Who should avoid cold water? Essential precautions for health and safety

September 29, 2025 •

4 min read

According to the National Weather Service, sudden immersion into cold water can cause a cold shock response, a major risk factor for accidents. Knowing who should avoid cold water is crucial to protect against potentially serious health complications, from cardiovascular stress to hypothermia, especially for individuals with pre-existing conditions.

Quick Summary

Individuals with pre-existing health conditions such as heart disease, high blood pressure, diabetes, and certain circulatory issues should avoid cold water immersion, as it can trigger dangerous physiological responses like a sudden increase in heart rate and blood pressure, or cold shock, and also carries risks for the elderly and young children due to weaker immune systems and poor temperature regulation.

Key Points

Cardiovascular Disease: Individuals with heart disease, arrhythmias, or high blood pressure should avoid cold water due to the risk of dangerous spikes in heart rate and blood pressure from cold shock.
Circulatory and Nerve Issues: Conditions like diabetes, Raynaud's phenomenon, and neuropathy make cold water risky due to poor circulation, impaired sensation, and pain.
Respiratory Problems: People with asthma or a recent respiratory infection should be cautious, as cold water can trigger breathing difficulties or worsen congestion.
Specific Demographics: The elderly and young children are more susceptible to rapid heat loss and hypothermia and should generally avoid cold immersion.
Hypersensitivity: A cold-induced allergy (urticaria) makes cold water immersion unsafe, with risks ranging from hives to severe systemic reactions.
Always Consult a Doctor: Anyone with pre-existing medical conditions should speak with a healthcare provider before attempting cold water therapy to assess individual risks.
Do Not Combine with Intoxicants: Never attempt cold immersion while under the influence of alcohol or drugs, as they impair judgment and temperature regulation.

Who is at risk from cold water exposure?

While many people enjoy the invigorating feeling of a cold plunge or shower, for certain individuals, exposure to cold water can be more than just a shock to the system—it can be dangerous. The body’s immediate reaction to cold water immersion, known as cold shock, causes a gasp reflex, rapid breathing, and a significant spike in heart rate and blood pressure. For those with underlying health issues, this sudden stress can have severe consequences.

Cardiovascular concerns

People with cardiovascular conditions represent one of the highest-risk groups for cold water exposure. The cold shock response constricts blood vessels, forcing the heart to work much harder to pump blood. This places considerable strain on an already weakened heart and can lead to dangerous outcomes.

Heart disease and hypertension: Individuals with a history of heart disease, irregular heartbeats (arrhythmias), or high blood pressure should exercise extreme caution. The dramatic spike in blood pressure can increase the risk of a heart attack or stroke.
Peripheral vascular disease: This condition, common in diabetics, causes reduced blood flow to the limbs. Cold water can further constrict these vessels, potentially causing pain and exacerbating the issue.
Pacemakers: Those with pacemakers or other heart rhythm devices should always consult a doctor before considering cold therapy, as the cold shock could interfere with the device's function.

Circulatory and nerve issues

Beyond heart conditions, other issues involving circulation and nerve sensitivity are major contraindications for cold water immersion.

Raynaud's phenomenon: This condition causes blood vessels in the fingers and toes to overreact to cold, leading to numbness, tingling, and pain. Cold plunges can trigger painful and prolonged attacks.
Diabetes and neuropathy: Diabetes can cause nerve damage, or neuropathy, particularly in the extremities. This impairs a person's ability to sense temperature, increasing the risk of cold-related injuries like frostbite without them realizing it. Poor circulation, also common with diabetes, is worsened by cold exposure.
Cold agglutinin disease: This rare autoimmune disorder causes the body's immune system to attack red blood cells in response to cold temperatures, leading to potential tissue damage.

Respiratory illnesses and allergies

For some, cold water's effects on breathing can pose a serious threat, even without existing heart issues.

Asthma: The initial gasp and rapid breathing from cold shock can trigger an asthma attack in susceptible individuals. The sudden, uncontrolled breathing can lead to dizziness or a panic response, making it hard to stay afloat or exit the water safely.
Cold-induced urticaria: This is a physical allergy to cold, where exposure to cold temperatures causes the appearance of hives, itching, swelling, or more severe systemic reactions. In extreme cases, a severe reaction could cause a dangerous drop in blood pressure or fainting.
Recent respiratory infections: Some evidence suggests that cold water can thicken nasal mucus, potentially worsening symptoms for those with a cold or flu.

Special considerations: children, elderly, and other groups

Certain demographics require extra caution around cold water due to weaker immune systems, poorer temperature regulation, or other circumstances.

Children and the elderly: Both young children and the elderly have a higher risk of hypothermia, as their bodies are less efficient at regulating core temperature. A short period in cold water can cause a dangerous drop in body heat.
Pregnancy: The effects of cold immersion on pregnancy are not well-studied, but the stress it places on the cardiovascular system and the body's dramatic temperature changes are generally considered inadvisable. Pregnant individuals should avoid cold plunges and always consult their doctor.
Under the influence: Alcohol and drugs significantly impair judgment and the body's ability to regulate temperature, dramatically increasing the risk of cold water-related incidents and hypothermia.
Post-operative patients: Those who have recently had surgery should avoid cold water immersion, as it can cause shock and potentially interfere with the healing process.

Weighing cold water risks vs. rewards

For most healthy individuals, short, managed exposure to cold water can be a safe practice with potential benefits. However, for those with pre-existing conditions, the risks often outweigh the anecdotal rewards. Always prioritize safety and medical advice.


Condition / Group	Primary Cold Water Risk	Cold Plunge Recommendation
Heart Disease	Cardiovascular stress, heart attack	Avoid entirely and consult a doctor.
High Blood Pressure	Rapid spike in blood pressure	Avoid, or use extreme caution after medical consultation.
Diabetes	Poor circulation, neuropathy, frostbite	Avoid due to reduced sensation and circulation issues.
Raynaud's Syndrome	Painful attacks, nerve issues	Avoid, as cold triggers painful episodes.
Asthma	Cold-shock induced breathing difficulties	Use extreme caution, start slowly, or avoid entirely.
Cold-Induced Urticaria	Allergic reaction (hives, swelling)	Avoid all cold exposure to prevent severe allergic response.
Elderly	High risk of hypothermia	Avoid, or use minimal, supervised exposure.
Children	Rapid heat loss, hypothermia risk	Not recommended for young children due to rapid heat loss.

Conclusion

While trends in cold water therapy, such as ice baths and plunges, have gained popularity for their purported benefits, the practice is not suitable for everyone. The potential for serious health risks, particularly related to cardiovascular, circulatory, and respiratory systems, requires individuals to be informed and cautious. The physiological stress of cold shock can be dangerous for those with underlying conditions. For anyone considering cold water immersion, especially if you fall into any of the high-risk groups discussed, consulting a healthcare professional is not only a good idea but a critical safety measure. Understanding your personal health profile is the most important step before diving in. A trusted medical resource, like the American Heart Association, can provide further guidance on cardiovascular health and cold exposure..

Frequently Asked Questions

The cold shock response is the body's involuntary reaction to sudden immersion in cold water. It causes a rapid gasp reflex, hyperventilation, and a spike in heart rate and blood pressure, which can be dangerous for those with heart conditions.

Cold water immersion causes blood vessels to constrict, putting extra stress on the heart to pump blood. For someone with heart disease, high blood pressure, or a history of arrhythmias, this extra strain can increase the risk of a heart attack or stroke.

It is not recommended for individuals with diabetes, especially if they have nerve damage (neuropathy) or poor circulation. Neuropathy can prevent them from accurately sensing temperature, and poor circulation is worsened by the cold, increasing the risk of injury.

Yes, some people have a condition called cold-induced urticaria, which is an allergy to cold exposure. Contact with cold water can trigger a reaction that causes hives, itching, or even more severe and potentially life-threatening systemic reactions.

Both young children and older adults have less effective thermoregulation and are more prone to rapid heat loss. This makes them more susceptible to hypothermia, even after relatively short periods of cold water exposure.

The initial cold shock and rapid breathing upon entering cold water can trigger an asthma attack. This is particularly dangerous in the water, as it can cause panic and make it difficult to breathe or swim.

Yes, it is generally advised that pregnant women avoid cold plunges. The physiological stress on the body from sudden temperature changes and increased heart rate is not well understood for pregnancy and is best avoided.

Drinking cold water may thicken nasal mucus, potentially worsening congestion. While hydration is key when sick, extreme cold therapy might not be advisable and could place unnecessary stress on a body that is already fighting an infection.