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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.
THE GIST (See “Treatment Takeways” (below) for ideas on how to do cold exposure)
- 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 – particularly for someone with ME/CFS, FM or Long COVID but both anecdotal reports and studies suggest that some people with chronic fatigue syndrome (ME/CFS) and/or fibromyalgia (FM) can benefit.
- Recent studies suggest that cryotherapy or cold exposure can do several things that could be helpful in these diseases including enhancing dopamine and endorphin levels, parasympathetic nervous system activity, blood flows, rmuscle recovery, improve sleep and exercise performance, and reduce oxidative stress, inflammation, muscle tension, etc.
- There is cold (ice bath, ocean water plunge, cold shower) and there are the really, really cold temperatures found in cryo chambers. 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).
- Back in 2007 a researcher proposed using cold exposure in ME/CFS but it took17 years for the first study to appear. The cryo-chamber plus stretching study found that ME/CFS patients tolerated their time in the frigid cryo-chamber (-30 secs to 2 1/2 minutes) quite well and reported reduced fatigue and daytime sleepiness, and increased cognition. The authors cited cryotherapy’s “relative ease of application, good tolerability, and proven safety”, and suggested more studies be done.
- At least 3 fibromyalgia studies reported an “improved quality of life, and/or reductions in pain and “disease activity” and improved immune readings (IL-1, IL-6, TNF-a, IL-10). A recent hypothesis paper proposed that cryotherapy be used to combat central sensitization – the process by which pain and other sensory signals get amplified in the brain.
Hardcore cold exposure.
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
A cryosauna.
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 shifted out to sea, 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.
Treatment Takeaways
- 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.
- Cryotherapy chambers can be found in major cities but are expensive ($50-100 per session). Ice baths, cold showers, cold dips in the pool, ocean or lake bathing, etc. can all be done cheaply, and many products are available (see blog.
- Andrew Huberman believes how cold the exposure feels to you is more important than how cold it actually. . 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.”.
- However, they are done cold exposures are very short! Huberman suggests doing just 11 minutes of cold exposure a week (2-4 sessions lasting 1-5 mins) total. Because cold exposure can disturb some people’s sleep if done later in the day, he suggests doing it in the morning. Focused breathing can be quite helpful – see the blog for a description.
- If you can handle it (brrr!) letting your body reheat naturally after cold exposure activates a special kind of fat called brown fat that may be able to “supercharge your metabolism” and “improve overall metabolic health”.
- Check out the blog for some how to video’s
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.
Pools, ice tubs, and bathtubs can all provide a nice chill!
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
Breathing techniques can be helpful.
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”.
Ready to take the plunge?
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.” (???) )
Risks
WebMD states that people with the below conditions would avoid whole body cryotherapy. The two that stick out for me with regard to ME/CFS, FM, and long COVID are neuropathy or nerve damage and blood clots. Note, though, that the kind of micro blood clots believed present in these diseases may be different from the kinds of blood clots this article is referring to. Also, the four ME/CFS/FM studies found that cryotherapy was well tolerated. A 300 person fibromyalgia study that is underway should tell us a lot.
- Acute renal and urinary disorders
- Allergy symptoms related to cold
- Cardiovascular or respiratory system diseases
- Circulatory problems, including a history of blood clots or deep vein thrombosis
- Fever
- Acute respiratory illness
- Had a heart attack within the last 6 months
- Have a pacemaker or other implantable device
- Neuropathy or nerve damage
- An open wound, skin infections, or wound-healing problems
- Serious cognitive disturbances
- Seizure disorders
- Severe anemia or wasting disease
- Substance use disorder and current alcohol or drug use
- Untreated high blood pressure
- Unstable angina
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.
Health Rising’s Donation Drive Update!
We don’t let a little cold get in the way of finding ways that may help with these diseases.
Thanks to the over 100 people who have contributed thus far!
When it comes to treatment possibilities we don’t let cold, pain, or seemingly unorthodox treatments get in our way.
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I’m 71 years old and I’ve had ME/CFS, fibromyalgia, and Raynaud syndrome for 40 years. I can’t imagine this working for me. In fact, it would be the most excruciating pain and torture I could imagine! I guess I don’t have any polar bear DNA. Thanks anyway, Cort. This blog has me laughing but I’ve been a regular reader for several years now. Happy Holidays!
It’s crazy isn’t it? I think this is one of those start VERY SLOWLY and work yourself up kind of thing – for those who are intrigued by it.
Yes, I completely agree. No shock allowed. The purpose of Hormesis is gradual acclimatization.
Hello Cort and everyone,
As some of you know I have been weighing all of these aspects (on Healthrising) of health and of homeostasis, and of the cell defense response (CDR) since March 2020. In August that year I met a 65-year old having both CFS and Fibromyalgia diagnoses.
My first major conclusion on reading research papers was that the CFS and the other chronic diseases that this woman had (which I am omitting) were all VASCULAR issues. Vascular issues based on HPA Axis dyshomeostasis. It is 2024 and I have never abandoned that medical basis, even as my ideas (to hopefully help CFS patients and maybe Fibro patients too) have evolved and also gotten more microscopic.
I told that friend i 2020 that it would be good if she could manage contrast showers (hot, then cold, then hot, then cold for longer….etc.) since they would reduce inflammation and boost dopamine. She said she could not even be sure to stand up for the duration. Fair enough.
One main reason I had suggested it was that it became clear to me that, at least in Fibromyalgia, dopamine was sorely (no pun) lacking. Dr. Gerald Albrecht was using MRI software-tailored to viewing activity in the brain in order to see what areas of activity were scaled down. “It smells like dopamine” he commented in his lecture about Fibromyalgia, the focus of this study.
He compared the dopamine drought in Parkinson’s and in other chronic disease.
I too watched Dr. Huberman in the past year and heard the above message. But back in 2020 fall I had already encountered “The Ice Man” Wim Hof and his combination of breathing methods (breath holding plus not breathing for periods of seconds) with cold exposure. The breath-holding allows INCREASED oxygen saturation of the cells, while exhaling and NOT inhaling immediately
allows increased Co2 discharge.
While Cort has said that Huberman “believes” certain points about cold’s healthy effects, Wim Hof already surrendered his body as a test subject… and research PROVED the claims.
Lastly, the other thing I observed in my friend was a set (syndrome) of symptoms that also spoke of a lack of dopamine: in pain relief, in muscle relaxation, in endurance (also muscle relaxation). It would account for shaky footing, for not being able to continue exertion of muscles, and also to a lack of feeling that one CAN continue to exert mentally or physically.
If you were not aware: when a person, say, goes running, or swimming, their muscles can sometimes run out of oxygen, especially in athletes who are pushing themselves to the max. That is where anaerobic metabolism of glucose comes in because it gives respite to the oxygen system of producing energy, long enough for carbon dioxide to be cleared, so that the person can resume oxygen-based metabolism of glucose. But those moments of exertion and of lactic acid build-up, albeit normal for anaerobic metabolism, bring on muscle stiffness.
Hopefully that sounds quite familiar. Why? Because what COMBATS the muscle stiffness is : DOPAMINE. It is as much a “you can do this” motivator of exerting muscles as it is a motivator of thoughts and behaviours, learning, accepting challenges.
And you must be aware, thanks to Cort Johnson, that the muscles, brain and even emotions seem to “run out of steam” as a *group*. One impacts the other impacts the other other. It surprised me that Cort described the Limbic system as responsible for fight/flight/autonomic neural regulation — not because it isnt true… not at all! .. but because I KNEW that was true… but then… another set of opinions said that the Limbic system was really just your emotions. I said “hey wait a second…”
but Cort has justifiedly set the record straight. It is both.
Dopamine is a relaxer or smoother-outer.
Not sure if you would be aware, but Dr. Huberman included this fact: when Dopamine is sent to a site in the body, so is Norepinephrine (noradrenaline). The way I interpret this is: since we can go from L-Dopa, to dopamine to epinephrine, to norepinephrine, AND BACK AGAIN…. the body and brain are AGILE with what needs next to be done with the Norep. It may need to
go back one step and be Dopamine, or forward one step and be Adrenalin (Epi).
He said: if Dopamine goes to the site, then so goes Norep. If Norep goes to the site, then so does Dopamine. They do not travel singly.
So think about it: Dopamine motivates your mind to push beyond limitations and also pushes your muscles to do that, but your muscles obey your brain too. Brain could run out of Dopamine before muscles are spent. I had also recommened to my friend in 2020 that she *consider* taking Wellbutrin, Wellbutrin is a Dopamine re-uptake inhibitor, but also of Norep. Bingo. Why?
Because dopamine brings endorphins for pain relief, all in the search for relaxation.
Have you ever read that a RELAXED mind is more efficient than a stressed one? Think: Grace under pressure. But remember that Grace — is a gift.
Her response was, despite Dr. Gerald Albrecht: “no way… I am NOT going to take a psyhiatric drug.” And she is still where we left off in 2001 January.
WELL !!!
The only two mainstream drugs that have ever seemed to help Fibromyalgia pain are:
Lyrica
Wellbutrin
Everything is constrained by subset subterfuge.
But Dopamine is universal. It is CRUCIAL to smooth/calm
muscle movement in our bodies
and sadly lacking in Parkinson’s disease.]
Not sure if you have been reading, but now Parkinson’s
disease is considered reversible.
Diabetes 2 is considered reversible by fasting and oil intake.
Alzheimer’s disease has been RENAMED: Diabetes T3 (type 3)
There are functional medicine doctors who are claiming that
all chronic diseases can be reversed. Dr. Wahls reversed her
own for herself.
It is mostly through DIET.
please: Triet !!
Hi Christopher,
Like many of the symptoms of Long COVID, the diseases that you mention, Parkinson’s, TTD and Alzheimers (or at least dementia) are associated with Secondary Mitochondrial Dysfunction (SMD).
I agree that diet plays an important role in treatment and possible recovery.
I’ve been writing about diet in the treatment of Long COVID over the last two years. Additionally, there are lifestyle considerations including avoiding post exertional malaise and stress. Some basic supplements also help to support mitochondrial recovery.
A summary of these points can be found at a free post on Substack https://open.substack.com/pub/longcovidjourney2wellness/p/long-covid-tlc-for-mitochondria
Kind regards,
Mardi Crane-Godreau, PhD
Dear Christopher
Wellbutrin is known to be mitochondria toxic, though:
https://link.springer.com/article/10.1007/s00210-019-01791
It is therefore a difficult decision and I understand the hesitation of the mentioned person.
I accept that observation. Unfortunately I can’t read the Springer article because it requires a subscription. My point is not that one needs Wellbutrin. Not at all. My point is that one of the few things that has seemed to help Fibromyalgia did so by inhibiting the reuptake of both Dopamine and Norepinephrine (noradrenaline). It is one illustration of the deficit of dopamine.
Thank you for your reply. I understand that Wellbutrin can be very helpful.
I am actually faced with the same decision, whether to try it or not. I am bedridden with Bell 20 and have shattered mitochondria after several chinolone antibiotics and covid.
If there would be a way to genetically or similarly test how it works in my metabolism, I would risk trying Wellbutrin, but at this stage I think I need to prevent potential further damage.
Sorry that the link requires subscription. Here is another similar one:
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0042-123034
It says:”
Bupropion is a widely prescribed antidepressant/smoke cessation drug. However, hepatotoxicity is one of its side effects reported in some recipients. The mechanisms by which bupropion induces hepatotoxicity is not clear yet. This experiment was intended to assess the cytotoxic mechanisms of bupropion toward primary rat hepatocytes. Additionally, the effect of α-tocopherol succinate (ALPHA-TOS) and N-acetyl cysteine (NAC) and mitochondrial permeability transition (MPT) pore sealing agent cyclosporine A (Cs A) on this toxicity was investigated. Cell death, LDH leakage, reactive oxygen species (ROS) generation, lipid peroxidation (LPO), and mitochondrial depolarization were examined as toxicity indicators. Results revealed that bupropion led to a surge in ROS formation, depletion of intracellular glutathione, elevation of LPO, and mitochondrial collapse. ALPHA-TOS, NAC and Cs A administration diminished the intensity of cellular damage caused by bupropion. This experiment suggests the protective role of ALPHA-TOS, NAC and Cs A against bupropion-mediated cytotoxicity possibly through their reactive radical scavenging properties and their impacts on mitochondria. Furthermore, mitochondria might be contributed to the oxidative stress response and subsequent toxicological results observed by bupropion.”
Thank you Petra.
Do you know of the meaning of the rock called Petra? I believe it may be taking action here…
I read your description of the negative effect of Bupropion upon mitochondra.
Allow me to
agree
but also to point out a few related facts that may ease your mind on the subject of trying a low dose of Bupropion.
a) I take it, along with Effexor (venlafaxine)
for alleviation of debilitating anxiety from “automatic thoughts” which incite an adrenaline or fight-flight response. Such anxiety has prevented me from pursuing University
I have quit various challenges and train-wrecked my life path to my iwn concept of “success” , which ought to have been glorious but was hideous.
.. only to quell the almost, but not quite, zero dopamine levels in my cognitive brain tgat told my limbic system — during those too-numerous to count episodes — that I must have been dying. . I still had apetite, however.Even emotional eating– which did not work, though. I never lost the logical concept of possibility, even a miracle… but I definitely lost hope. It was pure character only, since no one else could possibly “feel me” (and God forbid that they ever feel it).
The dopamine just didnt show up in the cognitive brain (one of the 3 or 4 victims in CFS) . I definitely had a deficit of attention… but yet… since the age of 15… managed to reduce my anxiety by meditating (I realize now…) on the very subject of my fear:
The Curriculum.
Yes, mitochondria do output ROS.
OF COURSE !!!
They do during aerobic (normal) exertion, or aerobic glycolysis.
but they output MORE during anaerobic glycolysis. (Which, by the way, is cancer’s only option)
(pardon the break.. my index finger is cramping)
(not really– but yes, annoyed)
My correction: where we were in 2021 January
yes, have visited the site in Jordan already ;). Thank you for your thoughts and sorry for your struggles and challenges. Glad that you did not give up and found things that helped.
I will reconsider it. Starting at a low dose sounds like a good plan.
Doesn’t Low Dose Naltrexone increase dopamine levels? LDN does seem to help quite a few people (I was worse on it). It will be interesting to see the results of Jarred Younger’s trial of his version of LDN.
I love the dopamine connection in part because the basal ganglia which potentially figures in both movement and reward – and the dopamine connection just got a lot more interesting for me with the fact that its important in muscle relaxation – a key issue for me since the beginning. 🙂
Right ! So how I originally looked at CFS was that possibly the Acetylcholine would be released and that would open the TRPM3 as normal, but when Norepinephrine (Noradrenaline) and Dopamine should be also coming along to make muscle movement smooth, one of the obvious indications of the lack of dopamine was the shaky footing, but also the lack of endurance. Really the lack of endurance is the key, do you agree? It is the difference between the muscles seizing up like a runner or a weight lifting overworking after a long absence from the activity, and the muscles getting something akin to the “second wind.” Now, I don’t mean the long-distance runner who gets a second wind in a marathon, since that is more about endorphins, but I just mean that the muscle truly should shut down (tighten) if it is overworked. But in the case of CFS it happens prematurely. And in just the same way as switch from aerobic glucose metab. to anaerobic glucose metab with excess lactic acid release. “Any number of factors might be responsible for low dopamine levels. These include sleep deprivation, obesity, drug abuse, saturated fat intake, and stress.May 19, 2024”– Verywellmind.com
Also,
https://www.sciencedaily.com/releases/2012/06/120619225725.htm
“A group of Spanish researchers has discovered a new function of the neurotransmitter dopamine in controlling sleep regulation. Dopamine acts in the pineal gland, which is central to dictating the “circadian rhythm” in humans — the series of biological processes that enables brain activity to adapt to the time of the day (that is, light and dark cycles).
…
All animals respond to cycles of light and dark with various patterns in sleeping, feeding, body temperature alterations, and other biological functions.
The pineal gland translates the light signals received by the retina into a language understandable to the rest of the body, for example through the synthesis of the hormone melatonin, which is produced and released at night and which helps to regulate the body’s metabolic activity during sleep.
Another hormone, norepinephrine, is involved in regulating this synthesis and release of melatonin in the pineal gland.
The functions of norepinephrine are carried out via binding to its receptors in the membranes of cells.
It was long believed that these norepinephrine receptors all acted independently of other proteins, but in the new study, researchers have discovered that this is not the case.
In fact, the receptors collaborate with other dopamine receptors forming ‘heteromers’.
When dopamine then interacts with its receptors, it inhibits the effects of norepinephrine — which means a decrease in the production and release of melatonin.
Interestingly, the researchers found that these dopamine receptors only appear in the pineal gland towards the end of the night, as the dark period closes.
Therefore, the researchers conclude, the formation of these heteromers is an effective mechanism to stop melatonin production when the day begins and to ‘wake up’ the brain.
“These results are interesting as they demonstrate a mechanism in which dopamine, normally increased at times of stimulation, can directly inhibit production and release of a molecule, melatonin, that induces drowsiness and prepares the body for sleep,” explained Dr….”
and further to this:
https://www.sciencedaily.com/releases/2023/09/230907105845.htm
“While aripiprazole [Abilify] has long been a standard treatment for psychiatric disorders, such as schizophrenia and bipolar disorder, recent studies indicate that it is effective in treating circadian rhythm sleep disorders, including delayed sleep-phase syndrome. This condition causes patients to sleep and wake extremely late at times. However, the precise mechanism through which aripiprazole addresses these sleep disorder symptoms remains elusive.
Located in the hypothalamic suprachiasmatic nucleus (SCN), the central circadian clock comprises clock neurons that synchronize with each other, maintaining a rhythm of approximately 24 h. Simultaneously, SCN is receptive to external inputs like light, aligning itself with the environmental light-dark cycle.
The researchers have found that aripiprazole disrupts the synchronization among the clock neurons in the SCN, heightening the responsiveness of these neurons to light stimuli in mice.
Additionally, aripiprazole influences intracellular signaling within the SCN by targeting the serotonin 1A receptor, a prominent receptor in the SCN.
” — Sep. 2023
Surprisingly I understand this ! I have previously taken Abilify. But it causes weight gain big-time. The drug name is not the point. The point is the mechanism.
How I read that last article is this: because Abilify/Aripiprazole disrupts the sync of the neurons that take I guess 24 hours to complete a chain reaction (think dominoes), then they are desperate for a sign of what time it is, and become extra sensitive to light to get it. I have read about delayed sleep-phase syndrome before, which you can also call jet lag.
Bottom line: poor sleep reduces dopamine receptors in the brain, and a lack of dopamine receptors is a lack of alertness. But bear with me as I refer to that lack of alertness as being in the feelings of the body and mind. Quite oppositely, the Reticula Formation, which I think Cort is including when he speaks of the brainstem, is hypervigilant. So, hyperalertness won’t let the person sleep deeply, meanwhile the rest of the body/brain seems to LACK alertness. Delayed waking…. that also struck a chord. You may be out of bed, but do you feel awake?
So glad to see this thing I’ve known about for years as helpful to my own ME and (even more so) HPOTS, is getting some good exposure in the community via HR. Its a very counterintuitive topic, and a practice that is full of paradox. Like how we sometimes actually need to deliberately become less comfortable to become more comfortable. And how those who would think cold exposure is not for them due to feeling cold all the time, would probably benefit the most from trying it.
Also although it’s something I embrace personally, I think it’s good for some people to get assessed for cardiovascular risk (at least to some degree) before engaging in acute cold exposure. That’s a balance I’ve tried to bring to it but, in the absence of being able to access the proper scans etc.. I end up mostly just following my intuition, being cautious, and getting good results. It’s just harder in the winter. I think summer is the best time for most folks to start. But this article might just inspire me to resume my practice with a quick cold shower.
Hint: you can start the shower hot, turn it to warm while breathing and preparing yourself to relax, and then turn it cold for the end. And you can increase the length of this cold ending a bit more each time.
On days when my HPOTS is particularly ‘squirrely’ there is nothing like a cold shower to calm it down, both subjectively and objectively (ie heart rate and blood pressure). But I suggest that as with many medications its best to start low and go slow.
“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 is ‘browned’ due to increased mitochondria in the fat, the increased mitochondrial metabolism induces heat instead of energy. I wonder given the energy deprivation in ME/CFS how this might impact the patient?
It makes me feel a ‘good’ exhaustion, like when I was healthy. I get good rest and sleep afterward.
I have PACS (mostly PEM) since end of 2020 and the cold shower was my first self experience to feel better and it still is so I am glad to read that article! Might try cryochamber as a next step.
As well BCAA+ works for me when doing physical effort.
Yes David. And what I know of cryochambers is that they are used extensively in Poland, but simultaneously Polish medicine did not recognize CFS. At one time NO ONE recognized CFS, but I’m saying that when USA came around, Canada, England came around, Poland did not.
What I understand is that the chamber is about -200 C. At first one goes in for 30 seconds, and goes out to recover for a while. Next they increase it to 1 minute… and so on.
Unlike a bitter Canadian or Michigan winter, one is not exposing skin to pure cold air. One would wear a sweater perhaps, so frostbite is not an issue. But even a sweater is no match for -200 .
Thanks Christopher !
You forgot two important facts.
1. Exposure to cold is a stress on the body, and all physiological stress is known to cause/exacerbate PEM.
2. It is known and well-documented that people with me/cfs have difficulty with thermoregulation, so where a healthy person will recover from cold exposure in an hour or so, someone with me/cfs will be shivering for the whole day, using energy they don’t have trying to get their temperature back up with reduced ability to thermoregulate.
I can confirm that both of the above happen, having tried it myself.
The studies you quote are on healthy people and do not take into account the above features of me/cfs.
I would strongly advise anyone with me/CFS to AVOID this treatment.
If you read the blog again Bryce you will see that I cite 1 ME/CFS study and 3 fibromyalgia studies – so, no the studies I quoted are not all on healthy people. I think you are making the common mistake of assuming that your experience will automatically translate to others experience. Of course, some people will not do well with cold exposure and some people will – that’s true of any treatment. As the blog noted the ME/CFS study found that the cryochamber was very well tolerated, no one dropped out – while during their exercise study, half the group dropped out.
The mantra is always the same – go low and go slow.
“Well-tolerated” by people well enough to participate in a research study, that is those with the most mild cases of me/CFS and clearly not experiencing thermoregulation issues. When I had more mild me/cfs, with minimal thermoregulation issues, I probably could have tried this treatment and not been harmed, but after a major crash I got much worse and my inability to regulate my body temperature deteriorated too, as did my physiologic reaction to light and sound. There is no way I could now handle the physiologic stress of this treatment. Nor could anyone who is too sick to participate in a research trial, because they are far more likely to have thermoregulation issues, and the shock of the cold to the nervous system is far more likely to induce PEM, not to mention the sustained energy requirements of shivering and trying to restore core body temperature.
There’s no pretense that this is for everyone but having a treatment be useful for everyone is not a hurdle a study has to pass in order for me to a blog on it. I would point out that ice baths were the last thing John Falk could tolerate before he died.
Even if it is just for patients who are well enough to participate in this kind of study it’s worth getting the word out about it. If we only talked about things that worked in more severe patients we’d probably have a pretty short list. (On that note if very severe patients can tolerate craniocervical surgery, I imagine that most people can try – if they want to – to very slowly and safely incorporate cold exposure into their treatment regimens. If it’s not working then just stop it.)
As I noted the participants in the ME/CFS study tolerated the very brief exposures to extreme cold in the cryochamber very well and none dropped out – while half of a similar group of patients did not make it through an exercise study; i.e. whatever reason, as stressful as cold exposure is, it doesn’t seem to generate the kind of PEM that other kinds of exertion do.
Time will tell, hopefully, how viable this is, and who it works for.
It benefits me greatly, and I am definitely not mild and have major thermoregulation issues. I know it seems counterintuitive but it ABSOLUTELY helps me!
I am at about 30% functionality, see my other comments for details. Of course everyone has to judge their own tolerance for themselves, but I really think a lot if people are missing out on something potentially very helpful.
Bryce,
… then here is something you might like and might risk: HEAT. Infrared and red light. They both penetrate the skin and they are known to give electron excitement to the mitochondria without the mitochondria having to metabolize more. Gratis energy. In fact, if the infrared is “near” enough, it also penetrates the skull and reaches… oh… I dunno (yes, actually I do)… the substantia nigra… which is super-important in the motor and pre-motor cortexes of the brain. The SN is *substantially dark* because of its OUTSTANDING density of brain melanin. Not just any melanin, but black melanin (“neuromelanin”:) … and a *substantially dark amount of it. Melanin utilizes UVB energy to convert cholesterol to Vitamin D3 in the skin pigment. Even in the eye pigment…. (hair pigment……. ???) But…as they have done with the appendix in the intestine, they don’t know what this pigment is for.
Ok:
1. Melatonin is a HUGE free-radical scavenger (who knows why?)(the purpose of sleep itself???…)
2. Medical science has said that the similarity between the word melanin and the word melatonin is a coincidence. NOT AT ALL ! The iris of the eye contains dark brown melanin (African, Hispanic, other), light brown melanin (Asian and quoteunquote ‘white’ people,)…yellow melanin (more prominent in people of Asian descent who tend to lack light brown and *definitely lack dark brown melanin, but I too, as a peachy person, have yellow… or else I would be pink)…. red melanin…, and red melanin with an absence of both dark and light and yellow melanins:
We categorize that as Albino.
Hmmmm.. and something about brown fat vs beige fat vs white fat…. (ahh, but I digress… or maybe not! … in a bad direction) We have brown fat, beige fat and white fat.
What do we now know about adipose tissue, ergo, fat colours?
a) That brown fat can be metabolized readily or quickly… BUT… only if the body goes ketoacidic at night, or during fasting.
b) we also have beige and white fat (adipose tissue) which can be converted to brown, and to beige, respectively, in that order. Diets are attempting to turn other adipose fat into BROWN so that we can lose mass.
But we ALSO KNOW THIS: Adipose tissue is comprised of TRI-glycerides. Glycogen is a DI-glyceride, and Glucose is a mono. Blood glucose is VERY reactive, or free-radical. That is why we require INSULIN to chaperone it, and a cell-membrane-receptor to pull it in.
TWO THINGS HERE: The body tends not to waste calories.
EXCEPT: during a phase in mitochondria that we now know as “Caloric bypass”
also known as wasting calories, also known at Ketoacidity or Ketosis.
But NOT KNOWN at that healthy point as Diabetic KetoacidOSIS. NO !!!
AT NIGHT, during sleep, including deep or phase 4 “Delta brainwave” sleep.
The other need is for the weaker or less productive mitochondrial phenotypes (since there are several programmed ones (or maybe just 3…) to experience Mitophagy. When this occurs, mitochondrial replacement then must also occur. But this will be generated from the mitochondrial DNA, not as a direct copy of a damaged mitochondrion.
Inform me if you know more about DNA, but is the mitochondrial DNA first derived from the main DNA of the cell? I guess maybe, maybe not, but one has to ask whether a sperm cell or an ovum cell has mitochondria. I’m going to have to say yes. I would also assume that stem cells are an option if you believe that, no, the mitochondrial DNA must be damaged in “damaged mitochondria”.
Here is a million dollar question: when some cells in the patient’s body are experiencing CFS, does that mean that *all 3 trillion cells* are doing so? I don’t believe so. The damage depends on where the insult hit. An insult can be an injury, toxicity, virus, bacterium, pressure etc. An insult is not necessarily an infection, but the term does comprise all of those impacts including infection.
My theory is that both in covid with the ACE2 receptor, and in all influenzas with first the a,2 sialic acid receptor and later the a,6 sialic acid receptor, SMOOTH MUSCLE is the most receptive type of cell and that that includes: BLOOD VESSELS (endothelial muscle cells), the kidneys (microvessels),
widespread organ/sphincter damage, including esophagus, iris of the eye.
We have several nerve cell receptors such as nociceptors (toxic and heat/cold), baroreceptors (pressure), mechanoreceptors (trauma), and thermoreceptors.
From ScienceDirect:
https://www.sciencedirect.com/topics/neuroscience/thermoreceptor#:~:text=Applied%20Neurophysiology%2C%201988-,THERMORECEPTORS,firing%20rate%20of%20the%20other
” Thermoreceptors are preferentially receptive to cold or to warmth. Both have a resting discharge so that an appropriate change of skin temperature reduces the firing rate of one type as well as increasing the firing rate of the other.”
Now, Bryce, unexpectedly, as all of our discoveries tend to be: I am very excited that you challenged the exposure-to-cold hypothesis. Because it then led me to one further quote from the same article:
“Thermoreceptors are present in the preoptic-anterior hypothalamus area, responding to a deviation in core temperature relative to the temperature set point. However, other thermoreceptors in skin, viscera, and spinal cord are also important. Afferent impulses from these peripheral receptors travel in the spinothalamic tract afferent pathways, but also ascend as multisynaptic fiber pathways diffusely in the lateral spinal cord, to the reticular formation of the brain stem, and finally to the hypothalamus and thalamus. In addition to thermoreceptors, changes in fluid volume and electrolyte concentrations also affect thermoregulation. Dehydration results in central hyperosmolarity, which inhibits the firing of ‘warm’ neurons in the preoptic-anterior hypothalamus area, and reduces heat-dissipating responses. It has also been demonstrated that hyper- and hypovolemia, without changes in osmolarity, cause a rise and fall in body temperature, respectively, and much of the changes are mediated by neuropeptides. ”
Well …that is a lot to consider. Unless: you are an H-R faithful.
We are accustomed to the fact that the Hypothalamus temperature set point has been altered downward, which seems to be part and parcel of the CDR Cell Defense Response. I am seeing a hypothermic tendency (CFS patients are never warm enough) which includes the absence of Shivering. YES cells can be commanded by their mitochondria to produce only heat, or to produce energy plus heat, or to produce reduce energy plus shivering, or they may simply heat high, in high exertion activity.
That all is much more data to work with.
That was my thought throughout reading the entire article. And I’m not sure this should be done medically unsupervised. Or if the patient is alone.
There’s a problem here with citing Huberman’s ‘Bro Science’ for healthy athletes as medical advice people suffering illness should follow. Bryce has a good point. I hate to see these articles promoting programs and equipment and drugs that aren’t going to work and just drain the resources of seriously ill folks.
As for cold swimming, I’m all for it. I love to swim and will swim whatever the water temp as long as I can stand it, but there are serious risks to this therapy. I did laugh at the ‘brown fat’ comment, since I remember when an opinion went around that cold swimming was bad because it made the body create and store fat at a greater rate so swimming wasn’t good exercise. Watch that pendulum folks it may hit you in the head.
Let’s stick to medically appropriate fully vetted studies and skip the Bro Science.
The blog got written because I noticed that a number of fibromyalgia studies had been done; then I noticed that an ME/CFS study had been done, then I noticed that cold exposure had been recommended by a researcher over 15 years ago. Huberman showed up when I looked up studies outside of ME/CFS to learn more about cold exposure.
So if its “Bro science’ 🙂 please recognize that for me, it started with ME/CFS and FM studies.
Sorry, but I read every word, and I have also listened to many of Huberman’s podcasts. My opinion remains the same. I’ve read and donated to your posts for many years now, and your attack is unfair.
Hi! I think we both got tweaked by the last lines in the comment and I am going to remove my last line.
“Let’s stick to medically appropriate fully vetted studies and skip the Bro Science.”
You probably did not mean it to be but that was one of the most upsetting comments I can remember reading.
There’s something about the term “Bro science” that really rankled. To me it suggested that you didn’t believe I did my homework and that I was doing some sort of fluff piece – which is sure to raise my blood pressure!
The FM and ME/CFS studies may be small and may not be great but that’s what we generally have. I started with them and wound up at Huberman – not the other way around.
Anyway, I’m sorry that my reply rankled – of course it did – and I am going to redo it.
I’m with you on this one but anyone that hasn’t tried it and doesn’t have cardiac issues can certainly go low and slow and try it. I couldn’t even imagine it when I was really sick. Now I can splash cold water on my face and go outside in freezing temps without a jacket, long enough to fill the bird feeder, without CFS issues. MCAS on the other hand can kick in due to a cold breeze on warm skin, depending on the day, so like everything with these syndromes, it’s all very personal.
I have had ME/CFS for 25 years. Got Covid in 2022 and didn’t know that I had Covid and got my booster shot. Not a good idea. Then I got deathly ill for 4 months. Last August got Covid again and took plaxlovid. In October I had a major crash. The end of Oct. I tried cryotherapy and red light therapy at Restore (which was 10minutes from my house). I did about 6 treatments (most were 3 minutes) and felt worse and stopped. It was really cold but not as unbearable as I anticipated. I am still in a major crash but when I am feeling better, I plan to give it another go
Often during flare ups I crave cold water. We used to live near a creek with water that ran down from the mountains so it was really cold. It always helps my CFS but on one occasion it reversed the flare up. If I get into cold water after any exercise it seems to prevent the PEM. I always finish my shower with cold water too.
No wonder I do noticeably better on chillier days & seasons!
(32 years CFIDS/ME) But having Reynaud’s also, I’d never want my hands and feet any colder than necessary.
I tried this myself a few years ago. I lasted several months doing cold showers, but ultimately found that my body could not tolerate the stress of the cold response. Like pacing it probably depends where on the CFS/ME spectrum you are as to how much cold/exercise endurance that you have.
Thank you for interesting article. But I tkink we need to be careful about the idea that ice bath has same effect as cryotherapy.
in Japan, a small club which consists of doctors and researchers has studied about hot bath, hot spring, sauna’s effect on human.
Generally, water affects core temperature much more than air. Because air doesn’t move heat very much.
For example, their study shows taking 42°C bath impacts more than 90°C dry sauna. This suggests hot bath is harder choice for human body and gentle dry sauna like Waon therapy is preferably for ME/CFS people.
Following study also shows ice bath immersion significantly lowers rectal temperature than whole body cryotherapy . And this effect lasts long which means delayed recovery.
I think this trend makes a big difference for us. If stress is much bigger than positive effect, it just worsens symptoms.
And also some of us may suffer lasting lowered body temperature even if they can endure the whole body cryotherapy.
Thank you for reading.
This is my first comment. I really like reading your article, Cort.
And I hope you all be all right.
Costello JT, Donnelly AE, Karki A, Selfe J. Effects of whole body cryotherapy and cold water immersion on knee skin temperature. Int J Sports Med. 2014 Jan;35(1):35-40. doi: 10.1055/s-0033-1343410. Epub 2013 Jun 18. PMID: 23780900.
Interesting – thanks for the input.
I discovered that ice dipping is not very beneficial for individuals with cold hyperalgesia or cold allodynia, especially those with comorbidities such as hypothyroidism, dermatomyositis, Raynaud’s syndrome, lupus, Sjögren’s syndrome, systemic sclerosis, or mixed connective tissue disease.
https://swaresearch.blogspot.com/2024/11/understanding-cold-hyperalgesia-and_16.html
For sure…
I have a hydro tank and moved to cold water immersion when I couldn’t afford to heat it. The water is ambient temperature (so around 60F/14C at the moment) and I stay in for 20’.
My level of ME is the low end of moderate so I spend the majority of my time in bed or lying down. Once I’ve acclimatised to the cold, I like the sensation of it (whilst immersed). Being near-weightless allows me to do more (though this would also be so in warm water), so it’s a beautiful thing to be able to move, but also very easy to do too much and trigger PEM (and the cold makes this trickier to judge).
Its primary benefit for me is the joy I feel when I’m in the water – the cold, the absurdity, the ability to move. It doesn’t help my ME in any discernible way, but it does help me emotionally with endurance. Once out, it’s important to dry quickly and dress in multiple layers of clothing; this is by far the biggest exertion for me and is a problem.
About 45’ later, I get the ‘after drop’ and remain very cold for several hours, and this is where it takes a toll. I have no shiver reflex since getting ME and dysautonomia, so have to mega-layer up, but it still takes many hours to recover body warmth. Ultimately, it’s the joy that keeps me doing it.
Interesting the effect it has – both the joy and the after-effects… We are such interesting people! Thanks for relaying your experience.
Sorry folks, but as an M.E. sufferer who lives in chilly Scotland, and who knows a lot of us with M.E. I must yell in the loudest voice I can manage:
DO NOT TRY COLD TREATMENT FOR M.E.
Our poor punch-drunk Mitochondria are tired enough just keeping us alive without having to keep us warm as well.
The importance of keeping M.E. bodies at a nice, even temperature is well-known: not too hot nor cold.
I thought I’d seen the last of quack cold therapies 30 years ago – it made everyone a lot worse back then, and will do so now.
Again I would note both ME/CFS and FM studies showing that very brief exposures to admittedly very cold temperatures can be helpful as well as studies in healthier people showing that they seem to move the body in the direction we want to go – increased dopamine and parasympathetic nervous system activity, reduced inflammation, reduced pain, and improve mitochondrial functioning.
Living in chilly Scotland or any other cold climate, of course, has nothing to do with the kind of very brief exposures done with this approach.
As to the quack index – if you go to PubMed and check out the many scientific studies being done on cold exposure – I think you’ll be able to take cold exposure off the quack list.
Well I agree with using caution but I am someone with low-mod (30% function) MECFS who DEFINITELY benefits from cold therapy. Its actually one of my favorite things. Yes sometimes it wipes me out for a day or two – but its a very different kind of ‘sick’ exhaustion from what i normally feel or from just overexertion. It feels like the ‘good’ kind I used to experience when healthy, when I would feel a wonderful satisfied, even exhilarated kind of tired and sore after a hard days work. I loved that feeling then and I love the way cold exposure makes me feel now. Even when it wipes me out, I get very good rest afterward. I do have major thermoreg issues, esp with heat, but doing the cold sessions actually seems to help with that, feels like its resetting something in me. The only way I could tolerate a sauna or any heat therapy is if i do it in contrast with cold as well, and end with cold.
In fact, I am excited to look out my window and see snow this morning because that means I can go putter outside and actually do a little activity without feeling like I am dying. When outside temps get around 70+ I can barely step out of the house. In summer, if i even just go out for a car ride I have to wear a wet bandana and my husband has to stop often and let me get in the icy creek to bring my temps down. Literally my favorite thing to do, and if we can ever move I am buying land with its own creek so I can do this daily. In the meantime I am looking at a diy cold tank, though not quite the same Imsure the benefits will be. Oddly, I HATE cold showers but can dip right into a cold creek without hesitation! If only my hubby would consider northern Minnesota… 😀
Another thing i love is my Ice Beanie. I use it all the time and find it so soothing and helps with headaches, sensory sensitivities and brainfog. Highly recommend it!
I know it will not be the same for all and definitely recommend caution, but I do believe hormetic stressors – at a level we can safely tolerate and recover from – are absolutely a good thing (i know severe folks have crossed a threshold that makes ANYTHING more difficult or even undoable, but I think lots of us less-severe can benefit). I think its the main thing helping me to make incremental progress. To each their own healing journey, but cold exposure is a huge part of mine! (and before I got sick I was a summer-lover who was cold all the time!)
Ok time for a snow angel!
I just wish there was more info in the above blog on some of the dangers that may come with cold plunging etc.
I know of two people that it didn’t go so well.They are not here to tell they’re experience
I didn’t find much on side effects but this is what the Mayo Clinic said
” Acute exposure to a cold environment, either air or water, causes a stress reaction, as well as a temporary jump in blood pressure. That’s because cold causes the blood vessels to temporarily constrict, which in turn results in higher pressure. There also may be other negative effects that aren’t known yet.”
It can be very dangerous to take a very cold bath especially for your heart because your arteries narrow. Also i don’t believe in it.
That’s why we do studies Gijs – so we don’t have to rely solely on what we believe or don’t believe it. 🙂
Numerous studies have not found any heart problems by the way, in ME/CFS.
Hi Cort, Oh, I beg to differ. Dr. Paul Cheney found evidence of left diastolic dysfunction in ME/CFS patients and he did an echocardiogram on all his patients at their annual visit. Essentially patients with LDD have trouble with their hearts refilling after exercise. Peckerman also found evidence of heart problems in ME/CFS patients.
I would like to see a list of these numerous studies that didn’t find any problems with the heart.
Now let’s move on to Long Covid which has documented heart problems of a different nature. Irregular heart beats and high blood pressure. I have had both of these since my second bout of Covid.
And I just learned after a visit to an ENT, that Long Covid can also damage your hearing. My hearing profile was very bad.
When I had Covid the first time, the only thing that made me feel better was a hot bath. In the winter, I get so cold, my nose gets icy and that is inside the house. Note, we live in Florida.
In a recent news article one in four people who had the Omicron variety of Covid now have Long Covid. This is a national health emergency not likely to be cured with cold therapy.
I would like to see serious studies on these incredibly serious disorders.
Right, Cheney found poor filling – and he was ahead of the game there – but that’s almost certainly due to reduced preload as shown by Systrom’s invasive exercise studies; i.e. the left side of the heart is not getting enough blood to fill it properly. Cheney believed it was due to mitochondrial problems – he did not find any structural problems – but it’s probably due to blood being lost on its journey from the heart through the tissues back up to the heart.
Small hearts have been found but those fit well with the reduced preload, low blood volume found; i.e. they’re compensatory. The reduced stroke volume found is due to the same.
Check out the extensive review of biological abnormalities put forth by Lipkin and Komaroff – there’s no mention of structural heart problems. Numerous studies have looked for them.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10278546/
I looked up high blood pressure and did not find that heart problems cause it.
I would like a potential cure as well and when they pop up – like Rinvoq – they are, of course, very exciting but until they do we’re stuck with finding things that can help.
Many ME patients have tachycardia and POTS with the problems mentioned above by Betty. The sympathetic autonomic nervous system being in overdrive has also been mentioned in studies. The mechanism that extreme cold has on the human body and nervous system contradicts this. It is remarkable that Visser et al. have shown that there is a significantly reduced blood flow to the brain. There are no studies that show that a cold shower or bath for ME POTS patients has a good effect in an objective manner. Cort, most studies in science are only of limited value in terms of truth. Although it is the best method of the bad ones we have. To this point extreme cold bath or shower in order to be positive is anecdotal .
Yes, it’s because the sympathetic nervous system is in overdrive that this may be helpful. The SNS does ramp up during the short exposure but then is apparently followed by a longer reduction of SNS activity and an upregulation of parasympathetic nervous system. That’s why parasympathetic nervous system activation is often stated as one of the benefits of cold exposure. PNS activation could conceivably help with the heart rate increases.
Yes, findings regarding cold baths, etc. in ME/CFS and FM are anecdotal. Studies focus on cryochambers because they are much easier controlled. It simply makes sense that very brief exposures to cold induced by other means would have similar effects and indeed the studies that have been done with ice baths in healthy people suggest that is so.
Will ice bath studies ever get done in ME/CFS/FM or long COVID? I have no idea. I would guess not but in lieu of that if anyone wants to try this approach I would simply go slowly.
Start with a heated shower and reduce the temperature at the end of the shower and see how it goes. I think that’s pretty safe!
What you wrote is not entirely correct. Wim Hof’s method was created to inhale deeply using breathing techniques to induce hyperventilation. With the help of Wim Hof’s techniques, you stimulate the sympathetic part of the nervous system because you produce more adrenaline during extreme cold. Extreme cold also has a reduced blood flow in response – something that ME patients suffer from, hence the compensatory effect of the sympathetic nervous system. At least if it is compensatory, because we don’t know for sure. At extreme cold temperatures, your kidney, heart and muscles have a harder time. You may also experience blue lips, fingers and toes. Reduced oxygen, which ME patients also suffer from. It also has an effect on your immune system and metabolism, whether that is positive or negative, I don’t know for ME patients. It seems a strange and contradictory therapy for ME patients. I think many ME experts would not recommend this.
Many thanks for the above article. My own personal experience in this sort of area is that I’ve tried going for walks in the cold in winter and have found them bracing and invigorating, but then afterwards I was exhausted (PEM?). Perhaps if I were to shorten/adjust the walks, I might find a distance/duration where the benefits (invigoration, endorphins, immune toning etc.) outweighed the subsequent negative effects (exhaustion).
Cómo siempre hay que recordar que los “remedios” no son para todas. Con EM/SFC desde hace 33 años, como decía alguien más abajo, antes hubiera podido intentarlo, ahora no. Aún así, y a pesar de estar en el norte de España, para mí el verano es la época más odiada. Mi cabeza está permanentemente caliente y siento un alivio infinito al meter la cabeza en el congelador, pero sólo la cabeza. Mis manos y pies suelen estar fríos. Está claro que es un gran problema de termorregulación . Ahora además, con los sofocos de la premenopausia me encantaría tirarme desnuda en una montaña de nieve , pero eso ya es otra historia. La conclusión , como siempre, recordar que los remedios ( no curas) no son para todos, recordad siempre los distintos grados cuando escribáis. Un saludo.
English translation:
Thanks – that brings to mind that cold exposure increases circulation and parasympathetic activity (better blood flows) and does tend to lead to better cold resilience over time. It also brings to mind the idea that living within the same controlled temperature range is not thought to he healthy. Our bodies are designed to be exposed to some temperature swings. This jives with the idea of hormesis – the ideas that exposure to some stressors is health enhancing. Here’s what AI said about this
Cannot being exposed to temperature swings be deleterious?
Yes, not being exposed to temperature swings can have some negative biological effects. Our bodies are designed to adapt to changes in the environment, and temperature variations play a role in maintaining healthy physiological functions. Here are a few potential effects:
Reduced Thermoregulation: Constant exposure to a single temperature can impair the body’s natural ability to regulate its internal temperature, making it harder to adapt to temperature changes outside the controlled environment.
Metabolic Changes: The body’s metabolism can be affected by prolonged exposure to a specific temperature, potentially leading to weight gain or loss, and changes in energy levels.
Absolutamente de acuerdo pero con cuidado y moderación. Para mí ir a la piscina cubierta o al spa también es un suplicio ( y lo echo de menos) y voy a la playa pocas veces, sólo si la temperatura no es demasiado elevada.
El problema con nuestra enfermedad es que tenemos que ser nuestros propios coach de salud día a día, hora a hora y eso también es agotador. Lo mejor para mí es ir alternando cuidados, semana sin preocupaciones y otra con obligaciones hasta donde de el cuerpo y la mente.
Saludos.
English translation
I absolutely agree but with care and moderation. For me going to the indoor pool or spa is also an ordeal (and I miss it) and I go to the beach rarely, only if the temperature is not too high.
The problem with our illness is that we have to be our own health coaches day by day, hour by hour and that is also exhausting. The best thing for me is to alternate care, a week without worries and another with obligations as far as the body and mind go.
Best regards.
This beats sticking your head in the freezer! I use mine all the time and it helps with headache, sensory sensitivities and thermoregulation:
https://icebeanie.com/
🙂
Jajaja, gracias, tengo uno, pero la sensación de respirar oxígeno que me da el congelador, no me la da el gorro. Cuando puedo, en invierno, un pequeño paseo al frío también me sienta muy bien. Pero sólo cuando hay fuerzas 😉
Great article Cort! I especially appreciate your treatment focused articles, thank you for what you do. I have found small doses of cold exposure very beneficial for my long covid and PEM symptoms. My symptoms are on the mild end of the scale so it has worked well for me. I did notice that I had a flare up of symptoms when I recently made the mistake of shivering on the beach talking with a friend for 45 minutes after a cold ocean plunge (5 minutes in the water). When your lips are turning blue and teeth are chattering, its beneficial to get yourself into warm clothes pronto!
It no longer works for me but for years a jump in cold water help me get thru several vacations where it made me almost feel normal
I tried to donate but don’t remember my password and was unable to. Not very savvy about how to do this.
Sorry to hear that! Would an Amazon gift card work? If you’re in the US simply go here – https://www.amazon.com/b/ref=s9_acss_bw_cg_gchol17_3d1_w?node=2973102011&pf_rd_m=ATVPDKIKX0DER&pf_rd_s=merchandised-search-7&pf_rd_r=0V9DW68EHAYRKTM5DD07&pf_rd_t=101&pf_rd_p=40d7945d-3e31-45bd-945a-a771a5fb7ea3&pf_rd_i=2238192011 – find your gift card, and put my email address (cortrising@gmail.com) in the “To:” box, and voila – instant Amazon gift card!
Thanks for the article Cort. Do you think that short bursts in cold outdoor weather could have similar effects as cold plunges? I guess one downside is not having temperature control with the outdoors. But it seems a bit similar to the cryotherapy, although less extreme.
Some Related Research on Cold Therapy; Dr Rhonda Patrick started out as a Cancer researcher, and then moved into anti-aging research, as this is her passion. Now she operates a YouTube channel where she interviews leading researchers on topics related to aging (and how to slow down the process) – based on solid detailed scientific findings. (Note that she doesn’t sell any vitamins or cures for anything). Her YouTube channel is called “Found My Fitness”. She has looked into the physiological effects of cold, including how and why it can be beneficial. However, her research (and findings) are generally targeted towards keeping healthy people healthy longer. Thus, her research findings and recommendations may not apply to all people with CFS, Fibro, ME, Long Covid, or others with significant health challenges. However, she is a good speaker, and talks sound science, so if treatments with cold interest you, you may find her (in-depth but understandable) presentations on it interesting. Here is a link to one of her video presentations on the subject;
https://www.youtube.com/watch?v=XaLd5w6zF7A
If you want to see more of her videos on this subject, you could do a YouTube search for; “Found My Fitness – Cold Therapy Research” (which should bring up several more presentations).
Personally, I live in Canada, and a day before Cort published this article I had to go out to sweep a foot of snow off my car and shovel all around it. It was very cold that day. I think that my fingertips were starting to freeze (inside my winter gloves) by the time I was done. After I finished (and warmed up inside), two of my fingertips were red, sore and inflamed.
However, to my surprise, later that evening my hands and feet were nice and warm (as opposed to being uncomfortably chilled as they usually are). I also noticed that my muscles were more relaxed, and my nerves (all over my body) were relaxed (rather than agitated, sensitive or wired) . Even my mood was calmer, and I was better able to socialize (and enjoy it) – perhaps due to a reduction in brain fog. I had almost forgotten the feeling of being relaxed. (Dopamine?). It was unexpected but enjoyable. I could very much relate when Coldlover’s post (above) described it as tired, but in a good way. For me personally, I think that a good portion of these benefits may be due to increased circulation, but I can’t be sure. I also don’t know if it would be sustainable for me. I hope that (unlike exercise alone), it might increase circulation without PEM (or perhaps with less of it). Note that I exercised (shoveling snow for about 20 mins) as well as experiencing uncomfortable cold (in spite of a parka), but I suffered less PEM the next day than I had expected. Each person may have to find their own balance of how much cold and how often – is optimum for them (if any). I am not promoting this therapy for everyone, but this coincidental recent experience suggests that (at least for me), there is something to this claim of potential benefits from cold exposure.
Thank-you again for the great article Cort 🙂
Our hot water service broke a couple of winters ago and I had to have cold showers for about a week. I didn’t experience any positive effects, but I have to say, very little of me went under the shower!
🙂
Have been taking cold showers for years. Mostly finish a regular cold shower with cold. It gives a short lived boost and i really miss it when I dont do it.
I don’t do it when I feel very cold or am very bad. But in the last case I usually don’t shower anyway.
This brings up a question about my fibromyalgia experience. I have noticed that my knees are often cold to the touch, and I wonder if anyone else here might have that experience?
Skiing is one of the activities I can do without any limitations. No PEM ever. I finish the day feeling great and continue to have an exercise buzz for the next several days. Maybe I’ll give cold exposure a try.
I see Cortene mentioned, are they still around. Most recent news on their website was from 3 years ago.
Hi
I have been lake swimming / dipping throughout the year for the last 4 years (temps range from 2’C to 23’C).
I have suffered from Post COVID fatigue since early March and returned to cold water dipping about 6 – 8 weeks later. It has improved my mood and envigorated my body, but then I was addicted to swimming in a lake and observing the nature around me before.
Friends with managed long standing ME have also benefited, as do friends with no noticeable medical condition. We all find the experience mindful and brain and body rebalancing, a feeling that lasts all day.
On another note, I have reynauds and have noticed that blood returns to my hands much quicker. Before it took over 4 hours (and that was with more exercise and heat applied). Now it’s only about 20 minutes after I get out of the water/ get dressed.
My husband Parkinson’s disease symptoms has greatly subsided since using the PD-5 protocol, almost all his symptoms has subsided 4 months into using the PD-5 protocol. Google bine health center . co m don’t give up hope.
Hi everyone,
I tried that and crashed terribly. So please be careful!
I’m one of those people who is always cold, and the idea of deliberately taking a cold shower sounds like torture. But I decided to give it a try, and I’m finding that not only can I tolerate it, but it makes me feel good! I don’t know if it’s having an impact on my illness, I haven’t been doing it for long, but I do find that it increases my cold tolerance and so that’s a win.
I do a beginner’s version – start with a warm shower and then switch to cold, then back to warm. Working my way towards ending with cold and allowing my body to warm up on its own. We’ll see if it actually impacts my illness – I have been sick long enough now to know it’s best for my mental well being not to have expectations…