shops and flea markets. Or older friends or schoolmates buy them and sell them on, as has been observed in schools.

If you look at sales in online shops, several shortcomings appear negative, by the way in large online shops of specialised retailers as well:

  • the ingredients of liquids are usually not stated
  • instead, product images suggest that you are consuming something healthy: fruits, herbs, and often ice cubes as an indicator of a special “freshness”
  • nicotine-containing liquids, especially disposable vapes, often lack the legally required nicotine warning. There are numerous varieties with and without nicotine – the illustration usually shows the nicotine-free variant; if you select a nicotine-containing variant, the illustration should change, but this is not always the case
  • buyers can usually filter by manufacturer or flavour, but often not by nicotine level.

This is not only problematic regarding the protection of minors. Consumers of all ages have a right to know as much as possible about nicotine products. The range of products on offer is now practically unmanageable and there is a lack of structured consumer information. Nevertheless, young consumers are the most important target group for regulation: around one in four schoolchildren has already tried e-cigarettes; more children between the ages of 11 and 14 vape than smoke, and young adults (up to the age of 24) are the most frequent users of e-cigarettes. In contrast, the largest consumer group should actually be found among slightly older smokers because they have been smoking for many years as the campaigns in favour of e-cigarettes focus on long-term smokers who have not yet managed to stop smoking using any other method.

It won’t be enough to wait for the disappearance of cheap disposable e-cigarettes at the end of 2026 when the EU Battery Regulation comes into force. Firstly, in two years’ time, we will have many more children and young people addicted to nicotine than we already have and secondly, the battery regulation is easy to circumvent. The mere letter of the law will already be fulfilled if there is a recharging option, regardless of whether this makes sense or not – it would not make sense for non-refillable liquid. It won’t be enough either to simply ban disposable vapes earlier, even if that were the federal government’s intention. The market will develop new products: Devices that can theoretically be used several times but are still cheap enough for young beginners. The additional manufacturing costs are easily saved in terms of device safety and filling. The licence to print money, which still exists for disposable devices and liquids, despite the liquid tax, will not be taken away. The mass experiment on humans will continue.

In which European countries are flavourings already banned or restricted? Netherlands, Denmark, Hungary, Estonia, Lithuania, Finland, Ukraine

Where are bans on the way? In France, Great Britain, Norway, Slovenia

In Germany, too, we need to get straight to the point: ban all sweet and “fresh” flavours, preferably leaving only tobacco flavours.

*All the flavour names in the text and the article picture are used in the mentioned BVL list.

More on flavours in e-cigarette liquids: A search in the meta-database PubMed, published on 08.03.2024, on the harmful effects of e-cigarettes comes to the following conclusion:

Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes.