The CDC is currently investigating close to 450 cases of vaping related illness and 5 reported deaths. A recent study in the New England Journal of Medicine has found evidence of a lipoid pneumonia in a case where a 21 year old became sick after vaping nicotine and tetrahydrocannabinol (THC) daily.
Macrophages, which are scavengers that rid the body of pathogens and other harmful substances in the body, were found to be “lipid-laden”, or full of a fatty substance. They suspect this fatty substance to be caused by inhalation of Vitamin E acetate that was only present in marijuana vaping products and not the average nicotine e-cig. Vitamin E is commonly used in hand creams, moisturizers and as a supplement due to its oily nature, but is not to be inhaled.
Since the lungs are designed to oxygenate the lungs and exchange out carbon dioxide, oily substances can clog the works.
Experts say the Vitamin E acetate is not believed to be apart of regular e-cigarettes that do not vape THC, the psychoactive component to marijuana.
This is a developing story….
Vaping linked to seizures
The FDA is investigating 127 reports of seizures in e-cigarette users (up from 35 this Spring).
Many were teenagers and young adults.
Since 2010 the agency has received multiple reports but is unclear if e-cigarettes actually caused the seizures or if there were underlying medical conditions predisposing the neurological disorder.
The 92 additional cases since this April is concerning and the FDA is working to determine if vaping contributes contributes directly to serious neurological conditions.
In April FDA Commissioner Dr. Scott Gottlieb tweeted:
While we’re still learning about the long-term potential benefits and health risks of e-cigs, existing scientific research offers some clear evidence that several of the dangerous chemicals in tobacco smoke are also present in the aerosol of some e-cig products.
Dr. Ned Sharpless, current acting FDA Commissioner, is encouraging people to report adverse events as, “Additional reports or more detailed information about these incidents are vital to help inform our analysis and may help us identify common risk factors and determine whether any specific e-cigarette product attributes, such as nicotine content or formulation, may be more likely to contribute to seizures,” (Reported by CNBC).
What is a seizure?
A seizure occurs when there is abnormal electrical activity in the brain. If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.
Nicotine toxicity has been linked to seizures. E-cigs sometimes contain more nicotine than cigarettes alone.
A study published by the American Heart Association found nine different E-cig flavors to impair blood vessel function, which can impair heart health.
Endothelial cells, which delicately line blood and lymph vessels, were found to become inflamed at low concentrations of some vapor flavors. And at high concentrations of others, exibited cell death. Nitric oxide production, necessary for vessel dilation to improve blood flow, was impaired as well. These are often the same changes seen in early heart disease.
The 9 flavors (and the chemicals within) cited in the report to cause the endothelial inflammation and/or damage were:
- Mint (menthol)
- Vanilla (vanillin)
- Clove (eugenol)
- Cinnamon (cinnamaldehyde)
- Strawberry (dimethylpyrazine)
- Banana (isoamyl acetate)
- Butter (diacetyl)
- Eucalyptus/spicy cooling (eucalyptol)
- Burnt flavor (acetylpyridine)
Strawberry flavoring appeared to have the most adverse effect on the cells.
Now many other flavors were not included in this study, so its unknown how safe they may be.
For more on the study, read here.
An alternate study published last November looked at vaping flavors and their effects on heart muscle cells.
For more on this study, read here.
The moral? Just because we love the taste of something, doesn’t mean its safe to inhale.
Vaping Linked to Heart Disease and Cancer
A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.
Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day. They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml. That dose would be commonly consumed by many humans who vape.
They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.
Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.
In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:
- Formaldehyde (human carcinogen)
- Acetaldehyde (carcinogen related to alcohol drinking)
- Acrolein (highly irritating and toxic)
- Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
- Metals (possible carcinogens and toxins)
Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.
A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children). E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).
The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.
More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.
For more on the study read here.
Toxic metals found in vaping liquid
Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.
Last year one study reported that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.
Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:
We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).
Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”
These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure. Moreover they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.
Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.
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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.