Prof. Dituri measures brain benefits of ice bath... on himself
Summary
Whole body cold water immersion promotes brain function in several ways including, mitobiogenesis to boost brain power, ketone production to upgrade brain fuel, increased neuroprotective factors like BDNF, FGF21, and RMB3 to promote brain regrowth, and better brain blood flow.
When Joe Dituri, PhD, measured his own brain activity while submerged up to his neck in the ice bath, he found that cold provides a big boost to brain activity.
The implications of Dituri's discovery could be profound for people like who have suffered traumatic brain injury--like Dituri himself.
History is littered with examples of the use of cold as a therapeutic agent — from the ancient Greek physician Claudius Galen, who used it to treat fevers, to its application for improving the outcomes of surgery after serious battlefield injuries. Mounting evidence of its effectiveness led surgeons in the 1950s to use hypothermia as a tool to ameliorate the side effects of brain surgery. Even today, cold is an effective treatment for birth asphyxia — a lack of oxygen during the perinatal period that can lead to brain damage. - Knott 2015
How do ice baths boost brain health?
Traumatic brain injury
Joe Dituri, PhD, spent 28 years as a Navy special operations dive officer. He has jumped out of hundreds of planes and helicopters, performed extended underwater missions at depths of as much as 1948 feet, and holds the Guinness World Record for living underwater 100 consecutive days.
But his most dangerous experience was when a car slammed into the side of his antique truck, destroying both the truck and a portion of his brain in 2021. When Dituri woke up in the hospital, he had no idea what had happened. Nor did he recognize the attending physician who was his former student at the University of South Florida. Dituri realized he had suffered a traumatic brain injury.
His experience as a diver had already taught him about the importance of managing oxygen levels, and what can happen in the brain and bloodstream when oxygen goes awry. After retiring from the Navy, he earned a PhD in Biomedical Engineering that focused on the hyperbaric oxygen therapy -- that is, breathing at air pressures greater than atmospheric to push more oxygen into the bloodstream. That increased oxygen can promote healing in areas of the body that might otherwise be hard for oxygen to reach, like the lymph system, the spinal cord, and the brain.
Following his science training. Dituri set out on a self-designed program of hyperbaric oxygen therapy (HBOT) to promote healing his own traumatic brain injury.
Then he had a surprising intuition.
He thought. "I should do an ice bath."
Ice baths for brain healing
There are several ways that whole-body cold water immersion will help heal the brain. For example, the cold will:
stimulate mitobiogenesis, cold improves insulin sensitivity throughout the body and increases the power-producing capacity of brain cells,
increase levels of neuroprotective biochemical factors like fibroblast growth factor (FGF21) and brain-derived neurotrophic factor (BDNF) that protect brain cells from damage, promote neuroplasticity and likely improve memory,
induce endogenous production of ketones--the preferred brain fuel,
increase blood flow to the brain, both by forcing more blood up to the head and by supporting endothelial cell production of nitric oxide, which is critical for vasodilation and vascular health.
Following these intuitions, Dituri reasoned that a whole body ice bath would induce vasoconstriction in his limbs, forcing blood into his core and his head. That improved blood flow in his brain could promote healing. So he bought some ice and filled his bath tub to experiment on himself. Although he says, "The ice bath sucked," the more ice baths he did, the sharper he felt his thoughts were getting.
EEG in the ice bath
One of the tools that Dituri uses to track the progress of his patients is an electro encephalogram (EEG) that measures brain waves across several frequencies. The EEG tells Dituri about the amount of and what type of activity is taking place in the brain. Two of the critical measures that Dituri tracks are called phase lag and coherence.
Phase lag is an indication of how fast the brain is working, while coherence indicates how well different parts of the brain are working together.
Until the 5-year-old daughter of one of his patients asked he'd ever used the EEG in the ice bath, the thought hadn't occurred to Dituri. The precise measurements he typically collects require the subject to stay very still, which would be a challenge in 33F water.
So Dituri started by training himself. He collected ten minutes of data on his own brain while warm and dry, then ten minutes of data while he was submerged up to his neck.
The results astounded him, and he showed them to me several months ago.
The EEG results can be displayed graphically on circle charts that illustrate brain activity. An injured brain (Figure above, left) has lots of empty space in the circles for both coherence (top row) and phase lag (bottom row). A healing brain (Figure above, right) will show circles that are more filled in because as the brain heals, activity, speed, and connectivity increase.
The data Dituri showed me of his brain in the ice bath looked like solid ten-pointed stars. in other words, whole-body cold stimulation was lighting his brain up like a Christmas tree.
Rat models of cold water swimming for healing from brain injury
It may seem like 5 minutes of perfectly still freezing cold water immersion is a lot to ask a human research subject to endure in the interests of science, but its nothing compared to what a team of researchers headquartered in Tianjin China did with a group of rats. To test the effects of cold water immersion on traumatic brain injury, these researchers "pretreated" a group of rats in a tub of 4°C water for 3 minutes at a time, once a day for a week. They then subjected an experimental group of rats to brain injury, while leaving another group uninjured to serve as a control. Finally, they tested the rats ability to navigate a water maze to gain a measure of their brain function.
Compared to rats who suffered no brain injury, the rats pretreated with cold water swimming completed the water maze almost as quickly, while brain-injured rats who were not pre-treated with cold water swimming performed poorly. The researchers attributed this to greater levels of endothelial progenitor cells circulating in the blood of the cold-water preconditioned rats, and a resulting improved recovery in microvasculature and blood circulation in their cold-water pretreated brains. They also cited previous studies that showed cold water immersion increases synthesis of vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF), both of which promote neural repair in injured tissues and organs (Zhao et al. 2017).
Nueroprotective functions of RBM3 cold shock protein
In my article Cold Shock Protein Critical for Cancer? I wrote about the mechanisms by which cold-induced RNA-binding protein (CIRBP) can repair defects in nucleic DNA to guard against cancer. However, CIRBP is just one of many cold shock proteins with beneficial effects on health.
Another is called RNA binding motif 3 (RBM3) and it both inhibits tumor growth and provides protection against brain injury. For example, RBM3 "exerts a neuroprotective function via structural plasticity, a process wherein synapses are continuously remodeled by dismantling and reassembling processes in healthy adult brain" (Zhao et al. 2017). When RBM3 expression is high, as it is in hibernating animals, it promotes neurogenesis, preserves brain cells, and protects connections between synapses.
Human trials in cold plunge therapy?
Dituri's next research task is to see to what extent his own results can be replicated in others. So far, he has two other subjects with sufficient central nervous system control control under acute cold water exposure and they show similar results in increased brain activity.
The activity measured on the EEG is a promising indication of positive brain response to cold plunge therapy. Tests of cognitive performance after several weeks of daily ice baths might be even more informative, but human trials have not yet been undertaken.
A comprehensive program for treating traumatic brain injury, like the type that Dituri has developed at his Undersea Oxygen Clinic, demands more than just cold therapy. Hyperbaric, red light and infrared light exposure on the cranium, a diet high in DHA (e.g., fatty fish and shellfish), sunlight exposure (or UVB, for Vitamin D) and green light therapy through the eyes might all contribute to acceleration of brain healing. Dituri's approach thus far is to "try everything, all at once" that might speed healing. Because none of these modalities have a downside, Dituri reasons that it makes sense to combine them all in the search for programs that work faster than "diagnosis and discharge," which was all that was available to him.
References
Knott G. Cold shock protects the brain. Nature. 2015 Feb 12;518(7538):177-8.
Zhou ZW, Li YD, Gao WW, Chen JL, Yue SY, Zhang JN. Cold water swimming pretreatment reduces cognitive deficits in a rat model of traumatic brain injury. Neural Regen Res. 2017 Aug;12(8):1322-1328. doi: 10.4103/1673-5374.213553. PMID: 28966648
Zhou RB, Lu XL, Zhang CY, Yin DC. RNA binding motif protein 3: a potential biomarker in cancer and therapeutic target in neuroprotection. Oncotarget. 2017 Mar 3;8(13):22235.
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.