Category: Health

Oct. 14, 2022 — Patients with type 2 diabetes achieve much better control of their blood sugar if they participate in mind-and-body-practices such as yoga, a new study shows.

While past research has been done specifically for yoga, this study, published online recently in the Journal of Integrative and Complementary Medicine,  also looked at the benefits of other mind-and-body practices for these patients, including qi gong and meditation.

The study is “the first to show that there is a very consistent effect [on hemoglobin A1c, a marker of diabetes] regardless of which modality you use,” says one of the researchers, Richard Watanabe, PhD. 

“So I think one of the important messages … is that any sort of mind-body intervention seems to be helpful, which makes this a much more flexible tool than telling a patient that they should [just] do yoga,” says Watanabe, who is a professor of population and public health sciences at the University of Southern California’s Keck School of Medicine in Los Angeles. 

There are other options available, “and if you are a busy person and getting to yoga is not doable, you can learn about meditation and do it anywhere. So again, it [is] … a flexible tool to help their patients with blood sugar control,” he says. 

“The most surprising finding was the magnitude of the benefit these practices provide,” says the lead author, Fatimata Sanogo,  from the University of Southern California, Los Angeles, in a statement. “We expected there to be a benefit but never anticipated it would be this large.” 

But how do mind-body practices reduce A1c? It’s not totally clear, Watanabe says, noting that more research needs to be done to figure this out. 

“But I think everyone’s hypotheses is that these methods reduce stress, so the idea is that they reduce stress hormones and since these hormones do have an effect on glucose metabolism, reducing them using these modalities reduces A1c and blood sugar levels,” he explains. 

Alternatively, mind-body practices might improve insulin sensitivity. “You basically allow insulin to be more efficient at increasing glucose uptake by insulin-sensitive tissues,” Watanabe says. 

So should doctors prescribe any one of the mind-body practices looked at in the study? Maybe, Watanabe says. 

“Our results suggest that the effect you are going to see with the mind-body intervention is going to be on top of whatever standard of care patients are getting, so it definitely cannot hurt,” he says. He also notes that for patients with diabetes, constantly having to monitor their blood sugar levels and watch what they eat is very stressful. 

“That just contributes to the difficulty in controlling blood sugar,” he says. “So I think physicians need to evaluate their patients and help them pick the thing that fits best with their lifestyle and personality, so it’s really up to the physician to work with patients and help them find something that works for them.”  

A Study of Studies 

The researchers conducted what is known as a meta-analysis, where they identified 28 studies, published between 1993 and 2022, looking at the use of mindfulness practices in patients with type 2 diabetes. 

All studies excluded patients who needed insulin to control their diabetes as well as those with medical complications such as heart disease or kidney complications. The types of mind-body practices analyzed included meditation, breathing techniques, yoga, and an ancient Chinese practice known as qi gong, a type of slow-moving martial arts that’s similar to tai chi. 

Using hemoglobin A1c (HbA1c) as a test that tells patients what their average blood sugar levels have been for the last 3 months, the results showed that the overall reduction in average A1c was 0.84 percentage points. 

And reductions in A1c were seen with all types of mind-body practices. In patients who practiced mindfulness-based stress reduction, A1c was reduced by a mean of 0.48 percentage points. This practice involves focusing on one’s breath and on a particular thought, object, or activity to engender a stable emotional state and be fully present and aware of one’s surroundings. 

The practice of qi gong also reduced A1c by a larger degree of 0.66 percentage points. 

But the reduction in A1c was largest among those who practiced yoga, at 1.0 percentage points — about the same degree of reduction in A1c that’s seen with metformin, a drug widely used to treat type 2 diabetes around the world.

In fact, for every additional day of yoga practiced each week, the mean A1c differed by -0.22 percentage points over the study period. 

Fasting blood sugar also improved significantly with mind-body practices. 

Overall, the average reduction in A1c and fasting blood sugar “was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes,” the study authors said. 

In late September, the FDA released its final report on the Software Precertification (Pre-Cert) Pilot Program, which it launched in 2017 to explore different regulatory approaches for digital health tools.

By 2022, the agency determined a new regulatory framework would be useful for software as a medical device, but it couldn’t do that alone.

“We are not fully capitalizing on these capabilities and approaches for software in the current statutory and regulatory framework for medical devices,” the FDA wrote in its report. “Based on these observations from the pilot, FDA has found that rapidly evolving technologies in the modern medical device landscape could benefit from a new regulatory paradigm, which would require a legislative change.”

David Rosen, a partner and public policy lawyer at Foley & Lardner, notes there have been big changes in the digital health space in the past five years, including advances in consumer wearables and tools that aim to guide clinician decisionmaking. He sat down with MobiHealthNews to discuss the pilot program and how digital health companies should approach the regulatory process.

MobiHealthNews: What were some of your big takeaways from the Pre-Cert pilot?

David Rosen: The whole idea behind the Pre-Cert program was to look at different regulatory approaches to try to assist companies in developing software for use as a medical device. And it was predicated on companies making sure that they have a robust quality organization and organizational excellence, and that they do some real-world monitoring of the software as it’s being used. 

In general, I think that’s a very appropriate goal and a good goal for the FDA to consider, because this is the evolution of how healthcare is being delivered. The model is evolving, and we have this new paradigm, and I think the FDA has to be open to shifting how they regulate things outside of the normal scope of traditional medical devices that they typically see. 

You saw the report from Sept. 22, and there were a few limitations. There were only a few devices available for consideration. There were nine participants. But the FDA didn’t want to have a significant number of products going through the De Novo process, because they didn’t know how that process was going to work. So that was kind of a very interesting little situation for the FDA to evaluate. 

Again, the whole idea behind the pilot Pre-Cert program was to help companies and help the FDA better understand the design and development and management of digital health products. So I think that the Pre-Cert program did help with that. But I think the bottom line is that the FDA decided that the current regulatory paradigm isn’t going to work for this, and that they need a different FDA regulatory pathway and review process to deal with software as a medical device.

MHN: So what do you think digital health and health tech companies should take from this program and these results?

Rosen: First, they need to watch what the FDA is going to be doing in the future. This culture of quality and organizational excellence though, in terms of verification and validation of software, is really, really important. 

I’ve worked on a lot of these products, and you see companies have different approaches in how they want to verify and validate the usefulness of the data. And I think that we have to be very circumspect, and the companies have to be very circumspect, and they need to work and educate the FDA on how their program works and why the metrics are appropriately valid to come up with some sort of treatment decision. It needs to be a cooperative approach between the industry and FDA to move this whole situation forward to help bring new products into the marketplace.

MHN: You previously worked at the FDA. What are some of the big challenges that you see when it comes to regulating software?

Rosen: The whole pandemic situation has really made it very difficult, because CDRH [Center for Devices and Radiological Health] has been really inundated with COVID-19, in-vitro diagnostic tools and things like that. It was a lot better when we could do things in person. We could have a meeting, and we could do a demonstration, and we could have more interactive dialogue with the FDA. I think those are the kinds of things that really help both the FDA understand what industry is doing, and then help the industry understand and appreciate FDA expectations as to how to develop these products.

MHN: I also wanted to ask about the FDA’s recent guidance on clinical decision support software qualifying as medical devices. What do you think this signals about the FDA’s process right now?

Rosen: Anytime that the FDA is issuing guidance, we look at what the motivation was for issuing those guidances, how much experience that the agency has had, and the regulatory process at this stage. 

I think they’ve seen a number of people coming out with clinical decision support software. I think it’s important to level-set the expectations associated with that software and to ensure that it’s helpful to the industry, to say “Hey, this is what FDA is thinking, this is what the expectations are.” It doesn’t necessarily mean to set out a rigid approach to what you have to do. But it certainly sets forth what FDA is thinking about.

I think it’s a very positive situation when you see the agency moving forward, issuing these types of guidances. They’re thinking about these things, and we will have a better regulatory understanding and regulatory scheme in the future for these types of innovations in healthcare, which I think is really important at this stage.

NeuroFlow, a behavioral health company, secured a $25 million growth investment led by growth equity impact investor SEMCAP Health, bringing its total funding to $32 million.

The company raised $7.5 million in a Series A funding round in 2019 and $20 million in Series B financing in 2021.

WHAT THEY DO

NeuroFlow’s cloud-based platform allows healthcare providers to track, assess and connect with patients between traditional office visits. The company also offers AI-driven clinical decision support with recommendations for the next steps for individual patients. 

The Pennsylvania-based company will use the funds to expand its network and increase R&D investments to grow its platform. It will also increase its workforce in all departments. 

“We’re excited to bring in a strong partner like SEMCAP to support our next stage of growth. This gives us the opportunity to meet the demand we are experiencing and to invest in a platform that helps deliver a happier, healthier quality of life for those across the spectrum of mental health needs. With this financing, we’ll focus on strategic hiring, R&D for the platform and the launch of a Spanish-language app,” James Kanka, NeuroFlow’s vice president of marketing, told MobiHealthNews in an email.

MARKET SNAPSHOT

Last month, NeuroFlow announced a collaboration with CirrusMD, a startup offering on-demand, text-based telehealth, where CirrusMS would leverage NeuroFlow’s clinical decision support platform, patient engagement tools and intervention services.

In February, NeuroFlow announced a partnership with Aflac, giving the insurance provider’s employees access to digital mental health resources via NeuroFlow’s educational content service.  

The 80/20 principle has been a centerpiece of the Primal Blueprint approach and philosophy since the beginning, but I still get comments and questions about it. In case you’re not familiar, the 80/20 principle suggests that in the context of a full and earnest commitment to making health-promoting choices, conforming with the 10 Primal Blueprint Laws 80% of the time will yield a solidly healthy result.

Many tell me how much they love the concept. It’s a feature that makes the Primal lifestyle possible for them. Others suggest that it leaves too much room for backsliding. Still others find it confusing—does it mean living 100% Primal only 80% of the time and partying it up that other 20%? Or does it mean living 80% Primal 100% of the time? (The answer is neither, as you’ll see.)

I love having these kinds of discussions within the community. Your perspectives help me to continue to grow and evolve my thinking even after all these years. So let me share my perspective on the 80/20 principle, and I encourage you to share your own thoughts in the comments as well. Just because I’m “the Primal guy” doesn’t mean I get to dictate how you interpret what it means to live Primally, nor how you embody these teachings in your own life. It’s obviously a general principle and, as such, it’s intended to mean different things to different people.

What Is the 80/20 Principle, And What Is It NOT?

In short, the 80/20 principle is a rule to make Primal doable in the context of the modern world. It’s a feature that makes the Primal Blueprint a fully achievable, enduring lifestyle that reconciles with the grind and disruptions of daily life.

Let me put it this way: the 80/20 principle is an acknowledgment that we’re adults who take full responsibility for every choice but occasionally find ourselves in circumstances that aren’t conducive to adhering fully to the Primal Laws. You should always have the intention to do your best, to aim for 100%. But you should not let your commitment to Primal living become a source of stress or anxiety, and you shouldn’t beat yourself up or throw in the towel when perfection isn’t possible.

You have agency and reasoning skills, so you should be able to make conscious compromises. Perhaps you’re on vacation and really want the experience of sampling the local cuisine. For you, it’s part of the adventure. You authentically choose within the 80/20 principle to make the most of your hard earned adventure. (Personally, this is my favorite manifestation of the principle.) Maybe it’s a special anniversary or family gathering. You don’t use the situation as an excuse to wildly abandon your commitment to health and longevity. You loosen the strings enough to find the best balance between short-term experience and long-term goals.

Sometimes the 80/20 principle is a matter of feasibility. Travel doesn’t always present the most ideal Primal options. A difficult period in your life (new baby, death or serious illness in the family) may temporarily disrupt your focus or ability to do all the good things you normally incorporate into your routine.

There are also the Primal ideals, especially when it comes to food. I know not everyone has ready access to or the budget for grass-fed beef, pastured butter, organic produce, or a wide diversity of produce year round. This is where that old saying comes in: “Don’t let perfect be the enemy of good.” The majority of the health benefits from Primal come from eliminating the grains, sugars, and nasty oils. Worrying about organic, local, and so on is the cherry on top. Likewise, if all you manage right now is walking and microworkouts, but you haven’t found a way to build sprints into your routine yet, you’re still miles ahead of the person who is still sedentary.

Sometimes you just have to do the best you can. It’s not a question of motivation or commitment but the influence of external conditions. Think of it as a cushion, not a cop-out, and focus on the big picture. Primal success is less about what you do at any one meal or single bout at the gym and more about what you do over the course of a given week or month.

And What Is It Not?

Most importantly, it isn’t permission to only shoot for 80% compliance or success. If you set out to make your Primal commitment 80%, guess what. It will likely fall well below that. If you set out to make your commitment 100%, you’ll probably settle in somewhere between 80 and 95%.

It doesn’t mean getting 20% of your calories from ice cream and the other 80% from meats and salads. The 80/20 principle isn’t about “cheating” 20% of the time.

It isn’t intended as a “get-out-of-Primal-free card” for flocking to grains, skimping on fat or protein, or ignoring a continuing sleep deficit.

It doesn’t mean you’re perfect during the week and then go on a bender on the weekend.

It doesn’t mean working out 10 months of the year and then taking two months off to veg on the couch.

It doesn’t mean picking your favorite 8 of the 10 Primal Blueprint laws and scrapping the other two.

And let me be clear: there’s nothing wrong with achieving 100%. If you find the Primal Laws easy to incorporate fully into your life, that’s cause for celebration, not concern. I would never suggest that you’re missing out on life because you don’t feel the need to indulge in conscious compromises. More power to you if you’re happy and fulfilled without them.

Is This the Same as the 80/20 Rule Diet?

Decidedly no, but I’ve gotten this question a fair amount, so let’s clear it up. When people talk about the 80/20 diet, they usually mean the eating strategy attributed to Australian nutritionist, chef, and personal trainer Teresa Cutter. In this approach, you are supposed to “be good” 80% of the time, but you are allowed to indulge the other 20% of the time within reason. No foods are off the table. It’s a “have your cake and eat it too” diet, and it’s very much NOT what the Primal 80/20 principle represents.

The Primal 80/20 principle isn’t a diet at all; it’s more of a mindset. It’s about giving yourself permission not to be perfect, not actually planning dietary excursions into your week. By the same token, the 80/20 principle isn’t carb cycling, alternate day fasting, or any other structured eating pattern. With those, the assumption is that you’re (mostly) sticking to Primal foods but eating at specific times or with certain macronutrient ratios.

And of course, the Primal Blueprint encompasses more than nutrition, so the Primal 80/20 principle does as well. All aspects of Primal living—movement, sleep, stress management, social connection, cognitive challenge—fall under the 80/20 umbrella. There are probably some aspects you’re closer to 100% on most of the time and others you struggle with. For me, the food part is easy, but I’ve historically struggled with the stress bit.

When Does the 80/20 Principle NOT Apply?

There are times when 100% compliance—or something close to it—is important. One example that comes to mind is when someone is using an elimination diet (autoimmune protocol, low-FODMAP, etc.) to explore chronic symptoms. Unless they are strict about eliminating and then systematically reintroducing potential trigger foods, the diet probably won’t be much use.

Another time when it makes sense to be stricter is during the transition to a keto diet. Ketosis is a notoriously fragile metabolic state. Eat a single high-carb meal or snack, and wham, you’re out. When you’re in the process of adapting to keto, it makes sense to be consistent for at least the first four to six weeks to facilitate the process. Even after that, there’s little wiggle room if staying in ketosis is important to you.

The Bottom Line

At its core, the 80/20 principle is a recognition that life isn’t totally predictable and that we’re not in Grok’s Kansas anymore. Denying that reality and trying to fit Primal principles perfectly into modern life can be like jamming a square peg into a round hole. The point of 80/20 is to release the pressure valve that comes with thinking that you are supposed to be perfect and that this Primal living thing should come easily all the time.

As the Primal Blueprint cements itself in your routine, it generally becomes easier (and more desirable) to live well above that 80%. That was my experience, and I can’t even count how many people have told me the same over the years.  The Primal Blueprint comes naturally for me now because my entire lifestyle revolves around it and I’ve been doing it so long. It’s so much a part of my routine that I don’t often think about it except when I travel. It will become your normal as well, but the chance that you’ll always be the perfect Primal specimen are small. I’m not, and I’m fine with that.

I encourage everyone to focus on the process and the big picture, not simply the daily details. The Primal Blueprint is first and foremost about taking full responsibility for your life and health. No excuses, no guilt.

As always, thanks for reading, and keep the questions and comments coming!

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Hey folks, Board-Certified Health Coach Chloe Maleski is here to answer your questions about becoming a health or fitness coach. Considering a career change or side gig? Ready to take your Primal knowledge to the next level? We’re here to cheer you on! Have a question you’d like to ask our health coaches? Leave it below in the comments or over in the Mark’s Daily Apple Facebook group.

Patrick asked:
“Primal eating, combined with exercise, has changed my life. You could say it was my personal pandemic project—made possible due to working from home. I’m considering becoming a health coach myself but work in a totally different field (accounting). I have no experience with science, nutrition, fitness, etc., outside of reading blogs like this one. I have ZERO experience coaching. Any recommendations for getting started? Is the Primal Health Coach program suitable for newbies? How long does it take to complete? Do you cover the business side or just nutrition?

Hurray! So fantastic that you turned working from home into a life-changing, wellness-promoting project, Patrick! It really is true: Just a couple of years (or less) of consistent effort can change the state of our health and our life’s trajectory.

Fantastic as well that you’re eager to take what you’ve learned and achieved to the next level. The Primal Health Coach Certification is an excellent way to make that happen.

As a coach, I can attest that there’s a depth of knowledge that only comes from teaching and guiding others. Regardless of whether you make health coaching a new career, a side gig, or another project in self-learning and discovery, the training is transformative. Let’s take a look at your specific questions and cover the Primal Health Coach basics.

Is the Primal Health Coach Certification for newbies?

In short, yes! You do not need prior experience in coaching or prior knowledge of science or nutrition to enroll and succeed.

Many established healthcare professionals and others with similar backgrounds do complete the certification as a way to boost their knowledge, enhance their credentials, and better support their clients and patients.

That said, many others who join have little or no experience in the health and wellness space. Some are regulars here at Mark’s Daily Apple and simply want to take their Primal knowledge to the next level. Others, like you, are considering a career change that integrates what’s worked for them and how they earn a living.

Others don’t know much about Primal eating and living at all (at least not yet!) but are attracted to the growing field of health coaching and the possibility of launching a thriving business they can do from anywhere.

Not “just” nutrition

One thing that sets the Primal Health Coach Institute apart from similar programs is that we understand the importance of solid nutritional and lifestyle knowledge AND that those alone are not enough to succeed as a coach or business.

As you might expect, we cover Primal eating and living fundamentals, including the science behind why they work and how they can be tailored to fit clients with different needs and goals.

This includes nutrition, of course, but also the other 10 Primal Blueprint Rules. We dive deep into the what, how, and why—explaining the details while taking care to use clear language that you’ll be able to share with others. We also provide extensive resources, allowing you to take your learning even further if you choose.

Equally important, the PHCI provides more than a health education. We help you develop coaching skills and learn how to get a coaching business off the ground and keep it thriving. This well-rounded preparation is essential for standing out in the sea of coaches and helping your clients get real, sustained results.

Taking things one step further, we ensure our graduates can start making money as soon as they have their certification in hand by providing a wealth of resources, done-for-you templates, and even a ready-made coaching program. Rather than leaving you to “sink or swim,” we provide ongoing webinars, optional events, and masterclasses. We also have a tight-knit community of coaches who support one another on our mission to promote healthier, more vibrant living.

How long does it take to become a Primal Health Coach?

That’s up to you! The Primal Health Coaching Certification is an online program that you can complete at your own pace, making your way through the material anytime, anywhere.

Moving relatively quickly and completing one chapter a week, you could finish everything in 6 months. That said, there’s no rush, and the program is designed for flexible self-study. There is a lot of material to cover and digest, and the curriculum is robust—utilizing multimedia delivery modes and supporting diverse learning styles.

Even after completing all 23 chapters of multimedia materials and graduating, you retain lifetime access to the program and our Business Resource Center. Because we’re always adding new resources and content to stay up to date with the science, this is gold! It’s also a way for you to stay connected to PHCI faculty and thousands of students and grads.

What does the Primal Health Coach Certification Program offer?

I encourage you to head over to the Primal Health Coach Institute for full details on the certification, glowing testimonials, and next steps. Also check out the PHCI blog for insights into what coaching looks like and how to succeed in this expanding arena.

That said, here’s an overview of what you’ll receive.

The Primal Health Coach Certification Program offers the most in-depth and up-to-date ancestral health education in the world. We don’t just create health experts. We certify health coaches who are true catalysts for behavior change. And we make sure they have the business knowledge and marketing resources to go out in the world and change lives. The program includes:

• Online course made up of 23 chapters of multimedia educational resources tailored for diverse learning styles, including videos, webinars, and supplemental eBooks
• College-level fitness and nutrition education that covers the basics and way more
• Business-building tasks and development projects to help you shape your business story, name, and niche, plus develop your product and set up a payment system (all before graduation!)
• Practical experience developing your coaching skills, crafting your signature coaching program, establishing a 90-day marketing strategy, and writing your personal sales and enrollment script
• Peer-to-peer training, coaching practice, and case studies
• Training in language and liability issues to ensure that you stay within your legal scope of practice
• Access to a private Primal Health Coach Facebook community, a valuable resource for community-based learning and building your professional network
• Lifetime subscription to our Business Resource Center, an exclusive portal designed to help you launch your business and scale for maximum profit and impact

How to become a Primal Fitness Coach

I know you asked about our Primal Health Coach program, but that’s only one of the PHCI’s growing suite of offerings.

If Primal fitness is more your thing, you might consider the brand new Primal Fitness Coach Certification. This program can be completed on its own, or you could go all in and add it to your repertoire as a Primal Health Coach.

It offers the same high-level, well-rounded, multimedia educational experience but with a focus on preparing fitness coaches who are proficient in training clients to be fit for life. This functional fitness certification covers best practices for daily movement, strength-training and conditioning, HIIT exercises, sprinting, and more.

Take your Primal knowledge to the next level

Either of the above programs will prepare you to set up a thriving coaching business and help others transform their health and lives. And…even if coaching isn’t your calling, they are still an excellent way to deepen your knowledge and take your own wellness journey to the next level.

You’ll not only get a new layer of external accountability and positive peer pressure, but will be joining a likeminded community while learning to “be your own coach.” This alone makes the investment worth it.

Of course, working with a Primal Health Coach one-on-one is another excellent way to see results AND get a sense of whether becoming a coach is right for you. Visit myprimalcoach.com to learn more. I hope to see you on the inside!

Are you a Primal Health Coach Institute student or grad? Or thinking of becoming one? Let us know and drop other questions for me in the comments!

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This quick and easy green bean casserole is the perfect addition to any holiday dinner. This recipe calls for Primal Kitchen’s Mushroom Gravy to help cut down on the preparation time. In no time you’ll have a warm and comforting dish that will compliment any meal. We keep things simple with onions and mushrooms, but if you’re looking to switch things up this recipe would be great with chopped bacon or bacon grease instead of butter.

How to make green bean casserole

First, preheat your oven to 375 degrees Fahrenheit. Then steam your green beans until they are tender. While they are steaming, prepare your crispy onions. Cut the onion in half and slice it into very thin half moons. Toss the onions in a bowl with oil, then add the almond flour, thyme and salt and pepper and gently mix until just combined.

Lay the onions out in a single layer on a sheet pan and roast in the oven for 7-10 minutes. Give the onions a shake or toss and continue roasting until they are golden. I recommend watching them because they can quickly go from browned to burnt. Set aside while you finish the green beans.

Heat the butter in a large oven-safe skillet on the stovetop over medium heat. Once melted and bubbling, add the chopped onion and sauté until golden, then add the garlic and cook until fragrant. Add the mushrooms and allow them to cook for about 2 minutes, or until they are just tender. Pour in the Mushroom Gravy and coconut milk and bring the mixture to a simmer.

Strain the steamed green beans and add them to the skillet. You can also add some coconut aminos or even a squeeze of lemon if you’d like. Mix in the thyme, pepper and salt and let the sauce start bubbling again. Fold the green beans into the sauce and cook on the stovetop until the green beans are well coated in the sauce and the sauce thickens slightly. Season with salt and pepper to taste. Transfer the skillet to the oven and bake for 10 minutes.

After 10 minutes, take the skillet out of the oven and spread the crispy onions on top all over the green beans. Place the skillet back in the oven for about 10 more minutes. The sauce the green beans are in should be fairly thick, and will further thicken as the casserole cools. Allow the casserole to cool slightly, then serve and enjoy!

 

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Analysis by Dr. Joseph Mercola
Fact Checked

• October 14, 2022Download PDF

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Analysis by Dr. Joseph Mercola
Fact Checked

• October 14, 2022Download PDF

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I’ve been around for long enough to see health trends come and go, but cold therapy is one that has staying power. Humans have probably been using cold water to treat injury and illness, wake up their senses, and challenge their physical fortitude for all of human history. The modern obsession with cold plunges, cryotherapy chambers, and sitting underclothed in the snow doing controlled hyperventilation (a la “The Iceman” Wim Hof and his eponymous method of breathwork paired with extreme cold endurance feats) is just the newest iteration. There is something fundamental about the relationship between humans and the cold. 

Of course, Grok wasn’t taking cold showers to stimulate his immune system or revive senses dulled by hours and years of participating in corporate drudgery. He was washing in cold rivers and wading into the ocean to trap sea creatures out of necessity. But the effect was the same as when we modern humans do a polar bear plunge in the icy sea—a stronger, more robust body.  

Today, most of us enjoy (or rather, suffer from) round-the-clock thermally controlled environments. We’re rarely ever truly cold, not that bone-chilling, teeth-chattering cold where you wonder if you’ll ever feel warm again. Not unless we go out of our way to get uncomfortable. Many people claim to hate the cold, and I admittedly did my fair share of grumbling about having to face frigid mornings as a kid growing up in Maine. But as anyone who has taken the time to embrace the cold knows, once you get used to it, your body actually craves the cold. Like so many things that are uncomfortable in the moment, it’s good for you in the long run. Your body knows that on a cell-deep level. 

At the same time, there is a lot of academic debate about the limitations of cold exposure and cold therapy. Promoters of cold water therapy say that it can boost immune function, decrease inflammation and pain, and increase blood flow. Skeptics wonder if it’s all it’s cracked up to be. Some go so far as to argue that it does more harm than good in certain circumstances. Let’s explore. 

Types of Cold Therapy

I’d roughly break cold therapy into two categories: 

1. Cold exposure to reduce pain, improve mobility, speed healing, or enhance recovery (acute effects)
2. Cold exposure for general health and longevity (long-term effects)

“Cryotherapy” is the general term for using cold (“cryo”) to produce health benefits, but you probably associate the word specifically with whole-body chambers that blast you with extremely cold air (typically between -200 and -300 degrees Fahrenheit, or -128 to -184 Celsius). That’s one way to access the benefits of chilling out. You can also

• Apply ice packs or cold compresses to targeted areas of the body
• Partake in ice massage, getting a rubdown with ice cubes or chilled implements
• Use cooling sprays
• Take cold showers or contrast showers (alternating hot and cold)

Cold water immersion, or dunking your whole self in very cold water, is popular among the ancestral health crowd and potentially the most beneficial form of cold therapy. This covers anything from your standard ice bath to jumping in a brisk mountain lake to joining your local polar bear club and swimming in frigid water in nothing but your skivvies. For a more controlled cold water immersion experience, you can purchase a cold plunge tank for your home, or go the route of my friend and longtime coauthor Brad Kearns and make your own DIY cold plunge out of a chest freezer! 

I’d also put going out in cold weather slightly underdressed in the cold therapy camp. It may not be as actively therapeutic as the other methods, but it does a body good nonetheless.

How Does Cold Therapy Work?

Cold therapy falls under the umbrella of hormetic stressors—stressful stimuli that, when applied appropriately, produce adaptations that make us healthier and more resilient to future challenges. It’s the “that which does not kill you makes you stronger” effect.

The body doesn’t like to be too cold or too hot, preferring to stay in that “just right” zone. Hence, it will actively protect itself against big excursions outside its comfort level. When you expose yourself to cold—especially via cold water or air over your whole body—a number of homeostatic mechanisms kick into gear to keep your core temperature from dropping too low. 

Blood vessels near the surface of the body constrict, a process known as cutaneous vasoconstriction. This pulls blood into the core and slows heat loss through the skin. 

Stay in the cold water or air long enough, and you’ll start shivering, which produces heat. 

Next comes an increase in non-shivering thermogenesis (“thermo”=heat, “genesis”=making). You’ve probably heard of brown fat, the mitochondria-rich, metabolically active fat that generates heat in baby and adult humans alike. Well, cold exposure activates existing brown fat and tells the body to make more brown fat to boot. This translates to increased metabolic rate. Besides producing heat, a sped-up metabolism might enhance recovery following workouts and injury. It’s also why some people argue that cold exposure could be the next big weight-loss breakthrough (a somewhat dubious claim I’ll discuss shortly). 

Cold also stimulates the immune system, reduces oxidative stress, and triggers a host of favorable hormonal responses.  For example, it increases norepinephrine levels, which decreases pain sensations, and ACTH (adrenocorticotropic hormone), which helps the body respond to stress and regulate blood sugar and blood pressure. 

Long-term, repeated exposures to cold improve cold tolerance, which is why those grizzled old-timers in the polar bear club seem to have no trouble jumping into the northern sea despite the ice and slush floating on top. The water literally isn’t as shocking to their systems.

Benefits of Cold Therapy

I’m a fan of cold exposure in general. My interest is mostly related to how it challenges you physically and mentally, making you tougher and perhaps extending healthspan and lifespan, though we can’t say for sure. There are people testing that hypothesis on themselves right now, but those results are decades in the making. In the meantime, I’m thoroughly sold on cold as a hormetic stressor that improves overall well-being. 

There are other more immediate benefits too, and some areas where we get it wrong. 

Recovery after exercise or injury

The image of a hardcore pro athlete getting into a metal trough of ice water after a big game or meet is burned into the cultural psyche. If you take a spill and twist an ankle or tweak your wrist catching yourself, your first impulse will probably be to ice the injury. 

The inclination comes from a good place. Cold blunts pain and reduces inflammation and (sometimes) swelling. However, there is considerable debate about whether icing does more harm than good in the long run, with many experts arguing that you should skip it. I go into greater detail about icing injuries in a separate post, but for now consider that acute inflammation (not the chronic systemic type) is there for a reason. Trying to shoo it away more quickly than the body would naturally do on its own could actually delay healing or compromise the exercise adaptations that make you stronger in the long run. 

That said, there are specific cases in which I would apply cold therapies. One is after an injury if the pain is severe and/or the swelling is great enough to potentially impair healing. Be aware, though, that icing can sometimes increase swelling. The second is for athletes who are doing multi-day events and need to deliver another good performance the day after a hard effort. Cold therapy can be useful for delaying the onset of muscle soreness and, perhaps most importantly, offsetting perceptions of fatigue, helping the athlete to believe they are rested and ready to hit the ground running again.

Otherwise, for athletes who want to expose themselves to cold for general health reasons, I’d recommend partaking in cold plunges or showers far away from the stimulus of workouts—at least several hours after. Besides blunting the adaptive response to workouts, if you have significantly raised your core body temperature during exercise, you don’t want to drastically and dramatically shock it with frigid temps.

Better immunity, less illness

Cold therapy boosts the immune system, stimulating white blood cells, anti-inflammatory cytokines, and natural killer cells that can fight infections and possibly even gobble up tumors. Now, I’m not suggesting that cold showers cure cancer, but there is the possibility that cold therapy could prove an interesting adjuvant treatment down the road. 

One study of over 3,000 people found that those who took cold showers lasting between 30 and 90 seconds for a month reported 29 percent fewer sick days from work compared to those who did not take cold showers. Other researchers have found that cold water swimmers have fewer upper respiratory tract infections than their partners who don’t swim.

Get cold to lose weight?

There’s some evidence that cold exposure—even just staying in a cool room (62 degrees Fahrenheit, 19 Celsius) for a couple hours a day—can significantly increase metabolic rate and energy expenditure, leading to fat loss. Influential self-experimenters like author Tim Ferriss and former NASA scientist Ray Cronise swear by using cold to accelerate fat burning. Average people around the world credit cold plunges with helping them lose weight. What gives?

This isn’t just a tabloid hack. When you’re cold, your body expends a lot of energy to maintain homeostasis—up to five times normal resting metabolic rate in extreme cold conditions. Much of this comes from shivering, particularly in acute cold. 

As I already mentioned, cold exposure also increases your body’s stores of metabolically active brown fat and dials up non-shivering thermogenesis. Simply having more brown fat on board won’t cause that stubborn white fat to melt away, though. You need repeated cold exposures to “turn on” that brown fat so it burns more calories to produce heat. Cold showers or cold plunges would theoretically need to become a regular thing (or just crank the thermostat down for a couple hours each day). Brown fat, when activated, also pulls glucose and fatty acids out of the bloodstream. More brown fat is associated with lower insulin levels and greater insulin sensitivity.

So there’s something to this idea that cold could facilitate weight loss. Still, I’d hesitate to put this in the forefront of fat reduction techniques. Even as drug companies are spending millions to develop pharmaceuticals to tap into the power of brown fat, ditching grains and sugars, increasing daily movement, and working on sleep and stress are always going to be the big needle movers when it comes to all aspects of health.

Better sleep

Speaking of sleep, many folks claim that cold showers at night help them sleep more deeply and soundly. I haven’t seen studies to back that up, but I would believe that cold showers kickstart the body’s natural nocturnal drop in body temperature that accompanies sleep onset. 

This is something you could experiment with yourself. Try an evening shower where you start warm and gradually drop the temperature into a comfortably cool zone. I wouldn’t recommend jumping into an ice bath right before bed because that will spike your cortisol, which isn’t conducive to falling asleep. One exception is possibly for people who, for reasons of schedules or convenience, have to conduct their workouts close to bedtime and hence raise their body temperatures. One study found that male athletes who worked out at 6 p.m. and then hopped into cold water (56 degrees Fahrenheit, 13 Celsius) for 10 minutes slept better than athletes in a control, no cold water condition. 

But wait, there’s more!

These are the main rationale for using cold therapies, but there are many more. Researchers are also interested in whether cold therapy improves cardiovascular health, sleep apnea, chronic fatigue syndrome, depression… one almost starts to wonder if there’s anything cold can’t do. 

Bear in mind, though, that the degree to which cold therapy actually leads to desirable responses and adaptations depends factors including but not limited to 

• Type of cold therapy
• Temperature
• Duration
• Age
• Sex
• Baseline health 

That’s a lot of nuance to wade through. You can’t just throw a 10-pound bag of ice in your bathtub and assume all your problems will go away. For long-term benefits to accrue, cold exposure probably needs to become part of your regular routine. Much like meditation, you can get positive results from an occasional session here and there, especially when a new issue crops up in your life. However, the people who get the most out of it will be the ones who practice regularly.

Risks of Cold Therapy

I’m certainly in the camp of “cold exposure does some really cool things and generally makes us healthier and heartier.” Most people probably need less comfort in their lives, and cold showers, chilly winter walks, and the occasional cold plunge would do them a lot of good. Don’t be dumb about it, though. Our ancestors spent a lot of time and effort surviving the cold; the least we could do is respect it. 

If you’re new to cold therapies, start small. Go for short times at moderately cold temperatures, and build up your tolerance and exposure gradually. Hypothermia is nothing to mess around with. When you go from an ambient temperature to very cold water, your body has a natural cold shock response that can be dangerous, especially for people with preexisting heart conditions. People who have any kind of cardiovascular issue will want to talk to their doctor before starting cold therapy, especially cold water immersion or cryotherapy. Likewise, for acute or chronic injuries, get advice from a pro who can help you craft a smart recovery protocol.

Is It All Just a Placebo Effect?

A lot of the excitement around cold exposure comes from personal anecdotes from citizen scientists around the world. It’s entirely possible that some of the touted benefits they’re experiencing are due to placebo effects. In fact, I’d bet on it. 

And I’m not saying that’s a bad thing. The mind is a powerful tool, and if it helps us get better just because we believe we can, that’s great. But even if some of it is a product of your own belief system, there are piles of studies showing actual physiological mechanisms that explain or predict the benefits of cold therapy. So no, it’s not just a placebo.

So what say you? Are you already incorporating cold showers, cold plunges, or winter swimming into your healthy lifestyle? If yes, what benefits have you noticed? If no, what’s holding you back? 

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