An Integrative Medicine Approach to Hyperhidrosis

Sweating is a natural and necessary process that allows the body to cool down to avoid overheating, but when excessive sweating occurs it is known as hyperhidrosis. In this condition, your sweat glands produce too much sweat even when not needed to regulate temperature. This can be increased with a variety of triggers like emotional stress and spicy foods, as well as certain medications and other medical conditions like hyperthyroidism or anxiety.

Excessive sweating can occur anywhere that sweat glands are present, most commonly on the palms of the hands. This condition can cause distress and embarrassment and impacts around 3% of adults or over 15 million people in the United States between ages 20 and 60. 

To address this excess sweating, an integrative dermatology approach looks at underlying contributing factors and works to bring the body back into balance using diet, supplements, and lifestyle measures.

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What is Hyperhidrosis?

Sweat is an odorless fluid that is normally produced by eccrine sweat glands in the skin to help the body regulate temperature and avoid overheating. You have the highest concentration of eccrine glands in your armpits, soles of your feet, palms of your hands, forehead and cheeks, genitals, and lower back. Sweat is produced in these glands and transported through sweat ducts to the skin surface, where it evaporates to help cool down your body. 

When these sweat glands are overactive, hyperhidrosis results. Hyperhidrosis refers to excessive sweating that can occur at random times of the day, even when there is not something like heat, exercise, or emotion causing your glands to produce sweat. Sweating in hyperhidrosis can be very significant, causing sweaty hands, underarm sweat that soaks through clothing, and sweating in other areas of the body, like the face, resulting in embarrassment and discomfort. This excess sweating usually occurs on both sides of the body. Over time, this chronic condition can cause skin breakdown, itching, and inflammation when sweat irritates the skin, as well as body odor when bacteria on the skin mix with sweat.

Hyperhidrosis can be divided into two main types. Primary focal hyperhidrosis is the most common type of hyperhidrosis and begins before age 25. It usually affects the armpits, hands, feet, and face. Secondary generalized hyperhidrosis causes widespread sweating that can even occur during sleep.  

What Are The Possible Causes of Hyperhidrosis?

Normally, the body produces sweat in response to certain triggers. Sweat glands are controlled largely by cholinergic innervation but are also influenced by adrenal hormones stimulated by the sympathetic nervous system response. The most common cause of sweating is elevated temperatures and/or humidity. In addition, sweating in hyperhidrosis can occur in response to emotions like stress, anxiety, fear, or nervousness; exercise or physical activity; coffee or alcohol; and certain foods, like spicy foods, fatty foods, sugary and salty foods, and foods with high levels of protein.

Primary focal hyperhidrosis is due to faulty nerve signals that trigger eccrine sweat glands to be overactive. It most commonly impacts the palms, soles, underarms, and sometimes the face. This type of hyperhidrosis is due to a genetic change (mutation) that can be inherited.

Secondary or generalized hyperhidrosis can result in increased sweating all over the body and is due to an underlying medical condition or occurs as a side effect of certain medications. Some of the most common medications that can cause sweating as a side effect include Albuterol (Proventil®), Bupropion (Wellbutrin®), Hydrocodone, Insulin (Humulin® R, Novolin® R), Levothyroxine, Lisinopril, Naproxen (Aleve®), Omeprazole (Prilosec®), and Sertraline (Zoloft®). Generalized hyperhidrosis is also a symptom of some other medical conditions. For example, acromegaly, chronic infections like tuberculosis, anxiety, cancer, diabetes, heart disease or heart failure, hyperthyroidism, menopause, obesity, and disorders of the nervous system, such as Parkinson’s disease, can all result in excessive sweating.

Functional Medicine Labs to Test for Root Cause of Hyperhidrosis

Functional medicine laboratory testing can help to assess factors contributing to excess sweating and evaluate for the presence of accompanying health issues.

Hormone Balance

Since fluctuating levels of estrogen can contribute to hot flashes during menopause and excess sweating, hormonal testing like the DUTCH Complete can assess hormonal imbalances. In addition to sex hormones, this test evaluates cortisol, organic acids, and oxidative stress metabolites to determine if menopause, adrenal issues, or other hormonal factors may be contributing to hyperhidrosis symptoms. 

Thyroid Testing

Since thyroid disease, especially hyperthyroidism, can cause excess sweating and secondary hyperhidrosis, assessing thyroid hormone imbalances can provide insights into why excess sweating is occurring.

Thyroid function can be evaluated with a Complete Thyroid Panel that measures levels of thyroid-stimulating hormone (TSH), T3 (free and total), T4 (free and total), and reverse T3, as well as thyroid antibodies such as thyroid peroxidase (TPO) and anti-thyroglobulin (TG) and antibodies to evaluate autoimmune involvement that occurs in Hashimoto’s hypothyroidism or Grave’s hyperthyroidism. These tests can be assessed using functional medicine ranges to assess how the thyroid is functioning.

Blood Sugar Balance

Low blood sugar (hypoglycemia) or large swings in blood sugar can cause excess sweating. Blood sugar balance and insulin function can be evaluated with a fasting glucose test to measure the level of glucose in the blood when you have not eaten for several hours, usually after an overnight fast. 

If blood glucose levels are too low, this suggests that hypoglycemia may be an issue contributing to hyperhidrosis. In addition, measuring fasting insulin can evaluate if there is too much insulin in the blood that is causing too much glucose to go into your cells, resulting in low blood sugar or hypoglycemia.

One way to evaluate many of these metabolic markers of glucose balance and insulin function in one test is with the Metabolomic Profile. ‍

Additional Labs To Test 

Hyperhidrosis is usually diagnosed based on a thorough physical exam and history. There are also some tests that can help confirm the diagnosis. 

The starch-iodine test is conducted by applying an iodine solution to sweaty areas of the skin and sprinkling starch over these areas. If excess sweating is present, the solution will turn dark blue.

To test for excess sweating with the paper test, a special paper is placed on the affected areas to absorb sweat. It is then weighed to assess how much sweating is occurring.

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Conventional Treatment for Hyperhidrosis

The conventional treatment approach for hyperhidrosis aims to reduce excess sweating using antiperspirants or certain medications. Depending on the part(s) of the body that are affected and the severity of the sweating, various approaches may be used.

Antiperspirants are used to seal sweat glands so the body cannot release as much sweat. To complement this approach to hyperhidrosis, deodorants are sometimes added to reduce body odor. Medicated wipes containing glycopyrronium tosylate and aluminum chloride gel are also used.

Some medications can also be used to help reduce sweating. These include anticholinergic agents like glycopyrrolate and oxybutynin that work to block nerve signals to sweat glands telling them to produce sweat. Other oral medications that are sometimes used include certain antidepressants and beta-blockers to block the physical impacts of anxiety. 

In more severe cases that do not respond to antiperspirants and/or medications, several approaches are considered. Iontophoresis involves running a low electrical current through a water bath in which you place your hands or feet in to block sweat glands. 

In some cases, Botulinum toxin (Botox®) is injected into overactive nerves to stop sweat production for months at a time. 

A more permanent treatment is microwave therapy, where the miraDry® device is used to emit thermal energy (heat) against the skin, which permanently destroys sweat glands. Another long-term treatment option is surgery like endoscopic thoracic sympathectomy, where a surgeon cuts a nerve to turn off the signal that tells your glands to produce sweat or laser sweat gland removal.

Functional Medicine Treatment for Hyperhidrosis

An integrative dermatology approach to hyperhidrosis aims to uncover and address underlying contributing factors. Diet, lifestyle, supplements, and integrative therapies can help reduce excess sweating, reduce anxiety and stress, and bring the body back into balance to improve quality of life.

Nutritional Recommendations

Hyperhidrosis can be triggered by foods containing stimulants like caffeine and theobromine. To limit these in the diet, avoid coffee, tea, caffeinated soft drinks, alcohol, and chocolate. 

Instead, focus on a personalized anti-inflammatory diet with plenty of whole fresh vegetables and fruit while avoiding inflammatory foods like processed foods, factory-raised meats, and additives, as well as foods that one is allergic or sensitive to in order to avoid additional stress and sympathetic stimulation. This way of eating has also been shown to reduce anxiety and stress.

Supplements & Herbs

In addition to an anti-inflammatory diet that limits sources of stimulants like caffeine, targeted supplements may help control excess sweating and improve quality of life.

Schisandra

Schisandra (Schisandra chinensis) is a botanical that has adaptogenic, anti-inflammatory, and antimicrobial properties. It has been shown to support blood sugar balance as well as skin and liver health. Research suggests that schisandra can help reduce excess sweating.

Black Cohosh

When excessive sweating is due to menopause, Black Cohosh (Cimicifuga racemosa) may be helpful. It has been shown to reduce hot flashes and sweating associated with menopause.

Omega-3 Fatty Acids

Omega-3 fats are essential for the body and must be obtained from diet or supplementation. These fats are needed for normal neurologic function and help to increase vagal tone and activity to activate your relaxation response, reduce heart rate, and decrease anxiety and sweating. Supplementation with omega-3 fatty acids has been shown to reduce night sweats in menopausal women. Good food sources of omega-3s include cold-water fish like mackerel and salmon, walnuts, flaxseeds, and chia seeds. 

Complementary and Integrative Medicine

Integrative medicine approaches can be added to dietary and supplement approaches to help reduce sweating in hyperhidrosis.

Opt for Breathable Clothing

To allow your body to ventilate and let sweat evaporate more easily, opt for breathable clothing made of natural absorbent materials like cotton, silk, and linen. Avoid synthetic and blended fabrics and polyester, which trap heat and make you sweat more.

Acupuncture

In traditional Chinese medicine (TCM), several different imbalances can result in excessive sweating. For example, too much heat in the stomach is associated with excessive sweating in the hands and feet, while dampness and spleen deficiency can result in night sweats. 

Acupuncture involves inserting small needles into specific acupoints to address such imbalances. This practice has been shown to help reduce excess sweating in hyperhidrosis. Case reports show success in reducing sweating in primary hyperhidrosis using acupuncture improved symptoms.

Meaningful Stress Management 

Mind-body practices like meditation, yoga, breath work, and tai chi emphasize deep breathing and can help your parasympathetic nervous system be activated to balance out sympathetic stimulation and reduce anxiety and stress that can contribute to excess sweating.

Biofeedback 

Biofeedback is a specific type of mind-body therapy where you receive feedback about physiological parameters of stress (skin temperature, heart rate, blood pressure, muscle tension, breathing rate, etc.) and then use that information to consciously control some of these parameters. A six-week program of biofeedback resulted in increased feelings of relaxation and clinical improvement in excessive sweating in chronic hyperhidrosis patients. 

Cognitive Behavioral Therapy (CBT)

In addition to stress management practices and biofeedback, cognitive behavioral therapy (CBT) can help to lower levels of norepinephrine to reduce feelings of anxiety of excess sweating.

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Summary

Hyperhidrosis results in heavy sweating that occurs even without normal triggers like exercise or heat. This can be primarily due to a genetic cause or secondary to medications or other medical conditions. 

Hyperhidrosis can cause a lot of distress and discomfort. Fortunately, a functional medicine approach looks at underlying contributing factors and aims to reduce excess sweating using diet, supplements, and lifestyle approaches. With an anti-inflammatory diet limiting caffeine, an individualized supplementation plan, and mind-body approaches like CBT or biofeedback, you can reduce unwanted sweating and improve your quality of life.