87 - Dr Mark Harper - Cold Water & Long Covid

Episode 87 of the Long Covid Podcast is a chat with Dr Mark Harper, consultant anesthetist, researcher and cold water enthusiast! We chat about cold water and all it's amazing benefits on both mind & body, as well as how you can do it safely.

Chill (swims around the UK)
Mark Harper website
Mental Health Swims

Buy Mark's book "Chill"
https://blackwells.co.uk/bookshop/product/Chill-by-Mark-Harper/9781797213767; https://www.waterstones.com/book/chill/mark-harper/9781797213767

For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com

(music credit - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  
Hello, and welcome to this episode of the long COVID podcast, I am delighted to welcome my guest tonight, Dr. Mark Harper, who is a consultant anaesthetist at Brighton and Sussex University Hospitals and also a cold water enthusiast who's passionate about how it can help people's health. So a very warm welcome to the podcast. 

Mark Harper  
Well, thank you for having me.

Jackie Baxter  
I'm delighted to have you here tonight. And I'm really excited to talk about cold water because this is something that I am super, super into as well. So to start with, would you mind just saying a little bit about yourself and what it is that you do? Well, as

Mark Harper  
Well,  you said, I'm a consultant anaesthetist  so I put people to sleep, and more to the point wake them up again, that's the easy bit is putting into sleep, the hard bit is waking them up again. I do that part of the order in Brighton, half the year I do it in Norway. 

On top of that I do research and my first sort of research career was stopping people getting cold. So if you get cold during an operation, that's bad for you. And you have more complications, basically. And so I spent many years trying to stop people from getting cold and wrote a PhD about that. But now I expose people to the cold - very important to realize they shouldn't become hypothermic, but that's something we can cover later. And in that way, make them better. And in fact, ironically, it could reduce the complications from surgery as well by doing that, 

Jackie Baxter  
Wow, that's fascinating, isn't that something so simple as cold can be both a good thing and a bad thing and all sorts of different kinds of circumstances? It's yeah, that's cool.

Mark Harper  
I think the key thing is, and this is something we're always to remember with the cold water swimming, and everything is exposure to cold, exposed to cold being a stress is good if you're exposed to cold, but you don't want to do too much of it. And so it's like having a workout. And you're just, you know, really working hard. And so you're really challenged. And that's good. But if you pull a muscle, and that's the same as hypothermia, then that's bad for you.

Jackie Baxter  
It's the classic everything in moderation thing I guess, isn't it? 

Mark Harper  
Exactly. 

Jackie Baxter  
So how did you get into the sort of cold water side of it?

Mark Harper  
So total really researching perioperative hypothermia. So this is getting cold during surgery, when I started swimming in the sea, and I'm a pool swimmer, basically. But one summer the pool was shut by me. So that pool shuts for a couple of weeks, I couldn't do my normal training, I was just complaining to the old friend of mine about this - and he said Ah - swim with the sea swimmers. And I didn't even realize the club had a group of sea swimmers, let alone they swam all year round. And of course, I was just as amazed as everyone else is when they find that people do this kind of thing. And so I started swimming in the sea myself. 

And at that point, I also what I found was, I still remember that first time I did that swim, it was just that it maybe kilometer, kilometer and a half - nothing to stressful, like going for a stroll, really. And then I walk up the beach and just feeling really good, much better than I thought I would feel. And then as I discovered more about the effects of getting cold, I sort of started discovering stuff about cold water exposure and cold water adaptation. And what I noticed was that the stress response to surgery was the same as what's been described as the stress response to cold water. But even better, the way you adapt to cold water reduces your stress response. 

And so we could apply that to patients and maybe reduce their complications. Because stress response here we've kind of discussed this, you know, you want a bit of a stress response - you want it in moderation, but you don't want too much of it. And so what you get with surgery, although you don't feel anything, your body is still reacting as if it's being attacked with a knife, which essentially it is. And so by reducing that stress response to a more moderate levels, you can reduce the number of complications - because that overreaction to the stress response which has a large impact on your post-operative recovery.

Jackie Baxter  
That's so interesting, isn't it? I mean, I've obviously been looking at this through the lens of long COVID and sort of chronic illness, fatigue conditions perspective. So that's amazing to hear about how it can actually help so much with other things as well.

Mark Harper  
The interesting thing is I think they can all be related, because what you're seeing with all these chronic conditions, and we're gonna come onto long COVID specifically in a minute, but they're all related to inflammation. All right, again, you want the moderate amount of inflammation, it's good, it's our first line of defense against attack by pathogens, by injury or for healing after injury. But what you don't want is a too much of it. And again, that's what you get with cold adaptation is a reduction to moderate levels and useful physiological - what I call physiological levels of inflammation rather than than pathological levels.

Jackie Baxter  
So maybe we should talk about the sort of benefits of cold water - and you've just mentioned inflammation. And that is, you know, one of those kind of buzz words around long COVID, isn't it, you know, we talk about inflammation being one of the potential underlying things.

Mark Harper  
The thing about COVID is, you know, okay, it's spread by respiratory route through the air, through the lungs, some of the most dramatic effects and some of the effects that kill people are and not just that - is the effects on the lungs. However, what it primarily is, is a disease of inflammation. And what you find that people have really bad COVID, you know, and talking about the illness here rather than long COVID - Is that they have basically an allergic reaction, a anaphylactic reaction to the bug. And that's why - what you see is exactly what you see with an anaphylactic reaction, plus a few more bits thrown in. And so by reducing that reaction, huge reaction, then you can potentially reduce the risk of illness and whatever from COVID. 

And we know that people who exercise had a lower risk, and that's something that reduces inflammation. We also know that if you exercise, you're doing regular exercise, when you have the vaccination that makes it more effective. So there's a lot of stuff going on there, which is related to exercising and stressing the body but in a moderate way. 

So and with long COVID. You know, I think long covid is very complex. And I think, and especially when you look at the autonomic reaction, you know, that sympathetic, parasympathetic crazy all over the place type of thing. It's not as simple as inflammation, but it is, you know, like fibromyalgia, like all these conditions, what is being described is a condition of inflammation. And so if you can do something that reduces this crazy response, and this excessive response, then that is likely to help. And we certainly found that with fibromyalgia, and I think we're beginning to see it with long COVID as well.

Jackie Baxter  
Yeah, and what I've kind of been realizing over time, from my own experiences, and from speaking to people as well, is that all these things are so interconnected. So we talk about inflammation, and your autonomic nervous system and your immune system, and all sorts of other things that aren't coming to mind right now. They're all so interconnected. So if you were to trigger off one thing, then you have this kind of chain reaction, don't you? So that could kind of work in reverse couldn't it? If you think right, well, I'm going to tackle inflammation, then you would hope that you know, the reverse of the chain reaction where you'd get a kind of like, opposite chain reaction, negative chain reaction, I don't even know what you'd call that, where you'd get the like, de-triggering of all these things.

Mark Harper  
Well, yeah, I mean, always you think about the body. I mean, there are a couple of things in that one is this, this whole distinction, we didn't quite touch on it. But this whole distinction between mind and body is, you know, Descartes has got a lot to answer for. You know, there is just no separate thing. It's just what we're aware of is through the mind - the body is totally linked, everything in the body is linked. And, you know, the mind is part of the body and you just can't separate the two out. 

But also, every system in the body is kind of - I always seems doctor dolittle's push-me pull-you, you know, it's all in a dynamic balance. And what you find is, as you pull one way, the other thing is pushing the other way. So, you know, what you're describing, what you see is, you know, the sympathetic nervous system has just like gone crazy and the parasympathetic doesn't have a chance. Or I think what what also happens is, with long COVID, you get the sympathetic sort of the push-me, because that always pushes you and that pushing you to one extreme, but then it gets a bit knackered and the pull-you bit - the parasympathetic pulls you all the way the other side, you're just going crazily from side to side with no sort of kind of respite in the middle. 

And that is what we're talking about here. We need to look at it in - we need to look at bigger things - a single molecule, a single drug is just never going to work for this. What has worked and certainly in COVID, maybe not in long COVID is steroids, they're dirty drug, you know, they have all kinds of effects and they're anti inflammatory. So, this is you know, what we need to do is look at this, this whole chain and see how we can they break up the cycles, which are just really a bad part of the cycle really not useful at all. 

Jackie Baxter  
Yeah, definitely, it's almost like the bigger picture is the one we need to be looking at, isn't it - rather than diving too deep into anything specific? 

Mark Harper  
Yeah. 

Jackie Baxter  
Because if you can find kind of the bigger kind of overlying-underlying kind of thing, then that's going to help everything, isn't it, rather than treating one specific symptom?

Mark Harper  
yeah. And with something as complex as this, you know, anaphylactic reaction is like a whole host of things, it might take just one trigger, but it sets off a whole chain reaction, as you were just talking about. And that chain reaction, you can't stop it with one thing, you can't just block histamine, you can't just block that or the other, that is all being set off at the same time. And you have to sort of kind of bring it all back with a more global response. 

And so we're saying, with inflammation and how the body is linked together, you know, this is a good example of it with the autonomic nervous system, you know how that's linked, you know, because one of the things about cold water swimming and one of the things that work, so that will have an effect, is putting your face in cold water. That stimulates the parasympathetic nervous system, and that has a direct effect on your levels of inflammation in the body. So they're all linked.

Jackie Baxter  
And of course, a lot of people with long COVID are actually you know, so sort of debilitated with fatigue, that actually, the thought of being able to get to a local lake or pond or loch or whatever country you're in, would actually be too much for them to start with, whereas getting their face into the cold water in their bathroom, for example, that might be a slightly gentler route in for someone that wasn't able to get out?

Mark Harper  
Yeah, without a doubt. I mean, it's really interesting. So I do this thing with schools, where we take the kids and to teach them about the sympathetic and the parasympathetic nervous system. I get them to put their hands in a bucket of ice water. And that sets off the sympathetic nervous system. Then I get them to put their faces in a bucket of cold water or ice water. And it's incredible. We don't actually, interestingly, we don't see that much of effect from the hand experiment. But from the face, it's remarkable. You see, yeah, they put it in, and you see little delay, but then their pulse goes down and down, which is the parasympathetic nervous system kicking in.

Jackie Baxter  
Why the difference between the hands and the face? Like  why does one trigger one and one trigger the other?

Mark Harper  
Well it's more that the sensory nerves that come from the face are different to the sensory nerves in most of the rest of the body. And what it does is it goes through a nerve called the trigeminal nerve, but that is linked to the parasympathetic nervous system. And the reason it's come about evolutionarily, I think, is because it's the diving reflex. So if you throw a baby into the water, it will hold its breath. And that is the diving reflex, which is mediated through the parasympathetic nervous system. And so it's kind of a survival mechanism that has evolved, and it's still there. Not as strong, but it's still there in adults.

Jackie Baxter  
I mean, we probably shouldn't be throwing babies into water. But it's good to know that if we did...

Mark Harper  
Oh, but we do - I mean, yeah, I used to do it with my kids, but in a controlled environment, I'm not saying throw them over the side of a boat into the water. But when you're in the swimming pool, yeah, they just loved it, you know, from about three, four months. Yeah, we took as to little dippers and did baby swimming classes, which was just fabulous. And yeah, and it worked every time - we got the pictures, they're just amazing pictures. They're just like the Nirvana baby, of the kids under the water, just looking perfectly happy.

Jackie Baxter  
That's fantastic. Isn't it? Amazing. So we kind of talked through the how it related more specifically is Long COVID, didn't we?

Mark Harper  
I think we - one thing - I've talked specifically about the parasympathetic. But so that's a short term effect, it's an immediate effect. I think it's worth pointing out that the sympathetic reaction is also important in this, because when you put your body into water, you get the sympathetic reaction. And so your heart rate goes up, your blood pressure goes up - all these things. But what happens is, if you do it regularly, over a few times - the water doesn't have to be too cold, less than 20 degrees is fine. And you don't have to do it too often, you've probably - you can do it over the course of a day, if you warm up. You can adapt over the course of a day if you warm up in between, but you could do it once a week for six weeks, and that would work as well. 

And it doesn't have to be for very long either - just a few minutes, but when you go into cold water, it stimulates the sympathetic nervous system over those six times, over a few weeks, your reaction will grow less and less. So where's first of all, you'll take a big gulp of breath in, you'll hyperventilate, that goes down. Your heart rate, your reaction, your heart rate, your blood pressure is attenuated so it goes down. It doesn't go completely. But that also, in turn means that your heart rate generally goes down, you know, so your general resting heart rate will go down a little, and your resting blood pressure may go down a little as well. 

So you're having a long term effect. So what that means is, you know, that stress response is sort of brought down to more moderate levels. So you spend more time in the good green zone rather than hitting the bad pathological zone.

Jackie Baxter  
Yeah, that's interesting. I mean, I noticed like, when I started doing it, I mean, I wasn't in for very long to begin with, but over time, I was able to go in for longer. But to start with, you know, I would get into the water, and I would get out of the water. And I would go, Oh, my goodness, that was cold. But, you know, I would feel great for you know, quite a short period of time, but it'll be like, Wow, I feel like I've been like plugged into a socket, I would have more energy. But it wouldn't last. After a couple hours, or by the next day, I'd be back down to Ughh I'm knackered again, you know, and then you know, a couple of days later, I go back in the water, like, oh, great, got my energy back but it would never last. And then over time, that has kind of adapted. So now actually, you know, I always feel better when I get in the water. But my energy levels don't drop so much in between. And it's almost like my body has kind of - is that an adaption?

Mark Harper  
You know, it's probably smoothed off, hasn't it? You're not getting the highs. It's like when you eat a really sugary food, you know, your insulin go levels go up massively. And then they go down, and they go down so you're feeling pretty bad about it. Whereas you start eating better foods, you know, lower GI foods or whatever, you see a more moderate effect and the swing isn't so far. And yeah, I think it's really important to point out that you don't have to be in the water very long at all to get the effect. I mean, you weren't in very long. I mean, anyone with long COVID is going to really struggle to stay in a long time. 

And I mean, we getting in towards summer now but two, three minutes, is probably enough, it's just long enough to get your breath back. Because you know how you go in - after 20 years, I still get a real shock from it. I don't like getting in, it still really hits me when I go into the water. But after a very short period, your breath comes back, you can lie back, you can start enjoying the scenery. When you've got in that far, you've done everything really, you can maybe get a bit more. But by that point, you've had the most significant effect. 

And of course, you're not staying too long. Because you'll become hypothermic if you haven't got long covid. But if you have got long COVID, of course, it's going to be exhausting. So it's important not to push it, you know,this thing about pushing it and staying in longer and longer. Yeah, fine, if your water temperature's good, and you're enjoying it, but don't do it for the sake of your health, because that's probably a bad thing. Don't push through that pain barrier beyond that initial shock, because it's gonna do you more harm than good. It's realizing little is all you really need. Just get your breath back.

Jackie Baxter  
Yeah, I think that was something I realized. And I've heard other people talk about as well, you know, they said, Oh, I went in, and I felt good. But then you know, it kind of knocked me afterwards. And I kind of realized that actually, if you're going to get cold, then it's going to cost you energy to warm yourself back up again. So you want to get in and get the effects of the cold water and you know, get that kind of feeling of being plugged in. But without letting yourself getting so cold that you're going to knacker yourself and use all your energy to warm yourself back up again, because that's kind of a waste of time, isn't it?

Mark Harper  
Yeah. And that's it. And yeah, it's kind of you just don't need to do that. And you don't need it. That's the key thing to know. You know, if you want to get the benefits, you will get them from just going in for that brief period of time. You can't go in and get straight out again, that you can't do, but just long enough that everything comes back into focus. And you've done enough.

Jackie Baxter  
Yeah, that's definitely, definitely useful. I mean, you know, I think a lot of people are the same. I certainly am. I'm like, Oh, let's see how long I can stay in for. And I just kind of realized that that's not helpful. I need to get out before I start feeling cold. Otherwise, it's just not really helpful.

Mark Harper  
Yeah, I really think that when you get out and you want to go back in, and you feel you'd like to go back in then you've done it, right. 

Jackie Baxter  
Yes. Yeah, that's true. 

Mark Harper  
If you in too short a time, you've just got the pain and you say, Oh I don't want to go back in, that was horrible. But if you stay in just long enough, you're still warm. You want to go back in. becBut if you stay in too long, you're starting to feel cold and uncomfortable and you won't want to get back in so it's the perfect sort of middle ground.

Jackie Baxter  
Yeah, finding that sweet spot. 

Mark Harper  
Yeah. 

Jackie Baxter  
Yeah. So, I mean, I've noticed myself, and I'm sure this is common across everybody with long COVID is this wildly fluctuating symptoms, and one of the things that I have found quite annoying, - they're all annoying, aren't they really. But this sort of temperature dysregulation, so where I'd be either too cold or too hot, usually too cold. And then when I went into the cold water, you know, on some days, I'd be like, Oh, this is great. I could stay in here for ages, this feels like a bathtub. And then the next day, I would go in, and my body would be like, shaking before I even got in. I just couldn't tolerate it for so long. And I think this is probably related to hormones as well, so women are probably going to get hit worse by that, maybe. But what would be your advice there - other than you know, don't stay in too long if you're already feeling cold.

Mark Harper  
I mean, it's a bit difficult. With long COVID I think he's a bit difficult because you don't have normal body temperature regulation. But I think one of the key things, one of the things I do is you know, one of my six rules in my book ,is to go in warm, you know, make sure you're warm when you go in. It's best to warm up - again it's gonna be difficult if you've got long COVID. But yeah, the best way to warm up is through exercise, you know, generate heat from the inside out. 

I mean, if you do something like you go into a sauna, then your body is heated all the way through. So that's absolutely fine. There's a kind of bit in the middle, where the outside is a bit warm, because you've been in front of a heater or something like that, and the middle bits not so warm. And yeah, that sort of confuses the body a bit. So the point being that, yeah, if you can go in warm - if you're in a cold day, you know, maybe it's not the best thing. I don't know, you know, this is not something I've experienced. I mean, when you got out, was it just horrible? Did it make your symptoms worse afterwards? Or did it still had a positive or neutral effect, it was just, it was just hideous getting in?

Jackie Baxter  
I think by the time I had caught on to the cold water, I had kind of realized that I needed to listen to my body more. So I think on the days where I was feeling like, Holy hell, what is this? This is cold, you know, I would kind of know that that wouldn't be a day to push it. So I would get out much quicker. I would generally still go in if I got the chance. But I would definitely get out a lot quicker.

Mark Harper  
And then when you got out it was still okay? It didn't sort of kind of wreck things and make things worse for you?

Jackie Baxter  
I think generally not, it would probably take me longer to warm up afterwards as well. And I guess I sort of knew that, you know, it's always going to take you a bit of time to warm up afterwards. And you know, you're going to have that sort of shivery, five minutes, while you sort of drink your hot drink and throw on your 16 down jackets and things. So I guess maybe it's really listen to your body, which is what we get told all the time, isn't it? 

Mark Harper  
Oh, yeah. And you know, that's key. Yeah, whether or not you've got long COVID. When it comes to the cold water, you've got to listen to your body. And there's this whole thing about one minute per degree, which, you know, anything that attaches a specific number is wrong, because you know, you've already mentioned it. Yeah, we've got hormones, some days you're cold, some days you're warm. Some days, you've cycled to swimming spots, sometimes you've driven, sometimes you've had four hours sleep, some days, you had 12 hours sleep, you know, all of these things have an effect on how well you're gonna tolerate the cold. And so the only way to know is to listen to your body.

Jackie Baxter  
Yes, I think that's yeah, that's good advice across the board, actually. Yeah. I've noticed that as things have been getting better, that actually I'm very much more sensitive to everything than I would have been before I got sick, because I'm now aware of all these different kind of things that play into how you feel. So whereas before, I'd be like, I feel a bit colder today, but you know, I swim this distance. So I'm going to swim this distance. And now I notice it straight away, I'm thinking, Oh, wow, my body is really needing this today, but not enjoying it very much. So maybe we're just going to do a little bit today. But you know, that's something I've learned over the last couple of years of doing it wrong. Unfortunately, that's how we learn isn't it - mistakes?

Mark Harper  
Yeah, I've been through that as well. Now it's funny, I just sort of go down and it's like, Oh today so definitely a short swim today or today I fancy a much longer one. And it's funny how it's become subconscious now with practice and yes, I've been there, made all the mistakes as well.

Jackie Baxter  
So yeah, what would probably be really useful would be to kind of talk through some sort of top tips for people. I mean, in Scotland, we're starting to warm up a little bit, the water's getting a little bit warmer, the dayligh's a little bit longer, which is quite nice, the midges are starting to come out, which is not so nice. But it's starting to get into the sort of weather where people who have long COVID or whatever it might be thinking, maybe I'll give it a try, whereas maybe they wouldn't have done during the winter. So what are the kind of starting out kind of tips? 

Mark Harper  
Well, I think it's, you kind of said it in a way - is that it's getting warmer. So start when it's warm. I started the middle of August. And that's what I just carried on, you know, I had no intention of carrying on. 20 years and a book later, and a sort of second research career here I am talking to you! But it was - I'm sure it was because I started when it was at it's warmest, so it's probably about 18 ish, 20 ish, at the time, and you know, it still had that effect. So that's one thing. So now's a - that, you know, we're getting it, I mean, it's still May - still quite cold, take a little while, June July, possibly better. 

But in the meantime, you can can work up to it, you know, there's that, you know, we know cold showers. So the two things that affect the effect of a cold - if you see I mean, one is the absolute temperature of the water, and the second is how quickly you become cold. So with a shower, you know, in a normal house, probably getting water is coming out about 18 degrees, or whatever. So it's not as cold as Loch Ness, for example. So it's not quite as cold, but it's still cold. And the other thing is, you don't get quite as cold quite as quickly as you do when you put your whole body in water at once. 

So, you know, there are things you can begin with, which is try a cold shower. And, you know, this is the interesting thing, that there was one study which showed, it took an office and divided half the workers into a group which had cold showers and half who didn't have a cold shower in the morning, and the cold shower group took less sick days off. So you know, we've seen a measurable effect, it's not as much as immersion, but you have an effect. So that's one way of starting. 

And then you take it up next level is getting in to the bath, get into a cold bath, again, that's gonna be 16-18 degrees centigrade, something like that. And that will have more effect than the shower, but it will start adapting you to it. 

Then there's also the face thing, we've discussed that already - putting a face into a bowl of cold water or ice water, or whatever. But I think the important thing, though, is - especially with the autonomic effects of long COVID - is that you just do one first, and then the other, if you just do the face in the water, that's fine. But if you gonna do the bath, then get your body into the bath first and get used to it, get past that initial Ah - shock. And then, only then, take on the parasympathetic nervous system and put your face in the water.

Jackie Baxter  
And that with the bath - we're still talking just a couple of minutes, as enough, is it?

Mark Harper  
again, just long enough to be until you re-conbobulate. You know, 18-20 degrees, you can stay in longer, and it's totally safe. But you know, why bother? You know, why put your body under that extra stress? And I think what's happening is you're just, you're beginning to break some kind of cycle that's going on - this kind of vicious cycle that's going on the body and this is what we're trying to do. 

And it's certainly I think this is why it works, I think for mental health as well. Is you know, there is this inflammatory effect. But there are bits you can't explain just through inflammation. And I think what's happening is it's interrupting negative thought patterns as well. 

I mean, so a bit of a tangent, but yeah, the reason I think this is that I saw, there's a great TED Talk by a woman called Jill Bolte Taylor, called My Stroke of Insight. Now she's a neuroscientist in the US, who had a stroke one day, and she woke up with it, Oh, I'm having a stroke. She knew about strokes. She was a neuroscientist, but she didn't care. She said, Oh this is quite nice, actually. And the reason she thought it was quite nice, is because what was happening is she's having a bleed into the left hand side of the brain. So it's suppressing the left hand side of the brain. And that is the part of us, which does time, does worrying, does, you know, keeps us safe. You know, logical reasoning, thinking. And that was being suppressed by the bleed whereas the right side of the brain that's being in the moment, that empathy, that being at one with nature, it's just that all that happy, happy parts, as it were. 

And you know, she recovered - 6 years later, she recovered. The thing that motivated her was to get everyone to take a step to the right, as she calls it, is because she saw how amazing this was. We're stuck in the left side of our brain which is constantly anxious, constantly trying, that's how to do this. What we need to step into the right side of the brain. 

And certainly I'm lucky enough not to have suffered from mental health issues or anything. But, when I get into the water, I get in. Brain going everywhere. You know, I've often cycled down, I'd be hot and sweaty, and then, you know, get out, I'm utterly transformed, I am in the right hand side of my brain, I am thinking - this is nice, is lovely, you know. And so, you know, I think it's just taking out of the left hand side of the brain, taking away, breaking that cycle and sending you to a different place. And I think maybe this is what we're seeing some similar effects on the autonomic nervous system, I don't know, or the inflammation, we're just breaking these cycles in some way.

Jackie Baxter  
Yeah, I mean, I think mental health and the mental health side of long COVID is something that is quite difficult to talk about some of the time, because I think many people with long COVID have struggled with their doctors, with their health professionals, because they've been gaslit, either by their doctors or by their family and friends, or by you know, whoever. And a lot of people have been told, Oh, it's just anxiety. So people who have genuine mental health concerns alongside their long COVID, because why wouldn't you - when you're, you know, long term ill, I think a lot of people are quite worried about saying to their doctor, I have anxiety, because they're, you know, worried that their doctor is going to turn around and say, Oh, well, yeah, that's what I've been telling you for ages. And, you know, sort of all the gaslighting and stuff. 

And this is something that I get really annoyed about, because mental health is incredibly important. And, you know, I have had a huge amount of anxiety, it's not the cause of my long COVID. But you know, it's caused by long COVID, but then feeds back in and makes the other physical side of it much worse. So you end up with this cycle. So I think, yeah, you know, something like cold swimming, that can really help the mental health side of it as well, I think that is a really, really important side of it, and shouldn't kind of be overlooked.

Mark Harper  
As I said earlier, you know, you can't take the one from the other, you can't take the mental health from the physical health, because your physical health affects your mental health, we know 60% of depression, is related to inflammation. And this is how I came to think that maybe we could use cold water swimming to treat depression. Because at first it was like, you know, I felt really good when I had a swim. But then I read an article in the newspaper, saying, well, actually, maybe depression is an alert of some sort of an allergic reaction, because so much of it is related to inflammation, and you can fix the inflammation type of depression. 

And again, it's really difficult because depression is many, many things. Long COVID's many, many things. Fibromyalgia is a very complex process. But you know, taking it from a very simple lesson, yeah, the 66% of whatever it is, depression that is related to high levels of inflammation, responds to different treatments, including anti inflammatories, to that type of depression, which is not inflammation related. So you just can't take them. Yeah, you can treat the inflammation, say through cold water swimming, and both will get better. You just can't take them apart. 

You're gonna feel anxious with it. Because you've got these high levels of inflammation, you've got this crazy autonomic nervous system, your microbiome is probably all screwed up as well, and you gotta treat all of these things. And that's why I think something like cold water swimming is such a good thing, a good thing to try, and it might not work for everybody, but it's this global thing that works. It works over the whole body, and the body and the mind and in the kind of integrated way. And that's why I think it's worth giving it a go.

Jackie Baxter  
Yeah, definitely. And it's fascinating what you were saying about the person with a stroke. And I have a very, very busy mind. I'm one of these people where my brain refuses to switch off and it's like a hamster wheel. And I think it drives anyone I'm speaking to you completely crazy. And I've definitely noticed that being a little bit of a theme across people that I've seen with Long COVID. 

But when you get into the water, it calms down, it shuts up, it goes away. And I was swimming the other night was beautiful, sunny calm loch. And my friend said to me, That look on your face, you have never looked so happy - and Imust have just been like floating in the water with this massive smile on my face. And all of the other things in my life that are stressful, that I'm worried about or that I'm thinking about or the plans that I have or you know, whatever it is. None of them were there at all. I was just like floating. And it's amazing, isn't it? How it can do something like that?

Mark Harper  
Yeah, it is. And this is exactly what Jill Bolte Taylor described, you just took a step to the right, and you're out of that busy to-do list on the left hand side of the brain.

Jackie Baxter  
We can't live all our life like that, we probably need that other side of our brain sometimes. 

Mark Harper  
Definitely yeah

Jackie Baxter  
But yeah, yeah, we do, we need to get out of there some of the time, at least I think. And that's something that I find very, very difficult.

Mark Harper  
There are other ways. Many other ways to do it - yoga, breathing, you know, I love I just do a short breathing thing - six minutes of six seconds, six seconds out, it's so simple, it's this little app on the phone. And, you know, it just transforms me from frazzled to not frazzled, and a bit more awake and stuff like that. So yeah, it's not just down to the swimming, but yeah, I definitely have a real hit when I go swimming.

Jackie Baxter  
Right, we've made a massive tangent, because we were talking about tips for for getting in the water.

Mark Harper  
I've got a few rules about getting into the water. So one is you get your body in first and then afterwards, and then go in warm. Make sure you know where you're going in is a another one, you know, there's this thing called Agnes Allen's rule, which is "almost anything is easier to get into than out of", it applies over everything in life, I mean, I think is utterly brilliant. Anyway, but that's the same with cold water - make sure you know how you're gonna get out befor you get in. And then warmth is important, when you get out, you know, all that water on your skin, you won't feel it, but that water in your skin will cool you down very rapidly if you don't get dry quickly. So get out, get dry, get warm, you know, get out of the wind as soon as you can. 

And then do it with someone else, you know, it's much safer, and there's so many people. And then you know, we've got like Chill, which is the group that we been running our clinical trials through started in Devon, they run courses. So Mental Health Swims is kind of like a meet up group. There's also like the Blue Tit, which is another Meetup group. And then you have like, Chill, which is more kind of giving confidence in the water, you know, that confidence and fun and everything. But yeah, just gives you that introduction to the water. So you can get used to it. 

And you know, there's a couple of groups in Scotland already. But we started in North Devon, and that's expanding all the time, very keen to sort of support people to go out there, that's about just getting into the water, getting used to it, getting the head under the water, not being scared of that. And then so with the view that you take it further and you know, this is what we found, is that people will come on the course. And then they'll, which is eight weeks or a swim sometimes over four weeks. And then they'll go on and over 60% continue to do it in some form afterwards.

Jackie Baxter  
Yeah, that's amazing, isn't it? 60%. And, I mean, you were just talking about groups just then. And I joined a group quite quickly, I started sort of going in my other half came with me. But you know, he couldn't come all the time - I wanted to go in more often than he did. He did it because I did, rather than because he particularly wanted to. But joining a group, I mean, one of the things I've noticed with long COVID is how isolating it is, a lot of people aren't able to work, you're not able to socialize in the way that you were before, a lot of the hobbies that you did, you can't do anymore, therefore you're not seeing your friends through those things. You know, even a lot of people aren't able to sort of see people at all, you know, engaging online even is exhausting, sometimes more exhausting than doing it in person. 

But you know, when I joined this swimming group, they didn't know the me from before. So they weren't comparing the me from before. And they weren't judging me on anything. You know, if there were days where I didn't want to swim very far, I just wanted to sit in the water, then that was fine. But you get that social aspect that so much of us have lost. I think we've maybe forget how important that is sometimes. 

Mark Harper  
Yeah, 

Jackie Baxter  
because you're still sort of stuck on your physical symptoms. And all this isn't working or, you know, this isn't working, my nervous system's haywire. I've got inflammation here, and I've got, you know, whatever it is that people are suffering with. So yeah, I think the sort of social aspect of it has as been quite a big thing for me, and I didn't expect that.

Mark Harper  
And we know, social connection is one of the most important, one of the most significant determinants of health, in any form - quite apart from long COVID. The social isolation is totally independent and powerful indicator, or cause in the loosest possible sense of the word, of ill health. So that's absolutely and this is one of the reasons why I think outdoor swimming is so good, is because it's this whole package of benefits, you know. 

Again, yeah, as I said, it's a global thing anyway, that cold water gives you a kind of global effect. But also you've got blue therapy - being with water, yeah, we've got green therapy, being out in nature, we've got social things, you've got autonomy, you're self-determining your treatment, and you've got exercise, all these things we know, independently to be good for health. So that's why it works. And it's neatly packaged up into something that is quite fun to do.

Jackie Baxter  
Yeah, and you can do it at your own level, I think as well, is just such a big thing, isn't it? You know, like, exercise can be a bit of a contentious subject when we talk about long COVID, because, you know, exercise, people see that as like pushing yourself, going for a run, you know, something big, and a lot of people aren't able to do that. Or if they do make themselves do it, then it puts them in bed for a week or something. But you know, doing some sort of sort of exercise or movement that works for them. 

And I don't know, I'd be curious as to your thoughts about post exertional symptoms as well, because, you know, if you go for a walk, and it's a bit further than you should go often it'll, you know, knock you out, and you'll get post exertional malaise or post exertional symptom exacerbation. But I have never got that from cold water. I've got it from all sorts of other things like brushing my teeth sometimes, but I've never had it from the cold water. And is that just because I've never pushed myself too far? Or is that because of the cold?

Mark Harper  
I honestly don't know. I can offer some theories. One is yes, because of the cold. But I think also a really interesting one is because it's supports you - the water supports you. And because it compresses around you as well. You know, maybe, I don't know, does this have some effect on the way the vessels, the sympathetic nervous system, all this expansion and contraction of blood vessels? Maybe it's because it has some effect on that. But I think it's something to do with the way you're supported. But I don't know quite what it is. 

But this is it. I did the thing at the Scottish Parliament a few weeks ago, you know, for the Save Our Pools campaign for Scottish swimming. And one of the points I tried to bring out there is, how swimming as an exercise is something that for a lot of people with illness is kind of the only thing they can do because they are supported while they're doing the exercise. You know, you can go your Zimmer frame and do walking or with your walking sticks. But yeah, there's always the risk of fall, it's always very tense. Whereas you get into the water. There's no tension there at all. You can just let go. You were just describing a minute ago how you were just lying back, and we all do that, it's one of the joys of being in the water. And you can just let go.

Jackie Baxter  
Yeah, it's yeah, it's much lower impact, isn't it? So I guess for people that are unable to do quote, unquote, exercise, but you know, want to try something and you know, want to get outside, maybe getting into the water, and even just kind of sitting in the water for a couple of minutes. That might be a good way to start, maybe.

Mark Harper  
Yeah, and we know that any, any increase in exercise has a measurable effect, you know, you can do lots, the more you do, the better, basically. But any increase in exercise has a measurable effect on cardiovascular health. So you know, even just getting out the car, walking down the beach or down the path to your swimming sport, getting in the water, getting out of the water, walking back again, that will have a measurable positive impact on your health. So yeah, as you said, you we think about exercise as a 10k run or something like that. We don't need to, we can just think of it as any physical activity. And yes, the more we can do, the better. But obviously, with long COVID, that's very difficult to do a lot of exercise.

Jackie Baxter  
Yes, exactly. Yeah, the more you can do the better but within the kind of parameters that is not going to trigger issues, I guess, isn't it?

Mark Harper  
Yes, exactly. I mean, I suppose the other thing I'd say is, so I wrote those six rules and then after the book was published obviously I've talked about it quite a lot, and I brought it down even more to like the next one was two things - which was minimize discomfort, maximize fun. And by that I mean you know, minimizes discomfort - wear shoes, wear gloves, that's gonna have no effect, it's the effect on the body and putting your face in is great. But you know, wear a swimming hat, because it is just the face, not the whole head. It's just the face - and putting the whole head in, you can be uncomfortable - don't want that. So use all those little extra bit. Wetsuit is such a pain, but you could use a rash vest or something like that. Getting in and out of a wetsuit makes it - yeah, it will have an effect, but it makes it more effort than it's probably worth for what we're talking about here. So think carefully about that. 

Jackie Baxter  
yeah, I definitely found that the wetsuit was more trouble than it was worth, I would rather get changed quickly and stay in for less time.

Mark Harper  
While it's really interesting, I think, with long COVID, you know, it's something I've been a bit worried about. I feel it should work. But because of all the the sort of really difficult symptoms, particularly the autonomic ones, I've been a bit concerned that maybe for this, it wouldn't quite do the job. But you know, your experience, and, you know, more and more feedback we're getting is that it is a good thing. So anyone who does take it up, has any comments about it, please get in contact. And just let me know what your experience with it is. Because I'm really interested to know if, I want to know if it has a bad effect, or it has a good effect, because this is how we can take it forward. And you know, work out ways of introducing it to people, because it is potentially as you found, and others have found, of great benefit. 

Jackie Baxter  
Cool. Well, thank you so much for joining me tonight. It's been so fun chatting to a cold water enthusiast, but also really helpful as well. And hopefully you've inspired loads of people to maybe at least think about giving it a try. So thank you.

Mark Harper  
Yeah, pleasure and thank you for sharing your experiences as well.

Transcribed by https://otter.ai