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if you can handle them brief exposures to intense cold could help with chronic fatigue syndrome, fibromyalgia, orthostatic intolerance, and long COVID 

• Note that in addition to The Gist, a Treatment Takeaways section can be found in the lower right section of the blog.

On the face of it, cold exposure seems insane. Taking a dip in an ice bath, plunging into a cold lake, or just shivering through a cold shower seems more like torture than anything else – and that’s for a healthy person.

Think what it might do, then, to a more fragile person with chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), fibromyalgia (FM), or long COVID. It seems like it’s just asking for trouble.

Both anecdotal reports and studies suggest, though, that some people with chronic fatigue syndrome (ME/CFS) and/or fibromyalgia (FM) can benefit from ice baths, cold showers, and/or short dips into cold oceans or lakes. Studies suggest that people with ME/CFS and/or FM can actually tolerate whole-body cryotherapy – which exposes people briefly to unearthly cold temperatures – quite well.

Intentional cold exposure for better health has a long history that dates back at least to ancient Greece. Over the past fifteen years or so, cold exposure has become a “hot” item and papers are currently flying off the printing presses.

Numerous Potential Benefits

It should be noted that most studies are small, but recent studies suggest that cryotherapy can boost antioxidant levels, reduce oxidative stress, reduce inflammation, enhance parasympathetic activity and heart rate variability and reduce heart rates, improve insulin sensitivity in type II diabetes, lower glucose levels in women, reduce inflammation and quicken muscle recovery after exercise, improve red blood cell health and reduce clotting, improve exercise performance during exercise, etc.

Andrew Huberman believes an extended dopamine release that can last for several hours after cold exposure may be the most significant benefit. Low dopamine may be a big deal in ME/CFS and FM. For me, I wonder if increased parasympathetic nervous system activity (rest and digest) would have the most benefit. (Note that cold exposure temporarily increases sympathetic nervous system activity (fight/flight) but enhances parasympathetic nervous system (rest and digest) activity afterward.)

One review paper asserted cold exposure can retrain the autonomic nervous system – something potentially quite helpful for these diseases and impacts many systems in the body:

“repeated shock-like cryogenic cold stimulus over the entire body surface that induces reactions in the autonomic, endocrine, circulatory, neuromuscular and immunological systems, resulting in an adaptation that contributes to the restoration of the homeostatic state. Therefore, based on the existing evidence, WBC can be described as follows: a “training method” for the autonomic nervous system; a novel anti-inflammatory and antioxidant treatment; a treatment with beneficial effects on body composition and adipose tissue.”

Concerning pain cold exposure can trigger the release of feel-good substances called endorphins, modulate the levels of neurotransmitters involved in pain, slow pain signals to the brain, increase blood flows, and relax tense muscle fibers. One study suggested it may be able to increase slow-wave sleep – the most restorative part of sleep.

Andrew Huberman also calls cold exposure “great training for the mind” because it forces us to exert “top-down control” over the deeper the brain centers, resulting in a calmer, clearer mind. Because that involves activating our prefrontal cortex – which studies show is hampered in ME/CFS and FM – that might be helpful in these diseases. (Some research suggests that the inability of the prefrontal cortex to tame the limbic system (fight/flight/autonomic nervous system regulation) plays a role in ME/CFS/FM.

Almost all of the purported benefits could conceivably be helpful for people with ME/CFS, FM, postural orthostatic tachycardia syndrome (POTS) and/or long COVID.

GETTING COLD

Cold vs REALLY Cold

There’s cold and then there’s REALLY cold. Fifty to fifty-nine degrees is considered optimal for ice baths and that is quite cold. I remember dipping into a 55-degree ocean one spring day in sunny Southern California before the cold water current shi and it seemed freezing. This temperature range is cold enough to constrict your blood vessels and reduce inflammation in your muscles, but not so cold that you risk hypothermia or frostbite.

Then there are the really, really cold temperatures found in cryochambers. If you think taking an ice bath is intense, an ice bath (50 and 59 degrees Fahrenheit; 10-15 degrees Celsius) is downright tropical compared to the temperatures found in cryogenic chambers (-166 to -220 F; -110 to -140 C). People enter cryochambers wearing a swimsuit, a woolen headband that covers the ears, a nose and mouth mask, and dry shoes and socks. They’re out of them in a minute or two.

Chronic Fatigue Syndrome (ME/CFS)

Cryotherapy showed up quite early in ME/CFS. A 2007 hypothesis, “Possible use repeated cold stress for reducing fatigue in chronic fatigue syndrome: a hypothesis“, by Nikolai A Shevchuk proposed using it in ME/CFS.

Shevchuk may have been the first researcher to mention “hormesis” – exposing oneself to small amounts of stress – in conjunction with ME/CFS as well. He proposed that repeated short-term exposure to cold would activate the brainstem and HPA axis, increase metabolism, reduce serotonin, and improve opioid tone.

He believed that “exercising” the HPA axis with cold exposure might restore it to normal functioning. Interestingly, given Cortene’s hypothesis of increased serotonin levels, Shevchuk cited the “serotonin hypothesis of central (or brain induced) fatigue” when he suggested cold exposure would reduce overly high brain serotonin levels. On the other hand, activation of the reticular activating system in the brainstem would increase “arousal” and reduce mental and physical lethargy. The effects of cold on neurotransmitters, nerves, etc., could help with pain overall, muscle pain, and speed up recovery times after exercise.

Shevchuk proposed – 17 years ago – a study in which 58 ME/CFS patients take cold showers at a specific flow rate for a specific time frame (5-minute “cold up” pre-shower period (exposure to feet upwards)) followed by a 3-minute shower, twice a day for 8 weeks. His idea wasn’t taken up. It wasn’t until the early 2020s when Julia Newton teamed up with Polish researchers that a cold exposure study was done. In the study, 32 ME/CFS patients spent from 0.5 to 2.5 minutes in a cryo-chamber (-120 C) for ten sessions over 12 days. The exposure time began at 30 seconds and reached 150 seconds in the last session.

Immediately after the exposure, kinesiotherapy sessions involving breathing exercises, and passive stretching exercises for 30 seconds of the ankle, knee, hip, wrist, elbow, shoulder, and neck area were done.

Despite concerns that the ME/CFS patients might have low cold tolerance, they reportedly tolerated the sessions very well. The authors noted that while over half the ME/CFS patients dropped out in a previous aerobic activity study, none of the patients did in this study. Whole body cryotherapy mimics exercise to some extent but it appears to be much better tolerated in people with ME/CFS.

The study and its follow-ups reported finding reduced fatigue and daytime sleepiness, and increased cognition. While the study noted “a high heterogeneity” in responses a month after the sessions, most participants still showed improvement in all three fatigue scales a month later.

The authors cited cryotherapy’s “relative ease of application, good tolerability, and proven safety”, and suggested more studies be done.

Fibromyalgia

Cryotherapy has received a bit more attention in fibromyalgia. Most of the studies – as befitting a new and kind of fringe topic – are small and don’t appear to be particularly rigorous.

A 2013 Italian (15 consecutive sessions) reported an overall “improved quality of life“. A 2018 French study (10 sessions over 8 days) reported improved “health-reported quality of life” that lasted for at least one month. A 2021 German study (3 and 6 sessions) dug a little deeper and found reductions in pain and “disease activity”, that were associated with significantly altered immune readings (IL-1, IL-6, TNF-a, IL-10). The fact that three months later the effect was gone suggested cryotherapy may need to be done every couple of months.

Earlier this year, Italian researchers proposed in a hypothesis paper that cryotherapy should be helpful to combat central sensitization – the process by which pain and other sensory signals get amplified in the brain. A large (n=300) cryotherapy fibromyalgia study underway in Italy is expected to wrap up next year. Note the lack of cryotherapy studies in the U.S.

Getting Whole Body Cryotherapy

Note that most studies used a cryo-chamber. Cryotherapy centers in major cities do not appear to be hard to find – I found at least 8 in Phoenix – but are costly. The answer to an AI query stated that WBC sessions generally cost from $50-100 and package deals may lower the price.

Getting Cold Naturally

Doing an ice bath, cold shower, plunging into the ocean, or walking around in the cold is probably more arduous but is much more affordable. Numerous videos explain how to do an ice bath, build an ice bathtub, etc. Affordable, portable ice bath tubs ($30 – $100) can be readily found on Amazon and some gyms provide ice baths. You can also buy your own ice bath machine ($1,000 – $2,000) or aquatic water cooling machines ($1,000 – $1,500).

How cold your water at home is depends on how cold it gets at night. If temps get cold enough, a pool provides an easy way to get a cold dip. Likewise, during winter, many people can get quite cold water right out of the tap.

How Cold is Cold Enough?

One piece of good news is that the worst is first: the more you do cold exposure, the easier it is to tolerate. You might want to keep in mind that when you’re exposed to cold, the first minute is the worst.

One website asserted that from 50-59 degrees is optimal, but Andrew Huberman believes how cold it feels to you is more important. He says, “The key is to aim for a temperature that evokes the thought, “This is really cold (!), and I want to get out, BUT I can safely stay in.” For some people, that temperature might be 60°F, whereas for others, 45°F.”

That said, the colder the temperature you can tolerate, the less time you need to spend in it to achieve benefits. Huberman cited a study which found that significant increases in dopamine (likely a very good thing for ME/CFS, FM, etc.) from being in cool water (60 F) for about an hour, which another found significant increases in epinephrine after about 20 seconds in 40F (very, very cold water). (A couple more degrees and it would start to freeze.)

Moving your limbs a bit is recommended as it breaks up the thermal layer that forms around you when you are still.

Focused Breathing and Meditation Can Help

Focused breathing can be helpful in any stressful situation and few things are more stressful than immersing yourself in frigid temperatures.

Zenwave states that breathing techniques can transform an ice bath from “a mere physical challenge into a meditative experience that cultivates mental resilience”, and provides 8 breathing techniques from Wim Hoff’s famous technique, to Tummo, to controlled exhale breathing to box breathing, etc.

The website proposes that “Deep Diaphragmatic Breathing” or “Box Breathing” might be best for beginners, while the Wim Hof Method” or “Tummo Breathing” may be more challenging but also more rewarding. If you’re experiencing anxiety, try the “Controlled Exhale Technique” or “Progressive Relaxation Breathing”.

Zenwave also suggests meditation techniques to be used pre-post and/or during the cold exposure that can be used to calm the mind.

Duration

Huberman suggests doing 11 minutes of cold exposure a week (2-4 sessions lasting 1-5 mins) total. Because doing cold exposure can disturb some people’s sleep if done later in the day, he suggests doing it in the morning.

Letting Your Body Warm Up Naturally

If you can handle it (brrr!) Dr. Susanna Soberg has found that letting your body reheat naturally after cold exposure activates a special kind of fat called brown fat – which your body burns to create heat. Brown fat, Soberg asserts, “supercharges your metabolism”. She believes allowing your body to heat up on its own can “improve overall metabolic health” and is “particularly effective in addressing metabolic disorders like type II diabetes”.

Soberg says her “Thermalist Method at home” course ($268 for 3.5 hours) provides “step-by-step techniques on how to effectively integrate cold & heat exposure with breathwork techniques.” (Health Rising is not affiliated with this course).

(Soberg may have a good program, but her blogs are short and rather unilluminating. A recent blog on “Chronic fatigue and sleep deprivation and how to fix it“, for instance, provided a short overview of a 2016 ME/CFS study, and for the fix it part, Soberg simply wrote, “Proper sleep management can improve symptoms and overall well-being.” (???) )

How To’s

 

Conclusion

Baby steps are required with a treatment that produces such a shock to one’s system, and cold exposure. Doing cold exposure after exercise and stretching after the session may help. Only small amounts – just 11 minutes of intense cold exposure a week- are needed.  Cryo-chambers appear to be readily available in major cities but cold exposure can pretty easily be done at home. If it feels cold to you – then it’s cold enough. Like other hormetic approaches, cryotherapy is not a cure, but the science suggests it may be able to help in several ways including increasing dopamine levels and improving parasympathetic nervous system activity.

• Blogs on two other hormetic practices – red light therapy and sauna – are coming up.

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