The Wim Hof method

A regular theme of the SoPD website is the reviewing of novel phamarcological treatments that are being tested on models of Parkinson’s. And while the breadth of the research is exciting and encouraging, the average reader may feel distant to the results of those studies as the experimental drug being tested is still a long way from possible regulatory approval. There have been numerous requests to explore more readily applicable research, which could be useful for the Parkinson’s community to explore (for example, diet and exercise). This is dangerous ground for a blogger to tread on, but in the interest of stimulating discussion (and possibly research), we shall do our best. In today’s post, we will discuss what the Wim Hof method is, what research supports it, and potential issues with applying it to conditions like Parkinson’s. Before we start: This post is not an endorsement of the Wim Hof method, but rather an exploration of the research that has been conducted on it. The author has had no contact with Mr Hof or any associated parties, nor is he aware of any clinical research investigating the Wim Hof method in the context of Parkinson’s. The author is simply fulfilling a request to discuss the topic.

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Source: PDUK

I am regularly asked to give an opinion (or write a blog post) about a method or technique that is being advertised online as a remedy for all aliments (including Parkinson’s).

“What do you think of the ________ method?” folks will ask.

Many of these techniques I am unaware of and I can simply give a polite “I honestly don’t know” kind-of response. But for others, where I do have a little information I find myself rather conflicted.

Why conflicted?

A lot of these online methods/techniques involve commercially-focused entities hidden behind a veneer of testimonials, and very few of them have any actual real science backing them. It is difficult for anyone to give an opinion, let alone write a post about it.

But if people in the Parkinson’s community are experiencing some kind of benefits from a particular method, who am I to say otherwise or pour doubt on their experience given the lack of alternatives (I do draw a line, however, at dodgy stem cell clinics – they are all charlatans).

Source: The conversation

But recently a friend within the PD community asked me to look into the “Wim Hof method”. And while I reluctantly agreed to, I have to say that I was pleasantly surprised

Why surprised?

Because there was actual real research backing up some of the claims! The method has never been clinically tested on Parkinson’s (as far as I’m aware), but researchers have had a look at the method and the results are worth discussing.

What is the Wim Hof method?

Wim Hof (aka the “Ice man”) is “a Dutch extreme athlete noted for his ability to withstand freezing temperatures” (Source: Wikipedia).

Wim Hof. Source: Formnutrition

Mr Hof has set a number of Guinness world records for various activities involving exposure of the body to extremely low temerpatures. For example he previously held the record for longest time embedded in ice (1 hour 53 minutes!?!).

Wim Hof embedded in ice. Source: Buythiz

“Previously held the record”?

Yes, that record has subsequently been broken by Josef Köberl of Austria who was embedded in ice for 2 hours, 8 minutes (?!?!?).

Wim attributes his ability to do these amazing feats to his “Wim Hof Method”.

And what is the Wim Hof method?

From what I have read (and I could be wrong here – happy to be corrected), the Wim Hof method involves 3 pillars:

1. Breathing

The first pillar is a breathing exercise which has been likened to controlled hyperventilation. You sit in a comfortable position insuring that you can expand your lungs without any impediments. Many folks do the exercise immediately after waking up as the stomach is basically empty.

Then you warm up by inhaling deeply. Really deeply. Drawing in breath until you feel a slight pressure inside your chest. This breath is to be held for a moment and then exhaled completely. Once all out, you should hold for a moment before repeating the process. This warm up should be repeated 15 times.

Next, you should close your eyes and do 30 power breaths. This is the “controlled hyperventilation” part, and it involves inhaling through your nose and exhaling through the mouth in short but powerful bursts. Like you are blowing up a balloon. It is recommended that you keep a steady pace and use your midriff fully.

During these 30 power breaths, you should be very mindful of your body. Try to be aware of all aspects of your body and imagine all negativity melting away.

After these power breath, draw in a slow breath – fill your lungs to their maximum capacity. Then exhale completely and hold for as long as you can, before once more inhaling. Set aside at least 5 minutes after each session to relax your body.

This breathing technique can be done daily. If at any point you feel dizziness or experience pain, stop the session, lie on your back, and breathe normally again.

2. Cold Exposure

Cold exposure is an important part of the Wim Hof method. And admittedly Mr Hof takes it to an extreme, but he has been doing this for many years and his body is used to it.

He is very quick to tell people not to ‘dive in’ – do not simply jump into ice water with no prior exposure. It is better to gradually build up.

He recommends initiating the cold exposure after the breathing session. If you are new to cold exposure, it is best to start with a shower. Gradually reduce the temperature over the space of a few minutes. It is recommended that you try to remain calm and relax your breathing. It may help to close your eyes as you embrace the cold.

Cold exposure apparently takes practice, but you can get better at it over time (several weeks according to Wim).

3. Commitment (or Meditation)

During both the breathing exercises and the cold exposure, meditation is a fundamental part of the effort. The meditiation used in the Wim Hof method is very similar to Tibetan Tummo meditation and pranayama (the formal practice of controlling the breath used in many forms of yoga).

Is there any scientific research supporting this method?

Yes there is.

And this is the only reason I am mentioning this method here on the SoPD.

To be very clear, however, there has been no research involving the Wim Hof method and Parkinson’s (that I am aware of – happy to be corrected on this).

But the research that has been conducted in interesting, and it really starts with this study published by Dutch researchers in 2012:

Title: The influence of concentration/meditation on autonomic nervous system activity and the innate immune response: a case study.
Authors: Kox M, Stoffels M, Smeekens SP, van Alfen N, Gomes M, Eijsvogels TM, Hopman MT, van der Hoeven JG, Netea MG, Pickkers P.
Journal: Psychosom Med. 2012 Jun;74(5):489-94.
PMID: 22685240

In this study, the researchers collected blood from Wim Hof before and after an 80 minute full-body ice immersion session, and they exposed those blood cells in cell culture to a bacterial endotoxin (called lipopolysaccharide or LPS) which elicits as strong inflammatory response from the body.

In this endotoxin experiment, the researchers compared the results of Wim’s blood cells with blood samples collected from a comparison group of 112 individuals. They found that Wim’s results were very different to all of the comparison group results. His blood cells displayed a much reduced pro-inflammatory response and increased anti-inflammatory signal.

The researchers concluded that the Wim Hof method “seems to evoke a controlled stress response“.

And the investigators could have simply stopped there, but they didn’t.

Looking at their results, the researchers must have asked the question “is this chap Wim Hof an outlier in nature, or can this method be applied to a group of volunteers?” because the next thing they did was conduct a clinical study involving healthy male volunteers.

The results of that study were published in the journal PNAS (for the uninitiated, PNAS is a pretty fancy place to get your research published in):

Title: Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans.
Authors: Kox M, van Eijk LT, Zwaag J, van den Wildenberg J, Sweep FC, van der Hoeven JG, Pickkers P.
Journal: Proc Natl Acad Sci U S A. 2014 May 20;111(20):7379-84.
PMID: 24799686             (This report is OPEN ACCESS if you would like to read it)

In this study, the researchers took 30 healthy male volunteers, randomly split them into 2 groups – one of 18 individuals who practiced the Wim Hof method for 10 days and another of 12 participants who received no training – click here to read more about the details of this clinical study.

At the end of the 10 days, members of both groups were intravenously administrated with the same bacterial endotoxin (LPS) that was used in the first study. The participants who were trained in the Wim Hof method were allowed to do their exercises 30 minutes after the treatment was given.

The researchers collected blood samples before and throughout this bacterial endotoxin treatment, and when they analysed the samples, they noticed something remarkable:

The Wim Hof method group exhibited significant increases in the release of epinephrine.

What is epinephrine?

Epinephrine (also known as adrenaline) is a hormone, that is involved in numerous bodily functions.

Source: Wikipedia

It is most commonly associated with the rush that one gets when doing crazy risky things, like sky diving.

Adrenaline inducing. Source: RD

And it is also used to as a medication to treat a number of conditions, such as anaphylaxis (severe allergic reaction) and cardiac arrest.

But what is often over looked about epinephrine is its anti-inflammatory properties.

Epinephrine regulates both pro-inflammatory and anti-inflammatory signalling, which leads to reduces generation of inflammatory molecules, like TNF-α (Click here to read more about this).

Epinephrine acts by binding to a variety of adrenergic receptors, which have been the focus of much attention recently in the field of Parkinson’s research (Click here to read more about this).

What happens to epinephrine in Parkinson’s?

Previous research suggests that levels of epinephrine are reduced in people with Parkinson’s (compared to healthy controls – Click here to read more about this). Levels of epinephrine can also be affected by some medications used in the treatment of Parkinson’s, such as catechol-O-methyltransferase (COMT) inhibitors.

So the Wim Hof method group exhibited significant increases in the release of epinephrine?

Yes, they did.

As you can see in graph A in the panel below, during the LPS-induced inflammatory period (the grey boxed area), epinephrine levels were significantly elevated in the blood of the Wim Hof treatment group, while the control group only exhibited a spike 1 hour after the endotoxin was given (0 hours on the x-axis of the graph).

Source: PMC

And as you can see, similar elevated levels were not seen in other proteins analysed in the blood samples (such as dopamine, norepinephrine and cortisol – norepinephrine is similar to epinephrine, but there are differences – click here to read more about this).

This increase in epinephrine levels correlated with an increase in levels of anti-inflammatory messenger molecules (called cytokines) like IL-10, and a reduction in levels of proinflammatory mediators, like TNF-α, IL-6, and IL-8.

Source: PMC

These results suggested to the researchers that Wim Hof was not “an outlier in nature” and his method may be applicable to other individuals, providing similar results (increased production of anti-inflammatory mediators and subsequent dampening of the proinflammatory cytokine response).

A follow up study suggested additional benefits in the treatment group (Click here to read that report).

Subsequent to this study, researchers in Detroit (USA) have conducted imaging studies on Mr Hof, and their results were published in 2018:

Title: “Brain over body”-A study on the willful regulation of autonomic function during cold exposure.
Authors: Muzik O, Reilly KT, Diwadkar VA.
Journal: Neuroimage. 2018 May 15;172:632-641.
PMID: 29438845

In this study, the researchers used several imaging techniques to assess changes in sympathetic innervation and glucose consumption in Wim Hof “during both thermoneutral and prolonged mild cold conditions“.

The results provided “compelling evidence for the primacy of the brain rather than the body (peripheral mechanisms) in mediating the Iceman’s responses to cold exposure“. The researchers concluded that the Wim Hof method might allow individuals to develop a better control of certain aspects of their autonomic nervous system.

What is the autonomic nervous system?

Everyone has heard of the central nervous system which comprises the brain and spinal cord, and controls all of our voluntary actions. The autonomic nervous system controls involuntary responses to regulate physiological functions. It is generally assumed that the autonomic nervous system is largely regulated unconsciously, thus any research suggesting otherwise is of interest.

And finally, more recently, the Dutch researchers have published another study on the Wim Hof method:

Title: An add-on training program involving breathing exercises, cold exposure, and meditation attenuates inflammation and disease activity in axial spondyloarthritis – A proof of concept trial.
Authors: Buijze GA, De Jong HMY, Kox M, van de Sande MG, Van Schaardenburg D, Van Vugt RM, Popa CD, Pickkers P, Baeten DLP.
Journal: PLoS One. 2019 Dec 2;14(12):e0225749.
PMID: 31790484             (This report is OPEN ACCESS if you would like to read it)

In this study, the researchers assessed the safety and anti-inflammatory effects of “an add-on training program involving breathing exercises, cold exposure, and meditation” (the Wim Hof method) in people with axial spondyloarthritis.

And I know what you are going to ask:

What is axial spondyloarthritis?

Axial Spondyloarthritis is a chronic, inflammatory arthritis. Its main symptom is back pain, in addition to stiffness and fatigue. It generally starts in early adulthood (typically before 45 years of age), and affects 10 to 30 people per 10,000 in the general population.

Source: UCB

The researchers took 24 people with moderate axial spondyloarthritis and randomly divided them into 2 groups – 13 people were given the intervention (training in the Wim Hof method) and 11 people acted as a control group (no intervention). The treatment period last 8 weeks (Click here to read more about the details of this study).

The investigators found that there were no differences in adverse events between groups, so the Wim Hof method (over the short term) was considered safe and well tolerated by individuals with axial spondyloarthritis.

In addition, the researchers reported that the Wim Hof method treatment was associated with significant reductions in biological endpoints (particularly erythrocyte sedimentation rate) and improved patient-reported outcomes measures.

The researchers concluded that the “findings warrant full-scale randomised controlled trials of this novel therapeutic approach in patients with inflammatory conditions“.

Sounds interesting. Where can I try this?

Before you do, please understand that (and this is the third time I am writing this) I have found no research regarding the use of the Wim Hof method on people with Parkinson’s. There are some online testimonials, but they carry no weight here at the SoPD – we like data. Thus, this should not be rushed in to.

And it should definitely be supervised. Given the nature of the breathing exercises, blackouts can occur. In fact, there are reports of people unfortunately dying while experimenting with the Wim Hof method (although to be fair, those cases had taken the method to an extreme – click here to read more about this).

If readers are considering trying the Wim Hof method, they should definitely discuss it with their doctor/clinician before taking any first steps. Remember, this is not an endorsement of the method, just a discussion of the research.

What issues could there be with applying the Wim Hof method to Parkinson’s?

Autonomic nervous system dysfunction is very common in Parkinson’s. It affects 70% to 80% of cases. From orthostatic hypotension (reduced blood pressure when standing up) to gastrointestinal issues, many of the complaints associated with the autonomic nervous system dysfunction in Parkinson’s may actually pre-date the motor features of the condition (Click here to read more about this).

Given these issues, folks with Parkinson’s may have a harder time applying the Wim Hof method and need greater supervision.

And this is why some clinical studies are required to assess the safety and tolerability of the approach in Parkinson’s, before it can then be determined if the method has any actual benefits.

So what does it all mean?

I’ll be honest, I was reluctant to write this post because I didn’t want to be seen to be validating or endorsing something that has not been tested in Parkinson’s.

But the PwP who introduced me to it and asked me to explore it for them, pointed out that I am always writing about pharmaceutical agents on this website (for example, ambroxol, exenatide, etc), and these have limited applicability for the PD community. This same individual said that it would be useful to occassional focus the SoPD attention on research-backed approaches that could be more immediately impactful.

It was a fair point, but in this particular case (as I have pointed out repeatedly) there is no Parkinson’s-related research to focus on.

I was intrigued with the idea, however, that a breathing/meditation/cold exposure method could have biological effects on anti-inflammatory processes in the body. And I would like to see more research on this (particularly in the context of PD). It will not be everyone’s cup of tea (cold showers are certainly no good for my dickie ticker), but it would be nice to generate some discussion around this idea – who knows where it may lead.

 

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EDITOR’S NOTE: The Wim Hof method is promoted by a commercial company called Innerfire. The author of this blog has had no contact with any individuals associated with that company. This post does not represent an endorsement of the method promoted by that company. The author was simply curious about the research behind the approach and is sharing it here in order to generate discussion about alternative approaches to potentially managing Parkinson’s – that said, there is currently no research suggesting that the Wim Hof method has ever been tested in people with PD, and thus no indication of whether it is safe for individuals with Parkinson’s.

The information provided by the SoPD website is for information and educational purposes only. Under no circumstances should it ever be considered medical or actionable advice. It is provided by research scientists, not medical practitioners. Any actions taken – based on what has been read on the website – are the sole responsibility of the reader. Any actions being contemplated by readers should firstly be discussed with a qualified healthcare professional who is aware of your medical history. While some of the information discussed in this post may cause concern, please speak with your medical physician before attempting any change in an existing treatment regime.

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