Dr. Mark Haper
MD PhD
A discussion covering the benefits of cold water therapy, including improved mental health, increased circulation, and reduced inflammation. Natalie and Mark share personal experiences and research findings on the therapeutic effects of cold water swimming and its potential as a treatment for depression. They also explore the advantages of cold water immersion for overall health, including the reduction of visceral fat, the burning of calories, and the importance of avoiding hypothermia. Safety concerns and optimal temperature ranges are also addressed. The speakers emphasize the simplicity and accessibility of cold therapy, highlighting its potential for incorporation into outreach programs for teens.
00:00 Introduction and Background
07:31 Mark’s Background and Education
25:01 Comparing Cold Water Therapy and Cryotherapy
29:47 The Benefits of Face Plunging
31:59 The Importance of Nature and Social Interaction in Cold Water Therapy
34:51 Cold Water Therapy for Teens
37:23 The Social Aspect of Cold Water Swimming
43:22 The Importance of Ancient Wisdoms
46:44 The Right Amount of Cold Stress
49:38 The Best Way to Warm Up After Cold Water Therapy
54:27 The Point of Diminishing Returns in Cold Water Therapy
Dr. Mark Harper 0:00
There’s a fascinating study which showed that, you know, that took off an office, half the workers had a cold shower every morning. Half the workers didn’t, and the ones that had a cold shower…
Natalie 0:11
What do you think about the face plunging?
Dr. Mark Harper 0:14
Putting your face in iced water is a parasympathetic effect, so this is your rest and digest system. It slows everything down. Your heart rate goes down, your blood pressure goes down. And the great thing about the parasympathetic stimulation…
Natalie 0:29
Is this something that’s like, you know, brand new? All of a sudden, we’ve got this idea for cold therapy, you know, because somebody, one day, Wim Hof, maybe got in the water and was like, This feels great. We should all do this. Or is there actual, you know, history behind doing these kind of cold therapies and the benefits for the body and the brain?
Dr. Mark Harper 0:47
Minimize discomfort, maximize fun.
Natalie 0:52
All right. Mark, welcome to the Invigor Medical Podcast. We are so excited to have you.
Dr. Mark Harper 0:56
Thank you. I’m so delighted to be here.
Natalie 0:59
Oh, good. I’m thrilled too. I really am truly, very thrilled. And for anyone that’s a regular listener, they’re probably wondering where my co host, Derek Berkey, as he couldn’t be here today, and he asked me, Nat, do you think you can handle this on your own today? And I was like, say less. I have been so excited to have you on as a guest, talking about cold water therapy. It’s something that I’ve been into for years, back before it was, like, really cool to be into. And anytime I posted about it, people just thought I was absolutely bonkers crazy. So I, I was telling you before we started recording, usually there’s just, like, questions and outlines on the iPad that are made up for me that I reference, and I have a full page of notes in my phone with questions for today. So suffice it to say I’m ready for today, and I’m so thrilled to have you with us, and you’re coming to us from Norway, right?
Dr. Mark Harper 1:48
Yeah, yeah. So I work here half of the year and swim here half of the year which can get pretty cold.
Natalie 1:56
I love it. I can imagine what’s the water temp like there, like in the coldest months.
Dr. Mark Harper 2:00
Oh, in the coldest months. But the thing is, we have, yeah, at the moment, actually, it’s, it’s got quite nice warm where I usually swim, 16 centigrade. So, yeah, that’s quite comfortable, maybe 60 fahrenheit. But in the winter, you probably have four or five months where you’re sort of under five degrees centigrade, so 40 or less, that’s farhenheit.
Natalie 2:22
That’s pretty chilly.
Dr. Mark Harper 2:24
I’ve actually, once been into the sea when it was below freezing point.
Natalie 2:29
Woah. And so you just like, might have a little ice on top of that water you have to break through.
Dr. Mark Harper 2:33
Well it’s quite funny. The Norwegians have got this word for you know, the skin on the top of a milk. Yes, you get that. They’ve got a word called snack for that.
Natalie 2:33
Snack, okay.
Dr. Mark Harper 2:33
And you get that on the sea. When the sea gets to about freezing point, you get this kind of layer of jelly on the top before it properly freezes. So that’s what they call that little layer of jelly on the top. And there was that there when I swam that day.
Natalie 3:06
Okay, before we get into things. And I feel like I’m going to be so scattered on all of my thoughts, but let’s start where we should start, which is a little bit about you and your background, right? Because I think one thing that we’re, I know, one thing that we’re intentional about at Invigor medical is making sure that we bring on professionals to speak to certain topics, versus just somebody that did something one time and maybe did a little research, and now they have lots of ideas on a topic. So I’d love to know a little bit about your background and how you got here, and then maybe what’s the personal story that led you into cold swimming or cold water therapy.
Dr. Mark Harper 3:42
Yeah, they’re all kind of linked, really. So on one level, it’s just the fact I swim always one. That’s how I keep fit always. I wasn’t particularly good competitive swimmer growing up, but, yeah, I used to, I kept going, and I still swim in the pool, you know, two or three times a week. Train properly, but I never, yeah, even one summer, summers I used to lifeguard on the beach on the south coast of the UK, and I never really went in the sea. But then one summer, just I moved back to Brighton when I became a consulting anesthetist. So that’s kind of like an attending, I think is the American term for it.
Natalie 4:21
Anesthetist, is that what you said?
Dr. Mark Harper 4:23
Yeah, and then I suppose it’d be an attending anesthesiologist. Okay, so medically qualified, yes, person who gives anesthetics.
Natalie 4:31
Yes. Gotcha.
Dr. Mark Harper 4:32
And so I sort of moved back to Brighton and kept swimming with my old swimming club. And one summer the pool shut for a couple of weeks in the summer and, you know, I was just complaining to a friend of mine. I said, I can’t swim for next two weeks. Ah, he said, Go and join the sea swimming lot. And I didn’t even realize our club had a sea swimming group. And, you know, I thought, I was as surprised as anyone else when I realized they swam all year round.
Natalie 5:05
Right. You’re not expecting that.
Dr. Mark Harper 5:06
But anyway, I sort of went in, went in, you know, just expecting to swim for a couple of weeks while the pool was shut. But I still remember that first time when I got out, I just felt so good. I really wasn’t expecting that, at all. And so that two weeks has become over 20 years now I’ve been doing it, and it’s become, you know, research, a book and that kind of stuff, right?
Natalie 5:32
Right. Because you’ve written a book now, as well.
Dr. Mark Harper 5:34
Yeah. And, but on the other hand, so that was one thing, I got into cold water swimming.
Natalie 5:41
Okay.
Dr. Mark Harper 5:42
But kind of at the same time, my main research and what is the basis of my PhD was actually around stopping people getting cold.
Natalie 5:53
Oh, interesting.
Dr. Mark Harper 5:55
So if you have a an operation, you have a stress response to this operation, okay? And the greater the stress response, the more complications you get.
Natalie 6:05
That makes sense.
Dr. Mark Harper 6:05
One of the ways we can reduce that stress response is stopping you from getting or becoming hypothermic. And this is actually quite an interesting point about cold water swimming generally, is it’s that exposure to cold which is good for you, but becoming hypothermic, so your core temperature goes below normal is always bad for you.
Natalie 6:25
Right, okay.
Dr. Mark Harper 6:27
So anyway, so I was researching this topic of hypothermia, how to stop it, all the things we can do to warm people, to measure temperatures and things like this. And I started coming across articles about cold water adaptation. So this is, you know, where you go into the water a number of times, and your stress response adapts. And the way it adapts is it reduces that stress response. And we don’t want to get rid of that stress response, because that’s an evolutionary thing. You can have sort of pathological levels, you know, too much of a good thing, basically. You want to stay in the good zone rather than go in the too much zone. So I started reading about this, and the way the body adapts to that stress response is exactly kind of what we’re trying to do as anesthesiologists, to reduce the stress response to a level which is good for the body, rather than that which is too much for the body.
Natalie 7:25
And is that what’s happening when you’re like in surgery and under anesthesia, like your body’s getting cold, and so you’re trying to keep it from getting too cold? Is that part of it?
Dr. Mark Harper 7:33
Yeah, that’s part of it. So what happens is, although you don’t remember anything, although you don’t feel anything, what is happening is your body is still reacting as if it’s being cut into by a knife.
Natalie 7:44
Because it is!
Dr. Mark Harper 7:45
Which it is.
Natalie 7:46
Right? Just because you don’t have a conscious awareness of it, your body has its own intelligence, right?
Dr. Mark Harper 7:50
Exactly. Yeah, your body still feels that effect. You’re only affecting the brain with this so you’re having this massive stress response, and you don’t and it’s too much for the body, really, it causes complications. The greater that stress response, in very broad terms, the more complications you get from the surgery, maybe the longer your recovery is.
Natalie 8:12
Right.
Dr. Mark Harper 8:12
And one of the things that exacerbates this response, this stress response, is getting cold. There also a number of other factors. You know, it’s just that, yeah, the body just reacts. And if you can reduce that reaction to to being cut into by a knife, then you can reduce the number of complications. And so the way the body adapts to cold is exactly what we want for reducing complications. You know, for example, your levels of insulin resistance go down. So basically, your body insulin massively important hormone in the body, not just your sugar levels, but with all other kinds of things and insulin resistance, so when the body is not so sensitive to insulin, is actually an independent marker of complications following surgery.
Natalie 9:08
Wow.
Dr. Mark Harper 9:09
But we know if you adapt to the cold, your insulin resistance goes down, so you’re more sensitive to the insulin. So that, in itself, makes you think, Well, you know, it might reduce complications overall. So my first theory, and the first paper I published on this was it was in medical hypotheses, so it’s not it’s still not a clinical reality, but the but that was about using cold water swimming, and theoretically, why cold water swimming could reduce complications to surgery if you adapted before you had your operation. But then after that, what happened was one day, I was just in in the pub after work, reading the newspaper, and I came across an article which said that depression is associated with inflammation, and it turns out about 60% of depression is associated with inflammation.
Natalie 10:07
Wow.
Dr. Mark Harper 10:08
And I knew from my reading that one of the effects of cold water adaptation was a reduction in inflammation, and I knew how good I felt when I swam without being depressed. I thought, well, maybe we could use cold water swimming as a treatment for depression. So what we did after that is we set up this thing called chill UK, where we take people out into the cold water, give them a course in water safety, feeling confident with the water and having a lot of fun. And with those people, we looked at treating anxiety and depression. We have really good effects from that. Since then, we’ve done a feasibility, randomized, controlled trial, and now we’re actually in the process of recruiting, I think our first course starts the end of this week to a full scale randomized control trial called Outside Too which pitches cold water adaptation, or cold water swimming against normal treatments for depression.
Natalie 11:20
That is so exciting to hear. I cannot, like things like that-Any kind of alternative treatment outside of pharmaceuticals, is something that really excites me, because I think that we’re just so stuck in in, you know, treating symptoms and not getting at the root cause of things and keeping people sick instead of equipping them to be healthy, and just the rise that we see in depression and anxiety, you know, in our society over the last, you know, 10, 15, 20, 50, years, is just staggering. And I know part of it is awareness and diagnosing. Obviously, that’s part of it, but it’s just too high to not also correlate it to the fact that we’re just not healthy anymore, and we’re not incredibly equipped to be healthy, and we’re often stuck in this cycle of, you know, diagnosis, medication, diagnosis, more medication, side effects of medication, or, you know, and not actually getting healthy, and not even to talk about. It’s a whole other conversation about our food and the lack of nutrition we have there and how many additives are in it. But as you’re talking, there’s so many different directions that I want to go, but the first thing I want to start with is, you say cold water swimming a lot. I say cold plunging. People talk about cold showers. There’s also some who just do face ice baths, right? Because of the Ava’s in the face and it can some people say that it’s just as effective as a cold plunge, so I’d be curious what you have to say about that. But is first of all, can we just differentiate, if necessary? Is it? Is it that moving in the cold water is paramount? And then if all you have is, like, your ice bath in the backyard, that’s also still good. And then maybe it’s the cold shower or, like, or is it, if it’s all good, just do any of it. Like, can you speak to that a little bit?
Dr. Mark Harper 12:59
Broad messag is, it’s all good. Exercise is good for us, right? So if you do cold swim, if you do swimming as part of a cold that’s going to be a bit better, a better that’s however, I don’t think that has the major effect.
Natalie 13:12
It’s the cold.
Dr. Mark Harper 13:12
Yeah I think you’re getting, most of the effect is getting into cold water and you’re exposing yourself to the cold. Now, you know, we get the maximum response to this probably somewhere between 10 and 15 degrees centigrade. So, yeah, that’s not really that cold. What’s that 50 to 60 Fahrenheit? Maybe.
Natalie 13:14
Right. No, it’s really not that cold.
Dr. Mark Harper 13:24
There are two things which affect the response to the cold. You know, this exposure to the cold. One is the absolute temperature, and two is the rate of cooling. Okay, so the absolute, I say the absolute temperature below 10, you probably don’t see any more effect on the physiological response. I mean, even at 20, so 68 Fahrenheit, you get-all your blood vessels close up when you go into cold water. Vasoconstriction. You get maximal vasoconstriction access at 68 Fahrenheit.
Natalie 14:08
Wow.
Dr. Mark Harper 14:09
You’re getting a strong physiological effect at anything 68 degrees or below. So that’s one is it doesn’t have to be that cold. So ice baths aren’t that necessary, or they aren’t necessary. Cold showers is an interesting one. The thing about them is, you don’t cool as quickly because you’re not totally immersing yourself. So a cold bath would be more effective. But also, the temperature of a cold shower likely to be around 68-70, that’s, you know, just what we have in our water tank.
Natalie 14:42
Unless it’s the winter time. I know my cold showers in the winter time are way more effective than in the summer. In the summertime, I’m like, This just feels refreshing in the winter time. I’m like, I don’t wanna be me in here.
Dr. Mark Harper 14:53
Yeah. So you know, so basically that it’s not like to be as cold, and it doesn’t cool you as quickly, but they do have an effect. There’s a fascinating study, which showed that, you know, that took off an office, half the workers had a cold shower every morning. Half the workers didn’t, and the ones that had a cold shower had less sick days. So it does have a measurable effect; however, it’s unlikely to be as much as getting, you know, totally immersing yourself in cold water.
Natalie 15:24
Right. Well, and that makes sense to me, and I think it’s nice to be able to have that option, because not everybody has access to an ocean that’s chilly that they can swim in, right? And we have rivers here in southeast Washington, but even from where I live, unless I kind of want to go to the smaller, very Rocky River, hard to submerge myself in, not as much access. And then, of course, in the in the summer, it’s probably, to me, it doesn’t feel as cold because I’ve got that cold adaptation. But to other people, they’re like, this is so cold I don’t want to be in here. So to know that showers is something that you can utilize, and it’s still beneficial, there can be benefits. And I mean, honestly, that’s where I started. I can’t even remember where I first heard this. It was 2018 I was coming out of the fog of a divorce, trying to be healthy, trying to get mentally well, and I saw something somewhere, can’t even remember, what about cold water therapy. And I was just kind of like, I want to do something, and this is something that I can do that’s easy, ish, accessibly easy, right? I don’t have to go anywhere to do this. It’s not a medication. It doesn’t cost me anything except effort. And so I started doing it. And it was, it was intense at first, but as I adapted to it and started getting into the winter months, then also when we got snow, I would go out and lay in the snow, like a couple minutes on one side couple minutes on the other side, learned it was important to put gloves on after the first time when I got a-couldn’t feel a finger for a few hours after that one so pro tip, put on gloves. And then it was shortly after, after that that I finally did my first plunge in the river here in southeast Washington in the winter time. But I love knowing that the shower is still beneficial. What do you think about the face plunging? Because that’s something else for me, like especially in the summertime, when I don’t feel as much of a kick of the effect of a cold shower because the water itself is warmer. Having a bowl of ice water to plunge my face in for as long as I can, take breaths and keep going, I do notice a big effect from that. So, like, is that something that you’ve played with or done any research on?
Dr. Mark Harper 17:27
Yeah, so, so just to go back quickly, I would say you say pro tip, gloves. Gloves, shoes, also a hat. I like to have a swimming hat, something on head. These are all good. They do not reduce the effect of your cold plunge in any way at all, and they make it much more pleasant. And yeah, if you’re on something like in the river, for example, they are really good. Yeah, the shoes are great to give you that stability and things like that. So, good pro tip.
Natalie 17:56
Yeah, I need to get some shoes. Usually I don’t swim in the water. To me, it enhances how painful it can be. But so I get in there and I keep my hands above the water, like this in prayer. And I actually like do meditation. I like focus on my breathing, keep my hands out. It’s like, right here on my chest. I’m like, up to my chin, you know. And so that’s what I do, so that I don’t get my fingers in. But having something to protect my toes would be smart, especially coming out of the river on the rocks. It is sensitive when I’m stepping on those rocks, and my feet are really cold. So I’m gonna have to find some shoes that are gonna help with that better.
Dr. Mark Harper 17:56
They make such a difference. I can imagine great shoes where you can walk all the way down. I’ve got shoes where I can cycle in and they’re really light and they drain, they’re kayak shoes. But anyway, to go back to your question on ice on the face. Now, I think this is a bigger physiological thing, actually. So when you go into cold water, when you put your body, the rest of your whole body, in cold water, you get a sympathetic response. So you get that fight flight response. It’s a stress response, simple as that. What regular cold plunging does is it attenuates that response, so your blood pressure doesn’t go up as much, your heart rate doesn’t go up as much, you don’t secrete as much adrenaline, okay?
Natalie 19:16
Okay.
Dr. Mark Harper 19:17
So that’s a sort of a long term effect that cold plunging body is a long term effect. Now with the face is different, because that is putting your face in ice water is a parasympathetic effect. Okay, so this rest and digest system, it slows everything down. Your heart rate goes down, your blood pressure goes down. And the great thing about the parasympathetic stimulation is it has a direct anti inflammatory effect.
Natalie 19:47
Oh, really?
Dr. Mark Harper 19:48
So that is doing, you know, that is doing exactly what we want to. You’re getting an extra layer out of that. So some people won’t put their face in the water, and that’s fine. You’re still going to get a really good effect from the cold adaptation. But if you want an immediate hit of cold water, goodness, putting your face in is effective. There’s a talk of research. I mean, there’s, there’s a bit of research about that actually. I mean, there’s a lot of really interesting stuff, like vagal stimulation. They actually put electrodes into the vagal nerve, which is the basis of the parasympathetic nervous system. So if you stimulate the vagus nerve, you stimulate the parasympathetic nerve, parasympathetic nervous system, and you have this anti inflammatory effect. But actually using that now for resistant depression, don’t need it. You stimulate it by putting your facee in the in the cold water.
Natalie 20:51
Wow.
Dr. Mark Harper 20:51
But I think more fun and the better illustration is, I’ve run these courses for teenagers. What I do is I have a half day. I run a half day for them, and we do a bit of a physiology, and we do some experiments. And one of the experiments is to put your hand in the ice cold water and measure what happens to the pulse. It goes up. It’s painful. And I was surprised when this actually worked, but it really does work. Then you get them to put their face in the cold water, in the ice water, and you actually see, after a little delay, few seconds delay, their pulse goes down. And you would have thought, actually that wouldn’t be the case, you know, because it is still painful.
Natalie 21:34
And because you’re holding your breath.
Dr. Mark Harper 21:36
But it shows how strong an effect it has on a wow, parasympathetic nervous system, which, as I say, that will have an anti inflammatory effect, which is what we’re looking for, for both depression and for a whole range of other so many illnesses.
Natalie 21:54
So many things are rooted in inflammation. We just had a specialist on last week who’s an autoimmune disorder doctor, I mean, just incredibly at the forefront of his field, the research that he’s doing. And, you know, we had a whole segment on the podcast that was talking about inflammation and how it’s connected to all of these things. And, you know, chronic inflammation, seeing it, and things. So that was one of the things that first stuck out to me about cold therapy. And I do want to do one more differentiation. So we’re talking about cold water swimming versus plunging, versus showers, versus this. Like, what about cryotherapy? Right? Because that was also something that started to come in, the rise these, you know, cryo chambers you get in and it can get this cold, like, minus this many degrees, which is interesting, because it’s, there’s a point where I’m like, okay, is cold? Like, once we reach a certain temperature, is colder, really better. So is it just like, cool to be like, I went in at negative 45 you know? And I did it one time. Granted, I’d already been doing cold water therapy for a couple of years, and I didn’t really like it as well. I didn’t love the feeling of the cold air on my head the whole time, like, at least when I’m in the river, I can choose to put my head in for periods of time. And obviously it wasn’t, the cold wasn’t as I don’t know, all encompassing, is what I would say, and it took me longer to get cold, and it’s almost like I felt the effects of the cold more, because I had none of the numbing of being in the cold water. So I don’t know if you’ve done much research or thought or had questions around cryotherapy, but if you have, what would you say about comparing the benefits of cold water therapy versus cryotherapy?
Dr. Mark Harper 23:34
So the thing about Cryotherapy is that’s done in air bases cold right, right, air has what’s called a very low specific heat capacity. It doesn’t contain much heat, so that’s why it has to be so cold when you go into a cryo chamber to actually take heat away from the body, whereas water has a really high specific heat capacity, which means it just takes that heat out from you straight away, right? And as I said, you know, one of the key things is how quickly you cool, and that’s due to the physical properties of water compared to air. And that’s why, you know, you put your hand in an oven, you know, 100 degrees centigrade, 212, Fahrenheit, it’s nothing.
Natalie 24:21
Right.
Dr. Mark Harper 24:22
Yeah, whereas if you put your hat, you wouldn’t put your hand in boiling water because you would destroy it.
Natalie 24:30
That’s a great analogy.
Dr. Mark Harper 24:31
So that’s the thing. So I’ve never done it. My suspicion is, and what your experience kind of confirms this is, you don’t really cool quite as quickly and it isn’t the all immersing effect. So I think a bit like cold showers, it doesn’t kind of quite do it the same as as immersion. And of course, the other thing is, another point you made, it’s not quite as accessible. You have to find a chamber, yeah. And one of the things that I always like to bring about cold plunging is particularly, if particularly somewhere outside. It’s more than just the cold. I mean, you know, great if you’ve just got a cold, you just got an ice bath, you just got a plunge thing. Great, you know, use it’ll have an effect.
Natalie 25:20
Yeah.
Dr. Mark Harper 25:20
But what we found, particularly with our research and my own experience, is that it’s not just that. It’s being out in nature. We know that’s good for you. It’s blue therapy, views of the sea or open water. We know that’s good for you. It’s social.
Natalie 25:36
Yeah, doing it with a group.
Dr. Mark Harper 25:37
You know, you do it with other people. I mean, you mentioned with your friends.
Natalie 25:39
Suffer together!
Dr. Mark Harper 25:40
You know and you have a laugh. You know, you’ve shared this bonding here, this fact that you’re doing something crazy brings you closer together and enhances that social effect. So it’s a whole package of benefits. So it’s a whole other thing, cold water swimming, compared to going into a cryo chamber, or even having a pot in the back garden. But yeah, if that’s what you can do, there’s nothing else I could do, I would do that. Don’t get me wrong. But even then you’re outside, aren’t you? In the backyard.
Natalie 26:16
Right. Um, I don’t know. You’re just thinking, say, talking about that and people in the social aspect of it, it made me think. I’m wondering, have you ever done this with teens? Because I’m thinking about everything teens are going through, how much more plugged in they are to technology, how much more comparison there is with social media, the social pressures and strains, how much more anxiety and depression our teens are facing, wanting a sense of belonging. I’m thinking, like, would, well, first of all, my question is, Is there an age that’s too young to be in cold therapy, like, from a healthy perspective, and if not, like, if it’s appropriate for teens? Like, it would be so cool to, like, have some kind of group that’s giving back to teens in some way. So maybe somebody that’s listening is already doing some kind of outreach to teens. And think about incorporating in once a week, especially in the winter months, you know, getting kids, these teens, into cold water therapy. I don’t know that was just, that’s not all my questions here. It’s just something that occurred to me. I have a pre teen. She’s 12 years old, and just knowing all the things that you know, her friends go through, she goes through, and that it’s only going to amplify as they get, you know, into high school, I’m always trying to think of ways to amplify her overall health and well being. So I don’t know what are your thoughts on that, on this, you know, being an opportunity for teens.
Dr. Mark Harper 27:27
So I have done some research on this. Okay, and so, for start, I ‘m not sure how old you have to be. I mean, certainly my son probably started when he was about six or seven. A bit more difficult. He still goes in occasionly with his friends, and that was my youngest son. So, yeah, actually, the reason we persuaded him to go in was because we said, you can have more screen time. You don’t get any screen time on Sunday unless you go swim.
Natalie 27:54
Oh, that’s smart. I like that. Yeah, yeah.
Dr. Mark Harper 27:57
So anyway, and yeah, he’s fine, yeah, again, don’t stay in too long. That’s the key thing, you know, because young ones get cold want to get cold and can become hypothermic and that’s just unpleasant, right? Get them in. Get them exposed to it. That’s great. But coming on to sort of more the yes, that’s the age when you can you start. And pretty much, if you’re careful and sensible, pretty much anytime and but yeah, start in the summer. This is good rule anyway, start when it’s warm, rather in the middle of winter.
Natalie 28:27
Hey, I hope you’re enjoying today’s podcast. I just wanted to take a quick break, because if you’re listening, you probably know what we do here at Invigor medical podcast, but maybe not what we do at invigormedical.com so let me introduce us. At Invigor, we provide prescription strength treatments and peptides for weight loss, sexual health and lifestyle optimization. Every treatment plan is carefully prescribed by licensed doctors and sourced from legitimate pharmacies. You don’t ever need to buy questionable research chemicals again. And bonus, as a podcast listener, you get a 10% discount on your first treatment plan with code PODCAST10 at invigormedical.com Now let’s get back to today’s episode.
Well, and then that made me think, have you ever heard of Dutch baby sleeping?
Dr. Mark Harper 29:12
Dutch babies?
Natalie 29:13
Dutch baby sleeping. Okay, it’s strange. Like my my sister and my niece turned me out of this, and how oftentimes the Dutch, at least historically, like would literally put their babies out in their strollers, in the outside, in the frigid temps for their naps, like completely bundled up, like with a hot water bottle, just their face exposed for their naps. And at night time, open the window and get the room incredibly cold and get them all swaddled up with their bottles, and then close the window and trap in the cold air for them to sleep. And it’s like the Dutch baby way of sleeping. And I started doing this with my son, who’s eight, who’s been struggling with sleeping, and I noticed every time he woke up, he was just like sweaty, but he wants the blankets. And I started just opening his window, and like, he started sleeping way better. So and that just popped into my head too. I’m getting lots of errant thoughts here.
Dr. Mark Harper 29:54
Well, maybe I was a Dutch baby. My mom tells me when I was a baby, I had to get outside. If I didn’t get outside, and then some days in the snow, she would have to put me-she didn’t know what the neighbors thought, but the only way to get me happy was to put me on the front porch, out in the open air, in my pram, and then I’d be content.
Natalie 30:21
I love it. I love it! There’s definitely some…
Dr. Mark Harper 30:24
So coming back to teens.
Natalie 30:25
Yeah.
Dr. Mark Harper 30:26
So what we did, so I did this, so I was talking about these courses I’ve been running, so we ran that as a research study as well. And what we did is we looked at teenage mood, so it’s not looking at mental health. What you do is you measure this measure called the profile of mood state. You measure it before and after a swim, okay, and there’s this, the headline figure is total mood disturbance. And what we found with, I think it’s about 40 or 50 of them the total mood disturbance, you know, it improved. Their mood improved. And they also said, probably around 80+ percent said they would want to do it again. And University said that the feedback was they want to do it with their friends, you know, go to a social thing? You know, so it appears that if you do it with their friends, if you set up something where they get to do it with their mates, then they will do it and they like doing it.
Natalie 31:30
Well I mean, that makes sense. I mean, the book that I’ve been reading on adolescent psychology, you know, is talking about what an important phase it is of adolescents to grow this attachment to friends. It’s part of like separating from the parents and seeking independence, but in the interim, there’s a lot of dependence on the social connections that they build. But just saying, total mood disturbance. I think anybody that’s parented a teen that hears about anything that can improve mood, it’s like, Sign me up. Sign my teen up for that, please. But, you know, thinking about Dutch babies, and I know there’s some other, you know, historical examples in certain countries of sending the preschoolers out to play in the frigid temperatures at school. Like it’s just a normal thing to have this exposure to the cold. And it’s not really something that we’re as familiar with, you know, in our westernized culture. But can you speak to that at all? Is this something that’s like, you know, brand new, all of a sudden, we’ve got this idea for cold therapy, you know, because somebody, one day, Wim Hof, maybe got in the water and was like, this, feels great, we should all do this. Or is there actual, you know, history behind doing these kind of cold therapies and the benefits of for the body and the brain?
Dr. Mark Harper 32:41
Yeah, there’s a massive history of it. Historically, yeah. I mean, there’s 1000s of years of this. I mean, talking about the stuff with the teens, I think there’s a really interesting book. So, where I come from, in the UK, Brighton, it started out as a small fishing village, but then because of what’s called the Sea Cure, which was people coming down to go in the sea and to be to bathe, going back. I mean, go back to Hippocrates, to Galen. You know, Hippocrates is right on airs and places. It’s all in ancient history. It’s always been recognized. I think what happened was, so the sea bathing thing happened for certainly in the UK for many years, hundreds of years afterwards. But the pharmaceutical industry started doing great things in the middle of the last century, and at that point we kind of forgot about the other things. You know I couldn’t do my job as anesthesiologist without drugs.
Natalie 33:42
Of course. right!
Dr. Mark Harper 33:43
You know, they’re fantastic!
Natalie 33:45
Yeah.
Dr. Mark Harper 33:45
But we forgot the other things, like cold bathing, like going in nature, like being in the, yeah, the sanatoriums, the TB sanitariums, all fresh air, top of a hill, things like this, you know, they’re actually all really good things, but we’ve kind of forgotten about that.
Natalie 34:02
Right. I’ve talked about this many times on our podcast, where it’s like, you know, all of the science and the progress that we’ve made medically and scientifically is all incredible, and it’s done so many good things. But you know, especially in westernized culture, in pursuit of that, we’ve left behind so many ancient wisdoms, so I love that we’re starting to bring back to the forefront. No, these are things that have been going on for 1000s of years with benefits. And now the cool thing is, now we can take these ancient wisdoms and with science, understand more about why they’re impactful and why they’re important. So I think that’s so cool. And so I do want to make sure, because whenever people ask me about, well, why cold therapy? Like, why should I do this? Let’s go through some of what the benefits are. We’ve already talked about it a little bit. You’ve mentioned some of the things, but I mean, there’s so many that I’ve heard about that come to mind that I want to ask about, right? And one thing that I’ve heard about is in regards to fat two kinds. One of being the effect on brown fat cells or adipose tissue, and the other on visceral fat. Do you know anything about that? Or can you speak to it?
Dr. Mark Harper 35:09
Yes, but I’m afraid I’m going to be a bit disappointing.
Natalie 35:12
Okay. Hit me.
Dr. Mark Harper 35:15
So yeah, brown fat, good fat. You know, it is good fat. There’s no doubt about it. It takes, in fact, clears fat from the bloodstream, it converts it, and it’s converted into heat energy. So that’s great. And you do find with cold adaptation, even in adults. I mean, it’s mainly a thing in kids and it can be a probably on babies particularly, but it can be a really important source of heat, keeping people, keeping babies warm. But you do see with adaptation, you get more fat in adults; however, the issue is that, you produce so little of it Gotcha. And you know, it’s probably the calorific output of it is probably less than 100 calories a day.
Natalie 36:11
Oh, wow.
Dr. Mark Harper 36:11
So nearly nothing it clears, the figure is about 0.35% of fat from the body, even in the adapted person. So it is a thing. However, it doesn’t have what I would call a clinically significant effect. There was, I did, I did have one comment about, someone commenting about the brown fat, and she said, Well, you know, I’ve been cold water swimming for two years. Why am I still fat?
Natalie 36:42
Right? It’s not a cure. It’s not like a magic pill to make you not fat anymore. Right, right, right.
Dr. Mark Harper 36:47
With visceral fat, I don’t know, really, to be honest, I don’t know. I mean, I think, as with anything, doing anything healthy, like this, getting your body out. I mean, we know that any exercise at all is effective. Any increase in exercise you’re walking up two flights of stairs is enough to have a measurable effect on your cardiovascular health. So it’s nothing. And so just sort of getting out, walking down to the water, getting in, getting out, walking back to the car. You’re doing something good at that point, and it’s exactly the kind of thing it’s like to reduce your your visceral fat.
Natalie 36:47
Yeah, totally.
Dr. Mark Harper 36:54
However, I don’t know of any research that has looked specifically at the visceral fat.
Natalie 37:05
Right. Okay, another question that are something that I’ve heard before. I’m like, pulling up my own notes here, was something about like, you actually can burn calories with the effort your body takes to reheat itself, right? So, but that kind of leads into another question that I have, because one thing I’ve always wondered is, because I know a lot of people that will cold plunge or whatever, and then immediately get in the hot tub or get in a hot shower to warm up. So I’m wondering, are the benefits of the cold water diminished at all by immediately using hot water to warm yourself up, or is maximum benefit to let your body do the work to warm itself back up on its own?
Dr. Mark Harper 38:15
So there are a couple of questions in there. So yes, the effort of warming up afterwards does take energy. I’m not sure, again, if that’s a clinically significant amount of energy, but it definitely does take energy, and it gets the body working. So it’s a good thing. However, you don’t want to get too cold to use most energy up when you’re shivering. Yes and actually, you know, you can shiver without being hypothermic. I did this a few years ago. I had this 10 mile swim in 30.5 degrees centigrade water. And you know, I was fine, you know, my body was working, and after I was shivering so much, however, I’d taken a temperature capsule I’d swallow the temperature capsule so I could see what my core body temperature was, and it was still totally normal.
Natalie 39:09
Wow.
Dr. Mark Harper 39:09
Yeah, so, but it’s unpleasant. So for me, I don’t like shivering. So over the years, I’ve worked at how long I need to be in so I don’t shiver. My body just tells me, get out now, you won’t be shivering. Staying a bit longer, you will be and it’s not bad. Yeah, it’s all right for you, right? As long as you don’t become hypo, yeah, actually become hypothermic, and this is one of the key points. You don’t have to be in the water that long to get most of the effects, right. So just two or three minutes, you just go in, you know that initial shock you get. So you get that, you get over that, your breathing comes back under control. You can look around, enjoy the scenery, that’s going to give you the majority of the effect, without the shivering and all that kind of stuff afterwards. But, yeah, the body does use energy to to reheat, but as to whether it’s going to help you lose weight? Don’t know. It might well help you. You know, just the body moving is just getting stuff going around the body. Now, another thing is so about the heating up before and after, it’s always best to go into water warm.
Natalie 40:19
Okay.
Dr. Mark Harper 40:20
So if you can go from a sauna into the water, you’re totally warm through. Basically, that’s your heat storage facility. You don’t want to become hypothermic. So if your body is absolutely totally full of heat, you’ve got more to give up before you yourself become hypothermic. And it appears that it’s just a matter of exposure to the cold, okay, it doesn’t matter that that’s the thing and how you warm up, yeah, okay, you might not be using as much energy, sure. But if you warm up after to the hot tub, that’s fine, but be a bit careful with the shower. I mean, there’s this theoretical thing that your body suddenly, your Vasi, all your blood vessels dilate. That’s not my experience. I’ve been doing this for 20 years. Start with it luke warm because if it’s too hot, you might not feel that the heat and it might you might actually damage your skin. But the actual warming up thing isn’t an issue in terms of being dangerous. A sauna, again, is great. There is a good, an increasing body of evidence that Saunas are good for you as well, you know? That heat stress. So what we’re talking about is cold stress.
Natalie 41:36
Right.
Dr. Mark Harper 41:37
But heat stress as well, from a sauna can be good for the body, and can have you know, certainly, regular sauna bathing certainly seems to help with cardiovascular health. So, so that’s it. My one caveat is, before you go in, what you don’t want to do is be in the middle. You’re you’re basically best to warm up from the inside out. So through exercise, through muscle use, and that’s what your body’s doing when it’s shivering. It’s just using your muscles to generate heat. If you sort of warm up, you’ve just been in a warm car say, but you’re you’re a bit cold in the middle, and then your core is warm, you know, the body gets a bit confused. You start cooling quicker than if you hadn’t warmed up at all so warm from the inside out, or be completely warm through, like you are with a hot tub or a shower.
Natalie 42:28
Yeah. Well, that’s how I’d always kind of done it is right after a workout, is when I’d get in the cold shower or go roll in the snow or jump in the river. And I mean, part of it is like, I’m so hot I want to cool off. So mentally, it wasn’t as much of a struggle to get myself in it right, because I’m like, this is going to be great. But then I read and, gosh, I wish I knew where and what, so I could be able to cite it. And it was talking specifically to the to the mental benefits of cold therapy, right, which I want to dive into with you. We’ve kind of already talked a little bit about, but was saying that for the maximum benefits mentally, to get in the cold water as close to right after you’ve woken up as possible, mainly because your body temp is already it’s like at its lowest point during the day. So it actually it takes you more effort to get into it. And so you would feel the effects of mentally, of like doing the hard thing, pushing through it, and it was saying something like dopamine being increased by like 80% or something, or like eight times, something like that, from getting in first thing in the morning. And I talked with a few friends who have played with cold plunging for years, and one of them is a previous leader of mine who has primarily used cold plunging for his mental health, to the point where his wife will tell him, you need to go get in the tub, because she can see such a marked difference for him. And so he, I mean, I literally was on a call with him one day, probably 830 or nine o’clock, and he gets on the call, and he was so energized, like, and not like crazy caffeine, like, there was just something about the way he was talking in his face and the way his brain was firing. And I was like, Whoa, Scott, what is going on? And he’s like, I always do my cold plunges later in the day, but I’ve started doing them the first thing. And he’s like, The way I feel is insane, like the impact. So I think that’s interesting, because you just mentioned being mindful of your your body temp and being warm, and the whole point of this was supposed to be, you know, first thing in the morning your body temp is naturally lower. So I don’t know. What do you think when you know hearing that and the comparison?
Dr. Mark Harper 44:33
It’s difficult to know. I mean, I don’t know. I personally prefer, well, I generally do it early in the day. It keeps me going for the whole day. You know, I’m just buzzed for the whole day. It was great. But if I go an hour or two later in the morning, even it feels easier. The temperature is really cold, it feels easier. I suspect there might be some differences in how it affects you. But. That, I think again, the overall effects not going to be be altered by that. What is great about that first thing in the morning is it just gets you through the day. You’re great for the whole day, right? And that might be something that really helps people.
Natalie 45:19
What’s important is you do it right?
Dr. Mark Harper 45:22
So it’s kind of a short term. I think it might be a short term benefit from doing it first thing in the morning, but I’m not sure, again, if there’s anything clinically significant, about doing it later in the day, but I’d love to see you know, maybe I’m wrong. There’s not something-I haven’t seen that article. So if you ever find it, send it my way and I’ll have a look at it.
Natalie 45:41
Okay. I’ll have to send it your way. But when I feel like we’re still kind of like, early on in a lot of ways, in measuring the mental health benefits, I mean, you yourself talking about this study that you’re starting, you know, to measure, you know, cold water, swimming versus traditional treatments for depression. You know, you don’t see a lot of those, you know right now, but hopefully we’re going to see more and more of them, because alternative treatments to mental health issues are, I think, can be incredibly powerful, and we want to see more research surrounding those things. Okay, then I was going to ask you, we kind of already touched on this, but I want to emphasize like, is there a point where, like, it’s like, why are you even trying to get the water colder? You know, like, the cold plunge on your back porch, that you’re like, cracking the ice every morning, and you’re like, Oh, I’m so macho because I’m getting in this super cold water. Like, what’s the point where it’s like, it’s not really any better for it to be, you know, minus 20 degrees versus 40 degrees. Like, is, is there a point? Or is like, colder better?
Dr. Mark Harper 45:50
Yeah, there is a point. And that point is, might be, is somewhere, probably that would be about 50 Fahrenheit, 10 degrees centigrade. Below that, you know, I definitely get more of a buzz. I sort of feel more of an effect, when I go into cold water, but in terms of the benefits, you’re not getting any more below that temperature. Aand of course, the risk below that temperature is you’re more likely to become hypothermic, which, as I’ve said, is always bad for you. So you’ve got to be very careful. You don’t need to be in very long.
Natalie 47:16
Right. What do you say to the naysayers out there who say things like, you know, cold therapy actually is really damaging to your body, and actually can shave years off of your life because of the exposure, the stress exposure to the body?
Dr. Mark Harper 47:33
I think this whole stress phase, the body needs stress. It needs to be exposed to stress.
Natalie 47:39
Acute stress versus chronic stress.
Dr. Mark Harper 47:44
The right amount of stress is good for the body, and this is why I’m here going on and on about the fact is, it doesn’t have to be too cold, it doesn’t have to be too long. So we need that stress. You know, if you work out at the gym. What makes your muscle stronger? It’s those micro tears in the muscle, and it’s getting them and, you know? And that is what makes us grow stronger. Yeah, we overdo it, yeah, of course, we’re going to injure ourselves, and that’s bad for you. Hypothermia is the same as, you know, pulling your muscle at the gym, but cold exposure that is getting those micro tears that’s building us up and building us back stronger.
Natalie 48:24
Right. No, that makes so much sense to me. So I have a lot of friends who, I have some more friends now, who are doing cold therapy, right? It’s still a smaller percentage than the whole group, but we, one of my friends, has a cabin up in the mountains here in Washington, right on the Naches River, and there’s a handful of us that always get in the river anytime we’re out there for a weekend, and then the rest of the group is always out there, like, You guys are crazy. I could never do this kind of thing. And I always want to be like, Well, you never know until you try. And also, it sucks a lot less for me now than it did when I first started, which I think is what you referred to as cold adaptation. So what would you say to people that are just like, Absolutely not could never be me. Would you say to everyone you should at least try it, because it’s that beneficial, or I don’t know, what would you say? What would your advice be?
Dr. Mark Harper 49:17
Yeah. I think the vast majority of people, you would say, I say, just try, yeah, virtually no medical contraindications to it. Yeah, I’m reviewing the people coming through for the our trial at the moment, and you know, they’re very few. I’ve said, no, no, that’s you can’t, you know, it’s not safe for you to do this, right? The key thing is start. You know, it doesn’t have to be that cold. Start in the summer, start where the waters 68 or below. That’s the first thing. It will still feel cold. And always do, you gotta do it three times at least, and preferably five or six times, preferably six times. You know, the cold adaptation programs that have been studied., they do it 6 times, but you could probably, you’d probably get good at adaptation. I mean…
Natalie 50:05
Why is that significant?
Dr. Mark Harper 50:06
You’ll probably know whether it’s right for you after three or four times.
Natalie 50:08
Okay, that’s what I was gonna say. Why is that significant, instead of just doing it once or twice to do it more times?
Dr. Mark Harper 50:13
Well, the thing is, the second time’s always the worst. The first time, you’re all psyched up for it, you do it and you get out of there.
Natalie 50:19
That’s true, because then the second time you’re like, Oh, I remember how much that sucked. So it almost takes a little more.
Dr. Mark Harper 50:24
It sucked, right? You but you, you’re not really set up for it. You’re not adapted yet, and so you’re sort of, it’s actually worse, because you’re not so psyched up, you know, it sucked, but I survived it. But then the third time, you’re beginning to see adaptation. You can do this even in a day, as long as you warm up in between. Yeah, you can do this over a course day. And that’s what we did with Sarah on the TV program I was speaking about earlier. Yeah, we adapted her over the course of the day. Second time, she almost didn’t want to go back and she said, Oh, just one more go. The third time, it’s like, Oh, I love this.
Natalie 50:58
Oh my gosh, that’s so cool. If you want to experience the benefits of cold water therapy, you know, whether it’s you’re swimming, you’re plunging, you’re in the shower, the face, whatever, how often do you need to do it to really experience the benefits? I mean, if you just do it once a week, are you still going to feel the effects, or is it like really important that you’re doing it multiple times a week?
Dr. Mark Harper 51:19
Well, I think the the answer to that comes from our studies so far, because what we’ve been doing is taking people into the water once a week, okay? And we have shown, you know, we haven’t done the definitive trial yet. We’re in the process of doing that, but in everything we’ve done so far, you know, they’re going into the water once a week, and we’ve shown a clinical effect on that.
Natalie 51:40
Wow. Just once a week.
Dr. Mark Harper 51:41
It has a benefit on depression and anxiety. So once a week is enough. So this is what I say is, is not too often, once a week, not too cold, anything under 20c/68f, and not that long. Just long enough to get your breathing back under control, two or three minutes get past that shot, and then I’ll say, so I feel like, as a rough and ready rule, three minutes and put you’re facing three times. And again, it’s not like facing in and out. It’s facing over the shot, which is just a few seconds out, face in, face out, and do that three times. Very, very simple, nothing, nothing, very much, no longer and harder and colder.
Natalie 52:27
Right. Right.
Dr. Mark Harper 52:28
Enjoy it. Have fun.
Natalie 52:30
Right! The way that you’re talking about it makes it so accessible, you know, and that it doesn’t, you know, it’s like-what I always say to my friends is, like, you could do anything for 60 seconds, right? Like, seriously, just do it for 60 seconds and see, and my guess is, once you’re in there for 60 seconds, because really, it’s like, the first 30 to 45 seconds that are really tough, that take that sort of like, oh my god, I’m gonna say it, this sucks, this hurts. And then it’s like, you kind of start to feel a little bit numb, and then your heart rate starts to slow down, right? So your breathing starts to get more regular and slow and then, and then it’s like, okay, maybe I can do this. Okay, yeah. And then you’re kind of looking around, and then you’re starting to notice the sensations in your body. And like I said, I love to use it meditatively, to just really focus on my breathing. I love it when we’re doing it in the river, up in the mountains, because you’re so right. Being in nature, it just amplifies it. It’s like the world gets smaller. So it’s just this right here, I’m surviving in this cold water, but like, suddenly everything all around you expands and gets larger. And there’s just such a presence in the moment for me that I’ve experienced. And, yeah, that feeling of, you know, especially, of like, I remember we were out there at Friendsgiving, and, you know, it’s a big group of friends doing our friends giving. And I had a few drinks the night before, and I wanted to sleep the next morning, and we were supposed to go on a hike, and a couple of the guys were like, come on, we’re getting in the river. And I was like, I have to do that, because I know how I’m gonna feel afterwards. And sure enough, I was not hungover. I was ready for that hike. I was bright eyed and bushy tailed and raring to go. And it’s just crazy, and I think it’s why I started to annoy my friends years ago talking about cold therapy. Because I’m just like, it feels so good you have to know how good this feels. Like you just, I feel like, once you’ve done it, you just, like, want everybody else to know how good this feels. And like, this is free, you could feel this good for free. It’s gonna cost you three minutes of your life, and you can feel this much better. So thank you for taking all of my questions there. There were a lot of you’ve satisfied a lot of my curiosities, and I really appreciate you taking the time to be with us. You know, from Norway, it’s like art at this point, after 9pm for you. So thank you so much for taking the time. And I want to make sure people know where they can find you, where they can find your book if they want to be involved in your study, if they happen to be in the UK. So list us off on how people can gain more access to you and the work that you’re doing.
Dr. Mark Harper 54:47
Okay, so the study is Outside Too, and it’s outsidetoo.org, or the UK, I think, but look for Outside Tto, cold water swimming study. You’ll find us.
Natalie 54:58
Okay.
Dr. Mark Harper 54:59
So I’ve got a website, DrMarkharper.com, you can look at that. I do occasional bites on Instagram @thewildswimdoctor, and yeah, my book is called Chill | The Cold Water Swim Cure available at all the usual outlets. I mean, it’s a US public publisher, Chronicle Books, so available widely. And you know, it gives you what I do in it is, it gives you the physiology, a bit more of the detail of the physiology, things like the physics of water, why it feels wet, for example. And then a sort of outline of how you can do it, you know, doing it three times, and the kit you need, or the kit that helps, and stuff like this. And then I’ll just tell some extraordinary stories. You know, not, not my stories, you know, people’s extraordinary stories of how they found benefit from cold water swimming. So, yeah, they’re really inspirational. In fact, you know, I’ve recently recorded the audio book.
Natalie 56:04
Oh fun!
Dr. Mark Harper 56:07
And the engineer said to me afterwards, God, these stories are so inspirational. I’m gonna start cold water swimming.
Natalie 56:16
That’s so cool. I love that. I’m definitely gonna have to check it out before we sign off here, is there any additional or last final thoughts that you want to offer to our listeners?
Dr. Mark Harper 56:28
No. I mean, the my final summary of what, how to do cold water swimming is minimize discomfort, maximize fun.
Natalie 56:36
Oh, I love it. That’s such a good way to look at it, because don’t think many people think of it that they would just immediately retract from the idea of being cold. So that’s a great way to put it. Well thank you so much for taking the time, especially with the time difference in Norway and being later in the day. We greatly appreciate it. I know Derek was so sad to miss this one, and I’m so glad that I was not the one that missed this one, because I’ve been really looking forward to it. And we will definitely link all of your stuff in the show notes and to your website and the study so people can make sure to stay connected to you and all the work that you’re doing, and thank you for taking the time to share it with us here. It’s been a pleasure to have you on.
Dr. Mark Harper 57:11
Oh it’s been an absolute pleasure. Really enjoyed it.
Natalie 57:14
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