#254 - AMA #47: Cold therapy: pros, cons, and its impact on longevity

Hey everyone. Welcome to a Sneak Peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to Peteratti amd.com subscribe so without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask me anything episode 47. I'm once again joined by Nick Stenson. In today's episode, we dive into all things related to cold therapy. For those of you who are regular listeners of the podcast or maybe follow me on social media, you probably notice I spend quite a bit of time talking about the benefits of heat exposure, in particular around saunas. But we do receive just as many questions about cold exposure and the benefits thereof. So we decided to do a dedicated AMA around the topic where we incorporated all of those questions. For this ama, we focus on what we do and don't know around cold therapy, including the different types of cold therapies. This would be showers, cold plunges, and cryotherapy as the three main types. How can cold therapy affect mood or even be a treatment for depression? Talk about claims that cold therapy can help activate brown adipose tissue or bat for metabolic health. Talk about what happens if you exercise in the cold. Any potential downsides around cold therapy? Talk about potential geoprotective benefits around cold therapy. That is to say, does cold therapy provide any benefit in terms of slowing aging and or delaying death living longer? And then we talk about the consensus, or lack thereof around what an effective cold therapy protocol should look like. One thing to note is this is an audio only ama. There's no video for it. However, the show notes will display anything I reference and more so without further delay, I hope you enjoy ama47.

All right, Peter, welcome to another ama. How you doing?

I'm doing very well.

So Peter, for today's ama, we're really focusing on one core topic that we get asked about a lot, which is everything around cold therapy. And so for people who listen to the podcast, follow you on social media, we've spent some time recently talking about the benefits of sauna and heat. And way back in the day, I think it was on AMA 16, you and Bob talked about hot and cold and we've kind of updated your thoughts on hot therapy, but we haven't touched on cold. And so what we did is we just compiled all those questions around cold exposure, cold therapy, and if that has potential similar benefits to sauna. And so we'll hopefully cover them all today, including really what we know and don't know about cold therapy, how it can affect mood or be a treatment for depression, what we know about the claims that it helps activation of brown adipose tissue for metabolic health. Any potential cons around cold therapy? Are there possible geoprotective benefits, exercising in the cold? And ultimately, do we know anything around a consensus for an effective cold therapy protocol? So if all goes according to plan, that's what we'll cover today. Anything you want to add before we start jumping into that?

Only that I am exceptionally happy that the F1 season as of our recording is finally back. It's a very difficult time for me when F1 is not happening. So anyway, leave it at that.

For those listening at the time of this recording, It's Friday before F1 starts on Sunday.

So practice. We've just finished FP1 and FP2 for the first race.

So how many episodes of Drive to Survive have you watched?

I'm trying to nurse it along. I've only watched 5 of 10 so far and I will say that of the first five, number four is my favorite so far.

Okay, and how are you thinking about this season? Any early predictions? Knowing again that by the time this comes out, a lot more will be known, but we're recording this completely brand new to the season.

Certainly going by what we saw in the testing week, Red Bull looked incredibly strong. The top three look predictably strong in Red Bull, Mercedes and Ferrari. I think the two biggest surprises were the strength of Aston Martin, which were horrible last year, and the not only the continued weakness of McLaren, but it looks like McLaren took a step back again. That could all be untrue by the time the season unfolds. But that's really interesting. McLaren, of course, have a new rookie driver, Oscar Piastri, who, I don't know, I think seems like the real deal. Just because you win F3 and F2 doesn't mean you're going to succeed in F1. And I don't know Oscar, but I know people who do know him and the way they speak about him suggests he will have a great future in F1. So if that's true, then it's always great to see someone like that in the rookie season. Obviously, Ferrari have a new team principal, which I think will help them a lot. As you know, I was never a fan of their previous team principal. I thought he was a clown. So I hope it's a better season than last season from a competitive standpoint. I believe it will be. Last season ended quite competitively but began well. It sort of began competitively between Red.

Bull and Ferrari and ended more competitively.

Between Red Bull and Mercedes. I would like it to be just more competitive. If it were a four horse race this year, that would be amazing.

Yeah, it'll be. It'll be fun to see how these first few races unfold. All right. So all right. Much to cold. Yeah. Much to your sadness, we're going to move away from F1. So I think with cold, I think it'd be helpful just to start with what are even the most common cold exposure therapies. When people hear other people talk about, yeah, I'm doing cold therapy. This is how I use cold. I think it'd be helpful just to understand what that even means.

Yeah, there are many ways to think about this. I think the two most common ways to think about it and the ways that we'll talk about it are cold water immersion, which will kind of abbreviate CWI if I get lazy, and then whole body cryotherapy, which is usually abbreviated wbc. Of course, I'm not referring to the World Boxing Council for those boxing fans out there. So cold water immersion, as it suggests, is you are immersed in cold water. The most common protocols you'll see could be as cold, frankly, as ice water. So that's 32 degrees. But typically in research studies, you're kind of seeing more sort of 40 degrees Fahrenheit up into the 60s. And the variability you see in temperatures comes down to the duration of immersion. So once you're in sort of the 30s and 40s, we're talking about two to three minutes. And once you're talking about these 30 minute protocols, you're typically up at slightly higher temperatures. Okay, so a couple other terms. Right. So head out. Immersion refers to a submersion, basically to the sternum or neck. But there are some protocols that will be submersion to waste only. So when that is relevant, we'll try to comment on on that. Now, the problem with this subject matter, and I'll just sort of preface this all up front, is we rely heavily on meta analyses. But as you've probably heard me say 500 times now on this podcast, a thousand sows ears makes not a pearl necklace. So a meta analysis can only be as good as the sum of its parts. And if its parts are very heterogeneous, which they often are, but not heterogeneous in the right way, then your analyses are somewhat limited. So one of the challenges here is you're trying to ascertain information from highly variable studies. Talking about WBC whole body cryo, these are things you wouldn't do this at home unless you're insanely wealthy and you would have your own chamber and your own nitrogen tank. So these are things that you typically go and do someplace else. So you go to these cryogenic chambers, you see these places all over the place and you basically stand in a tube that blasts liquid nitrogen inside. And these temperatures are pretty cold. Right? So this will be anywhere from -160 to -260 degrees Fahrenheit. And again, at that point it's hard to understand what those temperatures mean. Most of us have no sense of what that really means. For what it's worth, that's kind of like minus 110 to minus 160 degrees Celsius. And you might say, well, gosh, how can a person tolerate that? Well again you have to remember there's a totally different conductivity of gas versus liquid. So because it's a gas that's coming at you, it's not going to be nearly as capable of extracting heat from your body. Nevertheless, you tend to sit in these things for about three minutes. I've done a bunch of whole body cryo back in the day. My daughter used to take drum lessons next to a place that had a whole body cryo. And this is back when I was training a lot. So every time I took her to drum lessons I would go and get a three minute session where I'd stand in the tube for three minutes. You put little booties on so your feet don't freeze, but otherwise you're standing there in your gitch and it's cold. But truthfully, anybody who's done both will tell you that cold water immersion is much subjectively colder than whole body cryo. But anyway, it's a long winded answer. But just so folks have a sense of what we're talking about.

And within those it seems, although you do see cryotherapy and you see a lot of stuff around that, like you said, that's one where you have to go to a place where things like an ice bath or cold plunge is much more accessible to people. And I think because of that we receive a lot more questions around those two things in particular, ice bath, cold plunge. And so what do we know about some of the benefits of cold exposure therapies like those two things?

Yeah. So to build on that we're going to spend much more time talking about cold water immersion for two reasons. Maybe three reasons. One, we're getting more questions about it. Two, it's more accessible. All you need is a tub to do it. I mean, when I started doing it, I just would go out and buy ice at the grocery store and stick it into my bathtub. So I'd put cold water in the bathtub and then just dump ice into it and then sit in it. And then of course you can have cold plungers which cost a fraction of what a cold body cryo device looks like. The other reason we're going to spend more time talking about cold water immersion is there's simply much more literature on it.

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