Vaping, Marijuana & Air Pollution: What They're Really Doing to Your Lungs

In this episode of Hormones & Hope, Dr. Chhaya Makhija welcomes pulmonologist Dr. Vijay Balasubramanian for an in-depth discussion about respiratory health, environmental exposures, and the everyday habits that shape our lung function over a lifetime.

We often focus on improving our heart health, lowering cholesterol, managing blood sugar, or losing weight, but healthy lungs are just as essential to living well. Every breath fuels our body with oxygen, making lung health a cornerstone of overall wellness.

Dr. Vijay shares his expertise on how the lungs work, why they naturally change as we age, and how conditions like obesity, sleep apnea, and cardiovascular disease can all influence the way we breathe.

He also explains why shortness of breath is never a symptom to ignore and why finding its underlying cause is so important.

The conversation takes a deep dive into the modern threats to lung health, including air pollution, wildfire smoke, vaping, marijuana use, and occupational exposures. Dr. Vijay discusses how these factors can contribute to inflammation, chronic lung disease, pulmonary hypertension, and permanent lung damage, while offering practical strategies to reduce your risk.

From avoiding smoking and vaping to staying physically active and minimizing harmful exposures, small choices today can have a lasting impact on your respiratory health for years to come.

If you're looking to better understand your lung health, protect your breathing as you age, or learn how everyday exposures affect your body, be sure to check out this episode.

Dr. Vijay Balasubramanian is the Founder/ Medical Director of Valley Advanced Lung Diseases Institute (VALDI) in Fresno. He is Board Certified in Pulmonary Medicine and specializes in Advanced lung diseases such as Interstitial Lung disease and Pulmonary vascular disease. VALDI is the first of its kind in the central valley of California. Its goal is to provide Access to care for Advanced Lung diseases - Diagnosis & management. Through its collaboration with Stanford Lung Transplant Program, patients are also able to be seen locally for consideration of Lung Transplantation if needed.

He earned his medical degree at Stanley Medical College and completed postgraduate fellowship training in the United Kingdom (MRCP UK) and the Medical College of Wisconsin. He recently completed his Academic tenure as Professor of Medicine at UCSF Fresno. At UCSF Fresno, he established a nationally renowned Pulmonary Hypertension Program.

He is nationally recognized in the field of Pulmonary Hypertension with extensive academic accomplishments including Research and publications. He is the recipient of multiple Teaching awards. He has shown strong commitment in organizing and supporting his patient support group for over 15 years.

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Transcript

SPEAKER_02 0:00

So, true or false, most people lose lung function gradually as they age, even if they don't have lung disease.

SPEAKER_00 0:06

Yes.

SPEAKER_02 0:07

Uh, matter fact, obesity can significantly impair lung function and lung capacity.

unknown 0:13

True.

SPEAKER_02 0:14

Untreated sleep apnea can affect both heart and lung health. True. Matter of fact, uh, air pollution can contribute to uh long-term lung damage even if someone's not been exposed to tobacco smoking. True. True or false, uh, autoimmune diseases can affect the lungs and uh lead to severe respiratory symptoms. True. All right, is this a myth or a fact? Sharpness of breath is always a symptom of only a pulmonary or a lung problem. Welcome to Hormones and Hope, a podcast where we bridge science and wellness to help transform your health. I'm your host, Dr. Chaya Makija, or you can call me Dr. Chaya, a triple board certified endocrinologist and lifestyle medicine physician and founder of Unifying Endocrine and Diabetes Care. Each week we dive into the powerful intersection of clinical medicine and real-life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out. So let's get empowered. So if you're curious about a metabolic health, you talk about brain, we talk about diabetes, we talk about heart health, we talk about kidneys, we talk about your weight, insulin resistance. We've never talked about lungs, a very, very important organ, and we have two of these. And it gets impacted by external and internal environment. So to answer most of your questions that you had sent me, because I told them that I'm gonna have a specialist which is related to the pulmonary organ system. And the questions that we have is going to be enlightening for all of us today. I'm going to introduce you to Dr. Vijay Balasubramania. And I've got to know about his work recently, even though we've been in the same town for more than 50 years. And uh I also found a great connection. He loves education, including teaching students, residents, and also great with his research. He resides in Fresno. His practice is also in specialized pulmonary vascular diseases, intestitial diseases, and how the environment can impact your lung health, your pulmonary health, and of course the diseases related to pulmonary disorders. So welcome, Dr. Vijay. There's another connection, by the way, between uh Dr. Vijay Balasubramaniam and me is that he's been to my hometown from India in Pune, and he's also visited my college or my medical school, Bija Medical College. He's played cricket. That's the national sport in India, and that was another common theme.

SPEAKER_01 2:49

That's right.

SPEAKER_02 2:50

And uh I'm really delighted to have you. And it's our delight, pleasure, privilege to have him interview in person today. So welcome. Uh, we would love to know about you, Panmanary, uh, why this specific field and and your educational background.

SPEAKER_01 3:07

So I did my training in India, my undergraduate medical training in India, followed by my postgraduate training in respiratory medicine, as they call it in Europe, in England. So I completed my MRCP over there, which is their highest degree. And then I was working as a registrar in respiratory medicine, actively involved in academic uh activities, research, education, and all of that. And then both me and my wife had the opportunity to come to USA. We had already cleared most of our US exams soon after our initial MD training. So we ended up in Medical College of Wisconsin, Milwaukee, and uh where I completed my pulmonary fellowship, which is where I developed my special interest in pulmonary vascular disease and advanced lung disease like ILD. So you know, and then the invitation from UCSF Fresno came to us, and uh we were uh both me and my wife were eager to kind of come and settle down in a place that way we can focus on the kids and family and other things. And uh so I joined as faculty here in 2006, and uh after that I became a professor here at UCSF, started the pulmonary hypertension program in 2008, and uh as a single physician program, we were able to get national recognition at the highest caliber comprehensive clinical care center. Okay. And then I decided to focus my attention on advanced lung disease, having done nearly 18, 19 years of teaching institutions. So the vision was to create a center for advanced lung disease. So I started my own venture, and my institution now is called Valley Advanced Lung Diseases Institute. So caring for the Valley's Advanced Lung Disease. And uh at the same time, we are heavily invested in teaching. So we have students, residents coming and rotating, and we are constantly presenting uh abstracts and posters and manuscripts and publishing. And on top of that, we're also engaging in uh phase one to phase three clinical trials that allows for valley patients to be exposed to cutting-edge clinical trials for some of the rare complex lung diseases.

SPEAKER_02 5:34

Very, very impressive. So, with that, you know, it's uh more than half of your life that uh you've been serving, right? Because you start uh medical education, what at age 18 in India, if they're according to medical schools and uh and yeah, so it's more than half of your life with medicine, serving and learning, growing.

SPEAKER_01 5:56

My favorite quote from history is from Albert Einstein. Where he says, the more I know about something, I realize how much I do not know. I don't know. Yes. Okay, so I really feel that is a very important aspect. So nobody's a master of anything. And uh so as long as we realize that we are not a master of anything and we are constantly on the learning mode, I think that's how new education is born, new learnings are born. The second you think you're a master, learning stops.

SPEAKER_02 6:31

The innovations and the curiosity, yes, that's always ever growing. Beautiful. So we'll start with our rapid fire, which is uh going to be one word, or if you think it's going to be a one-liner, that's it. Or if you need to deep dive, we'll do that after we end our rapid fire. So you're ready? Okay. So true or false, most people lose lung function gradually as they age, even if they don't have lung disease.

SPEAKER_00 6:56

Yes.

SPEAKER_02 6:57

Metterfact, obesity can significantly impair lung function and lung capacity.

unknown 7:02

True.

SPEAKER_02 7:02

Okay. Untreated sleep apnea can affect both heart and lung health. True. True. Metterfact, air pollution can contribute to uh long-term lung damage even if someone's not been exposed to tobacco smoking. True. Okay, air pollution. True or false, uh, autoimmune diseases can affect the lungs and uh lead to severe respiratory symptoms. True. Also true. All right, is this a myth or a fact? Sharpness of breath is always a symptom of only a pulmonary or a lung problem.

SPEAKER_01 7:37

That's uh myth. Okay. Sharonness of breath is a very general other conditions can commonly present on shortness of breath. Most important common things being something like anemia, pregnancy, things like that.

SPEAKER_02 7:51

Thank you. Um, in regards to smoking and vaping, marijuana, can that affect lungs function negatively? Yes or no?

SPEAKER_01 8:00

Yes. True.

SPEAKER_02 8:01

Yes. Okay. I would love to get a deep dive into air pollution and uh smoking.

SPEAKER_01 8:06

But actually, going back to your first question, I wanted to can you repeat that first?

SPEAKER_02 8:10

Yeah, so most uh age-related uh uh decline does that happen with the lung function.

SPEAKER_01 8:16

So just a little one-liner on that. So if you know, uh if you think about athletes, the prime time of athletes is doing their late teenage part, going into the mid-20s. Because after the age of 30, everybody's lung function starts deteriorating. That's why the prime time for athletes to function at their highest level is before the age of 30. After the age of 30, we all start losing our lung function. And if you're a smoker and if you have additional risk factors, you lose it more exponentially.

SPEAKER_02 8:49

So since uh you led this to smoking, so what about smoking and waiting marijuana? Because that's legalized in most of the states. How is that exposure affecting the runs?

SPEAKER_01 9:00

So in a different way. So again, this is a learning curve because this whole, again, if you want to use the analogy of smoking nicotine, when in the 50s, 60s, and 70s, when nicotine was so prominent and everybody was all the major sponsors were smoking cigarette companies. Later we realized the impact of smoking about in lung cancer and other cancers, throat cancers, things like that. So it's gonna take some time for us to realize what the long-term impact of uh uh marijuana smoking and vaping is going to be. But on the other hand, we do have some more newer impacts. So now, for example, vaping. We'll take one at a time. So a vaping causes, it's called vaping-induced lung injury. Okay, so vaping-associated lung injury. So V-A-L-I or V-I-L-I depends on whichever uh abbreviation you want to use. So that can cause direct toxicity in the lungs, causing inflammation in the lungs. And what we what we refer to as interstitial pneumonitis, a lot of young people can actually present with that. And it may not be related to the actual nicotine that they are vaping. It may be related to the products that the flavors, the strawberry flavor, the raspberry flavor, things like that. So the chemicals that are being used in making that uh vaping product can be the ones that lead to this type of an injury. So that's a more acute injury. It could, and that spectrum can range anywhere from somebody having a mild cough and shortness of breath with mild changes and goes away very quickly, and they cough a little bit and goes away just like a smoker's cough. But on the other hand, the spectrum can lead all the way to them developing respiratory failure, ending up in the ICU on mechanical ventilation, and going through a rather critically uh what we call critical illness and a course in the ICU, which can have its own impact and consequences. So yeah, the spectrum is huge. And the same goes to marijuana. So now with marijuana, it's different. So with street marijuana, you can uh because they're it's an organic compound, it tends to stay in unhealthy places and moist kind of areas and things. The marijuana's products can be infested with mold, uh, like aspergillus. And this can lead to other lung conditions like aspergillosis and things like that associated with just poor quality marijuana. And marijuana itself, the direct toxicity of marijuana, we don't know yet. And that only long-term data will tell us. But uh we already know quite a bit about the downsides of vaping and marijuana.

SPEAKER_02 11:58

So, you know, with that, I guess clinicians and you being the specialist, you've probably seen the ins and outs for the young adults, for teenagers, and uh for the ones who are thinking about or actually in this practice of vaping or smoking or using marijuana, what advice, what words of wisdom do you have for them?

SPEAKER_01 12:18

Well, anything inhaled is a good bad idea in my mind. Okay, so if you can avoid inhaled pleasure in whatever way, it will be a good idea. So when I'm talking about inhaled pleasure, I'm talking about chemicals and things like that. But instead, if you focus your attention on more wellness-related inhalation type situations like yoga, pranayama and stuff like that, those tend to be on the positive side or improving lung health. So in a general term, inhaling anything, uh, whether it's smoking, marijuana, vaping, using any kind of a device to inhale something into your lungs, it's not a good idea. On that note, let's look at it from a different perspective. Of all the organs that you initially mentioned during your introduction, you you mentioned about heart, uh, liver, lungs, I mean other brain. Lung is the only organ that's directly exposed to the atmosphere compared to others. So we directly communicate with our lungs with the atmosphere. So we me inhale the stuff. So if you're in a polluted atmosphere, you inhale that stuff, organic dust, inorganic dust. So the lungs do take a lot of insult as it is. You don't need to insult it even more.

SPEAKER_02 13:44

Yeah, so well said. So now, since you you're now going towards the organs, I really wanted to bring about that science of lung because that's really not talked about as much or focused on with metabolic health. At least, you know, when I am seeing the patients, right? The breathing aspect of it. You just talked about breath work and how important that simple steps, which we think is automation, that is uh inspiring and expiration of our breath, how important that is. Can you give us the science of lungs? Just break it down, simplify for our audience as to where are they located and what's their capacity like? Because I get marveled with the size of the lungs and the capacity that we have, but the capacity that we are using. And the one that you're using is actually being misused or abused by uh these compounds, chemicals, or even pollution.

SPEAKER_01 14:35

Well, it's a great question. And again, just that question alone I can talk for the entire day, but obviously we don't have that. So the lung's function is to bring oxygen, and oxygen, as you know, is important for our metabolism to function. So we need glucose, which we consume, and then we need oxygen for that metabolism, what we call aerobic metabolism, that needs to happen in the cells. So the heart pumps blood, and the blood goes from the left side of the heart and it carries the oxygenated blood to head to toe, and the tissues absorb all that oxygen, and then the venous blood, which is returns to the right side of the heart. And the right side of the heart pumps the blood into the lungs, where through the process of diffusion, the oxygen from the lung tissue goes into the bloodstream and then goes back into the left side of the heart, and the cycle continues. So oxygenation is the process which basically starts from the lungs, the process of how the oxygen transfers across the membranes, the alveolar membranes as we call them. They go into the bloodstream and then they go to the tissues. Now, that's one way of looking at lung function. The other way of looking at the respiratory system is your respiratory st system anatomically starts from the nose to the breathing muscles, which is the diaphragms. And you have the sinus, the nose nasal system, the back of the throat, the pharynx, as we call it, larynx, vocal cords, which is how our we make our voice, our sound. And then below that is the windpipe, trachea, the airways, and then the air sacs. So that's your anatomic part, and obviously from the tip of the nose to the vocal cords is what we call the urin, nose, throat doctors territory. The pulmonologists come into play below the vocal cords. So anything below the vocal cords, then we come into play as uh lung doctors, pulmonologists. So that's one b uh one other way to think about lungs. The other important thing is not to forget the brain. The brain impulses make us breathe. And that comes from the brainstem. So if somebody gets injury in the brain stem, they may not have the impulses to breathe. So uh that's how we get our. So if somebody takes a big dose of uh, say a suicidal dose of diazepam or sedative, the impulses to breathe go down. Okay, so nothing's wrong with your lungs, it's just that they don't have the impulse to breathe. So there are very many ways in which the lungs can get affected. And so it's we need to find out what the issue is, where the problem is. So as a lung doctor, our job is to find out are the lungs the reason for the patient's respiratory problems, number one. If it is the lungs, is it an airway-related issue? Airways being your windpipe, bronchi, small airways, like an inverted tree. So the big trunk of the tree, the branches of the tree, the twigs, the leaves being the air sacs. So we need to first find out where the problem is. And then the second thing is what is the nature of the problem? Is it uh inflammation? Is it an infection? Is it uh what is the main or is it degeneration, which can happen as well. So those are the kind of broader ways of thinking about lung disease in general.

SPEAKER_02 18:32

So this was normal physiology, anatomy, the structures, right? You specialize a lot. I think you had seen that in one of your descriptions about, you know, especially Central Valley and the environmental exposures or the air pollution. How do you, as a specialist, figure out that it's the external environment causing some damage to the lungs or causing that particular intestitial lung disease or any form of say infection? What are the preventive measures or what are the screening measures before we think about prevention in terms of external environmental influences negatively affecting our lung health?

SPEAKER_01 19:13

Unfortunately, or fortunately, whatever, however we want to say this is a broad question and has many, many implications, especially in the Central Valley. So let's briefly talk about just the effects of pollution in the Central Valley. So we have, it's a well-known fact that our PM 2.5 concentration in the, which is particulate matter 2.5, which is the smallest particle, there's PM10 and PM 2.5. PM 2.5 is the one that goes into the smaller airways, into the airzacs, causing problems. So the PM 2.5 concentration is very, very high in the valley, and therefore there's high levels of pollution as a result, causing airway diseases such as asthma and other things. Now, because of what we do in the Central Valley, which is also an agricultural hub, so there's a lot of organic dust. So as a result, you can develop unhealthy type of reactions in the lungs, what we call interstitial lung disease, as a result of, say, the common thing being farmer. We call it farmer's lungs. So, and uh that means somebody who is uh farming on a day-to-day basis, exposed to various organic dust, can develop this diffuse inflammation in the lungs. And uh, we call that technical medical name for it is called hypersensitivity pneumonitis. But people use all kinds of phrases: farmers' lungs, cotton wool workers' lungs, uh bird fancier's lungs. If people are kind of uh having birds at home, which is a very common practice here in the valley. So there are many other versions of silo workers' lungs, people who work in the silos. It's all the same thing. And again, because of the heat that we are exposed to in the valley, a lot of the and the lower socioeconomic status, there's a widespread use of swamp coolers. Then there's something called swamp cooler's lungs. So basically all these phrases refer to the same condition, which is called hypersensitivity pneumonitis. That means the lungs are reacting to certain antigens or proteins in the air in an unhealthy fashion, resulting in inflammation in the lungs, which progresses to scarring in the lungs, so what we call pulmonary fibrosis. So that's another way in which environmental effects specific to the valley, in which it can affect in many, as you can see, many diverse ways.

SPEAKER_02 21:46

Right.

SPEAKER_01 21:47

The other big issue from a pulmonary vascular disease, meaning to say blood vessel-related issues in the lungs, is the widespread use of drugs, recreational drugs, particularly methamphetamine. So we so see a lot of methamphetamine induced lung damage here, either in the form of acute lung injury or another more difficult to diagnose complex condition called pulmonary hypertension, high blood pressure in the lungs, which can lead to death in young people. And it's a very serious disease. It's treatable but serious. So right here in the valley, we have so many challenges which pertain to the environment. And um yeah, I think that hopefully answers your question.

SPEAKER_02 22:36

Yeah. So, you know, with uh the individuals, like you can't avoid staying here. So the ones who are sensitive, uh, what precautions or what precautionary measures are available versus say you and me breathing, like I don't feel any different in terms of you know just avoiding like when it's when there are fire seasons, that's a different story. But day to day, are there any preventive measures if you're living in an environment which has a high particulate matter or the score?

SPEAKER_01 23:04

Good question. So obviously, if you have the means and the ability to move from the valley to a healthier atmosphere, that's always a good thing. But that's not always practical. Families, life, we lead it here. So try to reduce your exposure to so that's why I said we don't we insult our lungs enough. We don't need additional insults to the lungs that are self-inflicted. So try not to smoke and try to avoid any inhaled pleasures. So if you can avoid those things, that would certainly help the most. And I always joke with a patient that there's no medication that I can give that's going to be as powerful if I take all the medications that I have in the form of inhalers and things and compare it against you stopping smoking. This stopping smoking is a lot more powerful than all my inhalers put together. So the analogy I provide to patients is uh since we are in California and the land of uh forest fires, so somebody smoking nicotine or whatever is like pouring oil into the fire, and then we are pouring water on the fire. As long as you're pouring oil, there's no amount of water that's going to put out the fire. Okay, so problem starts with first avoiding the antigen. So stopping smoking, stopping exposure. So if you're a farmer, you need to wear a mask, and there are masks that are available that will prevent these type of organic dust and particulate matter from entering your lungs. And if there are things like uh say bird fancier's lungs, try to not have birds at home. It's the indoor birds in the cages that can cause these issues. So you might want to think about getting them displaced somewhere else and make sure that the person that's affected the most is not the one taking care of the cages and things like that. So the advice is very, very general and simple: avoidance of the protein and the antigen that might be stimulating one's problem. So for COPD, it's smoking. For asthma, it's various allergies, tree, pollen, those kind of things. So obviously that can be seasonal in nature. And for anybody with interstitial lung disease, it would be respective exposures. If you can't put a finger on it, that would be a general outline.

SPEAKER_02 25:36

Last but not the least, you know, if we had to summarize it, I think uh lung and heart health, yes, their their proximity in terms of the anatomical location is also so beautifully designed by the Almighty, plus their functions are interrelated. Any three simple habits that you suggest your patients and also uh advice to the community in terms of protecting that cardiopulmonary health?

SPEAKER_01 26:02

Good. So it's a great question, Dr. Makija. So just to address the earlier part because it's very dear to me for what I do about the lungs and the heart. Yes. Okay, so I always look at that relationship like a husband and wife. All that means is the heart pumps the blood, the lungs provide the oxygen. Okay. So both do work very much cohesive to each other. So both are equally important. And um, so the other way to also look at it is the heart pumps five liters of blood a minute. And the lungs, we call it minute ventilation, where it produces five liters of air that we breathe in and out in a minute. So the way I look at it when I'm teaching students or medical students and things, for every milliliter of air that's in the lung, there's one milliliter of blood waiting to be matching. Yeah. So that's how so it's kind of a natural dating service, as I call it. Okay, so that's how the heart-lung relationship works very well. So keeping the heart healthy, doing all the heart healthy stuff, which you may have addressed in your previous podcasts, are going to keep the lungs healthy as well. Okay, so at the end of the day, treating our body with respect is the biggest homage you can provide to yourself, okay, is treat, don't insult our body, just treat our body, what we have been given with respect. And again, I would start with the for the lung health, I would say rather than first going to the exercise and things, do just like how when we take the medical oath, we say do not first do no harm. Same thing, first do no harm. Don't smoke, don't insult it more with vaping and stuff like that. So first do no harm, okay? And second thing is if you can sort of develop some healthy habits. So running, swimming, yoga, all those things are likely to be very helpful. So I would just put it in two different categories. That's it, not even three. Is one is do no harm. Do no harm and some healthy habits, like some of the examples that I've quoted.

SPEAKER_02 28:18

Yeah, very beautifully ended. Yeah, thank you. You're leaving us with a lot of hope with improving now the cardiometabolic pulmonary health. So don't insult it.

SPEAKER_01 28:30

There you go.

SPEAKER_02 28:30

Yeah, awesome. Thank you so much. Yeah.

SPEAKER_01 28:33

Thank you.

SPEAKER_02 28:33

Um, if our audience had to seek out medical expertise from you, can you share how to reach you or where you're exactly located?

SPEAKER_01 28:42

Yeah. So my practice is called Valley Advanced Lung Diseases Institute. It goes by an abbreviation called Valdi. Okay, V-A-L-D-I. And we have uh Valdiinc.com as the website.

SPEAKER_02 28:57

So thank you so much, Dr. Bala. I was very, very impressed by the way you just uh break down and simplify uh the anatomy of the physiology and how you're connecting it with our inherent nature. So I really enjoyed the conversation. Thank you so much.

SPEAKER_01 29:13

There you go. Thank you.

SPEAKER_02 29:15

Thanks for hanging out with me on hormones and hope. If you've liked this episode, do me a favor, hit subscribe, share it with someone you care about, and drop a review if you're feeling generous. Want more tools to support your hormones and health? Head over to unified endocrine care.com. We've got free guides, resources, and more waiting for you. Until next time, stay curious, stay kind to your body, and keep your hormones happy.