Try This: Everything You Need to Know About Cold Water Immersion Therapy

Hi ,One thing I love about being in the health space is seeing people get excited about a promising new area of wellness. Lately, it's cold therapy, and for good reason!

With “The Iceman” Wim Hof and Dr. Andrew Huberman shining a light on everything from improved focus to quicker recovery to positive effects on our mood, metabolism, and energy levels—cold therapy is all the rage!

But with curiosity and excitement often comes questions and uncertainty. When it comes to deliberate cold exposure, the questions I hear the most are:

“How do I actually practice cold exposure? Do I need an ice bath or will a cold shower work?”

“How long do I have to do it to get the benefits?” 

“How cold does the water have to be?”

“When is the best time of day to do it?”

“Should I do cold exposure right after a difficult workout or wait?”

Today, I’m going to help answer these questions using what I’ve learned from my own experimentation, the research out there, and listening to experts I admire, like Dr. Andrew Huberman, who has dived deep into his deliberate cold exposure protocol on his podcast Huberman Lab. 

If you've been looking to start a cold-water therapy protocol but aren’t sure where to begin, this newsletter is for you!

Let’s jump in!

What Is Deliberate Cold Exposure, and How Does It Work?

The first thing you need to know about deliberate cold exposure is that it is…well, deliberate! It is an intentional choice to immerse yourself in cold temperatures for a brief period of time for a positive outcome. Scientists refer to this small dose of a mild stressor as hormesis.

Basically, how it works is that exposing yourself to uncomfortably cold temperatures increases the production of norepinephrine and epinephrine (also known as your “fight or flight” hormones), which increases your heart rate, heightens your senses, and puts your body into survival mode.

Survival mode isn’t somewhere we want to be all the time, but intentionally turning on our fight or flight hormones using cold exposure does seem to have a positive effect.And don't worry, the discomfort subsides. Your breathing and heart rate will start to slow down the more you do it, so you can rest assured knowing that this feeling is only temporary while your body gets acclimated to the cold temperature. In this next section, I’m going to give you a few examples of the benefits of cold exposure.

Enhances Mood, Focus, Attention, and Energy

When we expose ourselves to cold temperatures—either with an ice bath, a cold shower, or going outside underdressed on a chilly day—that surge in epinephrine and norepinephrine you feel is accompanied by a dose of dopamine.

Dopamine is the neurotransmitter that’s responsible for motivation and drive. It also boosts our mood and improves our attention and energy levels. What’s super interesting is that these positive changes in mood, energy, and focus after deliberate cold exposure extend for hours after the initial cold exposure. 

Increases Metabolic Rate

Another super-interesting benefit of cold therapy is what it does to our fat tissue. A surge in norepinephrine turns on genes that stimulate mitochondria production in our fat tissue.And when our fat tissue is more mitochondrially dense it goes from slow-energy-burning white adipose tissue (WAT) into more metabolically active brown adipose tissue (BAT), which burns energy at a faster rate.

Supports Longevity

Having BAT has benefits for our longevity, too, by optimizing our metabolic health. Higher amounts of BAT are associated with better blood sugar control, insulin sensitivity, lower cholesterol levels, and healthier body fat distribution (i.e., less belly fat) (1). 

BAT also increases the expression of SIRT1 and cold-shock proteins. These longevity genes ramp up antioxidant production, support immunity, and put us at a lower risk of age-related chronic disease (2).

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Deliberate Cold Exposure: HIIT vs Weight Training 

We’ve all heard about professional athletes taking ice baths to support and speed up recovery. There’s an extensive body of research that backs this up, with one review paper showing that cold water immersion (i.e., ice baths) immediately after high-intensity exercise improved muscle power and performance and reduced inflammation and soreness (3). 

Interestingly, though, the same benefits cannot be said when we’re talking about building our muscle mass. If that’s your goal, deliberate cold exposure—either with an ice bath or cold shower—for up to four hours after your workout can actually hinder your muscle gains (4). 

This was super interesting to me because I just started working with a trainer to put on some muscle, and I recently bought a cold plunge to start getting the benefits of deliberate cold exposure myself.

To avoid hindering my muscle gains, I’m going to make sure I do my cold exposure first thing in the morning before my workout so I can reap all the physical and mental benefits before going into my day.

Okay, now that we know how deliberate cold exposure works and its benefits, let’s talk protocol!

The Different Ways You Can Practice Cold Therapy

Before we cover the exact temperature and time you want to do deliberate cold therapy to get the maximum benefits, let’s first define the different ways you can practice, starting with the most to the least effective.

• Cold-water immersion: This is where you are fully submerged in cold water up to your neck, with your hands and feet completely underwater. You can think of this as a cold plunge or ice bath. There’s a variety of cold-plunge and ice-bath brands on the market, but they can get expensive, and you don’t need anything fancy to do full-body cold-water immersion. A DIY ice bath in your bathtub or inflatable swimming pool works just as well.

• Cold shower. This is where you turn your shower temperature to cold and let the water run over your head and body. This isn’t my favorite because I don’t like having only part of my body in the cold and prefer having my whole body underneath the water at once. But I know some people who swear by it, so if this option works for you, go for it!

A quick disclaimer about cold therapy:

For the majority of people, cold therapy is generally regarded as safe, but if you have an underlying medical condition, please consult your healthcare practitioner first before getting started.

With that being said, I don’t think we fully understand how cold therapy is tolerated by the different sexes yet. I recently had clinical psychologist Dr. Jay Wiles on my podcast who said that too much cold exposure could be detrimental to women’s hormonal health.

That’s not to discourage anyone from exploring cold therapy, but it's important to be mindful that too much could potentially contribute to, or worsen, hormonal imbalances in women. If you want to hear more of our conversation about this, check out this clip.And lastly, Dr. Wiles says that Wim Hof-style breathing is not meant to be mixed with cold therapy because it can be dangerous and lead to people passing out.Now let’s talk protocol!

How to Get StartedIf you've never done cold therapy before, the best (and cheapest) way to begin is by filling up your bathtub with cold water from the faucet. There’s no need to be hardcore when you’re first starting out, like emptying your ice bin or dumping bags of ice into your tub. Not that you can’t do this in the future, but it's best to ease your way into cold therapy by getting used to what it feels like first. Then, once you’ve mastered the cold bath, you can increase the challenge by adding in some ice. How Cold?You may be surprised to hear that there actually is no exact temperature for reaping the benefits of deliberate cold exposure—it’s entirely up to you and what you can safely tolerate.Starting out, the goal is to be uncomfortably cold, like your brain is telling you it wants out, and you have to actively push through the discomfort—that kind of cold. I measured my bath water on the coldest setting, and it was about 73 degrees Fahrenheit. General bathtub temperatures range from 60 to 75 degrees, which might not sound cold, but it will certainly feel cold, especially just starting out.Stay in your cold bath for as long as you can. Ideally, you want to work your way up to 60 to 120 seconds. Once you’ve mastered that, you can play with adding ice to lower the temperature. As a frame of reference, cold plunge tubs typically go down to about 39 degrees Fahrenheit. How Long?The colder the water is, the less time you need to stay in it. For example, my brother-in-law, Dr. Neel Patel, stays in for a max of three minutes at 35 degrees Fahrenheit and five to seven minutes at around 55 degrees. See below for the maximum time to strive for per week. Pro Tip: Count to yourself while immersed in the cold water, and remember the duration you stayed in, so you can challenge that number next time.

Try This:

1. Optimal cold-water exposure per week. According to Dr. Huberman, 11 minutes is the minimal effective dose, and it’s up to you how you want to break it up. He recommends two-to-four sessions per week with each session’s total time lasting anywhere between two and six minutes. This will look different for everyone and also changes from when you’re first starting out to when you’ve become more acclimated to the cold water (it doesn’t take long!). You don’t have to do the whole two minutes at once when starting out. Do however much you can safely tolerate and gradually work your way up to the 11 minutes total per week.

2. Try cold exposure first thing in the morning. I find it easier to do cold therapy first thing in the morning because the rush of adrenaline I get helps me wake up. This is especially useful on days when I’m taking a break from coffee; it’s almost like the equivalent of taking a shot of espresso! And because the dopamine release is long lasting, I feel positive and upbeat going into my morning workout and tackling the day ahead.

Final Thoughts:

I hope this helped answer some of your questions about cold exposure and its long list of benefits! To be honest, I’ve been loving the way it makes me feel, and I can definitely speak to the mental clarity, focus, and performance benefits. 

As for longevity, I guess only time will tell, but I trust experts like Dr. Andrew Huberman and my business partner, Dr. Mark Hyman, who's been doing cold therapy for a while now and has reversed his biological age by nearly 30 years! 

Have you ever tried deliberate cold exposure? What was your experience? Do you think you’ll try the protocol above? Let me know using the feedback feature below!Here's to your health,Dhru PurohitReferences:1. PMID: 343375582. https://www.lifespan.io/topic/cold-stress/3. PMID: 351572644. PMID: 26174323