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/

Vaping and TRP channel activators.

Vaping is a slang term used to describe a method for inhaling tobacco or other herbs without literally burning them with a flame. Electric heating devices turn volatile chemicals within the tobacco or herb into a vapor (gaseous form of the chemical) that can be inhaled. Typically smokers of tobacco don’t draw the smoke of cigarettes or a pipe deeply into the lungs while smokers of marijuana do tend to inhale and hold the smoke. Either type of smoking does create toxins from the act of burning the herb/tobacco leaf.

Electric vaping cartridges heat a liquid mixture that may contain nicotine from tobacco or THC/CBD from marijuana possibly along with other chemicals to help keep the mixture mixed (emulsifying oils such as glycerine) or chemicals that add a flavor and/or odor. The goal of vaping was to reduce the health risks that are linked to carcinogens in tobacco or to the chemicals that are created during burning a substance (too many decorative candles in a poorly ventilated home can also be a health hazard). Unfortunately there have been health problems and even some deaths linked to vaping nicotine or cannabinoid containing vape products.

Health risks have been linked to the glycerine (exogenous lipoid pneumonia (ELP), a type of pneumonia caused by excess fats/lipids in lung cells) (2), however other health problems have also occurred. No one chemical has been found that can be linked to all of the health problems or deaths that have occurred. (1) In addition to the type of pneumonia attributed to the glycerine content, several of the chemicals used to add flavor to vape products have been linked to various negative health symptoms.

Cinnamon contains cinnamaldehyde which has been found to be a health risk in vape products. (7) Risks have also been linked to o-vanillin, found naturally in vanilla, and pentanedione (found in honey). Other potentially harmful chemicals were also a frequent problem when fifty flavored vape products were tested 92% were positive for diacetyl, acetylpropionyl, or acetoin. (9) Glycerine may be harmful as a fatty substance that doesn’t belong in the lungs but may also be acting as modulators or activators of TRPV channels. (glycerine/glycerol) (12) Butter flavorings use 2-3-Pentanedione which has already been associated with lung problems associated with microwave popcorn. (13)

More complex flavors include several flavoring chemicals in combination, and risk may also increase from combinations or increased total quantity of the chemicals used as flavorings. Products available for sale may not be subject to regulation or labeling requirements so what a vape liquid contains may not be available to a consumer or a medical professional.

Natural phytonutrients found in vanilla and cinnamon add fragrance and health benefits, however when inhaled deeply into the lungs they may be overactivating cells due to their ability to open channels through cell membrane walls which allows excess calcium to enter the cell, or through the membranes of mitochondria found within cells. Cinnamaldehyde and vanillin are both TRP channel activators. TRP channels are portals through the cell membrane wall or in the membrane of organelles within the cell such as mitochondria, the main energy producing part of every cell. The TRPA1 channel is a type associated with coughing and mucous production. (8) Ethyl vanillin activates TRPA1 channels (10) and more typically vanillin is known to activate TRPV channels (the V stands for vanilloid). (11)

Vitamin E content in vape mixtures has also been linked with health risks associated with vaping. (4) Vitamin E can act as a preservative against oxidation, or spoilage of the oil content in a mixture, and it may also act as a TRP channel modulator – affecting the ability of other chemicals to open TRP channels. Vitamin E might help keep them closed in some tested conditions. (5) Cannabinoids can also act as TRP channel activators. (6) The non-euphoria producing cannabinoid known as CBD activates TRPV1 channels and the euphoria producing cannabinoid in marijuana known as THC activates the TRPA1 channels. (11)

Normally the fragrance of foods is sensed within the nose. The tongue and the lungs have no scent receptors. The cinnamon smells fragrant in small amounts but sniff a large amount and you may sneeze and your nose will likely start dripping with extra mucous production. Extra mucous production is a protective mechanism to keep potentially harmful or irritating chemicals from being inhaled into the lungs.

Horseradish has a very pungent smell and hot pepper simply burns when eaten or when it gets on delicate mucous membranes and eating either will also cause increased mucous production and release – in other words – a runny nose. Horseradish and hot pepper also contain potent TRP channel activators – they are causing mucous to be released. Extra mucous production is normal for your nose, it can just drip or be blown out, but deep within your lungs too much mucous production can cause the lungs to overfill and it may lead to pneumonia or Chronic Obstructive Pulmonary Disease (COPD) also involves lungs that are too full of liquid. COPD patients are recommended to avoid use of e-cigarettes as they may increase the inflammatory response of COPD lung cells (3)

The simplest take home point might be to avoid flavors in vape products altogether – the lungs can’t smell them, neither can your tongue, only your nose can. Unless you are inhaling through your nose, where mucous membranes are designed to prevent entry of toxic chemicals and TRP channel activators, then it would likely be safest to avoid sweetened or flavored vape products and avoiding unregulated products helps reduce the risk of unknown ingredients present in unknown amounts. An article on Healthline includes a long list of specific chemicals found in vape products that may have health risks. The article reviews other known health risks and includes links to the research articles. See: Is Vaping Bad for You? And 12 Other FAQs. (9)

*Vaping is not recommended during pregnancy due to the health hazards that are known, and the many unknowns about the health risks to a developing baby.

Continued:

Disclaimer: This information is provided for educational purposes within the guidelines of Fair Use. It is not intended to provide individual guidance. Please seek a health care provider for individualized health care guidance.

Things that may overstimulate TRP channels.

For more information and reference list about TRP channels see G3: Relaxation & Stress, and G5: Preeclampsia & TRP Channels.

Reference List

  1. Health Canada, Information Update – Health Canada warns of potential risk of pulmonary illness associated with vaping products, Oct. 11, 2019, hc.media.sc@canada.ca; https://www.newswire.ca/news-releases/information-update-health-canada-warns-of-potential-risk-of-pulmonary-illness-associated-with-vaping-products-867534807.html
  2. Viswam D, Trotter S, Burge PS, Walters GI, Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. BMJ Publishing Group Limited 2018 http://dx.doi.org/10.1136/bcr-2018-224350 , https://casereports.bmj.com/content/2018/bcr-2018-224350
  3. Heightened response to e-cigarettes in COPD, European Respiratory Society, https://openres.ersjournals.com/content/5/1/00192-2018
  4. Brueck H, Vaping is leading to a spate of lung injuries, comas, and death. Lung experts say oils like vitamin E may be partially to blame. Insider, Sep 19, 2019, https://www.insider.com/why-is-vaping-dangerous-for-your-lun
  5. Nazıroğlu M, Özgül C, Vitamin E modulates oxidative stress and protein kinase C activator (PMA)-induced TRPM2 channel gate in dorsal root ganglion of rats. C. J Bioenerg Biomembr (2013) 45: 541. https://doi.org/10.1007/s10863-013-9524-x https://link.springer.com/article/10.1007/s10863-013-9524-x
  6. Muller C, Morales P, Reggio PH. Cannabinoid Ligands Targeting TRP Channels. Front Mol Neurosci. 2019;11:487. Published 2019 Jan 15. doi:10.3389/fnmol.2018.00487 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340993/
  7. Clapp PW, Lavrich KS, van Heusden CA, et al., Cinnamaldehyde in flavored e-cigarette liquids temporarily suppresses bronchial epithelial cell ciliary motility by dysregulation of mitochondrial function. American Journal of Physiology-Lung Cellular and Molecular PhysiologyVol. 316, No. 3, https://www.physiology.org/doi/abs/10.1152/ajplung.00304.2018?journalCode=ajplung
  8. Geppetti P, Patacchini R, Nassini R, Materazzi S, Cough: The Emerging Role of the TRPA1 Channel. Lung (2010) 188(Suppl 1): 63. https://doi.org/10.1007/s00408-009-9201-3 https://link.springer.com/article/10.1007/s00408-009-9201-3
  9. Is Vaping Bad for You? And 12 Other FAQs, Healthline https://www.healthline.com/health/is-vaping-bad-for-you
  10. Wu SW, Fowler DK, Shaffer FJ, Lindberg JEM, Peters JH. Ethyl Vanillin Activates TRPA1. J Pharmacol Exp Ther. 2017;362(3):368–377. doi:10.1124/jpet.116.239384 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539581/
  11. Premkumar LS. Transient receptor potential channels as targets for phytochemicals. ACS Chem Neurosci. 2014;5(11):1117–1130. doi:10.1021/cn500094a https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240255/
  12. Kahn-Kirby AH, Dantzker JLM, Apicella AJ, et al., Specific Polyunsaturated Fatty Acids Drive TRPV-Dependent Sensory Signaling In Vivo. Cell, Vol 119, Issue 6, 17 Dec. 2004, pp 889-900 https://www.sciencedirect.com/science/article/pii/S0092867404010475#!
  13. CDC – Flavorings-Related Lung Disease: Exposures to Flavoring Chemicals, NIOSH Workplace Safety and Health Topic, https://www.cdc.gov/niosh/topics/flavorings/exposure.html

Clinical Endocannabinoid Deficiency, (CED), and phospholipids.

During normal health we make cannabinoids internally – endogenously, hence the term endocannabinoids in contrast to cannabinoids found in plants such as cannabis/marijuana/hemp. Most cannabinoids do not cause euphoria even though the group may be best known for that affect.

Anandamide (AEA) is the endocannbinoid that is chemically similar to the euphoria causing cannabinoid found in marijuana known as THC, tetrahydrocannabinol. Cannabidiol, CBD, is a non-euphoria causing cannabinoid found in some strains of marijuana. It is chemically similar to the endocannabinoid known as 2-AG which in times of normal health is found in greater concentration within the body than anandamide.

Cannabinoids within the body are found as a structural part of cell membranes. They also can be released from the membranes and used as signaling chemicals within the brain and peripheral nerves, affecting many things including memory, appetite, sleep, movement, and fertility. The cannabinoids when released from the cell membranes can also be modified into another type of signaling chemical that is important in immune health (eicosanoids).

Due to genetic changes or other issues with metabolism or health some people may not be able to make cannabinoids internally and would need an external source to maintain health. Due to marijuana having been listed as a controlled substance considered to have no medicinal value research has been limited to studies about toxicity and addiction. Research on the role cannabinoids plays in health is becoming more available but is still in early stages considering the many functions they have within the brain and body.

Conditions that may involve Clinical Endocannabinoid Deficiency, (CED):

Conditions that may involve a deficiency in cannabinoids chronically may include symptoms of pain, muscle spasms, nerve numbness, mood disorders, movement disorders, digestive and appetite problems, appetite and growth failure in infants or colic, menstrual problems and infertility/miscarriages and hyperemesis prenatally.

  • Pain/inflammation: Migraines, Fibromyalgia.
  • Mental health: Anxiety, PTSD, Major Depression, Bipolar disorder, Motion Sickness, The balance of cannabinoids (2-AG ~ noneuphoric CBD and anandamide ~ euphoric THC) is a problem in schizophrenia.
  • Nervous system: Multiple sclerosis, Diabetic Neuropathy, Brachial plexopathy, Causalgia, Phantom limb pain, Glaucoma, Huntington’s, Parkinson’s, Cystic Fibrosis,
  • Appetite/digestive system: Anorexia & Bulimia, Neonatal Failure to Thrive, infantile Colic, Irritable Bowel Syndrome.
  • Fertility/reproductive system: Dysmenorrhea, Hyperemesis, repeated miscarriages (Russo 2016), (anandamide is needed for implantation of a fertilized egg in the uterus and development of the placenta to occur normally, too much or too little can disrupt the process, Fonseca 2013), male infertility due to sperm motility problems is associated with low levels of anandamide (AEA) (Amoako 2013), (too much can also negatively affect male or female fertility).
  • Other food sources of cannabinoids exist in addition to marijuana or hemp however the amount provided is in lower concentrations so you might need a large salad that includes several sources at one meal, and other sources in beverages, supplements, or at other meals.
Conditions that may involve Clinical Endocannabinoid Deficiency (CED)

Food sources of cannabinoids or phospholipids (a precursor chemical):

Cannabinoids, can be found in smaller amounts in foods than in medical marijuana or synthetic THC medications. Good sources include:

  • Chocolate, dark cocoa powder.
  • Seeds: hemp kernels, pomegranate, seeds & peel, pumpkin, sesame, flax, fennel, cardamom, cumin and coriander;
  • Grains: amaranth, rice bran, sorghum, buckwheat, wheat;
  • Beans/legumes;
  • Coconut/Nuts: pine nuts, peanuts, cashews, almonds;
  • Green plants: lettuce, spinach, mustard greens, leek greens, asparagus, avocado fruit and dried kernel, celery, carrots, onion, garlic. Squash, cucumber and okra seeds, butternut squash, pumpkin, sweet pototo or yams, parsnip root, Jerusalem artichoke root.
  • Herbs: Rosemary, Gingko leaf, Wormwood/Artemisia;
  • Grapefruit and citrus juice with the pulp.
Good Food Sources of Cannabinoids and/or Phospholipids

Disclaimer: This information is provided for educational purposes within the guidelines of Fair Use. It is not intended to provide individual guidance. Please seek a health care provider for individualized health care guidance.