Uncommon Cold: The Science & Experience of Cold Plunge Therapy (Preface)

This book exists to help you choose your own health state.

My ice bath book is advancing towards publication of a limited first edition that will only be available at CryoCon2024 or through my icebath company, Morozko Forge. This edition is the integration of hundreds of scientific studies and a dozen personal stories of health transformation I’ve conducted with readers of this blog. It has chapters on cancer, testosterone, sexual performance, autoimmune disorders, Type 2 diabetes, exercise performance, Alzhiemer’s and more.

I’m publishing the preface here, in its entirety, so you can get a better idea of my personal motivates for writing the book, and the difference that it might make in your own health. To read the Introduction, visit https://www.morozkoforge.com/post/uncommon-cold-book.

Preface

Science can create knowledge.  It cannot tell us what to do with it.   

This book is an integration of peer-reviewed science and personal experiences. The science is rooted in my critical review and inclusion of more than six hundred sources, whereas the experiences shared are both my own and those of the dozens of people I’ve interviewed. Both ways of knowing – science and experience – are important to me. Although I am a scientist, I am not of the Twitter-trolling “peer-reviewed, double-blind, randomized, controlled trial or it didn’t happen!” variety. Nothing matters more to an individual than their own N=1 trial, and no one can deny another person’s experience.

Some of my critics are quick to point out that my PhD is in Civil Engineering – not medicine, nutrition, psychology, neurobiology, or pathophysiology – and they are correct. Given this book is for the skeptical as well as the curious, perhaps it behooves me to explain how an engineering scientist like me wound up writing about health and wellness.

Type 1 Diabetes

My journey into personal wellness began when my six-year-old son was diagnosed with diabetes. It was December of 2001. I was married with three kids living in northern New York and had just finished defending my doctoral dissertation.

A day or two after Christmas, he developed a fever. I assumed he had caught a run-of-the-mill virus, as kids tend to do. Decades prior, my mother had given me orange juice when I was sick. She always said that the vitamins in the juice would help me get better. So, I gave him orange juice to drink. But over the course of several days, he got worse instead of better. He had almost no appetite, and when he did get hungry, he was too weak to eat. I just kept giving him juice, thinking it would give him strength to fight the virus.

I could not have been more wrong.

When my wife returned from a six-hour round trip to pick up her parents from the train station in Plattsburgh, NY, she was shocked at the rapid deterioration of his condition while in my care.

"I'm calling John," she announced. John was our next-door neighbor and family physician. We both lived around the corner from our little community hospital, and his teenage daughters babysat our young kids. John was a stand-up guy, and we felt lucky to share a property line and call him a friend. My wife described our son's symptoms over the phone, "He's got a low-grade fever, no appetite, and no energy."

John replied that it sounded like he was sick and that he would get better soon on his own.

Then my wife added, "And he's peeing a lot. Every night, he wets the bed."

John paused. "Your son has diabetes and your life is going to change. Meet me in the Emergency Department right away," he said.

My wife failed to share the part about diabetes until later. All she said to me at the time was, "John says to meet him at the hospital."

I carried my son across the street, around the corner, and into the Emergency Department. We lived so close that driving would have been more of a hindrance than a help, even during the winter in northern New York. The staff took him from my arms and admitted him to the pediatric intensive care unit right away, and I still did not know what was happening to him, or why, until John came to find me.

John sat me down and said, "Your son has diabetes, which means his body no longer produces the insulin necessary to metabolize carbohydrates. His body is running exclusively on fat, and he is suffering from ketoacidosis. His blood pH has dropped to dangerously low levels. He was probably hours away from a coma when you brought him in. We've got him on an insulin drip in the pediatric ICU, and he's going to get better fast."

Then John handed me an orange, a syringe, and a vial of insulin. He said, "No one leaves this hospital until you figure these out."

He showed me how to draw two different types of insulin into a syringe and inject them into the orange. Then he told me to start practicing. The way I understood it, my son's life now depended on my ability to prick blood from his finger, measure his blood glucose with a special meter, calibrate an insulin dose, and inject him with it.

So I stayed at his bedside all night and practiced while he slept.

Watching over him that night, I witnessed a slow-motion miracle. He looked better by the hour as his little body absorbed the insulin. It was as if the IV was dripping life itself into his veins. When he woke up in the morning, the first words out of his mouth were, "I'm hungry." They brought him eggs, he gobbled them up, and I cried.

It felt like I had nearly killed my son with orange juice, and John had brought him back from the brink of death. I still feel shame about my role in his illness to this day.

For the next fifteen years, my son, wife, and I carefully documented every bite, every shot, and every blood sugar reading. This was before the age of insulin pumps, continuous glucose monitors, and Bluetooth-enabled smartphone data trackers. Back then, it was all done by hand. We recorded the data in waterproof field books that went everywhere with my son. His body was a laboratory, those yellow journals were our lab notebooks, and we made several discoveries.

The first discovry was that the worst thing he could eat was Oreo cookies. No amount of insulin could prevent a blood sugar spike when he ate Oreos. I thought, "If this is what Oreos do to him, what the hell are they doing to our daughter… and the rest of us?" So, I banned Oreos from our house.

The second thing I learned – although this lesson took a bit longer – was that nearly everything I had been taught about nutrition was wrong. The most obvious example is the realization that orange juice is unhealthy. It's unhealthy for people with diabetes, and for kids, and sick people – for anyone, really. In fact, given the way that orange juice spikes blood sugar, it can be downright dangerous.

Properly caring for my son required unlearning most of what I had been taught about nutrition and replacing those fallacies with facts about diabetes, healthy diets, and metabolism. Some important lessons included:

• Type 2 diabetes differs from Type 1 in that people with Type 2 diabetes make insulin. People with Type 1 do not.

• Type 2 diabetes is reversible. Type 1 is not.

• Vitamin D deficiency during the first year of life increases the risk of developing Type 1 diabetes.

• There is no minimum dietary requirement for carbohydrates. Without carbs in the diet, the body converts protein into blood glucose via gluconeogenesis.

• Ketosis is a normal, healthy metabolic state that presents risks only for Type 1 diabetics. For all else, ketosis may be preferable to carbohydrate metabolism.

• Whole foods are better than processed. Animal products are healthier than plant-based.

• The calories in/calories out hypothesis is a myth. It's the nutritional content of the food that matters, not the calories.

• The FDA food pyramid is a lie.

Over the next decade and a half, I put copious energy into learning how to keep my son healthy and strong. He and his sister played sports, so I hired trainers and coaches to ensure they received good instruction and maintained high fitness levels. 

The irony being that at the same time I was working tirelessly to preserve and improve my children’s health, I was neglecting my own. It wasn’t as if I woke up one day and was shocked that the bathroom scale read 250 pounds. I knew I was getting fat, that my hair was turning gray, and that my health was suffering. I just wasn’t motivated to do anything about it.

That indifference to my well-being was becoming progressively clear in other areas of my life, too. My finances were a mess, my marriage was dissolving, and my unmanaged travel anxiety was holding back my academic career.

Divorce

Relationship experts say that having a child with special needs can strain a marriage, and they are not wrong. Chronic medical diagnoses in children can understandably create tension in their parents’ relationship. For me, the knowledge that there was something wrong with my child – and the feeling that it was my fault – came with a lot of grief. However, I don’t think our son's diabetes was the driving force behind our divorce. Diabetes is manageable, and there was little reason to believe he would suffer adverse health effects if we were conscientious about his diet, exercise, and insulin, which we were. The factors pulling us apart dated back further.

About a decade after my son's diagnosis, while we were living in Arizona, my wife sat me down to tell me she was not happy. She said she wanted to move back to New York without me.

Her dissatisfaction was what finally woke me up to my sorry state. It got me thinking about the man she believed she was marrying decades prior. At the time we said our vows, I was twenty-nine years old. I was lean, athletic, and handsome. I owned a home and taught full-time at the community college in her hometown. She had every reason to expect a bright future for us. What she wound up with almost two decades later was two more incredible kids – and an obese husband who suffered career-stunting travel anxiety and was deeply in debt. I could not help but look at myself and wonder, "What the hell happened?"

When I think back on how my wife and I felt when we first met and fell in love, I realize it had nothing to do with any well-reasoned appreciation of our shared relationship goals. We started with raw animal attraction, added shared novel experiences, and married not when we consciously decided to support each other's dreams and endeavors but when we discovered she was pregnant. What we did share was a deep-seated, trauma-induced desperation for belonging and family. Still, after more than fifteen years of constant conflict, we were locked in a destructive pattern of co-dependence that was the relationship equivalent of a chronic illness.

I decided it was time to see if I could improve my marriage by turning myself into a man worth falling back in love with. What followed was a journey of personal and physiological transformation. With the same focused attention that I put into managing my son's diabetes, I set out on a mission to learn everything I could about love, attraction, relationships, diet, fitness, and self-improvement, and then I started applying those lessons to my life. On top of my constant reading, I sought advice from my mentors, men's groups, friends, and anonymous online forums. Some of the subsequent realizations included:

• My wife and I had built a co-dependent relationship in which we both relied on – and tried to control – the other's behavior to manage our negative emotions.

• Our co-dependence was built on covert contracts that fostered resentment between us.

• I had become fat for psychologically protective reasons that I was going to have to confront and resolve if I were ever to become lean again.

• Men and women are different in important ways that my parents hid from me to protect their political ideology and personal shame.

• Degradation of health and attractiveness does not have to be synonymous with aging.

One of the most visible changes I underwent was dropping sixty pounds by skipping meals, cutting out processed foods, exercising, and quitting alcohol. At one point, I was losing weight so fast that some of my faculty colleagues--primarily those who only saw me at academic conferences--pulled me aside and told me they were worried about me.

"Are you OK?" they asked in hushed voices, their brows furrowed with concern. "Do you have cancer?"

I reassured them I was not sick or dying. On the contrary, I explained, I had merely stopped eating the processed garbage occupying 99% of grocery store shelves, and I had never felt better. My kids were proud of me, my self-confidence increased, and I could tell some women found me attractive again.

At home, my wife and I continued to bounce from therapist to therapist, carrying our futile power struggles with us. It occurred to me that the improvements I was making in myself might be exacerbating our existing dysfunction. Ultimately, co-dependence – the only relationship dynamic we'd ever known – was incompatible with the changes I was making in myself, and the New Me – the better, healthier, happier Me – was unsatisfied with the status quo.

I told my wife that she was welcome to travel this new path with me but that we could not return to our co-dependent dynamic. No matter what happened, our “first” marriage was over. The only potential path forward together required building a new “second” marriage with a healthier dynamic.

Shortly thereafter, following one final gut-wrenching couples' counseling session, my wife definitively declared that she wanted a divorce.  I agreed, and we separated.

A lonely health scare

Right around the time I started dating again, I began taking cold showers, which was my first experience with any kind of deliberate cold exposure. One of the books I was reading said cold showers would toughen me up and boost my self-esteem.

I hated them.

But I also knew that I needed to change my thinking for my next relationship to be better than my last one so I could avoid repeating the same mistakes I’d made in my marriage. Doing difficult things that I hated seemed like a good way to learn to manage my anxieties and build mental resilience. Cold showers led to ice baths, and ice baths led to Morozko Forge – but maybe none of it would have happened if not for the results of a blood test that scared the hell out of me.

To monitor my continuous health improvements, I had a full workup of blood tests done, which included panels for cardiac, hormone, and metabolic health, as well as some male-specific tests, including PSA (prostate-specific antigen). PSA is a measure of inflammation of the prostate and is associated with an increased risk of prostate cancer.

When my PSA came back elevated, I suddenly became scared that I did have cancer after all, as my concerned colleagues had inferred.  The conventional diagnostic cascade for a man with a PSA as elevated as mine (7.0 ng/ml) starts with a prostate exam, which leads to a biopsy, and eventually a prostatectomy. I realized that if I had surgery to remove a cancerous prostate, the odds were overwhelming that I would suffer a lifetime of erectile dysfunction.

My newly divorced, catastrophizing mind asked, “If I can no longer get an erection, what woman will ever love me?”

The prospect of being alone and unattractive frightened me more at that moment than the prospect of a long, slow death from prostate cancer. So, I did not tell my kids and I did not tell my estranged wife. I was afraid they might try to pressure me into medical procedures I would later regret.

Instead, I resolved to try everything except conventional Western medicine to get my PSA down. I chose to treat my inflamed prostate with ice baths and a ketogenic diet, which is when I started cold plunging every single day.

It worked. The ice bath/keto protocol dropped my PSA to 1.8 ng/ml in a matter of months, and my life, once again, got better – not by following conventional medical advice about how to get healthy, but by rejecting it. The experience fit the same pattern I’d noticed with my son’s Type 1 diabetes when I ultimately had to question everything I had been taught as a child about diet, health, nutrition, and aging.

The corruption of medical science

Science as a method for knowledge creation is a wonderful thing. I have tremendous respect for the process, and chose to make it my career. Practicing science disciplines our thinking, organizes our investigations, creates new knowledge, and liberates the human mind. However, the myopic emphasis on peer-reviewed scientific literature as the only source of reliable or actionable knowledge -- especially regarding our health -- is hubristic, flawed, and often interest-conflicted.  Tangentially, the belief that academic institutions operate independently of pecuniary influence is equally erroneous.

Institutional backing used to serve as a proxy for credibility in research. However, today's academic institutions – and many of the scientists they employ – are so interest-conflicted by government grants, corporate sponsorships, and lucrative consulting agreements that only research serving the economic interests of benefactors gets the imprimatur of the university. This corruption is especially apparent within the healthcare sector, which, according to the Open Payments database run by the Centers for Medicaid and Medicare Services, logged a record-breaking $12.58 billion in direct payments to certain healthcare providers – including university-affiliated teaching hospitals – from drug and medical device companies in 2022.[1] Drug companies influence physicians from the very earliest stages of their careers by sponsoring classes and donating textbooks either pharma-funded or pharma-authored. In 2018, researchers discovered that the authors of Harrison's Principles of Internal Medicine, a medical school staple text now in its 21^st edition, collectively received over $11 million in payments from drug and device manufacturers between 2009-2013 – not a dime of which was disclosed to readers.[2]

The money that flows directly from corporate interests into medical schools is shocking. In 2022 alone, Massachusetts General Hospital, which serves as the teaching hospital for Harvard Medical School, received more than $86 million from drug and medical device companies, which included payments for research, royalties, consulting fees, and textbooks.[3]  And the conflicts don't end with that initial medical education. According to Dr. Adriane Fugh-Berman, Professor of Pharmacology and Physiology at Georgetown University, Continuing Medical Education (CME) courses required for all practicing medical practitioners to keep their professional licensure often amount to little more than product promotion for drug and medical device manufacturers.[4] Irrespective of how ethical and above board these programs claim to be, it has been shown that industry-funded research consistently produces results favorable to its sponsors.[5] And it seems clear the investment offers an impressive ROI. In 2022 alone, the pharmaceutical industry raked in more than $1.4 trillion US dollars in revenue, up 65% from $964 billion just ten years ago[6] – which is great for corporate medicine’s bottom line but less than ideal for people looking for unbiased, science-backed information on how to improve their health.

N = 1

Institutional research works (when it works) on a statistical scale. That is, clinical trials seek to discover what is statistically likely for a large group of patients. Results are not considered "significant" until researchers measure a difference between the experimental and control groups and can say with 95% confidence that it is not due to random chance. Given that I did a lot of sponsored research for the National Science Foundation, the Environmental Protection Agency, and the Department of Defense, I am well-versed in the research process.

That’s how I know that even the most flawlessly designed, sufficiently powered, randomized, double-blind, controlled trial cannot say with certainty what the experience of any individual will be. It is a logical fallacy to apply findings from a statistical ensemble to a particular individual because results that work for many people may not work for one. The experiments you run on yourself are the ones that matter most, and such experimentation occurs every time you make a change and try something new.

It doesn't matter if some study says that X works when X doesn't work for you.

We are now at a low point in modern history when it comes to institutional trust. While most people still like their physicians on a personal level, trust in the institution of medicine is at an all-time nadir.[7]  It doesn’t seem coincidental that this precipitous evaporation of trust is occurring at the same time the country is facing a massive mental and metabolic health crisis.

My firsthand experiences over the last several years have prompted me to question what it means to be an engineer. I have always believed that my chosen profession called upon me to make the world better for the people who live in it. I started my career researching and teaching about the environment, believing I was going to help save the planet from pollution. Later, I began to research infrastructure resilience and thought I was going to save people from natural disasters.

I still care about the environment and the impact of natural disasters, but I do not study them in the same way I used to. I now believe that my challenge as an engineer is to help resolve the population-wide health crises, which at this point is better described as an emergency. Our air and water are relatively clean, and people are reasonably safe from hurricanes, flooding, and earthquakes – but we are collectively getting fatter and more miserable by the day.

At this moment in history, my standing as a medical outsider strengthens the credibility of my advocacy instead of weakening it. I have the clarity of objectivity coupled with the research skills and professional experience to grasp the underlying science, and I consider it my mission to equip health-seekers with the knowledge and technologies that empower them to run their own N=1 trials without having to rely on the institutions that we’ve collectively realized aren’t working as intended. That’s why this book exists.  It is a compilation of the knowledge I acquired that led to my disillusionment with medical institutions and set me on my journey of health empowerment – first on behalf of my son, then on behalf of myself, and now on behalf of anyone willing to listen.

Nothing in this book is medical advice. Instead, I offer stories about what cold plunge therapy did for myself and others, coupled with peer-reviewed science that can help make sense of those outcomes. It's an indirect route to a scientific explanation for why certain things work that, according to allopathic medicine, aren’t “supposed" to work. The goal is to both inform and empower you to decide what might make a worthwhile experiment in your own life.

Truly, the only experiment that matters when it comes to your health is N=1. If you find something that works for you (let’s call it “X”) but X doesn’t work for a single other person on the planet – it still works. For me, becoming a better, stronger, more satisfied, more resilient version of myself was the goal. And cold plunging worked. And I think the “only N=1 matters” mindset can be perfectly illustrated by one more story.

The magic “off” button

Someone you will read a lot about in this book is my girlfriend, AJ. There are two things you need to know about us for this inaugural AJ anecdote: I give a good back rub, and she suffers frequent migraines. One fortunate day, maybe five years ago, when the onset of a headache coincided with a back rub, we accidentally discovered that applying pressure to a tiny, well-circumscribed spot on her back caused her head pain to disappear completely. The phenomenon was as amazing as it was bizarre.

Ever curious, she asked the doctors in our social circle if they had heard of anything like this. They all answered no. She consulted various acupressure and trigger point charts for an association, finding none. She searched medical literature for case studies. Nothing. So, she undertook her own review of the anatomy of the area in detail and studied the innervation of the teres minor – the muscle that underlay the spot – looking for a pathway between the “off” button on her back and her trigeminal or optic nerves, the presumptive source of her headaches. She essentially did what I did to arrive at this book on cold plunge therapy – she found something that worked and then doggedly pursued an understanding of why – the difference being that, unlike me, she never found one. Eventually, she decided that the mechanism did not matter. The only thing that mattered was the relief she experienced.

The critical part of her N=1 – that I can interrupt her headache at will – persists despite a lack of understanding of the mechanism. Although it makes zero damn sense and works for exactly zero other people (that we know of), we keep doing it because it works for her.

The lesson here is that when you find something that works for you, but you don’t know why, don’t let science or Western medicine try to convince you otherwise. I don’t do Twitter-trolling “you have no data” science because it’s a lie rooted in some other motive unconcerned with your health.  If I hadn’t done all this research and didn’t have all the mechanistically plausible explanations for the myriad of benefits at my fingertips, cold plunges would still work for me. And any dismissal or derision arising from self-interested individuals, corporations, or institutions cannot change that fact.

The purpose of this book is to empower you with knowledge of what works for others so you can decide what to try for yourself. Whether the benefits outweigh the risks of any experiment you choose is a question best left for you to decide. My hope is that you’ll share the results of your experiments with the rest of us, so that we all might benefit from what you’ve learned.

The most important experiment for any individual is their N=1.

---

[1] https://openpaymentsdata.cms.gov/

[2] Piper BJ, Lambert DA, Keefe RC, Smukler PU, Selemon NA, Duperry ZR. Undisclosed conflicts of interest among biomedical textbook authors. AJOB Empirical Bioethics. 2018 Apr 3;9(2):59-68.

[3] https://openpaymentsdata.cms.gov/hospital/220071

[4] Fugh-Berman A. Industry-funded medical education is always promotion—an essay by Adriane Fugh-Berman. bmj. 2021 Jun 4;373.

[5] Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero L. Industry sponsorship and research outcome. Cochrane database of systematic reviews. 2017(2).

[6] https://www.statista.com/statistics/263102/pharmaceutical-market-worldwide-revenue-since-2001/

[7] https://gssdataexplorer.norc.org/trends?category=Politics&measure=conmedic