Dr. Victoria Maizes

Hi Andy.

Dr. Andrew Weil

Hi Victoria.

Dr. Victoria Maizes

Today we will be speaking with Dr. Joy Hussain an MD, PhD, whose research and clinical practice focuses on sauna.

Dr. Andrew Weil

Oh, how terrific. One of my favorite things.

Dr. Victoria Maizes

Let's get her on.

Dr. Victoria Maizes

Dr. Joy Hussain is a family doctor and the Director of Health of an integrative medical clinic that promotes wellness, wearables and sauna therapies. She lives and practices in Australia, where she's certified in medical acupuncture and in 2021, she completed a PhD exploring the health effects of frequent sweating and sauna bathing. Welcome, Joy.

Dr. Joy Hussain

It's great to be here. Thanks so much for having me on.

Dr. Victoria Maizes

We're delighted. There are many different kinds of heat exposure. There's a conventional hot sauna, sometimes with water poured over the rocks to create steam. There are steam rooms. There's infrared sauna, hot tubs, hot springs. Some of the hot springs have minerals in them. Do they all work the same, or what do we know about how they differ?

Dr. Joy Hussain

That's a really great question that was one of the challenges when I did my PhD on the health effects of sauna bathing is there's a lot of confusing terminology as well as now, quite a lot of studies, that demonstrate that especially steam saunas, the more moisture that's added to the air, is a different physiological experience than compared to, say, a dry or Finnish style, or infrared style sauna.

Dr. Andrew Weil

I'm going to say sauna because my Finnish friends get very, nice. In Finland and always there is a wet phase following the dry phase. So you sit in dry heat and then they throw water on the stones. And you have a steam phase. And I'm quite partial to steam. I find it, much better for my respiratory system. I don't know how we got in the habit here that saunas are all dry, because that's not the way they're done in the parts of the world where they originated.

Dr. Joy Hussain

This is a great point. When I did a global sauna survey, which was part of my PhD back in 2016- 2017, it was amazing there were about 30% of over 500 respondents that were frequent sauna users who said they prefer steam saunas. But when you actually look and I can't say this on properly the same way that I haven't been able to adopt the Aussie accent here, I'm just stuck with my American accent.

But when we introduce steam or introduce increasing humidity, it actually impairs our major way of thermal regulating, which impairs is maybe too strong of a word that sounds negative. But what it does is it makes it so that you cannot sweat when you sweat, the condition that has to happen is there has to be dry enough humidity for that sweat to evaporate. And that's how we cool ourselves. And actually, as human beings, it's I think it's one of our interesting superpowers that we've systematically ignored in medicine over the years. So when you talked about in Finland and yes, every time I've been there we throw that water on the sauna rocks. But what that does is that increases the intensity of how quickly you're heating up your core body temperature. And then once it settles down, you're able to sweat and able to thermal regulate and bring that body temperature down a bit and increase the amount of sweating. Now, some people love that. And I liken it to exercise. There are some people that like to jog run. And that's what I think's happening when you, when you're in that Finnish style sauna, is you're jogging along and then you're, you're doing a sprint when you throw that water on the sauna rocks.

Dr. Andrew Weil

My experience again in Finland is that the after the steam phase, you go and, it once I sat outside, it was January and you just sat on a stone step and another was jumping into a frozen lake where they'd cut a hole. So the steam phase was pretty immediately followed by a cold plunge.

Dr. Joy Hussain

Yes. what we refer to now and cut is as contrast therapy, into a cold pool, which is what I tend to do when I do a Finnish style sauna. I think that is creating yet another intensity of experience. And no question of it can almost feel quite, almost like an orgasm, if I have to say. I mean, it is such it is such a whole body refreshing experience. And I think that's one of the appeals of is it feels so good. And I think endorphins are definitely getting released.

Dr. Victoria Maizes

I read a study, that, used a Japanese term and maybe you're familiar with it. It was called the to-to-no state, and it basically was described as this exhilaration that follows heat, cold, heat, cold, three times repeated. And and it is, you know, that, additional stimulus, is just must be working wonders on our physiology.

I'm interested in and hearing from you, Joy, what do you think is happening physiologically? Because it seems like an incredible stress on the system to go to those extremes.

Dr. Joy Hussain

Yes. Well, let's back up a little bit and let's make sure we're defining sauna. [AUDIO #1 Saunas and Hormones] Because really, sauna really just means a confined space or cabin, full of hot air. And that air can be humid or it can be dry. It can be everything in between. That's really when we say sauna, what we're talking about. And then, physiologically, what's happening? Well, first thing we're doing is we have these pathways that sense our body temperature. And they go to the hypothalamus. And in the hypothalamus, all kinds of magic happens that we're still sorting out and still discovering. And I think a lot of the hypothalamic hormones are impacted. And the hypothalamus releases endorphins, releases, heat shock proteins, it releases all types of, cytokines, miokines.

We're still discovering all types of hormones, and it activates the HPA axis, which stands for the hypothalamus pituitary gland and adrenal gland axis. And I think some of these hormones are what give us that exhilaration. That was a great word to use. That's exactly what so many people describe as feeling, with with just even hot air.

Dr. Joy Hussain

It doesn't have to be contrast therapy. In fact, a lot of really sensitive people, have to work up to being able to tolerate contrast therapy. I think it is a big stress on our system. And then physiologically, it actually increases your heart rate, increases the circulation to your periphery to your blood vessels of all different sizes.

And that's what got me into it. It's a different story. And then that is what's increasing the shear stress and moving circulation. A lot like exercise. And you're going to hear me say that over and over, because that's what I found in my findings, is I actually think sauna is the exercise that doesn't impact our breathing and respiratory system as much.

Dr. Andrew Weil

So, Joy, one of the reasons I don't like a purely dry sauna, is that I find it irritating to the respiratory tract. I love to sweat. I love sweating profusely in a dry sauna, but I like at least a little bit of steam at some point, which makes it makes my breathing feel much better.

Dr. Joy Hussain

So that's adding moisture to your nasal passages. many people do describe that in fact, many other people describe, with intense heat, pain sensations in places where we lack sweat glands like nipples, like the genital areas. They can be quite tender with, quite with, intense heat. Lips or another one that some people can get quite burning lips. So something I do and I recommend to a lot of my patients that are regularly signing, if they experience it, is to moisten, moisturize those areas. You know, maybe with, maybe not Vaseline. That's petroleum based. But something that can moisten your nasal passages. I tend to always wear a little bit of, beeswax on my lips before going in.

It helps insulate a little bit from that. The other thing is the sauna hat. So I wear a sauna hat when I go into the high temperature finish one. And I find that really helps me stay in longer so I can sweat longer.

Dr. Victoria Maizes

 [VIDEO #1: Types of Heat Exposure for Health] Andy, I'm just curious, you spent a lot of time in Japan where extremely hot baths are common and often communal and you're also interested, I know, in the Turkish hammam. Another heat exposure. How would you say those are similar or different to a sauna?

Dr. Andrew Weil

Well, the Japanese hot bath, some of them are so hot, you can't believe you can get into them and you really have to ease your way in. So I'm sure you're getting the cardiovascular benefits of sauna. You're probably also sweating, although you may not be aware of it. It's very relaxing. I think the communal experience is fabulous.

Dr. Andrew Weil

It's so different from what we have here. I was once at a little mountain retreat where I was teaching a workshop, and, it was for Japanese doctors and, a an eminent Japanese professor who was a cancer specialist was coming, which was a great honor. And it's sort of dinnertime. One of his students rushed in and said, professor Obitzu is here, and he wants to take a bath with you.

Dr. Andrew Weil

The Turkish hammam is fabulous and there's many different things that go on in it. Everything from sitting in dry heat, sitting in wet heat, soaking in water, having cold water thrown on you. I wish there were more hammam available here. So I think all of these things can be highly pleasurful. I don't know whether you're getting the same with the hammam, the same kinds of intense, benefits the joy has been describing.

Dr. Joy Hussain

it's funny that you say that there's been some Polish studies that have demonstrated it's quite the opposite. It's more intense when you limit your ability to sweat, which actually, when you're in water immersions, warm or hot water immersions, you actually limit your ability to sweat. It's something called hydro meiosis. Once our, skin surface is moistened enough, the sweat glands, shut down so well, or they reduce.

Now when you get out. Yes, they open up and you can release that sweat and evaporate again. But without that evaporation, you're not actually getting the sweating, but you are getting that increase in heart rate. And in fact, these Polish studies in both men and women, have demonstrated that, you actually, increase your core body temperature and increase your heart rate, increase your blood pressure to a higher extreme than you do in, say, a dry sauna.

And that's why I tend to refer to the dry saunas, which they use a lot of the infrared saunas in Japan and actually in hospital settings. I refer to that as low intensity, thermal therapy versus, say, what you're describing, in the, in the hammams and steam rooms is more high intensity.

Dr. Andrew Weil

So here's one of my experiences. I was in Japan first when I was 17 and lived with the Japanese family outside of Tokyo. It was November. The house was unheated, you know, had paper screens for walls. And I was the guest. I was invited to take the first bath in the in the wood fire tub, which was so hot I couldn't imagine getting into it.

But after soaking, finally getting and soaking in it, I would come out and dive under the futon and and I would be warm for the whole night, even though the room was really, really cold. So it heated up my core very nicely.

Dr. Joy Hussain

Yes. And that's something we're discovering, around the effects of sauna that it improves sleep. But it's counterintuitive what we're finding around sauna. I don't know if you've read, Why We Sleep by Matthew Walker or some of his work, neuroscientists, he has demonstrated that we actually need to cool down our body temperature to be able to go into the correct stages of sleep. And so it's always been ironic that how can a sauna help you sleep when you need to actually cool down? But something I've heard him mention is, is it's the drop. It's the absolute difference. Not so much where you're starting and where you're emptying that allows you to enter that, that zone. And when I did my global sauna survey, that was one of the striking findings is 86.7% of these, over 500 people said it improved their sleep not just for one night, but for two nights up to two nights.

Dr. Andrew Weil

Now what is an infrared sauna and does it offer any benefits over other kind of sauna?

Dr. Joy Hussain

Well, that's like saying, are the benefits between running and jogging the same or different that? I think there's similar type effects, but different depending on how sauna fit you are, just like how exercise fit you are. And I again, I keep coming back to this, this analogy with, cardio exercise because I think that's where the sweet spot is with saunas.

And in fact, I see people gravitate to one or the other. And those that suffer from, say, chronic fatigue syndrome or chronic pain syndromes, where I feel like the nervous system is sensitized, do a little bit better with the gentle heat of a sort of an infrared sauna, you tend to run it lower.

It it's at about 60°C, as opposed to the kind of 80, 90°C Finnish style or or even hotter with the Turkish hammams. The Turkish hammams are actually at a lower temperature, but they feel hotter because you can't sweat. So, and, so I, I tend to say those that are elderly or, have that sensitive system tend to prefer the infrared sauna better.

Dr. Joy Hussain

They can tolerate that better, whereas the more Finnish style is more popular amongst the young, the, the ones who are using it for better athletic performance and recovery after performance. And those that are sound like you, that like to go for a bit of an adrenaline junkie.

Dr. Victoria Maizes

I have had both experiences and the infrared for our listeners at first. When you go in, you may not feel like anything's happening. It doesn't feel hot. And, that's because it's, the infrared light. It's light that's directed towards your body as opposed to the room heating up. So it's really quite a different experience. But my understanding is lots of athletes are using infrared because there are portable devices that help them with healing after musculoskeletal exertions, for example.

Dr. Joy Hussain

That's exactly what I was referring to. There's quite a lot of studies. And that's one of the issues about sauna studies, is they're spread across all different disciplines and I'd have to say the exercise physiologist, the sport scientists are the ones that are doing a bulk of it, as well as the cardiologists that are involved. And now we're starting to see the psychology community, the neuroscience community, start to weigh in.

But it's spread across all these disciplines when I did my clinical trial a couple of years ago. I did it at a sports center, the Queensland Academy of Sport, and a lot of athletes were coming and going. When I had my participants coming in to do exercise on a indoor bicycle compared to infrared sauna.

And after doing it for a couple months, the athletes started agitating. What are we going to how come we aren't in that? And so they ended up buying one too. And the athletes were exactly saying what you said. They just said it was so nice. It helped them not get a sore muscles. It helped them recover more quickly, after a really intense workout.

Dr. Joy Hussain

And that's been shown in quite a few studies to, that it also increases your heat acclimation, which is another, I think, promising, use of sauna is especially infrared saunas for the elderly with all the heat waves and climate change that's happening. And that's one of my strong interests that I like to get some trials, seeing if we can get elderly, more resilient around our changing hot climate, especially here in Australia.

That's such an interesting idea that it would boost resilience. I the other idea that I've heard you talk about is that it could be a strategy that women who are going through challenging menopause and experiencing hot flashes could benefit. Can you speak to that a bit?

Dr. Joy Hussain

That's one of my passionate. I'm actually designing a trial now called perspire Perimenopausal sauna to improve responses to estrogen change.

Dr. Victoria Maizes

Great acronym.

Dr. Joy Hussain

Yes. That's a well, I'm. I hope it'll attract some funding. That's what I want updates to so I can get this going. But really, it's not a, it's not a coincidence that us women, when we're going through menopause more than 80% of us experience hot flushes, or what we call vasomotor symptoms. This dysregulation of our thermoregulation. And going back to when we talk about what's the physiology going on with sauna that I mentioned, the hypothalamus. Well guess what else the hypothalamus regulates. It's it it releases hormones like in to the pituitary gland that release luteinizing hormone, follicle stimulating hormone that affect our female hormones much more so than our male hormones. And I actually think unfortunate that a lot of the sauna studies have been done in men. And we generalize it to women. But I actually think there might even be additional benefits for women, and especially around perimenopause. So when I did that global sauna survey, quite a few women mentioned that they felt it might have helped them not experience any bad hot flushes.

Dr. Joy Hussain

And I myself found that too, that vasomotor symptoms was not something that, that I experienced, even though I have other cardiovascular risk factors where I expected. But I was regularly sauna-ing  there by the.

Dr. Andrew Weil

Here's a question that I have long wondered about. I encounter a lot of paranoia about soreness among my colleagues, saying that they're dangerous for people with heart conditions, with high blood pressure for pregnant women. That is in great contrast to what I find in Scandinavia, where I've talked to many doctors who think so on is a good for everybody. They send pregnant women and them up to the day of delivery. You know, they, they laugh at our concerns about them. And I see all these warning signs on spas that have saunas and so forth. How do you feel about all that? I couldn't agree with you more. I don't know who started that so much, but it was it's very firm in the West, in the U.S. and in Australia. In fact, even now I come across these, these billboards next to a sauna saying consult your GP or your family before going into it. And I think to myself, what is that GP going to tell them?

What do they know about? They don't realize? And in fact, that's another thing that I found out from the global sauna survey, is that people are using the sauna for their mental health and aren't aware of the cardiovascular benefits, which I actually think we need to be changing those billboards is saying, look, if you have a cardiovascular condition, talk to your doctor about getting a sauna protocol.

Dr. Victoria Maizes

Andy some years ago, you, introduced me to the Native American purification or sweat lodge. There was a Native American named White Dog who led a very hot lodge. And obviously that is a spiritual practice. It's a communal practice. How do you how do you put that in this panoply of different kinds of heat exposures?

Dr. Andrew Weil

That's an extreme in terms of just on the physical level, I have found that to be the most consciousness, altering, form of heat exposure, probably has to do with the both the intensity, the fact that you're doing it in complete darkness you're in a very closed space. You have to deal with a lot of fears. But at any rate, I have found that to be quite transformative and a phenomenal alteration of consciousness.

Dr. Joy Hussain

I have to weigh in and say, I, I couldn't agree more. And it's very difficult to capture these type of responses in clinical trials especially randomized clinical trials. I think, again, going back to those deep hypothalamic pathways in our brain that are getting activated with sauna and social setting, setting is important. Getting back to that discussion of infrared sauna versus, Finnish sauna, that a more traditional sense.

The traditional saunas tend to be built larger and to enhance social engagement in the sauna, whereas a lot of the infrared sauna is changing now. But they tend to be smaller and designed for single use. And I think that's one of the huge differences. And when I, when I came into sauna was when I lived in Alaska, I got a job, you know, as a remote family doctor out there.

And I have Raynards syndrome as well as a sickle cell disease gene. And I thought, oh, no, how am I going to survive Alaska? And the opposite happened. I actually thrived there. And I think it's because I was in the sauna year-round. We just that was our social thing, especially in the wintertime. We were usually sauna in 2 or 3 nights a week my husband and I, we ended up building a sauna and I went in the sauna when I was pregnant.

Again, I use different guidelines when I'm pregnant, with pregnant, patients too. Is that you have to you have to have some different parameters around it. And this is leading into a nice discussion of how can we get sauna into medicine? How can we change this paradigm of fear around the sauna, and instead to embracing it as I think a lifestyle tool that deserves a lot of recognition?

Dr. Victoria Maizes

You see a lot of, stuff around sauna in the biohacking community. And I think some of those little, portable, infrared saunas are quite affordable. People bring them into their homes. And so I do see a cultural shift in the West in terms of, people being very interested in it. But I also think they're interested because  there's a belief that the sauna will detoxify you. So what do you think about that belief? And is there any evidence that, regular sauna exposure gets rid of toxins?

Dr. Joy Hussain

Well, this is a very fraught space. And all the controversy, I, I actually feel that we're talking about that when laypeople talk about detox, they're talking about that exhilaration. They're talking about that, about that deep purification feeling you get of metabolic toxins, clearing metabolic toxins, which I think there is a lot of evidence about. Now, this this about environmental toxins. Look, there is some evidence. It's not great. It's not that it doesn't meet the gold standard randomized controlled trial, but and it is very minimal in scale compared to the detoxification processes that happen through our liver and kidney into our urine.

Dr. Andrew Weil

But you know our principal mechanisms of detoxification is sweating. You know, we eliminate things through sweat. And I often encourage people to sweat for various reasons. And that is certainly something that a sauna can help you do as long as you're drinking adequate water.

Dr. Joy Hussain

Yes. And you have to do it frequently. That's the other thing, is that we're talking about small amounts. Yes, there's evidence, especially with heavy metals. I did a clinical trial demonstrating organic organophosphate pesticides. And synthetic parathyroid pesticides are definitely detected. And released in higher concentrations with sauna as well as with exercise. So I agree with your point. It's about sweating, but it's something that has to be done regularly. Not a one time thing, you know? So this idea of getting into the sauna, I'm going to detox, you know, just. No, it's three months of getting into that sauna. 2 or 3 times a week. Yes. Now you're starting to get to a scale that might be comparable to what's going on delivered in the kidneys.

Dr. Andrew Weil

I think, though, much more important is what you touched on earlier, that I think, this kind of experience has a conditioning effect on the body that is very healthy. And whether it's looking at you dealing with menopausal symptoms, cardiovascular issues, I think it makes the body stronger. You are exposing it to a kind of stress, you know, on a regular basis. And this it works out various systems of the body in a good way.

Dr. Joy Hussain

That's fantastic. And I couldn't agree with that more. It's a multi-system activator again, a lot like exercise. And in fact you had mentioned about all those cardiac warnings around saunas, you know, or heart attacks. But I, I counsel my patients. Think of it like exercise. If you're cleared for an exercise protocol, you're cleared for a sauna protocol.

And in fact, something we haven't touched on the although you said it helps with your respiratory system, Dr. Weil. you mentioned that. Well, it's not surprising because you're getting that shear stress that increased circulation without the added stress of having to breathe faster. So that's one of my latest studies in just women was showing that the effects on, arterial stiffness, the effects on heart rate variability, which is a marker of the autonomic nervous system. All of these good effects were the same between sauna, and infrared sauna and, moderate intensity exercise, bicycling on an indoor. They were all the same, except that the core temperature or body temperature I use tympanic temperature is higher with the infrared sauna is achieved higher, and the breathing rate is much higher in, bicycling and exercising compared to the sauna. So for those that suffer from respiratory conditions, I say, or are limited by their breathlessness in exercising and especially heart failure, that's where those the most evidence get into the sauna to get those physiological benefits, and then work your way into being able to tolerate more exercise. There's synergistic to sauna and exercise.

Dr. Victoria Maizes

This has been such a great conversation. I like to think of sauna as an adaptive stressor. You are asking your body to do something that stretches you, that makes you uncomfortable. And not only on the physical, but actually also on the psychological, because it requires a kind of persistence of staying even though you're physically uncomfortable.

Dr. Joy Hussain

Yes. I cannot wait to start to see when it can be incorporated into the medicine system, because I think there are so many applications.

Dr. Andrew Weil

We have to change medical thinking about it in the West.

Dr. Joy Hussain

Yes, I agree, and I look forward to the next time I attend one of your conferences that there be a little pop-up sauna there for us all to get into.

Dr. Andrew Weil

Right will work.

Dr. Victoria Maizes

Great idea. Well, Joy, this has been a wonderful conversation. Thank you so much for your, research, for your focus on women's health and the benefits of sauna. And for, enlightening us about all of the benefits.

Dr. Joy Hussain

Well, thank you so much. It's been a real honor to talk about this and get the sauna word out. So thanks for giving me that opportunity.