How to deal with autoimmune disease flares- A Rheumatologist POV

Flares happen. We do everything we can to prevent them and understand why they occur, but sometimes, they just happen. This is true regardless of the inflammatory or autoimmune disease: lupus, arthritis, fibromyalgia, vasculitis, and all the others. As frustrating as they can be, there are things you can do to manage them with care and grace.

The Wim Hof method may reduce inflammation, per systematic review.

Does the Wim Hof Method have a beneficial impact on physiological and psychological outcomes in healthy and non-healthy participants? A systematic review

According to the new systematic review, the Wim Hof method may produce a beneficial anti-inflammatory response. RosZie, Pixabay, CC0 (https://creativecommons.org/publicdomain/zero/1.0/)

According to a systematic review published March 13, 2024, in the open-access journal PLOS ONE by Omar Almahayni and Lucy Hammond from the University of Warwick, UK, the Wim Hof method may produce a beneficial anti-inflammatory response characterized by increased epinephrine levels and a reduction in pro-inflammatory cytokines.

The Wim Hof method, founded by extreme athlete Wim Hof, is touted as a practical way to improve physical and mental health. It consists of three pillars: the Wim Hof breathing method, cold therapy, and commitment.

Several studies have assessed the impact of the Wim Hof method on immune and stress responses, exercise performance, and psychological responses, but independent studies are generally too small to draw clear conclusions. No one has synthesized the results of these studies to identify consistent trends.

In this systematic review, researchers evaluated the Wim Hof method’s physiological and psychological outcomes across eight trials. The most prominent changes were seen in stress and anti-inflammatory response parameters. Multiple studies found significant increases in epinephrine, a stress response hormone. Two studies found significantly lower levels of the pro-inflammatory cytokines TNF-ɑ, IL-6, and IL-8 and higher levels of the anti-inflammatory cytokine IL-10.

The impact of the Wim Hof method on exercise performance, as measured by respiratory parameters such as breathing frequency, was less clear. Some studies showed a benefit, and others found no significant difference.

While the results suggest that the Wim Hof method may have physiological benefits, researchers stressed the need for more robust, confirmatory research before the method can be recommended given the small sample sizes and the high risk of bias in current trials.

The authors add: “Our systematic review underscores the need for further investigation into the Wim Hof method’s effects on stress, inflammation, and overall health, offering valuable insights into its potential as a complementary approach to wellness.”

Chronic stress and inflammation linked to societal and environmental impacts in a new study. Is this ever true for you?

Mitigating global inflammatory stress requires a multilayered, multiscale approach

Scientists hypothesize that as-yet unrecognized inflammatory stress is spreading among people at unprecedented rates and affecting our cognitive ability to address climate change, war, and other critical issues.

Mitigating global inflammatory stress requires a multilayered, multiscale approach. Image: Vodovotz et al/Frontiers CREDIT Image: Vodovotz et al/Frontiers

From anxiety about the state of the world to ongoing waves of Covid-19, the stresses we face can seem relentless and even overwhelming. Worse, these stressors can cause chronic inflammation in our bodies. Chronic inflammation is linked to serious conditions such as cardiovascular disease and cancer – and may also affect our thinking and behavior.   

A new hypothesis published in Frontiers in Science suggests the negative impacts may extend far further.   

“We propose that stress, inflammation, and consequently impaired cognition in individuals can scale up to communities and populations,” explained lead author Prof Yoram Vodovotz of the University of Pittsburgh, USA.

“This could affect the decision-making and behavior of entire societies, impair our cognitive ability to address complex issues like climate change, social unrest, and infectious disease – and ultimately lead to a self-sustaining cycle of societal dysfunction and environmental degradation,” he added.

Bodily inflammation ‘mapped’ in the brain  

One central premise to the hypothesis is an association between chronic inflammation and cognitive dysfunction.  

“The cause of this well-known phenomenon is not currently known,” said Vodovotz. “We propose a mechanism, which we call the ‘central inflammation map’.”    

The authors’ novel idea is that the brain creates its own copy of bodily inflammation. Normally, this inflammation map allows the brain to manage the inflammatory response and promote healing.   

When inflammation is high or chronic, however, the response goes awry and can damage healthy tissues and organs. The authors suggest the inflammation map could similarly harm the brain and impair cognition, emotion, and behavior.   

Accelerated spread of stress and inflammation online   

A second premise is the spread of chronic inflammation from individuals to populations.  

“While inflammation is not contagious per se, it could still spread via the transmission of stress among people,” explained Vodovotz.   

The authors further suggest that stress is being transmitted faster than ever before, through social media and other digital communications.  

“People are constantly bombarded with high levels of distressing information, be it the news, negative online comments, or a feeling of inadequacy when viewing social media feeds,” said Vodovotz. “We hypothesize that this new dimension of human experience, from which it is difficult to escape, is driving stress, chronic inflammation, and cognitive impairment across global societies.”   

Inflammation as a driver of social and planetary disruption  

These ideas shift our view of inflammation as a biological process restricted to an individual. Instead, the authors see it as a multiscale process linking molecular, cellular, and physiological interactions in each of us to altered decision-making and behavior in populations – and ultimately to large-scale societal and environmental impacts.  

“Stress-impaired judgment could explain the chaotic and counter-intuitive responses of large parts of the global population to stressful events such as climate change and the Covid-19 pandemic,” explained Vodovotz.  

“An inability to address these and other stressors may propagate a self-fulfilling sense of pervasive danger, causing further stress, inflammation, and impaired cognition in a runaway, positive feedback loop,” he added.  

The fact that current levels of global stress have not led to widespread societal disorder could indicate an equally strong stabilizing effect from “controllers” such as trust in laws, science, and multinational organizations like the United Nations.   

“However, societal norms and institutions are increasingly being questioned, at times rightly so as relics of a foregone era,” said Prof Paul Verschure of Radboud University, the Netherlands, and a co-author of the article. “The challenge today is how we can ward off a new adversarial era of instability due to global stress caused by a multi-scale combination of geopolitical fragmentation, conflicts, and ecological collapse amplified by existential angst, cognitive overload, and runaway disinformation.”    

Reducing social media exposure as part of the solution  

The authors developed a mathematical model to test their ideas and explore ways to reduce stress and build resilience.  

“Preliminary results highlight the need for interventions at multiple levels and scales,” commented co-author Prof Julia Arciero of Indiana University, USA.  

“While anti-inflammatory drugs are sometimes used to treat medical conditions associated with inflammation, we do not believe these are the whole answer for individuals,” said Dr David Katz, co-author and a specialist in preventive and lifestyle medicine based in the US. “Lifestyle changes such as healthy nutrition, exercise, and reducing exposure to stressful online content could also be important.”  

“The dawning new era of precision and personalized therapeutics could also offer enormous potential,” he added.  

At the societal level, the authors suggest creating calm public spaces and providing education on the norms and institutions that keep our societies stable and functioning.  

“While our ‘inflammation map’ hypothesis and corresponding mathematical model are a start, a coordinated and interdisciplinary research effort is needed to define interventions that would improve the lives of individuals and the resilience of communities to stress. We hope our article stimulates scientists around the world to take up this challenge,” Vodovotz concluded.  

A daily step count of 9,000 to 10,000 may counteract the risk of death and cardiovascular disease in highly sedentary people.

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Increased step count linked to lower risk regardless of time spent sedentary
Increased step count is linked to lower risk regardless of sedentary time.

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In good news for office workers, a new study from the University of Sydney’s Charles Perkins Centre (Australia) has found increasing your step count may counteract the health consequences of too much sedentary time each day.

The study of over 72,000 people, published in the British Journal of Sports Medicine, found every additional step up to around 10,000 steps a day was linked to reduced risk of death (39 per cent) and cardiovascular disease (21 per cent) regardless of how much remaining time was spent sedentary.

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Previous studies have shown an association between greater daily step count and lower levels of death and CVD, and separate studies have linked high levels of sedentary behaviour with increased risks of CVD and death. However, this is the first to measure objectively, via wrist-worn wearables, if daily steps could offset the health risks of high sedentary behaviour.

Lead author and research fellow Dr Matthew Ahmadi said: “This is by no means a get-out-of-jail card for sedentary people for excessive periods. However, it does hold an important public health message that all movement matters and that people can and should try to offset the health consequences of unavoidable sedentary time by upping their daily step count.”

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Senior author Professor Emmanuel Stamatakis, Director of the Mackenzie Wearables Research Hub at the Charles Perkins Centre, said this growing body of physical activity research using device-based measurement provided huge opportunities for public health.

“Step count is a tangible and easily understood measure of physical activity that can help people in the community, and indeed health professionals, accurately monitor physical activity. We hope this evidence will inform the first generation of device-based physical activity and sedentary behaviour guidelines, which should include key recommendations on daily stepping,” said Professor Stamatakis.

How was the study conducted?

Researchers used data on 72,174 individuals (average age 61; 58% female) from the UK Biobank study – a major biomedical database – who had worn an accelerometer device on their wrist for seven days to measure their physical activity. The accelerometer data were used to estimate daily step count and time spent sedentary: sitting or lying down while awake.

The research team then followed the health trajectory of the participants by linking hospitalisation data and death records.

The median daily step count for participants was 6222 steps/day, and 2200 steps/day (the lowest 5 percent of daily steps among all participants) was taken as the comparator for assessing the impact of increasing step count on death and CVD events.

The median time spent sedentary was 10.6 hours/day, so study participants who spent 10.5 hours/day or more sedentary were considered to have high sedentary time, while those who spent less than 10.5 hours/day sedentary were classified as having low sedentary time.

Adjustments were made to eliminate biases, such as excluding participants with poor health who were underweight or had a health event within two years of follow-up. Researchers also took into account factors such as age, sex, ethnicity, education, smoking status, alcohol consumption, diet and parental history of CVD and cancer.

What did they find?

Over an average 6.9 years follow up, 1633 deaths and 6190 CVD events occurred.

After taking into account other potential influences, the authors calculated that the optimal number of steps per day to counteract high sedentary time was between 9000 and 10000 steps/day, which lowered mortality risk by 39 per cent and incident CVD risk by 21 per cent.

In both cases, 50 per cent of the benefit was achieved between 4000 and 4500 steps daily.

Study limitations

This is an observational study, so it can’t establish direct cause and effect. Although the large sample size and long follow-up allowed the risk of bias to be reduced, the authors acknowledge the possibility that other unmeasured factors could affect results. They add that steps and sedentary time were obtained in a single time point, which could also lead to bias.

Nevertheless, they conclude, “Any amount of daily steps above the referent 2200 steps/day was associated with lower mortality and incident CVD risk, for low and high sedentary time. Accruing between 9000 and 10,000 steps a day optimally lowered the risk of mortality and incident CVD among highly sedentary participants.”