ALS and Sauna Use: Reduce Risk Factors; Proceed with Caution

In the darkness the scientific and medical community continues to poke and prod for answers about the devastating disease of ALS. The prognosis of an ALS diagnosis is terrifying and living with this degenerative disease is a heavy burden that takes the lives of 6000 Americans every year. Watching a loved one live with ALS can feel like a ruthless and cruel punishment. To this day there remain more questions than there are answers about ALS. (1)

While there are many hypotheses regarding the cause of ALS, such as a genetic predisposition, there does not seem to be a single ‘one size fits all cause’. Recent studies, however, do show that excessive strenuous exercise over a long term period in life may have a correlation to the onset of ALS. This means that demographics of high performance elite level athletes, or perhaps marathon runners are at a greater risk for developing ALS than the rest of the population. While some other cases of ALS remain strictly hereditary, most cases are caused by a combination of genetic predisposition and environmental factors.

So, can saunas help individuals currently living with ALS? The disappointing truth is that saunas and heat should be avoided if you have already received a diagnosis of ALS as the extreme heat can incur further muscular atrophy and worsen overall symptoms. Another interesting question to pose is this: Can sauna use help prevent the onset of ALS? The answer to this is that perhaps by substituting sauna use for some exercise it may be possible to avoid over-exercise and therefore avoid ALS for some individuals. Additionally, the brain protective aspects that result from long term sauna use may also help to prevent its development later in life.

While high-heat ought to be avoided for individuals living with ALS it may be important to incorporate some light therapy into a treatment plan to promote positive mitochondrial activity and enhance the strength of connective tissues by increasing collagen production.

Explore the study that found a correlation between excessive exercise and ALS, how this terrifying disease may be prevented in some instances by substituting a sauna for exercise, and why patients of ALS must avoid high heat at all cost.

What is ALS?

Once known as Lou Gehrig’s disease after the famous baseball player who lived and died with this condition, it is now called Amyotrophic lateral sclerosis (ALS). It is a fatal neurodegenerative disease that will eventually take the lives of its patients. Most cases of ALS appear to be caused by a combination of heritability and environmental factors.

“Heritability studies suggest that ∼60% of ALS risk is genetically determined, and the remainder is environmental.” (2)

ALS is a neurodegenerative disease and can briefly be described by an increasing and rapid rate of death of neurons that control voluntary movement of muscles. Eventually without use, the muscles atrophy and can no longer be engaged. This disease affects motor neurons of both the upper and lower regions of the body.

According to the authors of the Mayo Clinic article entitled ‘Amyotrophic lateral sclerosis (ALS)’ (1) this disease can be described in this succinct manner.

“ALS affects the nerve cells that control voluntary muscle movements such as walking and talking. These nerve cells are called motor neurons. There are two groups of motor neurons. The first group extends from the brain to the spinal cord to muscles throughout the body. They’re referred to as upper motor neurons. The second group extends from the spinal cord to muscles throughout the body. They’re referred to as lower motor neurons.

ALS causes both groups of motor neurons to gradually deteriorate and then die. When motor neurons are damaged, they stop sending messages to the muscles. As a result, the muscles can’t function.” (1)

ALS is generally not associated with physical pain and may begin with some tingling in the extremities of the body such as the hands and feet. As more nerve cells die more motor skills become impaired and it is usually at this point that a diagnosis can be made. There is no known cure for this disease, but the speed at which it takes the functionality and life of its victims does vary from case to case.

Maintaining a healthy brain throughout life may help somewhat in the prevention of this disease, but little evidence has been able to correlate this with human cases. Sauna use has been demonstrated to help prevent cases of Alzheimer’s Disease by actually encouraging neurogenesis with exposure to dose appropriate heat. (3) While saunas may help to maintain healthy neurological states throughout life, once ALS has emerged, individuals living with this condition sadly must avoid high heat situations including saunas.

It does appear that exposure to certain light frequencies, such as infrared light, is safe for the ALS patient as long as the heat does not become too high.

A recent study published in 2023 has found a strong correlation between excessive exercise and the development of ALS. This discovery demonstrates the importance of recovery for high level athletes and even individuals who participate in extensive strenuous exercise such as marathon running. Individuals engaged in high intensity and frequent exercise may want to consider substituting some aerobic workouts with a sauna session. It is known that saunas can improve neurological health and offer many of the same benefits of exercise to lessen the overall toll that excessive exercise may take on the body.

An Exploration into Over Exercise as a Causal Factor in Developing ALS

Our society bombards the public with a strong emphasis on exercise as a necessary component for a healthy lifestyle. While this is true in most cases there is a more rare demographic who slips through the cracks of this advice and exercises excessively. Often these individuals are praised for their ‘healthy’ lifestyle and few may understand that they are running their bodies into the ground. An intrinsic aspect of human health is balance and homeostasis. Too much of anything can ultimately be unhealthy.

So, whether an individual is a high performance athlete relying on their physical prowess for their income, or simply a type ‘A’ personality that continues to push their body to the limits in cycling, running, swimming, as well as an array of other activities, may be putting themselves at risk for developing ALS.

Recovery matters. All exercise requires its opposite in the form of rest and recuperation. Strong willed individuals can push their bodies beyond the limit to achieve their goals and as a society we tend to glorify this, but at what cost? Gratefully, some researchers took notice of the potential correlation between excessive exercise and the development of ALS, these brave scientists published a study entitled ‘Physical activity as an exogenous risk factor for amyotrophic lateral sclerosis: a review of the evidence’ (2)

ALS is defined by the authors of this article as the tragic reality that is when they write this.

“Amyotrophic lateral sclerosis (ALS) is a rapidly progressive and fatal neurodegenerative disorder.” (2)

Furthermore, this study found that after a thorough review of many risk factors for developing ALS emerged a single variable that could be tested and validated. This variable was high intensity exercise. Here is what the authors write.

“Overall, we have found that the more highly powered studies using validated exposure methodologies, linked strenuous, anaerobic physical activity as a risk factor for ALS.” (2)

The authors of the study write that most genetic causes of ALS may lay dormant for upwards of 50 years and may only become active when stimulated by long-term environmental factors. This fact points to the late age on set in most patients.

“Many of the genetic mutations linked to ALS, even those which are highly penetrant, are present for more than 50 years before disease onset. Indeed, the late age of onset of ALS points to a multistep process, in which genetic risk factors are penetrant only in the presence of additional environmental ‘hits” (3).

The common gene mutation in patients of ALS is C9orf72 gene and the researchers sought to find out what happens to this genetic expression with long term high intensity physical activity. As it turns out the original name sake of this disease, Lou Gehrig was a high level athlete and subsequent cases of ALS have been found among other elite level athletes and individuals who had engaged in heavy amounts of physical activity.

“ALS has been commonly documented in high profile athletes. This group are reported to have a higher incidence and lower age of onset of ALS, leading to the hypothesis that strenuous, repetitive exercise may represent an environmental risk factor.” (3)

While it is true that exercise in general elongates healthspan, reduces inflammation, improves heart health as well neurological health, the unfortunate reality is that an excessive amount of exercise over several years particularly exercise that produces lactic acid regularly may have a correlative charge for developing ALS.

There are many cases of professional level soccer players (football in Europe) who have developed ALS. While it was originally thought that injury to the head may be the primary factor in developing ALS further analysis found that it was in fact the strenuous physical activity involved in competing at this level. A series of case studies as well as analysis of rodents in the lab have validated the hypothesis that excessive strenuous exercise on a long-term basis interacts with specific gene mutations to make this a leading cause for the development of ALS. (2)

What can be done to prevent the development of ALS in highly active individuals? It is important to remember that nothing is healthy when done in excess and that a counterbalance is important. Athletes, or individuals committed to strenuous physical activity, could consider using a sauna as a substitute for a workout or two every week. Saunas enhance neurological health as well as reduce oxidative stress that can result from an overload of lactic acid.

Sauna Use Enhances Neurological Health and Can Be Used as a Substitute For Some Exercise to Help in the Prevention of ALS Among Athletes

Increase neurotrophic factors
Release Lactic Acid
Substitute for aerobic exercise

Given the correlation between strenuous exercise and the development of ALS, all elite level athletes as well as weekend warriors should consider different ways to mitigate the harmful effects of overexertion of the body. One such approach is to ensure that adequate recovery occurs between workouts as well as to ensure the support of a healthy neurological state throughout the years.

Saunas can help maintain a healthy brain, improve the integrity of proteins throughout the body, detoxify from harmful substances including lactic acid, and can also serve as a substitute for some workouts throughout the week.

Brain Health, Neurotrophic Factors, and ALS

It is well known that saunas help to support brain health by inducing a cascade of biological factors that promote neurological health. Evidence suggests that the use of a sauna on a regular basis can prevent dementia and Alzheimer’s disease in some cases. (3) Given that ALS is a neurodegenerative condition it makes sense to ensure that a healthy brain is maintained throughout a lifetime when looking to prevent its development. This is especially true for athletes.

In addition to supporting neurogenesis (the creation of new neurons) saunas can also help support a variety of neurotrophic factors that ensure a healthy brain for life.

In the Science Direct publication entitled ‘Repeated hyperthermia exposure increases circulating Brain Derived Neurotrophic Factor levels which is associated with improved quality of life, and reduced anxiety: A randomized controlled trial’ (4) the authors delineate a variety of ways that saunas can improve brain health including the increase in BDNF (Brain derived neurotrophic factors).

“A 10-week programme consisting of repeated exposure to hyperthermia resulted in a significantly higher increase of circulating BDNF compared to a programme consisting of intermittent light intensity exercise.” (4)

Why is increasing the circulation of BDNF important in preventing the expression of ALS? In a disease such as ALS that preys upon the rapid death of nerve cells, any activity that does the opposite may help to prevent its expression in the body. Here is what the authors of this article write.

“Brain Derived Neurotropic Factor (BDNF) is present in both the central and the peripheral nervous system and it plays a fundamental role in neuroplasticity by affecting many functions such as cell proliferation and growth, cell differentiation, and protection against neuronal death in the hippocampus and it also play a role in triggering the Adipose-Derived Stem Cells to regenerate peripheral nerves.”

For anyone at risk for developing ALS it may go a long way to improving health if the brain remains in the best possible health throughout a lifetime.

Release Lactic Acid

It appears that those individuals engaged in strenuous exercise producing lactic acid regularly are more likely to develop ALS. While the correlation between ALS and lactic acid is not fully known, it does merit mentioning that saunas can be an excellent way to detoxify the body from a plethora of toxins both external and internal. Lactic acid eventually needs to find its way out of the body, but if exercise is performed with little time to recover (including the release of lactic acid) eventually the body will experience some degradation.

In addition to taking time to fully recover, the use of a sauna releases the toxic build up of lactic acid through its ability to powerfully detoxify the body. Ensuring that lactic acid is released from the body may have potential to reduce the risk of developing ALS.

It is not proven that lactic acid necessarily has a correlation to ALS, however it is known that high performing athletes will produce more lactic acid than other demographics. These same individuals are at a much higher risk for developing ALS.

Be on the safe side, and consider using a sauna to detoxify the body from an overload of lactic acid after strenuous workouts.

Substitute Aerobic Workouts with a Sauna

Athletes cannot afford to forego all workouts, but they could consider using a sauna as an alternative to moderate aerobic workouts. It is possible to save the strain on muscles and still engage the heart and lungs by using a sauna. For individuals who are using exercise to reduce stress or as a weight management protocol could consider using a sauna as a replacement protocol. Doing so could protect the body from excessive strenuous exercise and still accomplish the same goals.

Skip the additional run every week and substitute it for a sauna session. This will help you to release excessive toxins, improve neurological health, and will not set you back aerobically.

Saunas are beneficial for health for everyone most of the time, but may be especially important for populations vulnerable to developing ALS. While this is true, once ALS has developed please avoid high heat at all cost, including the sauna.

Individuals Living With ALS Should Avoid All Saunas All of the Time

In the tragic event that an individual develops ALS, it is important to avoid high heat at all times. This includes saunas, steam rooms, hot tubs, and even very warm baths. Motor control may worsen after exposure to high temperatures for ALS patients. (5)

In the publication Neurology Journals an article entitled ‘Uhthoff’s Phenomenon in Amyotrophic Lateral Sclerosis’ (5) warns patients living with ALS to avoid saunas and all excessive heat. Here is what the authors of the publication write.

“In Uhthoff’s phenomenon, there may be a transformation of nerve conduction from saltatory to continuous conduction due to conduction blockade. Given the above, it may be prudent to suggest those with ALS should avoid sauna baths or excessively hot bathing.” (5)

Given this information it must be highly recommended that patients living with ALS avoid the sauna. If you do have questions about this please confer with your medical specialist who is working with you.

Individuals living with ALS should avoid saunas and all high heat situations. Instead of sauna use it may be possible to use various frequencies of light to improve mood and overall wellbeing. There is little to no research on how light therapies interact with ALS at this time, however there are no any contraindications either.

Use a Sauna to Potentially Prevent ALS, but Avoid a Sauna if You Are Already Living With ALS

ALS is a terrifying disease and still has no known cure, and affects a higher percentage of very physically active individuals. So, if you are at risk for developing ALS for either genetic reasons or because you are an elite level athlete, consider using a sauna regularly to recover from workouts, protect your neurological health, and perhaps use a sauna to substitute at least one workout a week.

However, if you have already been diagnosed with ALS then please avoid saunas altogether.

High intensity physical activity can be healthy when it is not overdone, please be sure to balance exercise with plenty of recovery. Eat well and maintain a nutritious diet if you exercise rigorously. Athletes are cherished in our society and often touted as very healthy, but too much exercise on a long term basis may increase the risk of developing ALS.

If you choose to sauna regularly, especially as an athlete, please be sure to maintain excellent levels of hydration, including electrolytes in your beverages as well as other forms of supplementation such as magnesium.

If you have any questions about your diagnosis or your health, please consult with a medical practitioner. This article is not a substitute for medical treatment.

Our hearts go out to the individuals and their families who are living with ALS or who have lost someone to this vicious and ruthless disease.

Sources Cited