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Tag: physical labor

  • Just How Sweaty Can Humans Get?

    Just How Sweaty Can Humans Get?

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    This summer, I, like so many other Americans, have forgotten what it means to be dry. The heat has grown so punishing, and the humidity so intense, that every movement sends my body into revolt. When I stand, I sweat. When I sit, I sweat. When I slice into a particularly dense head of cabbage, I sweat.

    The way things are going, infinite moistness may be something many of us will have to get used to. This past July was the world’s hottest month in recorded history; off the coast of Florida, ocean temperatures hit triple digits, while in Arizona, the asphalt caused third-degree burns. As human-driven climate change continues to remodel the globe, heat waves are hitting harder, longer, and more frequently. The consequences of this crisis will, on a macroscopic scale, upend where and how humans can survive. It will also, in an everyday sense, make our lives very, very sweaty.

    For most Americans, that’s probably unwelcome news. Our culture doesn’t exactly love sweat. Heavy perspirers are shunned on subways; BO is a hallmark of pubescent shame. History is splattered with examples of people trying to cloak sweat in perfumes, wash it away by bathing, or soak it up with wads of cotton or rubber crammed into their shirts, dresses, and hats. People without medical reason to do so have opted to paralyze their sweat-triggering nerves with Botox. Even Bruce Lee had the sweat glands in his armpits surgically removed, reportedly to avoid on-screen stains, several months before his death, in 1973.

    But our scorn of sweat is entirely undeserved. Perspiration is vital to life. It cools our bodies and hydrates our skin; it manages our microbiome and emits chemical cues. Sweat is also a fundamental part of what makes people people. Without it, we wouldn’t be able to run long distances in high heat; we wouldn’t be able to power our big brains and bodies; we wouldn’t have colonized so much of the Earth. We may even have sweat to thank (or blame) for our skin’s nakedness, says Yana Kamberov, a sweat researcher at the University of Pennsylvania. Her team’s recent data, not yet published, suggest that as human skin evolved to produce more and more sweat glands, fur-making hair follicles disappeared to make room. Sweat is one of the “key milestones” in human evolution, argues Andrew Best, a biological anthropologist at the Massachusetts College of Liberal Arts—on par with big brains, walking upright, and the expression of culture through language and art.

    Humans aren’t the only animals that sweat. Many mammals—among them, dogs, cats, and rats—perspire through the footpads on their paws; chimpanzees, macaques, and other primates are covered in sweat glands. Even horses and camels slick their skin in the heat. But only our bodies are studded with this many millions of teeny, tubular sweat glands—about 10 times the number found on other primates’ skin—that funnel water from our blood to pores that can squeeze out upwards of three, four, even five liters of sweat an hour when we need them to.

    Our dampness isn’t cost free. Sweat is siphoned from the liquid components of blood—lose too much, and the risks of heat stroke and death shoot way up. Our lack of fur also makes us more vulnerable to bites and burns. That humans sweat anyway, then, Best told me, is a testament to perspiration’s cooling punch—it’s so much more efficient than merely panting or hiding from the heat. “If your objective is to be able to sustain a high metabolic rate in warm conditions, sweating is absolutely the best,” he said.

    And yet, in modern times, many of us just can’t seem to accept the realities of sweat. Americans are, for whatever reason, particularly preoccupied with quashing perspiration; in many other countries, “body odor is just normal,” says Angela Lamb, a dermatologist at Mount Sinai’s Icahn School of Medicine. But the bemoaning of BO has cultural roots that long predate the United States. “I’ve read discussions well back into antiquity where there are discussions about people whose armpits stink,” says Cari Casteel, a historian at the University of Buffalo. By the start of the 20th century, Americans had been primed by the recent popularization of germ theory to fear dirtiness—the perfect moment for marketers to “put the fear in women, and then men, that sweat was going to kibosh your plans for romance or a job,” says Sarah Everts, the author of The Joy of Sweat. These days, deodorants command an $8 billion market in the United States.

    Our aversion to sweat doesn’t make much evolutionary sense. Unlike other excretions that elicit near-universal disgust, sweat doesn’t routinely transmit disease or pose other harm. But it does evoke physical labor and emotional stress—neither of which polite society is typically keen to see. And for some, maybe it signifies “losing control of your body in a particular way,” says Tina Lasisi, a biological anthropologist at the University of Michigan. Unlike urine or tears, sweat is the product of a body function that we can’t train ourselves to suppress or delay.

    We also hate sweat because we think it smells bad. But it doesn’t, really. Nearly all of the sweat glands on human bodies are of the so-called eccrine variety, and produce slightly salty water with virtually no scent. A few spots, such as the armpits and groin, are freckled with apocrine glands that produce a waxy, fatty substance laced with pheromones—but even that has no inherent odor. The bacteria on our skin eat it, and their waste generates a stench, leaving sweat as the scapegoat. Our species’ approach to perspiration may even make us “less stinky than we could be,” Best told me. The expansion of eccrine glands across the body might not have only made our skin barer; it’s also thought to have evicted a whole legion of BO-producing apocrine glands.

    As global temperatures climb, for many people—especially in parts of the world that lack access to air-conditioning—sweat will be an inevitability. “I suspect everyone is going to be quite drippy,” Kamberov told me. Exactly how slick each of us will be, though, is anyone’s guess. Experts have evidence that men sweat more than women, and that perspiration potential declines with age. But by and large, they can’t say with certainty why some people are inherently sweatier than others, and how much of it is inborn. Decades ago, a Japanese researcher hypothesized that perspiration potential might be calibrated in the first two or three years of life: Kids born into tropical climates, his analyses suggested, might activate more of their sweat glands than children in temperate regions. But Best’s recent attempts to replicate those findings have so far come up empty.

    Perspiration does seem to be malleable within a lifetime. A couple of weeks into a new, intense exercise regimen, for instance, people will start to sweat more and earlier. Over longer periods of time, the body can also learn to tolerate high temperatures, and sweat less copiously but more efficiently. We sense these changes subtly as the seasons shift, says Laure Rittié, a physiologist at Glaxo-Smith Kline, who has studied sweat. It’s part of the reason a 75-degree day might feel toastier—and perhaps sweatier—in the spring than in the fall.

    But we can’t simply sweat our way out of our climatic bind. There’s a ceiling to the temperatures we can tolerate; the body can leach only so much liquid out at once. Sweat’s cooling power also tends to falter in humid conditions, when liquid can’t evaporate as easily off of skin. Nor can researchers predict whether future generations might evolve to perspire much more than we do now. We no longer live under the intense conditions that pressured our ancestors to sprout more sweat glands—changes that also took place over many millions of years. It’s even possible that we’re fast approaching the maximal moistness a primate body can produce. “We don’t have a great idea about the outer limits of that plasticity,” Jason Kamilar, a biological anthropologist at the University of Massachusetts at Amherst, told me.

    For now, people who are already on the sweatier side may find themselves better equipped to deal with a warming world, Rittié told me. At long last: Blessed are the moist, for they shall inherit the Earth.

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    Katherine J. Wu

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  • The Enigma of ‘Heat-Related’ Deaths

    The Enigma of ‘Heat-Related’ Deaths

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    The autopsy should have been a piece of cake. My patient had a history of widely metastatic cancer, which was pretty straightforward as far as causes of death go. Entering the various body cavities, my colleague and I found what we anticipated: Nearly every organ was riddled with tumors. But after we had completed the work, I realized that I knew why the patient had died, but not why he’d died that day. We found no evidence of a heart attack or blood clot or ruptured bowel. Nothing to explain his sudden demise. Yes, he had advanced cancer—but he’d been living with that cancer the day before he died, and over many weeks and months preceding. I asked my colleague what he thought. Perhaps there had been some subtle change in the patient’s blood chemistry, or in his heart’s electrical signaling, that we simply couldn’t see? “I guess the patient just up and died,” he said.

    I’m a hospital pathologist; my profession is one of many trying to explain the end of life. In that role, I have learned time and again that even the most thorough medical exams leave behind uncertainty. Take the current spate of heat-related fatalities brought on by a summer of record-breaking temperatures. Residents of Phoenix endured a month of consecutive 110-degree days. People have been literally sizzling on sidewalks. And news organizations are taking note of what is said to be a growing body count: 39 heat deaths in Maricopa County, Arizona; 10 in Laredo, Texas. But the precision of these figures is illusory. Cause of death cannot be measured as exactly as the temperature, and what qualifies as “heat-related” will always be a judgment call: Some people die from heat; others just up and die when it happens to be hot.

    Mortality is contested ground, a place where different types of knowledge are in conflict. In Clark County, Nevada, for example, coroners spend weeks investigating possible heat-related deaths. Families are interviewed, death scenes are inspected, and medical tests are performed. The coroner must factor in all of these sources of information because no single autopsy finding can definitively diagnose a heat fatality. A victim may be found to have suffered from hyperthermia—an abnormally high body temperature—or they may be tossed into the more subjective bucket of those who died from ”environmental heat stress.”

    Very few deaths undergo such an extensive forensic examination in the first place. Most of the time, the circumstances appear straightforward—a 75-year-old has a stroke; a smoker succumbs to an exacerbation of his chronic lung disease—and the patient’s primary-care doctor or hospital physician completes the death certificate on their own. But heat silently worsens many preexisting conditions; oppressive temperatures can cause an already dysfunctional organ to fail. A recent study out of China estimated that mortality from heart attacks can rise as much as 74 percent during a severe, several-day heat wave. Another study from the U.S. found that even routine temperature fluctuations can subtly alter kidney function, cholesterol levels, and blood counts. Physicians can’t easily tease out these influences. If an elderly man on a park bench suddenly slouches over from a heart attack in 90-degree weather, it’s hard to say for sure whether the heat was what did him in. Epidemiologists must come to the rescue, using statistics to uncover those hidden causes at the population level. This bird’s-eye view shows a simple fact: Bad weather means more death. But it still doesn’t tell us what to think about the man on the bench.

    Research (and common sense) tells us that some individuals are going to be especially vulnerable to climate risks. Poverty, physical labor, substandard housing, advanced age, and medical comorbidities all put one in greater danger of experiencing heat-related illness. The weather has a way of kicking you while you’re down, and the wealthy and able-bodied are better able to dodge the blows. A financial struggle as small as an unpaid $51 portion of an electricity bill can prove deadly in the summer. In the autopsies I’ve performed, a patient’s family, medical record, and living situation often told a story of long-term social neglect. But there was no place on the death certificate for me to describe these tragic circumstances. There was certainly no checkbox to indicate that climate change contributed to a fatality. Such matters were out of my jurisdiction.

    The public-health approach to assessing deaths has its own problems. Mostly it’s confusing. Reams of scientific studies have reported on hundreds of different risk factors for mortality. Sultry weather appears to be dangerous, but so do skipping breakfast, taking naps, and receiving care from a male doctor. Researchers have declared just about everything a major killer. A few months ago, the surgeon general announced that feeling disconnected is as deadly as smoking up to 15 cigarettes a day. The FDA commissioner has said that misinformation is the nation’s leading cause of premature death. And is poverty or medical error the fourth-leading cause? I can’t keep track.

    With so many mortality statistics at our disposal, which ones get emphasized can be more a matter of politics than science. Liberals see the current heat wave—and its wave of heat-related deaths—as an urgent call to action to combat climate change, while conservatives dismiss this concern as a mental disorder. A recent Wall Street Journal op-ed concluded that worrying about climate change is irrational, because “if heat waves were as deadly as the press proclaims, Homo sapiens couldn’t have survived thousands of years without air conditioning.” (Humans survived thousands of years without penicillin, but syphilis was still a net negative.) Similarly, when COVID became the third-leading cause of death in the U.S., pandemic skeptics said it was a fiction: Victims were dying “with COVID,” not “from COVID.” Because many people who died of SARS-CoV-2 had underlying risk factors, some politicians and doctors brushed off the official numbers as hopelessly confounded. Who could say whether the virus had killed anyone at all?

    The dismissal of COVID’s carnage was mostly cynical and unscientific. But it’s true that death certificates paint one picture of the pandemic, and excess-death calculations paint another. Scientists will be debating COVID’s exact body count for decades. Fatalities from heat are subject to similar ambiguities, even as their determination comes with real-world consequences. In June, for example, officials from Multnomah County, Oregon—where Portland is located—sued oil and gas producers over the effects of a 2021 heat wave that resulted in 69 heat-related deaths, as officially recorded. This statistic will likely be subjected to intense cross-examination. The pandemic showed us that casting doubt on the deceased is a convenient strategy.

    No matter how we count the bodies, extreme weather leads to suffering—especially among the most vulnerable members of society. A lot of people have already perished during this summer’s heat wave. Their passing is more than a coincidence—not all of them just up and died.

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    Benjamin Mazer

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