September 15, 2019

Stanton A. Glantz, PhD

Is the mystery cause of e-cig lung disease hiding in plain sight?

The search for what is causing all the severe pulmonary disease associated with e-cigarette use has focused on possible “contaminants” and the fact that many, but not all, the people who got sick used THC e-cigs, often as well as nicotine e-cigs.

But, based on the strong mouse study showing propylene glycol/vegetable glycerin (PV/VG) damages surfactant in lung air sacs, creating lipid globules that are taken up by macrophages that seem the same as has been seen in e-cig users who develop serious lung disease, I wonder if it is PG/VG that is causing, or one of the main causes of these serious cases of lung disease.

In addition to being used in virtually all nicotine e-cigs, it is used in at least some THC e-cigs.

This doesn’t mean that there could not be other things going on, but PG/VG, which is not a “contaminant” deserves serious consideration.

By the way, a recent story on this mystery in the New York Times talked about avoiding “illicit” e-cigarettes, something the FDA has also recommended.  The fact is that all e-cigarettes are “Illicit” in the sense of being on the market illegally.  The only reason e-cigs are on the market is because the FDA is not yet enforcing the provisions of the Tobacco Control Act that require premarket approval of e-cigarettes. 

If this turns out that it is the PG/VG that is causing these pulmonary problems, I don’t see how FDA can approve any e-cigs.  FDA needs to join CDC and other health authorities and start telling everyone to stop using e-cigs – nicotine and THC – until authorities figure out what is going on.



Has VG/PG ever been federally approved for inhalation as an ‘intended” use?


The data safety sheet for industrial users of PG advises users to "Avoid inhalation of hot vapors or extremely high concentrations of aerosols."


The fact that quotes like 'start telling everyone to stop using e-cigs until authorities figure it out' are being made, proves how poorly the research here is conducted.

The cause has been cleary stated by many authorities and researchers already.
The illicit THC cartridges that are being sold on the US market with vitamine e oil as an additive.

'The center for control & education' is educating on matters it is not up to speed with and scaring people back into the most toxic lethal & LEGAL product ever to hit the market in the history of the human race. This is litteraly putting blood on your hands. Such a shame. Use it as a tool like in the United Kingdom where they have good regulations and they are beating everyone handsdown in their anti-tobacco policy with the highest succesrates in decades.


As I noted in the blog post, some of the victiums vaped THC; many also vaped nicotine and there are also cases of people who only vaped nicotine.

As I noted in the blog post, there may be more than one cause of the lipid pneumonia, but the mouse study only exposed the animals to nictoine free e-cig aerosol.

E-cigarettes are not legal.  Ever since the deeming rule, all e-cigarettes on the market are illegal because they are tobacco products being sold without and FDA marketing order.  The only reason that they are able to be sold is because the FDA has been exercising "enforcement discretion" and not enforcing the law.


Several people have asked me why these problems are just showing up now.

My guess is that some people using e-cigarettes have been sufferrng severe lung disease for some time, but the prevalence of use was not high enough to get enough cases at one time for the disease surviellence system to pick it up.  Individual case reports have been reported in the medical litertaure for several years.

The particle size in the early e-cigs was larger than the subsequent generations of e-cigarettes, which meant that less of the PG/VG aerosol was delivered deep into the lungs.  (Indeed, this was one of the criticisms of them: they did not deliver nicotine deep into the lung where it was rapidly absorbed and transferred to the brain.)  This lung disease takes place deep in the lungs, in the airsacs.

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