The Science Behind Cold And Heat Therapy And How To Do It For Maximum Benefit with Dr. Susanna Søberg

Coming up on this episode of the Doctor's Pharmacy. You can go into something this simple cold water. You have an increased focus, increased drive, which would give you motivation for the rest of the day to pursue whatever you want to do and you get a more positive angle to your life even because you also increase oxytocin, which is also a stress hormone. It's also the what we call the love hormone.

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So welcome, welcome Susanna. Thank you very much so much for inviting me as well. And thank you for that lovely introduction. I'll see if I can live up to it.

Okay, well, you know, you're in Denmark. which is definitely a cold place in many parts of the year. And you've somehow found your way to study this topic, which was sort of like, I would say, not much attention was paid to it throughout medical science. And yet you've kind of created a career out of understanding the biology of what happens and why it's so important. So let's talk about this because seems like cold plunges are the latest craze. Saunas are popping up everywhere. It's a huge wellness trend, but it's something that's been around for a long time. I mean, Native American sweat lodges, the Finnish saunas, the Polar Bear Club. I mean, it's kind of been a fun thing. I actually went to Antarctica and I jumped in the Arctic, Antarctic Ocean. It was very, very cold. I stayed in for a minute or two. They had me by a rope in case I froze to death and they would pull me out, but I managed to get out. Thank you. So tell us how to just at a high level, how to cold and hot therapy have this massive potential to increase our health and our longevity even as a kind of strategy for enhancing our well-being and our lifespan.

Yeah, I love that question. It's a really good question. Taking it from the top, just actually why should we actually do this and why is it good for us? So overall said that I think that down the road, when I have read a lot of literature and also done my studies, I kind of realized that this is actually a good way to prevent lifestyle diseases. So it protects the body from getting in a inflam. It protects the value. Inflame. Thank you. It protects from inflammation.

That's right. I don't speak any Danish, so you're doing great.

Yeah. So inflammation will decrease when you stress the body, whether you stress it in a cold way with cold stress or with heat stress, you will lower the inflammation if you continue doing this. So from the first time that you go, you will already be starting this process because you are creating what you just mentioned before, the hermetic stress in the cells, which builds the cells stronger, but also the whole system is going to be activated, your immune system and more white blood cells will come out in your system because of the shock and also the stress hormones and which Eventually also then because of the increase in metabolism, which I know we will get back to that. What is that and how does that work? But all in all, this will lower your inflammation in the body and it will lower your stress level. So you will have a lower blood pressure, you have a lower heart rate, and you have done this for a while. And that is actually what we measure as an outcome for having a risk for cardiovascular diseases and lifestyle diseases. such as type 2 diabetes, but also inflammation is associated with neurological diseases such as depression and Alzheimer's disease. So what I wanted to do in my studies and why I actually went back to university after working at the hospital, I was like, okay, so many sick people here and the pile is getting bigger. I wanted to go around that pile and see if I could find out some way to give people some advice so this I don't know. This pile doesn't get bigger. I just wanted to figure out if I could give advice before they actually get sick so we could prevent disease and what keeps people healthy. So, hermetic stress was actually what I went for. So, yeah, the brown fat, which I know we will get into, but this can prevent lifestyle diseases and mental diseases.

I mean, this is just remarkable what you're saying. Essentially, there's this simple, basically free, almost free therapy that has the potential to deal with inflammation in the body, which we now know is the biggest driver for almost all chronic diseases, not to mention autoimmunity, not to mention aging itself as an inflammatory disease. And so we have this incredible technology that's been around for thousands of years that we've been using to help our body stay healthy, and I think of these as survival pathways. When we were in these non-perfectly thermoregulated environments when we were out there hunting and gathering and we didn't have 68-degree temperature controlled environments all the time, and we had to deal with these extreme temperatures of heat and cold. And when we had that, it seems to activate this ancient longevity pathway. And I think the inflammation story is so important. You mentioned mental health because it's not just increasing dopamine and other neurotransmitters, it's actually your brain is inflamed when you're depressed. And so this is actually an interesting doorway. And I just want to share a little anecdote. I'm going to get more into the details. I had chronic fatigue syndrome when I was in my 30s from mercury poisoning. And I was really sick. I was super inflamed. My gut was inflamed. My muscles were inflamed. I had myositis. I had brain fog. I had constant aching and pain everywhere.

Oh my God.

And I was just this mess of inflammation. And one of the only things that could actually help me get relief for a short period of time was doing a sauna and a cold plunge or doing them over and over again. And it was kind of like a miracle drug that nothing else worked. It wasn't curing me, but it literally helped me get some relief. So I know from firsthand experience, I mean, it's great to do when you feel healthy already and it just enhances your health. But even if you're already sick like I was, It was such a powerful intervention and it really is something I've used for decades to help me stay healthy, feel good, to reset my nervous system and to change my biology. So, it's super powerful.

I completely understand. I mean, did you have pain relief also?

Absolutely, pain relief. My brain fog lifted, my muscles stopped hurting. I felt like a normal human being for a few hours afterwards. And then my mercury poisoning, I had to deal with the mercury, the cause of it all. But eventually, it was so powerful. I kind of want to get into the science of this. We're going to get into hot and we're going to get into cold. But we'll start with cold. You're really one of the leading researchers in this, if not the top researcher. So let's break down what happens in your body when you go into cold immersion and what are the effects on your biology. And we'll go through all of them, including physical and mental. But I also want you to talk about what is the right temperature and dose because I think people are like, oh, that's scary. I don't want to do that. But actually, it may not be as much as we think we need. So let's talk about the science of it. What does it do to us? And then let's talk about the drug dose and delivery and the duration.

Let's do that. Yeah. Let's have it as a cliffhanger for now.

Yeah, yeah.

So, okay. So let's start with what happens when you go into the cold water. So as soon as actually you stand there on the jetty or on the beach or wherever you plunge in your cold plunge in your garden, as soon as you take off your robe, off your clothes, you will stand there in the cold wind and you will have an activation of your, starting your activation of your sympathetic nervous system, so your fight or flight system, because the cold receptors on your skin is going to send a signal to your brain in your temperature regulating center in the hypothalamus, where there will be this center which always regulate and sends whether you are getting a little bit too hot or a little bit too cold. from that it would send out these signals, so stress neurotransmitters in the brain, but also hormones, which are noradrenaline and adrenaline, cortisol also a little bit, not so much actually, but it's gonna activate your stress system. And that's gonna make your heart rate goes up a little bit, but also your blood pressure just a bit, it's not much, it's just between 11 to 19. millimeter, Mercury. Mercury, thank you. And which is not so much. And studies actually shows that this only happens with the heart rate going up and also the blood pressure going up a little bit. Only happens if you are a new winter swimmer. And when I say winter swimmer, it's just because that is the term I use the most here in Denmark, because that's what we call it. But what I really mean is cold water immersion. You could call it plunging. You could call it, it's just going into cold water and you can use the way you want to, what suits you. in your life. But here in Denmark, we have the open sea, so we call it winter swimming. And that is why my book is called that.

Yeah, yeah, yeah.

Just to explain the terms. So, okay, so you have an activation of your sympathetic nervous system. When you're new, it's more, of course. And when you're that, when you first.

Start, when you first start practicing cold immersion therapy, you start having, you have a more extreme reaction in your physiology.

Exactly. And that's of course going to activate when you then go into the water, that's going to activate full on your sympathetic nervous system. But because of the diving response, when you submerge your body into the cold water up to the neck, it's going to activate your diving response and your- and what's that? Your diving response is because you submerge the body into cold water and that's going to activate your parasympathetic nervous system. So it's actually also your vagus nerve. So that's going to make your system go a little bit into a conflict. So the heart rate really wants to go up because of the activation of the sympathetic nervous system, but the diving response, because of the activation of the digestive rest system, will make the heart rate and blood pressure go down. So there's a little bit of a stress in the body in the first, yeah, half a minute to a minute around that time, especially if you are new to this. So if you are trained and you have done this for a while, your body gets more adapted to it and you won't have as much of an activation of the sympathetic nervous system as you would if you were completely new.

So you'd have more of a parasympathetic response.

Yeah.

If you were doing it over a period of time, yeah.

Yeah, exactly. So you get adapted to this. And that's also because of some physiological processes that is happening in the body. And you can divide them into three processes, which is the metabolic process where the activation of the brown fat in the body body is this healthy kind of fat that we have. I'm not gonna go completely into that right now because it's not. We're gonna come back to brown fat. Yeah, we are.

We are. But that's.

It's a good kind of fat.

It's a good kind of fat.

The good fat. And then there's the bad fat. That is the white fat. And we want to activate the good fat so we can get rid of some of the white fat. So that's a good thing when you go into the cold water and you activate your sympathetic nervous system, because that is going to increase noradrenaline, activate the brown fat, and then you heat up. We're gonna go more. that. Okay.

But that's one of the points. Just to stop for a second. So just to unpack it because you're going fast. So the diving response essentially is to help you survive if you fall in cold water because it slows everything down and slows your metabolism down and slows your heart rate down. It's why people who have hypothermia, even when they seem to be near death, can be revived because everything kind of is conserved. Yes. So that's actually a good thing.

It is a good thing. It's because it's cold. Yeah.

Yeah. But that's sort of what the diving response is. for people who don't know what that is. And it's a powerful survival mechanism.

It is exactly, yeah. So the diving response only activates when you submerge into water, so not in the cold shower, for example. So when you do that, you have this activation of all your neurotransmitters in the brain and you will have this activation of the parasympathetic nervous system. If you are able to stay there longer than the cold shock. And when that subsides, it takes about a minute or two, then you have the full activation of the parasympathetic nervous system. And if you can get over to that and you can sit long enough in the water for that, you have to rehearse that. People should go very slow and this is not what you do.

The first 30 seconds are the hardest and then it gets easier.

Yes, that it gets easier. But it goes quick actually. Studies show that only already after the third time, actually, you go into cold water. And this has been tested in studies where they took subjects and put them into water and already after the third time, they could see a lower hyperventilation in the subjects. So they found that they didn't hyperventilate as much. So the heart rate and blood pressure went down, but it's also because of yeah, people get a little bit anxious about going into the water. What is this? Is it dangerous or is it so? Yeah. So the first thing that happens is the activation of your autonomic nervous system.

And then the metabolism, the brown fat is the next part, right? So then tell us about the brown fat, what it does, why we have it, why it's important. Because, you know, there's a fascinating group of Tibetan practices called tumo. You probably know about this, right? Tumo, you know about the Tumo practices? The drying of the sheets. So, the Tibetan monks, when they would go through their initiation, who lived up high in the Himalayas, they would have these sheets dipped in ice water in the cold Himalayan winters, and they would wrap themselves in the ice sheets, and they would have to meditate and activate their brown fat. Of course, they didn't know they were doing that. They were doing ancient breathing and breath practices, activated their brown fat, and dried the sheets on their body. and then once they got good at that, they were actually given the opportunity to go up into the snow, basically with just underwear on and a loincloth and have to sit overnight and keep themselves warm overnight in the winter. So, that's the power we have within us that people don't realize. You didn't know about this?

I didn't know that story.

Oh my gosh, it's amazing. You should Google it. It's called Drying of the Sheets are tumo. It's an ancient Tibetan practice.

It sounds like it's about the brown fat because it's not like you can say so intuitively we have known about how the body works and how we can heat up from the inside. We just didn't have the science around it. If you look back to our ancient Greeks, so Hippocrates and Socrates, they always said that they advised people to go into the cold water and go into the hot water because that's going to make your fluid, your your blood or your fluence, what is that called? Yeah, fluence. Yeah, your body fluence flow easily in the body if you do that. So they didn't really know exactly, they didn't have the science to back up what they were really saying, but they kind of intuitively knew that this was already going on. So it sounds like this story you're telling is because people can feel that they heat up when they get cold. That is also what My science show that you actually get physically warmer from activating your brown fat and doing this kind of activity going into the cold and going into the heat. But you get warmer.

Yeah, it's true. Seneca 2000 years ago was a stoic philosopher. He was a cold water enthusiast. He inaugurated the first of every year with a cold plunge in the Virgo Aqueduct. And Thomas Jefferson used a cold foot bath every morning for 60 years. and died at 83, which was old back then. So it's fascinating that there's actually Hippocrates also talked about it.

Yeah.

So this is not a new idea.

It's not a new idea. They called this thermalism. That's why I actually called my school or my course, I call it thermalism and thermalism core, a cure. Because yeah, that's a tribute to them because they already then saw this. And today we have some signs to back it up.

So, so you have this parasympathetic sympathetic shift in your body. And, and that actually, even though it seems like a stress, eventually it actually can help your nervous system calm way down. Right. And, yeah, and, and mitigate the effects of stress. I want to come into the brown fat, but I want to talk about this inflammation and also the mental health part, because I think that's important. And we'll, and we'll dive deep into the metabolism conversation. So, so with the cold plunge, you get a release of other neurotransmitters and it changes your cognitive performance and your mental health. And can you talk about that? And then we're gonna talk about inflammation, then we're talking about brown fat.

Okay. Okay. Great. So the mental health part. Yeah. So what is great, or you can say what we actually need today is to learn how to stress up to stress down. And that is what happens when you go into the cold water. So what happens is you get this increase of neurotransmitters in the brain of a no adrenaline, which gives you focus and drive. And it actually increases up to 2.5 fold within just a few minutes. And I think that is amazing. And we knew this already back in the 70s, which is shown in studies, old physiology studies back then. So it's not kind of like new news or anything. It's just that today we can take the science together and we can make a better picture around what actually is going on in the body when we put this together and also together with, with my research, which I published a year ago. But what it shows is that you have this increase in noradrenaline and you have more Focus, you will have more Drive because you also increase dopamine. And dopamine also increases 2.5 full above baseline. Wow.

Amazing. Yeah. It's like taking a Ritalin. basically, right?

It is, yeah. And I don't know.

What, you don't take Ritalin?

I'm saying yes, and people are being like, what?

No, no. From an academic perspective, it's like the same mechanism as Ritalin. Or cocaine. Or cocaine, right?

Yeah, yeah, exactly. And I have also- It's much safer for you.

It's much safer. yeah.

So I think it's amazing that you can go into something this simple, cold water, and you can dip yourself there. You have an increased Focus, increased Drive, which would give you motivation for the rest of the day to pursue whatever you want to do. And you get a more positive angle to your life, even, because you also increase oxytocin, which is also a stress hormone. It's also the, what we call the love hormone. But it increases your Way of viewing your life also. So this is the gratitude that you can feel when you go into the cold water. I don't know if you feel that, but, but definitely this is what I hear.

So I'm definitely grateful when I get out.

Yeah. Yeah.

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But all together when you go into the cold water, what it does for you collectively, it opens, it widens your window for stress actually. So that is a process when you go into the cold water and you can relax in a situation which is super stressful for you and you can use this and practice in the, I call it a cold water training sensor for your nervous system, because this is really where you can try and open up this window a bit more so you don't get as easily stressed in your everyday life. I'm not saying that we are not overstressed, but maybe we are, our window for stress has also narrowed. It has narrowed also. So maybe if we can open that window and we can tolerate stress a bit better mentally, Then we would also not have our as much mouth breathing society, which we have today. And when you breathe through your mouth, you activate your sympathetic nervous system, right? And that's gonna also affect your mental health. So it's like you're stressing yourself. It becomes this vicious cycle. Yeah. So you can use the code for your, to, you could say, create a better mental balance for yourself. Not only just in the moment, because in the moment, you will completely forget about your worries because the body goes into a moment of just survival. Even though you did it on purpose, the body is going to react that way, but you can use it. You can use that reaction to completely delete whatever was on your plate. It's a great reset.

It's an incredible reset.

It is. It is. I call it the control alt delete effect. Because that's exactly what it does.

Oh my God, that is so good. Control alt delete. so you can control all the lead, all of your stress response and come into a calmer nervous system state that allows you to be more focused, present, happier, increases all the happy mood chemicals, love chemicals. It's really quite remarkable and it's something that happens pretty quickly.

It happens so rapidly within a few minutes actually. So if you can stay in the waterfall, just getting over to the other side, I call it of the cold shock, where you stop hyperventilating and you can relax in the water, you don't really have to stay there much longer. You have already the benefits, right? So you can go up and what happened there is you completely deleted your worries and you then have a new, you can say, mindset. Your brain is full of all these good chemicals and that is going to make you view your problems, your life, everything, nature, people around you, in another perspective because now you have this positive sim, positive mind, right? And that's how you go into life. So if you can do this a couple of times a week, imagine how that's going to affect your life. If you, on purpose, can go out and take this happiness pill, it's just cold water.

Well, it's like a stress resilience, right? It's like, yeah, about, you know, if you if you had to never exercise in your couch potato and then to go hike ten miles, it would be a really hard thing to do. And if you are constantly in a state of stress that is psychological stress, but you don't have a way to reset your nervous system and become adapted to it, you don't develop stress resilience, right? You can develop exercise resilience where you can be fit and exercise. It doesn't bother you. Whereas if you don't have that, it's going to bother you. Same thing with what you're talking about. It's a way of building stress resilience in our life so we can handle more stresses over time and not be so buffeted around by all the difficult things in our life.

Yeah, exactly. And I think one thing that we can point to, which it's very difficult to prove, how do you get more stress resilience with this? But I think one thing we can point to as a kind of proof to this is that we have found in my studies that you actually get warmer from going into the cold water. So becoming a winter swimmer, cold plunger, dipper, whatever we call it, you become a warmer person meaning that you will be more comfortable in the cold. And I, as myself, can completely vouch for that because I was definitely a person who was a bit of a, I call myself a cold sissy back then. But today I am not. Today I'm like, I'm completely, like, I would say most, like, I'm, I don't fancy the cold and I don't think everybody, anybody should actually. That would be really weird, but. I like the cold today because I know what it can do for me. And a cold wind today doesn't bother me as much as it did when I wasn't going to swim. So my stress resilience against temperature changes has actually changed. So it doesn't bother me as much anymore. So I think that is one thing that we can point out and say, well, that's just a physical thing. So imagine what is actually also happening in your mind.

Yeah. So, and also, you know, what's interesting is a lot of mental health problems are problems of inflammation in the brain. So depression is inflammation in the brain. You touched on it earlier. ADD is inflammation. Autism is inflammation. Alzheimer's is inflammation in the brain.

Right.

So a lot of the things that, that are going on in the brain mood wise are inflammation as well as sort of all the other chronic diseases. So can you talk about the role of cold therapy? for inflammation in general and what it does and what the mechanisms of action are and how it works.

So now we're going to talk about the brown fat because that is what we activate when we go into the cold water. So the brown fat, I'm just going to repeat a bit because, yeah, I didn't really say it all. Yeah. So when you go into the cold water, as I told you, you activate the cold receptors in the skin, and that's gonna send a signal to the brain, and that's going to release. nor adrenaline, which is a stress hormone. And that's going to activate our healthy brown fat. And that's located, you can almost touch it actually, it's underneath your clavicular bones. And I measured it in my studies, it's just like one to two millimeters under your skin, so you can almost touch it actually. Yeah, exactly. And that's the largest depot. There are six places in the body where this, it's actually an organ. It's, it's, you can define it as an organ. It's six places, but it's around the central nervous system. And it makes sense. We have S2-S5.

It's around your back too, right? Between your shoulder blades and your back.

Yeah. So down the spine and under your superclavicular bones on your, what is this bone called? The sternum.

Sternum.

The sternum bone. Yeah, exactly. And also a little bit around the kidneys and a little bit around the heart, which makes makes sense. So the purpose of the brown fat is to keep you warm. And this is, of course, developed during Evolution and to keep the human body warm when we were out there and it was super cold and then it was super hot some other times. But back then we had the brown fat to keep us in the perfect regulation all the time, and that takes energy. So the brown fat, when that is activated, it increases our heat in our body. But that takes energy, so that uses glucose and fat from the bloodstream as fuel to activate it and increase our what's called thermogenesis. But it's also what's called non-shivering thermogenesis, meaning that the muscles are not helping at this point.

Thermogenesis just means heating up the body. So you can heat up by shaking and shivering or by the activation of this brown fat that's been there for millions of years.

Yes, exactly. Thank you. So it's like the first responder to our body when we get too cold or we get too hot. But it happens so quick. We have like 10 times more cold receptors in the skin than we have for heat, for example. And that is because we can easily die when we fall into cold water. Makes sense that we have been involved in that way.

That was before climate change.

Yeah, exactly. And today we We don't get exposed to any temperature changes, right? So it's like living these houses 24 degrees all the time, right? So the brown fat is gonna also be activated directly from the skin. So there are studies showing, recent studies actually, in showing that there are signals going directly from our skin and directly to the brown fat without passing the brain. So there's like two pathways to activate the brown fat. immediately within seconds as soon as you get a little bit cold on your skin. So also when you just go out in a t-shirt and it's cold. So, yeah.

So that increases your metabolism. That increases your metabolism and actually makes you burn more fat in general. Like you said, the brown fat activation helps burn the white fat, which is what we're trying to get rid of.

Yes. And also it burns your glucose. so your sugar and fat in the bloodstream. So it doesn't only take the fat that is like on your thighs and on your belly and you want to get rid of the white fat, right? But it clears up also the glucose and fat that is already floating in your blood vessels, in your blood streams. So it's going to clean up that and it's going to use from your depots as well. if you are cold enough or you can say for long enough and you do, for example, multiple plunges or you also use the sauna. The sauna can do some of these things too. We need to remember that.

We're going to get to there. We're going to get to there.

Yeah, exactly. So, yeah, that is like the first thing that happens within the body.

So essentially what you're saying is that it helps to regulate one of the biggest problems we're facing in society today, which is insulin resistance. which is problems with our blood sugar and metabolism. I mean, 93.2% of Americans are in poor metabolic health, which means they're somewhere in the continuum to diabetes. And what you're saying is that this cold therapy can be an adjunct to lifestyle treatments that actually help to improve your blood sugar, your blood pressure, your fat burning, your metabolism. It's just fascinating me, right?

Yeah, exactly. That is, that is what happens down the road when you continue this. And yeah, so it actually happens from your first plunge. So it's, it's going to do all this acutely, but eventually- Is there data.

That, sorry to interrupt, but is there data that show that you, you can lose weight by doing cold plunges?

No, not on the weight scale at least, but we can see in my studies which we published from Copenhagen University in 2021, that we can increase the brown fat activity and make the brown fat cells more efficient. Because what happens in the brown fat when you continuously expose yourself to the cold is that it increases mitochondria in the cells. And the mitochondria are the little energy fabrics that you would like more of, of course, because that's going to keep you young. and keep the cells young, and it's gonna help the brown fat cells increase more heat in your body, and that's gonna burn more calories from your body as well. So the more mitochondria you can build in your brown fat cells, the more efficient they will be and the more fat and sugar that will burn. And that's gonna decrease your, increase your insulin sensitivity, which we also found in my studies.

So basically, even though we haven't done the weight loss studies, theoretically it seems like it actually is increasing your metabolism, which will help you to lose weight and correct the insulin resistance, which will help you even lose weight even more. So it's sort of an incredible positive feedback loop in terms of energy, in terms of mood, in terms of mitochondria, in terms of metabolism, in terms of inflammation. What's the mechanism for reducing inflammation? Because I noticed that if I have pain or stiff or sore, I go into a cold plunge, I come out, it's just gone. It's quite amazing. It's like taking a bottle full of Advil or something, you know?

Yeah, it's amazing. And actually it's kind of like really hard to get down to and find in literature the precise pathway for this and what's actually going on. But what I have found so far is that you, of course, you activate also the IL-6. So it's like what you also do when you exercise, for example, but, and that is like, inflammatory cytokine. Yeah, exactly. And, and it's also gonna activate IL-10 so it's gonna do both, of course.

But because the anti-inflammatory cytokine.

Exactly. And because of that, you are gonna lower your inflammation. And when you lower your inflammation and you, at the same time, increase endorphins in your body, you will have a lower pain in your joints or whatever it could be in your leg or where you have your pain. But it's also because of the more blood circulation that comes to this place where it hurts. And in time, when you continue your cold plunging, you will have, can you say clean up? I don't know, but it's because of the increase of of leukocyte and monocytes which is going to clean up the inflammation, they will come out and like exactly. And that's going to take that away from your bigger blood circulation, but in the capillaries there you will have more and more blood circulation and a better vascularity and that's going to relieve the pain also. So I think there is more processes going on here which are a little bit difficult to come down to and say exactly what is going on. I think there is multiple things going on, but some of them could be this.

So, just basically three things. One is it seems to increase endorphins, which is like morphine or heroin, the pain relief chemicals you have in your body. It increases the activity of a important cytokine. Cytokines are these inflammatory or immune molecules. And, one of them is called IL-10 that reduces inflammation. And, three, it increases initially vasoconstriction, which it sort of shuts off blood flow, but then it actually, the rebound effect, the rebound effect is you get vaso dilation and then you get increased circulation. So, there may be like multiple mechanisms to reduce pain.

Multiple mechanisms. We can also just mention nitric oxide, I think, because nitric oxide, yeah, I think it's an important one because when you go into the cold, that happens also in the heat. We could go back to that. I keep saying that.

We're gonna get hot and soon.

The nitric oxide is gonna increase the blood vessel's ability to dilate and contract. And that's gonna increase the oxygen delivery to all your cells also in your body. And that is also a good thing for pain relief. yeah.

So nitric oxide is basically, or no, we did a podcast with Louis ignaro, who is the one who won the Nobel Prize for discovering this molecule. Wow. Yeah. And he can go back and listen to that. It's so effective. It can be so effective for many things. He was even talking about it as a treatment for covet because of the powerful anti-inflammatory effects. And so this is something our body makes to breath. If we breathe through our nose, it's really important to breathe through our nose. we breathe through our mouth, we don't make nitric oxide. But, you're saying is that this cold therapy also will activate nitric oxide, which is a powerful anti-inflammatory compound in our body. It's so important. It's so cool. All right. All right. So, now we're talking about all the benefits, the brain benefits and mood benefits, the dopamine chemicals, the stress resilience, the increase in our metabolism, the decrease in inflammation and pain, all these wonderful things. Now let's talk about how do we take this drug? Because it sounds like a miracle drug, right? What is the best way to do it? What's the amount of time we should do it? What's the temperature we should do it at? And what's the difference between a cold shower versus a cold bath versus an ice bath versus a cryotherapy unit where you can go and stand there? Talk us through all that.

Yeah, I can try. It takes a while. It takes a while, but okay, so if you use the C or the cold plunge, I mean that this is where you can do the same thing, right? So when you do that, you can, I think it's really important that people do a little bit of breath work before they go into the water because they need to think about their breathing and their nervous system as the steering for how well your cold plunge is going to be. And especially if you're a new, this is definitely something you would like to practice before you go into the cold water and you don't go totally into panic. If you can stand on the jetty or before your plunge and just do some breathing with your nose, so nasal breathing in and out, and try to relax if you're standing in a cold wind, it can be difficult actually. And by that you will lower your stress response, so you activate your parasympathetic nervous system. And if you can do that, you one, rehearse it before you go into the stressful situation where we would like you to continue this, but also you go into this stressful situation not already very alert. So that's not really going to help you. So when you have rehearsed this a bit and you can, it can take a few seconds and you don't have to stand there for very long, but when you can do that, if you have relaxed a bit, you exhale completely before you step in because that's going to make room in your lungs for doing the first like inhalation and if you are new and I am especially concerned for the new ones, I don't, I want them to have a really good experience. So that's why I'm talking to those people. Yeah. So if you completely exhale, you make room in your lungs, more capacity is there, right, for you to do like a inhal. And you would do that because you. Yeah, exactly. You activate your gasping reflex. So you cannot really help that. You cannot control it at. At when it happens at the first time or the second time, maybe. But what you can.

So if you scream when you jump in the cold water, that's okay.

It's completely okay. It's completely okay. I think people will forgive you. Yeah, but what you can do is you can. lower your stress when you go into the cold water and you gasp a bit, just try and remember, just think about your breathing. So the goal is to do completely nasal breathing in and out when you're in the water and also during your cold shock response. But this is not going to happen the first time. I'm just quickly going to say that. But you can try and rehearse it. So if you do a cycling, I just, I think it's, it's, it's fine if people do the try to keep the inhalation through the nose and then out through the mouth.

Yeah. So how many, how many breaths did you take? Just cycling while you're in there? Just do it while you're in the cold plunge?

I don't know. I haven't counted that.

I just, I mean, you want to do it for like a minute or two before you jump in? Is that the idea?

Oh, you mean on the jetty? I just think you should stand there for a few, it could be a few seconds or half a minute. It's just. until you feel that you have lowered your stress response, especially if you're a little bit anxious about this, try to calm yourself down. This is also a training for your anxiety, right? To open your window for stress. It also starts before you go into the water. Lower stress response before you go into the water. But in the water, try and see if you can nasal breathe. But if you can't, then just do the cycle of in through the nose and out through the mouth. And then you can switch eventually when you get more adapted to this, but.

It doesn't have to be the first. So breathing before and then breathing when you're in there. Yeah. And then.

And then how long do you stay in? And what temperature? Oh, yeah. So that depends on where you are. So we in Denmark, in Scandinavia, we have the nature to completely control what temperature we have in the sea. And I think that's amazing because our, the water temperature is always cold. so, so we go down to maybe one degree and Celsius. Celsius in January. But if, if we, for example, when we start, like, we call it winter swimming or cold water swimming. We call that from October. And October is like, that is when the color, the water is gonna get colder. And that's around maybe it, it varies a bit, but maybe yeah. It could be 15 or down to nine degrees. And then in November. So 15 degrees is.

Fair enough. About 59 is 59 degrees Fahrenheit. Right.

Fahrenheit. Yeah. Thank you. I'm.

I'm not good with the converting. That's okay. That's okay.

We gotta.

I wonder if everybody gets what this is.

There's listeners all over the world, so some are fahrenheit, some are. Yeah, exactly. Yeah. I should memorize this. Actually, I will try. Yeah. So. so when you get into the water, it's not that important exactly what temperature it is, as long as just cold water. You'll be amazed that actually your metabolism is going to be activated also from 20 degrees Celsius, actually. And, and you don't have to always have the water at one degree. If you can control that in a plunge or something, you can vary the temperature. So just a different.

Well, you sit down to nine. Nine is like 48 degrees, but a lot of these cold plunges. 40 or something.

Yeah. Yeah. So it's not, it doesn't have to be that cold, right?

To really have the same benefit. So you don't have to, like, power down to, like, 40 degrees to get the benefit. You get more, you get more benefit if it's colder.

So we haven't done any studies. There are no studies showing that, the, the relationship of temperature and activation of the metabolism and what what will happen down the road if you have like more benefits or if it's gonna stress your body too much. We need these studies in the future. But what I'm saying is that it for my study where we had winter swimmers in the ocean here where the temperature from October vary from I think there is like there is a table in the book actually where I put it in so people can see what's the temperature in Denmark, what are we talking about?

So it's the book is winter swimming for those who want to get it. Winter swimming.

Yeah. The book is winter swimming. It looks like this is actually pretty amazing, I think. So in the. Yeah. So in the book, there's a table shown from October until the season ends in Denmark, which is in April. So during this time, the temperature is going to be from 15 or nine. It varies a bit. And then down to one or zero degrees Celsius. And then it goes up a bit again in February and also in. In March a bit. and then in May it gets hotter, of course, the water. So. But it's not like it's that hot. I mean, 19 degrees Celsius in the summer, it could be a little bit warmer. It's still chilly. And it's going to activate your nervous system. It's going to activate your metabolism.

So that's interesting.

So.

So then, you know, cold plunges are, you know, 40 degrees. You can go down to 45. My bathtub, I, I measured the temperature in the winter. in my bathtub, I just put cold water on. And it's like 48, it's like 48 degrees, which is like 9 Celsius. Okay. It's pretty cold. It's pretty cool.

Yeah.

And so then you're in there and you could do it in a, you know, in the ocean, which was sort of more adventurous. You could do it in a lake, you can do it in a pond, you can do it in a river, or you can do it like in your bathtub in the winter if you turn on the cold water.

Right.

Just turn on the cold water. you can actually throw bags of ice in there if you want to make it even colder, right? And then, or you can buy one of these fancy cold plunges. I have a friend of mine actually, you know, bought a horse trough. It's like where you feed horses water. And then, you know, just, it's like a big metal tub you can buy it like for a few bucks at the horse supply store or something. And then he fills it up with water and then throws a bunch of ice in there. And it's like how he does it. So there's a lot of ways to do it. How long should you stay in? A minute, two, five, 10 minutes? What's the...

Per session. Yeah. So I can tell you what we found in my studies that we performed here in Denmark. So in my research studies from my PhD, we found that at 11 minutes, and this was shown in winter swimmers who had already been swimming for two to three winter swimming seasons, so they were adapted I wanted to study the adapted ones because I wanted to see if they were different from a group of control subjects, right? And I wanted to monitor how much time do they spend in the water. And I wanted to find out with how little can we get away with because I was not a winter swimmer myself. I was kind of like most comfortable people with temperature. I don't like the cold. So I was thinking, I'm pretty much like many other people. So can we figure out something that is easy to do but still efficient and efficient enough. So 11 minutes per week we found and divided on... Well, not 11 minutes.

All at once, but just like 11 minutes per week.

11 minutes per week and not at once, divided on two to three days. And also per day, we did at least in this study, they alternated with cold plunges and the sauna. So it was this contrast therapy where it started with a cold plunge and then they went into the sauna and then the cold plunge again sauna and they ended in the cold because I told them that that is how the protocol should be.

Yeah.

Because that's good for you. I can tell you why.

But yeah, yeah.

But just to answer your question, you're.

Talking about like three to four minutes a day a time is when you.

Divide 11 by three or four per day, right? So every plunge should not be more than one to two minutes. This is what my submersible does.

Just one to two minutes, not three or four minutes.

One to two minutes per dip.

Oh, because I put my stopwatch on, I stay in three minutes or four minutes sometimes.

Well, do you also alternate with the sauna?

Yeah.

No, no, you don't, because my studies show that that's good, that's contrast therapy. So what you should do is you plunge for one to two minutes and then you go into the sauna. And my protocol also shows that our winter swimmers stayed in total for 57 minutes in the sauna. So if you divide that also on these days and if you have of course the facilities you can go and alternate, then you should only stay in the sauna for 10 to 15 minutes and then back in the water and you end on the cold.

So basically for about an hour a week, you can have these dramatic health benefits.

It's amazing.

It's dramatic. Now, what about a cold shower?

Yeah, cold showers.

Because, you know, Wim Hof talks about like a two minute cold shower in the morning. Is that as good or what's the deal with that?

And cold showers are definitely something that I would also say that if people cannot come to a cold plunge, then I think that... You don't have a.

Bathtub or a cold?

Oh, exactly. Not all people do. then I think it's a very good alternative and people can start off in a cold shower. But there are different benefits and I think that if people can only do cold showers, then that is better than nothing. So I would say cold showers are very good for you. It will also activate your brown fat. It will also activate your sympathetic nervous system. You will not have the complete activation of your parasympathetic nervous system and you will only get adapted to that temperature which you take your cold showers in. of course. So there are studies on this showing.

Actually that if you live in Arizona and the cold water doesn't get under like 60 degrees well then, but if you live in Massachusetts in the winter it's like 40 degrees.

Yes, exactly. So it really depends on your cold water, how cold is it? So there's this interesting study where they compared temperatures of cold showers. If you can get adapted, the question was can you get adapted to cold water with cold showers. And they divided these groups in how long time they ended on cold showers in their hot showers. And there was also a group who just took hot showers. And they found that if you end on a few seconds, 10 seconds cold shower with a certain degree, it was 15 degrees, and the other group was 12 degrees and they then put them into cold plunges to see if those subjects who had taken cold showers at 15 degrees Celsius, if they had adapted to cold water just in general, so they tried that out in cold plunges at 10 degrees, but they hyperventilated just as much as the group who didn't take cold showers. So the temperature is going to depend, dictate whether you get addicted.

Yeah, I'm kind of addicted to cold and hot therapy, actually. I think I might be addicted. It's so addictive, it just makes you feel so good. It's like better than any drug I've ever found. Not that I take a lot of drugs, but it's like, it's pretty impressive. The other thing is, these cryotherapy units, you know, where you go in and you stand as like 270 degrees below zero, you put a little hat and mittens on and you sort of stand there for three minutes. Does that do the same thing?

Yes, there's a lot of like questions. I have a lot of questions around that and I have been through some of the literature. I can't say I've been through it all, but I definitely been through a lot of it. And I can say that It seems like it can activate your temperature receptors in the skin. So you will have an activation in some degree to your brown fat at least. And because the temperature is so low, you only spend, what, three minutes in there? Isn't that right? Like three, four minutes? Yeah, I think the protocols in the science literature is around the three, four minutes. If that is gonna have the same effects, as submerging into water, I would doubt because the modality is so different. It's so different. So that is also why if we cannot compare the cold showers with the cold dips, we can also not compare what do you call you call jacuzzi or hot tubs?

Hot tub, yeah, with a sauna.

Yeah, hot tubs with sauna because it's air and and water, more molecules, of course, in the water closer to your skin. So, it's gonna do different things. So, we need more studies also on the cryo to exactly say how is that gonna lower your inflammation. But I believe there is something there. I just need some more backup from the research.

Yeah, yeah, I got it. Well, we're gonna link to this study, but in Cell Reports Medicine, you published in 2021 a paper called Altered Brown Fat Thermoregulation enhance cold water or cold induced thermogenesis in young, healthy, winter swimming men. And there you talk about the sweet spot of the dose, right?

Yeah.

And you talk about this sort of concept of why there's a minimum threshold effect for both cold and heat exposure. So can you talk about what those thresholds are and a little bit more about that study?

Yeah. So we already just touched upon the protocol for that. What actually was the results of that?

That was the minimum threshold. It was like 11 minutes and 57 minutes of hot and 11 minutes of cold. Okay. That's what I thought you were getting to.

Per week, per week, per week. Yeah. And divided on multiple days.

I tend to do that in a day if I can. If I can go back and forth for like four times and then hot and cold, and I can get that in a day.

Yeah, and I think that, I mean, it could be that we don't know what's the higher threshold because we don't have studies showing exactly on the cold water if that's gonna have some detrimental effects on our system down the road. But we do have, yeah, I don't know if we should go there right now, but it's like we have these sauna studies, observational studies, where we can see a higher and a lower threshold for which a window for where definitely good for you. And that is why I think because of that it's just stress. Heat stress, cold stress, it's just stress for the body. We should keep ourselves try to hit the sweet spot in the middle where it's healthy for ourselves and for our system. Because you could be feeling really good when you get out of your cold plunge and some people can build up a long time, which I don't really recommend that people do, even though you can mentally feel, okay, I'm getting cooler and, I mean, not only physically, but I'm getting really tough and cool because I can sit in this plunge for a very long time.

Oh my God, yeah.

Yeah, and maybe also some get a little bit competitive around it. Yeah, yeah, yeah. I just want to underline that it might be that you cannot really see what's happening right now and you may feel really good afterwards, But it doesn't mean that it's not overstressing yourself. And maybe down the road, it adds up and gets too much. We don't know that, but we need to figure that out and do more studies on it. But I think it's very important.

Yeah, I agree. I think it's going back and forth. I went to a conference up in the mountains in Colorado, and they had a sauna that was amazing. A wood-fired sauna got super hot. And then they had a cold plunge outside, which was really cold. And so we had a group of us for all these overachievers and, you know, and so we were going back and forth and, like, increasing the time and time. And I. I got to five minutes in the cold, which was pretty damn cold. This one woman got to, like, I think, 10 minutes. It was just impressive. It was very impressive. She's like a Navy SEAL, you know?

Oh, okay. Yeah.

She wasn't a Navy SEAL, but I was, like, being a. you see? So that's really amazing. Now I want to, now I want to go into the heat part. So we did the cold. We did a good job on the cold. At a high level, is it better, do you think, to do hot and cold alternating therapies or like, is it good enough to just do cold or just too hot or what, what are the sort of advantages to doing both?

I would say anything is good. So if you only have the ability, if you can only do the cold, then do that. If you can do the heat, then do that. just do some of it if you cannot do both. But if you can do both, I would say it's a really good thing to try and contrast it. I don't think that you will, I can't say what exactly effects you will miss out on because my study shows the combination. Yeah, exactly. But we know what happens in the cold and we know that it creates this homoeostatic stress and you increase these stress proteins and it repairs the cells, which also happens in the heat. The mitochondria in the cold will increase and in the heat, the heat will make the mitochondria more efficient. So there are overlapping effects of doing the cold stress and the heat stress for your cells. And when I talk about cells, you should just think about your whole body because your whole body is like building blocks of all your cells putting together. so it's just not one cell I'm talking about. It's a whole organism.

So it's good to do both based on what your studies. Can you take us through the mechanisms of action of how heat stress benefits the body? What are the mechanisms and how does it work? Because in my book, Young Forever, I talk about hormesis and I talk about how in these Finnish studies you saw like a 40 plus reduction percent in mortality. in the group that did four to five saunas a week. And, the control group was like one sauna a week because pretty much everybody in Finland has a sauna. So, they all do saunas. So, the control group was also doing saunas, but it was still a pretty dramatic reduction. So, tell us about how does this work? What's the mechanism of action? What are they doing to the body?

Yeah, and I just want to say I think these results are remarkable from Finland and the study that you mentioned from 2017. 2015 is really showing what happens down the road. So this is like results after following these sauna bathers for 25 years. And the control group was actually also using the sauna. So one of the things that we research sometimes debate a lot is that the control group is some completely other group who doesn't do anything healthy like the sauna bathers or the winter swimmers. But this group has actually chosen to also do this kind of healthy thing. So even though they maybe not have the time to do four to seven times a week or they for some other reason don't do that, but they still just do one time. And that's at least a choice in your life that you want to expose yourself to extreme temperatures. So I think it's a really, it's a good study. I really love it. Yeah.

So tell us about the mechanism factor. How does the heat stress work to activate longevity switches in the body and healing responses?

So yeah, yeah, I'm not sure I can explain all of the things that's going on because I also know from the literature that there are still things that we don't know. But what we do know is that when we activate our heat receptors in our skin, there is like the co-receptors that would be sent a signal to the hypothalamus and we will have an increase in noradrenaline and we will also have an increase of all our stress response, of course. Nitric oxide will also be released and that will be an increase of the blood vessels would dilate because you need to get rid of your heat in your body. The brown fat will also be activated, it seems, that there are actually studies showing that the brown fat, which is increasing our metabolism, is also activated in the heat. And it's kind of like, contra-intuitive I know that. Yeah, it's kind of like I have tried this in India or in Sri Lanka, actually. So when you get really, really hot and you're too hot, then you are given a tea. to drink some tea. And that's like, why are you giving me something really hot when I am too hot already? But that is like, that is to drink that, get warmer in your core. And when you do that, you will help your blood vessel to open. And that makes your body, body's ability to sweat even better. So that is what the brown fat also does in your body. It activates. So you will open your blood vessel. You get, you can get rid of the heat. but the heat stress response is, the best response from that is actually an increase in sweating and your ability to sweat, but also a lower core temperature. So for every time you go and expose your heat, you activate your heat stress response in your body, you will prepare your body for the next time. And by that, the body is sensing, okay, I'll have to prepare myself. So your core temperature actually, by time, lowers a bit. And you can use that for something. And I don't know if you want to know that.

Yeah, of course. Now what? Use it for what? Yeah.

So, yeah, I. I love. I love that people like, what can we use a little core temperature for? And I'm also like, well, actually, when you lower your core temperature, you have a higher window for. for example, when you go and train in the training center, when you do your sport. Because what happens is, what is lowering your running economy is actually that your temperature goes up. So if you want to have a higher training economy or you can train for a longer time before you get exhausted, before you hyperventilate and you have to stop, that is your temperature going up. So if you can widen that window a bit, then you are actually getting fitter.

Oh, wow. So it makes you fitter. Actually, I think the science is there. It increases cardiovascular fitness.

It is cardiovascular fitness. And this is also shown in studies that because of the dilation and the contraction of the cells, of the blood vessels, but also because of the sweating that increases your ability to sweat, that is going to for your blood vessels, your blood your whole circulation is like a training. It's like training out or it's like a moderate HIIT training, I would say.

Yeah, yeah. Interesting. So it's like exercising by sitting in a sauna.

Exactly. Yeah.

Essentially. And what is interesting is it has really great cardiovascular benefits. Like tell us about the cardiovascular benefits of sauna.

Yeah. So going back to the studies that we just talked about before, the observational studies from Finland, which shows that if you go into the sauna two to three times per week, it will lower your risk of cardiovascular disease by 27%. And if you go into the sauna four to seven times per week, which is almost like one time every day, then you can lower your risk of cardiovascular diseases by 50%. So I think that there's a lot of health benefits which we can see here in this study on a long term, which is then, and now we'll go back to that, because of lower inflammation, because the heat stress is going to activate your system, your blood vessel will dilate, and you will have an increased ability to also contract and dilate your blood vessels.

Well, I mean, I think, you know, just to kind of talk about the cardiovascular fitness benefit, benefits in terms of blood pressure, heart rate, variability, autonomic nervous system health, stress resilience, reduction in, you know, congestive heart failure sort of complications. I mean, it's really quite interesting to see the data on this, right?

Yeah, exactly. So, the cardiovascular health increases because you also, it's like a cardiovascular fitness you do when you go into the heat. So, your blood pressure will actually be lowered. These, there are studies showing that the pressure goes down when you exercise your system in the heat and also your heart rate and your heart rate variability. So there are really signs now today backing up that the heat stress is a workout for your body.

Yeah. So just to unpack it a little bit for people. So heart rate variability is a metric that is measuring the complexity of your heart rate. The more complex it is, the healthier you are. and it's a great sign of your stress response, your autonomic nervous system, and it's sort of a great measurement that we can use. We can do it through our Oura Ring, Apple Watch, all kinds of Garmin Fitbit. We all measure this heart rate variability, which is really an important thing to track because it's really the sign of your overall health and it correlates with mortality and many other things. And so, what we see with sauna is it actually increases the complexity and increases the variability, which is really an important effect of the saunas and the heat therapy. There's another thing that happens that has to do with heat shock proteins. Are you familiar with the heat shock proteins? Can you talk about what are heat shock proteins, why they matter, and what they do, and why it's so important for us to activate these heat shock proteins in our body?

So heat shock proteins increase when you go into the heat and the body stem that now you're getting warm. So the heat shock proteins are in all your cells and you can increase that when we get warm or the cells get warm. And that is to protect the cells. So the heat shock proteins increase and they repair the cells from the inside, meaning that if you don't overdo it, the heat shock proteins is going to repair the cells so they will live longer. So that's good for longevity. So if your cells live longer, you will also live longer, right? so the heat shock proteins are, there are many of those. There is especially one family of those. It's called heat shock protein 70, which is the most studied I have found to show that when you activate that with heat, then this group of heat shock proteins is going to repair the cells. There was also the Foxo3, which, I don't know if pronounce that right, but Foxo3. O3.

O3, it's a mitochondrial regulator, right? It releases the longevity.

Yes, exactly. And that is also increasing in the heat. So, and that's gonna help you, your cells also be repaired and it's gonna live longer. And as long as you don't overdo it, that's back to the homedic stress, the healthy stress that if you overdo it, then, then that would just exhaust.

Yeah. I mean, if you get heat shock and you die or you go too cold, you had hypothermia. and you die, right? So it's that Goldilocks amount, right, which you're talking about.

Yeah, I think the stress will have, the over-stressing will start before you die.

That's right. So this is amazing. So heat shock proteins are important. Also they help with protein repair, don't they? A lot of proteins are damaged. And then one of the hallmarks of aging that we talk about, and one of the, I explain in my book, the hallmarks of aging is damage to proteins. and those damaged proteins don't work properly. And proteins are like the messenger systems in our body. They do so much and build tissue or repair organs, but they're also communication systems. And so a lot of the communications get screwed up and we have an information problem, almost like bad software running our biology. And so these sauna therapy seems to improve these proteins and fix them and repair them. Is that accurate?

Yeah, exactly. The heat shock proteins repair the proteins in the cells, which is like a little magic doctor in our cells that you can just call with just going into the heat. And I think it's very simple and you don't have to be really good at it or anything. You don't have to be anyone special. You just go into the heat and then you could just repair yourself just for a bit, just a little bit of dose of repairing myself and then you can go home. You don't have to overdo it even.

Yeah, and it's anti-inflammatory also, as you mentioned, and the Foxo is involved in regulating inflammation in the body. So it helps with that, but also it seems to activate the innate immune system. Our immune system gets boosted when we.

Do this hot therapy. Yeah, it seems also to be activated.

So what amount of saunas do we need? You mentioned 57 minutes a week. I mean, is that a reasonable amount? That's like, like four 15 minute sessions a week?

Yeah, so it's, I think if we, I'll try to compare this actually with the finished sauna studies just to see if it's comparable in what we can maybe call a good window for stress. So if we do the 57 minutes over a week divided on two to three days and with two sessions each day, that means you could do four sessions each week, or you could do six sessions each week. So it's between 10 and 15 minutes each session then. Okay. Hope you follow. Yeah, yeah, yeah, yeah.

I try to get so hot that I can't stand it, and then I go on and get so cold that I can't stand it, and then I just get out. So it's like I go back and forth. But you're saying you don't even need to do it that extreme. Just a little bit even makes a big difference.

I can come up with a good example after this. I can tell you how little you can do actually.

So that's not so scary then for people. It's like you don't have to be the Iceman and be like Wim Hof in the ice bucket for like two hours and get the benefit, right?

No, you can be completely normal, scared of the cold and hate the heat and just say to yourself, well, I'm not really loving running 10 kilometers either. That's not really something I personally love to do, but I do it and I go up and train. I like that now, but in the beginning, I didn't like it.

Yeah.

No. And everybody who takes a break from exercise don't love the first run for five kilometers. And they will hurt in your muscles. And that is just exactly when you do the hormetic stress by going into the cold and through the heat. But back to the, the 57 minutes. So you can divide that out. and if we compare it with the Finnish sauna studies, it seems that there is a higher and a lower threshold as well, where we see that if you do more than 19 minutes, up to 30 minutes, so 19 to 30 minutes, it seems also to have, right, I was done another place, so I say from zero minutes and up to, yeah, to 19 minutes, you will have an increase in, or you have a risk, a lower risk, sorry, a lower risk of cardiovascular diseases. And that window will continue up to 30 minutes, but it won't like be better or anything. Your risk will get better. So, but after 30 minutes, there seemed to be a plateau where, yeah, exactly, where the benefits don't, are not shown anymore. And maybe even the risk of cardiovascular diseases increases. So it seems that under 30 minutes is like the healthy. And if you can stop at 19 minutes, that is where you get the most out of it. So my protocol shows 10 to 15 minutes even gives you benefits. So that is like in between. That's why I call it a bit, maybe it's the sweet spot. I don't know.

I love that. I love that. Well, I also, I also emphasize important for people to stay hydrated. So make sure they drink plenty of water. And also, I recommend electrolytes because you lose a lot of electrolytes. And people will often be able to tolerate more heat if they stay hydrated and have electrolytes. So that's a little, little tip. So in terms of tech technology, I mean, there's infrared saunas, there's, you know, regular heat saunas, there's hot baths, there's sauna blankets. Are they all the same? what's your better? It doesn't make a difference. Do you have any data? Do we not know?

There's, yeah, I mean, there are not too many, I don't want to offend anyone, but it's like, there are not, there are not very good studies on, on this yet, but there are some studies and it shows that you can go into, you can use the infrared sauna and it's going the most studies are on like on skin, on eczema, and if it has a difference in eczema patients in children and also in adults, and it seems actually to increase the moisture of the skin. And if you don't overdo it, you won't get burned. That was also one of the things for infrared. For infrared. Yeah, you can burn yourself actually from there. But there are I think it's a difficult thing to go into infrared sonar research because there are different lengths of the sonar. Exactly. And there are the short, the mid and the long lengths of wavelengths. So it's very difficult to compare also these studies. So some sonars have only the long wavelengths and some have the near combined with, I mean, it's a little bit difficult to go into that.

We need more data. But they work and they work. And what about like a hot bath? Because many people don't own a sauna. What about a hot bath? Does that work?

Yeah. Hot baths are very good. it actually, it seems. So there are more studies on this. And I can just give an example.

So it should be as hot as you can handle it or it should not matter?

No, no, no, no, it shouldn't be. So there are studies in where they have tested type 2 diabetic patients and looked at glucose levels where they have been in a hot bath, they used a hot bath for and three weeks. And they saw that the type 2 diabetic patients who was in the study, they actually lowered their HB1C level, which is. Yeah. And the average blood sugar. Yeah. It shows the, the amount of how much sugar over a period of time they have in the blood. And there are also studies showing that it, that is like just on the temperature was 39 to 40 degrees Celsius. What is that?

Like a hundred. Like a hundred. They're 90s to 100. Yeah.

Okay. So that you can use that, right?

But baths can be effective, but they're different than saunas. And we don't know if they activate all the same pathways or do they?

Not the same, but it's also the diving response because you also go into the hot water, right? But it seems that it also activates the brown fat and it, but that is not tested like my study exactly where they have measured what happens if they're a heart bath. But you activate your metabolism as well. And you must do that because they also lowered their blood pressure, heart rate, and also the blood sugar. But the other study about the pain showed that you can have a pain relief if you go into a hot bath. at 20 degrees Celsius, which is like on the middle side, not too cold, but not too hot. But it's like, yeah. And also another study showed like 25 to 27 degrees also had pain relief effects. So you can have many, many different temperatures doing all this. So I just think that it also shows that you should vary the temperature and even the temperature just being different from your skin is going to actually make a difference.

It makes a difference. So basically, you don't have to live by the North Sea in the winter to do this, right? You can use a cold shower and a hot bath. And most people have access to that. You can do cold showers, you can alternate back and forth, you can do them independently, right? This is all stuff that most people have access to. But do you think it's worth the investment to buy some type of sauna, a sauna blanket, a small sauna your house or a cold plunge?

Yeah, I think so. If you if you if you are.

Person, if we look at all the things we spend our money on for our health, it's a gift that keeps on giving. I put a steam shower in my bathroom, really, like 23 years ago, and it's still working. I've had to replace the glass a little bit around the shower, but basically it's the gift that keeps on giving. And I just have a big bathtub and I fill with cold water. I don't have a cold plunge yet, but it's something I've been doing for so long and I find it one of the most powerful health enhancing technologies out there. And it's basically very inexpensive or can be close to free.

It can be almost free, but actually I think people should start thinking about this like, for example, exercising and going to the gym or buying your exercise equipment. You have to exercise your nervous system also. And you have to buy some equipment for this because this is training your physiology, but also your, your mental health. So this is, this is doing a lot more, I think. Of course, the exercise is actually doing some of the same things, but here you can do it really rapidly and you can mix this, but you have to invest in it and you have to, people just have to get used to the thought. of like exercising your nervous system, I think.

Well, this is so exciting because, you know, there's all these people talking about biohacking this and biohacking that, but you're a PhD research scientist and you spent your career focusing on the biology of hot and cold stress and how that can activate our body's own innate healing systems and even activate our longevity pathways, which I think is just phenomenal. And what's great about your work is that not only are you publishing papers in academic journals, but you created an online school for people called the Soborg Institute, which is not how you pronounce it in Danish, but for us who don't speak Danish, so it's the Soborg, Soborg is how I pronounce it, S-O-E-B-R-G Institute. And it basically teaches you how to use heat and cold therapy and breathing in a way to optimize your health. And you've written a book called Winter Swimming: the Nordic Way Toward a Healthier and Happier Life. It's super exciting. So give us just briefly like a couple of minute rundown on the Institute, what we're going to learn and why people should sign up right now.

Yeah, yeah. Well, I made the school because I get so many questions about how to do this and I would really love to teach everyone about this and like I did my subjects in my studies. So I have made this course. It's a free week course of 21 days. it's just something that you can do in your own pace, but it's about the cold, how to use the cold in different ways, but also the heat and how functional breathing is also going to lower your stress level. So the main thing about the course is how to lower stress and inflammation to a more healthier and happier life. So I give you like a rundown through all these videos. It's all video content. which you can take in your own pace and it's very bite size. So every video is very short, but there are many of them in a library. So it's really easy to go through. And I'm very happy that I just got the first reviews of my courses and they are actually brilliant. So I'm really happy. I spent so much time on this course. So I'm happy. It's well received so far. So yeah.

What's so great is that, you know, a lot of academic research researchers don't translate their work into practical applications for people. And, I'm so happy you created the Institute. I'm so happy people can go online and find it. We're going to put the link in the show notes, but you can just Google the Sobriquet Institute, S-O-B-E-R-G. You can also get her book, Winter Swimming. And, also, if you go get the course now, you get a 10% discount on the three-week online Thermolus course with the code HYMAN. So, I would encourage you to check that we'll put all this in the show notes. And, I encourage you all to make sure you incorporate heat and cold therapy into your life on a regular weekly basis. It's a game changer in so many ways. It'll make you happier, healthier, fitter, skinnier, and live a long time. So, I think it's kind of a win-win.

Yeah. Amen.

Well, Susana, thank you so much for your work. Keep going at it. We want to learn more research from you. over time. Everybody listening to this podcast, I hope you liked it. It certainly was exciting for me to learn so much about the science behind the things that I've known feel good, and now we know why. So thank you so much, Susana, and for those listening, if you actually had experience with hot and cold therapies, what have they done for you? How have they changed your life? We'd love to hear, leave a comment, share this with your friends and family. Everybody needs to hear about it. And subscribe wherever you get your podcast.

And we'll see you next week.

On the Doctor's Pharmacy. Thank you for having me. Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I wanna tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health. and get healthier and better and live younger longer. Hi everyone. I hope you enjoyed this week's episode.

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