What Are the Health Benefits of a Cold Plunge? with Dr. Asad Siddiqi

Last New Year’s Day, I went along with some members of the Health Matters team to Coney Island to do the Polar Plunge…

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

I got to spend time with friends plus it left me really clear headed and boosted all these positive feelings. In fact, we had so much fun that we did it again this year! It was truly a wonderful way to kick off the new year. So having experienced the Polar Plunge, the Health Matters team thought it would be a great topic to share with our listeners.

This month we’re devoting every episode to finding healthy habits for the new year. We’ll be talking with doctors about the science behind wellness trends, such as cold plunging, and what exactly makes things like alcohol and ultra-processed foods not so good for your health.

We’re kicking it all off with Dr. Asad Siddiqi, a rehabilitation medicine specialist at NewYork-Presbyterian and Weill Cornell Medicine. He explains exactly what happens to our bodies when we cold plunge, and what the actual benefits are, as well as some potential health risks.

Courtney: Hi, Dr. Siddiqi. Thank you so much for doing this with us. I’m so excited to talk with you.

Dr. Asad Siddiqi: Hi Courtney, thanks so much for having me.

Courtney: So, Dr. Siddiqui, we are here today to talk about cold plunges, and actually, myself and some of my colleagues, we have begun a tradition to go down to Coney Island together to do the polar plunge. And doing this plunge made me wonder, are there health benefits to this?

Dr. Asad Siddiqi: That is so cool. I have a lot of respect for people who kind of want to push their boundaries in that way. I mean, similar to people who are endurance runners or any other way that we would choose to challenge the limits of what we think is possible for our bodies and for our mind.

Courtney: Yeah, I think remembering when I did it, I was just like, I feel so alive.

Dr. Asad Siddiqi: Yeah.

Courtney: For me, like, my brain is always going a mile a minute. And I think because it’s just such an intense experience, my brain quieted. In our research we saw there’s some different types of mental health benefits associated with cold plunging. One is that it can help lessen the symptoms of depression and anxiety, and another is that cold plunging can help people manage stress better. Have you seen evidence of these benefits in action?

Dr. Asad Siddiqi: Yeah, certainly anecdotally. I have a number of folks that I have dealt with personally and professionally who say that introducing something like this, which, as you described, focused all your attention and energy on one particular thing, kind of pulls you out of any mental cycle or rut.

I can say that I definitely have heard stories like that. And can see the improvements in mood, the improvements in just overall perception of well being. I would say that the mechanisms may not be fully understood. And even, you know, whether this is some degree a placebo or just sort of a mind over matter type situation, I think if it does put someone in a better mood or a better place mentally, that it is at least, sort of a lower risk way of doing that.

Courtney: Is there evidence that it can reduce chronic inflammation?  And can you speak to why that might be the case?

Dr. Asad Siddiqi: Well, sure. So, a lot of times when we’re experiencing these musculoskeletal injuries, there are varying degrees of damage to the connective tissues of the body. So whether that’s the muscle, the tendon, which connects the muscle to the bone, or the ligament, which connects the bone to a bone.

And when you have disruption of those structures or fibers or strains of those structures or fibers, oftentimes that’ll be associated with local inflammation, swelling and fluid accumulation. So the benefits of the cold applied to those areas, it’s a way to kind of contribute to the decrease of fluid in the area. And some of the pain relief effects that come with, we think, some of that decrease in nerve conduction velocity. So those nerve signals that transmit pain may not get to the brain as quickly. It may kind of work synergistically to get someone back to normal moving patterns quicker and be able to rehab more effectively.

Courtney: It’s so interesting when you hear how these simple techniques really are effective. Like sometimes when I’m icing something that I hurt, I’m like does this really help? But then to hear how it actually slows down pain receptors is just fascinating.

Dr. Asad Siddiqi: Yeah. And I think, we can be quick to sort of dismiss the quote unquote, tried and true methods that have been used for ages but there’s a reason they’ve stuck around.

Courtney: Is it a good idea for athletes to use cold plunging as a recovery technique?

Dr. Asad Siddiqi: So it really depends on what your goal is and how you use it within training, because I think for a long time, it was kind of understood that like after a hard workout, being dumped in a cold tank or sitting in an ice bath was a great way to reduce pain, reduce inflammation, reduce swelling so that you could get back to activity faster and while there might be some merit to that from kind of everything that we talked about to this point, what we’re also seeing is that extreme cold temperatures can sort of slow the metabolic process by which muscle is rebuilt.

And so, if your goal is really to get all of the gains that you’ve kind of worked for in a workout, going right into a cold bath afterwards may actually be stunting that or limiting the impact by slowing the mechanisms that allow you to kind of rebuild the muscle after that workout.

Courtney:  Oh so it kind of slows down the muscle rebuilding. I didn’t know that. So maybe not the best idea as a post workout.

Dr. Asad Siddiqi: Maybe not immediately post workout. But again, we have to find a way to kind of put all of this into a comprehensive understanding when you’re sort of designing a workout for somebody. And I will say that cold after workouts certainly does have a role, it just may be a little bit more nuanced than we thought it was initially.

Courtney: Right. So who should be cold plunging and who shouldn’t? Are there certain groups that stand to benefit significantly from cold plunging?

Dr. Asad Siddiqi: Yeah, I would say the majority of people could benefit from this. And the way to optimize that would be to make sure that you’re doing it in a way that is thoughtful, that is kind of gradual, and that allows you to listen to your body. I think, you know, the majority of people, who are generally healthy could find something positive or beneficial from this experience, whether it’s a physiologic effect or even a mental effect.

That said, I think one of the challenges when something becomes somewhat of a phenomenon in the social media culture is people can get caught up in the right way of how to do something, or there can be a competitive element that gets introduced that can kind of push people beyond their limits.

I would say that some people probably have to be more careful  and do it with more medical guidance. So certainly folks with blood pressure control issues, heart conditions, neurologic conditions, particularly folks with peripheral neuropathy or any kind of decrease in the protective sensation of the hands or the feet, which can be a common feature in folks who have diabetes, have had cancer treatments, and are generally older.

The reason being, you want to make sure that your protective sensation is intact because that’s how the body kind of warns you when things are not going well and we know that something like frostbite is a significant risk and if your body can’t give you the feedback to let you know that tissue is being damaged, then it can be dangerous.

There are certain autoimmune conditions such as Raynaud’s Phenomenon, blood vessel spasm of the small blood vessels and the fingers that can also lead to ischemia or limiting the blood flow to the digits. Those are also folks who, typically, tend to avoid cold weather for that reason. And so cold water immersion for someone like that might also be a trigger. So those are a few of the common medical co-morbidities that you want to at least kind of have a discussion with someone that you trust in terms of your medical care to give you some advice. I always counsel people, there’s nothing good or bad inherently about the activity, it’s how you engage with it.

Courtney: So for our listeners who are cold plunge curious – how often is it safe to do this?

Dr. Asad Siddiqi: So, I think picking a starting point that is pretty, that is like a low bar is a good place to kind of gauge your tolerance and that could be anything from a cold tub that you kind of like immerse yourself in to even something as simple as, like, ending your morning shower with, one, two, three minutes of very, very cold water. I recommend starting low and going slow, if you will.

Courtney: Well, and I like what you’re saying about, like, even just making the shower cold for the last two to three minutes of the shower. And it seems like it doesn’t have to be extreme to kind of get some benefits of what we’re discussing.

Dr. Asad Siddiqi: Exactly.

Courtney: How cold does the water need to be? Does it need to be freezing or ice cold to be beneficial?

Dr. Asad Siddiqi: It certainly doesn’t need to be freezing. If you think about what our kind of core body temperature is sitting in, in the nineties and what’s kind of defined as hypothermia, which is sort of below 95 degrees Fahrenheit, you know, cold water immersion, I think, typically refers to cold baths that are less than 50 degrees. I believe it’s the National Center for Cold Water Safety has a great chart on their website that kind of plots the temperature of the water with the amount of time exposed and kind of gives you red, yellow, and green zones in terms of your safety.

And I point people to that as a resource. Certainly when you get down closer to like the thirties and the twenties, you’re looking at minutes, not hours of being in that before there’s potential for significant damage.

Courtney: So cold plunging is far from the only temperature based therapy. There’s also saunas, steam rooms, hot springs, or hot tubs that have seen a surge in popularity. So saunas specifically seem to be backed up by a decent amount of research as being beneficial. Can you explain why a 15 minute sauna jaunt is so good for you? And I’m so excited to hear if this is really good for you because it’s so nice to sit in a sauna.

Dr. Asad Siddiqi: [laughs] Sure, sure. I mean, it’s a great way, for lack of a better term to detoxify. What heat does and particularly being sort of immersed in a heated environment like that is the opposite of what cold does, is that instead of shunting blood to the core, it kind of brings all the blood to the periphery.

And so it helps you sweat out whatever’s in there. Can be a great way to bring everything that the blood carries in terms of oxygen and nutrients to the muscles that ultimately will be doing activity or recovering from activity in that sense. Like, we talked about how cold can sometimes kind of slow that process by sort of increasing the availability of oxygen and those building blocks and things like that after a workout, it gives the loaded or strained tissues a little bit more to rebuild with.

Courtney: So do you recommend any of these other activities like steam rooms or hot tubs?

Dr. Asad Siddiqi: Yeah, absolutely. I mean, somewhat, similarly, as a part of a comprehensive approach or a regimen for exercise and rehabilitation.

Courtney: So if it’s safe for the person, are there any benefits for a person to jump from cold plunge tub to sauna or vice versa?

Dr. Asad Siddiqi: So yes, oftentimes in folks who are trying to reset their autonomic nervous system. That part of the nervous system that kind of controls all the things that we don’t think about, like heart rate and respirations and skin temperature sensation, et cetera.

That can be a way for a system that is somewhat dysregulated, to be jolted back into, sort of, a reset state, if you will. And so there certainly can be benefit, to sort of the back and forth, but again, there’s also risk when you think about sort of the wild swings in terms of body fluids being shunted and respiration. But again, in a controlled environment where you are sort of mentally prepared for it and then maybe not such wide extremes of temperature,  there can definitely be some benefit and it can certainly feel good.

Courtney: Well that is so good to hear. Thank you so much for being here with us today. It was so great to speak with you and learn about cold plunging.

Dr. Asad Siddiqi: Thank you so much for having me.

Courtney: Our many thanks to Dr. Asad Siddiqi. I’m Courtney Allison.

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