Endocrine effects of sauna bath

This is a sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY-NC-ND 4.0 h ps://c ea i ecommons.o g/licenses/by-nc-nd/4.0/ Endoc ine e ec s o sauna ba h © 2019 Else ie L d. Accep ed e sion (Final d a ) Huh aniemi, Ilpo T.; Laukkanen, Ja i A. Huh aniemi, I. T., & Laukkanen, J. A. (2020). Endoc ine e ec s o sauna ba h. Cu en Opinion in Endoc ine and Me abolic Resea ch, 11, 15-20. h ps://doi.o g/10.1016/j.coem .2019.12.004 2020 Jou nal P e-p oo Endoc ine e ec s o sauna ba h Ilpo T. Huh aniemi, Ja i A. 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All igh s ese ed. 1 Endoc ine e ec s o sauna ba h Ilpo T. Huh aniemi 1 & Ja i A. Laukkanen 2 1 Ins i u e o Rep oduc i e and De elopmen al Biology, Depa men o Me abolism, Diges ion and Rep oduc ion, Impe ial College London, Hamme smi h Campus, Du Cane Road, London W12 0NN, UK; E-mail: ilpo.huh anie[email p o ec ed] 2 Ins i u e o Public Heal h and Clinical Nu i ion, Uni e si y o Eas e n Finland, Kuopio, Finland; Facul y o Spo and Heal h Sciences, Uni e si y o Jy askyla, Jy askyla, Finland; Cen al Finland Heal h Ca e Dis ic , Depa men o In e nal Medicine, Jy äskylä, Finland: E-mail: ja i.a.laukkanen@jyu. i Co esponding au ho : P o . Ilpo Huh aniemi Decla a ion o compe ing in e es s: NONE 2 Abs ac Sauna ba h b ings abou nume ous acu e changes in ho mone le els, pa ly akin o o he s ess ul si ua ions, pa ly speci ic o sauna. No epineph ine inc eases in hose accus omed o sauna ba h. Swea ing inc eases he p oduc ion o an idiu e ic ho mone, and he enin-angio ensin sys em becomes ac i a ed. O he an e io pi ui a y ho mones, g ow h ho mone (GH) and p olac in (PRL) sec e ion is inc eased. Also β-endo phin has been equen ly epo ed o inc ease, whe eas he esponses o ACTH and co isol a e a iable, p obably depending on he ype o sauna exposu e. Spe m p oduc ion dec eases in pa icula in sauna-naï e men, bu educed e ili y has no been associa ed wi h egula sauna habi s. Mino sex di e ences exis , he ho monal esponses being somewha g ea e in women. Sauna-naï e women may expe ience mild dis u bances in mens ual cycle, bu no e ec s o e ili y ha e been epo ed. The ho mone esponses a e sho -li ed, no malizing soon a e sauna exposu e du ing he eco e y. Adap a ion o egula sauna use plays an impo an ole in he esponses, which a enua e upon equen exposu e. Key wo ds: hea s ess, ho ba h, hype he mia, no epineph ine, g ow h ho mone (GH), p olac in (PRL), co isol, β-endo phin, enin-angio ensin, spe ma ogenesis, adap a ion 3 1. In oduc ion Hea s ess in he passi e (ho ba hs and sauna) o ac i e (exe cise) o m e okes mul iple physiological esponses, some o hem in ol ing he endoc ine sys em. Sauna ba hing, a common li e-s yle habi used mainly o elaxa ion, cleaning, pleasu e, and o elease bodily s ess, has modula ing e ec s on he ho monal and au onomic ne ous sys em ac i i y (1). The pu pose o his e iew is o summa ize he cu en knowledge abou he endoc ine e ec s o sauna. Besides he Finnish sauna- ype exposu e o d y hea , a he simila endoc ine esponses ha e been obse ed upon imme sion in ho wa e . A weal h o in o ma ion is a ailable on e ec s o sauna (and ho ba h) on ho mones om olde s udies ca ied ou 20-30 yea s ago, bu addi ional no el in o ma ion abou sauna and ho mones is a he sca ce. Some olde e iews exis on he opic (e.g. 2,3), bu in ecen yea s he endoc ine e ec s o sauna ha e no been add essed comp ehensi ely. We he e o e summa ize he key in o ma ion a ailable om olde li e a u e wi h he mo e ecen indings. A summa y o he ho mone esponses de ec ed upon sauna ba h is p esen ed in Table 1. 2. Neu oendoc ine and pi ui a y ho mones The neu oendoc ine esponses o sauna ha e concen a ed on s ess ho mones such as β-endo phin and ACTH, which espond a iably, anging om dec ease o no change o inc ease (4-8). When he hea exposu e eaches le el o subjec i e discom o he ACTH/β-endo phin inc ease is mo e consis en (9). The inc ease in β-endo phin may play a ole in he eeling o wellbeing a e sauna. The he mal s ess esponse o hese ho mones is abolished in alcohol, 4 cocaine and he oin addic s, which is explained by he dis up ion o hypo halamic opioid neu o ansmission upon ch onic addic ion (7,10). No e ec o sauna on gonado opins has been ound in ei he sex (4,6). Findings on TSH a e con lic ing wi h epo s anging om inc ease (11) o no change (4,12) o dec ease (bo h TSH and T4)(13,14). The wo an e io pi ui a y ho mones wi h he mos consis en esponses du ing exposu e o sauna a e GH and PRL. GH inc ease has been documen ed in nume ous s udies (4,9,15). Leppäluo o e al. (16) documen ed ha he GH esponse was unde con ol o he hypo hlalamic GH- eleasing ho mone (GHRH). Fu he mo e, an in iguing age di e ence was ound: while GHRH and GH esponded wi h signi ican inc ease in younge men (31-46 y s), no inc ease o ei he was ound in olde men (49-66 y s). The same in es iga o s de ec ed a enua ion o he GH esponses ollowing epea ed sauna exposu e in men (7 days wice daily) (4). The a enua ion o GH esponse was no ep oduced in young women (13). S imula ion o pe iphe al he mo egula o s (hea ing o a m) was ound su icien o inc ease he GH le els (17). The o he consis en endoc ine esponse o sauna is he inc ease in PRL le els (4,5,9). The inc ease is b isk (up o > 10- old), emained simila in men upon epea ed sauna exposu e (4), bu a enua ed in women (13). As an a emp o s udy he mechanism o PRL inc ease upon hype he mia, Low e al. (18) subjec ed men o exhaus i e bicycle exe cise a 33 °C empe a u e, and o passi e hea ing in a 41.5 °C wa e ba h. Simila inc ease in body co e 5 empe a u e ( o 38.8 °C) and a 2- old PRL esponse was obse ed. I was concluded ha he he mo egula o y a e en s, a he han ca dio ascula , p o ide he s imulus o PRL inc ease, p obably h ough changes in se o onine gic and dopamine gic ac i a ion, in ag eemen wi h he esponse o sauna. Howe e , i emains con o e sial whe he he body co e (17) o skin (19) empe a u e ise is mo e impo an in he PRL ise. Ano he s udy showed ha acial cooling p e en ed he PRL inc ease and inc eased he mal com o du ing sauna ba h, indica ing ha a small pa o o al skin a ea (10%) can ha e a disp opo iona e ole in he PRL esponse (20). 3. Co isol Findings on he acu e e ec s o sauna ba hing on he dis al esponse o he hypo halamic-pi ui a y-ad enal axis, i.e. se um co isol, a e a iable. In some s udies co isol le els ha e inc eased (21), in some an ini ial dec ease was ollowed by an inc ease (8), and also unchanged le els ha e been epo ed (9). Simila a iable indings ha e been made du ing he pos -sauna cooling pe iod (5,8,9,22). The di e ing esponses a e bes explained by di e ences in he du a ion and empe a u e o sauna ba h. A gene al end is ha highe humidi y and empe a u e e oke highe inc ease in co isol (9,22). Excessi e sauna exposu e o men ( wice a day o 7 days) supp essed he GH, ACTH and co isol esponses a he end o he expe imen (4). A e y ecen s udy examined he e ec s o a ious ypes o physical exe cise (endu ance, s eng h, combined), ollowed by sauna, on se um ho mone le els (GH, es os e one, co isol) in men (23). The expec ed inc eases in he le els o 6 he h ee ho mones we e ound when s udied in he a e noon, bu no in he mo ning - a con ounding ac o no aken in o accoun in all sauna s udies. Sauna a e he exe cise enhanced neu omuscula a igue, bu did no change he ho monal esponses e oked by exe cise. 4. E ec s on s ess and ca dio ascula ho mones Responses o sauna o he ca dio ascula sys em, wi h i s essen ial egula o y ho mones ela ed o hemodynamic consequences o hea exposu e, ha e been s udied in ecen yea s. Regula sauna ba hing has been sugges ed o exe a po en ial he apeu ic e ec on ele a ed blood p essu e, which may be pa ly explained ia a o able e ec s on he ca diac au onomic ne ous sys em balance, imp o ed ascula unc ion and inc eased excessi e luid loss (24). Sauna ba hs ha e shown o inc ease he demands o ca dio ascula unc ion (25). Sauna ba hing leads o an inc ease in hea a e (HR), he eby imi a ing e ec s o mode a e physical ac i i y on ca dio ascula sys em wi hou ac i e skele al muscle wo k. Sauna ba hing causes an inc ease in HR and hea a e a iabili y (HRV), which is a ma ke o au onomic ne ous sys em balance. HRV analysis p o ides an insigh in o ca dio ascula esponses o sauna ba hs. One ecen s udy showed he e ec s o a ypical Finnish sauna on HR and HRV in a popula ion wi h ca dio ascula isk ac o s among egula sauna ba he s (26). The esul s indica e ha sauna ba hing imp o es ca diac au onomic ne ous sys em balance, leading o inc ease in agal one and dec ease in sympa he ic one, wi h a o able modula ions in blood p essu e du ing he eco e y om sauna which may also be ela ed o a lowe ed ca dio ascula e en isk (27). 7 Inc eased swea ing du ing sauna ba hing is accompanied by educ ion in blood p essu e and a highe HR, whils ca diac s oke olume is la gely main ained; al hough a pa o blood olume is di e ed om he in e nal o gans o pe iphe al body pa s wi h dec easing enous e u n which is no acili a ed by ac i e skele al muscle wo k (1). Indeed, compa able wi h exe cise-induced adap a ions, hea s ess could inc ease HR up o 150 pe minu e (26). Du ing he ho sauna ba h HR inc eases g adually om he beginning o sauna ba h un il he end, co esponding wi h an inc ease in body empe a u e and hea load. An ea lie s udy conduc ed in young heal hy men showed ha he plasma no epineph ine concen a ions inc eased app oxima ely 2- old du ing ba h sessions wi h a mean empe a u e o 88 °C whe eas he e we e no subs an ial changes in plasma epineph ine and se um h omboxane concen a ions (28). The e ec i eness and sa e y o sauna ba h as an addi ional diapho e ic o diu e ic he apy equi es mo e s udies. Al hough in ensi e swea ing, induced by sauna wi h d y o we hea usually inc eases losses o wa e , u ea, sodium, po assium and chlo ide, a single sauna ba h session does no cause signi ican longe - e m changes in se um elec oly e o c ea inine le els (25). Oho i e al. (29) demons a ed ha 3 weeks o epea ed he mal ea men (Waon he apy) in pa ien s wi h ch onic hea ailu e was associa ed wi h dec eases in le els o b ain na iu e ic pep ides (BNPs) and plasma no epineph ine. Howe e , he e is only mode a e e idence ha sauna ba h imp o es le en icula ejec ion ac ion and dec eases BNP le els (30). Some o he s udies in which pa ien s wi h hea ailu e we e ea ed wi h in a ed- ay sauna he apy o se e al 14 ansien ho monal esponses obse ed canno be conside ed ha m ul o indi iduals in good heal h, bu hey may ep esen a bu den o hose in subop imal heal h s a us – an issue dese ing mo e de ailed s udy in he u u e. 15 Re e ences *1. Laukkanen JA, Laukkanen T, Kunu so SK. Ca dio ascula and o he heal h bene i s o sauna ba hing: A e iew o e idence. Mayo Clinic P oceedings. 2018;93:1111-1121. This is he la es e iew summa izing comp ehensi ely he a ious heal h e ec s o sauna ba h. 2. Hannuksela ML, Ellahham S. Bene i s and isks o sauna ba hing. Am J Med 2001;110:118-126. 3. 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Ho mone Change Adiponec in ↔ ↔↔ ↔ Ad enoco ico opic ho mone ↔ ↔↔ ↔,↑ ↑↑ ↑* Aldos e one ↑ ↑↑ ↑ Angio ensin II ↑ ↑↑ ↑ A ginine asop essin ↑ ↑↑ ↑ A ial na iu e ic pep ide ↑ ↑↑ ↑ Be a-endo phin ↑ ↑↑ ↑ B ain na iu e ic pep ide ↑ ↑↑ ↑,↓ ↓↓ ↓ Cholecys okinin ↔ ↔↔ ↔ Cos isol ↔ ↔↔ ↔,↑ ↑↑ ↑,↓ ↓↓ ↓ Epineph ine ↔ ↔↔ ↔,↑ ↑↑ ↑ Follicle-s imula ing ho mone ↔ ↔↔ ↔ Gh elin ↑ ↑↑ ↑ Glucagon ↑ ↑↑ ↑ G ow h ho mone ↑ ↑↑ ↑ G ow h ho mone- eleasing ho mone ↑ ↑↑ ↑ Insulin ↔ ↔↔ ↔ Lep in ↑ ↑↑ ↑ Lu einizing ho mone ↔ ↔↔ ↔ Mela onin ↔ ↔↔ ↔ Mo ilin ↑ ↑↑ ↑ No epineph ine ↑ ↑↑ ↑ P olac in ↑ ↑↑ ↑ Renin ↑ ↑↑ ↑ Soma os a in ↔ ↔↔ ↔ Tes os e one ↔ ↔↔ ↔, ↑ ↑↑ ↑ Thy oxine ↔ ↔↔ ↔, ↑ ↑↑ ↑ Thy oid-s imula ing ho mone ↔ ↔↔ ↔, ↑ ↑↑ ↑ Vasoac i e in es inal polypep ide ↑ ↑↑ ↑ _____________________________________________________________________________________________ * ↔, no change: ↑, inc ease; ↓, dec ease