Update on Nicotine and E-cigs with Beatrice Lemaitre

Beatrice Lemaitre, a tobacco specialist recently share his knowledge and experiences with the vape community. And he had answered some of the most concerning questions about vaping and TPD vape which you can’t miss out on. So without further ado, let’s go ahead.

Q: How did you get interested in vaping?

As a tobacco specialist, I discovered the electronic cigarette thanks to the many smokers I met in consultation. Their questions led me to work on the subject. It was in 2010, at the time of 1st then 2nd generation electronic cigarettes. I was very skeptical at first but never discouraged its use. I know too well the misdeeds of tobacco and the ecological disaster for the body of the smoker to penetrate, with each inhalation, more than 7000 chemical compounds, including the worst. My doubt was more about their ability to help smokers quit smoking completely and about their resemblance, for 1st generation products, to a real cigarette. I read I did research on the internet like many people and, in 2013, I participated in the Report and expert opinion on e-cigarettes, led by Pr Bertrand Dautzenberg, at the request of the DGS. Also participating was J. F. Etter, from Switzerland, who has also been interested in the subject for a long time. The debates were very lively and disagreements frequent.

Q: In your opinion, what is the first advantage brought by the e-cig compared to the classic cigarette?

The first advantage, and I have seen it many times, is to allow many smokers who were unable to completely quit smoking (alone or with the help of a validated treatment for quitting tobacco), or who, having stopped, were in difficulty to manage risky situations, to completely stop smoking, feeling GOOD and above all WITHOUT ANY FRUSTRATION. When everything goes well, when you have an e-cig that gives complete satisfaction, abstinence is sustainable over time.

And then, the vapor produced by an e-cig has nothing to do with the smoke of cigarettes: about fifteen products come from the heating of the e-liquid, without any combustion, unlike tobacco. Tobacco can be considered a “weapon of mass destruction”, a weapon that destroys silently, over years, quietly, slowly but surely. More than 7000 chemicals inhaled with each puff, including more than fifty carcinogens, carbon monoxide and nicotine in gaseous form which reaches the brain, through the arterial route, in less than 10 seconds (shoot effect) and, therefore, is terribly addictive.

Q: Are e-cigarettes addictive?

The real “drug”, very quickly but sneakily addictive, of all drugs, when you have the “right” brain receptors, is inhaled nicotine, in gaseous form, with tobacco smoke. It reaches the brain in a few seconds, violently activates the nicotinic receptors in the reward zone of the midbrain.

The nicotine of nicotine substitutes such as the nicotine absorbed with the vapor of the e-cig is indeed nicotine, but it is not a drug. It is “good” nicotine, intended to help smokers to turn away from tobacco, without lack. It diffuses effectively, but much more slowly, through the body to the brain. It helps to manage the symptoms of withdrawal and withdrawal when one wishes to turn away, without suffering, from tobacco.

The e-cig is now naturally part of all the aids available for quitting smoking. The e-cig is certainly a common consumer product that does not have a drug status. In addition, the e-cig can be combined with all validated treatments for quitting to help manage any situation at risk of relapse, but can also be used perfectly alone.

Q: How can you assess your addiction to cigarettes?

First, you should know that you are considered a smoker from 1 cigarette / day and that there is no small consumption without risk and without dependence. Some smokers will quickly smoke 20 or more cigarettes per day, sometimes even more than 40 cigs/d, while others will never have been able to smoke more than 5 cigarettes/d. Of course they will think “I’m not addicted” because I only smoke 5 cigs/day. Conversely, smokers of 20 cigarettes or more will be considered from the outset as highly or very highly dependent. Everything is not so simple and it is sometimes more difficult to quit smoking when you smoke little: if the physical dependence is indeed less than in a “heavy” smoker, other elements come into play.

In a smoker who smokes very regularly throughout the day (repeated need to maintain a sufficient level of nicotine), to simply assess the level of dependence, one question is enough: “after waking up, after how long do you feel the urge to smoke? “. Within 30 minutes or as soon as he wakes up, he is a heavily or very heavily dependent smoker. This is called Time To First Cigarette (TTFC).

Is daily cigarette consumption a relevant indicator for assessing tobacco addiction?

Yes and no; because there are many ways to smoke your cigarettes. We can light 30 cigs/d, but without really smoking them all in the same way, some remaining forgotten in the ashtray or thrown away barely smoked. The most relevant question remains the time between waking up and the felt need to smoke.

For young smokers, the assessment is more difficult because the consumption is not yet really established while the addiction is well and truly established. The HONC* test is then more relevant.

Q: The public often speaks of overdose. Should we be afraid of nicotine?

We see this in our consultation practice with nicotine substitutes when we recommend combining 1 or more than 1 patch with oral forms (chewing gum, lozenges, inhaler, oral spray). Inevitably the question “but am I not going to be too dosed in nicotine?” “. And there, it is necessary to explain well. The real problem is the initial underdose, which will make quitting difficult, if not impossible, and which will make the smoker think “I will never make it! “. Nicotine is not the problem, but the solution. Same questions when we talk about the association patch(s) and e-cigs. The media have demonized nicotine when what must be totally demonized are the 7000 products resulting from the combustion of tobacco and inhaled with each puff of a cigarette.

Q: Is the nicotine present in e-liquids different from that found in other substitutes such as chewing gum, patches?

The nicotine molecule found in tobacco (made by the roots of the plant), in tobacco smoke, in nicotine substitutes, in e-liquids is the same molecule. Nicotine is intended to appease the needs of the brain.

What totally changes is its mode of entry into the body and therefore of consumption. It’s like cooking, with the same ingredient, the results will be different depending on the method of preparation and cooking.

The nicotine in tobacco smoke, resulting from combustion (850 to 1000°C at the end of the cigarette) is in gaseous form (very fast arrival in the brain) and is accompanied by more than 7000 toxic compounds in tobacco smoke. tobacco (including more than 50 carcinogens and carbon monoxide).

The nicotine from nicotine substitutes diffuses slowly and through the veins, without any other product.

The nicotine in e-liquid is naturally found in the vapor produced by heating the e-liquid, but there is no combustion. About fifteen products only, and that we know well, and that we know how to control perfectly, accompany it.

With an e-cig, the smoker who wishes to quit smoking will find sensations that remind him of the cigarette (the hit) without the immense toxicity of tobacco smoke.

Q: Does everyone have to start with the same level of nicotine or does it have to be adapted to each person?

What you should not do is be afraid to use a sufficient dosage of nicotine to begin with. And then, you have to trust the smoker, who intuitively knows how to take the dose of nicotine that suits him. Every smoker is different, it’s true.

We can say that for a smoker identified as highly dependent, this will automatically be the most important e-liquid dosage. The “little” smokers can start with the intermediate dosage.

It is essential to receive the right explanations at the beginning, in particular on the technique of the initial vaping (aspiration for 3 sec). This is why I always advise, for a first use, to go directly to a specialized store capable of providing all the necessary information. Buying directly on the internet does not seem like a good thing to me (NDR: this is also why there are guides and an online advice service on the CAKVAPE website!).

Q: Can we combine e-cigs and other nicotine substitutes?

Yes, for “tailor-made” weaning we can completely combine nicotine substitutes and e-cigs, just as we can combine varenicline and e-cigs, as we associate, in our tobacco practice, patch and oral forms or varenicline and oral forms. In these cases, the nicotine dosage of the e-liquid may be lower. The advantage is help for the smoker in situations at risk of relapse, such as situations of conviviality, but also situations of loneliness and boredom. The objective is to help the smoker to live better without tobacco, to be more calm and relaxed, and all this without frustration which, when it exists, frequently leads to a relapse in the more or less short term.

Q: Some beginner vapers complain of having canker sores or coughing since they vaped. What can we tell them?

These are two different things.

For canker sores, it can happen, whether you stop alone without anything, whether you stop with patches, with drug treatment or with an e-cig. Why? The smoker’s mouth is in direct and constant contact with tobacco smoke, which has a pH different from the physiological pH of the oral mucosa. There will be a keratinization of the oral mucosa. When you stop smoking, changes in the mucosa will lead to the formation of mouth sores in some smokers. This passes and has no relation to the means used; it just has to do with the absence of tobacco smoke in the mouth. This only happens, with e-cigs as with other treatments, for smokers who quit smoking completely.

Q: Many smokers fear weight gain when switching to e-cigs. What do you think?

Weight gain is feared by many smokers. It is true that increased appetite is part of the craving and withdrawal symptoms. It is also true that the metabolism of a smoker is different from that of a non-smoker and that, given the same eating behavior, the smoker tends to burn more calories and store less fat. It is true that smokers generally have an underweight of 0 to 2.8 kg for men and 0 to 3.8 kg for women. It is also true that smokers who quit on their own, without help of any kind, by “willpower” alone, often gain weight.

With appropriate help, whether it is nicotine substitutes, or whether it is e-cigs, the situation is different. When the dosage is well adjusted, there are no cravings and withdrawal symptoms and therefore no uncontrollable increase in appetite. In addition, with the e-cig, we manage both, without difficulty and with pleasure, the lack and we have the behavioral side as a bonus.

Q: What nicotine levels would you recommend for someone who wants to switch to e-cigs?

Above all, no initial underdosing, good explanations and the possibility offered to come and ask for advice if they feel the need. Again, nicotine is not the problem but THE solution. So no initial under-dosing and not wanting to reduce your nicotine level too quickly: give time to time and move forward gently.

Q: Many beginner vapers have the desire to quickly lower their nicotine levels. What would you advise them?

Whether it’s e-cigs or other quitting treatments, I regularly tell my patients “Quitting smoking is not a magic slate”, “You have to allow time to time” and “It is urgent not to hurry”. While we have been smoking for many years, all of a sudden, when we decide to quit, everything should go quickly… However, for the brain of the smoker, it is not the same. In addition to pharmacological dependence, there is a whole conditioning learned over many years, behavioral and psychological (habits, management of emotions, whether positive or negative, etc.). Again, nicotine is not the problem,” but the solution.

Here too, in my practice, I often had to reassure ex-smokers who had quit more than a year ago, who regularly used either chewing gum or e-cigarettes. They were doing very well, but were made anxious by those around them. When they smoked, they were told nothing… But when, having become ex-smokers, they continued to use gum or e-cigs, for many months or years, they were under pressure from those around them who did not understand… that they continue to use nicotine gum or e-cigs.

The only important thing is to stop smoking at all and never go back to tobacco.

Q: Vaper, what do you think? Is breaking up with cigarettes preferable?

To be a vaper is to be a smoker. Only the total cessation of all cigarette consumption has a positive impact on immediate and future health. We said it above, for tobacco, there is no threshold of non-dangerousness. So, it is essential to choose your sides and, at some point, to switch completely to e-cigs, if that is what you have chosen.

Now, vaping and smoking can be a first step towards quitting altogether. But beware! If this phase lasts too long, the smoker will settle into new habits and total cessation may no longer be considered.

Vaping: yes. Smoking: no.

Q: A pregnant woman who wants to switch to e-cigs during her pregnancy, what can we tell her?

The e-cig cannot be officially recommended for pregnant women. Now, in practice, if a pregnant woman who was unable to completely quit smoking only manages to do so with an e-cig, it is obvious that she should not be discouraged from using it. Do not make the wrong enemy: what must be imperatively recommended during pregnancy is to stop all tobacco consumption.

Q: We often have parents who ask us for advice because their teenager smokes. What attitude should we have knowing that the sale of our products is prohibited to minors?

I think we have to explain to parents what an e-cig is, how it works and especially what tobacco is. They must be able to talk about it openly with their teenager and if he has purchased one, be able to discuss it with him. If they come to ask for advice, it is already because they have an open attitude.

A recurring fear commonly expressed is that e-cigs facilitate the transition to smoking. Studies conducted on large cohorts in many countries invalidate this hypothesis, with a certain decline in smoking among young people.

In any case, nothing will prevent a young person from having “his” experience if he wishes. But, to be factual, it is better to experiment with e-cigs than tobacco, which has a powerful and rapid addictive potential, which is not the case with e-cigs.

A big thank you to Beatrice Lemaitre for this precious teaching which allows us to advance in the understanding of nicotine and helps us to progress in our daily work with vapers. CAK Vape is a vape manufacturer providing vape OEM service to many vape brands. If you are interested in our product or service, please don’t hesitate to contact us.