Dr. Susanna Søberg: How to Use Cold & Heat Exposure to Improve Your Health

27:03People that go, I don't want to, the chattering of the teeth, and it feels like a loss of bodily control, which really it is. It's an autonomic response. Yeah, but I don't think that people should avoid it that much. It's just like seeing shivering as a way of your body in a, like it's training. It's training for yourself, it's training for your muscles, it's training of your metabolism, and that's going to increase what's called the insulin sensitivity. So if you can, like, in your mind, get used to the thought of shivering is just like when you go exercising in the training center and get that feeling of, like, oh, this is tough.

27:41Now it hurts a little bit. Yeah, it's going to hurt because that's what shivering also does, but it's just a different way of training yourselves in your body. It's going to create what is healthy stress. It's called homeasis in the cells. And the more you expose your muscle cells or your brown fat cells to these kind of like healthy stresses exercise cold and heat exposure, it's gonna make them better at like activating and also keeping you healthy. So as long as the cells get exposed to this, it's gonna keep them on its toes. You can say because it becomes more robust, increasing these heat shock proteins and and culture proteins in the cells to make you more robust for the next time.

28:25And that is also what happens when you go to the training center. And I keep drawing that parallel. And because people today know more about windmill, more about exercise, and what that's is going to do to your muscle cells. But the same kind of like training is also what you do when you go out into the cold water and submerge into cold water. because that is just your cold training center, you can say that. And also your heat training center going into the sauna because the cells are getting stronger with hermetic stress. So it's the same process, just different practices. So glad that you brought up the fact that the discomfort or the embarrassment or both of shiver is still crucial to actually to reach for and try and experience the same way that with exercise, I think a lot of people don't realize this, but when we did our series with Dr.

29:16Andy Galpin, it became clear to me what should have already been clear to me. And I think that most people don't realize, which is that if we were to measure heart rate, blood pressure, stress hormones, and inflammation in a human being during exercise, it would look as if they were ready to die. Blood pressure would be high, inflammation is through the roof, but all of that is setting in motion and adaptation or set of adaptations that allow blood pressure to be lower at rest, that allow inflammation markers to be lower at rest, all the things that everybody is seeking with exercise. In addition to, of course, the aesthetic changes that people are seeking with exercise.

29:54Sounds like the exact same things are happening with the cold. So the redundant message here seems to be that the more discomfort provided it's done safely, just like with exercise, the more shivering, the more cold shock provided it's not to the extreme and stop somebody's heart, right? we can talk about thresholds for that a little bit later. It sounds like all of that is going to set in motion. Some long -term changes that will make people feel better and will improve health. Could you just touch on a few of the longer -term changes that are known to occur? I mean, I'm well aware of the study showing that, I think it was European Journal of Physiology.

30:33It was the European Journal of Physiology showing long -lasting increases in catacolomines, dopamine, nor epinephrine and epinephrine for many hours after deliberate cold exposure. What are some of the other things that happen at the level of metabolism and brown fat in, let's say, the hours and day after a deliberate cold exposure? As soon as you go in, of course, there's an activation, but it seems like, no, you're asking for the later outcomes like blood pressure and stuff like that. Is that what you mean? Yeah, blood pressure, but also in terms of metabolism. I know that in your study, you should and we'll talk about brown fat in depth here in a moment but that there were changes to the brown fat that equate to changes in for instance people's ability to be comfortable in colder environments when they're not doing deliberate cold exposure Yeah, or in the same way that I can um exercise on an exercise bike or go out for a hard run But then if I go hiking with the family on Sunday and where it's a steep climb I can do that steep climb more easily because I'm quote unquote fit as a consequence of the of the exercise What are some of the fitness adaptations of deliberate cold exposure?

31:40Yeah, so what happens is that you get adapted a little bit every time you go. So you will like exercise, get a little bit stronger. So every time you go into the cold water for every time you will be more exposed to it, you will feel more comfortable in the cold. So you're going to build your adaptation, which happens on a metabolic level, which is going to be the brown fat. So you will have more activation of your brown fat, the mitochondria in the brown fat cells are going to be You have more of those and there will be more efficient at heating you up because it expects the body expects you to to do this again So you are prepared in a way the capillaries in your skin is also Will also become better at like constricting so you will have a better shield of your body to prepare you for the next time.

32:28So you will become better at going into the cold water in that way. So the body makes these mechanisms and changes your body in a way so you can expose yourself to the next time, right? And also you will have and also your stress response will also be subsided a bit. So you will have a less increase of your cataclysmines with time. With time also you You will have because of this activation of your brown fat or your muscles, you will have an increase in your metabolism, which will then make your insulin sensitivity better. And this is shown in studies, for example, there's this interesting study I found just before I started my PhD, which was from Gibor Stomer at L from 2016, where they measured metabolism, not on brown fat, but they measured insulin sensitivity in middle -aged men and women during one winter swim in the season.

33:31So they were not very young like they were in my study, but they were middle -aged and I think this is very interesting. So during these four, five months, they were winter swimming. They saw that they had a lower blood pressure after the season and they had a lower heart rate and they also saw that they have a better insulin sensitivity. And I think that is very interesting because if you can have a better insulin sensitivity, you can prevent lifestyle diseases. So, and we lower blood pressure, which is a very strong outcome also for telling how much inflammation you have in the body. And because it didn't measure a brown fat.

34:11I figured that it could be that was the missing link, that was one of the explanations to why we see this less inflammation in the body. So the longer outcomes, the long -term outcomes could be that you lower your blood pressure and you have a lower heart rate. You also have a better insulin sensitivity and a better glucose balance, but that is shown in my study. I'd like to take a quick break and acknowledge one of our sponsors, Athletic Greens. Athletic Greens now called AG1 is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast.

34:54The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or usually twice a day is that it gets to be in the probiotics that I need for gut health. Our gut is very important. It's populated by gut microbiota that communicate with the brain, the immune system, and basically all the biological systems of our body to strongly impact our immediate and long -term health. And those probiotics and athletic greens are optimal and vital for microbiotic health. In addition, athletic greens contains a number of adaptogens, vitamins, and minerals that make sure that all of my foundational nutritional needs are met.

35:27And it tastes great. If you'd like to Triathletic Greens, you can go to atletitgreens .com slash Huberman and they'll give you five free travel packs that make it really easy to mix up athletic greens while you're on the road in the car on the plane et cetera. And they'll give you a year supply of vitamin D3K2. Again, that's atletitgreens .com slash Huberman to get the five free travel packs and the year supply of vitamin D3K2. We'll get back to the insulin sensitivity and glucose balance. That's an impressive list of benefits. blood pressure, of course most people are aware of blood pressure and what it is.

36:03It's what they measure when we go to the doctor and it's not very sexy nowadays. Blood pressure, people are always blood pressure. It's not, you know, people want to hear about the inflammatory tone and the microbiome and all of that stuff is really interesting. But I think that blood pressure doesn't get enough attention. And we have spoken to on this podcast to Dr. Peter Atia, who is an expert in longevity, and health span and things of that sort. And I was surprised to learn, again, I shouldn't have been surprised, that the number one reason people die worldwide is cerebral vascular disease and cardiovascular disease.

36:40And there are basically three things on the list of things to address. One is not smoking or vaping, by the way. And not to wanna get there are a few other things related to blood markers, APOB and things of that sort. But then the big one is blood pressure. And so it's interesting because we don't think about blood pressure that much anymore as a kind of people interested in health optimization and health, but blood pressure is so vital to control. So it's wonderful to hear that deliberate cold exposure is one way to control blood pressure. I'm guessing in concert with other forms of exercise.

37:15Let's talk about brown fat and if you're willing, I'd love to drill into brown fat at a deep level. Again, my understanding of this is far more elementary than yours, obviously, you're the expert. My understanding about Brown Fatt is that it's located in specific areas of our body. Maybe more widespread than when I learned in school. I thought it was taught it was just that the clavicles in the back of the neck and upper back, but who knows, I learned that there's more of it when we're children, maybe more distributed throughout our body, and that it's rich in mitochondria. But what is so special about the brown fat?

37:55Like if we could just go into the biology of brown fat a little bit, what does it look like? You've measured it in human subjects. Where is it distributed really? Can it expand its distribution? Can we activate and expand the amount of brown fat as adults? And for those of you that are cringing already, thinking we're talking about getting fat or it's quite the opposite. We're talking about not subcutaneous fat, but fat located around the organs. But please educate me. Tell me where I'm wrong and expand my knowledge on brown fat. Okay, yeah, you're not wrong, but it's definitely true that there are more locations of the brown fat than we previously thought.

38:37There's this very nice study from 2017 by Lightner at Elle where they had made these the petites overlaid of their subjects, but you can see where in the body do we have brown fat? And where can we grow more brown fat, so to say? So the brown fat is very plastic, so it means that it can grow and it can decrease. And this is proven in studies where we have seen people with a failed cryo cytoma is like a very specific cancer type, where from the 70s where we can see that if they have this specific kind of cancer type, they have this tumor on the adrenal gland, so they have like a huge increase in noir adrenaline.

39:26And because of that, they have this continuous activation of the brown fat. And they have grown a lot of brown fat in the whole body, or abdomen, or where it's located in these six different places, but it is less, like, very much compared to like normal people. And what they then see, what we learned from this study is that brown fat can apparently grow if you have an increase in no adrenaline in the body. It's not like you want that because when that happens, you have a high blood pressure. You don't want it chronically, right? You just want it on like a short amount of time and then it can grow for a bit, but you don't want it chronically, of course, not.

40:04but because it activates also your sympathetic nervous system. So they have also showed that they have high blood pressure. They had, they lost a lot of weight, of course, because this is activating your metabolism. So they found luckily that when they remove this benign tumor, that the brown fat decreases again to normal size. And they gain weight again and they had normal blood pressure. So the story ends well. But it is kind of like proof of concept of the brown fat can actually grow. So it's plastic in its way of like it can grow and it can decrease again. So that's very good. Good studies to see what the body is capable of.

40:47But we don't of course want all that brown fat. We just want to keep it actually and keep it activated because what we see in studies is also that after the age of 40, people, studies have shown that there is an association with having less brown fat but increase obesity. So of course, we don't know yet whether brown fat decreases with ACE and therefore we get obese or we get obese and therefore we have less brown fat but as brown fat is an insulin sensitive organ in our body and we get obese just like the muscles get less sensitive insulin sensitive, the brown fat does as well. and therefore it may be decreases.

41:33It could be a theory that I think could be one of the reasons why we don't see that much brown fat in elderly people. Some have a lot of people working outside. There are studies showing this. Who are people who do physical work outside? Farmers and interesting. Yeah, they expose themselves to it. So they'll just keep it in their way. It's, and I suppose we should clarify for people in case they don't know that insulin sensitivity is a very good thing. You want that. You want yourselves to be sensitive to insulin. Insulin insensitivity is type 2 diabetes and is associated with obesity. So just a point of clarification there.

42:17Yeah, it's interesting to me. I usually work out at home, but I go to a gym once or twice a week if I can because it's good if I see the outside world. And there are a few individuals at the gym who are, they're not particularly large or muscular, but they are incredibly lean. And their posture is great, presumably from the musculoskeletal work. And they, they're in their 70s and 80s. I mean, it's remarkable, right? And I know all the tell -tale signs of hormone augmentation. I'm very good at spotting that. If you tell tell signs, I've talked about this on other podcasts and they're not that's not why they're They're fit they're they're they're clearly of that look and you see this right outside the gym too Of course for people that look like they've done a lot of physical labor their whole life.

43:09Yeah, they're just moving a lot They they have strong hands and features and they're and they're not necessarily Excessively lean but you can tell that they've been using their muskah see -all system and And I like to talk to these people and ask them, like, not what are you doing now for your workout, but what did you grow up doing? You know, and I would say, and obviously I've been run statistics on this, but more than 75 % of them respond that they grew up on a farm, or that they did some sort of manual labor, or were a postman, or a postwoman, or doing something where they moved a lot for their early years and throughout middle age.

43:49And most of them are now in retirement, but some of them are still working and they're all still moving a lot. So the relationship between shiver and brown fat makes sense to me. But is it the case that as we're just moving around, I've heard of neat, non -exercise -induced thermogenesis, so if we're just moving around that we are activating brown fat, or does there need to be this stressor? Does there need to be shiver and a cold stimulus or a enough, or do we need to do some sort of temperature shock type thing like deliberate cold exposure? Yeah, I think that is really good question because how, also, why do we have this tissue?

44:33If it has to be extreme, then you can question what do we need this tissue for? But it seems that you can activate the brown fat with just a little bit of exposure to cold. So coal is the most potent stress or activator of our brown fat because it's our temperature regulating organ in our bodies. So first respond to that. So the muscles will be a little bit too late and therefore we have maybe these two kind of tissues. So actually, just exposing yourself or hand actually just to co -water. So studies have shown that if you just put your hand in co -water, not that you're going to do that all day or every day or anything, it's not something you have to do.

45:14But it just shows that you can activate your brown fat just by getting a temperature change on your skin. So you can go outside and teach you. That's why we were just talking about people who work outside or move a lot or get in and out of it. Like changing the temperature of their body all the time, they will have more brown fat. and activating that is going to keep your metabolism higher and your insulin sensitivity started to have it also shown there. So the brown fat can be activated as soon as you just change your temperature in the skin. So going outside in a T -shirt, wearing cooling bests also studies have shown this for 10 days, it's going to also grow your brown fat.

45:54So you can get more brown fat if you expose yourself to the cold. you don't have to start in a cold shower, you don't have to start in a cold plunge if you're not really ready for that yet. But just exposing yourself to the cold wind has also shown to activate your brown fat. Or if you don't wanna be like in this awake state, then you can also just sleep in the cold. And you won't notice it that much maybe, but studies have shown that if you sleep in 19 degrees Celsius, then you will activate your brown fat and you will grow your ground fat, so you have more of it. So this very nice studies from Hansen LL from 2017 showed that a group of subjects who slept in a room at 24 degrees, and then they made this pet CT scanning to see how much brown fat do they have from the beginning, so what we call baseline.

46:50Then they measured again after a month of sleeping in 19 degrees, And they saw, I think it's remarkable, just one month at 19 degrees sleeping there. They had a dubet on and they were still had to close on when they were sleeping. So they're under a cover under a dubet? Under a dubet, yeah. The subjects were sleeping at 19 degrees for one month had increased insulin sensitivity. The next month they stepped at 24 degrees. They measured this again and then they had decreased actually a little bit. And then they stepped at 27 degrees. So quite warm room actually for the fourth month and they saw even less activation of the brown fat and also insulin sensitivity.

47:30So it seems that you can expose yourself and pretty rapidly the brown fat will respond to this because it's so sensitive to no adrenaline, right? So if you keep exposing yourself to a little bit of cold, you also get a little bit adapted to it, but that's because the brown fat has grown these more mitochondria in the cells, so these small energy fabrics that's gonna activate the cells, and that's gonna take up glucose and fat from the fatty acids from the bloodstream to keep the thermogenesis off. And that's gonna clear up some sugar and it's gonna clear up so in the bloodstream and some fat as well.

48:09So the brown fat can in that way decrease our unhealthy fat, which is the white fat, And the white fat is what we don't want too much of, but we still need some of course. And it's our energy storage, so it's very important that it's there. We just don't need a lot of it. So on our thighs and also around our inner organs, that's where it's located. So if we can have activation of the brown fat just by going out in the cold and just by sleeping in a cold room. Or if you have courage for it, you can go out and expose yourself in a cold plunge. cold showers is also going to do the trick. So you can do different variations of this.

48:48Just expulsion yourself to various temperatures. It's going to activate the brown fat because it was involved to keep us in a perfect homeostatic balance regarding temperature. So to keep us alive. Incredible. I just get a clarification around this 19 degrees Celsius room that they're sleeping in. So they're under a comforter, DuVay. And you mentioned they had a close on. The room is 19 degrees Celsius, but the temperature underneath their blanket might not be 19 degrees Celsius. So presumably it's the cold on their face that's activating the increase in brown fat that was observed. Is that a reasonable expectation?

49:29I think so, yeah, because you have so many co -receptors in your face. So it's actually it's enough. And I think it corresponds very well with the studies showing that you can activate the brown fat just by putting a hand into a bucket of cold water. And I did this experiment myself in my studies just to see how well did they respond to cold water. So it was a four degrees Celsius cold water for four minutes. And then I just measured blood pressure and heart rate to see do they have like an activation of this? I actually also measured the brown fat during this cold exposure for four minutes with an infrared thermography camera to see, can I see that the brown fat is activated?

50:11And just to go back to the location of the brown fat. So usually you cannot really see activation of your brown fat because it's located centrally around your sensor nervous system. And the biggest depot, as you mentioned before, is up here under the calivicular bones. And very close to the skin surface. And because it's so close to the skin surface, I could measure it with this very expensive camera. And it's not very feasible for people to go home and do this. Don't because it takes a lot of practice, I can tell. But we measured the brown fat with this. And I could see that after a few minutes that the activation was there, an increase in temperature aroused from that activation just for a minute.

50:58So it's very rapid. and I'm also messaged in my study how deep was the brown fat under your skin. So it's very close to the surface, which also shows that it needs to be there to heat you up and heat your inner organs. Well, I'm delighted to hear all of this, and I'll tell you why. One is by way of anecdote. I mentioned a little bit earlier that, as an undergraduate, I worked in a lab that studied thermogenesis, and we were doing that in animals, but we had this room that was very cold. The whole room was cold. The guy who I worked for at the time, and I'm Harry Carlisle, was a very accomplished physiologist.

51:33He came from this lineage. I don't know if this literature is still discussed much but it's a beautiful literature from Rothwell and Stock. They were the ones who discovered non -exercise induced thermogenesis. The fact that people bounce their legs a lot and move around a lot and have a lot of kind of stochastic movement burn up to 18, 1 ,800 calories more per day than people who sit more still. incredible. It just incredible. I don't think that gets as much attention as it deserves publishing journals like Nature, so very fine journals. But in any event, one of the things that I noticed when I started working in that laboratory was that I was cold because the room was cold.

52:16And Dr. Carlisle Harry said, well the key is to wear a t -shirt in here for about two or three days. and then you will cold adapt. I thought, well, wouldn't I want to put on a hoodie and get warm in there? So I was comfortable and he said, no, actually what you want to do is get yourself uncomfortably cold, activate your brown fat. And indeed, when I did that, I think it was just two days of being in that cold environment. Then I could come back on the third day and be perfectly comfortable because the brown fat had expanded or added mitochondria or both. And I was perfectly comfortable in that environment.

52:49I also got very, very lean in those days and weeks. Now, I've never been somebody who's very lean, nor am I somebody who carries a lot of excess adipose tissue. I'm kind of somewhere in the middle. I'm sure I could adjust that with feeding, if I want to. But it was striking what a powerful effect it had on my entire system of thermal regulation. And one of the things that I also delighted in when cell reports medicine published your study is they had in an accompanying press release that went out to those of us that press releases. And it described a saying in Scandinavia, which is essentially, I'm not gonna attempt to speak Danish, even though I have much of my family is in Denmark, I believe it not from Denmark.

53:34We have a lot of Danes in my family. I won't embarrass myself by trying to speak Danish as I did before the microphones were rolling. But that there's a saying that I think essentially translates to in the fall when you're approaching winter, you want to actually wear fewer layers, not bundle up when you go outside so that you can prepare yourself for the cold of winter and be able to heat yourself up using your brown fat. And that in the spring, as the temperatures are warming, rather than removing layers, you want to wear more layers in order to be a little bit uncomfortably warm so that in the heat of the summer, you're better at cooling your body.

54:15Do I have that right? And maybe do you know the saying and would you be willing to share it? Only the Swedes and Danes will be able to understand maybe the Norwegians too. If you don't know it, that's okay. Yeah, so I know the concept of it because we say it, you should wear less before winter and more before summer. No, there it is in English. So it doesn't have to be esoteric. Yeah, and you're completely right. And I think this is just something that we know in the Scandinavian countries. I think that we intuitively know this. But if we just go back a little bit in history, I think that around the 1950s, the Russian government went out and said, well, we should do something about the Tobacco Loas as a pandemic or epidemic, the worst at this time.

55:06So they wanted to have the people be more resilient to the cold and also increase our immune system. So in Scandinavia and actually also Russia, we put our babies outside to sleep in the prom. And that is like to also to get more resistant to the cold, but also to increase our immune system. And we still do that in Denmark. So we... Do you really? Yeah, we do. Babies are taken out in the cold. In the snow, in frosty rain, everything, my two boys have been sleeping out in winter, or at least the first many three, four, five years, because it's like very good for them, and they get a better immune system and get resilient to the cold, so they will have less colds.

55:55And also, they run around in a t -shirt when it's super cold, because they have activated all their brown fat. I didn't understand at that time, I must say. I must say, but I kind of like intuitively also new because we have inherited this way of doing things with our culture. So, and I have heard people coming from the US saying, a Danes are crazy. They put the babies outside and problems and leave them there. The nico inside and drink coffee on the cafe. Well, I don't think Danes are crazy. I adore the Danes. They're amazing culture and people. I'm so fortunate to have family members from Denmark.

56:31But I did notice, so when we were in Copenhagen, and I know we saw you there not long ago, that was June, the water in the harbor was cold. For even though the Pacific is close to here, which is very cold, felt pretty cold. But it was summertime, it ish. So people were in summertime mode, t -shirts and shorts and things that sort. But it did strike me that people in Copenhagen are dramatically fitter than they are in the United States. I mean, first of all, everyone's bicycling everywhere. Not many people wearing sunglasses, so trying to extract as much photon energy from the sun as possible, which I support.

57:18As everyone knows, that's a big fan of getting sun. But also, when we did see swimmers, They were swimming in this cold water and like it was nothing and They're the range and age of the swimmers was what was remarkable You saw the kind of fit triathlete looking types, but also young kids like really young kids And then people probably in there again their their 70s 80s maybe even 90s. Yeah, really remarkable vastly different than what you see if you go to the ocean here in Los Angeles or elsewhere So yeah, you skin and avians are onto something with this. I'd like to talk about your study. If you could give us a little bit of the backdrop about what motivated that study, and then walk us through what you did.

58:07Who the subjects were, what you had them do, what you measured, and as much detail as you would like to share, because I think it's such an important, even in fair to say landmark study, because it also explored not just cold, but sauna, and the co -use of cold and sauna as a way to probe metabolism and brown fat and other markers as well. And as you do this, I'm hoping at some point that you might tell us some of the observations that you might have made that interested you that perhaps were not in the paper, because that's one of the great benefits of sitting across from somebody who did the work in detail.

58:45So yeah, if you could tell us about your study, and what you did and what you discovered. Thank you for that question, Andrew. I love to like also explain a little bit what did we do because when people read this kind of paper, they just see the numbers. They don't see what happened before that. And human studies are very different from my study. My studies, you can do a knockout or something and then everything is like perfectly matched and controlled. Doing human studies is very far different from that because people are different even in the groups. So yeah, but what we, when I started this research in 2016, I did not really know what the brown fat was.

59:27So I started reading up on all this and I was very interested in preventive medicine. And also the studies that I did before brown fat was also like very much in the preventive side, like how can we, that was about something else, but the sweet tooth and how can we lower our sweet tooth and stuff like that. But after that, I wanted to do something new. So I looked into the brown fat, got hired in this fantastic research group, where it's a cell group, so they mostly did cell studies, and they didn't have anyone to do a human study yet. But they really wanted me to do that. So I read upon a lot of research about how does the brown fat get activated, what had been done already.

1:00:10And I mentioned the paper before with sleeping in the cold. I found that particular paper very fascinating. And that was also where, at that time, I was like, okay, so cold exposure as an intervention of sleeping in the cold could be a good thing to go out and say, well, people do this. But on the other hand, first of all, it was already done. That was one thing, but the other thing was like, well, I wanted to see if we can do it like some kind of activity so we can have people move also, go and do something, do something together or whatever. And the code made us think about, well what about winter swimming?

1:00:48And it was kind of like a bit of a joke in the beginning, it's like winter swimming. Yes, going to activate the brown fat right? But when we read the literature, we couldn't really find anything about activation of the brown fat with cold water, besides hand and a bucket of cold water that really, that was already there. So we were just thinking, okay, so it should be very potent, um, activation of the brown fat if it's cold water, but very different from cold air. So it was kind of also a new thing we were going into and we knew that we were going to do like a more of a, um, a proof of concept study, um, at the beginning of it because it was like winter swimmers, most in theory activated around fat, right?

1:01:33But we kind of didn't really know was this kind of stressor too much too little or what will happen actually. But we had this idea about, well, we always say that cold water, winter swimming will activate geomotivalism. But do we know if it does that? No, we don't. So, and while this idea was a little bit fun at the beginning, we kind of accepted it. He was like, okay, let's just try this out. But because we didn't have the funding for it, we was like, okay, let's do a proof of concept study. Let's go with a small number, but enough to see a difference between the groups. So the power calculation of that study is done on what we know from pet city scanning of the brown fat.

1:02:19So that's the main outcome of that, of course. So, and we wanted to go a little bit small on the numbers of participants because we wanted to dig a little bit deeper into the different mechanisms and also redo some of the days. So I really wanted to do that to see if I can replicate also the findings. And that's going to take a lot of a lot of funding, but it's also going to take a lot of time to do it. And so the proof of concept was just going small, but looking at different mechanisms, We also took fat biopsies, for example, and looked at the white fantasy if there were any differences between the groups before and after and stuff like that.

1:02:59So that's kind of like how it started. And the first year was like a field study for me. So I was not a winter swimmer when I started this. It was just... Oh, really? No, I wasn't at all. I was a bit afraid of the cold myself. A bit of a cold sissy, always cold, having big socks on and sweaters and stuff like like that. So I was like, I am so comfortable. I'm just like everybody else. Very comfortable. I like being completely temperature neutral. But I started like playing with this thought, like, well, if this is so healthy in theory, I should not pack myself up. I should start not doing that.

1:03:36Yeah. But the first year observation of winter swimmers on the jetty, they kind of joked about is they come on, you need to try this. You cannot study this unless you have tried it. And I was like, aha, very funny. Of course I can do that. But I couldn't. I read the literature. I understood in theory what happens when you go into cold water. But I completely understood it when I first tried it. The first few times, not so funny, it felt painful. It was just like running too long after a long break. And your muscles hurt the day after, right? You completely regret that you took that extra mile.

1:04:14What about when you say uncomfortable you mean uncomfortable when you got in and when you were in or uncomfortable afterwards because I find that On rare occasions, but I should just full disclosure. I I do deliberate cold exposure every morning For about a minute to two minutes in a cold plunge there are days that I miss But when I'm at home I do that and when I travel I do a cold shower. I do finish with a warm shower So, and we'll talk about why that's probably not the best idea. But, and I've been doing it for some years now, on and off. But so, just full disclosure, I'm a devotee. And I have family members that hate the cold, but have gotten into it and are starting to like it.

1:05:00But they don't. And I don't necessarily like the experience in the cold water, but I love the way I feel when I get out. And I am 100 % on that statement about loving it when I get out. Occasionally, it feels good to be in there. It feels invigorating. And I think I've learned to control the gas brief flex and the hyperventilation. And I just have told myself what we know, which is that the four brain struggles to engage for the first 20 or 30 seconds. But if you can get past that wall, it's far easier to push through. But when you say that it was really uncomfortable, do you mean the experience of getting in?

1:05:35or you also felt lousy afterward? Yeah, it's very important to clear that out. I only felt very uncomfortable doing it at the moment, but afterwards, the first time I went with a group and actually my husband was as well, because I really wanted someone I knew coming along because it's very normal if you haven't done this before, you feel a little bit anxious about it. This is a Stronin studies as well because blood pressure on heart rate goes up in those who are new to this kind of activity. So I was a little bit anxious about it. So it was really uncomfortable just doing it, but afterwards, as soon as I got up, I felt fantastic.

1:06:15And we went into the sauna and I did three rounds because I just loved it. I loved the feeling afterwards because you have all these. Newton's meter is going on your brain and you feel more positive, you feel, you feel invigorated, I had so much energy. And that like I could totally see why people would do this to get energy throughout the day because I definitely had that I didn't have to do three dips to get that I think one would be enough and I often do that also now today I do one dip sometimes I do two or three dips in in one round you can say one day but often it's like just one or two times a week for me that is enough to get that energy and to get that positive feeling.

1:06:59and I think that that is also why I put up my study in that way. I wanted to study the lowest dose, you can say, the lowest amount we can get away with, but still see health benefits. So what I observed there on the jetty was that some did it a long time. They were in the water for a very long time, and to me it seemed maybe a little bit extreme. Could you give me an example of a long time? Well, so maybe they were like really swimming and they could be 20 minutes or half an hour. That's a long time. That's a long time and there was like ice and people who came up. I mean, I just didn't really feel that this is something that I wanted to go out and recommend to people after my piece.

1:07:41You don't want any research subjects dying either because if you're not adapted, I mean, people can't do that. Also a 20 minute cold shower or 20 minute cold plunge. I know people do it, but it's probably not a good idea. No, probably not. It's going to exhaust your cells and make them age too fast. So exactly, when you pass that hermetic stress, the healthy stress level, that's what is happening, the quite opposite is almost chronic stress actually in the cells. Well, what happened then was that I found out that if I want to have this protocol get through ethical committee, I really needed to go very like sleep with not too long and make sure that they were also very healthy and to get approval, of course, of this study.

1:08:28But what I did was to recruit winter swimmers who already have been swimming for two or three seasons. And I just observed them. I said, I'm not going to do an intervention study yet. I did that after. but I wanted to do like a proof of concept where they were already adapted to the cold and then compare them to a matched control group who were matched on on you can say diet so were they vegetarian or not and one of them was in each group Also, they weren't all vegetarians. No, no, no, just one in each group. Yeah, I'm gonna say with all the amazing fish and meat in Denmark. I'd have a hard time being a vegetarian The breads are amazing, the fruits and vegetables too, but okay, so there were a couple of vegetarians in each group.

1:09:12Yeah, one in each, yeah. Okay. And they were met. Toad and vegetarian. I have family members of vegetarians, so I'm just poking fun. Yeah. Yeah, but they were matched on different things. So what we usually match them on is also PMI. We chose one gender in this study and we would always choose both men and women normally, but we do see that there are different brown fat levels depending on gender. So women have more brown fat than men. Really? Hmm. Interesting. Yeah. I think it's interesting. A deserved study. Yeah. Yeah. Why, actually, I think it's interesting because women are also smaller, so in size and mass, right?

1:09:56But they also have a lower perifold temperature, especially on hands and ears. Is that right? That's documented. that women do run colder than men? Yeah, and physiologically, I didn't say psychological yet. No, no, no. We won't go to the psychological cold heat. That's different. Yeah, that's a different podcast. Yeah, another time. So women are just colder physically, so on hands and ears, it's measured on that and feet as well. So compared to men, and men have bigger hearts than women and they can pump out more lot perifold than in a woman's body. So they that could be an explanation for the colder hands, for example.

1:10:40Thermocomfortable state is also different between gender. So men are more comfortable at 22 degrees Celsius and women are thermocomfortable at 24 degrees Celsius. And this is the thermostat wars of home have been now validated. There's a starting degree. By the way, prior to starting recording, I made the executive decision that we were going to go with Celsius throughout the podcast because the majority of the world uses Celsius. So for those of you that think in Fahrenheit, the internet is your friend in making those conversions. So we're sticking with Celsius. So men tend to be thermo comfortable at 22 degrees Celsius women at 24.

1:11:25Okay, interesting. It explains a lot about like also some arguments in the homes where men are turning down the heater and women are turning up the heater and they cannot really. So it's really, I'm on both sides here, I understand the men, we understand the women, but there is a difference there. Which was also one of the reasons why we had, we in this proof of concept study, chose one gender. So it is not like only because we wanted to study men. and it was just to see, to eliminate all the confounding factors which could have an impact on our results. So that was one of the reasons. But also because we, yeah, so women have more brownfath than men.

1:12:07Otherwise, we would have to like do four groups or something like that. And not having funding yet, we were like, okay, we need to do like, I just want a group, just a control group, and then a group who will always win to swim as. So I recruited winter swimmers who have been swimming for two to three seasons because I wanted them to be already adapted, but not going too long in the water. So they told me, I did a lot of screening here, of course, beforehand that interviews to see how much do you do and how long do you stand the water. and I monitored how long did they didn't stay in the water and recruited based on that they only did like two to three times per week.

1:12:50It seems reasonable for Denmark at least to do that. And they stayed only in the water for one to two minutes. So the coasts are subsides very quickly and you would get this activation of your restaurant digest system, which is your parasympatic nervous system. So the other branch of your other known as nervous system. And you get that activation because you submerge into cold water. And when you do that, you have an activation of your diving response. And that's going to slow down the, you can say, the consumption of oxygen also in your body. And that's going to slow down your heart rate. Could I pause you on this?

1:13:30Because I've heard this before that when we get into cold water, shower or immersion, we get this sympathetic autonomic response. So increased blood pressure, increased heart rate, release of norapinephrine from the locusts to the really is in the brain, release of adrenaline, dopamine, adrenaline from the, from the genitals, dopamine presumably within the brain, but that the parasympathetic response is activated when we put our face into cold water or go underwater, and that's a calming relaxation response. So this brings us back to, I don't want to take us off track from you described in the study, but this brings us back to the first question, which is, if I go completely underwater for a moment when I start my cold plunge, does that change the physiological outcome as compared to if I just submerge myself up to the neck?

1:14:20And actually nowadays there seems to be a little bit of a movement online of people putting bowl of ice water on their countertop and submerging their face into it. Did you see this? This is starting, I've seen more and more posts about this. So, could you just touch on that what the dive reflex is and why it acts, perhaps activates the parasympathetic response, this calming response. Well, so the diving reflex is activated when you submerge into cool water. Even just to the neck? Yeah. Or I thought you had to get your face under. I'm not arguing different. You're the expert. I just want to, yeah.

1:14:53I haven't really, I haven't read that. I've just seen that you can activate your diving response as soon as you go underwater with your body. So you don't have to do it with your face as far as I understand. I could be wrong. Yeah. So when you activate your diving response, you will slow down your your oxygen consumption in your body. And that is because the body tries to preserve oxygen so you will not get hypothermic too fast. So it's kind of like a survival system in your body. So this survival system is very important for us, of course. So that would be activated. And because of that, you will have to maybe one minute or so.

1:15:40That can be precise on that, because I maybe also varies a bit in humans. So one to two minutes, you will have full activation of the sympathetic nervous system, but also the parasympatic nervous system. And that's going to activate, for example, something like serotonin in your brain, which is like also good for mental balance and people feeling in mental balance afterwards. They after they go up, so that is like measured on a questionnaire and also measured like on anecdotes. Of course, people tell all the time that they feel good afterwards. We need studies on this. So if anyone's sitting out there thinking that's interesting, then please do some studies on that to get more out on that.

1:16:21Yeah. So you had, so you observe these winter swimmers who are have done this for a few seasons. They're coming around for a new season of winter swimming and you've decided to recruit them as subjects. They are getting into cold water, climbing down a ladder or jumping into the water up to their neck. They're climbing, yeah. OK, climbing down a ladder because it's done outdoors. What a fun study to do. My graduate thesis was done under fluorescent lights with no windows in a building that I had a ton of fun as a PhD student. I actually lived in the laboratory as a PhD student. I loved it so much.

1:16:55But not something required to do a PhD, by the way. But they're climbing down the ladder. Yeah. Getting it up to their next, staying in for one to two minutes, and then getting out. And how many times a week are they doing this? So to do this two to three times per week. And for each time they go, each day they go, they take three rounds of, so three dips and two sauna sessions. So they start on the cold and they end in the cold water. Okay, so it's get in for one to two minutes, then get out and get into the sauna. Yeah. What is the temperature of the sauna? About 80 degrees Celsius. Okay, then how long are they in the sauna?

1:17:36So they stayed there for 10 to 15 minutes, so depending on if they went two times per week or three times per week. Okay, and then they get back into the cold for a few minutes. Yeah. Two minutes. Yeah. Okay, then back into the sauna, 15 minutes or so. Yeah, then back into the cold for a third round. Yeah back into the sauna And then then they're ending on the phone back into the cold again and then ending on cold Yeah, and we will talk about why it's important to end on cold the so -called sobered principle How cold was the water in this particular? Given average because I realized it's outdoor winter swimming So it's going to vary depending on wind chill and things as well Of course.

1:18:18So it's a very uncontrolled environment to do this kind of study them, but I wanted to do something that was also very close to something people could do for free going out nature and use that and also have the nature like it's very healthy impact on us. It lowers our stress stress level as well. So by doing so I also measured the temperature every time they went. So I have this graph and it's actually in the winter swimming book. It shows the temperature and then mark going like from October to April. And it starts at 12 degrees. I think it's around 12 degrees Celsius in the water. And then it goes down to two degrees in on average in January and then up again.

1:19:01So it's within the spectrum of very cold water, I would say, from around 15 degrees Celsius and down. but it was actually not colder than like two to four degrees in an average when it was the coldest. So it doesn't have to be that cold to be good enough and enough to activate our metabolism. And what time of day are the participants doing this cold sauna alternation? So I think they did this throughout the day. So I didn't control whether they wanted to go in the morning in the afternoon or in the evening at that time where I set up this study, I was not controlling it in that way. I wanted them to go whenever they had time and I also think that is the most important message to give to people is when you do it when you have time.

1:19:51It's not doing it when you get home from work and it's six o 'clock in the evening and this is the time where you are, where you can do it, then then try out if it's going to impact your sleep or not. If it doesn't impact your sleep, then fine, but you have to try for yourself and find out what works for you. It's the same for coffee, for example, right? Some people can drink coffee in the evening and go to bed and they can sleep. I can't exercise or exercise. Exactly. So I can't, I can't do that. And that's because the coffee exercise, cold water, immersion, it's going to activate your sympathetic nervous system.

1:20:28You have an increase in stress response in your body, and that's gonna make it really hard to fall asleep for some people at least. Maybe you are super exhausted anyways, and then you will just crash anyways, but yeah. But that's the only thing. So I just told them to do this if they can during the daytime. And that's primarily what they also did. And then all along your measuring ground fat by way of this infrared camera, right? So what did you observe in terms of changes in brown fat? How quickly did that occur? And then I'd like to ask also about sauna a bit more because earlier you mentioned that you can activate brown fat with sauna as well, with heat.

1:21:11Oh, with heat. On the surface of the skin. How long did it take before you observed significant increases in brown fat and was it increased density of my brown fat or distribution, was it showing expansion to different regions throughout the body? And maybe you could also touch on some of the changes in insulin sensitivity and metabolism. Yeah, a very good question. And I didn't mention this before, but besides measuring temperature as an outcome for brown fat activity, we also did pit MRR scanning of the brown fat. So this is like the golden standard for measuring brown fat. And it's not very feasible for normal people to get an a pet CT or pet MRI scanning of the brown fat is super expensive.

1:22:01So we had both to see if we could have like a continuous a measure of brown fat in humans because that was already not not out there. So I wanted to see during both the experimental days, but also during day and night. What kind of like circadian rhythm do we have in our brown fat activity? So that's why I wanted to have that as well. So the PET CT scanning or the PET MRI scanning was to see a pond code activation stimulation for some hours. Do we have activation? Can we see the brown fat in this subject? And also during thermonotrylity of thermocomfortable state, how is that activated in each of the group, of course.

1:22:47Ah, so you want to see how comfortable people were away from the cold water and sauna just at different temperature environments, is that right? Yes, also measured that, how comfortable are you? I made this scale like visual analog scale and asked them, how comfortable do you feel with this temperature and throughout the study days during code exposure and thermal comfortable day, I had a whole day were just kept them thermal comfortable to see do they activate the brown fat if they're just completely thermal comfortable as good as we could get with that because we were asking people on a scale from one to ten and five being thermal comfortable where are you on this scale so one would be very cold and ten would be super burning hot.

1:23:34Yeah and so that was a way to like try to figure out how do they actually feel also during your studies. They also measured in electro -myography of muscles to see, do they shiver during the cooling day. Sometimes people shiver before they know they're really shivering. So I had to do it. Interesting. So our conscious perception of shivering might not be the best readout of shiver. Yeah, well, if you also get adapted to the cold water, you will have less shivering. There will be less vigorous. They will be very small, so you wouldn't probably know that you are shivering because the shivering is so small and the mitochondria in the muscle cells will be so dense that it does need to shiver maybe that much to get that thermogenesis going.

1:24:23And compared to when you're completely new to cold water exposure, and you're not adapted, then the body needs to create these mitochondria, these energy fabrics to keep you warm. and that's also what the exercise is in the beginning. But when we measured this, we did see that the winter swimmers were shivering less, or having less vigorous shivering. When they said, I'm cold. So even though they perception, their perception of the cold was pretty similar in the groups. And we could see that the activation of the muscles that we measured on, were different and more pictures in the control group.

1:25:07Were the subjects incentivized to be in the study were they paid or anything of that sort? They just happened to like doing cold and sauna. And so that's why they did the study. Well, they got paid a little bit for it but not much. And that's how we do this. Sure. I was just curious. Yeah, I was just curious. There might be some folks that wonder. So what did you discover in terms of changes in brown fat insulin resistance or insulin sensitivity rather and metabolism. So what we saw was we had these kind of different measures to see what's to try and unravel what's actually going on when they are already adapted to the cold water compared to a control group who was matched on various parameters.

1:25:53We did see that the winter swimmers had an increased insulin sensitivity. sensitivity, they produced less insulin on all the experimental days. So besides from just cooling them and measuring the brown fat on each of these cooling days, there were two cooling days and one thermal comfortable day, right? So I wanted to measure insulin when they were just, they were fasting, meaning that they hadn't eaten in eight hours before the study day. and they were completely laying still, not moving just in a bed. And we measured insulin during the experimental day just to see how, what level are they on?

1:26:34And we could see that the winter swimmer had lower production of insulin and they also, when they had a glucose drink, so we give them that to see if they, to test before we enroll them in studies to see if they have diabetes, for example, and not knowing, for example, that wouldn't, that would like ruin maybe the study. So we test for that and see if they have like a normal curve. So what we did see in that was that the winter swimmer has had a faster glucose clearance in the bloodstream. So after two hours, we could see that they had a lower level and the curve went down faster than any of the control groups.

1:27:12So despite having lower insulin release, they have better blood glucose clearance, which is really what you want what we all seek right you know excessive insulin is bad insulin being a More or less a shaperone for blood glucose I can do all sorts of other things as well of course, but And having high blood glucose obviously terrible yeah for cells especially brain cells I don't think people realize how toxic high blood glucose is having high glucose is sort of right I mean if you want to kill neurons you make you make their put them in an environment where there's too much sugar. Oh yeah, very neurotoxic.

1:27:51I mean, that's, and their mechanisms like insulin that buffer that, we keep, you know, keeping blood glucose in a reasonable range so that doesn't happen. I mean, I think that's why people will go into insulinemic shock. Hypoglycemic shock is also possible. So that range in which neurons are happy is not a tremendously large range. Incidentally, the range in which neurons are happy and surviving is much greater as one gets colder than when you heat up. I mean, you can basically destroy brain cells by getting too hot for too long. Oh, yeah. You can definitely destroy brain cells permanently by getting too cold for too long, but you have to get really, really cold for a really long time.

1:28:30Yeah. Very interesting. Yeah, we're thinking about doing an episode on Survival of the brain after death kind of things which actually happens. You know you hear about these people who are declared dead and then come back And there is actually now a lot of cryopreservation type Approaches for that. This is anyway we risk going into the the esoteric now. So I'll steer us back to our discussion about your study But so if I do the math These subjects are in the cold. Let's say they're doing three rounds of cold for one to two minutes, two or three times a week. What were the thresholds that you discovered were important for getting these positive changes in such as reduced blood sugar or clearance of blood sugar being more efficient, reduced insulin, improved brown fat distribution and density.

1:29:26how much cold exposure do people need, how much heat exposure do people need in order to extract these benefits? Yeah, so when we then calculated the numbers together, we can see that this was ended up being 11 minutes in total per week. So not in one session, of course, but they had two to three visits to the water and the sauna per week. So when we divide that out, it corresponds to being in cold water one to two minutes at a time, but also in the sun, it's 10 to 15 minutes at a time. And I think this is very like also similar to what we see in other studies when we look for example to the observational studies from the Finnish cohort study from Laukan et al.

1:30:10For example, they published this very amazing paper in 2015. some results from this long -core study where they show that that up to 30 minutes in the sauna was healthy and they you lower your risk of cardiovascular disease and that's like the threshold and if you go further than that then there is not more healthy benefits to gain from that. So and before that it's like 19 minutes then you will have this those response relationship up to 19 minutes, that's really in decreasing your risk of cardiovascular diseases. And I think we've been - That's per week, 90 minutes per week. 90 minutes per session now.

1:30:52Per session. Yeah, per session. If we then compare that with my study, which was 10 to 15 minutes per session, then I think it fits very well with what we call the hermetic stress or healthy stress. So you expose the cells to this kind of like potent very stressful situation where they increase heat shock purines in the cells and that will repair the cells But if you then overdo it and you go beyond there may be 30 minutes in the sauna this observational study from Finland with more than 2000 sauna bathers where they follow these for 20 years They see that a 30 minutes per session is like enough and if you go above that you don't get more health benefits out of it.

1:31:39So I think there's a window where we can say the healthy stress corresponds to like 10 minutes and I think it's like per session. And it's not much actually. So you don't need to, it shows that you don't have to expose yourself very much to the heat or very much actually to the cold to get this healthy benefits from going into cold, going into heat and have healthy benefits on your cardiovascular system. So I think this is very important also So, message to get out that you don't have to go extreme, you don't have to swim for a half an hour in the cold water. You can go in the water for one to two minutes per session, but go up to 11 minutes per week in total.

1:32:22And for the sauna, my study showed 57 minutes in total per week. And if we also then divide it out on these two to three days and two sessions each day correspond to 10 to 15 minutes. So it's a low -treasure, but I think it's good to have that to maybe we can aim for that if people need to have something to aim for. And I think it's really good to have that because then you don't overdo it. And if you overdo it, you exhaust the cells and that will increase your risk of cardiovascular disease also. Well, I get a lot of questions about this and I did solicit for questions for this podcast on Twitter.

1:33:03And one of the questions that I got was as one becomes more cold adapted, do the benefits start to wear off or can people do too much cold exposure? Of course, the answer to that is yes, you can become hypothermic, but I'm sensing a different answer now, which is, if I understand correctly, the threshold is 11 minutes total per week of deliberate cold exposure, divided into two or three sessions of maybe one to three minutes, depending on how long somebody stays in. And then 57 minutes, I want to be careful not to round up to an hour, but divided into maybe three 20 minute sessions or so. So one doesn't have to be perfect as long as you get a buck beyond that threshold.

1:33:44But I wonder something, which is, is it the case that if somebody said, oh, you know, I'm just going to do one 11 minute session per week? that might actually not be as beneficial as dividing it up because what you told us earlier is that the hermetic response depends on having that cold shock. You actually don't want to become too cold adapted. I mean, once the blood pressure response drops down so I'm in minute four, five, and six, you're getting very cold and you're shivering, but one is not getting the autonomic stimulus that they want. I guess I could liken this to if exercise worked in a way where it was only the first few minutes of exercise that really triggered the adaptation.

1:34:26Of course, this is not how it works, but in fact, probably quite the opposite. But if that were the case, then it's not simply the total amount of exercise, but dividing up the sessions into little bouts where every single time it acts as a stimulus. That seems to be the key here. This is very important because having watched the landscape of this on social media, but but also in books and generally, I think you're the first person to really touch on this, that the goal is not to get so cold adapted that you can sit in for the full 11 minutes in one session, where the goal isn't to be able to do an hour of very hot sauna.

1:35:06If you want to, I suppose people could do it for other reasons, but if the goal is to improve these health metrics, then the idea is to keep the stimulus a stimulus. Sure, exactly. Great. Well, this also, I think there's practical feasibility as you pointed out, because getting into a cold shower or cold immersion or natural body water for a couple of minutes is far less challenging to most people than finding a full morning to go spend there. But I've never really heard it articulated that the longer sessions might not be beneficial and might actually be detrimental. That's very important. Were there any other observations that you made that did not make it into the paper or that were kind of in the margin notes, in terms of psychological benefits or anything of that sort?

1:36:01There was this recent study on soldiers that talked about weight loss, it's sort of a controversial study for a lot of reasons. But one of the things they remarked in the paper was that there were a lot of psychological changes is improved buffering against anxiety. They even meant the men and women in that study reported one of the significant effects was significantly improved sexual satisfaction. They didn't tell us what that meant for these subjects, but as we won't go there. But a number of subjective improvements. Was there anything that you observed or took note of in your study that perhaps didn't make the main abstract but that we should be aware of?

1:36:36Yeah, there was some. And today I regret that I didn't measure on sleep, for example. I frankly didn't really think about that when I designed the study. So we were very much occupied with the metabolism and kind of had to stop. Maybe this could impact sleep quality. And I wish I just, if I had the thought that why don't you just ask them in a questionnaire, but I ask them every morning or everyone who's not many mornings to just two mornings, actually. I'm going to measure it on. But the winter swimmers told us before I wrote them that they had a really good sleep quality. The control group also had that, but they told me on the day where we They told me that they didn't, they had a good night's sleep, but they also woke up.

1:37:41So it's just telling me that they also had like a quick wake up and then they fell asleep again. And the winter swimmer's told they have a really good sleep. So it's like, in general, they also say we sleep very well. I sleep very well. So it's anecdotally general corresponds to what I heard in my study, but nothing that I measured on which would be fun to do in the future, but we didn't measure on sleep quality. That would have been a really good idea to do. They also told me that they were very comfortable when they were cold. They don't mind, when she's almost they don't mind going out, for example, in the cold with a t -shirt.

1:38:24They were also less scared of showing the skin. They're also one of So it kind of a reduced social anxiety. Yeah, they were just so comfortable in the lab. As you just mentioned before, coats on and everybody's joining around. It was very busy and all the other scientists out in the hallway. And also my supervisor had her office down the hallway. And one of the winter swimmers one day just got out of bed after it had been in the study for eight hours. It was a long day, right? He jumped out of the bed and had his clothes in the bathroom and he went out completely naked. He didn't care. He just went out.

1:39:07It was like, oh, I'm sorry. So that's a side effect perhaps of getting too comfortable with the cold. And we're not recommending that. Although in your book, you dedicated some, let me start that again, although in your book, you dedicated some pages to naked winter swimming or I should say naked cold water exposure as opposed to with bathing suit. Are there any data on this? I'm sorry, I'm struggling, but I think in most places in the United States, skinny dipping is not legal most public beaches. There are a few. In fact, where I my laboratory before moving to Stanford was in San Diego and I at the Salk Institute for Biological Studies, beautiful building, incredible sciences done there.

1:39:55The beach right below that is called Blacks Beach. Okay. And it's a known nude beach. And so whenever tourists were heading down the stairway there, I would sort of let them know, especially if they had kids, I'd let them know. You know what I'd say? And it's a nude beach of a particular genre. So I'd give them a little warning about what they could expect down below. It's a in any event those beaches are quite rare in the United States. Maybe compared to Europe. I don't know But yeah, maybe yeah, so is there anything special about Clothless versus closed Exposure? Yeah, I think in that sense We are more free with this kind of like but but remember we also had this winter swimming culture for so for hundreds of years And then Mark and the winds at the oldest winter swimming clubs that we have especially the one we have in Copenhagen where I did my next study, which we haven't talked about, but it's also not published yet.

1:40:51But in that winter swimming club, it's the oldest one we have, and it's huge. And they swim naked at this facility. Men and women. Men and women. And they have sauna where they can go in together. And they also have the separate sauna. But it's very much a Danish thing. And I think it's good if people want that. And I had it in my book because people want to know if they have to swim with their bathing suit on or if they can take it off or What's the difference? Is there any difference in this? And if you ask me there is no difference Oh if you have your little skinny be skinny on it's not gonna do any difference to your Cole exposure or your adaptation is not gonna do any difference for your benefits of course But I think that it has something else it has something to do with how you also observe yourself how you're surrounded and it's some sense of freedom in skinny dipping.

1:41:50So I think people in Denmark who does this, they do the winter swimming because they feel free when they do. They come home from work, they go to this club and they skinny dip and they feel like in touch with nature. And they have maybe done this their whole life. So this is an old tradition in Denmark in some of the clubs. But the newer clubs that are coming, they don't, they don't skin it. So everyone has bathing suit. I never skin it because there are people around, people with phones and taking pictures all the time. So this is different. Different nowadays, everything is reported. And also this old tradition is also fading away because of that.

1:42:31Yeah. I, I used to saw it on the cold at home, but when I travel, there, there's a, a Banya. So, Russian Banya has hot sauna and cold plunge. There's one in San Francisco called Archimedes Banya. And that one is clothing optional. So, some people are clothes, such as myself and then other people are not. And it's co -ed most of the time. I think they have female separated evenings or something like that. And then the other Banya is spa 88, which is on Wall Street in New York, is an amazing Banya as well. And these are starting to crop up in different cities, or maybe they've been there for a long time and has delivered cold exposure and sauna gets more popular.

1:43:09More people are using them. The one in New York that that spy idiot is always clothed. And it's interesting because people here naked are skinny dipping and they might get certain ideas in mind. It, all these places are very well lit and they all have a tone of kind of health that is about their kind of health and wellness. I guess the point being that there's no requirement to do one thing or the other, although in the studies that you did, obviously people were clothed. But I did pay attention to those pages in your book. I thought it was interesting that you put some dedicated passages in your book related to this.

1:43:49And I think - My publisher wanted that. I mean, you're publishing it on that. Yeah, it was not me. It was like my publisher really wanted to have a little discussion about that. So it was like, okay. Well, I think it, you know, it points to a larger theme, which is I think for a lot of people who already do these practices, There's no shock there. For people that do not do deliberate cold exposure or sauna, I think that there is this idea perhaps that, oh, these are traditions that are kind of fringe or that they're cut. And I just, I want to cue that point because there's so many things that are happening right now in biomedical research and medicine.

1:44:26in serious quality peer reviewed studies published in excellent journals like your paper on things like deliberate cold exposure, sauna, the use of particular supplements, natural herbs and supplements. I mean, there's an entire branch of the National Institutes of Health in the United States dedicated just to the study of supplements and behavioral interventions for health, like meditation and breath work. Really incredible. It's really incredible. and psychedelics, of course, being something that for a long time was part of a certain community and feel, and now is being frankly adopted by mainstream medicine, even pharma.

1:45:04So the times are changing. And so, yes, I think it's important to know that it's perfectly acceptable and encouraged to work clothing. Absolutely. Yeah. And one other thing that I wanted to mention going back to your questions around with there were any observations in the studies which we'd really maybe haven't discussed yet and maybe It's in in the back of the paper and not mentioned that much was one of the winter swimmers didn't have any brown fat when we measured him zero zero and and we do see this in In in previous studies as well that some humans don't have any brown fat Was he did he carry a lot of white fat out of post tissue?

1:45:48Was he obese? No, he wasn't. No, he was not obese because he would not have been in the study then. Oh, right. Yes, you mentioned this earlier. Forgive me. No, no. But he was, but what I did observe before I knew that he didn't have any brown for was that during the cooling experiment where I cooled them for two hours before they go into the pet city scanner, He was not able to control his shivering like the winter swimmer could. So he got very cold very easily compared to the others. So without, I didn't know what was different about him, but we could, all of me and the three others were working on the experiment.

1:46:36We were like, okay, what's going on? because we turned down the temperature, but he started like shivering, and then we had to turn it up again. And it was just all over the place, the temperature. It wasn't that controlled like the others. It was pretty similar protocol. I could just do pretty much the same, because they were same size and also same gender. So it was easier to like foresee what was going to happen and when will they start shivering. I quickly learned that. But with this subject, it was just with this volunteer was just very much different. And then when we scanned him and didn't find any brown fat, I didn't even think about it.

1:47:15So when we scanned him, we didn't see anything. I told the PCT people who like, oh, you put up the wrong scanning. Right. Playing the technology. Yeah. The technology was like this scanning looked like the thermal neutral day, the thermal comfortable day, where we also scanned them to see if they have any brown fat. So you have made a mistake. I was pretty sure. And they re -analysed this scanning, and they just concluded, well, the scanning was fine. The experiment went well. It was just that he didn't have any brown fat. So he was like, what we just in the paper called a brown fat negative, so he didn't have any.

1:47:53And in my studies, it would be called a knockout, so he didn't have any brown fat. So the observation with him, and I think that would be, that's interesting, is that he both shivered very early on and didn't regulate his temperature as well. He also told me that then he was like a five on the scale of how comfortable he felt with the cold. So it was from one to ten and five being thermo -comfortable and ten being very cold and one very hot. So on this scale up and down. And he was more up and down on this scale than any of the others. It was an observation that I did. But we did see in his blood samples also that his blood samples looked a bit more like the control group.

1:48:45Also his insulin levels were like the control groups are a little bit higher than the other winter swimmers. and he also had his blog, Blue Coast clearance, was not as fast as the other winter swimmers. So he was like an outlier, what we call it, and in the analysis, we also had to take him out of the analysis because he was an outlier. So the results showing that the brown fat is more efficiently activated in the winter swimmers is without him having him in that group. But it didn't ruin the study if we tried to put him in as well. And it didn't ruin the results or anything, but just to keep it more clear, we took him out of the analysis.

1:49:33Yeah, so he was a mutant, a knockout. Yeah, and I'm sure they're out there. Very interesting. So if you shiver early, then perhaps you have less brown fat to begin with, although it's hard to conclude from one person, that's sort of the implication there. or you have an adaptive to the code. So you should build that up. So in addition to looking at regulation of blood sugar, round fat, metabolism, and so on, were there any markers that you examined in the deliberate cold exposure group as compared to controls that reveal to you that deliberate cold exposure could have additional benefits, say for immune system function or for any function for that matter?

1:50:16Yeah, so for, we looked at inflammation, of course, we measure the outcome of blood pressure and so on, but we also measured IL -6 in the study just to see also an inflammatory and inflammatory marker. So IL -6 went up and it also follows with IL -10, so that is also very known in the literature. So we measured that and I think it's very important to think about the cold exposure and the heat exposure as something that then lowers the inflammation in the body. And if we can do that, we will have an open door for preventing lifestyle diseases, right? So for type 2 diabetes, but actually also for some mental diseases as well, so as known as depression and anxiety and also Alzheimer's disease, which are all associated research, also a newer research showing that inflammation increases the risk of depression anxiety and Alzheimer's, if it's neurological diseases.

1:51:16So if we can decrease inflammation in the body, we will decrease modern lifestyle diseases, but also these increasing mental diseases that we see in these modern lifestyle times. So I think it's very interesting that we can go out in nature and we can use these natural stressors and I don't want to have it sound very romantic or anything. It's just exposure to temperature, actually, just to cold or to heat. That is going to trick our body into a natural state again and reset it where the home when we're stasis the balance has lost a bit. So the body is going to repair itself in that way. And I think it's beautiful that we can do that just by changing the temperature of our body.

1:52:03And although people are very scared of doing this because in our times, we have been away from cold, away from heat, temperature for some, for decades now. Since we isolated our houses better and we are more sedentary, we also to sit more indoor, we don't move as much. So this very modern sedentary lifestyle has made us more temperature, comfortable, just neutral. So no wonder, I mean, that obesity is increasing. We don't expose ourselves to the natural stresses that we did earlier on in our involvement, but also up until maybe the 70s, the 60s, where we started having more comfortable lifestyle, right?

1:52:51and obesity increases in the 80s, we can see that from statistics. So I think that if we can take in cold and heat, and you mentioned other things also before, but of course exercise is very important here, and also a bit of fasting actually, because it all increases the hermetic stress in the body. So it doesn't have to be other than natural stresses to the body, which then could keep us in that natural balance again. Could we talk about what I refer to as the sobered principle, which is to end on cold? And the reason I called it the sobered principle is because in reviewing, oh, by the way, I wasn't an official reviewer of your paper, but I mean in reading and reviewing your paper for its after published contents, I noticed that you had people end on cold.

1:53:40And this has been a long standing debate in the deliberate cold exposure community. Should you warm up with a warm shower afterwards and get back in the sauna? What should you end on cold or end on heat? And the sober principle says end on cold. As I understand it, in order to force your body to heat itself back up and thereby increase metabolism further still. Is that right? Yes. So when you end on the cold, you force your body to heat up by itself. and that will require that you activate. You keep your brown fat activated and also your muscles, which is a good thing. It's a good collaboration to keep your thermogenesis up.

1:54:20And that's like an exercise even when you go home. So in that way, you don't have to think about your cold exposure or dipping in your plunge or open sea or what it is, as just an exercise that you do for one to two minutes and then it's over. If you end on the cold, you have an exercise for your body going on for hours afterwards. And that's not only on your metabolism, but it's also going to keep your neurotransmitters activated as well and increase that because your body is still cold. So you need those neurotransmitters to activate the brown fat as well. So that's going to make your brown fat cells more efficient, and also your muscle cells more efficient, so increasing my to conjure in the cells, which will then generate heat very fast.

1:55:04So if you have done this for a few times, so maybe three, four, five times, being new to this, but have tried it a few times, you will notice a switch where you like feel that you get easily warmer and you can keep yourself warmer. And that is also what we shown in my studies that the winter swimmers were physically warmer on the skin compared to the control group. So they think... When they are out of the cold. When they're out of the cold, just relaxing and we tested this on the days where they were sleeping on the lap. So we could see that they had a more activation of the brown fat, higher temperature.

1:55:45So probably because they also lose heat, they have a higher heat loss to the body compared to the control group because they have a more vascular skin because of the contrast of cold and heat. So they lose heat faster from the body during that day. But is that a bad thing? No, probably not, because that's going to keep your brown fat and your muscles a little bit activated. So you would have to, it has to work to keep you warm. And I would hypothesize that it also might lead to some of the subjectively reported improvements in sleep, because in order to follow sleep, you need your core body temperature to drop by about one to three degrees.

1:56:26So it's not just sufficient to be sleeping in a cold room and under the blanket. You also need your body temperature to drop. And so what you're saying, if I understand correctly, is that by forcing, by ending on cold and forcing oneself to heat up naturally, that increases the brown fat stores, which I sort of see as a kind of like the oil in the candle of the furnace that is thermogenesis and that in turn leads to increased heat loss, which people might think, oh, I don't want to lose heat from the body, but there are times when you want to lose heat from the body. Basically, it sounds like what we want is to be a very efficient heating and cooling system.

1:57:07Yes. That it's not about being cold or being hot. It's really about keeping the system tuned well, keeping the oil in the candle is brown fat functioning. Yeah. Yeah. What could I ask one question about fed or fasted? Is there any, or rather are there any known benefits of doing deliberate cold exposure and or sauna fasted versus after a meal, say within the last hour or something of that sort? I do my deliberate cold exposure first thing in the morning. So in general, I'm fasted because I don't eat until a little bit later in the day. But what's known about that and was that looked at in your study?

1:57:46I know you measured glucose, but that was as a separate test away from the cold. Away from the cold, yeah, but I also tested glucose on the days on the cold. So we measured that as well on the cooling days. Specifically on fasting and fat, I don't know. I don't think that I have seen studies specifically on this. Okay. More science needed. A number of people asked about the use of deliberate cold exposure to offset some of the symptoms of various diseases. Now, here we're not talking about curing disease. We're talking about offsetting symptoms. One question I've seen quite often is whether or not people with Raynode syndrome.

1:58:27This is a syndrome. My high school girlfriend had this syndrome and I'll never forget we went or had a school dance together. And this was when we first started dating and she had Raynodes which all leads to very poor blood flow to the extremities. And she was very cold, so she left to go to the bathroom and warm up her hands in the warm water. And I was left standing there at the dance and people came up to me and asked why I was there and who I was there with. And I kept telling them who I was with and they didn't believe me because they couldn't believe that she would be with me. Made total sense if you knew me at the time.

1:59:02I was way out on my league with her at the time. I like to think eventually I caught up. But in any case, she was in the bathroom for about an hour. So at one point I did consider the possibility that she had just left. But indeed she had, she warmed her hands back up. But people with rain notes suffer from this, from this thing of very, very cold extremities. Their fingertips will even turn blue, you know, as if they were starting to get frostbitten. It's quite dramatic. And that question gets It's asked whether or not there's any use of cold to try and increase the elasticity of the small capillaries and vessels.

1:59:42By everything you've described up until now, it seems like that would be a logical thing to do. In addition to that, whether or not people with autoimmune conditions, people with any other types of conditions are known to benefit from deliberate cold exposure. I'm not aware of any studies, but I get asked about this a lot, and there were a lot of questions about this for you in the Twitter feed. Yeah, thank you for those questions. And I get them as well on social media. And I have to say that I haven't seen any studies directed on this outcome on measuring Rhinoid's syndrome. I do know that it's not that rare actually a problem.

2:00:21And I know that many women or more women than men suffer from this. But logically, it would help them if they exposed their hands to cold and also heat to make the west it more vascular but and I have heard from people saying that it had helped them but also heard for some others saying it didn't help them. So studies are needed on this specific topic I think. I heard my hands when I go into the Kowai and I don't have this syndrome at all but I keep my hands above the water. You do? Yeah. I do that. Often I take a little bit of a swim and then of Of course, I have to have my hands in the water, but it helps me when I then get back to the daddy and then take my hands off.

2:01:08Because then I can stand there for a little bit and get my one to two minutes exposure and then I can go up because then otherwise, that would stop me from being in the water enough time that as long as I would like to. So people suffer from having these pain in the fingers and it can be very intense. So just take the hands off a bit from the water and that's going to help you. Also boots, neoprene boots, it's going to help on the feet. Some people have the hurt and feel the pain in the feet or in the ankles and that's going to help them also a little bit. Okay, so there is no problem with keeping hands out or feet in neoprene booties if people feel the need to do that.

2:01:53If that's what the pain of the hands or feet is a barrier for people doing deliberate cold exposure, then it seems it would be okay to do to keep hands out or to keep your feet in the space. Yes, because then you do get the exposure. But of course, hands and feet are very potent places in your body to get a fast activation of your nervous system, of course. But if you can just you can also just dip them and then take them up. It's kind of still going to activate that. But but your full body is covered in co -perceptors, you'll have a full activation anyways. Yeah. You are providing very reassuring information to people because I know a number of people that do not like to book their hands in.

2:02:35I find that the more of my body I get in, the more comfortable I am. Psychologically and or physiologically, I find that if where there's an interface between the water and the cold, it's most uncomfortable. So I prefer to just get everything under. I keep my head out. Although these days I've been dunking all the way in and then coming out and then dunking once more with my head under before I get out after the plunge. That raises a different question. Now we're getting into kind of the practicalities of deliberate cold exposure, which I think are important. Sometimes I'll experience and I hear from a lot of people that they'll get a kind of back of the head headache at the interface of the water when they're doing cold immersion to the neck.

2:03:18I assume this has to do with blood flow, that there's vasoconstriction right up until the neck and in the region surrounding it, but that maybe there's still blood flow to the head. But do we know what the origin of these headaches is? And again, this doesn't happen for everybody, but some people do experience them. Okay. Yeah. I haven't really heard about that one specifically. So, but I would say that there are different reasons for maybe keeping your head out of the water. but it seems like maybe for some that could be a reason for like just getting like a quick head donkey to go all the way in.

2:03:51Yeah, yeah, that's what I've started doing to eliminate. I wasn't getting headaches, but I could I noticed that interface. Okay, and I wasn't in the rest of the experience it so much, okay, experience of it so much. So I started dunking all the way in. I noticed in some of the photos that you've put out and in your book that you'll sometimes wear a cap while you go in. Yeah. Okay. And well, it comes from different reasons. So let's talk about some of the physiological reasons. So when you submerge in cold water up to the neck, and the study has shown, and this is from Denmark, studies from a BSPP at hospital, that's when you submerge into cold water up to the neck at zero degrees.

2:04:31So zero degrees Celsius is very cold. And you have a decreased blood flow to the brain by around 30 to 40 percent and make sense because you activate the sympathetic nervous system and therefore you will have a less blood flow to the brain. It makes you maybe a little bit dizzy here and... Proof again that you need a heart more than a brain because when the sympathetic nervous system gets activated blood flow is maintained to the heart to keep you alive but obviously taken away from the brain to keep you from thinking. That's why it's hard to think when you're stressed. Yeah well the muscles and your vital organs need to, you have to be able to run away from that tiger.

2:05:06Why? Did the rationale and its total sense? And who am I to disagree with mother nature? Well, but yeah. So one of the reasons being that you should keep your head out of the water is that you could increase that decrease in blood flow to the brain further if you don't the head. So there's this very nice paper from a research group in Canada, where that they have collectively looked at different papers where they compared heat loss in the papers where they dunk the head and compared to heat loss submerging up to the neck to see how much extra heat do we lose from our core when we dunk the head.

2:05:50So, and I think it's very interesting that if you submerge up to the neck, you have a heat loss of 11 % from the body, poor. and when you then also dunk the head, you will increase that heat loss rate by 36%. So that means I'm not saying that I'm not here to say what is right and what is wrong. I just think that people should know the information so they can, for themselves, evaluate what is best for them. But if you increase your heat loss rate by 36 % from your core, that's going to increase your after drop, which we touched upon a little bit earlier, even further. So that's meaning that you are closer to high -profermia than you are if you just submerge up to the neck.

2:06:35So you should really think about whether this is like something that you want to do or if it's just better for you not to get that cold in your core. The beanie is also because I have a little bit of sensitive ears, so it means that if there's wind and because we swim in the open sea in Denmark, We have a lot of wind. Our conditions are just very rainy, very windy, and when the temperature is also freezing, you could get this, what is that called, so very cold and light -headed just from wind. So if you also submerge into cold water and you then get up, you would get a brain freeze immediately.

2:07:15So it is enough to just go up to the neck, where a bean need should just not get dizzy also because the heat loss is increased of course, but also the blood flow to the brain has decreased. So the bean will keep you a little bit warmer, so you can stay for one to two minutes. So it's just a way of like getting around some of the conditions also. So people can choose that if they feel that, but it's quite normal to do in Scandinavia where a bean need. I love it. And so for those of you afraid of doing a two -minute cold shower. What Dr. Silver just described, let's you see how she and others are capable of doing things far harder than that.

2:07:56When the way you describe it with the cold wind and Scandinavia is quite striking. Along the lines of covering the head, there's this seemingly paradoxical thing of people going into hot saunas and wearing wool caps. If you go to or you go to Asana and there are people who are, well, from Eastern Europe, or typically are Finland, or Russia or Ukraine or elsewhere, what you'll see is that many of them are wearing wool caps in the sauna, which many people think is to make it hotter. That's actually not the case. It actually insulates you from the heat environment. The sense of urgency to get out of the hot sauna is a brain -driven mechanism.

2:08:41And so the reason that people wear will hats in the sauna is it actually lets you stay in the sauna longer Because it takes a lot of heat to the skin before you feel that you you'd have to quote unquote have to get out Whereas so when you insulate the brain You don't get that signal It's pretty interesting. I've tried this before just by putting a towel over my head in the sauna And you can stay in there much more easily and for much longer You know, as we talk about these different stimuli for the Hormatic response, the adaptation distress, you know, it occurs to me that the big ones in our evolutionary history have been light, right?

2:09:20I mean you were talking about seasonal changes We know they're especially as you go up to Nordic countries. There are seasonal changes in the amount of light by time of year, dramatic ones in fact less Less so at the equator. Of course, light, temperature, food, movement. And it's sort of interesting. And at the same time, perhaps it should have been obvious to us that there are stimuli that our bodies have evolved to adapt to in very powerful ways. And so the idea that temperature, heat, and cold could evoke these tremendous physiological changes that are beneficial for us. probably shouldn't surprise us at all.

2:10:02I mean, this is why I mean, these are not esoteric mechanisms. They're actually the foundational mechanisms by which our body and the bodies of other animals adapt. So I do have a question about the different ways that people could approach deliberate cold exposure. So for instance, children, I've been to bonnas where there are kids, you know, six or seven years old with their parents at the Bahnya. And so they're in hot sauna. I'm not suggesting people do this if they're not, you know, adapted to it and, you know, talk to your parents, kids and talk to your kids, parents, talk to your doctors.

2:10:40But it is remarkable. I mean, children doing sauna from a young age are deliberate cold exposure. Are there any date on this? And is it safe assuming that, you know, obviously that they can swim in or they're doing this in a tub or shower? And then I'd also like to ask you about, are there any additional male female differences? I know your study focused on men, but other studies have focused on both. And you of course are a woman and can that test your own experience with this. So children, men, women differences there in terms of protocols. Is there anything that people should build into the structure of their deliberate cold exposure that's unique to that?

2:11:20So, yeah, so this was an uncold exposure. So, yeah, I think that starting with the question about children, I think that it's important to to think about as children are smaller than adults. So we cannot really completely transfer all the information and the benefits and also protocols for how long and and stuff like that to children. We cannot do that because they are just smaller in mass. And one study that actually improves this is a study where they have compared heat loss in children, boys who were 12 years old compared to adults men and looked at heat loss of the core temperature. and expose them to a one or two minutes cold exposure or immersion up to the neck.

2:12:16And what they saw was that the boys in this study could actually defend their core temperature in the same way as the adults could, but they had to use their muscles way faster. So it means that they couldn't stay for as long and they use more energy to defend their core temperature compared to the adults. But for one minute, it seems that they could actually come in. But they will be colder when they then come out because they are smaller in their mass to their ratio, right? So it means that if the surface is so large on children and their mass and muscles being smaller to that ratio, it means that they can be in the water less time before they get hypothermic.

2:13:05So just think about that. They are just smaller. They can't defend their temperature for a very long time. But in this study they saw that for up to, I think it was a minute or so. They can warm it. Yeah. I'm glad you mentioned hypothermia and smaller -bodied people, children. I used to do some Pacific ocean swims in in the morning without wet suits. And I adapted to it pretty quickly. And these are fairly long swims. And we brought an excellent swimmer with us. That was interning with me for a while. He was 16 years old at the time and very lean. And he wasn't small for his age, but he was smaller than us.

2:13:44Then there was all guys on the swim that day. Sometimes women join us. And he got hypothermic. And he's an excellent swimmer. and he didn't report feeling overly cold. But fortunately, we got him to shore and he did him up again. So he lived. I don't think his mother is going to ever let him go swimming with us again. He's thriving in the world. He's a university student now. And he recalls that swim. I mean, this is why you always want to ocean swim with a buddy, with people. Yeah, he became hypothermic. His teeth turned yellow. He was got slurring his words. He wasn't making sense. We got him on the shore.

2:14:21and he was kind of drooling in a little semi -U4, and then kind of, hypothermia is no joke. So I think, yeah, so I'm really glad that this is coming up because the cold is a powerful stimulus, and kids are at a smaller body, people are at a greater risk of hypothermia. So a good reason to approach it with caution. Maybe start with cold showers, get then cold immersion and still water. Natural water and open bodies, the water of course are always going to be more dangerous for other reasons, currents and things like that. I'm drowning. So an important note there, what about any additional male -female differences or similarities that we should be aware of?

2:15:03And this comes up all the time on social media. Any time I post anything about a study, it's what about women because oftentimes there are differences. Yeah. And we also just talked about the difference in temperature in men and women. So it means that if we did, we replicated my study in women, it could be that they would have enough, you can say cold exposure with just nine minutes per week. It could be because they apparently are also just colder and they have increased metabolism in the brown fat. They have more brown fat. It could be, but this is just something that I frankly don't know. but women also do cold exposure winter swimming with the 11 minutes protocol.

2:15:50I do it myself and feel good about it. So I would say that women also regarding activation of the brown fit. It should be the same in theory, but I don't know if women actually do need to have another protocol when it comes to this rapid cold exposure. I think that it's another question if we are talking about ice swimming. When it comes to how far can you be in the cold water without getting hypothermic, then that will be differences in men and female. But if you do this cold exposure for a very brief amount of time, which is what I try to talk about, talk about what we call also micro -stressing the body to increase the the healthiest stress, then this is such a short amount of exposure that it's fairly the same.

2:16:43I think women can look at this as a fairly good protocol for them as well. I always say that if you really dread the cold and don't like the cold, then you are a perfect candidate for using deliberate cold exposure because the sympathetic aka the stress response will be greater and thereby the adaptation to that shorter one or two minutes is going to be much greater. Right? For people that are perfectly comfortable in the cold, it's harder to get an adaptation response. The same way that if somebody is very strong and they can lift a very heavy weight, that that very heavy weight is unlikely to evoke the same degree of adaptive responses if somebody is not quite as strong.

2:17:26So another reason to keep these exposures relatively short and more frequent than to do longer duration exposures frequently. However, let's say somebody only had two days a week to do deliberate cold exposure. Maybe they don't have access to Asana. Maybe they do. Would you suggest that they get in for one or two minutes, then get out, then get back in for another couple of minutes, then get out and call that for, you know, four or five minutes. to try and get to that 11 minutes total per week as opposed to getting in for a full five minutes and then getting out and coming back a second time that week.

2:18:05I know this is getting down into the weeds, but these are the sorts of things that I think people really want to know because a lot of people either don't live close to a body of water or don't have a cold plunge that they can do this with, although cold shower apparently works too. So most people live close to a shower. Yeah, it's definitely, I think the changes in temperature is what is strengthening your cells in the body. So if you can do the short amount of exposure and then get out and get back in, that is kind of, you can say, strengthen your cells because you are challenging them to adapt to changing temperatures.

2:18:46So during one session you can change this, right? You can do it if you are able to go to co -water, but also sauna, then you just do it that automatically. You will have a change in temperature. But you could also do it by veriating the temperature and your co -plunge if you have a plunge or if you have the open sea or you have seasons even. We have that in Denmark. So we have four seasons and the temperature is going to vary with that. So we have nature who can just change this for us and we don't have to think about it. If you have a cold plunge, well, then I would say that changing that temperature is what is gonna create this hermetic stress.

2:19:23And also keep your cells on its toes. You can say because you are tried, the body will still be stressed to try to adapt to the new temperature. As it's seen as something actually toxic to the body, right? It's a small piece of toxicity that you are exploding yourself to. You don't have to swallow it, but it's enough that you touch it, actually. Yeah, great, great way to frame it. That brings me back to this idea of circadian time. In your study, you didn't control for a specific time of day. And now I'm realizing that may be a great asset to the whole thing. So we know, for instance, that our bodies go through pretty dramatic shifts in temperature from the time we wake up.

2:20:07Our body starts heating up as we wake up and continues to heat until the afternoon. And then starts to drop in the later afternoon. and then assuming all things are working correctly, that body temperature drops and we sleep. So I could imagine that doing deliberate cold exposure at different times just by way of convenience or by way of intention could be very beneficial because my body temperature is going to be quite a bit warmer at one time of day versus another. And in that way, keeping the system tuned. And that's really what I keep hearing coming through as you explain these data and all these beautiful studies, yours and others, is that it's not really about getting cold.

2:20:45It's about going from warm to cold and from cold to warm. It's not, and I love this idea because I probably said this a hundred times on my podcast in a million times in my life and I'll continue to, which is that biology is not an event. It's a process. Like these metabolic and thermoregulatory processes are indeed like the turning of a knob.

2:21:13It's that they're going to have a lot more flexibility, a lot more fun and get a lot more benefit. As opposed to thinking, okay, I need to get into X degrees of water for X amount of time on X number of days in a very rigid way. All the time, how much and how cold and I mean, it's just like, well, because we also don't have studies showing exactly if you just keep five degrees in your water and you do that for a month, then what happens, and maybe the future we will know much more about this and I'm sure it's gonna come. And I really hope so. But I just think by logically changing that temperature up and down, up and down, and you also do that in your water, it doesn't really, it's not that important what temperature you have your water then, then just keep changing.

2:21:59It going up and down, it could be all up to 12 degrees Celsius. You're gonna activate your brown fat anyway. So I mean, 12, 19 degrees cold air is enough to activate your branches. So maybe we don't have to go as cold as I think many people think and putting ice even all the time. You don't have to. It's not, I don't think it's necessary to to expose yourself to that cold temperature all the time but very it a bit. So keep the system off balance and it's the way to keep it tuned. Yeah. You mentioned a study that is more recent or an ongoing that's not published. If you're willing, could you share maybe some of the data from that findings from that study?

2:22:44With of course the the cue to everybody that these are not yet published data so that the conclusions could change. The data could change for that matter. Yeah, so we haven't analyzed all the data yet and I know from the study that we did publish that we would need to look more at the data. So I don't really have any results yet that I can share because we are still in very preliminary analysis of this. So I wouldn't know yet what to exactly say about it. But what we looked at was both men and women method. So that's that's coming. Oh, that's fantastic. I'm that answer is going to please a great number of people and and intrigue everybody.

2:23:23So well, I want to really thank you for coming here today to talk about your work and the incredible direction that it points to because I think that, you know, no one study is definitive, but your study really, again, stands as a landmark in the landscape of exploring deliberate cold exposure and heat, how it can impact and potentially impact our health. Because frankly, there just haven't been that many high -resolution detailed modern studies of this. There have been studies of sauna. There have been some studies of cold. there are a lot of groups in physiology that work on hypothermia and very cold exposure, but most of the temperatures used in those days just aren't practical.

2:24:13So first of all, I just want to thank you for doing the work that you've done and for the work that you continue to do. I'm waiting with Bay did breath, as they say, to hear the results of this study that's ongoing on both men and women. So I'll have to have you back to inform us about that soon. And I want to thank you for the incredible public education efforts that you've been doing on social media and with respect to your book. And we of course will put links to all of those things in the show note captions so people can learn from you and can continue to learn from you. We certainly need more scientists who are both experienced with doing hardcore research as it's called and who also do the practices.

2:24:57I think that's a wonderful additional asset. You know, you're not just behind a lab coat or bundled up in a down feather jacket as everyone else is getting in the cold. You do these things and that you are so open and generous in the way that you share knowledge, which includes coming here today to share knowledge with me and our audience. So thank you ever so much. You're very welcome. I am so pleased to be here and thank you so much for inviting me and I could explain my study and I can share some of my insights from from doing that. So I'm very grateful for being here. Delighted and we'll have to have you back again.

2:25:33Thank you for joining me for today's discussion all about deliberate cold and deliberate heat exposure science and protocols with Dr. Susanna Soberg. If you'd like to learn more about Dr. Soberg's research or you would like to learn about the research of her institute, the Soberg Institute, please see the links in the show note caption. Also, in the show note caption, you can find a link to Dr. Soberg's excellent book, Winter Swimming. If you're learning from and are enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us. In addition, please subscribe to the podcast on Spotify and Apple.

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