Wim Hof Method and inflammation: breathing? cold? both?

If you only have a few seconds:

It has been shown that practicing the Wim Hof Method can reduce acute inflammation. A new study has just been published on this subject. Not only does it confirm the previous data, but it also shows that the breathing technique is the most important factor in reducing inflammation. Combined with breathing techniques, cold exposure training seems to reinforce the effects of the latter. However, cold exposure training alone has little effect on this inflammation protocol. On the other hand, voluntary cold training seems to have an effect on the severity of flu-like symptoms.

If you have a few minutes, read on…

A new study on the effect of the Wim Hof Method (WHM) on inflammation has just been published (Zwaag et al., 2022). This research was carried out by the team of the Radboud University Medical Centre, which had already studied this issue in the past. Thus, this study is a logical continuation of those published in 2012 and 2014, on the intervention of WHM in the context of acute inflammation.

At the risk of insisting, let me remind you that the protocol tested, by injection of endotoxin/LPS, allows to study the effect of an intervention, in this case on the practice of WHM on acute inflammation. This protocol alone does not allow robust conclusions to be drawn about infection control. For more information, I invite you to read a previous blog post on this subject.

Let’s return to the scientific data.

In all three studies (Kox et al., 2012; Kox et al., 2014; Zwaag et al., 2022), scientists induced acute inflammation in subjects by an experimental protocol of injecting an endotoxin. In the 2012 study, the subject was Wim Hof. In the 2014 study, the subject was a small cohort of young men, trained by Wim Hof. In the last study, the researchers were able to study several small cohorts trained in different modalities, i.e. with or without Wim, breathing only, cold exposure only, or both. The aim was therefore to verify the reproducibility of the 2012 and 2014 results, while attempting to dissect the effects of the different parameters related to this practice: is the presence of Wim Hof necessary or does a qualified instructor allow the same result? What aspect(s) of the practice (between breathing, cold exposure, both) affect(s) the subjects’ acute inflammation?

What has been observed so far?

In Wim Hof himself (2012) or in a small cohort (2014), the effects of MWH practice on acute inflammation were studied by injecting volunteers with endotoxin. Injected subjects practiced the breathing technique 30 minutes before the injection and 1.5 hours afterwards. The researchers monitored their condition: presence of flu-like symptoms (headache, nausea, backache, etc.) and inflammatory serological markers (proinflammatory cytokines – IL-6, IL-8, TNFalpha – and anti-inflammatory – IL-10). It appeared that subjects trained in MWH and practicing the breathing technique during the experiment i) had fewer flu-like symptoms, ii) produced more adrenaline, iii) more of the anti-inflammatory cytokine IL-10, iv) less of the pro-inflammatory cytokines IL-6, IL-8 and TNFalpha. Thus, these data showed for the first time that a consciously performed practice could modulate the autonomic nervous system and attenuate the innate immune system, both of which are classically described as being beyond the control of consciousness. Furthermore, these encouraging results led the researchers to propose that the practice of WHM could offer support to people suffering from autoimmune diseases by decreasing inflammation.

The continuation of this work can be found in this new study (Zwaag et al., 2022). Unlike assessing the effects of a treatment such as a drug with a single active ingredient, understanding the effects of a practice such as WHM is difficult. There are a range of parameters involved (instructor and ‘guru effect’, instruction time, cold, breathing, state of mind). To study these complex practices, it is not possible to set up a randomised double-blind clinical trial. However, the present study confirms and clarifies some of the data.

So what’s new?

First of all, the fact that Wim Hof’s presence is not needed to replicate the 2014 results may seem like a detail. But it is very important. Indeed, in order to understand the functioning of practices such as MWH, it can be very difficult to differentiate the respective contributions of the placebo and physiological components. In particular, it is important to confirm that the practices induce effects regardless of who teaches them. A charismatic figure like Wim Hof might induce a different response from a less famous instructor, for example. This is the “guru effect”. In other words, we have to check whether the techniques work as techniques or whether there is something else going on. This part of the study focused on the production of adrenaline, as this would be the basis of an anti-inflammatory cascade. The conclusion is that the production of adrenaline by the practice of WHM is not only reproducible but also without the presence of Wim Hof. So the techniques seem to work as such. This means that the practice can be taught on a large scale. And reproducible and widely applicable results mean that a real large-scale clinical trial can be set up. This will make it possible to conclude on the effectiveness of this practice on acute inflammation on the scale of a population representative of society as a whole. It should be remembered that the studies carried out to date have only been done on young men in good health.

But that’s not all…

The other main point of this study was to try to understand what the respective roles of cold and breathing are against acute inflammation. WHM enthusiasts will have noticed that only two of the three pillars of the method are present. The third pillar, the state of mind, was deliberately left out because it would have seriously complicated the experimental protocol. Thus, about ten subjects were trained in cold exposure, another ten in the breathing techniques, another ten in both practices, and a final ten were trained in… nothing! This is the control group. On the day of the experiment, all these young people were injected with the same quantity of endotoxin. The subjects who had been trained in the breathing technique practiced it in this experiment, while the others did nothing special. During the experiment, the researchers monitored the subjects’ reactions: flu-like symptoms (headache, nausea, backache, fever, etc.) and serological markers of inflammation (pro- and anti-inflammatory cytokines). It should be noted that more of these markers were measured in this experiment than in previous studies, namely TNFalpha, IL-10, IP-10, MCP1, MIP1a, MIP1b IL-6 and IL-8

The main finding of this part of the study is that breathing practice is primarily responsible for the anti-inflammatory response. Indeed, a decrease in pro-inflammatory cytokines was observed in all subjects practising breathing techniques (associated with training or not). This decrease is not observed in subjects trained only in cold exposure, nor of course in the control group. On the other hand, it is very interesting to show that the combination of cold + breathing training brings about an even greater reduction in inflammation: cold exposure training seems to reinforce the effect of the breathing techniques on the reduction in inflammation.

But the interest of cold exposure training does not stop there. Indeed, if this training alone seems to have little impact on the inflammatory response, it seems on the other hand to be important for attenuating the strength of flu-like symptoms. The breathing techniques alone, on the other hand, has little effect on the latter.

In the end, this study shows that cold exposure training and breathing technique act both independently, respectively on flu-like symptoms and inflammation. Moreover, they also act in concert, as cold exposure training reinforces the benefits of breathing techniques.

For those who want to go further:

About the absence of women in the study cohorts. This poor diversity of subjects may seem strange at first glance, but it is quite typical – unfortunately – of these pre-clinical studies carried out on few subjects. Indeed, if an intervention causes a change, it is discernible because we have a signal that “stands out from the background noise”. This background noise is (roughly) the physiological state of the subjects without the intervention. We therefore want the background noise to be as “smooth” as possible in order to increase the chances of perceiving a possible change in physiological state. To have a low background noise, we need subjects who are as similar as possible genetically and physiologically. So typically, these subjects will be of the same sex, same age range, same health status. So there are rational reasons for this. However, it must be admitted that these small-cohort pre-studies tend to accumulate data, and therefore knowledge, on a particular group (in this case, young healthy white men) at the expense of other groups, primarily women. More and more research institutes are trying to improve this situation. So let’s keep an eye on it.

About adrenaline. It will not have escaped the attention of the attentive eye that the adrenaline level at the beginning of the experiment is different between the 2014 and 2022 studies. In the 2014 study, the adrenaline level in the participants is already very high even though they have not yet started either the breathing exercises or the endotoxin injections. According to one of the main authors of these studies, there seems to have been a much more “intense” atmosphere in the 2014 study than in the 2022 study. This general excitement may have caused the difference. According to the authors of these studies, adrenaline is the starting point of an anti-inflammatory cascade, allowing the elevation of the anti-inflammatory cytokine IL-10 and finally the decrease of pro-inflammatory cytokines. Between the two studies, the trends are the same but the magnitudes are different. Perhaps the general arousal in the first study allowed for a greater amplitude of response through increased adrenaline production.

About breath-holding. The 2014 and 2022 studies tested the same two breathing techniques, known to MWH practitioners as the Basic Technique and the Power Breathing Technique. The main difference between the two is that the former uses a long breath hold leading to a hypoxic phase. The 2022 study shows that both techniques result in a similar rise in adrenaline levels, and therefore a similar anti-inflammatory response. However, the authors had shown in a previous study that short phases of intermittent hypoxia can induce an anti-inflammatory response independent of the adrenaline-related response (Kiers et al, 2018). It can then be speculated that the basic breathing technique, with breath holding, would induce a dual anti-inflammatory response: via adrenaline and via adenosine.

🔥❄️🧠✌️

Sébastien.

References:

Kiers D, Wielockx B, Peters E, van Eijk LT, Gerretsen J, John A, Janssen E, Groeneveld R, Peters M, Damen L, Meneses AM, Krüger A, Langereis JD, Zomer AL, Blackburn MR, Joosten LA, Netea MG, Riksen NP, van der Hoeven JG, Scheffer GJ, Eltzschig HK, Pickkers P, Kox M. Short-Term Hypoxia Dampens Inflammation in vivo via Enhanced Adenosine Release and Adenosine 2B Receptor Stimulation. EBioMedicine. 2018 Jul;33:144-156. doi: 10.1016/j.ebiom.2018.06.021. Epub 2018 Jul 4. PMID: 29983349; PMCID: PMC6085583.

Kox M, Stoffels M, Smeekens SP, van Alfen N, Gomes M, Eijsvogels TM, Hopman MT, van der Hoeven JG, Netea MG, Pickkers P. The influence of concentration/meditation on autonomic nervous system activity and the innate immune response: a case study. Psychosom Med. 2012 Jun;74(5):489-94. doi: 10.1097/PSY.0b013e3182583c6d. PMID: 22685240.

Kox M, van Eijk LT, Zwaag J, van den Wildenberg J, Sweep FC, van der Hoeven JG, Pickkers P. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proc Natl Acad Sci U S A. 2014 May 20;111(20):7379-84. doi: 10.1073/pnas.1322174111. Epub 2014 May 5. PMID: 24799686; PMCID: PMC4034215.

Zwaag J, Naaktgeboren R, van Herwaarden AE, Pickkers P, Kox M. The effects of cold exposure training and a breathing exercise on the inflammatory response in humans: A pilot study. Psychosom Med. 2022 Feb 23. doi: 10.1097/PSY.0000000000001065. Epub ahead of print. PMID: 35213875.