Do houseplants have beneficial effects on health?

Do houseplants have beneficial effects on health?


Having and caring for houseplants can:

  • Reduce psychological and physiological stress.
  • Improve recovery after surgery.
  • Increase attention and concentration.
  • Increase creativity and productivity.

In our modern societies, where everything seems to go faster and faster, many feel the harmful effects of stress and anxiety; however, this appears to have increased since the start of the COVID-19 pandemic. During spring and summer 2020, many Quebecers took advantage of the beautiful weather to recharge their batteries in nature, either by visiting a park, camping, walking in the forest, or renting a cottage in the countryside. As winter approaches, contact with greenery becomes scarce and travel to regions with warmer climates is risky and strongly discouraged by Public Health. Apart from hiking in our beautiful coniferous forests, one of the only possible contacts with greenery during this long winter will be the green plants we take care of in our homes. Houseplants decorate and bring a natural touch to our homes, but do they have proven beneficial effects on our physical and mental health.

Stress reduction
A systematic review in 2019 identified some 50 studies on the psychological benefits of houseplants, most of these studies being of average quality. The most noticeable positive effects of houseplants on participants are an increase in positive emotions and a decrease in negative emotions, followed by a reduction in physical discomfort.

In a randomized, controlled crossover study of young adults, participants saw their mood improve more after transplanting an indoor plant than after performing a task on the computer. In addition, participants’ diastolic blood pressure and sympathetic nervous system activity (physiological response to stress) were significantly lower after transplanting a plant than after performing a computer task. These results indicate that interaction with houseplants can reduce psychological and physiological stress compared to mental tasks.

Plants in the office
In 2020, a Japanese team carried out a study on the effects of plants in the workplace on the level of psychological and physiological stress of workers. In the first phase of the study (1 week), workers worked at their desks without a plant, while in the intervention phase (4 weeks), participants could see and care for an indoor plant that they were able to choose from six different types (bonsai, Tillandsia, echeveria, cactus, leafy plant, kokedama). Participants were instructed to take a three-minute break when feeling tired and to take their pulse before and after the break. During these 3-minute breaks, workers had to look at their desks (with or without an indoor plant). Researchers measured psychological stress with the State-Trait Anxiety Inventory (STAI). The participants’ involvement was therefore both passive (looking at the plant) and active (watering and maintaining the plant).

The psychological stress assessed by STAI was significantly, albeit moderately, lower during the intervention in the presence of an indoor plant than during the period without the plant. The heart rate of the majority of patients (89%) was not significantly different before and after the procedure, while it decreased in 4.8% of participants and increased in 6.3% of patients. It must be concluded that the intervention had no effect on heart rate, which is an indicator of physiological stress, although it slightly reduced psychological stress.

A study of 444 employees in India and the United States indicates that office environments that include natural elements such as indoor plants and exposure to natural light positively influence job satisfaction and engagement. These natural elements seem to act as “buffers” against the effects of stress and anxiety generated by work.

Recovery after surgery
It appears that houseplants help patients recover after surgery, according to a study in a hospital in Korea. Eighty women recovering from thyroidectomy were randomly assigned to a room without plants or to a room with indoor plants (foliage and flowering). Data collected for each patient included length of hospital stay, use of analgesics to control pain, vital signs, intensity of perceived pain, anxiety and fatigue, STAI index (psychological stress), and other questionnaires. Patients who were hospitalized in rooms with indoor plants and flowers had shorter hospital stays, took fewer painkillers, experienced less pain, anxiety, and fatigue, and they had more positive emotions and greater satisfaction with their room than patients who recovered from their operation in a room without plants. The same researchers performed a similar study in patients recovering after an appendectomy. Again, patients who had plants and flowers in their rooms recovered better from their surgery than those who did not have plants in their rooms.

Improved attention and concentration
Twenty-three elementary school students (ages 11–13) participated in a study where they were put in a room with either an artificial plant, a real plant, a photograph of a plant, or no plant at all. The participants wore a wireless electroencephalography device during the three minutes of exposure to the different stimuli. Children who were put in the presence of a real plant were more attentive and better able to concentrate than those in the other groups. In addition, the presence of a real plant was associated with a better mood in general.

A cross-sectional study of 385 office workers in Norway found a significant, albeit very modest, association between the number of plants in their office and the number of sick days and productivity. Workers who had more plants in their office took slightly fewer sick days and were a bit more productive on the job. In another study, American students were asked to perform computer tasks, with or without houseplants, in windowless rooms. In the presence of plants, participants were more productive (12% faster in performing tasks) and less stressed since their blood pressure was lower than in the absence of houseplants.

What about air quality?
Do plants purify the air in our homes? This is an interesting question since we spend a lot of time in increasingly airtight homes, and materials and our activity (e.g. cooking) emit pollutants such as volatile organic compounds (VOCs), oxidizing compounds (e.g. ozone), and fine particles. A NASA study showed that plants and associated microorganisms in the soil could reduce the level of pollutants in a small, sealed experimental chamber. Are these favourable results obtained in a laboratory also observable in our homes, schools and offices? Some studies (this one for example) conclude that plants decrease the concentrations of CO2, VOCs and fine particles (PM10). However, these results have been called into question by researchers (see this study) who question the methodology used in previous studies and who believe that plants are ineffective in improving the indoor air quality of our buildings. According to these researchers, it would be better to focus research efforts on other air-cleaning technologies as well as on the beneficial effects of plants on human health.

Indoor plants can provide health benefits by reducing psychological and physiological stress. Owning and maintaining plants can improve mood and increase attention and concentration. New, more powerful and better controlled studies will be needed to better identify and understand the effects of plants on human health.

Beyond Burger, Impossible Burger and other products that mimic meat: are they good for health and the environment?

Beyond Burger, Impossible Burger and other products that mimic meat: are they good for health and the environment?

Red meat: An issue for human health and the health of the planet.
Consumption of red meat and processed meat is associated with an increase in all-cause mortality and mortality from cardiovascular diseases, diabetes, respiratory diseases, liver and kidney diseases, and certain cancers. On the contrary, consumption of white meat and fish has been associated with a decreased risk of premature death. Another troubling aspect with the production of red meat is that it is harmful to the global environment.

In traditional European agricultural societies, meat was consumed once or less than once a week, and annual meat consumption rarely exceeded 5 to 10 kg per person. In some rich countries (U.S.A., Australia, New Zealand), meat consumption now stands at 110–120 kg per person per year, > 10 times more than in traditional agricultural societies. Livestock farming occupies more than 30% of the world’s land area, and more than 33% of arable land is used to produce livestock feed. World consumption of red meat is rising sharply, especially in developing countries. This has adverse consequences for the environment and represents an unsustainable situation according to several experts.

The main harmful effects to our planet caused by meat production (Potter, BMJ 2017)

  • Depletion of aquifers (producing 1 kg of meat requires more than 110,000 L of water).
  • Groundwater pollution.
  • Decrease of biodiversity.
  • Destruction of rainforest for livestock and the production of greenhouse gases by livestock. Both combined contribute more to climate change than fossil fuels used for transport.
  • Production of 37% of methane (CH4) from human activity (with 23 times the global warming
    potential of CO2).
  • Production of 65% of nitrous oxide (N2O) from human activity (almost 300 times the global
    warming potential of CO2).
  • Production of 64% of ammonia (NH3) from human activity, which contributes significantly to
    acid rain and acidification of the ecosystem.

Other potential negative effects associated with red meat include accelerated sexual development, caused either by the consumption of meat and fat, or by the intake of growth hormones naturally present in meat or added to livestock feed; more extensive antibiotic resistance caused by their use to promote animal growth; a reduction in the food available for human consumption (for example, 97% of the world’s soybeans are used to feed livestock); and higher risks of infections (such as bovine spongiform encephalopathy or “mad cow disease”) due to faulty practices in intensive farming.

Experts agree that we will have to reduce our consumption of red and processed meat in order to live longer, healthier lives, but especially so that our planet is in better condition and can support human activity long term. Eating mostly cereals, fruits, vegetables, nuts, and legumes, and little or no meat is probably the ideal solution to this environmental problem, but for many, red meat is a delicious food that is hard to replace. To satisfy meat lovers who still want to reduce their consumption, companies have recently developed products made only from plants whose appearance, texture and taste are similar to meat, whereas others are trying to produce artificial meat from in vitro cell cultures.

New plant-based patties: Beyond Burger and Impossible Burger
Plant-based burgers have long been available in grocery stores, but these meatless products are intended for vegetarians and consumed mainly by them. New products made from plants, but designed to have the same appearance, texture, and taste as meat have appeared on the market recently. These meat alternatives target omnivorous consumers who want to reduce their meat consumption. Among the most popular products, there is the Beyond Burger, available at the fast food chain A&W and recently in most supermarkets in Quebec, as well as the Impossible Burger, which will soon be on the menu at fast food chain Burger King under the name “Impossible Whopper.”

The main ingredients of Beyond Burger are pea protein isolate, canola oil and refined coconut oil. This food also contains 2% or less of other ingredients used to create a meat-like texture, colour and flavour, as well as natural preservatives (see box). It is an ultra-processed food that does not contain cholesterol, but almost as much saturated fat (from coconut oil) and 5.5 times more sodium than a lean beef patty. Nutrition and public health experts have suggested avoiding coconut oil in order not to increase blood LDL cholesterol (“bad cholesterol”) and maintain good cardiovascular health (see “Saturated fats, coconut oil and cardiovascular disease”). Moreover, the nutritional contribution of these two products is similar (calories, proteins, total lipids).

Beyond Burger ingredients: Water, pea protein isolate, canola oil, refined coconut oil, 2% or less of: cellulose from bamboo, methylcellulose, potato starch, natural flavour, maltodextrin, yeast extract, salt, sunflower oil, vegetable glycerine, dried yeast, gum arabic, citrus extract, ascorbic acid, beet juice extract, acetic acid, succinic acid, modified food starch, annatto.

Impossible Burger ingredients: Water, soy protein concentrate, coconut oil, sunflower oil, natural flavours, 2% or less of: potato protein, methylcellulose, yeast extract, dextrose, food starch modified, soy leghemoglobin, salt, soy protein isolate, mixed tocopherols (Vitamin E), zinc gluconate, thiamine hydrochloride (vitamin B1), sodium ascorbate (vitamin C), niacin (vitamin B3), pyridoxine hydrochloride (vitamin B6), riboflavin (vitamin B2), vitamin B12.

The Impossible Burger is made from soy protein, coconut oil and sunflower oil. It also contains ingredients that are used to create a meat-like texture, colour and flavour, as well as vitamins and natural preservatives. Among the ingredients added to mimic the colour and flavour of meat is soy leghemoglobin, a hemoprotein found in the nodules on the roots of legumes that has a similar structure to animal myoglobin. Rather than extracting this protein from the roots of soybean plants, the manufacturer uses leghemoglobin produced by yeast (Pichia pastoris) in which the DNA encoding for this protein has been introduced. The use of P. pastoris soybean leghemoglobin was approved by the US Food and Drug Administration in 2018. The fact that the leghemoglobin used is a product of biotechnology rather than from a natural source does not appear to pose a particular problem, but some researchers suspect that the heme it contains could have the same negative health effects as those associated with the consumption of red meat, i.e., an increased risk of cardiovascular disease and certain types of cancer. A causal link between heme and these diseases has not been established, but population studies (see here and here) indicate that there is a significant association between heme consumption and a rise (19%) in mortality risk from all causes. In contrast, non-heme iron from food (vegetables and dairy products) is not associated with an increased risk of mortality.

Beyond Burger and Impossible Whopper, served with mayonnaise and white bread, are not suitable for vegans (eggs in mayonnaise) or a particularly healthy option because of the saturated fat and salt they contain. However, the manufacture of these products requires much less energy and has a much smaller environmental footprint than real red meat, which is their strong selling point. According to one study, the production of a Beyond Burger patty generates 90% less greenhouse gas emissions and requires 46% less energy, 99% less water and 93% less arable land than a beef patty.

We believe that it is preferable, as much as possible, to obtain unprocessed fresh plant products and to do the cooking yourself, in order to control all the ingredients and thus avoid ingesting sodium or saturated fat in excessive amounts, as is the case with most ultra-processed products, including these new meatless patties. Fatty and salty foods taste good to a large majority of human beings, and the food industry takes this into account when designing the ultra-processed food products it offers on the market. If you want to eat a “burger” without meat, why not try to prepare it yourself with black beans (recipes here and here), oats, lentils or quinoa?

Production of “meat” in the laboratory
In vitro “meat” production involves culturing animal muscle cells (from undifferentiated cells or “stem cells”) in a controlled or laboratory environment. The first beef patty produced in a laboratory in 2013 cost 215,000 pounds (Can$363,000), but the price has dropped considerably since then. However, this product is not yet ready to be commercialized, as there are still several technological problems to solve before it can be produced on a large scale. Moreover, if the current experimental product can be used to successfully mimic ground meat, we are still far from being able to grow cells in a three-dimensional form that looks like a steak, for example.

The technology could be used to produce, for example, “Fugu” (puffer fish) meat, a delicacy prized by the Japanese, but which can be deadly if the chef or specialized companies do not prepare the fish properly. Indeed, tetradoxine contained in the liver, ovaries and skin of the fugu is a powerful paralyzing poison for which there is no antidote. Laboratory-made fugu meat would not contain any poison and would be safe for consumers.

Another example of an advantageous application would be the production of duck foie gras. A majority of the French (67%) are against the traditional method of production by gavage, which makes the animals suffer. One company (Supreme) is developing a method to obtain fatty liver from isolated duck egg cells.

Other companies are developing methods to produce egg white and milk proteins by fermentation rather than using animals. Although this “cellular agriculture” still seems a little “futuristic”, it could become increasingly important in the food industry and help reduce the production of meat that is harmful to our planet.

The effects of climate change on health

The effects of climate change on health

On May 11, the Mauna Loa Observatory in Hawaii recorded carbon dioxide (CO2) levels of up to 415 parts per million (ppm), an atmospheric concentration almost twice as high as before the beginning of the industrial era (280 ppm). This record concentration, never reached in the last three million years, is a direct consequence of the continued growth of CO2 emissions from the combustion of fossil fuels and land use (deforestation, change of land use). Yet, despite warnings from climate scientists over the last several years, global CO2 emissions continue to increase, so that if the current trends continue, models predict that CO2atmospheric concentration could reach 550 ppm in 2050 and nearly 940 ppm by the end of the century.

CO2 is the main greenhouse gas and the increase in its concentration is correlated with an increase in the average surface temperature of the planet. Compared to the period before the start of the industrial era (before the surge of human-induced CO2 emissions), the global average temperature of the globe has increased by about 1 °C and the majority of this increase (0.8 °C) has occurred since the 1970s (Figure 1). At present, the average global temperature is estimated to increase at a rate of 0.2 °C per decade as a result of the CObuild-up produced by current and past pollutant emissions (up to 20% of CO2 persists in the atmosphere for more than 1,000 years). It therefore appears that global warming could reach 3.2 °C in 2100, even if the signatories of the Paris Agreement respect their commitments to reduce pollutant emissions. The initial objective of the Paris Agreement to limit the rise in global temperature below 2 °C therefore seems unachievable.

Figure 1. Evolution of global mean surface temperatures from the pre-industrial era to the present day. The anomalies indicated represent the temperature differences in °C compared to normals calculated for the period 1951–1980.

The inability to reach this goal of “2 degrees maximum” is really worrying, as this target represented a political compromise aimed at limiting the damage caused by climate change, not at preventing it. Numerous modelling by climatologists show that each additional degree increases the risk, frequency and magnitude of the direct consequences of warming, whether in terms of extreme weather events (droughts, heat waves, hurricanes, rising of the sea level) or of its direct impact on terrestrial life (extinction of species, fall in agricultural yields, increase of infectious diseases, etc.). According to the recent work of the Intergovernmental Panel on Climate Change (IPCC), the limit of global warming should rather be around 1.5 °C to hope to avoid the main consequences of climate change. With an increase already reaching 1 °C and possibly 3 °C by the end of this century, we are on a trajectory that goes well beyond this “safety threshold” and it seems inevitable that we will be confronted, in the short and medium term, with the potentially dangerous consequences of global warming.

Health impacts
Recent analyses (here and here, for example) clearly show that the effects of climate change on health are already beginning to be felt. Figure 2 summarizes the main damage caused by global warming: diseases, injuries and deaths caused by extreme weather events (floods, heat waves, etc.), respiratory and cardiovascular diseases associated with increased air pollution, increased intoxication caused by deterioration of water quality and certain foodstuffs, malnutrition due to reduced agricultural yields, increase in insect-borne diseases, and mental health problems caused or aggravated by societal changes due to climate change (migrations, conflicts) (Figure 2). According to estimates by the World Health Organization, these phenomena caused by climate change could be responsible for about 250,000 additional deaths per year between 2030 and 2050.

Figure 2. Main consequences of climate change on health. Adapted from Haines and Ebi (2019).

Extreme weather events

Rising greenhouse gas emissions add energy to the climate, increasing the frequency, intensity and duration of extreme events such as heat waves, droughts and floods. According to the Center for Research on the Epidemiology of Disasters, the number of disasters caused by storms and floods has increased annually by 7.4% in recent decades. In 2017, a total of 712 extreme weather events were reported, generating an estimated cost of US $326 billion, nearly triple the losses recorded in 2016. Nearly half of the world’s population lives within 60 km of the sea and it is estimated that the number of people at risk of flooding could rise from 75 million currently to 200 million in 2080 if the rise in sea level of 40 cm (15 ¾ inches) predicted by the current models is realized. It should be noted, however, that this increase could be much greater and reach several metres if the Antarctic ice sheet is destabilized and/or that of Greenland disappears as a result of global warming.

Extreme heat
Several studies have reported an increase in mortality associated with extreme heat episodes, the best documented being those that have affected large urban areas such as Chicago in 1995 (740 deaths), Paris in 2003 (4,867 deaths), and Moscow in 2010 (10,860 deaths). Cities are particularly vulnerable to heat waves due to the “heat island” effect that generates temperatures 5 to 11 °C higher than neighbouring rural areas. If the current trend continues, it is expected that by the end of the century, extreme heat mortality could increase from 3 to 12% in the southern United States, Europe and Southeast Asia.

As mentioned in another article, extreme heat increases the risk of mortality when the temperature exceeds the thermoregulatory capacity of the human body and reaches 40 °C. Under these conditions, massive redistribution of blood to the body surface causes internal organs such as the heart to be insufficiently irrigated (ischemia) and stop functioning. Thermal shock and ischemia also promote the infiltration of pathogens into the blood and the development of a systemic inflammatory response that damages the organs (sepsis) and can also cause the disintegration of muscle fibres (rhabdomyolysis), releasing myoglobin, which is very toxic to the kidneys. Older people are particularly vulnerable to extreme heat, with a significant increase in mortality observed when the maximum temperature exceeds 5 degrees and above normal temperature (Figure 3). At the MHI EPIC Centre, a research team led by Dr. Daniel Gagnon, PhD, is studying the impact of extreme heat on the elderly and heart patients.

Figure 3. Increased risk of mortality among people aged 65 and over caused by heat exceeding normal temperatures. From WHO (2014).

Deterioration of air quality
It is estimated that the fine particles present in air pollution are currently responsible for about 9 million premature deaths worldwide, plus 1 million deaths from low altitude (tropospheric) ozone. The lungs are obviously the organs most exposed to air pollution, and people who live in polluted areas are more at risk of developing lung diseases. However, cardiovascular disease is the greatest consequence of the deterioration of air quality, accounting for about 80% of all deaths caused by ambient air pollution. Fine and ultrafine particles inhaled by the lungs reach the bloodstream where they cause an inflammatory reaction and oxidative stress that damage the lining of the vessel walls and increase the risk of cardiovascular events, especially in people who are already at risk (existing coronary heart disease, advanced atherosclerosis). It goes without saying that without a significant reduction in polluting emissions, these premature deaths will increase over the next few years, especially since certain consequences of climate change such as forest fires can further increasethe levels of air pollution by more than 10 times.

Impact on food supply
Higher temperatures, changes in precipitation cycles, and extreme weather events caused by climate change can greatly affect food production. Several countries are already experiencing declining agricultural yields, particularly in Africa and Southeast Asia, mainly because of prolonged periods of drought. Rising temperatures also have an impact on food safety: in Europe, for example, above-normal temperatures account for about 30% of salmonellosis cases and the incidence of food poisoning is strongly associated with a rise in temperatures in the previous 2 to 5 weeks.

It should also be noted that several recent studies (herehere and here, for example) have shown that the increase in atmospheric CO2 concentrations is associated with a decrease in the nutritional quality of some important crops such as rice and wheat, lowering protein levels, several micronutrients (zinc and iron in particular) as well as B vitamins. According to a recent analysis, if, as expected, the atmospheric concentration of CO2 exceeds 550 ppm over the next decades, 175 million people could have a zinc deficiency and 122 million people a protein deficiency (mainly in Southeast Asia, Africa and the Middle East).

Increase in vector-borne zoonotic diseases
According to the Intergovernmental Panel on Climate Change, the increased risk of transmission of infectious diseases through vectors such as mosquitoes and ticks is one of the most likely consequences of climate change. Global warming is promoting the geographical expansion of many of these vectors, including Aedes aegypti and Aedes albopictus mosquitoes, which are responsible for the transmission of arboviruses such as dengue, chikungunya, yellow fever and Zika; mosquitoes of the genus Culex, which are responsible for Nile virus transmission; and some ticks such as Ixodes scapularis, the vector for the bacterium Borrelia burgdorferi responsible for Lyme disease.

The emergence of Lyme disease in southern Canada, including southern Quebec, is a particularly worrying example of the consequences of global warming. Originating in New England (the disease was first described in the town of Lyme, Connecticut, hence its name), the tick responsible for the transmission of this disease began to be detected in southeastern Canada in the early 2000s. This expansion of I. scapularis tick territory to the north, at a rate of approximately 33 to 55 km per year, is strongly correlated with rising temperatures that now allow the tick to complete its life cycle. As a result, the annual incidence of Lyme disease in Canada has soared in recent years, from 40 cases in 2004 to nearly 1,000 cases in 2016 (Figure 4).

Figure 4. Incidence of Lyme disease in Canada between 1994 and 2016. From Ogden et al. (2014) and the Government of Canada.

Climate change is likely to have a similar impact on the risk of Nile virus infection and may even promote the emergence of diseases transmitted by arbovirus vectors (Aedes aegypti andAedes albopictus). For example, according to current models, Ae. albopictus will be present in 197 countries by 2080, including Canada, potentially exposing these populations to infectious diseases (dengue, for example) that were until now exclusively present in warmer countries.

In short, it is clear that if nothing is done, the negative effects of climate change on human health will increase, especially among populations that are vulnerable to global warming because of their geographical location (floods, drought, heat waves). But even when disasters occur elsewhere, they can nevertheless greatly influence life here, whether in economic terms (disruptions in the production of goods and services, lower agricultural yields) or social terms (massive migrations, armed conflicts). It is therefore all of humanity that is facing the climate crisis, and we can only hope that concrete actions will be quickly implemented to reduce greenhouse gas emissions.





The dangers of heat stroke during a heat wave

The dangers of heat stroke during a heat wave

Heat waves are sporadic events of high temperatures, which can have serious consequences on human life. More than 70,000 people died during the heat wave that hit Europe in 2003, and another 10,860 died during a heat wave in Russia in 2010. The criteria for defining a heat wave vary from country to country. In Canada, a heat wave occurs when it is 30°C or higher for at least three consecutive days. It has been estimated that the average temperature of our planet will increase by 1°C by 2100 if we reduce greenhouse gas (GHG) emissions or 3.7°C if we do not. In 2000, about 30% of the world’s population was exposed to heat waves for at least 20 days a year. By 2100, it is expected that this proportion will increase to about 48% if we drastically reduce GHG emissions and 74% if we continue to increase GHG emissions.

When it is very hot, humid or both, the excess heat absorbed by the body must be dissipated by the skin and the respiratory system in order to maintain body temperature at 37°C: this is the thermoregulation process. The hypothalamus initiates a cardiovascular response by dilating blood vessels to redistribute blood to the body surface (the skin) where heat can be dissipated into the environment. Sweating is activated, allowing heat to dissipate by evaporation (600 kcal/hour). When it is very hot and humid, the evaporation of sweat is greatly reduced and the body struggles to maintain an adequate temperature. Heat stroke is a serious and life-threatening condition, which is defined as a body temperature above 40°C, accompanied by neurological signs such as confusion, seizures or loss of consciousness. The main risk factors for heat stroke are shown in Table 1.

Table 1. Risk factors for heat stroke. From Yeo, 2004.

Cardiovascular disease
Extremes of age (younger than 15, older than 65)
Skin-altering conditions (psoriasis, eczema, burns)
Lack of air conditioning in home
Living in a multi-storey building
Low socioeconomic status
Occupations with prolonged exertion and environmental exposure to temperature extremes (e.g., athletes, military workers, miners, steel workers, firefighters, factory workers, rescue workers)
· Impaired thermoregulation (diuretics, beta blockers, anticholinergics, phenothiazines, alcohol, butyrophenones)
· Increased metabolic heat production (benzotropin, trifluoperazine, ephedra containing dietary supplements, diet pills, amphetamines, cocaine, ecstasy)
Previous history of heat-related illness
Prolonged sun exposure
Wearing heavy or excessive clothing

Physiological mechanisms
In a review of the literature on the causes of death during heat waves, 5 physiological mechanisms disrupting 7 vital organs have been identified (brain, heart, intestines, kidneys, liver, lungs, pancreas). The authors have identified 27 different ways in which heat-activated physiological mechanisms can lead to organ failure and ultimately death.

1- Ischemia.  When the human body is exposed to heat, the hypothalamus initiates a cardiovascular response by dilating the blood vessels to redistribute blood to the body surface (the skin) where heat can be dissipated into the environment. This compensatory process can lead to an insufficient supply of blood to the internal organs (ischemia) and consequently to a lack of oxygen (hypoxia).

2- Toxicity due to thermal shock.  High body temperature causes stress the body reacts to by producing stress proteins and free radicals that damage cells. This damage, combined with that caused by ischemia, affects the functioning of several organs.

3- Inflammatory response.  Erosion of the intestinal mucosa allows bacteria and endotoxins to enter the bloodstream, leading to sepsis and activation of a systemic inflammatory response. If hyperthermia persists, the exaggerated inflammatory response causes damage to various organs.

4- Disseminated intravascular coagulation.  Systemic inflammation and damage to the vascular endothelium caused by ischemia and heat shock can initiate this harmful mechanism. The proteins responsible for the control of coagulation become overactive and this can lead to the formation of clots that block the blood supply to vital organs. Depletion of blood clotting proteins can lead to subsequent bleeding (even in the absence of injury), which can be fatal.

5- Rhabdomyolysis.  This is the rapid degradation of skeletal muscle cells caused by heat shock and ischemia. Muscle proteins such as myoglobin are released into the bloodstream and are toxic to the kidneys and can lead to kidney failure.

The heart is hit hard
In the heart, the combination of ischemia, heat shock cytotoxicity, and hypokalemia (potassium deficiency caused by excessive sweating) can lead to cardiac muscle breakdown. This myocardial injury increases the risk of cardiac arrest due to loss of myofibrils and reduced efficiency of the body in controlling heart rate and blood pressure. Stress on the heart can be exacerbated by dehydration, which thickens the blood and causes vasoconstriction, increasing the risk of coronary thrombosis and stroke. In the pancreas, erosion of the endothelial lining allows leukocytes to infiltrate the tissue, exacerbating inflammation. In the brain, the permeability of the blood-brain barrier allows toxins and pathogens to enter, increasing the risk of neuronal damage. All these physiological responses are interconnected in such a way that the failure of one organ can lead to negative effects on others, initiating a vicious cycle of deterioration that often leads to permanent damage, long-term recovery, or death.

To prevent heat stroke (according to Peiris et al., JAMA, 2014):

  • Schedule outdoor activities during cool times of the day.
  • Drink plenty of fluids. Avoid drinks with too much sugar or alcohol, which can cause dehydration.
  • Wear loose-fitting, light-coloured clothing.
  • Acclimate to new hot environments, over many days if possible.
  • Be aware of medication side effects. If taking medications, be aware of those that may cause fluid losses, decrease sweating, or slow the heart rate. Common medications include those used for depression, blood pressure and heart disease, and coughs and colds.
  • Never leave an impaired adult or a child in a car unattended.

What to do if you suspect a heat stroke
Call 911 if you notice these signs of heat stroke: body temperature over 40°C; accelerated heart rate; accelerated breathing; hot and red skin; nausea or vomiting; change of mental state (confusion, headache, difficulty in articulating words, convulsions or coma).

What to do while you wait for help:

  • Move the individual out of the heat.
  • Remove clothing to promote cooling.
  • Position the person on his or her side to minimize aspiration.
  • Immerse the individual in cold water or apply cold, wet cloths or ice packs to the skin (neck, armpits, and groin areas, where large blood vessels are located) to lower the body temperature.
  • Continue cooling the individual until the body temperature reaches 38.4°C to 39°C (101°F to 102°F).
  • Do not give any fluids to the person because it is not safe to drink during an altered level of consciousness. If the person is alert and requests water, give small sips.
  • Avoid aspirin and acetaminophen; they do not help with cooling.