Excess body fat is a widespread concern, motivating many to seek effective strategies for achieving their desired physique. Among the various approaches, fat freezing has gained popularity due to its underlying principle: fat cells are susceptible to cold temperatures and can undergo destruction through a process called cryolipolysis.
Cryolipolysis, which literally translates into cold (cryo) fat (lipo) destruction (lysis), was invented, in part, by observing what can happen when kids eat popsicles. The cofounders of this process were intrigued by something called “cold-induced fat necrosis” that was reported to occur after young children ate popsicles that were inadvertently left resting on the cheek for several minutes. Skin samples taken from pediatric patients like these showed inflammation in the fat, but normal overlying skin. Using this concept, a cooling device was tested on pigs in 2007 to see if fat cells could be selectively destroyed. By 2010, the first cryolipolysis technology approved for human use, named CoolSculpting, was cleared as a treatment for love handles.
Understanding Cryolipolysis and CoolSculpting®
Cryolipolysis works because of one basic principle: fat cells die when they get too cold. CoolSculpting® is an FDA-cleared procedure designed to target and eliminate subcutaneous fat, the type of fat that cryolipolysis targets. It is important to note that cryolipolysis is intended for fat loss, not weight loss. The ideal candidate is already close to their ideal body weight, but has stubborn, pinchable areas of fat that are difficult to get rid of with diet and exercise alone. Cryolipolysis also doesn’t target visceral fat, so it won’t improve your overall health.
CoolSculpting® has been cleared by the FDA to treat nine different areas of the body. The treatment itself takes 35 minutes per application, and multiple applications may be needed to cover an area. The most common side effects of treatment include redness, bruising, swelling, tingling, numbness, or darkening of the treated area. Most of these side effects, if present, will resolve within several months after treatment. Perhaps the most significant, albeit relatively rare, side effect of cryolipolysis is, paradoxically, increased fat growth at the treatment site. Results can be seen as soon as three weeks, with maximum benefit seen at approximately three months. Average reduction in fat ranges from about 10% to 25% per round of treatment, and there is no evidence of any body-wide side effects. Cryolipolysis appears to be a safe and effective treatment for fat loss without the downtime of liposuction or surgery.
The Appeal and Risks of DIY Ice Pack Treatments
Given the cost and accessibility limitations of CoolSculpting®, some individuals have explored at-home alternatives using ice packs or other frozen materials. However, attempting to reduce fat at home with ice packs is not recommended.
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The "Ice Hack" Diet: Claims and Scientific Evidence
The ice hack diet is a dietary pattern that uses cold exposure to help stimulate weight loss. It typically involves adding ice to the diet, drinking cold liquids, and only consuming cold foods within a person’s calorie allowance. People who follow the ice hack diet prioritize eating cold foods to cool their body temperature. Proponents suggest this can increase metabolic activity and burn more calories. There is no evidence to suggest this is true.
Advocates of the ice hack for weight loss claim that a person’s inner body temperature is linked to metabolic rate and weight loss.
The ice hack diet attempts to trigger cold-induced thermogenesis, where metabolism increases to help keep a person warm. Some evidence suggests that targeting thermogenesis may help manage obesity and metabolic diseases. However, eating cold foods is unlikely to provide this benefit.
As a relatively new diet, no research proves that the ice hack diet works for weight loss.
Like any diet, the ice hack diet may lead to weight loss naturally if you’re on a caloric deficit (taking in less energy than you’re burning). The ice hack diet also involves consuming ice, which means you’re increasing your daily water intake. Consuming more water, particularly before meals, can help maintain the feeling of fullness, which might make you less likely to experience cravings or overeat at mealtimes.
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Ultimately, however, the temperature of your food is unlikely to be a primary factor in weight loss success. While your body increases metabolism to keep you warm, cold foods can’t make you cold enough long enough to affect body weight significantly.
The Role of Brown Adipose Tissue (BAT)
Brown adipose (fat) tissue quickly and efficiently increases heat production. Cold exposure may boost metabolism due to an increase in brown fat activity. Brown fat, or brown adipose tissue, is a type of fat tissue that plays a role in regulating metabolism.
Brown fat is more active in cold temperatures and breaks down blood sugar and fat molecules to create heat and help maintain body temperature.
Intermittent Cold Exposure (ICE) and Adipose Tissue
Intermittent cold exposure (ICE) has garnered increased attention in popular culture, largely for its proposed effects on mood and immune function, but there are also suggestions that the energy-wasting mechanisms associated with thermogenesis may decrease body weight and fat mass.
The recent increased interest in intermittent cold exposure (ICE) is related to the proposed benefits for mood, inflammation, immune function, and general physical wellness. While not as commonly mentioned, there are suggestions that ICE could reduce body weight as a function of the increased energy expenditure (EE) due to shivering (ST) and non-shivering thermogenesis (NST).
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Given the capacity of BAT to metabolize substrate at high rates per unit of tissue mass, it is logical to hypothesize that the activation, and perhaps expansion, of BAT might constitute a modality to combat obesity by increasing energy expenditure (EE).
Effects on Body Weight and Fat Mass
While ICE does not consistently lower body weight or fat mass, there does seem to be evidence for ICE as a positive modulator of the metabolic consequences of obesity, such as glucose tolerance and insulin signaling. The effects of ICE on BW are mixed, with studies reporting increases, decreases, and null effects. Studies using human subjects generally show no change in BW but do report a modest decrease in waist circumference, while rodent studies represent much of the variability initially mentioned.
ICE duration was examined directly by Ravussin et al. and Tsibul’nikov et al. The former directly measured the differential effects of ICE at 1, 4, or 8 h/d and all conditions demonstrated no change in BW. The latter compared 1.5 h to 8 h of ICE, where both groups demonstrated an increased BW, and the increase in BW was more substantial with the shorter ICE duration.
Effects on White Adipose Tissue (WAT)
Despite the lacking evidence for ICE to modulate BW, there is some evidence for its impact on white adipose tissue (WAT) weight and implications for WAT function based on morphology. Generally, ICE tends to increase the subcutaneous WAT (sWAT) and has variable effects on the visceral WAT (vWAT), where increases, decreases, and null effects are reported.
In humans, winter swimmers have an increased fat mass, but a decrease in vWAT as estimated via electrical impedance.
Effects on Brown Adipose Tissue (BAT)
ICE tends to increase BAT weight, based on the majority of studies. However, one study indicates no change and another reports a decrease. While there is a small disparity in the reports for ICE-induced increases in BAT weight, there are clear effects on BAT activity. ICE consistently increased the thermogenic response of BAT to a cold stress, where rodents and humans that undergo regular ICE show increased BAT activation in response to cold exposure.
Combined Effects of ICE and Exercise
The combined effects of ICE and exercise do not seem to provide any additional benefit, at least when exercising during ICE bouts.
Research on Localized Cold Exposure and Beiging
Cold or β3 agonists cause the induction of beige adipose tissue in human s.c. WAT depots of humans is postulated to improve glucose and lipid metabolism in obesity.
In this study, researchers characterized the ability of s.c. WAT from lean and obese insulin-resistant human subjects to beige in response to physiologic, localized cold, which consisted of repeated, 30-minute per day cold exposure by applying an ice pack to the thigh or abdomen for 10 consecutive days. They quantified beiging by measuring the protein and mRNA expression of UCP1 and TMEM26, along with mitochondrial bioenergetics, and determined whether baseline SI, BMI, age, or sex predicted the beiging response.
Key Findings
Repeated cold exposure upregulates UCP1 and TMEM26 expression in s.c. WAT. Cold treatment increased UCP1 protein staining 2-fold in s.c. WAT of both the cold-treated and the contralateral leg in lean subjects. TMEM26 mRNA expression increased in the s.c. WAT of the leg exposed to cold and of the contralateral leg of the lean subjects, but TMEM26 mRNA expression did not increase in the obese subjects. TMEM26 protein staining in the s.c. WAT of the cold-treated leg and the contralateral leg in lean subjects was higher than baseline. TMEM26 staining also increased in the s.c. WAT of the cold-treated leg and the contralateral leg in obese subjects. Analysis of the data indicated that TMEM26 expression increased more in the cold-treated leg of the obese subjects than the lean subjects.
These proteins were increased to the same extent in s.c. WAT of contralateral leg as the cold-treated leg, suggesting that icing 1 leg activates a crossover effect, which we postulate is mediated by the SNS. The obese subjects induced beige protein markers equally as well as the lean subjects, indicating that beiging could potentially be exploited therapeutically in obese subjects with metabolic disease.
Safety Considerations for Cold Exposure
If a person wishes to explore other methods of cold therapy, they should do so safely, keeping exposure short and in controlled environments. For example, a person may experience cold shock if they plunge into extremely cold water without first acclimatizing. Cold shock can cause dramatic changes in breathing, heart rate, and blood pressure, which can increase the risk of drowning and complications such as hypothermia.
The American Heart Association (AHA) also cautions against spontaneous cold plunges without weeks to months of preparation to acclimate the body to the shock. Jumping into extremely cold water can cause cold shock, a survival response that causes rapid breathing, increased heart rate, and elevated blood pressure.
Keeping these tips in mind can help you start cold exposure safely:
- Wrap all ice packs in a towel instead of applying them directly to your skin.
- Keep exposure times short, and gradually build up your tolerance.
- Start in the shower, where you can control the water temperature.
- In ice baths, wear protective layers on your vulnerable extremities, like your hands and feet.
- Be mindful of your exposure temperature in relation to frostbite and hypothermia onset (the colder it is, the faster these conditions set in).
- Familiarize yourself with the warning signs of hypothermia and frostbite.
- Never do a cold plunge, such as the polar plunge, when you are alone.
Alternative Approaches to Weight Loss
An effective alternative to the many online weight-loss gimmicks is a healthy lifestyle coupled with prescription weight-loss medications such as GLP-1 receptor agonists like semaglutide.