The death of dozens of people from vaping was explained by vitamin E. Let's try to figure out a strange story about a mass illness of young vapers.
Vaping, which is rapidly gaining momentum, has been giving alarm signals for about a year now. Accumulating testimonies from individual doctors, tissue samples from individual vapers who went to the hospital due to a deterioration in their well-being - at first all this did not seem very significant.
However, in April 2019, a message appeared about the death of one of these who turned to doctors - and the death of an unclear nature. As of November 5, 2019, there were 39 strange vaper deaths across 24 states in the US. Among the dead, at least one teenager 16 years old.
The symptoms of the disease are similar for everyone. Chest pain, shortness of breath, shortness of breath, sometimes fever, diarrhea, vomiting. Other pulmonary diseases give similar symptoms. However, antibiotics will not help the vape epidemic, and it seems that there is no effective cure for it at all. Doctors only suppress symptoms, reduce the strength of inflammatory processes in the organs of the respiratory system. It is not easy to treat a disease for which you do not know the exact cause.
Why do symptoms of mustard gas occur after vaping?
The term "vaping-associated lung injury" (VALI in English) appeared. As of November 5, 2071 people with such an injury were officially recorded in the States. Suspicions that not only Americans are dying from vaping are difficult to verify: in many countries, doctors would prefer to diagnose the death of a young patient with some known disease than to sign that they do not understand what happened.
Respiratory tract damage from the "vape epidemic" in the United States is very similar to the effect of inhalation of mustard gas - a chemical warfare agent actively used to destroy the enemy more than 100 years ago.
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By October 2019, a paper was published in The New England Journal of Medicine, where the authors tried to study lung tissue samples from people with VALI. It was about patients with serious lung damage: on x-rays they had opacity in the lungs, and two of the examined died from the same unclear cause. In all seventeen, the lung tissue shared signs of a lesion rarely seen in our time.
Brandon Larsen, one of the authors of the paper, put it this way: “To be honest, they [their lung tissues] showed the type of change that you would see in an unlucky industrial worker after a production accident, when a large barrel of toxic chemicals spills and a person inhales vapors from them, getting a chemical burn of the respiratory tract.
In such cases, the cells lining the airways and lungs die off, triggering an immune response, followed by swelling and exfoliation of the dead cells. The fluids that appear in this case partially enter the lungs. The swelling plus fluid makes breathing noticeably difficult and, with a certain degree of initial burn, can make it impossible, leading to death. A similar picture has been observed much more often in the past: mustard gas, a poisonous gas from the First World War, acts on the respiratory system in a similar way.
Vitamin E acetate: the killer is found, or are we grabbing at straws?
The US Centers for Disease Control and Prevention recently added a new element to the equation. After examining 29 patients with VALI, they found in each of them in fluids from the lungs the so-called vitamin E acetate - in other words, a synthetic form of vitamin E. Again, we were talking about people with a high level of lung damage, two out of 29 died. The flushing fluid in which vitamin E was found was first pumped into the respiratory tract through a tube and then pumped back out through the same tube.
It is clearly seen that the victims of the vaping epidemic in the States are unevenly distributed. Why is not yet known.
At the same time, nicotine was found in only 16 cases, and traces of tetrahydrocannabinol - only in 23 cases. Tetrahydrocannabinol is the active ingredient in relatively legal marijuana in the United States. US vaping liquids often contain it. Nevertheless, it turns out that nicotine and the components of marijuana were not in the respiratory tract of all patients, but vitamin E was in all, without exception. It was not possible to identify any other unusual substances that would not be found in healthy people in 29 surveyed.
From this, the US Centers for Disease Control and Prevention is tentatively concluding that vitamin E may be causing the strange lung damage. Could they be right?
At first glance, there are reasons to doubt this. The synthetic form of vitamin E has long been used in shower gels, skin creams, and so on. Advertising has long and confidently tells us that it allegedly stops the development of signs of aging (in fact, no), and taking capsules with this vitamin is common. Obviously, synthetic vitamin E cannot be highly toxic by itself.
However, the problem is that no one has experimented with inhaling vapors with a high content of this substance. Electronic cigarettes used by vapers can heat the liquid they evaporate up to 250 degrees Celsius. Vitamin E, as is often the case with organic compounds, can begin to decompose, giving compounds more dangerous than itself. It is possible that the cells themselves lining the human respiratory tract may be sensitive to vitamin E, which is rarely encountered normally.
Nicotine and hemp: what is their role in a mysterious epidemic
Today it cannot be ruled out that the disease is caused not by vitamin E, but by more traditional enemies of smokers: for example, nicotine or components of marijuana. But this is doubtful. Humans have heated tobacco and grass - and more than 250 degrees - for thousands of years in a row, but no one has seen the symptoms of acute lung failure leading to death from this. Regular smoking kills by other mechanisms.
A range of vape liquids containing the active ingredient in marijuana carry quite a bit of synthetic vitamin E with them.
US officials at the height of the epidemic began advising vapers to avoid the use of liquids containing tetrahydrocannabinol, the main active ingredient in marijuana. But this recommendation is not because they believe this substance is the cause of the mysterious deaths. It's just that liquids with tetrahydrocannabinol are more likely to contain high concentrations of vitamin E. This is not a very expensive substance that is considered safe. Small-scale manufacturers of tetrahydrocannabinol vaping blends with peace of mind include it in their products.
Nicotine vape blends in the United States are more likely to be produced by corporations that have less imagination and variety in their product chemistry. In addition, small blend manufacturers in the United States often work illegally, selling blends on the streets, while large ones cannot do this - therefore, the strictness of control over the composition of their blends is higher.
The conclusion is simple: almost certainly neither nicotine nor tetrahydrocannabinol themselves have anything to do with the epidemic.
Unknown impurities: who is more dangerous for a vaper - cyanide or high-fire journalists
The topic of "illegal" mixtures for cartridges sold on the streets was also attempted by the journalists of the American channel NBC News. They hand-bought ten cartridges of vaping liquids containing THC. In all of them, compounds were found that, when heated, turn into hydrocyanic acid - a rather strong poison. From this, media workers concluded: "left" impurities can cause the death of vapers.
Well, if their concentration there is raised to the required level - yes. One problem: in the conditions of the real vaping epidemic observed in the States, people do not die of heart failure. Namely, this is how hydrocyanic acid kills. It can cause respiratory tract lesions, but very different from those observed in vaping victims. Moreover, it is not possible to find victims of hydrocyanic acid in the washes from the respiratory tract.
If the "investigation" of NBC News is translated into Russian, it will sound like this: we really wanted to cut the hype on someone else's death, but we know chemistry in moderation. Therefore, they did not delve into vitamin E, but looked for a "terrible poison". Yes, his symptoms are not the same as those of the deceased. Yes, its concentration in the cartridges we bought is far from dangerous. So what? We need a hype, preferably all, and the rest is secondary. A sad example of the evolution of the once good American journalism.
Recently vaping has been feared as a new form of smoking. Now he has shown that he is capable of something in which ordinary smoking has never been noticed.
Let's summarize. It is not yet known what exactly kills the victims of the vaper epidemic. Washes from 29 people - in a situation where there are already thousands of patients and dozens of deaths - is not yet iron proof of the guilt of specifically synthetic vitamin E.
Nevertheless, there is a high probability that the problem may be in him. VALI is known to most commonly affect vapers using tetrahydrocannabinol fluids. Vitamin E makes it easier to retain THC in vaping liquids, so its content is higher than in most vape liquids containing nicotine.
This is not the worst news for our country. In Russia, vape liquids with tetrahydrocannabinol are exotic. We smoke grass in the old fashioned way, without the use of new technologies, so the chances of getting vitamin E into the respiratory system are much lower than in the West.
But we would not completely relax. If you are a vaper and the vaping liquid you bought has a detailed chemical composition, you should take advantage of this. Take the time to study it. If there is vitamin E, it is tocopheryl acetate, it is α-tocopherol, it is food additive E307, try to find another mixture. By the way, the presence of E306, E308 and E309 in the vape liquid, which are close to it in composition, should also be avoided, just in case. At least until people in America stop dying of unknown causes.
Author: Alexander Berezin