Thursday, January 9, 2020

Harvard study finds toxin in Juul pods that is known to cause long-term lung damage; highest in two flavors still allowed

By Melissa Patrick
Kentucky Health News

A study at Harvard University found that electronic cigarette products made by Juul Labs were contaminated with a microbial toxin that can cause long-term lung damage.

CNN photo
The researchers from Harvard T.H. Chan School of Public Health found that 46 percent of the 54 Juul pods they analyzed contained detectable levels of glucan, a component of fungal cell walls.

"Chronic exposure to glucan can cause inflammation in the airway and lead to long-term lung damage," David Christiani, a co-author of the study, said in a news release.

The study, published online in the American Journal of Respiratory and Critical Care Medicine, found that pods with menthol and tobacco flavors had the highest levels of glucan: 1,353 and 307 times higher, respectively, than in the company's other flavored products.

The news came just days after the U.S. Food and Drug Administration announced a ban of the sale of flavored e-cigarettes, except for menthol and tobacco-flavored products -- the two flavors found to have been most contaminated with glucan.

The ban is for cartridge-based systems, like pods produced by Juul, the leading manufacturer. It does not include flavors in tank systems sold in vape shops. Juul, which leads the e-cigarette market, had already stopped selling its fruit flavored products, including mint, prior to the ban. It continues to sell tobacco and menthol flavors.

The researchers also analyzed the Juul pods for endotoxin, which is a microbial agent and a component of the exterior cell wall of certain types of bacteria, including E.coli, and found them all to be "below the limit of detection."

This study follows a separate Harvard Chan School study, published in April, that found the same bacterial and fungal toxins in many popular e-cigarette products sold in the U.S. This study was conducted on 37 cartridges and 38 e-liquid products with the highest nicotine content from the ten top-selling U.S. brands in 2013, which was prior to Juul's 2015 introduction to the market.

It found that 17 of the 75 e-cigarette products, or 23%, were contaminated with endotoxin; and 61, or 81% of them, were contaminated with glucan. Similar to the Juul pod study, glucan concentrations were higher in the tobacco- and menthol-flavored e-cigarettes.

Christiani notes in the release that the glucan found in Juul pods is not related to the current vaping-related illness in the U.S., which the Centers for Disease Control and Prevention reports has hospitalized over 2,500 patients and killed 55 of them as of Dec. 27

In Kentucky, 43 cases are under investigation, with six of them confirmed and 12 of them probable. Ten of the reported cases have been ruled out.

The CDC says vitamin E acetate, an additive in some THC-containing e-cigarette products, is closely associated with  the vaping-related illness, which is called EVALI for "E-cigarette or Vaping product use Associated Lung Injury."  THC, or tetrahydrocannabinol, is the psychoactive ingredient in marijuana.

Christiani adds that  he’s not sure why Juul’s tobacco- and menthol-flavored pods have such high levels of glucan. He said it could be related to the raw materials used in the products or could be occurring during the production process.

Abby Haglage reports for Yahoo Lifestyle that most of the research so far on the health effects of glucan comes from working environments, and adds that traditional cigarettes have also been shown to contain glucan, "likely at far higher levels than e-cigarettes," she writes.

Greg Conley, president of the American Vaping Association, told Haglage that he took issue with the report.

"Microbial contamination is a reality with everything in life, including e-liquids and traditional tobacco products ... “ Conley told Yahoo Lifestyle. “These authors have identified no actual risk, just that some microorganisms were detected, and they are promoting their findings knowing that many will falsely interpret the paper to mean that vaping could be equally or more hazardous than smoking cigarettes.”

The Juul study recognized that the main limitation of the research is that it did not evaluate contamination of aerosols inhaled by users. The initial study calls for further research to be conducted with larger representative samples of products.

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