Medical Bits – Vol. 1.7: Your Health – Your Lungs

We don’t need to emphasize the importance of breathing. One of the true wonders of complex life is oxygen! Complex biologic life would not be possible without the high concentrations of oxygen available in our atmosphere. While water signals the potential for complex life, only oxygen makes it possible. As we have reviewed in the past, studies of our geologic evolution have demonstrated that its contents have not always been the same.  The steady rise in oxygen concentration was due to the emergence of photosynthetic algae. These simple plant forms and stromatolites (still present off the coast of Northern Australia and dated 3.8 billion-years old) are likely the fore bearers responsible for the early rise in atmospheric oxygen concentrations that promoted the rise of multicellular organisms (like you) over millions of years. Of course, this did not happen overnight… or over seven biblical days. Millions of observations over the course of human history and particularly in the last five hundred years, since the Copernican Revolution, and the application of the scientific method, have documented the evolution of our universe, solar system and planet.

The quest to understand the universe and our place within it is of course, the greatest of human adventures! The realization that a few set of physical rules are responsible for the evolution of our vast universe is just magical! It is truly amazing to realize that just hydrogen (75%) and helium (23%) form 98% of the universe. The other 2% that appears so plentiful to us in our tiny “neighborhood” was formed through the nuclear fusion of hydrogen and helium in the furnace of large stars exploding as supernovae or red giants with the consequent spewing of “star dust,” which eventually coalesced into other stars and planetary nebulas. These formations eventually gave rise to planetary systems such as our own and others, now known to be common throughout the universe. Carbon, oxygen, silica, and iron achieved high concentrations in inner, rocky planets such as Earth.

Oceans formed about 4.2 billion years ago. Simple RNA-microbial life forms appeared 4 billion years ago and were the earliest reproducible living “creatures”. Within 400 million years, the photosynthetic unicellular organisms mentioned above lead to profound atmospheric changes. Rudimentary animal life appeared 700 million years ago, and curiously, atmospheric oxygen levels reached current levels before the Cambrian period 550 million years ago, likely spawning the Cambrian life explosion. It took eons for you and I to stand-up and defy gravity… that ever present force without which no universe would be possible. And those “simple” natural laws: the FORCES of gravity (including its time dimension as proposed by general relativity), electromagnetism, weak and strong nuclear forces made possible our observable and non-observable Universe. What seems impossible overnight… becomes inevitable over the eons…

And of course, the scientific harnessing of electro-magnetism has allowed the medical imaging of ultrasound, x-rays, magnetic resonance imaging and radiotherapy by using high energy waves to combat disease.

But, back to breathing!

Breathing is so important that it is ever-present in our language and expressions:

  • Inspire: breath in
  • Aspire: breath toward
  • Conspire: breathe with
  • Perspire: breath through
  • Transpire: breath across
  • Respire: breathe again
  • Expire: breath out

Dum spiro, spero” (“While I breathe, I hope”). And of course…Spirit…about which, so much has been written…

Breathing and the utilization of Oxygen makes us more efficient at extracting energy from our caloric sources. You may remember from your early days in biology that simple organisms (and our own Eukaryotic cells) have maintained simple anaerobic metabolism as the main enzymatic pathway for energy generation. Aerobic, oxygen-dependent metabolism is almost 10 times more efficient than anaerobic metabolism. Our “engine” requires carbon as the primary fuel source, which is metabolized and “oxidized” to generate energy which our muscles and machinery transform into heat and work.

The respiratory system consists of the upper airway (nose, turbinates, sinuses, pharynx, and larynx), which filter and humidify air, the lower airway (trachea and bronchi) that serve mostly as conduits, and lung alveoli where gas exchange and the diffusion of external oxygen and internal carbon dioxide takes place. The pleural sacs surround each lung and are virtual cavities with little content and no clear function (likely evolutionary remnants and not necessary for survival, as demonstrated by diving mammals, elephants and marsupials, whose pleural sacs become obliterated through their embryologic stages in the womb).

Disease can affect each portion of the respiratory system!

The time is always right to do what is right.

Martin Luther King, Jr.


Medical Conditions: Vaping-induced Lung Injury

You have likely heard about the emergence of a “vaping lung disease epidemic.” The Centers for Disease Control, issued an emergency warning two weeks ago, reporting 450 cases of acute lung injury  in 36 states. Eighty percent of patients had used both nicotine products and tetrahydrocannabinol (THC) or cannabidiol (CBD) products. No active infection has been found but rather acute toxic lung injury of the delicate alveolar walls, leading to patterns of pneumonitis such as eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, diffuse alveolar damage, acute respiratory distress syndrome (ARDS) diffuse alveolar hemorrhage, hypersensitivity pneumonitis and rarely giant-cell interstitial pneumonitis. While you may not need to recognize these patterns of disease, your pulmonologist certainly needs to be aware.

E-cigarettes fluids contain several potentially toxic compounds: nicotine, carbonyls, volatile organic compounds (VOC’s) such as benzene and toluene) bacterial endotoxins and fungal glucans. Flavor chemical such as diacetyl and 2,3-pentanediol are known to perturb gene expression and cause damage in bronchial epithelial cells. If you, your family members or friends develop a dry cough, low-grade fever, nausea, and progressive breathlessness, I recommend prompt evaluation.

Some of my children’s friends have argued that “it’s better to vape than to smoke.” Vaping involves heating liquids and generating vapor, without combustion. Smoking any substances implies burning (utilizing oxygen in the combustion process) and generating various amounts of carbon monoxide and many other harmful chemicals. We all know the nefarious consequences of long-term smoking. Regarding vaping, the truth is that we do not know the long term effects of exposing lung and airways to potentially toxic chemical substances.

I would ask my esteemed and intelligent patients and friends, how it could possibly be good for our biology, for our “temple” which harbors our “spirit” and all of our dreams, to expose our lungs and consequently the rest of our body to chemical substances not intended by nature and biology.

You may argue that medications are not natural. Fair observation. But drugs are meant to re-establish health and correct pathology through the judicious use of proven molecules in safe amounts and to nudge our biology back to its natural homeostasis and normal functioning.

Please, avoid contaminating your “temple” with any toxic fumes, smoke, or drugs!

An excellent resource to investigate possible drug-induced lung disease is updated and maintained by Phillipe Camus and his colleagues at University Hospital Dijon, France.  And remember: “The Poison is in the Dose” (Dosis sola facit venenum), as admonished by Paracelsus (Swiss physician) in the early 1500’s. In general, the potential for harm is proportional to the dose. In excess, even water can be toxic…

Debunking Myths: Q&A

Myth: We can “sweat out toxins”!

NOT TRUE!!! There is no evidence that this is true or that it could possibly have any biologic foundation. A favorite is when I hear people indicate that they smoke tobacco or cannabis or they vape nicotine but they “sweat it out” by running. This is not true! Avoid toxins. Most organic compounds are lipophilic and accumulate in our fat. Some heavy metals and polychlorinated biphenyls may stay in tissues for years. There are many reasons to work up a good sweat, and we should try to do that daily, but “detoxifying” is not one of them!

Myth: Drinking bottled water is safer than tap water!

Not true! Tap water is probably safer and free of bisphenol A (BPA) which is found in plastic bottles and leaks into the contents and from there into your tissues. It has been associated with heart disease. Furthermore, 80% of all plastic bottles end up in landfills and oceans around the world! Use tap water, keep it simple, cheap, and protect the environment around you!

We will address other “myths” in future communications.

In the meantime, remember: keep cool, eat a nutritious and diverse diet, stay active and be happy!  The only fountain of youth proven by science, experience and millennia are exercise, laughter, humor and a good positive attitude! Enjoy every minute of the JOURNEY! Cheers! CP.

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