APPENDIX B

THE COLD THERAPY RX

WHAT IS THE NEXT STEP IN THE EVOLUTION OF THE EPI-PALEO RX?

The cold thermogenesis protocol should added gradually to the Epi-paleo Rx protocol. I hope you
all realize that not everyone will need it. Some will need it because they have special needs, including
gastric bypass patients, HCG users, those on exogenous steroids, chronic pain patients, and those with
metabolic syndrome type 2 diabetes as a few examples.
Prolonged and controlled local peripheral skin cooling can induce selective “damage” and
increased hypothalamic signaling by forcing adipocyte apoptosis and subsequent loss of subcutaneous
fat, without damaging the overlying skin or the underlying muscle layers. This means acute cold
causes rapid leptin sensitivity! It means fat is forced to liberate leptin from fat cells to slowly lower
its serum levels as long as the cold stimulus is applied safely. This is new scientific information that
was first carried out in pigs in 2008 and subsequently tested in humans and found to be quite effective
for fat removal in certain selected areas of the body. Maintenance of a normal temperature and the
normal variations of the circadian and lunar rhythms are achieved by changes in all physiological
systems, one of the most important of which is alteration in skin blood flow in humans. My version of
cold thermogenesis for the Epi-paleo Rx generalizes these effects for the entire body to force the brain
to slowly rewire in the hypothalamus to burn all excessive white adipose tissue (WAT) by inducing
the formation of brown adipose tissue (BAT) using cold alone.
A cursory version was first popularized by Ray Cronise in 2010 and by Tim Ferriss in 2011 but
neither one of them took this process to its biological end point for permanent fat loss. I have done an
epic 18 month bio-hack on this very topic. I believe what I have found has profound and wide clinical
applications for us all.
Moreover, neither of these men realized the dietary forces that can be used with cold therapy to
produce dramatic results. Cold is not just a fat loss tool. It has several other benefits to human
physiology. I believe the reason for this is because the hypothalamic biology is not well appreciated
by most scientists today. When you sustain this process, steepen and expand the temperature gradient
across a larger surface area, and specifically alter the macronutrient ratios, some amazing things
become possible. I share with you how cold thermogenesis can augment the Epi-paleo Rx reset and
can make a huge difference to those with vagal nerve damage who do not get a large bang from my
standard reset.
If you have a gastric bypass, type 2 diabetes, chronic pain, adrenal fatigue, or poor sleep cold
therapy will likely shock you at how well it helps you. NASA data from the 1970s has shown that
fasted mammals cannot increase glucose turnover rate when cold adapted. They also cannot increase
their muscle glucose uptake when exposed to cold environments because the cold enhances the supply
of fatty acids and ketone bodies to muscles during exercise. I have tested this on myself for the last 18
months to look for all the pitfalls I could muster. Before you begin you must make sure your cardiac
risks are low and talk things over with your doctor and family. Most people will have no trouble doing
this at home.

LET US LEARN THE BEST WAY TO COLD ADAPT FOR THE EPI-PALEO RX RESET NOW
When I began this I did a lot or reading on training of NASA astronaut, Special Ops and Navy
Seal. You first must choose what environment to which you want to cold adapt. Cold water immersion
dictates a more rapid drop in surface and core temperature than exposure to cold air. So most people
will choose to use water because it works a lot faster. Before you start, always eat a high-fat
(MCT>saturated fats>MUFAs>PUFAs) and/or protein meal right before you attempt to cold adapt.
Also, drink 16-32 ounces of ice cold water immediately prior to the test no matter what stage you are
at. Why? Your body temperature is incredibly hot at approximately 98.6 degrees Fahrenheit, and ice
water is approximately 40 degrees Fahrenheit. In order to maintain this homeostasis, your body has to
bring that ice water up by about 60 degrees, and, by definition, it takes 1 calorie to raise the
temperature of 1 liter of water by approximately 2 degrees. That means to raise the temperature of 1
liter of ice water by 60 degrees Fahrenheit, your body would burn about 30 calories. Two liters, which
is about eight glasses of water, would burn 60 calories. Do not drink more than 32 oucnes of water
before this test because cold adaptation also affects our thirst centers. You should always consider
drinking cold liquids as part of your dietary plan as it can increase your metabolic rate by 30-40%. If
you get a lot of brain freezes when you drink cold things this might signal you suffer from a high
tissue omega six level. You need to proceed with caution while trying to apply cold thermogenesis.
You will see why your omega 6 level matters soon.
I usually will do my training in the morning at sunrise or at night after dinner. I do not
recommend trying this on an empty stomach. In the beginning of my adaptation I also used bitter
melon extract to cold adapt. Bitter melon appears to be quite effective at creating BAT from WAT,
especially in those with type 2 diabetes or metabolic syndrome. No one knows why it really works but
I believe it is has to do with the loss of adiponectin and leptin from fat cells with the simultaneous
induction of Irisin from the cold stimulus on the skin and subcutaneous fat.

Step 1
Cold adaptation occurs 100 times faster using metal over air. But this is far too dangerous to use
at home, so never try it. Water is 24 times more effective than just cold air. You need a simple skin
thermometer, ice, a bathroom sink and a watch with a timer. How does one cool the skin but not the
core? Simply monitor your skin temperature as it goes from its normal temperature in your house
until it gets to 50-55 degrees Fahrenheit while in your cold environment on your skin surface and
maintain it there. Go no lower. When you get there, watch your skin color when it begins to get to pink
or white as its going south of 50-55 degrees. End the session then. In the beginning your sessions will
end faster than later because you’re cold adapting.
The easiest way to cold adapt is to first place just your face first in ice cold water. You must not
use any makeup or facial products. Just submerge your face into water in a sink or bowl of water with
ice. Wait until the water is between 50-55 degrees and enter face first and see how long you can
tolerate it using a time piece. Record the time. For the next two weeks work your way up increasing
the time your face is submerged until you need to take a breath. The rate of adaptation to this will vary
for people. When you finish this proceed to number two.

Step 2
Buy a compression shirt that is quite tight and begin to place 20 or 40 pounds of ice on your
torso. Double bag the ice to stop leakage on clothing or furniture. Compression shirts collapses the
surface capillaries and allows your skin temps to fall faster, quickly sensitizing you to cold. Initially
this will be tough but you will adapt to it in time. Try to extend your time 5 minutes each session until
you get to 60 minutes. You will notice your skin is pink to cherry read and numb in places. When you
get to 60 minutes then take the compression shirt off for further testing. Place the direct plastic ice
bags on your skin now and repeat the skin cooling. If you develop cold urticaria (hives or welts) at this
time, this is a sign you have high levels of tissue and serum omega-6 content. Stop the experiment and
follow a ketogenic Paleolithic diet until you have a blood omega 6 to 3 ratio that is below 10 to 1. You
can also test your serum for this ratio. If you do not develop cold urticaria proceed on to see how long
you can tolerate the cold. Make sure you have no metal on your torso, ears or nose when you do this.
Record your times. Pay attention to your skin color. After 10 minutes you will notice numbness and
tingling on these cold areas. As you increase your times increase you may notice numbness in areas
adjacent to the iced areas. This usually occurs with longer exposures and with more surface area
covered. The length of time you expose yourself should be matched to your BMI. The fatter you are
the longer your exposure should be. You want your skin to always remain pink to cherry red when you
are doing this. If it gets white you need to stop the test and take a warm shower. Do these things
indoors initially where you can control the air temperature during adaptation. Do not start this outside
until you cold adapt for at least a month. When you can tolerate the skin being covered for one hour
with pink to cherry red skin you’re now ready for the Cold Tub step.

Step 3
Once you complete Step 2, you can try cold showers to ready your body for immersion, but I did
not use this much when I was training my brain to rewire. I went straight to the bathtub and filled it
with cold tap water. With immersion, the major heat exchange in water occurs by means of conduction
with the surrounding water. The exceptions to this are the non-immersed body parts, in most cases the
head. The head can represent a significant site of heat loss to the environment owing to its minimal
insulation (small fat layers) and lack of vasoconstriction in the scalp.
I then add 20 pounds of ice to my chest and abdomen region while my body is in the tub. Initially
I kept my socks and gloves on my extremities and I wore a knitted cap. This was to combat the
vasoconstriction that normally occurs in the extremities. The hat was to keep in heat from the veins of
the scalp to allow for an adaptation to immersion. This step will take you some time to get used too.
You lose 20-40 percent more heat from cerebral blood shunting when you cool adapt. After I was
adapted to 20 pounds of ice (about 5-7 days) then I removed socks, gloves and head cap. If you get
lightheaded this means you’re not ready for the tub. Abort the tub and go back to dunking your face in
the cold water. If you can handle the 20 pounds of ice you can increase it 10 pounds of ice at a time to
cover more of your body with icy water. If you have access to skin thermometers (I did) that an
anesthesiologist would normally use during a surgery, you are looking to get your skin surface temp to
50-55 degrees. A patient told me we can buy them online. We are trying to use the peripheral nervous
system’s cold receptors in the skin to tell the brain something has radically changed in our current
environment. After you can get past 45 minutes of this you will notice your tolerance to cold
dramatically changes in water, air, and in ice. You will be able to wear less clothing and go outside
and not be cold. In fact you may notice your temperature rises in anticipation of the cold tub. I do this
now all the time. You will be able to drive on the highway with the windows down in the dead of the
winter and feel amazing. Your significant other will notice you seem to radiate heat at rest when you
lay down to sleep. The longer you tolerate this situation, the better adaptations you will get. The extent
of the training depends upon your goal.

Step 4
At 45 minutes you can choose to stop and then plan on doing this 2-5 times a week depending
upon your starting weight, body fat percent, and goals. You also need to be cognizant of where you
want to lose the fat on your body. If you have it in your belly, butt, and legs continue using the indoor
tub or an outdoor lake or pool. Immersion is the best way to shed body fat and regain leptin
sensitivity. Once you can accomplish this in your house for one month you can than move to the
outdoors if you like. If you have a pool, lake or hot tub you can set its temp lower to replace the ice
use. I tend to use the lake or my hot tub, but I use them differently. When I want a quick training to
maintain my adaptation I just jump into the lake for a 10-20 minutes from my neck down. I pay
attention to my skin color as I do this. The hardest part is emerging from the lake and walking back to
the house and not being in the water. It is easier now for me but in the beginning it was tough. Most of
the time I use my hot tub to train. I get in it and I cold adapt my upper body with ice bags on my torso
while my bottom half is submerged in the water. I alter the water temps to higher than my torso
because I have very little fat on this part of lower parts of my body today. So often I will sit in warmer
water while my upper half is completely exposed to the elements with ice on my chest and abdomen.
It is very effective at lowering your surface temperatures to 50-55 degrees in 2-3 minutes. This
augments thermogenesis naturally using convection currents of different temperatures. I can do this
for amazing lengths of time now after 18 months of training.
Do not try to bite off more than you can chew. Heat spontaneously tends to flows from a body at
a higher temperature to a body at a lower temperature. So a warmer lower body and a 50 degree skin
temp on the torso create a dynamic that makes using cold thermogenesis really easy daily. Anyone
who as soaked in a volcanic geothermal spring can tell you they hardly notice the cold on their
exposed. This method is really effective at increasing thermogenesis in the exposed areas for fat loss.
If you have a lot of belly fat this is not your best method, but it will still work. If you have torso, back,
facial, neck fat (sleep apnea) this works like a charm quickly.

Step 5
You burn a lot more calories when it’s cold outside so you MUST get outside in cold and try not
to wear a ton of clothing as you adapt. In the beginning, most wear a ton of clothing when they go
outside in cold weather. That slows adaptation to cold. According to Andrew J. Young, Ph.D., of the
U.S. Army Research Institute of Environmental Medicine in Natick, Mass., “There are two factors that
could cause energy expenditure to increase with falling outdoor temperature. First, if shivering is
elicited by cold, then energy expenditure increases. However, different people have differing
shivering-response sensitivity, and intensity of shivering will be influenced by magnitude of decrease
in body (deep core and skin) temperature, which in turn is influenced by body size and fat content that
vary widely among people, as well as clothing worn. So some folks don’t shiver at all (too warmly
dressed, excessive body fat, leptin resistance), and a man in the cold is not always a cold man. The
more leptin resistance one is the more you should consider a steeper slope of adaptation to lose fat.
The other reason energy expenditure might increase in cold weather is if you perform heavy
physical labor like weight lifting or walking in deep snow. Additionally, there is a likelihood that you
could have a slight increase in calorie burn (about 3 to 7 percent) from your body re-warming itself
from cold air touching your skin and warming the cold air that goes into your lungs. This is also why
when I emerge from my cold tub, lake or ice baths I will remain outside in the buff for several
minutes to really heighten the cold stimulus. I immediately go inside to a warm terrycloth robe, which
captures my thermal loss and increases caloric burn for about an hour after the cooling. This is a great
time to work out as well. You will also notice your ability to lift and workout increases by 5-10
percent. Recovery is simply stunning. You won’t believe what a cold tub does after a serious high
intensity work out. Your recovery will amaze you and you sleep will be shockingly solid. Nothing is
better to induce sleep in my view than cold thermogenesis induction.
The beauty of this adaptation is that is does not require any change to your core temps. When you
begin to mess with your core temps you can get into trouble with frostbite and freezing injury. The
higher your omega-6 content the worse cold adapted you will be. The higher your omega-3 content the
better you will adapt to cold. The higher protein/fat intake you have the slower you will adapt to cold.
The more carbs your have in your diet (leptin resistance) the easier you will find it to adapt to cold. If
you have a history of smoking, dipping, cigar use you will not cold adapt well. If you are dehydrated
(booze/wine) you will not cold adapt fast either.

Step 6
If you use just air to adapt to cold thermogenesis it will take a lot longer but there is one thing I
should mention. Slowly remove clothing as you proceed over time. As you remove clothing there is a
specific way you should pick the clothes to remove. You want to expose your face and head to cold as
soon as possible. Remember, when in number one we begin cold water adaptation to our face. This is
because all mammals have a reflex called a dive reflex that is built in because we all were formed in a
fluid filled placenta. When we expose ourselves to cold on our face first we stimulate slowing of our
heart rate. This is soon followed by vasoconstriction of blood flow in our extremities. When we
continue to dive deep we force blood and water to pass through our organs and endothelium to fill our
air filled cavities like our chest. This has been experimentally shown in humans during deep water
cold dives. We actually drown in pulmonary fluids but can still survive! As a physician, I see this
problem daily in our ICUs in patients with ARDS. Sadly, we do not treat them as I think we should
given what we know about the mammalian dive reflex, but that is another story. Do not worry I do not
plan to use this adaptation in my reset in the near future! I’d love to try it but I hear it takes years to
perfect.
When you first begin cold training with clothing on, the way you disrobe when you re-enter a
warm environment also matters for the adaptation to become more comfortable and less agonizing. So
first expose your face, then your head to the warm environment. Then expose your extremities to re
establish the blood flow and lastly your torso and abdomen. This progression of re-exposure to the
warm environment from the cold will make it more bearable as time progresses. If you remove
clothing in a different layered fashion you can abruptly increase cortisol release to cause a vascular
instability. This instability is felt to be behind a thermal dump that underpins vascular reperfusion
injuries seen in frostbite and hypothermia injuries. If you are not overheated by heavy clothing or your
warming environment, the cold (when other symptoms are warm) will trigger non-shivering
thermogenesis to be induced and you will continue to burn calories as free heat for many hours after
the cold exposure. This is why people who are in cold environments tend to be quite thin when they
are eating a non-Western diet. You will also notice a change in your hunger and appetite, because they
will decline. This addition is also quite beneficial to those with binge eating disorders too.
I believe that cold thermogenesis is an evolutionary forerunner for all mammalian physiology
before exercise was evolved or naturally selected for in mammals. This is a controversial point but I
think based upon what we know to be true today it’s not a fringe theory. The available food sources
also helped simultaneously sculpt evolutionary pressures that were naturally selected for in a cold
environment. I believe natural exercise was selected for by movements to warmer environments,
longer light cycles, and more abundant carbohydrates in the environment. Mammals did not first
evolve predominately in warm environments. Humans certainly might have evolved this way...but we
are descended from these eutherian mammals and their epigenetic programs remain buried within us
but are just not selected for these days. When we induce the programs, what this may mean for us
today is among the most exciting things in biology I have come across in 30 years. It appears cold
thermogenesis not only opens a novel metabolic pathway in modern mammals and humans but it also
activates our longevity genes. Many of the things aging researchers and scientist currently hold to as
core beliefs may in fact not be true. The ability to test these theories is now here because of how we
are unfolding the story of our own biology using a piece-by-piece approach that the QUILT provides.
Consider this: A 26.2 mile marathon burns 2,600 calories. My three-hour training session I did
this morning burned 3,800 calories. The cold effect on weight loss is great, but what excites me more
is which form of exercise do you think might cause more harm in the long run? One thought might
just alter your DNA!

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