Can cold water therapy be one answer to improving physical and mental health; even coping with pain?
Kati Burton, MS, RDN
January 2023
The temperature on the car dashboard reads 19 degrees Fahrenheit and I’m shivering. The anxiety continues to bubble up from just hours ago, when taking care of myself was set aside by the startling cries of a tiny human alarm clock. This was followed by finding just the right socks for my chic toddler and wondering, “does this really matter?” in between thoughts of what time my first meeting is and the beckoning fear of icy roads ahead. It is the height of Montana winter and getting ready for school and work in the morning can sometimes feel like preparing for an Everest expedition.
Now that my daughter is safely at school with all her friends and I’ve done a few tasks for work, I am sitting in my car in an icy parking lot staring at that illuminated number. Nineteen degrees. I think to myself, “I wonder what the water temperature will be today?” I try to set this aside and breathe in 30 short breaths in succession with just enough forcefulness to relieve the GO-HOME messages from my sympathetic nervous system. I start to relax, now breathing in deeply and exhaling slowly. It’s time to walk down and meet a few other wild dippers, or so we call ourselves.
It is a small crew today, just four of us. We are gentle and kind to one another, unlike the polar bear or birthday plunges I have been a part of when we would strip to our skivvies and run into the water screaming like banshees and the shock of it all sends us in droves of laughter, hearts beating wildly and high fives all around. This thing that we are doing here weekly, is quite different, or so I am told and have continued to learn from over the last 3 months. This group of wild water immersion enthusiasts are eager in the most beautiful, quiet sense. With bare feet, or for me with neoprene booties, we slowly walk across the ice and snow to the rocky river bed and enter the water up to our necks. All the morning anxiety, those personal battles to fight or flight in preparation for this cold pain completely melts away. After months of this practice, there is no sudden gasp for air, just a sense of calm, surrounded by mountains and trees and sky.
These sessions are typically three minutes long, though others immerse for up to 6-10 minutes in our local rivers, ranging from 32-40 degrees Fahrenheit in the winter. Taking 30-90 second cold showers at the end of your normal shower can help you prepare for this natural cold-water immersion that carries benefits with it that are just now being proven in scientific studies.
What could possibly be the benefit of showering or sitting in near freezing cold water?
Beyond just the extreme feeling of accomplishment and joy that people claim to experience, research is now showing the following physiological and psychological benefits (1):
Pain relief and muscle recovery: When cold and warm therapies are combined, or contrast water therapy, blood vessels constrict and open rapidly increasing blood flow. In the moment, but also beyond these episodes, research shows improvement of oxygen and nutrient delivery throughout the body. This may reduce swelling and speed up healing after an injury, but also may reduce chronic pain with routine back-to-back cold and hot exposure. Cold water immersion has also been shown in small studies to reduce delayed onset muscle soreness after exercise compared to rest or the use of cryotherapy (entering a chamber or body wrap that exposes the body to extremely low temperatures).
Improve mood: Research has shown that when immersing the body in cold water up to the collar bone, or even further to the base of the neck, the vagus nerve becomes activated. This has been a common tool in physiotherapy to prompt the brain to send signals to the body to up or down regulate hormones that stimulate healing and relaxation, which may also improve mood. Several studies have shown how cold water therapy has helped reduce symptoms of depression and anxiety. In one case study on reducing major depressive disorder, a 24-year-old woman engaged in a weekly open water swimming session noticed such a significant decrease in depressive symptoms that she was able to stop medication within one year (2).
Weight loss: Can sitting in cold water help us lose a few pounds? Recent studies, such as one from 2017 examining female winter divers, note cold water therapy may serve as a method to increase metabolism. In this particular study, basal metabolic rate was significantly higher during the winter months than in the summer, which would result in substantially more energy burning and potential weight loss. These women were also diving and swimming however, thus increasing their physical activity; a scientifically confirmed way of losing body fat and overall weight (3). The jury is clearly still out on this, as many small studies do not have enough participation to conclude significance.
The research has a long way to go to prove that cold water immersion can speed up muscle recovery, reduce pain, positively impact mental health, and maintain body weight homeostasis, but it is clearly an emerging study as scientists continue to explore factors that influence human lifespan. Small studies have shown that cold water therapy may improve sleep, bring down inflammatory markers that cause disease and injury, and even provoke mental clarity and sharpness. The biggest challenge in proving these life altering benefits may be finding the largest number of people willing to “take the plunge.”
Hold on future winter dippers! A word of caution.
Walking into and sitting in freezing cold water has serious risks. Especially when “plunging” into an ice bath or river or ocean without practice, the heart may not be ready to take the sudden rapid increase in heart rate and blood pressure. As the body’s core braces to save the vital organs, blood rushes from arms and legs making it very difficult to move to safety if needed. Hypothermia can set in if the body drops below 95 degrees Fahrenheit, which can lead to heart or respiratory damage (4). While the stress of the cold shock response may be beneficial in many ways, the risks carry serious consequences. For any of us with a history of heart or lung conditions, cold water immersion may lean more harmful than helpful. Discussing practical and small ways to explore this modality with your doctor is advisable.
Do what works for YOU.
So why is the dietitian telling you about my adventure with cold water therapy and some of its perceived and proven benefits? There are many fad diets and health trends out there, and all of us in the medical and science communities must weigh in on the validity of these claims to provide guidance and support for our patients and the broader public. When social influencers and movie stars (Chris Hemsworth, Limitless) are telling us that jumping in cold water may improve circulation, encourage weight loss, and help us live longer, happier lives, this calls for discussion. Unique human characteristics and health history are NOT part of these promotions, so always consider every health message you receive with an ounce or two of personal and professional wisdom (you and your doctor).
When I was a young girl, my mom would take me to the beach for routine swims in cold, ocean water. To this day, I still remember wading and diving into the waves, surfacing with a gasp, my heart thumping out of my chest. With a few words or a grasp of my hand, she would calm me down, “follow my breaths, in and out.” Every layer of my body would relax and surrender, focusing on the swim and always followed by the most significant sense of calm. Since these early cold saltwater days, this advice guides me through every major known and unknown stressor, including grief, anger, exhaustion and exhilaration. Even in childbirth as I sat in a pool of warm water, I heard my mother’s words, “follow my breaths, in and out.” Life gives us all sorts of pain to wade through. Whatever treatment you use to cope, to learn from, or find pleasure in, make it a practice and it soon becomes easier and maybe even, therapeutic.
Kati Burton is a Registered Dietitian Nutritionist and owner of Burton Nutrition. She enjoys eating sardines with her 2-year-old daughter, Agathe, and making gluten-free chocolate chip cookies (celiac disease diagnosis, 2021). She passes her non-working and non-parenting time running and skiing in the mountains with her husband Josh, swimming laps, and reading fiction. Kati fervently believes in enjoying cheese and an occasional glass of wine because life is too short. You can contact her to inquire about article topics or to schedule a nutrition counseling session at burtonnutrition@gmail.com.
References
(1) Bedosky, L. What is cold water therapy? A detailed scientific guide. Everyday Health. December 12, 2022. Accessed on January 3, 2023 at https://www.everydayhealth.com/wellness/cold-water-therapy/guide/.
(2) Van Telleken, C, Tipton, M, Massey, H, et al. Open water swimming as a treatment for major depressive disorder. Case Reports, 2018; 2018:bcr-2018-225007.
(3) Lee, JL, Park, J, Kim, S. Cold adaptation, aging, and Korean women divers haenyeo. J Physiol Anthropol. 2017;36: 33. Doi: 10.1186/s40101-017-0146-6.
(4) Williamson, L. You’re not a polar bear: The plunge into cold water comes with risks. December 9, 2022. Accessed on January 3, 2023 at https://www.heart.org/en/news/2022/12/09/youre-not-a-polar-bear-the-plunge-into-cold-water-comes-with-risks.
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