How Cold Water Treats Anxiety, Depression and Chronic Pain – Mark Harper, M.D., Ph.D. : 956

You're listening to the Human Upgrade with Dave Asprey. Formerly Bulletproof Radio. You're listening to the Human Upgrade with Dave Asprey. Today we're going to talk about cold water. Not about whether you should drink cold water, but actually what happens when you swim in cold water. What happens when you soak yourself in in cold water. And of course, our friend Wim Hof has been on the show. He's graced the stage of my biohacking conference and he's always fun to hang out with, so he's made some waves in the scientific community, but still, it's kind of fringy. But I think it's changing now and I think it's appropriate to give Wim some credit for saying, here's my lipopolysaccharide levels and I can withstand things other people can't and it's the cold water. But now there's a lot more science coming out on that. So I found a guest for you who knows exactly what's going on with some medical knowledge. And what you're going to learn in the episode is how you can use cold water on things like depression, anxiety, ptsd, arthritis, migraines and how to have your own cold water practice. And that can even cause stem cells to work better, better immunity. And I'm also going to have a little bit of SC skepticism and I'm going to display strategic laziness by saying, seriously, I don't want to do that, so just wait till I troll our guest today. And speaking of our guest today, he's from Brighton in the uk. I'm not sure exactly how to say that with the right Brighton accent, but he's going to teach us. That's basically in England, where they look out at France and make rude gestures, depending on what decade you're in. He's an MD and a PhD and. And he works halftime in Norway and normally he's about keeping people warm because, well, he's a doctor, but now he's making him cold. But not in that way. I just implied. So he has a team at the Extreme Environments Lab at the UK's Portsmouth University and they're doing clinical studies of sea swimming on depression, anxiety. And that's why I wanted to have him on the show. Not to mention his new book, the Cold Water Swim, a transformative guide to renew your body and mind. Mark, welcome. Thank you for coming on the show.

It's a pleasure. I'm so glad you have me on now.

It's kind of amazing you're In Norway and we're just having this casual video chat. It would have been pretty difficult for me to fly to Norway or for you to fly to me here in the dark gray northern parts of Canada. So just technically I'm feeling pretty grateful that we could just have this chill conversation. See what I did there?

Now.

You'Re a medical doctor and suddenly you're getting into cold water swimming. I've always thought it was kind of nuts. I remember when I was getting my mba, a group of friends would wake up in the middle of the night, something like six in the morning or something, and they would go for a cold water swim in San Francisco Bay. And I always thought they were nuts. I never joined them just because it was just it was too early and plus it was cold. But they swore that it was completely changing them. But it was always this hardcore, hardcore, almost like masochistic, like watch what I can do kind of group. Are you one of those guys, you like the I'm gonna see if I can endure, I'm gonna struggle and suffer. And was this your vibe when you started getting into this or was it something else?

Do you know what? It's completely the opposite. I was like you, you know, so, yeah, I've always been a pool swimmer. Yeah, that's, that's my exercise. That's how I get my training, how I keep fit is in the pool. And then one summer, you know, nearly 20 years ago now, I was complaining to an old friend of mine, I said, look, the, the pool shut for a couple of weeks in the, in the, in the middle of summer. It's just pool shut, no training. Yeah, it's a bit boring, isn't it? Said, go and join the sea swimmers. I said, I didn't even realize the club had a great group of sea swimmers. So I said, well, when do they, when do they swim? They said 7 o' clock in the morning. Well, when I said all year. No, really, I didn't even realize the club had a group of sea swimmers. So I said, well, when do they swim? They said 7 o' clock in the morning. Well, when I said all year. No. Really? Yeah. So I was just as shocked as everyone else. But you know, the pool was shut. I wanted my swim, I needed my exercise. I went down and swam around the pier the next day. And as I was walking back up the beach, it's about a mile, probably not even that, you know. So I was walking up the beach and this is the middle of summer, so it's 20 degrees centigrade. What's that 68 Fahrenheit, something like that. Walking up the beach and thinking, this, this feels really good. You know, I just wasn't expecting that. I was just expecting to have a swim. And you know, those two weeks, which is the initial plan, has turned into, as I say, nearly 20 years of doing it myself. But when I go into the water and it's really cold, I'm still, you know, I'm not hard about it at all. Yeah. And this is something I'm really keen to get across about. It is it's not about being hard. Be the dipper. Don't do the thing. I mean, Wim Hof, I mean, yeah, he's incredible, isn't he? But he is. I mean, he's an amazing physiological.

He's batshit crazy. And I've told him that to his face. He's a friend. Like, I love the guy, but like he does stuff because he cares and he has this energetic perspective on cold and how it's his teacher and breath. So he's just not like most people. Right. And that's okay. And what I'm trying to figure out is, is cold water swimming always going to be this unusual group of people who are either really sick or just really, like I'm going to charge forth or is this something, you know, my mom would be doing?

Well, that's really interesting. I think 20 years ago when I started doing it, that's what it was. But certainly in the UK and actually to an extent in Norway, over the last five, 10 years, it's changed and now it is more and more people. And particularly over the pandemic when other forms of excise were closed, the one thing, certainly if you live near cold water, the one thing you could do was get into, get into the cold water and get, get a swim, get a dip. And people tried it, they came out and they felt good and they've kept doing it.

I'm seeing it catch on as well. But it's endorphins, right? I mean, you get in the cold water, you get a bunch of. When you come out especially, you have this huge endorphin rush. And of course, if you're anxious and depressed or even dealing with ptsd, a big wave of endorphins helps enormously. So is there something going on besides, you know, getting a hit? And couldn't I just take a cold shower and be done with it?

Yes and no. So first of all, it's not just endorphins. And I think that's, that's Quite important, the endorphins get in. But it's the main driver of that feeling is your noradrenaline and your adrenaline and that, yeah, that really kicks in. And you know, that's, that's kind of what you get from cocaine. That is what you get from cocaine, you know, causes release these things. But when you do it, you put your body in the water, your body's releasing it naturally, it's got natural ways of controlling it. And so it's, it doesn't have the negative effects, I suppose. I did a TV program with, with a doctor called the Doctor who Gave Up Drugs, Chris Van Tuliken. And yeah, this is where we basically started out on our way of saying, well, actually this really does work for, for depression, anxiety. But that's, that's another story. But anyway, the first time he went in, he, afterwards he came out and he said to me, guy, if this was a drug, they'd make it illegal. But the, but what you say about the shower, yes, you can get it from the shower, however, it's not as effective. The thing is to get the effect or the. So getting to cold water is a stress and it's all about the benefits of. You feel good because you get this release of all these chemicals, but you also adapt to cold water. But getting into cold water, there are two factors which determine the amount or the extent of this stress. The first is how cold the water is, and the second is how quickly you get cold. And so if the water, the water coming out of the shower is probably 58, 70 degrees, maybe something like that, 68, 70 degrees. And that's not as cold as most cold water that you like to swim in, certainly in Canada, certainly in the uk. So you get your maximum physiological effect, although you get maximum vasoconstriction. I mean, that's one of the main things. So all your blood vessels to your skin shut down. That's one of the ways you react to the cold. And with cold water, you react, you get that at 68 degrees Fahrenheit. So it's not that cold. I mean, you get more of an effect lower down. But you're getting a significant physiological effect at 68 degrees Fahrenheit. So most places can deliver that, but it's not going to be as effective as getting into something colder. And yeah, of course, we have a shower. You're not hit all at once. You get. It's not as if you're totally immersed, you're just getting splashes, as it were.

So how much better is swimming in cold water outdoors for you versus either a really cold shower or just standing in really cold air for three minutes.

Well, the cryo chamber probably works quite well, but that has to be a lot, lot colder because air doesn't contain air, has such a low, what we call thermal heat capacity. And, you know, so that has an effect. And, you know. Yeah, if you've got a cryo chamber, I think you probably get the same effect in terms of the cold, the. With a shower, you can get an effect. You know, there was one study which showed that people who took cold showers, as opposed to those who didn't, spent less days sick off work. Yeah. So you do get an effect. You get an effect if you wear a wetsuit when you go into the cold water. But for me, the cold water isn't just about the cold water. I mean, that has a massive effect and that's a really important part of it. But it's the whole package. You get, you know, most people, I mean, I always recommend you swim with someone else, and a lot of people I know swim in groups, including myself. You have a laugh. So you're being in groups, you're reducing social isolation. We know that.

Really important factor, community and connection to others is a massive reason to do it. If, you know, you have an organized event, but that's going to be once a week usually. Or are you at a place where you do it every morning?

Well, yes, in Brighton, they do do it every morning. There are a lot of people who do it every morning and. But saying that, I think the frequency at which you do it probably once a week, is enough to really reap the majority of the benefit. You get a bit of a boost if you do it every day, but if you're doing it once a week, you're probably getting as much as you really need.

The studies that I've found showed that in mice that after three days of cold exposure, there was a shift in the fatty acid composition of cardiolipin inside the mitochondrial membrane. And it's funny because when people start doing cold showers, which is worth doing before you do your first cold outdoor swim, at least I think the first day, no one can do a minute of cold shower if they hit them right in the face, because you get a headache from it. But the second day, you might go 10 seconds, 20 seconds the first day, second day, 40 seconds, third day a minute, and you're still swearing the whole time and you hate your life. And then the fourth day when you finish, you're like, that wasn't so bad. I'm actually relaxed, I feel great. And that three day period matched what I'm guessing is just all mammalian mitochondrial behavior, where suddenly your cells shifted to be able to make more heat more quickly.

Yeah, There are two ways looking at this, there were two approaches to beginning to research cold water as a therapy. And I could have taken the route where you look at these really interesting and important things like cardiolipins and you say, well, that's how it has an effect. Maybe that's, you know, we could do it through this and that's three minutes and you know, or you can take it from the other end and say, look, I suspect this works, I feel good, I'm not depressed. And we know it reduces inflammation and we know inflammation is associated with depression, so let's see if it works. And then as time goes on, we can start really digging down into these. Yeah, fascinating aspects of how it works. I think I got the idea for this eight, ten years ago now and the problem has been getting funding for it because it's exactly what you say. It's not a randomized controlled trial. There's no drug company out there going to make millions from it. People, the uk, certainly the funding bodies there, the government, they want to encourage you to work with industry. They have no real interest in finding something that's pretty much free as long as you've got access. I think maybe it's easier to get access in the UK where we're surrounded by water, but, you know, and that's been a big problem actually. But yes, it's biohacking, it's stress response, hacking. That's what I'm doing.

What you're doing is you're saying, well, it's probably not going to hurt you. And so let's see if it works. And if it does, you got the results you wanted and we can dive deeper into mechanisms later if we want to. If not, we can just do what works, as long as we're not seeing evidence of harm. That's kind of how a lot of sick people get well, when you get this vasoconstriction in the skin, whether it's a cold shower or a cold water swim, probably more in a cold water swim because of water pressure on you, it's going to put way more blood into the brain. Right.

Well, I suppose one part of it is the brain is pretty well perfused all the time anyway. But I do think, I think again, yeah, I'm coming back to my biohacking rather than my scientific hack. Yeah, my PhD, that's, that's on stopping people getting cold, as you say. And that was all proper studies, as it were. But here I'm, I'm straying into the biohacking, as you're saying. And I mean, I don't know what goes on in the brain. I mean, for me, the best, you know, there is. Yeah, I can, I can talk about, you know, the cortisol, the serotonin, the dopamine, the noradrenaline and so on. But for me, the best again, going back to the. What happens? What do you feel? What do you experience? The best description comes from Jill Bolt Taylor. Have you come across her?

Absolutely. She's been on the show.

Oh, fantastic. Yeah. So, you know, her experience of having a stroke, knowing she's having a stroke and not caring about it, because that was the left side of her brain, you know, all that stuff, which is fear, which is time, which is the future, which is all that kind of stuff that was just bounced out and she just came totally into her body and she was at one with nature and full of empathy and things like that. Yes, this is the feeling I get. You know, here in Norway I have a 10 mile cycle to work, 500 meters before I get to work. There's a lake. I get there, my head's all, all sort of going round and round. I've got all that chatter going on. You know, I'm hot, I'm sweaty, get into the water. When I come out, you know, I'm a different person. It's like, oh, isn't, isn't the world amazing? Isn't this just a great place? Oh, I feel so good. I feel so calm. And her description, obviously on a completely different level to mine, but it really reflects my experience and here we're talking experience rather than details of circulation and oxygen and whatever. And I don't know whether it's because it's taking your concentration away from your brain, you know, away from your mind and into your body. I mean, I think that's, that's really something, that's how it feels.

Why is sticking your face in cold water so much worse than even sticking your balls in cold water?

Well, I think there are a couple of things about putting your face in which are worth bringing out here. The first is your face has so many nerve endings in it.

Why is sticking your face in cold water so much worse than even sticking your balls in cold water?

Well, I think there are a couple of things about putting your face in which are worth, worth bringing out. Here, the first is your face has so many nerve endings in it. Your face and your hands, they are the ones, they have so many nerve endings, you really have to use those. It's your interface with the world. So evolution has left us with a lot of nerve endings in that we want to protect our face, we want to protect our head, our brains, things like this. So you know, we're really sensitive to our faces. And the other thing is that so you put your body into cold water and it gives you a sympathetic stress response. But when you put your face into water it actually stimulates the parasympathetic nervous system and so your rest, digest, chill out and anti inflammatory response comes from putting your face into the nervous, into the water. So I think that's part of the reason why you have a kind of different effect from putting your face in. And that's it. And if you actually go swimming in a hole, if you just put your face in and you've got a high vagal tone, I mean you're super high on vagal tone. Yeah, it's over the top. But the thing is if you get into water that sets off the sympathetic response. And so if you put your face into water afterwards, it more balances it out. And the other thing that the benefit from putting your body into water is more about the adaptation to cold, the adaptation to stress, whereas, and that reduces your, your inflammation and your, your inflammatory levels. Whereas putting your face into cold water, that actually has a direct effect on reducing it. So you have a long term effect from body in cold water. You have an immediate effect from face in cold water.

I did not know that the face activated a different part of the nervous system. That's really important. Do you measure heart rate variability ever when you're doing cold swimming or not doing cold swimming?

Not yet, but it's on our list and it's a study we're doing at the moment because I think that's a really interesting way of starting to dig down into the mechanisms. I think that's a really interesting way to approach it. So I'll have to tell you the results in a year or two's time. But that's. Yeah, I think it's a really interesting.

It's intriguing because we do cryo at Upgrade Labs at some of our locations. By the way, guys own and upgrade labs.com if you're interested in being a franchisee. But cryo is optional for that. We do see in general members HRV goes up and we're doing all the data analysis from Huge amounts of data to tease out if someone does three of our interventions, which ones are the ones contributing to an increase or decrease in hrv. And we're getting HRV from whatever wearables they have. So it's almost like you, instead of doing a proper study, you could just tell everyone, hey, do you have a whoop or an aura or a Fitbit or whatever? You know, give us your data. Give us your data. When you go cold swimming and see what happens, it could be interesting.

It's really interesting. I'd love to. I'd love to see that. See that data part. I've been in contact. The guy who's driving this bit of research is an expert in heart rate variability.

Okay. So you're going to be looking at it.

He says that with these. He says. But yeah, he's a heart rate variability nerd. So he says that the whoop and the things like that don't give you accurate enough information. Yeah, their response rate isn't quite quick enough, but it would be fascinating to see. I'm not convinced by this. Yeah, I think you probably could see broad changes. So I'd be fascinated to see if you do notice differences with your methods.

One of our Upgrade Collective members here, Ski, did track his HRV with a polar strap and says, before, during and after a cold plunge, which isn't swimming, but it's at least a plunge, his HRV goes up, but if he does a sauna, it goes down. What about saunas? I mean, should we be doing what the Norwegians, given that you're in Norway, do they hop in the sauna, then go roll in the snow or d in the frozen lake and then go back in the sauna? Do you play around with that? Do you have whole communities of people?

Only for pleasure, not for science? I would say so, yes. So there are a couple of things. One thing is quite interesting is. So I went to this conference on thermoregulation or the scientific conference, and what I was fascinated about, coming from the cold side of things, is that a lot of what you see from our end is mimicked from the hot side of things. So it's thermal stress. And thermal stress can be cold thermal stress and thermal stress be hot thermal stress. So it does seem that you can have the same effect from a sauna. But what they were doing, what they had to do, is actually raise your internal temperature quite high, you know, so you're actually becoming hyperthermic and the. So I think that's. Whereas we get into the cold, I think One of the important things is you don't become hypothermic. You stay in long enough, you know, exposing yourself to the cold is stressful and that's good. And this is, this is how we're hacking our stress system is by getting used to that stress. Whereas actually becoming hypothermic is always bad for you. And this is why I come from. My PhD is all about stopping people getting cold during surgery. Because when you actually become hypothermic, you lose your thermoregulation, you become hypothermic, you have more complications. But the other aspect of saunas is, of course, getting in and out. Is it safe to get in and out? And yes, it is, and it's just a fantastic way. I've got a friend, a friend who lives a few miles away. She has a lake at the bottom of her garden. She has a sauna. Last year, lake totally frozen over. Dad comes out with the chainsaw, cuts a hole in the lake and there we are, warm up first and then go in the thing and then go into the water. And it's, it's so much better than if you, it feels so much better than if you go in cold. And the reason for this is, you know, your core is really protected. Yeah. You vasoconstrict, you shut down all the stuff to the skin or the blood supply to the skin. When you get in cold water, your body naturally does it and then your fascia, your fat or your muscles, they act as a kind of storage heater. And if that storage heater is cold, you've got no spare. You can't stay in that water very long, you're going to become hypothermic very quickly. But if that storage heater is heated right through, you've been in a sauna, then you've got more time. And it actually does feel better. I find it feels so much better if I go into the water warm.

It seems a lot easier to do a cold swim if you just got out of a sauna, that's for sure. Just like if you're living somewhere where the indoor heating is always set to some ridiculous temperature. All winter long you go outside without a jacket on you kind of, but it's because you're already too hot.

Yeah. Do you know what? Sweden has the highest temperature internal temperatures in the world. They keep their houses, their thermostats are set the highest in the world.

No kidding. I wonder why they do that. It's also the highest amount of coffee consumption per capita. It's an odd and cool country, but those words do not apply to Saab automobiles. Those were definitely not cool. Have to say sorry.

Yeah.

Now, you talk a lot in your book about community. And I know in certain parts of the world, like Norway, all of Scandinavia, parts of Russia, you know, the sauna is a thing you do and it's a community thing. It's co ed, it's naked and all. Talk to me about you're riding your bike to work. What, do you just strip naked? Are you wearing a Speedo underneath this? Like, how do you handle the dressing, undressing community? Is this usually a bunch of dudes? Is this co ed? Like, walk me through the cultural dynamics of cold water swimming and how it works in real life, because I'm. I'm confused.

Well, I think there are a lot of different cultural dynamics is what it comes down to. So I cycle to work, I work in Norway, I cycle there, I. I swim on my own, basically. But whereas when I'm in the uk, we've got, we've got the swimming club and it's got a little, it's an arch, so it's got a kind of shed under the, under the road, as it were, where we go. And lots of people, they've got 100 members. I mean. Yeah, usually, usually 20, 30 people there every morning from 7:00'. Clock. Well, actually from 6:30 in the morning, they're 20, 30 people. We got somewhere warm and out of the wind to change and that makes a massive difference. During lockdown, we weren't allowed to use the changing rooms. It was like super cold. And then you. Yeah, so you go into the sea, there's always someone to swim with. You go into the sea, you splash around. Yeah, we get a lot of waves certainly in the winter. Yeah, some days it's swimming days and other days it's waves days. You just play around like kids in the waves and then you go back in, you have a. Have a shower, get dressed. Yeah, go on, have coffee together.

And afterwards, do you take a warm shower or do you just drink the coffee to get warm?

So the best way to get warm either before or after cold exposure is from the inside out. So getting cold from the outside, warming up from the outside in. Yeah, just doesn't quite work. If you do that before a swim, you actually cool down quicker, whereas. And by this I mean using exercise. So that's the best way to do it. And if you go into the shower, I mean, it's not about having a hot shower. I wouldn't recommend A hot shower but a lukewarm shower, that's what I really like. And particularly if it's been super cold. My hands, I can hardly move my hands. Just keeping your hands warm. Getting a bit of that. But lukewarm. And I don't stand for very long. And then I carry on cycling and occasionally I have to drive down, drive for my swim and it's just not as good. I really noticed the difference. I haven't used that exercise. I haven't got my body moving before I've got into the water.

Okay, that makes sense. I asked Wim Hof the same thing, I think last time he was on the show, and he said it's okay to finish warm, but it's better to finish cold. And most people say finishing cold is the right way to do it. And of course you want to rinse salt water off your skin and things like that. And it seems like you could even burst some capillaries if you take a really hot shower after getting out of really cold water. Right. Because the blood vessels are going to be asked to do unnatural things. If you're taking a really hot shower, it wouldn't even feel good, right?

Yeah, no, totally. I mean, I think this is the problem. There's a lot of speculation out there that you go under a hot shower, you faint because you suddenly vase the light. You actually vase the light very slowly. But the problem is because you vasodilate very slowly after that swim, after that kind of cold exposure, the blood isn't moving that heat away from you. So a temperature of a shower that would normally be fine for you actually, you can damage the skin. You can actually cause a scald by having that kind of hot water. So it's the. Yeah, I work on the principle. It's the lowest temperature that feels comfortable. I hate a cold shower. I'm perfectly happy getting to cold water. I hate a cold shower.

Interesting. I notice too. Well, I guess if you're in the ocean, you have enough currents, but if you're doing an ice bath, which a lot of people do, the water's not moving around. So you sit there and you actually build a little buffer of warm water that you heated up around you. But if you have like a chilled cold tub with circulating water the way I do, it's constantly moving across your body. It actually cools you much more quickly than just sitting in a static ice bath. So I believe with almost every biohack that's out there, whether we're talking light therapy, electrical stimulation, cold water, we are going to figure out the rate, duration and timing of application that causes specific physiological changes. So there's probably some special treatment where you hot cold, hot cold three times and then you do the hokey pokey and you become enlightened? I have no idea. But there's nuances I would say that none of us knows yet that we'll tease out. But what I wanted to ask you about was about some of the specific things you mentioned in the book about say, chronic pain. A lot of people have chronic pain. I had it for much of my life. I just thought you were supposed to hurt all the time, especially my upper back and my joints. It was. I was diagnosed with arthritis when I was 14 and I don't have chronic pain anymore. I also do cold therapy and many other things. What have you seen with chronic pain and cold exposure? Your phone screen is aging your skin and wrecking your sleep at the same time. Artificial blue light goes from your phone screen straight into your eyes and deep into your skin. That light messes with your melatonin levels, interrupts your deep sleep and speeds up skin aging by breaking down collagen. The Bodyguard's Red light converter fixes this at the source. It's a first of its kind screen protector with real tech that converts blue light into beneficial red light before it hits your face. It turns your scrolling into a skincare routine. It supports healthier skin, reduced eye strain, improved sleep quality and and fewer screen related headaches. Third party testing showed a 50% plus increase in red light exposure within the optimal range of 620-770nm and this comes with zero compromise on your screen. The red light converter preserves your screen's true colors and full touch sensitivity. Beyond its wellness benefits, the Red light converter provides ultra thin edge to edge protection for your device and bodyguard stands by their quality. Enjoy peace of mind with lifetime replacements, ensuring your red light converter continues to protect and support your biology for the long haul. Visit bodyguards.com and use code Dave for 25% off. That's bodyguards with a Z.com for 25% off. You're listening to the Human Upgrade with Dave Asprey. What have you seen with chronic pain and cold exposure?

Well, I think it's really interesting. So there are a couple of really good examples from the book. Yes, there's David who I've sold with is in his 70s and he's had crippling arthritis. I mean literally crippling arthritis. And yeah, he gets himself out of the bed in the morning. He Comes down, he has to walk maybe a mile down to the beach, gets in the water on his crutches and gets into the water. And he says that means that he doesn't need to take his opioids until midday. And this is a guy who really doesn't want to take opioids. And he's tried going cold turkey and he just can't do it. He's a, he's an amazing guy. But I think also particularly interesting was one of the guys we had down joined our courses. So we ran these courses as part of a clinical trial. When we run them generally it's just as therapy now, but as part of a clinical trial we ran these courses for depression and anxiety. So we got people who are clinically diagnosed with one or other or both of them and got them to do an eight week course of sea swimming. It's about 30 minutes, totally, probably 15 and 30 minutes in the water. Not especially cold, somewhere between I probably 50 and 68 degrees centigrade Fahrenheit. And you know, and it was all about depression, anxiety. And Grant, you know, has suffered from chronic pain. You know, he's a really, was a really fit guy, semi professional cyclist, surfer, but kept on having blowing discs and in his back and has so much pain. And he came along because he was depressed. He said, look, I feel really, it's a really lonely place was one of his things about it. Yeah. And he was about to get referred on to the chronic pain clinic and he was hating this and, you know, and thinking about antidepressants and all that kind of stuff. And he came along, he saw a thing on the BBC, said, right, I'm gonna try that. And he went along for his depression. But he noticed coincidentally that his pain got better and he has not needed that referral to the chronic pain clinic. As a consequence, he's got this pool, so he swims in the sea. But he's also found this pool up in the things he says the chill pool. That's my tramadol.

There's some amount of toughness that's important and especially for men, but for some women as well, there's sort of the walk it off mindset, like it's just a flesh wound to go back to Monty Python. And well, that kind of works, but that's not what you're talking about here. It's that teaching the body. It's not going to die from being cold for a little while because it feels like you're going to die at first. And somehow it feels like when you show the body just chill a little bit, like you don't have to be stressed over this, that it may have a more systemic effect. I know that it helps with sleep to do stuff like that, but there's something else going on. Is it neurological or is it psychological? What would you say?

I, I think it's a whole, it's a whole package. I mean, I, I think, yeah, you, I think I've heard you talk before about the poly pill and the poly exercise and stuff like this. And that's what you're getting with it. So it is. So on one point, you've got a. Definitely a psychological thing going on. You know, you build resilience by just getting into that water. I mean, Sarah, who's, you know, the first patient we took in ever to cold water to test our theory, she, afterwards, after her first proper swim, she said, God, that's the hardest thing I've ever done. She was so proud of it. You know, she felt so good from it. But the other thing is it also has a physiological effect because getting into cold water regularly means that your body kind of downgrades its stress response, downgrades its stress level. So stress is good, inflammation is good. Inflammation is our first line of defense against bacterial attack. But what we, what we want to do is keep that in the physiological zone, the zone that's good for us. And the trouble is, so many of us are running at a level where it's too high, our baseline's too high, and we go into the, go into those peaks which are too high in that really pathological zone. And what you get from cold water swimming, regular cold water swimming, is that baseline goes down and those peaks go down. And this is what we see with your response, your breathing response, with your heart rate response, with your blood pressure response.

What about migraines? I was really intrigued. In your book, you're talking about a specific person. You don't have tons of trials, but someone with chronic migraines. Talk to me briefly. Just define what chronic migraines are versus occasional ones from eating msg, and what the treatment was and what the results were.

So this is a girl called Beth, and she was having 28 migraines a month. So, you know, pretty much every day she was getting a migraine. And a migraine is a whole body experience. You just totally flattened. She was doing a PhD. She had to give up her PhD because she just couldn't get out of the house for long enough. And, you know, you have, yeah, yeah, you have auras, you have funny feel. Yeah, your head goes weird.

You have nausea.

Yeah, nausea. I mean, it's just, it's just dreadful. I mean, the who says that a day with migraines, like a day being paraplegic, it's that bad. So she, again, you know, this is what I find really interesting. We don't have the trials, but, but what we have is people who have started doing it for starting cold water swimming for another reason. So she said, she read something about nature therapy and said, okay, look, I've got to do something. I can't work, I can't do my PhD. I want to go out and be in nature. Yeah, let's do that. And oh, how can we be in nature? Well, let's go down and swim in the sea every day. So she made this wonderful film called 100 Days of Vitamin C, which is CSEA. And she documented what happened, but she didn't go down to cure her migraine. But she found that her attacks became less and that they were shorter and it meant that she was able to finish her PhD. So, you know, it had that effect. Hasn't cured them, she still gets them, but it's calmed them down. And I think with, as with a lot of these things, it, the, it's the, the effect on inflammation. Although interestingly with migraines, there's something about them being generated from the trigeminal nerve. And the trigeminal nerve is what takes signals, takes those pain signals or take sensory signals from the face. And it's what links with the vagus nerve, which what's linked with the parasympathetic nervous system and reduces those levels of inflammation. So unproven, but, you know, it's kind of a bit more than the coincidence.

So walk me through what you've seen from cold water swimming and fibromyalgia.

Well, that's again, that's another of these cases where it was someone who came on our course as one of the chill courses, Martin, and he came on our chill courses for anxiety, but he had fibromyalgia. And he came in and again he said it worked for his anxiety. They noticed that his symptoms of fibromyalgia were reducing. And I thought this is. And he's come up with this fantastic comment which I keep coming back to, which he came out and he says he feels alert, alive with a sense of euphoria and achievement. Now if you've taken a pill, you do not get that. If you've been in the water, you do get that. And whether you're taking apart the effect, you know, the actual effect on the condition. I think that says a lot. You know, it's just the whole difference about it and interesting. I've just, just today been reading a, and ask a new scientist about fascia and we don't know much about fashion. We've always thought the fascia, the connective tissues in our bodies. Yeah, it's just a, it's just a sack of nothing.

It's more than that for sure.

Exactly. And you know it's such a complex thing and I think with a lot of things there's one is this level of inflammation. How do you decrease inflammation in these, these difficult to get to organs. I mean it's there all over the body but I think it's difficult to access because it doesn't have a massive blood supply. It's kind of cleaning up things, isn't it? You know the heart, the lungs, they take the blood supply and I think so there's the inflammation side of that and also stretching and getting out. I don't know. There's something in that fascia that I think we're missing and there's a good evidence that that's kind of what we're looking at with fibromyalgia. I mean it's in the name fibromyalgia fibers and muscles.

There's definitely an overactive immune system and the immune system includes the fascia. But like you said you can't get a lot of chemical signaling into the fascial planes. So that's more touch, it's more temperature, it's more light, possibly sound and there's all sorts of weird adhesions and things that happen. So I've done a lot of work on fascia and there are these domains where people really know what they're talking about. Even like somatic therapy. The problem is if you look at the Venn diagram overlap of medical schools and those, there is no overlap between those and there really ought to be like an open minded perspective on that would say well there's a tribe of healers over there, they're doing some weird stuff. We need to figure it out. And what I've come to understand is that if you can increase mitochondrial function systemically generally things like that get better. But oftentimes that means removing root causes that were causing the electrical issue which caused an over enthusiastic immune system. So it's, it's a messy problem. But if you're finding that when people do cold water swimming that they're getting improvements in fibromyalgia that's a relatively affordable thing to do. So if that cold water exposure could work for you, heck, it's worth a try, as long as you're not so fibromyalgic that you wouldn't be able to get out of the water. Because that could be bad.

Yeah, but I mean, that's the thing. It's something. I think what's great about cold water therapy is it's something that your body has control over. Yes, you get boosts in all these chemicals in the body, but when you're not bringing it in from outside your body, every single system you got, the parasympathetic and the sympathetic, you have, you have something pulling. You have something pulling in both directions. A dynamic equilibrium, every single system in the body, and that your body has control of it. So it's just pulling back. You've got control over it, even though you might be boosted up. And by strengthening the pulling back of the parasympathetic nervous system, you bring the sympathetic nervous system back into where it should be. And I think this is why it's so good. And you're unlikely to do yourself damage as long as you're sensible about it. Let's face, you don't need to be in for very long. Just. Yeah, I say three minutes and put your face in three times. That's all you need to do to get a really significant effect.

Who should not do cold water therapy? Like, there's gotta be contraindications.

There's gotta be, but they're actually relatively few, I would say, you know, there's a very uncommon but actually really serious condition called cold urticaria. And that is where you have this kind of awful allergic reaction, I suppose, or anaphylactic reaction to cold water or to cold generally. And that people with that shouldn't do it. But then, you know, a lot of people worry about the heart and actually getting to cold water. If you can walk down to the beach or get in or whatever, and particularly if you can get out of the cold water that you're going into, your heart is probably good enough to take it. What kills people with cold water isn't actually the heart. It's not the cold suddenly cause your heart to be harder and giving you a heart attack. It's more likely to be the fact that when you first start swimming in cold water, you can't control your breathing. You start hyperventilating. And this part of the problem in the way that you treat for anxiety, depression, is it feels like a panic attack. But you can't. And so what happens is people go in, they go straight in, they take a lung full of water before they started. And that's, that's the thing that stops people from going in, that kills people. The other thing is you've got to be a bit careful the first time you start doing it because you get your body in first and then your face, because otherwise, again, very unusual. But that sympathetic response can fight the parasympathetic response. You get this thing called autonomic conflict. And that can send off, you send your heart into funny electrical rhythms which isn't, isn't good for you. But on the whole, if you can get in, you can get out safely, it's pretty safe.

So overall, the risks are low. Medically, the risks are low from a predator perspective. And if you swim in a place with weird worm and amoeba parasites, well, then you should probably know better. Other than that, I think it's a low risk. And especially the sticking your face in a bowl of cold water, that's remarkably effective and it's such an easy way to start. And if your goal is to go, you know, cold water swimming with your friends in the ocean or a cold river, you might consider doing that for three days first. Right. Just so that you won't be quite as shocked when you get in.

Yeah, absolutely. That's a great idea. You know, do that, do the cold shower. Get accustomed to it. I mean, this is an important part of it is getting accustomed to it, getting used to it before you do it. And, you know, it's also important to point out you get the benefits at pretty high temperatures. I think anything below 20 degrees, you're going to feel a significant benefit in terms of your body adapting to it. The maximum or the minimum temperature, you have to go into like 10, 10 to 15 degrees centigrade. So that's what's at 50 or 55 degrees, something like that. It's not that cold. You know, it doesn't have to be ice water, just go into cold water.

Pretty much that's actually worth talking about for a little while. You always go through these phases of saying more cold is good. And so then you want your water to be at 33 degrees Fahrenheit or 0.1 centigrade, but that is relatively hard to do. It's really intense. Is that any better than something that's 60 degrees or, or. I don't know what that is.

Yeah, I'm sort of bilingual. It's all right. It's. No, absolutely not. In Fact, it's possibly worse. I mean I, I do find the colder the water is, the, the longer and the more intense the buzz I get out of it. But I'm in for virtually no time at all. You know, it's a couple of minutes, three minutes max. And I don't think again, you got to look at the proportion of the effect. You don't get any more benefit in terms of adaptation and things like this. It probably just feels a bit better maybe when you get out. I think in terms of your health there is nothing to be gained and actually probably worse because it's. Yeah, that temperature is actually beginning to be painful and that's, that's not much fun. I wear gloves and shoes in the winter. I'm not, I'm not hardcore at all.

Got it.

And, and so, and I mean, the only thing is, I think, you know, if you're in long enough that you get control over your breath. Yes. Even when you're a seasoned swimmer or a seasoned cold person, you go in and you still get that initial shock and it's a minute, maybe, maybe a bit longer and you're past it. You think that's all right now. And it's the same when you put your face in, it's a few seconds, you take it straight out, it just hurts. But if you put it in, you keep it in 5, 10 seconds and you're past that initial shock, I think that's all you need to do.

Mark, your book is called the Cold Water Swim Cure. And it's totally interesting to see the perspective of a medical doctor who's been doing this for 20 years and see what a difference it can make for all these different conditions. And so my call to action for you would be read Chill the Cold Water Swim Cure. And even if you decide you're not anywhere near somewhere where you're going to go for cold water swim, like you live in the desert, you probably want to incorporate more cold therapy via any mechanism you can get, whether it's cold face, cold shower, cold plunge, cryotherapy. Just doing that a few times a week I think has long term physiological benefits that are worth it. And it's okay to be a little bit lazy. It's also okay to make it part of your community time where you get to hang out with other people who care enough about how they feel to go do it. And I think that's the big point of the book, is that you're getting the sense of community and the connection to nature and the physiological benefits all at once, which means it's highly effective from a time spent activity for you. Mark, thanks for being on the show.

It was an absolute pleasure. Really enjoyed it.

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