Carlos Vieira, MD

Cold Therapy: History, Science, and Practical Applications

‍Cold therapy, also known as cryotherapy, cold exposure, or cold submersion therapy, has been used for centuries to treat various ailments. From depression to cancer, cryotherapy has been employed in hopes of alleviating or mitigating disease. But does cold therapy have an impact on preventing or reducing the recurrence of breast cancer? Let’s explore the historical context and recent scientific literature to understand the relevance of cold therapy in relation to breast cancer. Additionally, we will introduce the concept of hormesis, an essential aspect of cold therapy.Hormesis is a biological phenomenon in which a low dose of a stressor has beneficial effects, while a high dose becomes harmful. It follows the principle that “what doesn’t kill you makes you stronger”—within limits. As my grandmother used to say, “Everything in excess is a poison.” This applies to exercise, fasting, and cold therapy alike.

‍A Walk Through the Past

‍The Edwin Smith Papyrus (2000-2500 BC), one of the oldest medical texts, describes cases of breast abscesses treated with cold therapy. Following the Egyptians, the Greeks—led by Hippocrates—documented the analgesic effects of cold applications and the increased resistance to infections in infants exposed to cold air in On Airs, Waters, and Places. Cold immersion baths were also used by The Romans to treat different medical conditions including tertian fever. In modern medical history, John Hunter (late 1700s) studied hypothermia, concluding that cold temperatures could help preserve organ function. In the 19th century, William Osler implemented cold therapy to treat typhoid fever at Johns Hopkins Hospital, significantly reducing mortality from 24% to 7%.The evolution of cryotherapy, particularly through the use of cryogenic solutions such as nitrogen, introduced localized treatments for various cancers with some success. Today, cold scalp therapy is employed to preserve hair during chemotherapy, and cold mittens are used to reduce neuropathy. But what about cold immersion therapy? Is there any data supporting its role in preventing breast cancer recurrence?

‍Modern Perspective on Cold Immersion Therapy
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‍The short answer is NO. Surprisingly, there are no randomized controlled trials examining the effects of cold plunges on cancer prevention or recurrence. While local cryotherapy treatments have been researched, no data supports prescribing cold plunges or showers as a treatment for breast cancer. So why discuss cold exposure? Because of its potential health benefits, particularly in strengthening the immune system.
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‍The Immunological Effects of Cold Therapy

‍A study involving 60 healthy subjects found that those who took daily cold showers for 90 days had increased levels of interleukin-2 and interleukin-4, both of which contribute to antibody production. In mice, brief cold exposure led to an increase in CD4+/CD8+ T-cell ratios and enhanced natural killer (NK) cell activity in blood and spleen lymphocytes. NK cells play a critical role in destroying cancer cells. Short-term cold immersion (less than 10 minutes at 57°F) has been shown to reduce the production of tumor necrosis factor-alpha (TNF-α), a potent inflammatory cytokine, while temporarily increasing norepinephrine, epinephrine, and cortisol. Additionally, leukocyte counts—especially neutrophils—were observed to rise, which can enhance immune function. Cold exposure has also been linked to increased lymphocyte activity, improving the body's ability to fight viruses, bacteria, and cancer.

‍Potential Downsides of Prolonged Cold Exposure
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‍While brief cold exposure can boost immune function, prolonged exposure may have the opposite effect. Extended cold exposure has been linked to decreased lymphocyte production and a reduction in NK cells due to the persistent release of norepinephrine. Since NK cells play a crucial role in modulating immune responses and fighting cancer, their suppression could be detrimental. Studies indicate that cold immersion lasting over 30 minutes increases interleukin-6 (IL-6), an inflammatory marker associated with chronic inflammation. Additionally, prolonged cold exposure can impair skin and mucous membrane integrity, reducing secretory IgA antibody levels, which help protect against infections in the respiratory and gastrointestinal tracts.

‍Cold Exposure and Brown Fat Activation
‍The human body contains three types of fat: white fat, beige fat, and brown fat. White fat stores excess energy, beige fat represents a transition state between white and brown fat, and brown fat is essential for body temperature regulation .Brown fat is predominantly found in the supraclavicular area, around the spine, neck, and kidneys. It decreases with age, with only 14% of people over 40 exhibiting cold-activated brown fat. Cold exposure has been shown to increase brown fat reserves, which can improve metabolic health. Research also suggests that brown fat can improve sleep patterns.

Final Thoughts

‍Currently, there is no substantial evidence linking cold exposure to cancer prevention or recurrence. The optimal frequency and dosage of cold therapy remain largely empirical, yet brief exposure seems both effective and practical. While cold therapy offers numerous health benefits, more research is needed to determine its potential role in cancer prevention. Until then, it remains a valuable tool for immune enhancement, metabolic health, and overall well-being.

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