Moderation

The dose makes the poison” – attributed to Paracelsus , Swiss physician and chemist from about 500 years ago. The full quote: “All things are poison and nothing is without poison; only the dose makes a thing not a poison.” Even water and oxygen are poisonous in too large a dose. (1)

Modern chemicals are leading to different types of health problems than the classic understanding of toxicity which considers a substance toxic at the dose that would lead to death or cancer or a visible birth defect. One of the examples provided is BPA a chemical found in plastics and now in our environment which is considered safe in the traditional sense of toxicity – it doesn’t lead to cancer or death at small amounts however it may be acting as an endocrine disrupting chemical at very small doses. (1)

BPA acts as an estrogen receptor activator – estrogen is one of the main female hormones. At what dose of birth differences will society be concerned about the health of male infants? Endocrine disruptors including BPA are associated with differences in male sexual organs at birth. (2)

Returning to a research finding mentioned in the Vaping series (part 1, 2, 3), an experimental dose labeled Acute was 20 minutes of vape exposure each day for one week, and an experimental dose labeled chronic was 20 minutes of vape exposure for 3 weeks. (part 3, ref 4:17) Compared to what might be typical for a human both of those doses are pretty low. A human might smoke a half a pack of cigarettes per day – ten cigarettes taking minimally 5-10 minutes to smoke. Other humans might smoke a pack or two or even three packs per day.

A few humans might only smoke one or two cigarettes once a week during an evening out but that is less typical than the daily half a pack smoker. There may be some health benefits however in the smoking one or two during an evening out, if the time is going to be spent in a smoke filled environment. The lungs will increase protective layers of mucous to reduce entry of toxins when there is smoke exposure. Avoiding the smoke exposure altogether would be safest however.

Chronic cannabis smokers develop lung tissue that is less typical of lung tissue that is not chronically exposed to smoke. Emphysema was not associated with cannabis smoking at a rate much different than not smoking while tobacco smoking with or without use of cannabis was associated fairly closely for macroscopic emphysema risk. (3) Coughing, asthma, bronchitis may still remain risks from chronic smoking of cannabis. Infectious risks may also occur from use of water pipes or other types of pipes that aren’t cleaned regularly. (4)

Cleanliness and moderation – both are valuable. Moderation in all things is also valuable. The dose makes the poison whether smoking tobacco or cannabis, drinking water or alcohol, watching TV or playing video games or surfing the internet, even exercise can become a health risk if done excessively or in dangerous settings. Building up physical skills gradually can make exercise safer in various settings however building up a tolerance to some drugs or activities can just leave a person needing larger amounts to achieve the same dopamine excitement.

Dopamine is the main brain neurotransmitter for feelings of reward. Most major addictive substances cause an increase in dopamine directly (cocaine) or indirectly (most of the rest of common addictive substances) . See: Impacts of Drugs on Neurotransmission, (5), (7) It certainly would take less alcohol than water to harm someone or kill and tolerance can also develop to alcohol so more is needed to feel ‘drunk.’ Cocaine tolerance can build up to a point where the dopamine receptors no longer respond to other rewarding stimuli and the person may no longer feel pleasure except with increasing amounts of cocaine/crack.

In small amounts alcohol can have medicinal effects and reduce the stress of an emotional shock or physical trauma. That medicinal amount may be as small as a third of a typical serving size of alcohol, or up to one to two alcoholic beverage servings per day, for a smaller or larger adult. (G11: Alcohol) Often though, the problem is being able to stop at one or two alcoholic beverages as author James Thurber stated eloquently:

One martini is all right. Two are too many, and three are not enough.”

― James Thurber (died November 2, 1961)

Having an elevated stress level over time may make people more susceptible to addictive behavior. The stress response can become more likely to occur in the future when it has been chronically active in the past, as calming GABA activity is inhibited by the increased activity of dopamine receptors that occurs with stress or addictive behaviors. (12, 13, 14)

How much TV is too much TV? I heard recently on the radio that people in the U.S. spend on average 7000% more time watching TV than working on their finances – so we’re all financially stable then? Or most of us are behind on balancing the checkbook and planning for retirement? The number seems enormous, 7000%, in hours it means we are spending about 70 hours watching TV for every one hour spent looking into our financial health. See: Americans Spend 7000% more time watching TV than they do on their finances, by Brett Arends, (MarketWatch.com)

How much cellphone use is too much cellphone use? (8) That may involve more than dopamine over-stimulation. Chronic exposure to electromagnetic fields including from WiFi and TV sets may be increasing negative health symptoms beyond an addictive use of the electronic devices. Insurance company white papers have deemed the idea of 5G internet in urban areas as “High risk” with unknown health effects. (9) More than 180 scientists have appealed to the European Union to use caution regarding approving 5G installations which would need to be placed almost every block for reception rather than the current cellphone towers which are larger and can be placed at a farther distance from internet users. (10)

The effects of exposure to electromagnetic fields seems to be accumulative and infertility may result in just ten to fifteen years of exposure. Internet use throughout schools from grade school through highschool and college would be ten to fifteen years of exposure. How much infertility is too large a dose of infertility for a population to survive?

Research is limited and more is available about male infertility than effects on female fertility. Increased cellphone use (self-reported) was associated with decreased sperm count, sperm motility, viability and morphology (shape). Cell phone use was grouped into, No use, less than 2 hours per day, 2-4 hours per day, and greater than 4 hours per day. The researchers questioned the number of hours reported for use, however it has become fairly common to have your smartphone with you at all times – and that category – 24 hours per day, seven days per week was not included – and would represent living in a community with 5G installations. (page 257, 11)

Good news – meditation can help reduce the stress response (15), and while it might not help balance your checkbook, it may be a more beneficial way to increase dopamine levels than shopping or TV watching. (16)

Stay tuned for part two – moderation is too large a topic to take in one dose.

Reference List

  1. The Dose Makes the Poison Concept, Toxicity, chemicalsafetyfacts.org, https://www.chemicalsafetyfacts.org/dose-makes-poison-gallery/
  2. Sathyanarayana S, Beard L, Zhou C, Grady R. Measurement and correlates of ano-genital distance in healthy, newborn infants. Int J Androl. 2010;33(2):317–323. doi:10.1111/j.1365-2605.2009.01044.x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943951/
  3. Aldington S, Williams M, Nowitz M, et al. Effects of cannabis on pulmonary structure, function and symptoms [published correction appears in Thorax. 2008 Apr;63(4):385]. Thorax. 2007;62(12):1058–1063. doi:10.1136/thx.2006.077081 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094297/
  4. Marijuana “bong” pseudomonas lung infection: a detrimental recreational experience. Repirology Case Reports, Vol 6, Issue 2, Feb 2018, e00293 https://onlinelibrary.wiley.com/doi/full/10.1002/rcr2.293
  5. Impacts of Drugs on Neurotransmission, National Institute on Drug Abuse, drugabuse.gov, https://www.drugabuse.gov/news-events/nida-notes/2017/03/impacts-drugs-neurotransmission
  6. Brett Arends, Americans Spend 7000% more time watching TV than they do on their finances. marketwatch.com, Oct. 19, 2019 https://www.marketwatch.com/story/americans-spend-7000-more-time-watching-tv-than-they-do-on-their-finances-2019-10-18
  7. Yanofski J. The Dopamine Dilemma-Part II: Could Stimulants Cause Tolerance, Dependence, and Paradoxical Decompensation?. Innov Clin Neurosci. 2011;8(1):47–53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/
  8. De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-Phone Addiction: A Review. Front Psychiatry. 2016;7:175. Published 2016 Oct 24. doi:10.3389/fpsyt.2016.00175 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076301/
  9. 5G And The IOT: Scientific Overview Of Human Health Risks, Environmental Health Trust, https://ehtrust.org/key-issues/cell-phoneswireless/5g-networks-iot-scientific-overview-human-health-risks/
  10. EU 5G Appeal – Scientists warn of potential serious health effects of 5G. https://www.jrseco.com/european-union-5g-appeal-scientists-warn-of-potential-serious-health-effects-of-5g/
  11. Health Effects from Radiofrequency Eectromagnetic Fields, Report of the independent Advisory Group on Non-Ionising Radiation, (AGNIR report, April 2012) Documents of the Health Protection Agency, https://www.ices-emfsafety.org/wp-content/uploads/2014/11/AGNIR_report_2012.pdf
  12. Sinha R. Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci. 2008;1141:105–130. doi:10.1196/annals.1441.030 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732004/
  13. Beas BS, Wright BJ, Skirzewski M, et al. The locus coeruleus drives disinhibition in the midline thalamus via a dopaminergic mechanism. Nat Neurosci. 2018;21(7):963–973. doi:10.1038/s41593-018-0167-4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035776/
  14. Van Bockstaele EJ, Reyes BA, Valentino RJ. The locus coeruleus: A key nucleus where stress and opioids intersect to mediate vulnerability to opiate abuse. Brain Res. 2010;1314:162–174. doi:10.1016/j.brainres.2009.09.036 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3274960/
  15. Young SN. Biologic effects of mindfulness meditation: growing insights into neurobiologic aspects of the prevention of depression. J Psychiatry Neurosci. 2011;36(2):75–77. doi:10.1503/jpn.110010 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044190/
  16. Kjaer TW, Bertelsen C, Piccini P, et al., Increased Dopamine Tone During Meditation-Induced Change of Consciousness. Cognitive Brain Research 13(2):255-9 · May 2002 https://www.researchgate.net/publication/11408344_Increased_Dopamine_Tone_During_Meditation-Induced_Change_of_Consciousness
  17. part 3, ref 4, Laube BL, Afshar-Mohajer N, Koehler K, et al. Acute and chronic in vivo effects of exposure to nicotine and propylene glycol from an E-cigarette on mucociliary clearance in a murine model. Inhal Toxicol. 2017;29(5):197–205. doi:10.1080/08958378.2017.1336585 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553614/

Vaping, Part 3: Combined risks – oils and TRP channel activators.

The risks of vaping may be additive, inhaling oils may increase risk of exogenous lipoid pneumonia (ELP), and inhaling TRP channel activators may increase risk of oxidative stress of cells or mitochondria. See part 1 Vaping and TRP Channel Activators, and part 2 Vaping Risks: ELP pneumonia and Oils, for the first two parts of the series.

Inhaling something accidentally is called aspirating and may occur while trying to swallow saliva, food or beverages, or during vomiting, especially for someone with weak muscles as may occur during chronic illness or with aging. Inhaling vape mixtures is purposeful and the original goal was to reduce health risks known to be associated with toxins caused by burning tobacco or an herb. Tobacco also has known carcinogens which would be removed from a product made with only the nicotine such as nicotine gums, lozenges or a nicotine patch.

Nicotine and cannabinoids can have health benefits, while toxins found in smoke can increase oxidative stress and may cause symptoms such as digestive problems, eczema, in addition to respiratory problems such as a chronic cough or bronchitis. Finding a safer way to consume nicotine or cannabinoids would be desirable however vaping may not be the solution, or not yet.

Flavorings that add odor are unnecessary for a product that isn’t inhaled through the nose, but an antioxidant preservative such as vitamin E and emulsifiers* such as glycerine are added to preserve and stabilize the mixture. Safer substitutes might not be available as other substances that preserve and emulsify might affect the lungs negatively also. Air is for inhaling, not emulsifiers. Vitamin E is oil based, antioxidants that are water based are available such as vitamin C, but then how would it stay mixed with an oil based cannabinoid or nicotine which dissolves better in oil or alcohol?

Nicotine can dissolve in water better than cannabinoids (2) and original vaping mixtures were made for nicotine rather than the cannabinoids THC or CBD. Vaping devices are available for powdered herb which heat the herb at a lower temperature than burning it, the problem with that method is that some of the beneficial cannabinoids in some strains of medicinal marijuana are only produced at higher temperatures so the vaped medicine may not provide the full symptom relief that smoking the strain would provide to a patient.

Trying to remove the glycerine from a nicotine vape mixture might not be fully protective against health risks either. The risk may involve a combination of the nicotine and the glycerine, as suggested in an murine based study of e-cigarette chemicals. Chronic exposure to a mixture containing nicotine and propylene glycol** (3 weeks for 20 minutes per day) was found to slow mucociliary clearing while exposure to the propylene glycol did not. Acute exposure (one week for 20 minutes per day) to either mixture did not cause slower mucociliary clearing. The size of particles effects clearance with larger particle size being more likely to remain in the lungs and smaller particles more likely to be exhaled. (4)

Nicotine also can act as a TRP channel activator (3) so the combination of some of the flavoring chemicals or the nicotine and cannabinoids may be opening the cell membrane’s TRP channels and allowing the glycerin or glycol to enter and accumulate to a level that inhibits cell function, causing Exogenous Lipoid Pneumonia or other health problems.

Pregnant women are advised to avoid use of vaped products (and to avoid smoke from tobacco or marijuana). An animal based study did find negative effects on lung alveoli development in newborn animals exposed to e-cigarette vape mixtures for the first ten days of their lives. Reduced weight gain was also noted. The negative effects were seen in the group exposed to nicotine and propylene glycol mixtures rather than the group exposed only to propylene glycol. (6)

If there is a take home point it may be that “Smoking is bad, mmmkay,”*** consider trying the nicotine patch, gum or lozenges, — but avoiding nicotine, smoking, or vaping during pregnancy is advised.

Cannabinoids are needed for fertility for females and males in a U shape curve – too little can cause infertility and too much can cause infertility. CBD is non-euphoria causing and is equivalent to the 2-AG form that is found in greater amounts during normal health than the THC equivalent called anandamide. Neither is recommended currently for use during pregnancy however genetic differences may cause a deficiency. Chocolate and some other legal food sources are available. Non-euphoria producing cannabinoids are the most abundant in plants and are also found in human breast milk and are important for stimulating the infant’s appetite and growth rate. We need cannabinoids in every cell of the body for many functions.. See the post Clinical Endocannabinoid Deficiency, (CED), and Phospholipids, for more information about symptoms or conditions that may be associated with a lack of cannabinoids and a list of legal food sources.

Footnotes:

*Glycerine is a natural emulsifier, helping to keep a water and oil mixture mixed without needing to shake it – picture an oil and vinegar salad dressing that separates into two layers compared to mayonnaise which has egg yolk as the emulsifier to keep the oil and water mixed together. (1)

** Glycerine/glycerin is also known as glycerol and glycols are similar chemically to glycerol. Some forms are more toxic to humans or animals than other forms. They are sweet syrupy liquids and may be consumed by animals if spilled in the form of antifreeze which would be toxic. (5)

*** South Park, paraphrase of a quote by the school guidance counselor Mr. Mackey.

Series:

Reference List

  1. Pat Thomas, Read the Label: Emulsifiers, TheEcologist.org, Dec 14, 2008, https://theecologist.org/2008/dec/14/read-label-emulsifiers
  2. Nicotine, Chemistry Encyclopedia, http://www.chemistryexplained.com/Ne-Nu/Nicotine.html
  3. Feng Z, Li W, Ward A, et al. A C. elegans model of nicotine-dependent behavior: regulation by TRP-family channels. Cell. 2006;127(3):621–633. doi:10.1016/j.cell.2006.09.035 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859215/
  4. Laube BL, Afshar-Mohajer N, Koehler K, et al. Acute and chronic in vivo effects of exposure to nicotine and propylene glycol from an E-cigarette on mucociliary clearance in a murine model. Inhal Toxicol. 2017;29(5):197–205. doi:10.1080/08958378.2017.1336585 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553614/
  5. 14.6: Glycols and Glycerol, The Basics of General, Organic, and Biological Chemistry, (Ball DW, et al.) Chemistry LibreTexts, Last Updated, Aug 12, 2019 https://chem.libretexts.org/Bookshelves/Introductory_Chemistry/Book%3A_The_Basics_of_GOB_Chemistry_(Ball_et_al.)/14%3A_Organic_Compounds_of_Oxygen/14.06_Glycols_and_Glycerol
  6. McGrath-Morrow SA, Hayashi M, Aherrera A, et al. The effects of electronic cigarette emissions on systemic cotinine levels, weight and postnatal lung growth in neonatal mice. PLoS One. 2015;10:e0118344.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338219/

Vaping Risks, Part 2: ELP pneumonia and oils.

Exogenous lipoid pneumonia refers to a fairly rare type of lung illness that is caused by an external/exogenous source of lipids/lipoid. The condition was first associated with the use of mineral oil that was used in nasl medications prescribed for tuberculosis, common in the 1940s and ’50s. It has more recently been associated with the use of Vaseline (TM) type petroleum jelly, which has been used for making the placement of breathing tubes easier and more comfortable for patients. (1)

The mineral oil based Vaseline (TM) is used to coat the outside of the tube before inserting it in someones nasal passage. Unfortunately with long term use the presence of mineral oil in the nose may lead to aspiration, breathing in too much of the mineral oil. Within the lungs the extra oil collects and may cause inflammation of lung cells. Granulomas, groups of inflamed cells, may form which can eventually also lead to fibrotic scar tissue formation and long term loss of lung function. (1, 2)

The rare type of pneumonia, exogenous lipoid pneumonia, has also been reported in one case of excess intake of coconut oil by an infant (5) and two cases of sesame oil pulling. (6) Coconut oil or sesame oil pulling refers to a process used for cleaning the teeth and gums. About a half teaspoon of the oils, which both have anti-inflammatory benefits for general use, is swished throughout the mouth and between the teeth for several minutes to even 20 minutes. That amount of swishing can become tiring and aspiration might become a risk. The case involving an infant involved a sibling giving the baby a bottle with coconut oil by accident (coconut oil is used for hair care, may help prevent split ends). Infants have an increased risk of aspiration as the muscles controlling the closure of the lung passage during swallowing of food are less well developed than in older children or adults. (5)

The excess collection of fats within lung cells has also been observed in the lung disease called silicosis seen mainly in industrial workers. Silica dust is breathed in and the lung cells accumulate both silica dust and the condition can be more severe when there is also absorption of excess lipids from the blood from oxidized Low Density Lipoproteins (ox-LDL). (3, 4)

Returning to the topic of vaping and vape mixtures discussed in the last post – aspiration, drawing liquid or oily substances deeply into the lungs, is a direct result of vaping a mixture that contains oils. Excessive amounts can collect within lung tissue too easily because it is difficult to cough out excess mucous or fluid from deep within the lungs. Chronic Obstructive Pulmonary Disease (COPD) and pneumonia are both conditions that involve too much fluid within the lungs. It can be difficult to draw a deep breath because there isn’t enough air space left. The person is likely to weaken very easily and the condition may be quite painful from the pressure of the excess fluid accumulation. COPD may even be likened to a feeling of drowning – except that it is happening all day, every day.

The take home point of this post may be to use caution with vaping as excessive use may be increasing risk of lung damage, and as a bonus, be aware that regular use of coconut oil or sesame oil pulling for teeth and gum health may have a risk of lung symptoms if aspirated. In other words, if lung symptoms are a problem let your doctor know if you vape or use coconut or sesame oil pulling for the purpose of teeth cleaning.

Series:

Reference List

  1. Rea G, Perna F, Calabrese G, Molino A, Valente T, Vatrella A. Exogenous lipoid pneumonia (ELP): when radiologist makes the difference. Transl Med UniSa. 2016;14:64–68. Published 2016 May 16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912340/
  2. Nguyen CD, Oh SS, A Case of Exogenous Lipoid Pneumonia. Respiratory Care March 2013, 58 (3) e23-e27; DOI: https://doi.org/10.4187/respcare.01727 http://rc.rcjournal.com/content/58/3/e23
  3. Hou X, Summer R, Chen Z, Lipid Uptake by Alveolar Macrophages Drives Fibrotic Responses to Silica Dust. Sci Rep. 2019; 9: 399. doi: 10.1038/s41598-018-36875-2, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344530/
  4. Parthasarathy S, Raghavamenon A, Garelnabi MO, Santanam N, Oxidized Low-Density Lipoprotein. Methods Mol Biol. 2010; 610: 403–417. doi: 10.1007/978-1-60327-029-8_24 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315351/
  5. Pilania RK, Mathew JL, Sodhi KS, et al., Revisiting a Case of Persistent Pneumonia: Complication of Hair Oil Aspiration, Letter to the Editor, Journal of Paediatrics and Child Health, Vol 54, Issue 11, Nov 2018, pp 1284-1285 https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.14216
  6. Kuroyama M, Kagawa H, Kitada S, et al., Exogenous lipoid pneumonia caused by repeated sesame oil pulling: a report of two cases. BMC Pulm Med. 2015; 15: 135. doi: 10.1186/s12890-015-0134-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628246/
  7. Singh A, Purohit B. Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health. J Ayurveda Integr Med. 2011 Apr-Jun; 2(2): 64–68. doi: 10.4103/0975-9476.82525 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131773/