If you’ve got sweaty palms even when you’re cool as a cucumber, you might have wondered if your sweat losses are more than just heavy…
Humans are one of only a few mammals who produce large quantities of sweat to cool off.
Whilst this is a huge evolutionary advantage for most of us when we’re in a hot environment or exercising, the ~3% of the population who have been diagnosed with the excessive sweating condition known as “hyperhidrosis” may see this as less of a blessing and more of a curse…
What is hyperhidrosis?
People with hyperhidrosis you sweat excessively, often even when their body no longer needs to cool itself down. While it can include general sweating all over your body, the majority of cases show localised, or ‘focal’, sweating in the armpits, palms, soles and face.
There are two main types of hyperhidrosis: primary and secondary. The primary form typically develops earlier in life, but there isn’t a consensus in the literature for why it develops. Theories include genetic factors that may cause excessive neural stimulation, but more research is needed.
Secondary hyperhidrosis is much more straightforward to track. Certain medications (like antipsychotics, SSRIs, insulin), systemic disorders (like diabetes mellitus, hyperthyroidism, Parkinson’s), neurologic disorders and tumours are all associated with this diagnosis.
Men and women appear to be equally affected, with the most common age range being 20 to 60 years old. To obtain an official diagnosis, practitioners will collect a thorough history to determine if it’s primary or secondary. A complete blood count (CBC), basic metabolic panel, and other lab work will typically be ordered to rule out other diagnoses. They can also assess the severity of the condition through skin conductance, a thermoregulatory sweat test and an iodine-starch test.
How are athletes affected?
Athletes are already likely to accumulate high fluid and sodium losses due to their activity levels. Those who suffer from hyperhidrosis will inevitably experience increased total losses from their excessive sweating, putting them at more risk of dehydration and hyponatremia (low blood sodium levels).
It’s worth pointing out that, although not all heavy sweaters have hyperhidrosis, fitter athletes do sweat more. We’ve worked with some extremely sweaty athletes over the years, including a pro tennis player who measured a sweat rate of more than 3 litres (~48oz) per hour in hot conditions! 🤯 This is likley due to his sweating responses being up-regulated by lots of working out in hot conditions rather than a pathology like hyperhidrosis.
There are even some extreme examples of athletes who lose even more, including a 17-year-old student athlete who lost ~5.8L (204oz) an hour!
As well as the physical effects of sweating excessively, there are psychological implications associated with hyperhidrosis, as being excessively sweaty can be embarrassing and cause social anxiety (which usually only makes the sweating worse).
For an athlete who plays a sport where they need to grip a racquet, club or bat – like tennis, golf or baseball – the practicality of sweaty palms can also become a significant factor impacting performance.
How can athletes overcome hyperhidrosis?
While it may be tempting to just simply drink more water to combat your higher fluid losses, failing to account for sodium replenishment can leave a hyperhidrosis-level heavy sweater on a fast track to hyponatremia.
Getting a handle on your individual sweat losses – fluid and sodium – is important for all athletes, but especially if you’re part of the 3% who suffer from hyperhidrosis.
The best way to do this is to measure your sweat rate in different conditions and understand your sweat sodium concentration. A personalised hydration strategy will enable you to adequately replace your excessive fluid and sodium losses.
Some hyperhidrosis sufferers explore options aimed at minimising their excessive sweating. There are several non-surgical options available, including:
- Topical Agents (e.g. aluminium chloride) which block the sweat glands themselves
- Oral Medications (e.g. Glycopyrrolate) which block the chemical responsible for triggering sweat gland neuro-receptors, acetylcholine. Although these have been reported to include side-effects such as dry mouth, blurry vision and headaches
- Iontophoresis a daily process by which low current electrical impulses in water baths block the sweat glands which are submerged
- Botox injection every 3-6 months into the affected area to block the sweat glands
When these non-surgical options aren’t sufficient to stem the flow, a thoracoscopic sympathectomy can be used to treat sweating of the palms and face. This involves cutting the sympathetic chain of nervous fibres that directly stimulate sweat glands, essentially stopping the oversweaty nerves in their tracks.
Next steps
If you think you might have hyperhidrosis, it’s worth a conversation with your physician. Collecting information on your fluid and sodium losses can help inform the conversation, and regardless of the outcome, assist you with appropriately managing your hydration status.
