GLP-1 Medications and Cold Plunge Therapy: What the Science Says
- Rebecca Nolan Harris, PhD
- Oct 17
- 6 min read
If you're taking GLP-1 medications like Ozempic, Wegovy, or Mounjaro, you may be exploring complementary wellness practices to enhance your metabolic health journey. Cold plunge therapy has gained significant attention—but what does the science actually say about combining cold water immersion with GLP-1 medications?
The Metabolic Benefits of Cold Water Immersion: What Research Shows
Cold water immersion isn't just a wellness trend—it's a scientifically validated intervention with measurable effects on metabolism and glucose control.
Improved Insulin Sensitivity
Multiple studies have demonstrated that cold water exposure enhances insulin sensitivity, which is particularly relevant for individuals managing diabetes or metabolic syndrome. Research published in the Journal of Applied Physiology found that both acute and repeated cold exposure improved insulin sensitivity and reduced fasting glycemia in individuals with type 2 diabetes.
A study on cold water swimming showed that repeated cold water immersions during winter months significantly increased insulin sensitivity and decreased insulin concentrations in participants. The improvements occurred in both experienced and inexperienced cold water swimmers, suggesting these benefits aren't limited to cold-adapted individuals.
Brown Fat Activation and Energy Expenditure
One of the most exciting mechanisms of cold water therapy involves brown adipose tissue (BAT), often called "brown fat." Unlike white fat that stores energy, brown fat burns calories to generate heat through non-shivering thermogenesis.
A groundbreaking study by Dr. Susanna Søberg and colleagues, published in Cell Reports Medicine in 2021, examined young male winter swimmers who alternated cold water immersion with sauna sessions 2-3 times per week. The research found that winter swimmers displayed enhanced cold-induced thermogenesis and better thermoregulation compared to controls. The researchers concluded that winter swimming could increase energy expenditure, proposing it as a lifestyle activity that might contribute to weight loss or weight control.
A meta-analysis examining acute cold exposure found that compared to room temperature, energy expenditure increased by approximately 188 calories per day during cold water immersion at 16-19°C (61-66°F). Brown fat volume and activity also increased significantly during these exposures.
The Critical Factor: Shivering and the Søberg Principle
Dr. Søberg's research led to what Professor Andrew Huberman named the "Søberg Principle"—a key insight for maximizing metabolic benefits from cold exposure.
The principle is simple but powerful: End with cold and allow your body to reheat naturally without external warming.
When you don't immediately warm yourself with towels, hot showers, or saunas after cold exposure, your brown and beige fat must work to generate heat, significantly amplifying metabolic effects. Research shows that shivering releases succinate from muscles, which further activates brown fat thermogenesis. This means letting yourself shiver—while uncomfortable—is actually beneficial for metabolic adaptation.
Anti-Inflammatory Effects
Research from Joslin Diabetes Center demonstrated that cold exposure resolved obesity-induced inflammation while improving insulin sensitivity and glucose tolerance in animal models. The study identified that brown adipose tissue produces a naturally occurring molecule called Maresin 2 when stimulated by cold, which promotes the resolution of inflammation. This is particularly relevant since chronic inflammation is a hallmark of obesity and metabolic syndrome.
Studies have also shown that cold water immersion reduces pro-inflammatory cytokines including IL-6 and C-reactive protein, while cold exposure combined with exercise showed even greater immune-enhancing benefits.
How Cold Water Immersion May Complement GLP-1 Medications
GLP-1 receptor agonists work by improving insulin secretion, slowing gastric emptying, and reducing appetite—mechanisms that primarily address hormonal and digestive aspects of metabolism. Cold water immersion works through entirely different pathways: activating brown fat, engaging skeletal muscle through shivering thermogenesis, and modulating inflammatory responses.
This suggests potential synergy. While GLP-1 medications optimize your hormonal response to food and improve glucose control through incretin pathways, cold exposure enhances your body's ability to burn calories and utilize glucose through thermogenic mechanisms. The two approaches target different but complementary systems.
The Søberg Protocol: Evidence-Based Cold Exposure
Based on Dr. Søberg's published research and recommendations, here's a scientifically-backed protocol:
Weekly Targets:
11 minutes total per week of cold water immersion
Divided into 2-3 sessions (not all at once)
Each session: 3-5 minutes depending on water temperature and tolerance
Water Temperature:
50-59°F (10-15°C) for most protocols
The water should be "uncomfortably cold but safe" to stay in
Colder water = shorter duration needed
You should reach the point of light shivering
The Søberg Principle - Critical for Metabolic Benefits:
After exiting cold water, do NOT towel dry immediately
Do NOT jump into a hot shower or sauna right away
Allow your body to reheat naturally for at least 10-15 minutes
Let yourself shiver—don't huddle or cross your arms
This natural rewarming maximizes brown fat activation and calorie burn
Starting Protocol (Weeks 1-2):
Water temperature: 59°F (15°C)
Duration: 1-2 minutes per session
Frequency: 2 sessions per week
Total: 2-4 minutes per week
Progressive Protocol (Weeks 3-6):
Water temperature: 54-59°F (12-15°C)
Duration: 2-3 minutes per session
Frequency: 2-3 sessions per week
Total: 6-9 minutes per week
Maintenance Protocol (Week 7+):
Water temperature: 50-59°F (10-15°C)
Duration: 3-5 minutes per session
Frequency: 2-3 sessions per week
Total: 11+ minutes per week
Always end with cold and allow natural rewarming
Critical Safety Considerations for GLP-1 Users
Hydration: The Non-Negotiable Priority
This cannot be overstated: GLP-1 medications commonly cause nausea, vomiting, and diarrhea, all of which can lead to dehydration. Cold water immersion creates additional physiological stress. The combination requires exceptional attention to hydration.
Do NOT use cold plunge if you are:
Experiencing active GI symptoms (nausea, vomiting, or diarrhea)
Feeling dizzy, lightheaded, or unwell
Dehydrated or haven't consumed adequate fluids
Within 2-3 hours of eating (GLP-1s slow digestion significantly)
Have uncontrolled cardiovascular conditions
Before each cold plunge session:
Drink 16-20 ounces of water 30-60 minutes beforehand
Ensure adequate hydration throughout the day
Consider electrolyte replacement, not just plain water
Wait until any GLP-1 side effects have completely resolved
Never use cold therapy during the adjustment phase to new medication doses
Temperature Sensitivity Note
Many people taking GLP-1 medications report feeling unusually cold, especially during early treatment or rapid weight loss phases. This occurs because eating less means your body produces less heat through diet-induced thermogenesis. If you're experiencing this increased coldness, you may need to start with warmer water temperatures and progress more slowly.
Important Timing Considerations:
Wait at least 4 hours after strength training before cold plunge
Avoid cold exposure within 2-3 hours of meals (due to delayed gastric emptying from GLP-1s)
Allow 2-3 weeks of stable GLP-1 dosing before beginning cold therapy
Never combine cold therapy with alcohol consumption
Additional Research-Backed Tips
Maximize Your Cold Exposure:
Submerge as much of your body as possible, including shoulders
Keep your head above water (unless specifically trained in cold water diving response)
Breathe slowly and steadily—avoid hyperventilation
Use the "walls" technique: count mental barriers ("I want to get out") and push through 3-5 walls per session
Don't Do This:
Don't use cold plunge immediately after eating
Don't take hot showers immediately after cold exposure (breaks the Søberg Principle)
Don't push beyond safe limits—hypothermia is a real risk
Don't use cold therapy as a replacement for medical treatment
The Bottom Line
Scientific evidence strongly supports cold water immersion as a beneficial complementary practice for metabolic health. Research demonstrates measurable improvements in insulin sensitivity, brown fat activation, energy expenditure, and inflammation reduction—all factors that align well with GLP-1 therapy goals.
The Søberg Principle—ending with cold and allowing natural rewarming—is crucial for maximizing metabolic benefits. This protocol, backed by peer-reviewed research published in Cell Reports Medicine, provides a clear, actionable framework: 11 minutes of cold water immersion per week, divided into 2-3 sessions, followed by natural rewarming.
However, safety must be the priority. The dehydration risk from combining GLP-1 side effects with cold exposure is real and potentially serious. Never attempt cold therapy while experiencing medication side effects, and maintain exceptional hydration practices.
As with any addition to your health regimen, discuss cold water immersion with your healthcare provider before beginning, especially if you have cardiovascular conditions, blood pressure concerns, or are experiencing any complications from your GLP-1 medication.
Key Scientific References:
Gibas-Dorna, M., et al. (2016). Acclimatization to cold water swimming. International Journal of Occupational Medicine and Environmental Health, 29(4), 707-716.
Hanssen, M. J., et al. (2015). Short-term cold acclimation improves insulin sensitivity in patients with type 2 diabetes mellitus. Nature Medicine, 21(8), 863-865.
Ivanova, Y. M., & Blondin, D. P. (2021). Examining the benefits of cold exposure as a therapeutic strategy for obesity and type 2 diabetes. Journal of Applied Physiology, 130(5), 1448-1459.
Søberg, S., et al. (2021). Altered brown fat thermoregulation and enhanced cold-induced thermogenesis in young, healthy, winter-swimming men. Cell Reports Medicine, 2(10), 100408.
Tipton, M. J., et al. (2017). The human ventilatory response to stress: rate or depth? Journal of Physiology, 595(17), 5729-5752.
van der Lans, A. A., et al. (2013). Cold acclimation recruits human brown fat and increases nonshivering thermogenesis. Journal of Clinical Investigation, 123(8), 3395-3403.
This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting any new wellness practice, especially when taking prescription medications.
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