Friday, July 29, 2011

Are You Showering Right? Part 2

While hydrotherapy is thousands of years old and was mentioned by Hippocrates, modern hydrotherapy came into being in Central Europe in the 19th century. The two most famous proponents of the revival were Vincent Priessnitz and Sebastian Kneipp, the one a peasant who first cured himself, the other a priest who is considered the founder of naturopathic medicine. The spa towns of the Czech Republic and Germany remain the epicenter of hydrotherapy, and in the years since its revival, a very wide range of techniques have been developed and refined by practitioners. Naturopathic doctors learn about a number of techniques, including constitutional hydrotherapy, hyperthermy, contrast hydrotherapy, and others. One such technique, frequently recommended by naturopaths, is home-based contrast hydrotherapy done in the shower – this is a modern application of a method largely based on folk knowledge and clinical experience, but in recent years, there has been some research into the topic by some adventurous young docs.

For those who want to cut to the chase, here’s the treatment in its simplest form:
Step 1 – Take your shower as normal, using warm to hot water for approximately 5 minutes. (Some docs call this a pre-heating phase)
Step 2 – At the end of your shower, turn the temperature down, and finish with cooler water for about 30-60 seconds, making sure to expose your limbs, core (chest and back), head and face to the cool water.
To reap maximum benefit, this is meant to be a daily ritual.

One important point for those who are interested in trying it out is to accommodate to colder water slowly, over a period of days to weeks. Usually, this means starting with lukewarm water, getting used to that, then cooling the water a bit, getting used to that, and so on. In my practice, I’ve seen that patients find a more aggressive treatment to be hard to tolerate and harder to stick with – if you’re not used to it, freezing cold water first thing in the morning will leave you feeling cold all day, and that’s no help to anyone. If instead you follow a more moderate regimen and build towards colder water, you’ll reap the maximal benefit. In the process, don’t forget to be sensitive to how you feel from day to day – some days you’ll be able to tolerate colder water than others.

The modern theory behind this treatment goes like this – brief, controlled stresses improve your health by provoking a response from the body’s defense mechanisms. Major stresses (viruses, bacteria, etc.) provoke that same response, but in a way that comes at great cost. By stressing the body in a controlled fashion, we can experience a heightened effect from the body’s defense mechanisms, but with no significant side effects. This really shouldn’t surprise us, as it’s a similar process that causes plants to produce antioxidants. For plants, it’s the stress of being subjected to ultraviolet radiation and other environmental stressors that causes the formation of healthy antioxidant compounds, and in fact fruits and vegetables grown in more sheltered environments (like greenhouses) tend not to produce as high quantities of antioxidants.

So here’s what the research says about brief, controlled exposure to cold:

1. It can boost your antioxidant status, something that’s hard to do and even harder to prove. A German study showed that people who engage in winter swimming (an intense short-term exposure to cold) have higher antioxidant activity in their red blood cells. Here it was postulated that the improved antioxidant activity was due to repeated exposure to a controlled stress. To be clear: increased antioxidant activity in the blood is a true prize in the world of medicine. Few studies of antioxidants measure this as their outcome, so it’s good to know that something will do it. The reason this antioxidant activity is important is that it’s almost certain to prevent chronic disease of many types, including rheumatoid arthritis, cancer, and atherosclerosis, among others.

2. It modulates immune function. This has been studied in quite a large amount of detail at this point, and several studies have shown multiple immune enhancing effects from cold water stresses. (1, 2, 3) Those with scientific minds may want to know that the specific changes noted were a boost in Natural Killer (NK) cell function, CD8+ and CD4+ cells, as well as tumor necrosis factor (TNF-a). An additional study showed that the immune-stimulatory effects were boosted by exposure to either hot water or vigorous exercise before the cold stimulus. These immune modulating effects has prompted one researcher to postulate that cold water stimulus may have anti-tumor activity. This remains a hypothesis, but for those interested in learning more about the topic, the published paper is available in full text for free, and it contains a truly encyclopedic set of references.

Easy to do and effective, home-based contrast hydrotherapy is a recommendation I make to a lot of my patients with a variety of conditions. In addition to the benefits I’ve noted above, it also has effects on the cardiovascular system and on a number of hormones. Additionally, unlike many treatments, which are appropriate only for certain diseases or certain people, I believe this treatment to be mild enough and universally beneficial enough that nearly everyone can benefit from it. So that’s your cue – get out there and get your immune system working better!