Cold Showers: What’s the Evidence?

Some people have questioned the evidence behind hydrotherapy, especially the cold water treatments that are described in the book that Alexa Fleckenstein and I co-authored. German research supports the effects of cold water used on the skin as therapy. Unfortunately, the studies are in German, and they are small. (1) Because Pharma firms have no interest in inexpensive water cures, there probably won’t be big studies any time soon. Fact is, the German insurance system pays all or part of physician-prescribed treatments, including hydrotherapy and herbs. The importance and therapeutic potential of water, and especially cold water, are now simply taken for granted in Germany.(2) Here are some specific research studies supporting the health benefits of cold water treatments. Citations are listed at the end. (More cold water research details in Own Your Health (2003)

Boosting the immune system
A pilot study of immune effects from cold water therapy with a small number of breast cancer patients found significantly increased disease-fighting cell counts in every category examined, including neutrophils, lymphocytes, monocytes.(3)

Reducing the perception of pain
In a study in Japan, cooling by ice water was one of the “competitive stimuli” that reduced the perception of the pain of a laser beam on the skin. (4)

Improved circulation and function in the legs
A Swedish group administered three weeks of alternating cold and hot hydrotherapy to the legs of patients suffering from intermittent claudication (reduced blood flow) and found that improved systolic blood pressure in ankles and toes, reduced pain, and markedly better walking ability went beyond the results of standard treatment and persisted for at least a year after treatment.(5)

Swimming in the winter?
Ten healthy subjects who regularly swim during the winter were evaluated at Berlin’s Institute of Biochemistry at Humboldt University Medical School. Their blood and urine showed increased levels of anti-oxidants, which prevent cell damage, indicating their bodies’ increased tolerance to stress.(6)

(1)Summarized in Bühring, M., Naturheilkunde: Grundlagen, Anwendungen, Ziele (Natural Medicine: Basic Application and Goals), Munich, Verlag CH Beck, 1997.
(2)Haas, S.S., Hydrotherapy and more: Adapting Kneipp’s Natural Medicine to the U.S., Complementary Medicine for the Physician, 2000; 5(8):57,61-64.
(3)Kuehn, G., Sequential hydrotherapy improves the immune response of cancer patients. In: Mizrahi A, et al., (eds.) Potentiating Health and the Crisis of the Immune System: Integrative Approaches in the Prevention and Treatment of Modern Diseases. New York: Plenum, 1997.
(4)Kakigi R., et al. Pain relief by various kinds of interference stimulation applied to the peripheral skin in humans: pain-related brain potentials following CO2 laser stimulation. J peripher Nerv Syst 1996;1:189-198.
(5)Elmstahl, S. et al., Hydrotherapy of patients with intermittent cluadication: a novel approach to improve systolic ankle pressure and reduce symptoms. Int Angiol. 1995;14:389-394.
(6) Siems, W.G., et al., Uric acid and glutatione levels during short-term whole body cold exposure. Free Radic Biol Med. 1994;16:299-305.

46 Comments

Filed under Chronic Pain, cold shower health benefits, Healing, Health, Water

46 responses to “Cold Showers: What’s the Evidence?

  1. Mama Kelly

    Certainly food for thought. I may start finishing my showers on cold in an effort to boost my own immune system a bit.

    Thanks for an informative post.

  2. Leon

    The Pharmacies should know about cold water therapy because medication is expensive and the side effects are discomforting. Cold water, is to me, never discomforting, except when it first beats on my skin. Then it gets warmer. My body is alot better because of the power of the cold bathing. I have never felt better until I started the regimen.

  3. Dear Mama Kelly,
    Let me know how you feel after you’ve been doing the cold showers for a little while. I’ve been doing this for several years and hardly ever get a cold!
    Roanne

    • Tree

      This is true. I’ve been swimming with a polar bear club for 2 years now where the water temperature sometimes dips into the high twenties. Now, I’m usually never sick and my body never gets cold. I’m a true believer in cold water swimming. I also have arthritis in my back that ceases to cause me pain the entire day following a ten minute swim in the cold water. Try it!

  4. Roanne,

    There will never be the same money in funding alternative medicine studies – No Big Pharma to pay millions for the research.

    On the flip-side, the clinical work is more trustworthy in my opinion – without the corruption that comes from paying research chairs, and the FDA their ‘fees’ along the way.

    The more important thing is ‘injury’ – How many people are going to get injured by cold showers? My guess is that it will be several millions less than those who take drugs – especially those for ‘depression’.

    I think when it comes to natural methods to find health and healing, we are all unique – what works wonders for one, may simply take the edge off for another. And vice-versa.

    I see a lot of this from a more spiritual side – one that says we are all unique – and what works is complex – because it involves everything from our bodies and minds, to this incredible spirit of ours.

    In our culture we seem to want to ‘prove’ everything with science. Ironically, I think that feeling good and being at peace, and experience each day to its fullest is the only ‘proof’ any of us need.

    Our own experience trumps science. And we certainly should feel confident enough to trust this ‘experience’ – whatever it is for us.

    Duane

  5. Roanne,

    It occurs to me that I might have not given credit to the research you’ve been involved with in your writing – your books, etc.

    I did not mean to imply in any way that the research done on natural methods had no validity.

    On the contrary, I believe that much of the Big Pharma research is money-drive and political – hardly true science.

    I hope my comment didn’t come accross as not having faith in studies with natural methods – actually, I meant just the opposite.

    And, the experience we have with these natuaral methods – meant to say that this is (in my opinion) the best way to heal – safer, and more effective.

    I hope I didn’t cause any hurt. If so, I am sorry.

    Duane

  6. Not at all! I agree with you, and so does Alexa Fleckenstein, MD with whom I wrote two of the books. She has always said that there is no funding for herbal treatments, for example, because you can’t patent a plant!

  7. I would like to see more studies with Huperzine A – an herb for Alzheimer’s Disease.

    The small group studies have been amazing – with good results and few side effects.

    It is a Chinese moss, and I believe it may be able to run Alzheimer’s Disease out of town.

    Dr. Joseph Mercola, and others believe that many of these herbs (although not entirely safe for everyone, and certainly able to produce side-effects themselves) are much safer as a group than many of the ‘medicines’ we use.

    I have often wondered (and contine to wonder) if many of the medicines we see prescribed are simply copied (while slightly modified) versions of what we see in nature.

    In other words, they may take something like this Chinese moss, and copy it in a lab – while slightly modifying it – in order to get a patent…..

    Certainly have no proof of this – who would? But, I do wonder…..

    The best places I’ve found on the subject of herbs – the American Botanical Council – here in Texas, and the American Nutraceutical Association – http://www.ana-jana.org.

    At the above site, you can search both herbs and supplements – by name, or by medical condition.

    Also, Vitasearch at http://www.vitasearch.com has good clinical trial information about a variety of supplements – for all kinds of ‘dis-eases’.

    Duane

  8. Coldshower

    ANTIPYRETIC EFFECT OF MODERATE COOLING

    One of the first scientific reports of cold water treatments of fever was written by Scottish botanist and military physician William Wright (1735-1819) at the end of the 18th century [60], which was a departure from the then prevailing paradigm according to which fever should be assisted and promoted in order to allow agents of disease to come out of the body with sweat [14]. This is what he wrote about one of his first experiments during a febrile illness that he caught on a boat near Jamaica in 1777:

    “September 9th, having given the necessary directions, about three o’clock in the afternoon I stripped off all my cloaths, and threw a sea cloak loosely about me till I got upon deck, when the cloak also was laid aside: three buckets full of cold salt water were then thrown at once on me; the shock was great, but I felt immediate relief. The head-ach and other pains instantly abated, and a fine glow and diaphoresis succeeded. Towards evening, however, the febrile symptoms threatened a return, and I had recourse again to the same method, as before, with the same good effect. I now took food with an appetite, and, for the first time, had a sound night’s rest” [60].

    He continued the cold affusions twice a day for two additional days, to prevent a relapse [14,60]. The method was later promoted by another Scottish physician James Currie (1756-1805), who went on to test this approach on scarlet fever, smallpox, measles, influenza, as well as shipboard fevers and tropical fevers (malaria) and reported beneficial effects from experiments on himself and on his children as well as from various correspondents [14]. Unfortunately, James Currie published most of his findings in his books rather than peer-reviewed journals [10].
    Cold water treatments were met with initial enthusiasm, especially in Germany and were used rather widely in Central Europe and in the United States in the late 18th/early 19th century [10]. The interest gradually abated by the 1830s, and cold water treatments of fever were virtually abandoned afterwards [14]. The biographers of James Currie cite several reasons:
    1) Cold affusions were too stressful and frightening for patients, and were often vehemently opposed by a patient’s family [14]. Patients often preferred the less stressful tepid washings (the equivalent of modern sponging [1]) or tepid baths instead of cold water affusions [14].
    2) Reports of success with febrile infections lead to indiscriminate use for other non-febrile conditions and resulted in patient discomfort and disappointing results when used in inappropriate circumstances [14]. This situation was aggravated by the fact that body temperature of patients was rarely measured at the time [10,14].
    3) There were other, less stressful treatments of fever, which were often preferred by patients and doctors. Some of these other antipyretic treatments, such as James Currie’s favorite bloodletting, had no actual effect on core body temperature as we know today, but they replaced cold water treatments all the same [14].

    More recently, in the 1970-80s, the use of cold affusions was popularized to some extent by P. K. Ivanov in Russia [36]. A cold water treatment can be designed in such a way that it may be effective, yet minimally stressful, such as a gradual cold shower at 20 degrees C as described eslewhere [47]. It should be noted that controlled clinical trials of cold hydrotherapy for the management of fever are lacking.
    It is worth mentioning that physical cooling methods such as cold water immersion or cold water spraying/evaporation are a quickest and most reliable way of lowering core body temperature known today [18,57]. Some reports show that a cooling speed of up to 0.3°C per minute can be achieved [22,24]. In modern clinical practice, cold baths are not normally used for reducing fever (antipyretic drugs are usually prescribed [7]), although sponging with tepid water is sometimes used instead of antipyretic drugs [1]. Sponging with tepid water (around 30°C) can reduce fever within 1.5 hours and was found to be less effective than acetaminophen [1]. Cold water treatments on the other hand, are routinely used in the management of heatstroke and severe hyperthermia and can quickly reduce body temperature [18,57]. Despite the rapid cooling effect in the case of elevated body temperature [14,22,24], immersion in 16-23°C water cannot normally cause hypothermia (core body temperature of 35°C or lower) in humans, even if the immersion lasts for several hours [54]. This suggests that cold showers or cold baths at 16-20°C could be used to achieve virtually complete elimination of fever within minutes with minimal risk of hypothermia. The procedure may have to be repeated several times per day in order to maintain near-normal temperature [14,60], and, interestingly, there is evidence that exposure to cold can abolish febrile responses to endogenous pyrogens [51], suggesting that the antipyretic effect of cold exposure is mediated not only by physical cooling but also by neuroendocrine changes.
    Reducing or eliminating fever appears to be desirable (e.g. during influenza illness) because, theoretically, pyrexia is not expected to provide any known therapeutic advantage at least in viral infections, as opposed to bacterial infections where fever may be beneficial [35,46]. While antipyretic therapy such as acetaminophen has no effect on the development of an immune response [21], one study showed that acetaminophen can prolong influenza illness to some extent in experimental animals through an unknown mechanism [42].

    ANALGESIC EFFECT

    Numerous experiments show that laboratory animals subjected to a brief cold water swim experience substantial analgesia for 1-2 hours with respect to tonic pain and for 5-10 minutes in the case of phasic pain [6,27,37,41,55]. This effect is in part mediated by a dramatic increase in the plasma level of beta-endorphin after exposure to cold [17,45,56] (also reported in humans [16,19,53]), which is an opioid peptide and an endogenous painkiller [56]. The other component of this systemic analgesic effect is non-opioid in nature and appears to be mediated by noradrenergic pathways in the spinal cord and the locus ceruleus in the brain [5,32,44]. While the non-opioid component of analgesia appears to be attenuated with repeated cold swimming [23,33], the opioid component was shown to be augmented [8,33]. An additional possible component of cold swim-induced analgesia is the gate control effect of local sensory stimulation [39], which basically means that pain in the foot, for example, can be relieved by stimulating sensory receptors in the foot through vibration or immersion in cold or hot water, etc [12].

    EFFECTS ON INFLAMMATION

    Exposure to cold has been known to have an inhibitory effect on all cardinal signs of inflammation for quite some time [20,34,39]. In addition to reducing heat and pain, exposure to moderate cold also reduces redness (erythema) [40,43,50] and swelling (edema) [13,52]. While most of the available evidence relates to the effects of cold on local inflammation, moderate exposure to cold appears to inhibit physiological manifestations of systemic inflammation as well by reducing fever and causing systemic analgesia as described above.
    It should be noted that the relationship between cold and inflammation is not a simple one, as exposure to extreme cold appears to induce inflammation [28]. Cooling of the skin to near-freezing temperatures causes pain [31,38] and redness [59] and cryotherapy of warts with liquid nitrogen is known to induce local inflammation [15]. Another interesting aspect of this relationship is that while repeated systemic exposure to moderate cold reduces physiological manifestations of inflammation [51,57], it also appears to cause a modest pro-inflammatory shift in serological factors, namely, it slightly increases the plasma levels of interleukin-6 [9,29,30], tumor necrosis factor alpha [30], haptoglobin [30], hemopexin [30], and slightly decreases the plasma level of α1-antitrypsin [30] and testosterone [29]. As explained in the next section, repeated exposure to moderate cold does not appear to be immunosuppressive [30,49], in contrast to other anti-inflammatory treatments such as corticosteroids [4,11].

    IMMUNOSTIMULATORY EFFECTS

    Cell-mediated immunity is thought to play an important role in the host defense against viruses and tumors [25]. The most intriguing property of repeated exposure to cold is that it appears to stimulate both innate and adaptive cell-mediated immunity [30,49]. Studies show that both single and repeated brief exposure to cold can increase the numbers and cytolytic activity of peripheral natural killer (NK) cells [9,49,58]. Repeated brief exposure to cold has been reported to increase the total number of peripheral lymphocytes [30] as well as the number of peripheral activated (HLA DR+ and CD25+) CD4+ T lymphocytes and CD8+ T lymphocytes [30,49] and to enhance proliferative responsiveness and cytokine production of splenocytes [2,29]. These observations are consistent with non-specific activation of cell-mediated immunity and a possible mechanism of this effect may involve the numerous neuroendocrine changes resulting from transient activation of the sympathetic nervous system, hypothalamic-pituitary adrenal and hypothalamic-pituitary thyroid axes by brief exposure to cold as described in more detail elsewhere [48]. The non-specific activation of lymphocytes by repeated cold treatments does not appear to cause autoimmunity [26,29,30,37,49], but, interestingly, repeated cold exposure was shown to reduce spontaneous incidence of tumors [26] and to increase survival of mice infected with intracellular parasite Toxoplasma gondii [3], the observations that may be consistent with enhanced cell-mediated immunity. To date, there have been no controlled trials demonstrating a beneficial clinical effect of cold hydrotherapy in human subjects, for example in patients with cancer or with a viral infection. Exposure to cold may also have adverse effects on health (e.g. in Raynaud’s syndrome) as described in detail elsewhere [48].

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    • Interested in Data

      Hello, would anyone be able to direct me to the German study related to breast cancer and cold water therapy? The study is widely noted on many web sites, but no one is able to produce the study. I am fine if the study is in German. I am a cancer survivor and use the cold plunge pool after fitness workouts on a regular basis. My oncologist is interested in finding out more about the breast cancer study.
      Thank you.

  9. What a wonderful article about cold water exposure – I just wish you had given your name! I am curious who put in so much effort into this cause…

    The cold water cure did not start with Sebastian Kneipp as you demonstrated – but neither was William Wright the first one. Sebastian Kneipp had read a tract about cold water curing by Johann Siegemund Hahn, who in turn got his ideas when he traveled through England around 1700 and heard of the ideas of John Floyer (1649-1734) a proponent of cold bathing. Long before Floyer however, Caesar Augustus’ private physician Musa had cured him from a liver abscess (which allegedly lead to abandonment of the famous warm Roman baths…I am not sure that is altogether true…). And before Musa, some cave man figured it probably out for himself.

    Like many good ideas, certain things are reinvented or rediscovered again and again after the knowledge is forgotten. One wouldn’t know now that in the USA around 1900 there was a “cold water craze” when Kneipp’s ideas first had hit the continent. Many spas were opened, especially in the Mid West and down to Louisiana. They had their own newspaper and magazines. Then, with World War One, everything German got a bad name, and definitely after World War Two and the Holocaust – so the old ideas were lost. To my knowledge the last cold water spa on the continent is on the Vancouver peninsula.

    You have put together an excellent bibliography. You are right that it shows lack of clinical studies though. The evidence in physiological studies is all there – but who would ever put big money into a large study about cold water? Fat chance, I’d say.

    Hope we hear more of you!

    Alexa Fleckenstein M.D.

  10. Pingback: More Evidence About the Health Benefits of Cold Showers « Own Your Health

  11. Michael Zorich

    I am trying to convince my teenage son who is getting sick too often to use alternate hot and cold shower and this post came in very handy. I am originally from Russia and people over there have used extreme alternate method to promote health (jumping from very hot sauna into the very cold water) for century. I have tried it couple of times and it is a greatest feeling. Do not try if you have poor heart conditions though. On a daily basis I am doing contrast shower for many years and did not have a major decease for a very long time even though before it was all to easy for me to come down with a flue. It works.

  12. Cold shower is great for immune modulating and reducing colds and flu. But if your son gets sick often, I also would reduce – or better even, eliminate – sugar and dairy from his diet. And perhaps his doctor should check if he has a gluten problem.

    The foreign rights to “Health20 – Tap into the Healing Power of Water” have been bought by someone in Russia (also by Estonia, among others). So, perhaps, one day you can read it in your mother tongue!

    All the best!

    Alexa Fleckenstein M.D.,

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  16. This is great info; thanks. I quoted a couple of your descriptions of studies and linked to this page on my blog, http://www.tri-freedom.com/?p=116

  17. ps

    hello!
    i’ve been taking almost only cold showers for the past 7 years (about 90% of the showers i take). im 29 years old right now and since i starded doing that, for personal reasons, i stopped getting ill. if you want to start taking cold showers i would suggest anyone to do this before going to bed at night so as to warm up again. meditation before taking a very cold shower, especially in the winter, has proved effective for me, jet i would say that listenig to ones own body is the most important thing to do while doing such practice. its seems quite shocking, but our body has been confronted to cold shocks since millions of years and i would guess its quite capable of dealing with it. once i showerd during 9 months only 2 times with warm water, even if it was winter and during the winter the cold water from the tab is even colder, at least here in switzerland. one last advice i would give anyone is to avoid taking cold showers during real illness. but if you are not ill, but only feel a little bit weak, a cold shower might be all you need so as to boost up your immune sytem and heart rythm back again! also if you are beauty consearned about your skin! i have heard many times, the last time today, how soft my skin is, and trust me, im a guy, all i use is nivea, jet the cold water really does good to my skin! good luck! p.s.

  18. You are right, ps: A cold shower does not kill us but makes us stronger.

    Usually, I recommend a cold shower at the end of a warm one, but your way works too. The point is to not take a cold shower on a cold body – first warm up with exercise.

    When I was young, my rented apartment had only a cold shower. Did not kill me but showed me the invigorating power of cold water.

    And by the way: Nivea – an old European stand-by – is fine. But plain olive oil (if you wish with a drop of essential oil like rosemary or thyme) is even better for your skin.

    Water greetings!

    Alexa Fleckenstein M.D.

  19. ps

    thanks alexa for the tips. sometimes i do sport or play drums after the cold shower so as to warm up again (especially in the winter) but warm up before the shower is shurely better, i just never really thought about what was better,.
    anyway! its an interesting subject these cold shocks!
    i starded a subject on green wikia (like wikipedia) about cold showers. i used the german version but i will try to place also some links on the english one. here the first link. very simple but i just made it very fast yesterday, maybe you can also add some info!

    http://de.green.wikia.com/wiki/Kalt_duschen

    i will try the olive oil + essential oils!
    thanks!
    ps

  20. Patrick McGeown

    Thanks Alexa for your website. I found cold water by accident. This year the public swimming pool stayed open six weeks later than usual. Winter crept in. I continued to swim and found myself longing for my 1 km cold swim. I have never experienced anything so exhilarating as this in my life. Sadly our local pool closed but now I have taken up cold showers. I stay under the water for about five minutes (but wear rubber thongs as my bare feet freeze on the tiles). It has only been a few months but I feel great – in fact, I can’t get enough of it and want to shout the praises of this to one and all. Most I share with think I am mad. But madness is a small price to pay for the euphoria. I normally have circulation problems in winter – this year will be a test.

    • Patrick McGeown

      It is eights months since my last post. I lasted the whole winter with cold showers. Although at night I would start with warm to scrub the dirt off and finish with cold. Then cold every morning. I haven’t had a cold since I started. At times I have had a few “off” days but nothing like before. And certainly nothing more than three days. Maybe I need to move to a colder climate on a permanent basis.

  21. Patrick McGeown,

    Your five cold minutes are very brave – and Kneipp only recommends a few seconds (20 to 30). But truth is that different bodies have different requirements – and yours seems to be happy with that amount of time. Of course, cold water exposure also differs with different water temperatures.

    I couldn’t have described better the total bliss after a cold shower than you did it! Thank you!

    Have you tried the other modalities for an all-around health – movement, fresh food, herbs and order? Let us know!

    Alexa Fleckenstein M.D.

  22. James Bond and the Cold Shower

    Most of us have never read the books – just seen the films. But somebody recently told me that James Bond is always taking cold showers. And yesterday I got one of the books – and it is true.

    Invariably, Bond has a hefty night behind him – some pursuit either in bed or on the road (or wherever he goes). He takes a hot shower, or a hot bath, and ends it with a cold shower. And then? He feels just terrific.

    His immune system is never mentioned. But Ian Fleming, the author, must have known something about the restorative power of cold water. Because he sneaks it in (so I have been told – would somebody please check for me?) into every single book.

    I have done cold showers since my teenage years. Now I know I am in good company…

    Alexa Fleckenstein M.D.

    • Walt.S

      Victor Suvorov – real Soviet military intelligence officer, and defector, described the benefits of taking cold showers as “you will look 15 years younger”.

  23. Pingback: Cold Showers - The Ultimate Cure?

  24. Callie

    is this a bad idea for people with adrenal fatique/insufficiency?

  25. Hello. Great job, if I wasn’t so busy with my school work I read your total site. Thanks!

  26. ps

    i placed some literature on green wikia about scientific literature dealing with whole-body cryotherapy in humans and other animals.

    http://green.wikia.com/wiki/Cold_showers

  27. Roanne, you hardly ever get a cold for several years because of cold water shower? I really need to boost my immune system. Maybe I’ll give it a try :)

  28. Since I have been doing daily cold shower bursts after my hot shower I have not had a serious cold – for years. I do get occasional irritating colds/congestion, but they do not last long; I use Alexa Fleckenstein’s herb combination for colds and flu from her Health 2 0 book, along with her hot blueberry soup!

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  30. It is very nice blog about Cold shower you provide us lots of information about this i am just trying to do this and now i know the effects and the benefits of cold shower thanks for sharing this

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  40. When I initially left a comment I appear to have clicked on the -Notify me when new comments are added- checkbox and
    from now on whenever a comment is added I recieve four emails with the exact same comment.
    Is there an easy method you can remove me from that
    service? Many thanks!

    • Sorry about the multiple e-mails. I think you have to adjust your own settings. This is what I found on the “Help” menu of the WordPress site:

      If comment notifications are enabled, the post author will receive an email when a new comment is left on a post they wrote. Comment notification emails are sent to the post author at their account’s email address.

      You can choose to receive an email for every comment or just for comments that are held for moderation. You can change these options from the Settings → Discussion page:

      E-mail me whenever:

      Anyone posts a comment
      A comment is held for moderation
      The comment notification email has all of the information about the comment including the title, author, email, URL, IP address, comment contents, and links to approve, delete, or mark the comment as spam.

      I hope this helps!

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