What Your Sweat Could Reveal About Your Health - Chasing Life with Dr. Sanjay Gupta - Podcast on CNN Audio
Dr. Sanjay Gupta
00:00:00
Welcome to Chasing Life and welcome to Summertime. You know, it's that time of year. Barbecues, baseball games, the beach, lounging by the pool, maybe lounging by the lake like we do in my home state of Michigan. I love summertime. But you know, summertime also means heat and for our bodies, that means sweat. We all sweat every day. Some of us more than others, yes, but nothing to be ashamed of. You certainly know that sweat is our body's natural cooling system. There's been all this research recently telling us that sweat can do a lot more than just turn down our body's temperature. Each droplet of sweat could be full of signs and signals about what's going on deep inside our bodies. Sweat could be the key to understanding not only our hydration, but also our nutrient levels, our kidney health. Sweat is a lot fascinating than you probably ever realized. And today I'm sitting down one of the scientists who's leading that research. His name is Professor John Rogers, and he is director of Northwestern's Querry Simpson Institute for Bioelectronics. He is an expert on sweat, and he's gonna talk me through the basics of sweat, but also its potential, and help me understand how sweat could save a lot of lives and help us all perform at our very best. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing Life.
Dr. Sanjay Gupta
00:01:37
First of all, just some terms. What is sweat?
John Rogers
00:01:40
So sweat is a fluid created by glands that exist about a millimeter below the surface of the skin. These glands connect to ducts that transport sweat generated by the glands to the surface of the skin. The density of sweat glands is highest on the fingertips about 400 glands per square centimeter.
Dr. Sanjay Gupta
00:02:01
On your fingertips? I didn't realize that.
John Rogers
00:02:04
Yeah, if you look at the sort of the magnified view of your fingertips, the sweat pores exist on the upper surfaces of the ridges of the texture of the skin of the fingertips. So quite a lot of sweat will come out of your finger tips. You get sweaty palms, you know, you feel nervous or something like that, you're exercising. But you have also sweat glands distributed across your entire body, obviously not just your fingertips. So there's pretty high density of sweat glands in your forehead. About a hundred and fifty sweat glands per square centimeter on your forearms uh... Maybe half of that on your back and your your abdomen that kind of thing so there are two classes of sweat glands one is called eccrine sweat glands uh... And those are the ones that i just referred to. There are other sweat glands that a little bit different and they involve a more complex chemistry associated with the sweat those are that apocrine glands they exist the armpits the genital regions and so on.
Dr. Sanjay Gupta
00:02:59
Most people hear sweat and they think... I get hot, I sweat. That helps my body cool down. Is that the primary reason we sweat?
John Rogers
00:03:07
Primarily, that is the reason for thermal regulation, so maintaining thermal homeostasis. So sweating is triggered when the core body temperature rises above a certain threshold, and then the rate of sweating is determined by the external temperature and humidity level and so on. But sweating can also be induced by nervousness. There are sort of emotional cues that will cause a sweating. You're really nervous in an interview, you will start to sweat.
Dr. Sanjay Gupta
00:03:35
Are you sweating now?
John Rogers
00:03:36
Not yet, yeah. We'll see how it goes. And there are different kinds of foods that you can eat, right, that will cause sweat.
Dr. Sanjay Gupta
00:03:43
So you mentioned three reasons that we sweat to cool the body when we may be nervous and maybe in response to certain foods. Is the sweat different depending on what the stimulus for the sweat?
John Rogers
00:03:56
It's more or less the same, although the chemical composition of sweat can depend on sweat rate and the total volume of sweat that's been lost. So if you sweat very quickly, for example, at a high rate of sweating, the chloride concentration can be higher than its slow rates of sweating. So there are some dependencies there on the rate and the amount of sweat has been lost, but not so much on the mechanism by which the sweat is induced.
Dr. Sanjay Gupta
00:04:25
Is your sweat fundamentally going to be similar to my sweat? Is there variation from human to human?
John Rogers
00:04:31
So there's quite a large variation in the electrolyte level in sweat, and that's just genetically determined. It can be modulated by that, but there's sort of genetic baseline that determines your kind of average electrolyte levels. But it can be modulated by dietary habits, it can modulated be the amount of exercise you're doing, your fitness levels, that kind of thing. But for more basic biochemical species, let's say creatinine and urea, which we'll talk about in a little bit in the context of kidney health. That tends, what we're seeing in the data is that those two biochemicals species in sweat correlate very nicely with the same species in blood.
Dr. Sanjay Gupta
00:05:15
Now I do want to take a moment here and explain a couple things. First of all, the reason sweat carries the same biomarkers as blood is because they have something in common: interstitial fluid. Interstitial fluid comes from blood as it's traveling through small blood vessels or capillaries. It's found throughout the body and its main function is to transport oxygen and other nutrients to cells and also remove waste from cells. But here's the thing: When sweat glands are activated, they are pulling from that same interstitial fluid, which then diffuses across layers of skin to become sweat. The second thing you're gonna hear us talk a lot about the concept of correlation. Specifically, whether or not certain levels of biomarkers detected in sweat could have the same medical significance if found in blood. When I went to the doctor, I got my blood drawn and everything, they're measuring basic chemistries, my sodium, my potassium, chloride, things like that. They might also measure my cholesterol and lipids and things like that. What can sweat measure?
John Rogers
00:06:21
So for the things that we're looking at specifically, it's electrolyte level, electrolyte replenishment becomes very important for athletes, for workers in oil and gas manufacturing, construction, that kind of thing. Chloride for cystic fibrosis diagnostics, we published on that and we've done studies on large cohorts of infants. Kidney health is one that we think is really, really interesting. Looking at creatinine and urea concentrations in sweat, as I mentioned. We're also very interested in sweat, the nutritional biomarkers that are in sweat. So we have assays for vitamin D9, vitamin C, calcium, zinc, and iron. And we're in the process of establishing whether those species in sweat also correlate with species in blood. That's ongoing work. But I think that would be very powerful because you would be able to assess nutritional balance very quickly, right? And I think especially in lower and middle income countries. Nutritional deficiencies in pediatric patients can cause health challenges throughout an individual's life.
Dr. Sanjay Gupta
00:07:24
We're going to take a quick break here, but when we come back, I'm in the hot seat.
John Rogers
00:07:28
Take a look and see if you've started sweating.
Dr. Sanjay Gupta
00:07:32
They say to never let them see you sweat, well for me, that's about to change. Last year I decided to go pay Professor John Rogers a visit at his lab at Northwestern.
John Rogers
00:07:46
All right, welcome to our testing facility.
Dr. Sanjay Gupta
00:07:49
He had one goal for me.
John Rogers
00:07:50
So we have a portable sauna here. It's going to replicate the environment that you would.
Dr. Sanjay Gupta
00:07:54
And that's right, in the lab was a portable sauna. Picture of this small tent where your entire body is zipped in, except for your head. And then the temperature inside that tent is cranked up to a cozy about 135 degrees Fahrenheit. And the whole point is to get me to sweat, which you can probably see that I'm starting to do, having been in here for about 15 minutes. Now, while I was in the sauna, Professor Rogers had me wear this small patch that he and his team had designed. This patch sticks straight onto your skin. And then on the backside there are these reservoir channels. If you're looking at it, it basically looks like a semiconductor. Now when a person sweats, or in this case when I sweat, the channels fill with that sweat and turns the patch different colors to correlate with different levels of biomarkers in your body. What is interesting though, is that they're basically trying to measure sweat on my arms here. And you can tell on this one, for example, that I've started to sweat. You can see some sweat on my arm. This is measuring all these different things, ketones, chloride, All these things that you'd normally get tested with a blood draw by sticking a needle in your arm. Now, you don't need to be in...
John Rogers
00:09:07
Let's take a look and see if.
Dr. Sanjay Gupta
00:09:09
I'm starting to feel it a little bit, about 12 minutes.
John Rogers
00:09:13
Not much yet on that side, why don't we check the other device. So it's started to fill. There's chloride assays over here, so you're seeing a slight pink color, which means probably chloride concentration around 10 millimolar, 15, something that range. Great job. Thank you.
Dr. Sanjay Gupta
00:09:30
I sat here and did nothing, literally.
John Rogers
00:09:32
Yeah, yeah. Well, your sweat glands did something. They're working.
Dr. Sanjay Gupta
00:09:39
Finding a way to actually collect the sweat, that has been the key in studying it. You know, I think it's sort of fascinating. I remember thinking this before I met you, but then sort of reflecting on it afterwards, this idea that we study blood, we have all sorts of different ways of imaging the body. Why weren't we studying sweat all along? It seems like an easy one to sort of study.
John Rogers
00:10:05
I think probably the reason why it hasn't sort of taken off earlier is it's just difficult to collect pristine uncontaminated volumes of sweat. In the early days, you'd use like a device to kind of scrape along the surface of the skin, sort of collect enough sweat that you can get it into a pipette or a syringe or a vial or something like that. The other way to do it is you have like an absorbent pad and a layer of tape on top of it and you kind of put it down and then you peel it off bring the sweat out of the pad, but kind of clumsy approaches overall. So I think that was kind of a missing element, kind of an engineering mechanism for collecting volumes of sweat in a very reliable, reproducible way.
Dr. Sanjay Gupta
00:10:48
'Was it just the, as you call it, the clumsiness that led to this sort of being under-studied, or do you think there was just so much inertia around blood and urine and things like that?
John Rogers
00:11:00
'Well, probably a combination of both. I do think there was sort of this missing capacity for collecting tiny volumes of sweat and manipulating those. There's no question that that did not exist prior to maybe 2016 or so. So that was definitely a shift. The other thing may be a broader societal change where there's a greater and greater appreciation of sort of continuous health monitoring using non-invasive sort of wearable devices, you know, whether that's a you know, a watch type device that goes on your wrist or something that goes on your finger or what we've been interested in, sort of soft skin adherent patches, essentially, be placed on anatomically relevant locations of the body for measuring different conditions associated with patient care. And so maybe in that context, it just makes a lot more sense to think about sweat and the ability to kind of capture that biochemical information and sort of a continuous wearable sort of platform. You put it on, sweat enters in. The color develops, you take a smartphone camera, you snap a picture of the device, it does automated color extraction, and the color then calibrates to a specific concentration of those species. So that's the way our devices work. Very simple, sort of single use device construction is the way we have it set up.
Dr. Sanjay Gupta
00:12:21
So it's not a binary thing because it's not just color changing. You're actually then quantifying what that color means it sounds like.
John Rogers
00:12:28
Yeah, that's right. The vibrancy of that color, the depth of that color correlates directly to a specific concentration level in a continuous manner.
Dr. Sanjay Gupta
00:12:38
Is the real secret sauce here, this figuring out of the microfluidics, is that what you're alluding to? Yeah.
John Rogers
00:12:44
Yeah, from an engineering standpoint, that's it. But as you've pointed out, really establishing through sort of medical research, what are the correlations between sweat chemistry and blood chemistry? And that's a little bit kind of outside of the domain of the microfluidic device itself, because you can in principle study those correlations with any kind of collection vehicle. I think the microfluentics allows that kind of reproducibility and precision in collecting pristine volumes of samples. Of sweat, but that's more kind of in a biology domain, figuring out those correlations. But then the engineering piece, I think it's already in place.
Dr. Sanjay Gupta
00:13:18
Well, so when it comes to sweat, then where do you think this is going to go? I mean, are you going to get better if you look at lots and lots of data, for example, blood data and sweat data, and you have these huge machine learning models now, will we get better correlating sweat with blood so that sweat becomes more meaningful? Where is this heading,?
John Rogers
00:13:42
Well, that's a great point. I would say, you know, this kind of machine learning models are gonna be important in really getting a very deep understanding of one's health condition from a combination of biophysical sensor outputs, as well as some of this biochemical information that we're capturing through sweat. And you collect it all together. I think it's gonna be a really powerful opportunity. So I think is a really exciting area for the future. The other thing is a lot of these species just correlate in a very natural way. It doesn't really even require machine learning. Like creatinine and urea we were just talking about, caffeine, alcohol. I think what we will find, we haven't completely proven this, there are a lot micronutrients in sweat. Vitamin C, for example, a number of different essential minerals for a healthy diet appear in sweat as well. We're very interested in pediatric health in that context. You put on a patch, you do kind of almost a full panel analysis of species relevant to a healthy nutrition. But I think there are enough reasons to be interested in sweat, again, biased perspective, that we're plenty motivated. We're gonna continue no matter what. And I think it's a great discovery area in terms of the biology. And there are some immediate applications here that don't even require these correlations to be established.
Dr. Sanjay Gupta
00:14:56
What about lipids? Could lipids potentially be measured through sweat like cholesterol or triglycerides or triglycerides?
John Rogers
00:15:01
That's a good question. We're hoping for cholesterol. We haven't found substantial amounts of it. Cortisol is an interesting one, and we just submitted a new paper on sweat cortisol. As you mentioned, there's a correlation there. The concentrations are super low. I mean, some of the challenge just is related to the very minute concentrations of some of these. More of a kind of an engineering challenge, I guess. Sweat's 99% water. It's only 1% of all of these different chemicals, you know, collected together, so they're very minute in terms of their presence. But amino acids are there, we can capture those. I think it's a really interesting discovery space, like we started talking about. There just hasn't been a lot of work on sweat, but I think a lot of the pieces are there and we're pretty excited about it.
John Rogers
00:15:50
So how has it been going? Are people using it for these purposes?
John Rogers
00:15:56
'Well, so great question. So full disclosure, I'm involved in a startup company that has kind of spun out of the academic work that we do kind of in our university lab environment here. I don't have any day-to-day role. I don't have a consulting relationship, anything like that, but I am the board. So it's good to kind of disclose that. But the company is called Epicore Biosystems. And so they have a couple of large sort of customers and business relationships in sports and athletics. And in worker safety. So in those cases, you don't have to worry about correlations to blood because you're tracking sweat loss as a mechanism for determining how much water you've lost as a result of an athletic competition, a training, or if you're in the oil and gas industry, you're working in a hot human environment, you're just sweating. And it also measures electrolyte loss via that same mechanism. And that's important for sports performance because it's well known that poor hydration can lead to cramping and injury and decreased levels of performance. And so the idea is these devices can provide a precise way to determine how much body water you've lost as a result of sweating. And you can use that information to hydrate at appropriate levels. So avoid over hydrating or under hydrating. And by similar token, you can determine how much electrolyte supplement salt tablets you need to take in order to get back to where you were before you lost electrolytes by sweating. And so they have a joint product offering with Gatorade. I don't want to pitch products, but you ask. And so I think they've done about 3 million of these Gatorade, GX patches and There's an app that goes along with the patch. It works exactly the same way that I was just describing. It's a sticker, you put it on, you know, and the channels fill with sweat. You can determine the extent of filling, and then there's a colorimetric reagent. In this case, it responds to chloride concentration, which is pretty much electrostatically balanced with sodium, so it's a good indicator of overall electrolyte concentration. And with the electrolyte consideration, you determine electrolyte loss. And so that guides replenishment.
Dr. Sanjay Gupta
00:18:09
But if I wanted to buy one, could I buy one?
John Rogers
00:18:11
Yeah, you can buy them at Dick's Sporting Goods. You can order them off of the Gatorade website. They're bundled in many cases with the GX bottles and the pods and that whole thing. So I think they're about $10 for a pack of two kind of in that.
Dr. Sanjay Gupta
00:18:27
Well, you know, I just got to say again, when I first heard about your work, it made so much intuitive sense to me that you have sweat as a biofluid, from which we can learn a lot of things about someone's health. And it seems like you've just taken it further and further. It's fascinating to me. It seems to me that it'll just continue to grow.
John Rogers
00:18:49
I appreciate your interest and appreciate you having me on your podcast.
Dr. Sanjay Gupta
00:18:53
Absolutely. Have a great summer professor.
Dr. Sanjay Gupta
00:18:56
That was Professor John Rogers, Director of Northwestern's Querry Simpson Institute for Bioelectronics. Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, Grace Walker, Lori Galloretta, Jesse Remedios, Sofia Sanchez, and Kyra Daring. Andrea Kane is our medical writer, our senior producer is Dan Bloom, Amanda Seely is our showrunner, Dan Dzula is our technical director, and the executive producer of CNN Audio is Steve Lickteig. With support from Jamis Andrest, John Dianora, Haley Thomas, Alex Manassari, Robert Mathers, Leni Steinhardt, Nicole Pesaru, and Lisa Namarow. Special thanks to Ben Tinker and Nadia Kunang of CNN Health and Katie Hinman.
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Is Schizophrenia a Personality Disorder?
Key takeaways Schizophrenia is not a personality disorder but rather a type of psychotic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders under 'schizophrenia spectrum and other psychotic disorders.' Symptoms of schizophrenia include hallucinations, delusions, disorganized thinking, disorganized motor function, and negative symptoms like decreased self-motivation, diminished emotional expression, decreased speech output, social disinterest, and reduced ability to experience pleasure. Unlike personality disorders, which involve long-standing patterns of interactions that impact behavior, schizophrenia involves altered perceptions of reality. It typically presents with psychotic symptoms in adulthood, during the 20s or later in life, with varying frequency and severity of symptoms and episodes mixed with symptom-free periods. Many symptoms associated with mental health conditions can create social isolation, pressure, and a deterioration of relationships. Stigma and fear of judgment may keep you away from peers. Sometimes, the symptoms you're experiencing may contribute to low emotional expression or decreased ability to experience joy through others. Living with schizophrenia can present a number of these challenges, but it doesn't mean you're living with the rigid, long-term patterns of behavior that accompany a personality disorder. Is schizophrenia a personality disorder? Schizophrenia is not a personality disorder. It's a type of psychotic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, 5 th edition, text revision (DSM-5-TR), under 'schizophrenia spectrum and other psychotic disorders.' Psychotic disorders involve altered perceptions of reality. These experiences make up the symptoms of psychosis, which are key features in all psychotic disorders. Psychotic symptoms include: hallucinations delusions disorganized thinking disorganized motor function negative symptoms What are negative symptoms? Negative symptoms are those indicating a loss of function. They include: avolition (decreased self-motivation) diminished emotional expression alogia (decreased speech output) asociality (social disinterest) anhedonia (decreased ability to experience pleasure) Symptoms of psychosis are primary features of schizophrenia. To receive a formal diagnosis, you must be experiencing delusions, hallucinations, or disorganized thinking for the majority of a 1-month period. According to the DSM-5-TR, schizophrenia typically presents with psychotic symptoms in adulthood, during your 20's, or later in life, depending on your circumstances. Symptoms can vary in frequency and severity and often come in episodes mixed with periods of time where you have no symptoms at all. Unlike schizophrenia, personality disorders don't have to include a component of psychosis. They're identified by long-standing patterns of behavior that impact how you interact with the world around you. Personality disorder characteristics tend to be more long-term and constant. They're often noticed in childhood and become enduring, rigid patterns of thought and action throughout life. Is schizophrenia a multiple personality disorder? In 2008, a survey from the National Alliance on Mental Illness (NAMI) found the greatest misconception surrounding schizophrenia was that it involved multiple or 'split' personalities. According to the report, 64% of Americans believe this to be true. Schizophrenia isn't a multiple personality disorder, but symptoms of psychosis can make it seem like someone has morphed into a completely different person. Hallucinations, for example, can mean hearing voices or seeing people who aren't actually there. Talking out loud at a hallucination might make it seem like you're talking with another 'self.' Similarly, delusions can change aspects of your personality. You might have been a long-term advocate of something only to suddenly cast it aside, due to delusion. Schizophrenia can make you — and those around you — feel as though your personality shifts during symptom episodes. In schizophrenia, however, you're experiencing psychosis, not dissociation, which is the mechanism underlying dissociative identity disorder (previously known as multiple personality disorder). It is possible, however, to be living with both schizophrenia and dissociative identity disorder. What's dissociation? Dissociation is a mental escape mechanism that separates you from reality, often brought on by traumatic experiences. Dissociation is one way your brain tries to protect itself by distancing you from overwhelming memories and circumstances. Schizophrenia vs. schizotypal personality disorder Schizotypal personality disorder is considered a schizophrenia-spectrum disorder. You may have an increased chance of developing this condition if you have a family history of schizophrenia. Despite this link and some overlapping symptoms, these conditions aren't the same. Schizotypal personality disorder in the DSM-5-TR is a Cluster A personality disorder that involves overarching eccentric behaviors and beliefs. Like all personality disorders, schizotypal personality disorder features an inner experience different from cultural norms. It emerges in childhood and contributes to challenges in maintaining close interpersonal relationships. The uncommon behaviors and thoughts in schizotypal personality disorder can be similar to hallucinations and delusions in schizophrenia. Delusions are unwavering beliefs in something that can be proven otherwise. When you're experiencing a delusion, no evidence to the contrary will sway your belief, not even seeing, hearing, or participating in undeniable proof. Schizotypal personality disorder involves nontraditional beliefs; however, they're often related to intangible concepts, like clairvoyance, the paranormal, or superstitions. They're not necessarily rigid or untrue, though they can be. You may also experience unusual sensory perceptions or 'bodily illusions' when living with schizotypal personality disorder. Unlike hallucinations, these sensory distortions involve real stimuli — just misinterpreted. Schizotypal personality disorder symptoms According to the DSM-5-TR, symptoms of schizotypal personality disorder can include: a persistent belief that everything happening is directly related to you magical thinking that influences behavior and decisions preoccupation with paranormal phenomena bodily illusions atypical perceptual experiences uncommon, sometimes metaphorical, speech patterns and thinking paranoid ideation suspiciousness atypical emotional responses (or lack thereof) eccentric behavior unkempt appearance persistent social anxiety even in familiar company Living with schizotypal personality disorder may come with transient or passing psychotic episodes. These reality lapses can last minutes to hours and tend to be in response to stress. If they occur, the DSM-5-TR states they rarely meet the criteria for an additional psychotic disorder diagnosis. Treatment options of schizophrenia vs. schizotypal personality disorder Both schizophrenia and schizotypal personality disorder are lifelong conditions that can involve psychotherapy and medications to help lessen their impact. Medications may be used for both disorders. You may be prescribed: antipsychotics antidepressants anxiolytics (anti-anxiety medications) The medications your healthcare team recommends will be based on your symptoms, but antipsychotics are considered a first-line treatment approach when psychosis is present. Psychotherapy can also help you cope with a schizophrenia spectrum condition, though research is limited on how effective it is for schizotypal personality disorder. Common therapies include: cognitive behavioral therapy (CBT) group therapy compliance therapy meta-cognitive training mindfulness therapy narrative therapy Coordinated specialty care (CSC) might also make a difference in your quality of life. CSC involves a multidisciplinary support network to help you adjust to living and working with schizophrenia. Delusions and skewed perceptions, however, can make it difficult to recognize the need for treatment when living with schizophrenia or schizotypal personality disorder.
