Over the past few years, more and more of my friends and colleagues have been plunging into the cold and telling me how great they feel because of it. While my reaction to the idea of turning the water to cold at the end of a nice hot shower is on par with that of slapping myself in the face, I must admit that I am intrigued.
Most intriguing to me, in fact, is that according to principles of Traditional Chinese Medicine (TCM), exposure to extreme cold should be avoided at all costs! Many acupuncturists are ‘up in arms’ about the practice and cautioning their patients against it.
When I was in high school, I volunteered in Lourdes, France, one of the most prominent pilgrimage sites in the world. According to tradition, a young girl witnessed several visions of the Virgin Mary in a grotto near the town and the visions led to the discovery of a spring, which believers consider to have miraculous healing properties. Since then, visitors from all over the globe travel to Lourdes to bath in the waters of the spring. I too, had the opportunity to bath in the waters. After waiting in line for a short while, I entered a room, undressed, and was assisted under water for a brief period of time. Guess what? The water was ice cold.
My recollection of this experience, in conjunction with the growing popularity of cold plunges and ice baths, begs the question: Is the water healing or is it the cold?! I needed to learn more.
Lucky for us, a member of our very own community is not only extremely passionate and knowledgeable about cold therapy, she is equally as eager to share it with us! I recently had the pleasure of meeting with Sara Norris, a Level 2 Wim Hof Method Instructor, for an informal interview and guided ice bath experience.
In this (very thorough 7 page) blog post, we’ll ‘dive in’ to the benefits of cold exposure, specifically when practiced via the Wim Hof Method. We’ll explore the concepts of TCM that trigger the cause for concern. And, we’ll arrive at my personal conclusion- that we can use TCM concepts, in addition to, the proper guidance of certified instructors like Sara, to ensure the benefits of cold exposure are achieved in a safe way, without resulting in harm or damage to the body.
THE MANY BENEFITS OF COLD EXPOSURE
NOT SO MODERN, AFTER ALL
My initial understanding of Cold Exposure was that it was a more modern activity. How wrong I was! Sara pointed out that cold water immersion or “ice bathing” has been a common practice in Scandinavia for centuries. In fact, various cultures have incorporated it into their traditions and rituals over the years. Ancient Greeks and Romans practiced cold water bathing as part of their bathing rituals in public baths and it has also been practiced in Russia, Japan, and Finland. In the late 1900s and early 2000s, the practice was less popular with the younger generations, but when covid closed down gyms, sports matches, and more regular avenues of exercise, the traditional practice began to regain traction.
WIM WHO?
Wim Hof is a slightly eccentric, seemingly super-human, Dutchman. Nicknamed, “The Iceman”, Win can be credited for bringing the concept of ‘cold exposure as a health benefit’ to the attention of the world. He has set numerous world records for extreme feats involving cold exposure, including climbing Mount Kilimanjaro in shorts, running a half marathon above the Arctic Circle barefoot, and immersing himself in ice for extended periods of time.
A METHOD TO THE MADNESS
An important thing to realize is that Wim doesn’t simply jump into cold water- there are three main components to his technique, named The Wim Hof Method:
Breathing Techniques: The Wim Hof breathing technique involves a series of controlled hyperventilation followed by breath retention. The practice involves several rounds of breathing, with each round consisting of deep inhalation through the nose, followed by exhalation through the mouth, allowing the breath to release naturally without force. After several cycles of deep breathing, the individual exhales fully and holds their breath for as long as possible, followed by a recovery breath.
Cold Exposure: Cold exposure is the fundamental aspect of the Wim Hof Method but cold plunges and ice baths are not the only option! Cold showers or simply any exposure to cold will do. Upon starting, the exposure should be gradual, starting with shorter durations and gradually increasing exposure time as you become more practiced.
Meditation and Mindset: Cultivating a mindset of focus, relaxation, and awareness during the breathing exercises and cold exposure is crucial to Wim’s method. Visualization techniques, positive affirmations, and meditation help to enhance mental resilience.
BENEFITS OF BREATHING: Enhanced Immunity, Decreased Inflammation & Pain Reduction
Some of the touted benefits of cold exposure actually come from the Wim Hof breathing techniques, alone. When the breathing technique is combined with cold exposure, the benefits are amplified and they are immense.
The first study on the Wim Hof Method was in 2011 and involved Wim, alone. Because he was able to accomplish such extreme feats, researchers wanted to figure out what was so special about him. For the study, researchers exposed Wim to an endotoxin, which typically causes flu-like symptoms while he practiced breathing techniques of the Wim Hof Method. He was not adversely effected by the endotoxin and markers in his blood showed an up-regulation of natural killer cells and decreased inflammation after exposure- incredible! But, was Wim super-human? Was there something special about him? Or, was it possible that feats like this could be achieved by just about anyone who embodied his teachings and replicated his techniques?
To find out, the experiment was repeated in 2014 with a test group of 30 individuals, 18 of whom Wim personally trained in the Wim Hof Method for 1 week. These results were remarkable! 100% of the control subjects (the 12 that were not trained in the Wim Hof Method) reacted to the endotoxin, while 100% of the 18 subjects that Wim trained, did not. The experiment points strongly to the potential of the Wim Hof breathing method to modulate the immune response. Another study in 2018 confirmed these findings (ie. reduced levels of inflammation in response to toxin exposure) and found that the test subjects reported less subjective pain.
How is this happening? As Sara eloquently and simply explains: Win’s breathing technique of deliberate and controlled hyperventilation mimics a stress response that our bodies evolved over thousands of years of existence, called hermetic stress. This type of stress is induced in response to a threat- for example, running from a lion or tiger, or chasing down an antelope that is our only option for food. When in a state of hermetic stress, our bodies release adrenalin so that we can perform at our fastest and strongest.
There are 2 two main parts of our immune system, the innate immune system and the adaptive immune system. Inflammation is primarily associated with the innate immune system and its goal is to heal the body. When our bodies are under hermetic stress, they are not concerned about healing, so the inflammatory process is switched off. Instead, the adaptive immune system is triggered, which evokes more of a ‘‘wage war’ response. This part of our immune system stimulates the activation of Killer T cells and lymphocytes.
COLD SHOCK PROTEIN
When the body is exposed to sudden cold or extreme temperature fluctuations, one result is the release of Cold Shock Proteins from the liver. These proteins serve a specific role- they help our bodies adjust to the harsh environment and protect our cells from damage. They help our cells cope with the stress by working on the DNA and RNA inside cells, editing it and repairing it, enhancing performance and protecting essential cellular components from damage. While much is unknown about this process, it does make sense that higher amounts of these proteins in our bodies, resulting from regular cold exposure, would benefit our health.
BROWN FAT: Thermoregulation, Weight Loss & Sugar Metabolism
Last but not least, cold exposure is unarguably, excellent for metabolism. This has to do with something called brown fat. The more a person is exposed to cold, the more brown fat they have in their body. Interestingly, newborn babies have a high amount of brown fat.
Brown fat is a specific type of fat tissue. While other fat tissue simply stores fat for energy, brown fat actively burns the fat it stores to produce heat; this process is called thermogenesis.
(Side Note: Brown fat contains a substantially higher number of mitochondria than other fat tissue. Red Light Therapy, offered at Basic Balance, enhances mitochondria function and is helpful for weight loss because it stimulates the release of fat from fat cells)
Thus, people who practice regular cold exposure are activating their brown fat reserves to keep their bodies warm. Individuals with higher levels of brown fat are more efficient at regulating their body temperature and studies show that they tend to have a higher metabolic rate, as well.
Sara explains that the body will ‘give’ glucose (ie. sugar) to brown fat before ‘giving it’ to regular fat. Thus, having high amounts of brown fat may result in a healthier sugar metabolism, too! This is especially interesting because cancer cells feed on glucose. In fact, research in mice suggests that cold exposure may have anti-tumor effects and can potentially reduce tumor size!
LAST BUT NOT LEAST: Stress Resilience, Mental Toughness & Mental Health Benefits
Exposing the body to extreme cold is stressful! And the more you do something, the more your body adapts to handle it. Over time, regular cold exposure helps to desensitize the body's stress response, leading to decreased sensitivity to everyday stressors and improved stress resilience. It promotes mental toughness by challenging us to endure discomfort and helps foster a sense of accomplishment and self-discipline.
“Cold is merciless. It shows you where you are. What you are.” -Wim Hof
Cold exposure has also been associated with an increase in dopamine levels in the brain. Dopamine is a neurotransmitter that plays a crucial role in mood regulation, reward processing, and motivation. A study in 2010 showed a 250% increase in dopamine post cold exposure! Levels of Serotonin, “the feel-good chemical”, and Oxytocin, “the boding chemical”, have also been shown to increase post cold exposure. Oxytocin fosters a sense of connection and community; this is Sara’s favorite part of guiding people to endure the cold. She notes that after a group cold plunge, people are content to talk and connect with one another, and she points to the importance of community nowadays, more than ever.
TRADITIONAL CHINESE MEDICINE & EXTREME COLD
ENVIRONMENTAL INFLUENCES
A primary cause for concern according to 5,000+ years of Chinese medical wisdom, is that our bodies are largely influenced by the environment that we live in. Traditional Chinese Medicine (TCM) identifies 6 external pathogens that detrimentally impact our health when we are exposed to them in excess: Heat, Summer Heat, Wind, Damp, Dry, and (you guessed it!) Cold. According to TCM, pathogens can invade the body.
For example, extreme exposure to Wind causes Bells Palsy, a condition in which the facial muscles stiffen. This affliction is a classic Wind Invasion. Western medicine recognizes it too, since medical doctors recommend Bells Palsy patients avoid sleeping under direct airflow of a fan or AC unit. When Damp settles into the joints, it stagnates the Qi, causing pain, and presents with symptoms akin to arthritis. Have you wondered why arthritic pain is worse in damp conditions like rain and snow? Damp-Heat in the joints causes rheumatoid arthritic pain; in such cases, the joints are hot and swollen and the pain is aggravated by heat. In contrast, Damp-Cold in the joints is alleviated with heat (a hot shower, for example) and is worse in cold/damp weather. Perhaps, it is making sense to you now, why your acupuncturist asks you so many questions! Is your knee pain worse in the winter? Better with a hot shower? Aggravated on a rainy day? Did you have a febrile disease as a child? Do you work outside? What are your hobbies? A treatment plan will differ depending on whatever external pathogen has ‘invaded’ your body and where in the channel, joint, or organ, it may be located.
The Shang Han Lun, or “The Treatise on Diseases Caused by Cold”, is one of the most important books in Traditional Chinese Medicine and it focuses, almost entirely, on damage caused by exposure to cold!
AVOIDING EXTREMES
‘Slow and steady’ is a guiding principle in TCM- as Tracy, our associate acupuncturist, likes to say, “a teaspoon at a time.” This concept alone, is in stark contrast to the fast and extreme nature of a cold plunge.
According to TCM, the short term benefits derived from any extreme shift come at an expense. Short term extremes stimulate Yang energy at the cost of depleting Yin. For example, a little bit of alcohol is great to move Liver qi, while alcohol in excess depletes Liver Yin; Cirrhosis, a result of alcoholism, is the embodiment of Liver Yin Deficiency. Small amounts of tobacco stimulate the Yang energy of the Lungs (so you feel energized) but smoking addiction results in Lung Yin Deficiency (hence, a chronic cough and dry skin/wrinkles). Exercise in moderation is healthy but if a women exercises too much, she can stop menstruating.
ONE SIZE DOES NOT FIT ALL
Traditional Chinese Medicine (TCM) is all about balance. It is a beautiful and effective language for medicine that is based on the observation of nature. When boiled down, TCM follows basic, common-sense principles: If heat is present, acupuncture clears heat and cooling foods/herbs are recommended. If cold is present, acupuncture dispels cold and warming foods/herbs are recommended. If there’s stagnation, acupuncture and herbs aim to move it. If there’s deficiency, they aim to nourish and build. In cases where Yang is rising (hot flashes or migraines, for example), the goal is to descend Yang energy and nourish Yin, in order to keep Yang grounded.
All this to say, A TCM diagnosis and treatment plan is customized to how each individual patient presents, meaning two people with the same western medical diagnosis may be diagnosed differently and benefit from different treatment plans; it is never a ‘one size fits all’ approach. As such, cold exposure may be beneficial to some and not to others.
PERSONAL CONCLUSION
We can use these TCM concepts, in addition to, the proper guidance of certified instructors like Sara, to ensure the benefits of cold exposure are achieved in a balanced, healthy way- for the right people, at the right time. Here’s how:
SLOW & STEADY
Although the extremeness of the cold will shock the body, TCM, Sara, and Wim Hof, all teach the importance of gradual exposure to it. If you choose to begin practicing without guidance, Sara recommends turning the shower to cold once you've finished your normal shower and immersing yourself, as much as you are able and willing to, into that stream of cool water for 15 seconds. Do this 5 out of 7 days in a week or every time you take a shower. The next week, immerse yourself for 30 seconds, and the following week, 45. Continue to slowly increase your immersion time until you've reached 2-5 minutes. When this becomes effortless, you can immerse your hands/feet in ice water for 30 seconds, working up to 2 minutes, and gradually increasing exposure time until culminating in a full 2 minute ice bath. After 2 minutes of cold water immersion, you have received all of the physical benefits that the cold exposure has to offer; the only additional benefit to staying longer would be the mental benefit achieved by overcoming a challenge or goal you have set for yourself.
During cold exposure of any kind, Sara recommends focusing on a calm and controlled breathing pattern, as this calms the nervous system. She recommends a deep inhale through the nose followed by an extended exhale through the mouth.
I would ad that it’s important to listen to your body. If you feel GREAT after you start slowly exposing yourself to the cold, keep going! However, the time of exposure may need to be adjusted based on your current state of health or your life circumstances. For some, a daily practice could be beneficial. For others, it might be a weekly or monthly activity. Perhaps a daily practice has benefited you for months but you sense that you need a break. Listen to your body and adjust accordingly. And, if you’ve taken a break, return to it slowly and gradually, again.
CAUTIONS & CONTRAINDICATIONS
Both Sara and TCM agree that cold exposure is not for everyone.
According to Sara, people with Epilepsy, Raynaud's Type 2 (the autoimmune type), uncontrolled high blood pressure, or those who’ve experienced a recent cardiac event should avoid ice baths. People who are susceptible to migraines (especially tension-related migraines) should use caution, as the contraction of the upper back and neck muscles can sometimes trigger one. If you have any cardiovascular history or issues, it would be wise for you to speak with you medical doctor prior to starting cold exposure.
With all activities, the context, dosage, and intensity are all factors to consider when deciding benefit vs harm. My personal opinion is that while cold exposure may be a great health exercise for a healthy person, I would not recommend it for a sick person as medicine.
Sara is certified in guiding people through ice bath therapy. To gain her certification, she completed a 6 month course that culminated in a week of in-person training in Poland. Sara cautions that certifications are now being handed out for very short trainings, sometimes in the span of a day. The difference between having a well-trained guide could be the difference between life and death. For example, jumping into a pond or putting your head under water immediately upon ice-bathing can result in death due to the involuntary inhalation of water into the lungs.
PRACTICING IN BALANCE: YIN & YANG
Extreme cold creates shock, which scatters Qi in the body. As one sits in the cold water submerged, their Qi reconsolidates again. However, if one does not have enough Qi present and accessible in their body to ‘weather’ the scattering, the experience would cause more harm than benefit. So, if one is feeling particularly weak or fragile, it would be wise to consider that cold exposure may not be a suitable therapy.
An interesting, albeit rare, side effect that Sara mentions is Global Amnesia. In such cases, an ice bath would cause sudden temporary memory-loss. This side effect is only typical in the older population and in cases when they are pushing their limits in terms of how long they are staying in the water. TCM would view this as an example of a person that does not have enough Qi (available and accessible to them) to reconsolidate it, after the shock of the extreme cold has scattered it.
Individuals with ample Qi (available and accessible to them) may be able to dunk themselves into an ice bath, no problem. Others would need to rely on breath work or meditation, as taught by a proper guide, to build their Qi beforehand and to reconsolidate it after the shock. Breath work helps build and reconsolidate our Qi because it stimulates Yang energy in the body in order to balance the extreme Yin (ie. cold) of the environment; Yang is the heat and function of the body- our metabolism, circulation, digestion, etc- and Yin is what holds Yang- it is the fluid, the stillness, nighttime… the cold.
In other words, extreme cold is an inherit stress, but stress can stimulate our Yang energy to meet its demands, if the necessary resources exist in the person and are accessible to them. In such cases, the body will ‘level-up’ to become stronger and more resilient.
Sara points out that after the cold exposure, it’s important to allow your body to warm up again, naturally, as the process stimulates cold adaptation and brown fat production which supports and strengthens our metabolic processes. Ie. don’t turn your shower water to hot again! Embrace the shivering or use a method like Horse Stance (a qi gong exercise that you can find here: https://www.youtube.com/watch?v=MQuoyqWzgpI — widen your legs only to your comfort level!) to cultivate the Yang in your body that is necessary to achieve the benefits.
AWARENESS OF COLD INVASION
Remember those external pathogens we talked about? A potential consequence of cold exposure is that of Cold invading the body. The benefits of cold exposure may very well outweigh the risks but do be on the lookout for possible negative side effects such as:
Joint pain seems to improve immediately but steadily gets worse over time with continual cold exposure, especially in the winter time and on colder days.
You have trouble warming up after the cold exposure; you feel cold constantly.
For women: an increase in menstrual cramping, menstruating for shorter lengths of time, increased clots and/or less blood flow during menses, dull/ achy sensation in the lower abdomen. Women with metal IUDs should be especially aware of how their body is responding to cold exposure. Potential harm can be mitigated by keeping the lower abdomen/ womb warm during the luteal and menstrual (Yin) phases, from menses to ovulation. Microwavable rice packs and warm ginger tea can help greatly with this. Women may also choose to avoid cold exposure during this time of their cycle.
TRAINING WITH SARA NORRIS
Sara is holding workshops on the Wim Hof Method in Keene on April 27 and on May 4-5. If you are interested in finding out more, visit her website, batheandbreathe.com, for information about the workshops and to register. You can also reach out to Sara directly with any questions you may have using the contact form on the website. Contrast Therapy is another passion of Saras; she is not only a Level 2 Wim Hof Method Instructor, she is a Certified Sauna Master, and plans to open a Thermal Spa (with cold dip and sauna) in Keene in the near future! You can find Sara on Instagram and get updates about the opening of her Thermal Spa @bathe_and_breathe.
… AND A BIT OF INSPIRATION
The day I interviewed and agreed to an ice bath under Sara’s guidance, I had gone snowboarding in the morning. It was a particularly cold and windy day and I was already chilled. In all honestly, I was not looking forward to it. As I walked outside in the snow, barefoot in my bathing suit, my resistance was overcome by a vision that Sara had shared with me:
During the interview- after explaining that cold baths don’t actually get any easier the more you do them (hah!)- Sara casually mentioned a late December morning during which she had woken around 4:30 or 5am to another cold, very dark winter day, and needed to use a nearby 2x4 piece of scrap wood to smash the thick sheet of ice apart that had formed on her bath overnight, while her husband snuggled cozily in bed, wondering what the heck he was hearing.
That vision of Sara will serve as the inspiration for my cold journey ahead- even though I plan to start with just 15 seconds of cold after a hot shower… in the summer time!!!
References:
1. "Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans" by Kox et al. published in "Proceedings of the National Academy of Sciences of the United States of America" (PNAS)
2. ”Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans," by Kox et al. (follow-up study) published in “NeuroImage" Journal
3. A study published in the journal Cell in 2014, a study published in the journal Cancer Cell in 2019, and a study published in the journal PLOS One in 2018
4. “Human physiological responses to immersion into water of different temperatures” by P Sramek, et al. Eur J Appl Physiol, 2008
5. “Cold Plunge, Cold Shower, Hot Mess”- by Ann Cecil-Sterman