The use of face masks has been controversial during the pandemic considering a lack of adequate scientific study, even though they have been used in hospitals for decades without noticeable issues. However, scientific evidence does suggest masks can restrict a user’s ability to breathe. Respiratory inhibition led us to a link between masks and decreased immunity, genetic modification, and DNA damage via oxidative stress. How can cannabis affect these symptoms as a major agent of redox homeostasis?
CO2, masks, and you
If we ignore statements that disclose a lack of scientific evidence due to limitations, masks help more than they harm. Covid-19 is a deadly pathogen with severe long term detriments and face coverings are one possible control measure. Yet, certain types of tight masks do lead to toxic CO2 levels known as hypercapnia.
How else can masks worsen migraines without disrupting the gas exchange?
CO2 is used by our bodies as a mechanism of oxygen intake. The more CO2 we breathe in, the more oxygen our bodies absorb. This function is lost in Chronic Obstructive Pulmonary Disease (COPD), which causes an individual to rely on the hypoxic drive. In this event, a lack of oxygen is required for involuntary respiration. Although, N95 respirators and surgical masks both contribute to hypoxemia which is a drop in blood-oxygen pressure.
Generally speaking, oxidative stress is not unusual but should be avoided so DNA can properly repair and antibodies can be produced without inhibition.
A third gas in the breath-axis
CO2 can induce nitric oxide (NO) production in the lungs, which aids in the uptake of oxygen. Nitric oxide is a massive gaseous vasodilator that our bodies require to protect blood vessels. It also prevents heart attacks when utilized via medical nitroglycerin. Since nitric oxide is a major catalyst to some vasodilative illnesses, headaches are a common side effect of both mask-wearing and medical nitroglycerin treatment.
- Masks cause headaches that PN Medical recommends breath exercises to combat. (maskaches)
- Migraines are mostly centered around nitric oxide, an anandamide deficiency, and oxidative stress
- Hypercapnia (CO2 toxicity) induces nitric oxide and acidosis.
- The use of respirators and masks can increase CO2 (hypercapnia).
- Nitric oxide increase can cause nitrosylation in the human body under normal conditions, but especially in the presence of low PH (nitric acid).
- Excessive nitrosylation can lead to specific DNA effects. Deamination of guanine and cysteine bases will cause damage and modification, respectively.
The nitric oxide that is produced in our lungs does not pass into our blood vessels, not as the original oxide. The hypotensive gas can pass through the lung’s alveoli-barrier but it rapidly breaks down before it can get into the bloodstream. Therefore, wearing certain types of masks can directly increase free radical oxygen (ROS) and nitrogen species, thus leading to nitrosylation and hypertension. So, the associated CO2 toxicity is not acute enough to poison or kill you according to MayoClinic. But, headaches caused by masks are a sign of oxidative stress, inflammation, and ultimately some DNA damage.
Nitric oxide and cannabinoids in tandem
Alterations in NO synthase are largely involved in the pathogenesis of COPD, the third leading cause of death in the USA by 2020. Notably, just two decades have passed since NO was defined as a cardiovascular inflammatory mediator in 1998; work that won Robert F. Furchgott, Louis J. Ignarro, and Ferid Murad a Nobel Prize. Only four years earlier, an endocannabinoid that directly regulates nitric oxide, anandamide, was formally discovered in 1992.
Nitric oxide’s role in hypotension reflecting it’s hypertensive degradation products provides a pivotal homeostatic effect. A similar function is witnessed in the more forgiving endocannabinoid system which works in tandem with many biological mechanisms, especially oxidation.
- Cannabis and certain foods contain keys to our natural endocannabinoid system (ECS)
- The ECS regulates our bodies free radical levels
- The endocannabinoid, anandamide, can inhibit and supplement nitric oxide
- The ECS plays a critical role by protecting our cells from mutation and damage
Cannabinoid therapy that is guided with proper doses can mediate the immune system and level off cytokine agents. Carrots, black peppercorns, and different varieties of cannabis can even prevent mask-induced DNA effects and cellular damage by agonizing the ECS. Whereas, smoke (not mediated by terpenes and cannabinoids) will too increase oxidative damage.
Science has a maskache
Generally speaking, dozens of years in medical practice gives the consensus of safety – for face coverings. Rather than DNA damage or oxidative stress, the side effects of masks merely include:
- Skin sensitivity
- Cognitive decline in surgeons older than thirty-five years of age
- Bacterial infections after four to six hours of use.
Then again, their ability to stop Sars-Cov2 has yet to be accurately quantified, although control measures have forced the virus to mutate at least once. Conclusively, more research is needed on different types of face coverings outside of controlled settings if Canada’s Health Officer, Dr. Tam, expects them to be used for three more years, CBC. No study has truly answered why masks cause headaches or focused on chronic nitrosylation, especially subsequent antibody reduction, genetic modifications, and DNA damage.
Thankfully, individuals in many locations who suffer from a respiratory illness will not have to rely on breathing exercises to avoid mask-induced DNA damage. We will discuss this and the other body parts that face masks are connected to in the next installment.
Let us know your thoughts on mask mandates in the comments. Have you suffered a headache from a face covering?
- Arun, M., Balamuralikrishnan, B., Kumar, A. K., Sureshkumar, S., Mustaqahamed, S., Mohanadevi, S., Easwaran, M., Raman, N., Haripriya, K. B., Palanivel, H., Balachandar, V., & Sasikala, K. (2016). Association between exposure to nitric oxide and changes in select molecular markers of health among men in the gold jewelry manufacturing industry. Karbala International Journal of Modern Science, 2(3), 178–187. https://doi.org/10.1016/j.kijoms.2016.04.002
- Barnes PJ. Oxidative stress-based therapeutics in COPD. Redox Biol. 2020 Jun;33:101544. doi: 10.1016/j.redox.2020.101544. Epub 2020 Apr 20. PMID: 32336666; PMCID: PMC7251237.
- Beder A, Büyükkoçak U, Sabuncuoğlu H, Keskil ZA, Keskil S. Preliminary report on surgical mask induced deoxygenation during major surgery. Neurocirugia (Astur). 2008 Apr;19(2):121-6. doi: 10.1016/s1130-1473(08)70235-5. PMID: 18500410.
- Borkum, J.M. (2016), Migraine Triggers and Oxidative Stress: A Narrative Review and Synthesis. Headache, 56: 12-35. https://doi.org/10.1111/head.12725
- Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET, et al. Effectiveness of adding a mask recommendation to other public health measures to prevent SARS-CoV-2 infection in Danish mask wearers: a randomized controlled trial. Ann Intern Med. 2020 Nov 18. doi: 10.7326/M20-6817.
- Burney S, Caulfield JL, Niles JC, Wishnok JS, Tannenbaum SR. The chemistry of DNA damage from nitric oxide and peroxynitrite. Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis. 1999;424(1-2):37-49.
- Dean JB. Hypercapnia causes cellular oxidation and nitrosation in addition to acidosis: implications for CO2 chemoreceptor function and dysfunction. J Appl Physiol (1985). 2010 Jun;108(6):1786-95. doi: 10.1152/japplphysiol.01337.2009. Epub 2010 Feb 11. PMID: 20150563; PMCID: PMC2886689.
- E. McAdam, H.N. Haboubi, G. Forrester, Z. Eltahir, S. Spencer-Harty, C. Davies, A.P. Griffiths, J.N. Baxter, G.J.S. Jenkins, Inducible Nitric Oxide Synthase (iNOS) and Nitric Oxide (NO) are Important Mediators of Reflux-induced Cell Signalling in Esophageal Cells, Carcinogenesis, Volume 33, Issue 11, November 2012, Pages 2035–2043,
- Fletcher SJ, Clark M, Stanley PJ. Carbon dioxide re-breathing with close fitting face respirator masks. Anaesthesia. 2006 Sep;61(9):910. doi: 10.1111/j.1365-2044.2006.04767.x. PMID: 16922771.
- Fikenzer, S., Uhe, T., Lavall, D., Rudolph, U., Falz, R., Busse, M., Hepp, P., & Laufs, U. (2020). Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clinical research in cardiology : official journal of the German Cardiac Society, 109(12), 1522–1530. https://doi.org/10.1007/s00392-020-01704-y
- Fuchs J, Hengstler JG, Jung D, Hiltl G, Konietzko J, Oesch F. DNA damage in nurses handling antineoplastic agents. Mutat Res. 1995 Mar;342(1-2):17-23. doi 10.1016/0165-1218(95)90086-1. PMID: 7885391.
- Grifoni E, Valoriani A, Cei F, et al. Interleukin-6 as prognosticator in patients with COVID-19. J Infect. 2020;81(3):452-482. doi:10.1016/j.jinf.2020.06.008
- Guan T, Hu S, Han Y, et al. The effects of facemasks on airway inflammation and endothelial dysfunction in healthy young adults: a double-blind, randomized, controlled crossover study. Part Fibre Toxicol. 2018;15(1):30. Published 2018 Jul 4. doi:10.1186/s12989-018-0266-0
- Jacobs, J. L., Ohde, S., Takahashi, O., Tokuda, Y., Omata, F., & Fukui, T. (2009). Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: a randomized controlled trial. American journal of infection control, 37(5), 417–419. https://doi.org/10.1016/j.ajic.2008.11.002
- Johnson AT. Respirator masks protect health but impact performance: a review. J Biol Eng. 2016 Feb 9;10:4. doi: 10.1186/s13036-016-0025-4. PMID: 26865858; PMCID: PMC4748517.
- Keen L 2nd, Pereira D, Latimer W. Self-reported lifetime marijuana use and interleukin-6 levels in middle-aged African Americans. Drug Alcohol Depend. 2014 Jul 1;140:156-60. doi: 10.1016/j.drugalcdep.2014.04.011. Epub 2014 Apr 26. PMID: 24799289.
- Kelm M. (1999). Nitric oxide metabolism and breakdown. Biochimica et biophysica acta, 1411(2-3), 273–289. https://doi.org/10.1016/s0005-2728(99)00020-1
- Laskin, J. D., Gardner, C. R., & Laskin, D. L. (1998). Inhaled nitric oxide primes lung macrophages to produce reactive oxygen and nitrogen intermediates. American journal of respiratory and critical care medicine, 158(3), 931–938. https://doi.org/10.1164/ajrccm.158.3.9708014
- Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand. 2006;113(3):199-202. doi:10.1111/j.1600-0404.2005.00560.x
- Mohammed Ashraf, Puthiyachirakkal & Mhanna, Maroun. (2013). Pathophysiology, Management, and Outcome of Persistent Pulmonary Hypertension of the Newborn: A Clinical Review. Frontiers in pediatrics. 1. 23. 10.3389/fped.2013.00023.
- Nabel CS, Manning SA, Kohli RM. The curious chemical biology of cytosine: deamination, methylation, and oxidation as modulators of genomic potential. ACS Chem Biol. 2012;7(1):20-30. doi:10.1021/cb2002895
- Özdemir L, Azizoğlu M, Yapıcı D. Respirators used by healthcare workers due to the COVID-19 outbreak increase end-tidal carbon dioxide and fractional inspired carbon dioxide pressure. J Clin Anesth. 2020;66:109901. doi:10.1016/j.jclinane.2020.109901
- Pahal P, Hashmi MF, Sharma S. Chronic Obstructive Pulmonary Disease Compensatory Measure. [Updated 2020 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
- Puthiyachirakkal M, Mhanna MJ. Pathophysiology, management, and outcome of persistent pulmonary hypertension of the newborn: a clinical review. Front Pediatr. 2013;1:23. Published 2013 Sep 2. doi:10.3389/fped.2013.00023
- Rebmann, T., Carrico, R., & Wang, J. (2013). Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. American journal of infection control, 41(12), 1218–1223. https://doi.org/10.1016/j.ajic.2013.02.017
- Rosner E (2020) Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19. J Infect Dis Epidemiol 6:130. doi.org/10.23937/2474-3658/1510130
- Russo EB. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis Cannabinoid Res. 2016;1(1):154-165. Published 2016 Jul 1. doi:10.1089/can.2016.0009
- Smith, O. Nobel Prize for NO research. Nat Med 4, 1215 (1998). https://doi.org/10.1038/3182
- Tong PS, Kale AS, Ng K, et al. Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study [published correction appears in Antimicrob Resist Infect Control. 2016;5:26]. Antimicrob Resist Infect Control. 2015;4:48. Published 2015 Nov 16. doi:10.1186/s13756-015-0086-z
- Vurucu, S., Karaoglu, A., Paksu, M. S., Yesilyurt, O., Oz, O., Unay, B., & Akin, R. (2013). Relationship between oxidative stress and chronic daily headache in children. Human & experimental toxicology, 32(2), 113–119. https://doi.org/10.1177/0960327112459204
- Zavorsky, G. S., Hsia, C. C., Hughes, J. M., Borland, C. D., Guénard, H., van der Lee, I., Steenbruggen, I., Naeije, R., Cao, J., & Dinh-Xuan, A. T. (2017). Standardisation and application of the single-breath determination of nitric oxide uptake in the lung. The European respiratory journal, 49(2), 1600962. https://doi.org/10.1183/13993003.00962-2016
- Zhiqing L, Yongyun C, Wenxiang C, et al. Surgical masks as source of bacterial contamination during operative procedures. J Orthop Translat. 2018;14:57-62. Published 2018 Jun 27. doi:10.1016/j.jot.2018.06.002