One of the more bizarre headlines in the news is a report that two people died in a “sweat lodge” and quite a few more people who were there required hospital treatment.

Any physician hearing of this will suspect the deaths were from one of two causes: One carbon monoxide (which reportedly has been ruled out) or second, heat related illness, or heat stroke.

Excess heat can be a killer:

Heat-related illnesses, such as heat exhaustion and heatstroke, occur when your body can’t keep itself cool. As the air temperature rises, your body stays cool when your sweat evaporates. On hot, humid days, the evaporation of sweat is slowed by the increased moisture in the air. When sweating isn’t enough to cool your body, your body temperature rises, and you may become ill.

During the 2003 heat wave, thousands died in Europe, mainly the elderly who did not have air conditioning.

The most common picture is heat exhaustion, where you get tired, confused, sweat a lot, and stop urinating. You might get a headache and muscle cramps. If you are old, or sick, especially if you have diabetes, weak kidneys or a weak heart, you can get very ill or even die. As you dehydrate (sweat your body’s water out), your blood pressure goes down and your blood becomes thicker, both of which can lead to a stroke or heart attack. Since you sweat electrolytes (salts), your body’s electrolytes can get out of whack, leading to muscle cramps, or even irregular heartbeats and death.

The most vunerable are the elderly, of course. During one heat wave, thousands of elderly people in France died of heat related injuries.

Usually a younger person who has heat exhaustion feels bad, but figures out he is hot, so seeks a cool drink or moves to a cooler area.

But the more serious heat illness, heat stroke, can be fatal.

In heat stroke, your body stops sweating, and your body temperature quickly goes up. The person is confused, and can go into convulsions with little warning. Those most vulnerable to this are infants, the elderly, those taking certain medications (usually sedatives or medicines that decrease sweating). Another risk group are athletes who exercise in the heat, those who work outdoors in the summer, and those who work in poorly ventilated rooms.

Heat stroke is a medical emergency, and the treatment is to cool off the patient IMMEDIATELY, using ice or cool water and fans.

There are certain precautions to prevent heat related illness: the main one is to keep hydrated (drink lots of water or other fluids). Another is to wear a hat or in the shade. A third one is not to stress oneself is one is not used to the heat. Keeping cool by positioning a fan helps, as does adequate ventilation if you work inside.

So when we read about the “sweat lodge” deaths, a few items make the average physician wonder if heat was the cause of the deaths.

Pertinent details number one: The room was 416 square feet (example 20×20 feet) and there were 64 people, so it was crowded. Body heat alone can raise the temperature of a room, even if the original temperature was within safe limits.

Another pertinent detail: They were in the room for over two hours.

Sauna manufacturers recommend you start with a thirty minute session, and as you get accustomed to the sauna, increase the length to 50 minutes.

That’s why if you visit a sauna or hot tub in a hotel, you will notice warning signs inside the saunas and hot tubs, warning you to limit your time to twenty minutes, not use them if you are pregnant, have heart problems, or high blood pressure, and not to drink alcohol if you plan to use them. There have been people who died in hot tubs and saunas, and hotels hate to lose customers this way.

Third detail: That area of Arizona is hot, and that may have contributed to the excess heat in the interior of the building, especially if the room was not well ventilated and no one was keeping an eye on the temperature.

Fourth detail: the two victims were from cooler climates, one from the hills of New York state and the other from Milwaukee. They may not have been “acclimatized” to the heat.

Now, sweat lodges are used by the Objibwe and other northern Plains tribes for both spiritual and health reasons. Many tribes have built one for their members. But essentially they are similar to saunas or old fashioned Turkish baths, all of which have a long history of being used to feel better in cool climates or the cool season of the year.

Saunas/sweat lodges/Turkish baths help you get rid of excess fluid in your tissues (something that probably saved lives before Lasix/furosemide was available) and of course the heat helped achy joints. The “relaxation” of the”treatment” will contribute to a person’s mental health, and I suspect the stress hormone cortisol  will increase, which also can contribute to a temporary feeling of well being.

Just because a treatment is “Natural” doesn’t mean it is “harmless”: anything can be overdone, be it herbs or vitamins or exercise or faith healing or fad diets–or sweat lodges.

One wonders why these folks didn’t leave when they started to feel ill. Were they too embarrassed to stand up and leave? Or did an “expert” reassure them that their headaches and dizziness were “normal” from the “detoxification” process, rather than recognizing these as symptoms of heat illness?

Finally, one wonders if anyone was encouraging those in that hot room to drink adequate fluids: this could mean a quart an hour if the temperature is high enough.

A sweat lodge/sauna experience can be safe and helpful, if common sense is used. So when the temperature goes twenty below, go to your health club and enjoy yourself…but set the timer and don’t overdo it.

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Nancy Reyes is a retired physician living in the rural Philippines. She writes medical essays at HeyDoc Xanga blog.

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