Prof. Dr. Mayer – How to switch from tobacco to electronic cigarettes?

Archived version of Prof. Dr. Bernhard-Michael Mayer’s blog post.
Originally published on 02.06.2014

This post is based on personal experience and hearsay rather than scientific evidence.

Many years of interaction with successful and less successful users of electronic cigarettes make me believe in certain prerequisites for an effective switch from tobacco smoking to the inhalation of nicotine containing vapor. It is a pity to watch people giving up electronic cigarettes on easily avoidable grounds. Therefore, I wish to share my experience with beginners and propose three rules of thumb that may pave the way to a successful and sustained switch.

As a smoker you may wish to stop but be afraid of the well known physical and  psychical pain associated with smoking cessation. Maybe you have tried unaided deprivation, nicotine replacement therapy (NRT) or different kind of pills advertised as cessation aids, all of them with a low level of long-term success. If you put electronic cigarettes in the same category as NRT, you will  necessarily be expecting the same pain upon switching.

1st rule: Don’t think of electronic cigarettes as smoking cessation tool.

In the beginning you may replace some cigarettes by the electronic version, but still keep smoking. Don’t put yourself under pressure! If you feel you need it, smoke cigarettes without a guilty conscience. With the proper hardware and liquid (see below) your urge for tobacco smoking will vanish with time. You will realize that electronic cigarettes resemble the real ones in many aspects, including airway sensation (called flash or throat hit), handling, and the production of smoke-like vapor. Your need to smoke cigarettes will continuously decrease and may be fully absent after a while. And even if not and you become a “dual user,” consider that your health condition will benefit from every single cigarette you don’t smoke.

2nd rule: Be prepared to spend some time and money to find hardware that fits your personal needs.

There is vast variety of models available, making the appropriate choice difficult for beginners. Smokers often select their first electronic cigarette more or less by chance (or based on the most appealing advertisement) and, if unsatisfied, they blame it to the whole category of “electronic cigarettes” rather than to their model. Therefore, it is essential that you get as much information as possible, not from advertisements but from experienced users that are active in social networks, in particular the large internet fora in the USA, Germany, UK, Australia etc. You will have to engage yourself in a topic that is certainly more complex than getting a pack of cigarettes and a lighter.

No matter how high your level of prior information, your first experience could still be disappointing. Personal needs are fairly diverse, and there is no such thing like “the best electronic cigarette.” Instead of giving up you should try another starter set, or another type of atomizer or maybe upgrade to a regulated battery. Don’t get put off by the costs! In the beginning, you will probably spend more for electronic cigarettes than you had spent for smoking, but on the long run you will save a large amount of money (besides the more important health gain).

3rd rule: Start with a menthol-flavored high nicotine liquid.

There is no accounting for taste, so the choice of the appropriate liquid(s) is highly subjective. As a beginner, it will probably drive you crazy when a brief internet search reveals liquids with literal hundreds of different flavors that are offered by hundreds of different companies. How can you find out the tastiest liquid? Short answer: you cannot! It is a matter of trial and error! Most users end up with a small selection or even one favourite liquid after a while, but some never stop trying new flavors from various sources.

Regardless, in my opinion there is a rule of thumb that hardly fails: begin with 3-4 different flavors and consider that none of them will taste like your favourite cigarette brand. So tobacco flavors are not necessarily the best choice. Don’t hesitate to try some fruit flavors, such as strawberry or orange, and make sure that you have at least one menthol-flavored liquid in your basket. Menthol flavor is a kind of backup if anything else fails. Possibly you wish to combine menthol with a fruit flavor, e.g. strawberry, which is very popular. Anyway, in the beginning there will be no way
around some trial and error. If you have a chance, participate at one of the meetings organized in social networks, where you can taste a wide variety of liquids from other users.

The most important issue is probably the nicotine concentration. If the concentration is too low to provide you with enough nicotine, you will get unsatisfied and may return to tobacco smoking. The appropriate concentrations are individually different and depend on the performance of your atomizer: more power results in more vapor and, in turn, more nicotine per draw. As a rule of thumb you should begin with a high nicotine concentration (20-30 mg/ml) and dilute with nicotine-free liquid if necessary.

In the first days you may experience a cough reflex due to increased airway resistance caused by stimulation of nicotinic receptors on sensory C-fibers of the bronchi, an effect that is masked by antitussive agents in tobacco. The coughing response ceases within a few days and should not seduce you to prematurely reduce the nicotine content of your liquid. Nicotine has no serious adverse effects, and there is no reason to anxiously reduce the amount of nicotine in your liquids.

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