Medicine is warming up to ice baths
Summary
Modern medicine seems to have discarded the ancient wisdom of cold therapies in favor of pharmaceuticals.
Polish researchers conducting clinical trials proving the efficacy of cryotherapy for treatment of chronic illness may be reversing the modern trend by supporting more traditional ways with new data.
Case studies in cold plunge therapy support its use for treatment of brain injury, mental health disorders, metabolic & cardiovascular disorders, multiple sclerosis, and chronic inflammation such as rheumatoid arthritis.
Cold Therapy in Ancient & Modern Medicine
The salubrious effects of cold therapy have been understood for centuries. For example, a team of researchers based primarily in the United Kingdom recently wrote that "the beneficial effects of cold-water immersion (CWI) on
human physiology dates as far back as 3500BC" and that ancient Greek physicians such as Hippocrates prescribed cold water therapies for medicinal purposes and analgesic benefits (Allan et al. 2022).
Unfortunately, as drug development has became more sophisticated, physicians have increasingly departed from the ancient wisdom of cold therapy in favor of pharmaceuticals. For example, cold water immersion has been a traditional remedy for the treatment or rescue of newborns with hypoxic brain injury. The story of entrepreneur and philanthropist Jon Huntsman, Sr. (1937-2018) is particularly dramatic. In his autobiography Barefoot to Billionaire (Huntsman 2014) he describes how a midwife in Blackfoot Idaho used cold and warm water contrast treatment to bring him to life after he failed to start breathing at birth.
She had my Father hold me under the cold-water spigot, and then under the hot one, and to keep doing it... cold, hot, cold, hot, cold, hot. He and the midwife repeated the routine for several minutes until, barely perceptible, my tiny (newborn) mouth opened and closed -- just once. - Jon Huntsman, Sr.
What's remarkable is that Huntsman not only survived extended oxygen starvation as a newborn, but his brain recovered so well that he became a super successful businessman and donated more than a billion dollars to charitable causes including cancer research.
Jackson et al. (2024) describes the myriad pathways by which mild hypothermia "produces potent neuroprotection" by stimulating the production of fibroblast growth factor 21 (FGF-21) and brain-derived neurotrophic factor (BDNF) for brain growth and function. Moreover, an international team of researchers funded by the US National Institute of Health (NIH) reviewed the extensive literature on therapeutic hypothermia and concluded "Evidence shows that artificially lowering body and brain temperature can significantly reduce the deleterious effects of brain injury in both newborns and adults" (Ma et al. 2012).
There is now overwhelming clinical and experimental evidence that mild to moderate postasphyxial cerebral cooling is associated with long-term improved survival without disability. - Gunn et al. 2017
The wisdom of therapeutic hypothermia for neonatal asphyxia was abandoned in the 1980's (Kochanek et al. 2009). Now, infants with hypoxic brain injury can be treated with Viagra instead of cold water immersion (Wintermark et al. 2024).
However, medical science may be taking an increasing interest in re-discovering what was once widely understood. New review articles have appeared in the last several years that both summarize existing scientific knowledge and suggest promising new pathways for research. The recent contributions of Polish researchers are especially helpful. For example, Tabisz et al. (2023) describe the medical benefits of deliberate cold exposure in several areas of chronic illness including mental health disorders, metabolic & cardiovascular disorders, and chronic inflammation.
Could it be that the best work on cold therapy is coming from eastern European countries that once languished under Soviet rule because they avoided capture by American pharmaceutical corporations?
Cold Benefits Mental Health & Mood
Most of the research related to nervous system benefits has been focused on whole-body cryotherapy (WBC). Here, several studies demonstrate improvements in cognitive function. For example, 21 patients suffering from mild cognitive impairment experienced lasting improvements in memory after WBC (Rymaszewska et al. 2021). Other studies have obtained similar results with regard to memory and also measured improvements in learning ability and attentional control (Senczyszyn et al. 2021). In addition to cognitive benefits, improvements in mood and sleep have been attributed to WBC. For example, Rymaszewska et al. (2008) demonstrated a decrease in the severity of depression and anxiety, while Tabisz' review cites other studies that noticed improved sleep and quality of life.
These studies are borne out by the experiences of Latvian product designer Edgar Treimanis. Suffering from a long-lasting major depression, Treimanis sought to drown himself in the warm water of his bathtub, only to be interrupted during his attempt by his brother. The next day, determined to escape his family's notice during his next attempt, he resolved to run down to the beach and drown himself in the Baltic Sea.
But when Treimanis waded into the cold Baltic waters, the shock to his nervous system jolted him out of his depression. His Father, having followed him to the beach, caught up to him, dove in after his son and they embraced in the water. Together, they went home to rewarm and promised each other that they would swim every day.
Since then, Treimanis has wanted to live. What's more, he's continued his practice of cold water therapy, won an award for one of his product designs and stayed out of the funk that drove him to attempt suicide.
Treimanis' case is not unique. In Depression Cured by Cold Plunge I wrote about scientifically supervised cases of severe depression that resisted drugs and talk therapy, but responded well to winter swimming. As with Treimanis, these patients resolved their depression and were able to discontinue taking medications. That may be because the cold is more effective than drugs for modulating neurochemistry. In addition to the dopamine and norepinephrine boost provided by the cold plunge, new research has revealed that lower skin temperatures can stimulate production of oxytocin and motivate stronger social connections (Fischer et al. 2024).
Cold Benefits Metabolism & Cardiovascular Health
The metabolic benefits of cold plunge therapy have already been well documented. For example, in Ice Baths for Mitochondrial Therapy I wrote about the use of cold water for reversing insulin resistance and stimulating mitobiogenesis -- the production of new mitochondria. But what I didn't write about was the effect of cold on markers of cardiovascular disease and the improvement in blood lipid profiles that can be expected from a regular cold practice.
When a team of Polish researchers used exercise and whole-body cryotherapy with 30 adult obese subjects, they measured decreases in cardiovascular risk factors including triglyceride levels and an increase in HDL (i.e., good) cholesterol -- without changes in body mass index or percent body fat (Lubkowska et al. 2015).
This remarkable finding suggests that even in the absence of weight loss, cold therapy can create metabolic and cardiovascular improvements that reduce markers of ageing and mortality. Moreover, other studies corroborate these findings, and add that cold therapy will remodel body fat by reducing dangerous visceral (belly) fat (Pilch et al. 2022). As I first wrote in How To Increase Brown Fat? Ice Bath, a regular program of cold therapy can even reduce the liver fat that is characteristic of deadly non-alcoholic fatty liver disease (Wibmer et al. 2021).
Cold Therapy Reverses Chronic Inflammation
It seems that every athlete, trainer, or physical therapist is already familiar with the use of cryotherapies for reducing the acute inflammation that accompanies injury or overuse. However, few people understand the potential for a regular cold plunge practice to alleviate symptoms of chronic inflammation.
One important blood marker of chronic inflammation is called c-reactive protein (CRP). Elevated CRP is a clinical indication of rheumatoid arthritis (RA) and associated with increased risk of heart attack. Consequently, some physicians monitor CRP levels in their patients to detect possible heart disease.
When 25 patients with rheumatoid arthritis were enrolled in a study to investigate the potential of whole-body cryotherapy (WBC) to alleviate pain and increase mobility compared to a control group undergoing physical therapy, researchers in Warsaw, Poland observed improvements in both groups. However, only the cold therapy group experienced a reduction in C-reactive Protein (Sadura-Sieklucka et al. 2019).
Rheumatoid Arthritis
These results are similar to an earlier study that enrolled more than a dozen RA patients in a 4-week program of daily WBC for 2-3 min at -140 to -160C. Although they didn't measure CRP, these researchers discovered a significant reduction in histamine levels in the cold-treated group (Wojtecka-Lukasik et al. 2010). Given that RA is an auto-immune disorder, and elevated histamines are associated with immune system irregularities, this study suggests that cold therapy may reduce chronic inflammation by reversing immune system dysfunction.
The experience of Erin Miller is emblematic of the way in which cold therapy can benefit RA patients. Miller is a registered nurse who works as a medication safety specialist in a California hospital. She exercises regularly and eats healthy, but she also suffers from such severe RA pain that is sometimes used to interfere with her ability to perform her medical duties.
She resisted taking steroids and pain medications, because her expert training in medication safety informed her of the adverse side effects that long-term use of these medications can cause.
When she discovered cold plunge therapy, her rheumatoid arthritis (RA) symptoms disappeared. After just 2-3 minutes of full-body cold water immersion "for the first time in 4-5 years, I woke up and didn't have any pain in my hands."
Multiple Sclerosis
I've written previously on the life-changing potential of cold plunge therapy for multiple sclerosis, another autoimmune disorder. For example, in Cold Plunge for Multiple Sclerosis I chronicled the experiences of former Navy SEAL Justin Hoagland, who was bound to a wheelchair by his debilitating symptoms of MS until he started a regular practice of ice baths. And in Multiple Sclerosis Relief I related the story of Julie Blew, who considers her ice bath her "best friend" because of how it allows her to practice yoga and compete in long-distance running races. Their experiences are consistent with a study that showed significant reduction in self-reported fatigue among MS patients who participated in a clinical trial of WBC (Miller et al. 2016). Moreover, cooling therapy studies show a dose-dependent relationship, meaning that more cooling generally results in greater benefit (NASA 2003).
What the Tabisz' review adds is that one mechanism by which MS patients obtain relief is likely a reduction in neuroinflammation (Tabisz et al. 2023). That finding reinforces the view that cold therapy benefits the brain and can be used to treat disorders of the central nervous system.
Cold Plunge for Extended Illness
I first wrote about the potential for cold exposure to provide a boost to the immune system in Can Ice Bath Prevent Illness? In that article, I cited research that showed a boost in natural killer (NK) immune cell activity resulting from cold exposure. The article dates back to June 2020, when many were feeling ravaged by COVID, and it talked about how Vitamin D and cold exposure could give the immune system a boost when it's most needed.
One of the people who needed it was American record producer Andrew Watt, who is perhaps best known for working with superstars like The Rolling Stones and Elton John. But in March of 2020, like many others Watt caught COVID.
Unfortunately, his case lingered. Despite the advice of the best medical doctors, nothing Watt tried seemed to work. He felt tired all the time, and his blood panels showed that his body hadn't yet fully recovered from his earlier illness.
That's when a friend of Watt's, also a musician, recommended he try thermal contrast therapy. Watt started a daily practice of sauna and ice bath -- and he got better. The next time he measured his blood markers, the doctor told Watt he was "the most normal he'd ever seen." By the time I interviewed Watt in December 2023, he was full of energy and exercising. He said he felt like he was in the best shape of his life, and even tried precooling his workout.
Although conventional medicine had failed, the sauna and the ice bath worked for Watt.
Hypothermia for Hypermetabolic Distress
There may be good medical reasons to think that Watt's experience might work for others, too. During the peak of the pandemic, medical doctors at the North Shore University Hospital in Manhasset New York noticed that critically ill COVID patients often go hypermetabolic in the final, fatal stages of the disease. This condition, they reasoned, was likely a contributing factor to the respiratory and inflammatory distress that often preceded mortality in elderly COVID patients.
They decided to try cold therapy to induce hypothermia as a last resort attempt to save four of their patients lives.
Each patient was a difficult case, at high risk of mortality do to co-morbidities. Neither a 69 year-old man with diabetes nor a 73 year-old made it. They underwent the cold therapy, but both died more than a month later when life support was discontinued. However, a 57 year-old obese man and a 62 year-old obese woman with asthma both recovered. The doctors concluded that "mild hypothermia may be used to attenuate the hypermetabolic response in critically ill patients with COVID-19," although they admit that more comprehensive research is necessary to "determine the optimal timing and duration of the hypothermia" (Yu et al. 2020).
The Future of Cold Plunge Therapy
One of the downsides of social media is that it can reward bad behavior with clicks. That is, social media pays content creators for engagement -- not truth. Moreover, according to a 2023 report the healthcare/pharmaceutical industry is the fifth-largest spender on digital advertising in the United States -- ahead of automobiles, entertainment, and travel. This combination of incentives amplifies hyperbolic, science-flavored criticism of personal experiences, case studies, and clinical trials conducted outside the protection of pharmaceutical funding.
As the popularity of ice baths has exploded, so has a cacophony of critics ridiculing people who post about the benefits they've received from cold plunge therapy and lampooning the scientists who have published studies in support of those experiences. Nonetheless, knowledge is more persistent than clicks.
Increasingly, a credible scientific community is forming around cold plunge and related metabolic therapies. Aside from celebrity science communicator Prof. Andrew Huberman (Stanford University), others like insulin expert Prof. Ben Bikman (Brigham Young University) and metabolic mental health psychiatrist Dr. Chris Palmer (Harvard University) are helping advance the leading edge of metabolic science in both the laboratory and the media. Part of our mission at Morozko is to connect our audience to these credible sources of scientific knowledge that helps sort out the helpful from the hyperbole.
References
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About the Author
Thomas P Seager, PhD is an Associate Professor in the School of Sustainable Engineering at Arizona State University. Seager co-founded the Morozko Forge ice bath company and is an expert in the use of ice baths for building metabolic and psychological resilience.