Dr. Courtney Conley: Dementia, 4,000 Steps, Big Toe & The 6th Vital Sign | TUH #274

If you were to ask someone what they want to be doing in the last decade of their life, every single person would say walking.

In older populations, foot strength and the foot mechanics have got to be so inherently connected to longevity because of the fall risk.

I really want to stress that walking should be a physiological necessity on the same importance as breathing and sleeping. Those three things, when optimally done, This is what it's about. This is longevity.

And that's what's inspiring to me about the longevity sciences is that a lot of it is just a back-to-the-basics approach.

Us being a biped, it is literally what defines us as a human being. And it's a part of our body that was designed to handle loads. But when it's ignored or put in footwear that is ill-fitting or doesn't fit or respect the anatomy of the foot, you're gonna have problems.

If we just back up for a section, somebody's watching this podcast and starting to be convinced that I need to walk more. Where do they start?

What I will tell my patients— listen. Ultimate Human.

Hey guys, welcome back to the Ultimate Human podcast. I'm your host, human biologist Gary Brecka, where we go down the road of everything anti-aging, longevity, biohacking, and everything in between. Today's guest is a really, really special guest because as I was doing the talent research and hearing from you about guests that you wanted on the podcast, and we found this doctor who specializes in something everyone needs to know about that is accessible to every single person watching this podcast, I realized we are academic brothers and sisters. Um, because we went to the same undergraduate school, we went to the same grad school, and we got the same degrees. So I was like, wait a second, the University of Maryland National College of Chiropractic, which is, which is now National University of Health Sciences. You got a human biology degree there. I got a human biology degree there. In undergrad, I did get biology. You got kinesiology. But, um, I was actually born in College Park, Maryland.

Oh really?

Did you go to College Park? Yeah. Oh gosh, I mean, that's crazy. I was like, I was like, and then I immediately called Malia. I'm like, how old is she? I wonder if I, if I tutored her in my anatomy. 'Cause I tutored anatomy for the 3 years that I was at National. And I was like, and he was like, "No, but she's too young." I was like, "Little spring chicken of her." So, I mean, such a small world. It was National College of Chiropractic at the time, and now it's National University of Health Sciences. But I got a great education there. I found them to be very science-based, very, very medicinal. It was not, You know, it was not a school, a chiropractic college at the time, that taught that spinal manipulation was the be-all and end-all of everything. Yeah, you know, they really taught that whole person approach, that whole anatomical approach. And it's funny, I get asked a lot, like, what is a human biologist? I'm like, I don't know, that's what my degree is in, so I call myself a human biologist. My degree says, conferred the degree of— so yeah, I think you're the first human biologist, uh, other than myself that we've had on the podcast. So it's vindication for me. Um, so, uh, but anyway, welcome to the podcast.

Thank you so much for having me.

And, and it's, it's funny how similar our tracks were, you know. Um, starting— you graduated in 2003? Yes, I think. Yeah. So was it National University of Health Sciences by then?

Yes.

Okay. Lombard, Illinois, man. Yeah. Uh, I love the school, did not like the weather.

Yes, it's one of the reasons I moved out of Chicago. Me too.

I learned to believe in seasonal affective disorder up there because I lived in, uh, Well, we lived in Lombard, and then after graduating, I moved to the South Loop in Chicago, and like, you don't see the sun for 6 months. And I was like, everybody's just eating pizza and getting in bar fights and cranky.

It's definitely not one of those areas that in the winter you can play outside.

Yeah. No. Not like Colorado. No, no, it's not. And the Board of Trade was like 3 blocks from my house, and it was such a brutal walk to go 3 blocks in the wintertime in Chicago. I was like, I don't know where I want to live, I just don't want to live here. You want to be here. Sorry, sorry, Chicago, great city, don't get me wrong, but terrible weather. So, you know, um, your background and your journey started with, like a lot of my podcast guests, um, with the sort of this pain to purpose journey. Yeah. You know, you were kinesiologist, um, you were working in an ortho lab, building orthotics, and something about you said, this is all wrong. We're actually destroying foot mechanics. And you banged a turn and started on this trajectory.

Yes, I think whenever you have a passion for something, there's this personal quest behind it. And mine has always been with feet. Yeah. And yes, when I was in school, learned about the foot and ankle, I think we had maybe half a semester.

Yeah, we spent a lot of time on the spine, spinal anatomy.

But my professor there was so knowledgeable and passionate about the foot, and it just really sparked my interest. But at the time, basically what we were taught was, well, if the foot hurts, here's a foot orthosis.

Right.

And if it continues to hurt, we know a good surgeon. And there is a time and a place for everything, but for some reason, you know, that just did not make a lot of sense to me, because if you look at everywhere else in the human body, where we look at rehabilitation, for example, we don't treat it anywhere near like that.

No, we don't treat it by itself. You know, interestingly, I read a book called "Born to Run" years ago, It reframed my thought on foot mechanics. It was the first time that, and it was about these tribes in Mexico that would run extraordinarily long distances. Like 70+ miles was not odd for them over rough terrain and it was barefoot. And the whole thesis that came out of that was that basically the foot industry is casting our feet in these non-anaconda, anatomical positions and causing up-chain issues, knees, hips, shoulders, rotator cuff, spine, because of how we've gotten accustomed to, we need cushioning, we need support, we need high arches, we need all of these other things in order to walk properly, when the truth is the human foot is so adaptive. I think I remember from school, there's 300 planes of motion in the foot, something like that.

It's always so, it boggles my mind. It's an evolutionary, mismatch of what we really have done to our foot. Chris McDougall's work has been an inspiration of mine for a long time. And I think when we think about the mechanics of the foot and what the foot's actually doing, it has been beautifully designed to handle loads. Yeah. But when we ignore it, you have problems.

Yeah. You call walking the most underprescribed medicine of the 21st century.

Yes.

And what do you think is like most fundamentally misunderstood about walking?

You know, I was thinking about this on my flight here and I love the name of your podcast, "The Ultimate Human." And I was like, you know what? Do you know what makes us the ultimate human? The fact that we can walk on our own two feet.

Well, you just answered the last question of my podcast 'cause my podcast always ends with, what does it mean to you to be an ultimate human? So you just avoided a question at the end.

It's important though. It's us being a biped. It is literally what defines us as a human being, as a species.

Yeah.

And we've wildly ignored it.

Yeah.

And it's a part of our body that was designed to handle loads. When we're walking, we have multiple times our body weight going through our foot.

Yeah.

And when someone says to me, "The foot needs arch support," I always question that because it doesn't. It's been evolved to handle these loads, but when it's ignored or put in footwear that is ill-fitting or doesn't fit or respect the anatomy of the foot, you're gonna have problems.

We actually have a foot with us here today. I do, Eddie.

This is Eddie. This is Eddie.

Tell me that's not an actual real person. Okay.

I am a very big Pearl Jam fan.

Okay.

So all of my foot models are named after Eddie Vedder. Oh, they are named after Eddie Vedder.

Okay, I like Pearl Jam too, but this isn't— this isn't Eddie Vedder's foot. That is not— okay, good. I'll be a little gross. So, you know, again, I remember learning that there's 300 planes of motion in the foot. I remember being fascinated by that. Um, I also remember this book Born to Run, and it like reframing my— and I— so I started for months, I started wearing the toe shoes.

Yes.

I got so much— I was so ridiculed for these things, and They were really a pain to put on 'cause I had to tuck each toe into these foot shoes. And I think because I had worn terrible shoes for so long, those actually started to hurt my feet. Oh yeah. And, you know, I went back to modern footwear, but I've also noticed that as I overpronate, which I have a very bad collapsed arch on one side of my feet, that, you know, I do get medial knee pain and then I get lateral hip pain. And it's worked its way up to my shoulder. And I'm convinced that that kinesiological connection between my foot mechanics all the way up to my gait and my shoulder are connected.

You are correct.

Yeah. And I think that it happens so slowly over time that we start to treat them like isolated incidents.

There's no part of the body that you can treat in isolation. A lot of my patients in my clinic will present with low back pain or hip pain, and I'm always evaluating the foot. Really? It's our first connection with the ground. It's what keeps us upright and balanced when we walk and when we move. So to not assess the foot and all the planes of motion and the ranges of motion that give us efficient movement is, you know, a disservice.

So I guess the big question is, is it fixable, right? I mean, 'cause every golf pro you talk to says, I would rather teach somebody to swing a golf club for the very first time than take somebody who's been swinging it wrong for 20 years and retrain them, right? So, you know, by the time you get ahold of an athlete or someone with Borgate, I mean, those mechanics have been there, those neural pathways have been ingrained for decades, maybe. Right, so where do you start with changing foot mechanics?

I think when you look at it from the most basic perspective, if I had low back pain, we would tell people to strengthen their glutes, strengthen their core, become more active. This is the very same conversation we can have at the foot. It is, it can get stronger. We can improve mobility at the big toe. We can improve mobility at the ankle. We can improve strength of the foot. And these are the conversations we need to have. So yes, things can change and they will change.

And I think it translates to a lot more than just foot mechanics. I looked into some of the research that you've done or cited, you blew through the 10,000 steps myth, saying that just getting 10,000 steps a day is not where it's at, 7,000 is enough, but you talk about the pace of walking and you also talk about the, relationship between the pace of your gait and longevity, which is where I have a keen interest.

Yeah, that fast brisk-paced walking is where it's at. And I think people would find that it's actually faster than you would think.

Really?

It's about, so on a treadmill, 3.0, 3.5, 4 miles an hour. If you look at the cancer research, it is 4 miles an hour, 30 minutes, but you can decrease your risks of cancers, liver, lung. I mean, it's the panacea of medicine, but it's that pace, that fast pace that we're looking for. And it is quite, you know, depending upon where you live, you know, I live in Colorado. You have a 4.0 mile per hour, you know, pace going up a mountain. It's brisk.

Yeah, yeah. Well, Colorado is actually one of the fittest states in the nation, believe it or not. Randomly ran into that fact on another podcast. And the amount of outdoor activity they do is sort of second to none. So they're year-round exercise.

Well, that's one of the reasons I wanted to move out of Chicago.

Yeah.

For 6 months out of the year, you're indoors.

Yeah.

For, you know, not that mountainous Chicago.

Across country.

Yeah.

Well, we've really hammered Chicago. I lost every Chicago follower right now. It's like, delete us. So they're out.

But in Colorado, you can, I mean, you play in the winter.

Yeah. No, they all do. They're all outside. Like, the ski slopes are packed. And then the slopes are just as packed in the summertime with mountain biking and hiking and trailing and like, you know, and everybody's fit.

Yeah. There's something, I recently moved to the mountains. I live at about 8,000 feet and there's something gritty about it. You can't be, you have to be a little— Tough.

Tough.

Yeah. You know, it's not easy living by any means, but there's, there's a sense of accomplishment, if you will, with just daily tasks, walking around and walking your dog. And I appreciate that.

Well, I wanna get back to the 10,000 versus 7,000 steps and the brisk pace, because I feel like the vast majority of my audience can walk. Yes. You call it the most underrated prescription in the 21st century. What would you do? In terms of what kind of prescription would you write for walking? To increase speed? To reduce— you know, I saw 7 to 50% reduction in cardiovascular risk, reductions in all-cause mortality, reduction in dementia risk, which I found very fascinating, just simply by drawing your attention to regular walking.

Yeah, I think it's very individualistic. So you have to consider Who's in front of you? So I have patients who are in chronic pain. They've been in pain for years. Their baseline might be 2,000 steps, 2,500 steps. With those patients, if I can increase their step count by 500 steps, that's about 5 minutes a day. Okay. You're decreasing your risk of all-cause mortality by 7%.

I saw that.

It seems like a no-brainer.

Yeah.

It's challenging because these people for years, now it's not just a musculoskeletal diagnosis that triggered their pain. It is now much more complex. There's an emotional side to it, there's a mental side to it, but that's the beautiful thing with walking is that you can start to increase your step count. It's a safe activity, it's easily accessible. So when we get these patients to 5,000 steps per day, they decrease their risks and their symptoms of depression.

Yeah.

You get them to 7,000, now you're decreasing the risk of getting depression. And, you know, I think you can attest to this. There is always a correlation, a 100% correlation between my patients that are not walking or are unable to walk in their mental health status. They just go hand in hand.

Could not agree with you more. And I think a lot of it has to do with neurotransmitter function. You know, I have a saying that the presence of oxygen is the absence of disease. And the reason why I say that is if you look at the actual neurophysiologic structure of emotion, very often oxygen is a component of elevated emotional states, passion, elation, joy, arousal, libido, all the hell yeah, I won the lottery emotions. And they're more accessible than people think. And you can access them through things like mobility. And I've seen a lot of side-by-side studies on SSRIs versus exercise, and exercise wins hands down every time, but we never prescribe exercise. I mean, I don't think anybody that's been depressed, their physician ever said, "Why don't you just get outside and—" It should be on every doctor's prescription pad.

The number one thing on a prescription pad.

Listen, there's what I share on this podcast And then there's what I share with my inner circle. If you've been following me for a while, you know how I hold nothing back here. But my VIP community, that's where the real magic happens. Picture this. You're struggling with energy crashes, brain fog, or just feeling like you're not operating at your peak, and you don't know where to get real answers. But here's what really sets this apart. You're not just getting my insights. When I have incredible guests on the podcast, VIP members get to submit questions for a private podcast segment. So that world-renowned expert we just interviewed, you get exclusive access to their knowledge tailored to your specific situation. This section is under the private podcast section in the Ultimate Human Community. And speaking of exclusive, you're getting my personal protocols, the exact tools I use for water fasting, gut optimization, and morning routines that have taken me decades to perfect. This isn't theory. This is what works in the real world. The community launches challenges throughout the year where you get direct access to me and my network of experts. It's like having a personal health advisory board for less than $100 a month. Your health is your wealth, and this investment pays dividends for life. Join the VIP community at theultimatehuman.com/vip and step into your ultimate potential. Now let's get back to The Ultimate Human Podcast. So, so starting with gait analysis, um, if, if when someone comes into your clinic, um, for an evaluation, like, what, what are you specifically looking at?

I love watching people walk.

New York must be high stress for you. Like, she's jacked up, he's jacked up. This guy's got overpronated, underpronated, ankle roll.

My fiancé's always like, "Can you just leave them alone? They're probably happy." I'm like, "I know, but I feel like I can—" Don't go to Disney World, they waddle. I mean, it's, I always call it a neurological window. It's like a window to someone's soul. You can tell when someone's had a good day or a bad day. Like the happy walk. The happy walk, the excited walk. But yes, when someone comes into my office, either get them on the treadmill, if they're not used to that, I'll just have them walk in my office. And I'm just getting a big picture view of what they look like. Do they look comfortable? The word we often use when I teach the courses is efficient. Do they look efficient? Does it look like they could walk for long periods of time? And oftentimes it doesn't, it looks like a struggle. And walking gait should not be a struggle because we as human beings were designed to walk for very long distances for long periods of time. Yeah. So we look at those types of things.

And where do you fall on shoes? Don't look at my shoes. Hey, don't look down. I know you want to. I already did. Eyes right here. This is a judgment-free zone. Um, yeah, where do you fall on shoes? Because let me tell you something, like, I think the worst thing we ever did was put women in 7-inch stilettos. Oh yeah. And you know, I, I have these Ferragamo, um, beautiful loafers. Um, they shed— they bring a tear to my eye every time I take them out of the closet. They're so beautiful. They hurt my feet. I, I mean, I can't even walk through an airport with these things. The little flat piece of leather, toes jammed in to the front, and a hard wooden sole in the back. Yeah. And I think we have definitely exchanged fashion for function. Oh, 100%. Um, But where do you start with footwear recommendations for—

When you look at your foot, the widest part of your foot should be your toes. So very simply put, the shoe should respect the anatomy of the foot. Why is there always that triangle at the front of every pair of shoes? If you look at the majority of shoes, they are tapered at the toe box. Yeah. And it's this fashion over function that we've really grown accustomed to from a societal perspective. Yeah. And that really needs to change because I truly think that if we just put people's feet in footwear that respected the anatomy of their foot, my office would be way less busy. Yeah. Especially from structural changes that happen, your diagnoses of bunions and neuromas and hammertoes and pain in the forefoot, those go away. When you can allow your foot to splay and improve its strength. But it just doesn't make sense to take the widest part of your foot where you also have the most load when you're walking.

The dorsiflexion, like when you push off.

As you push off. Yeah. And put that into something that's tapered and squeezed together. It just doesn't make sense. If you wanted to balance, which we all should, it's walking gait. Would you balance better with your foot looking like this or like this? Yeah. It's, you know, especially with the aging population. Yeah. It's an imperative conversation to have.

Yeah. You know, I saw images of geishas, their feet. Like foot binding. Yeah, foot binding in like the Asian culture, it was like, very, um, considered beautiful if women had really, really tiny feet. So they would actually put them in wooden shoes that wouldn't allow their feet to grow, and the toes would grow in underneath of their— it's heartbreaking. It looks like they were in a blender. And, um, and then they would just sort of tap and hobble. They look like a little ballet dancer trying to tap the floor. And I guess that was considered, yes, attractive too. Um, and But I see people's feet like that. You do? Yes. Yeah, I mean, just destroyed. Yeah, destroyed. Yeah. So you like anatomically correct shoes should be wider at the, obviously at the front than they are at the heel.

Especially the big toe. Like if you were to look at, I'm gonna bring Eddie out here.

Yeah, let's bring Eddie in here.

If you look at the foot, the big toe should be straight. That big toe is what we utilize when we push off our foot when we're walking. And there's a lot of strength and power that comes from that big toe. And I'm not just talking about a walking gait, I'm talking about professional athletes cutting and sprinting. A lot of that power comes from the foot and ankle, and in particular, the stability of the big toe. So when you compromise the function of that toe and you take it and you angle it like this, you're disrupting the integrity of the midfoot, you're making it harder for the big toe to engage, and you will compromise what's happening at the ankle, at the knee, and at the hip. So that's my lowest-hanging fruit, is just wear a shoe where your big toe can be in the position that it was designed to be in.

And can it— will it slowly come back and anatomically correct itself?

Depending upon when you intervene. That's why I think this conversation needs to happen sooner with our children, right, rather than later, when the foot is still flexible. So for someone who comes into my office that has a bunion, for example, if it's flexible and I can literally take it and move it, that's always a good sign to me. Okay, because then I know I can work on strength. I can utilize toe spacers, for example. We get them in the right footwear. But depending upon someone's age and how rigid the foot becomes If that big toe now starts to tuck under the second toe, we've seen feet like this.

Yeah, I've seen professional basketball players' feet that are like that.

If you can't move the joint, these are different conversations. This is, do I need surgery? This is, do I need some type of orthopedic shoe to now rocker me through my forefoot because I've lost stability here? Yeah. So we don't want to get to those conversations. I mean, those bunions and hammertoes and a disruption of the integrity of the forefoot increases our risks of falling as we age.

Yeah. Falling is the greatest risk too.

It's a much bigger conversation than I think we're paying attention to.

Yeah, and I think we can make up for that in younger years, right? Yes. 'Cause we're a little more nimble, we have more proprioception, maybe we can, if we're off balance, we can just double step. Yeah. If we catch the back of our, heel with our toe, we can catch a step, but in older populations, grip strength and that foot strength and the foot mechanics have gotta be so inherently connected to longevity because of the fall risk, basically.

Yes, you mentioned grip strength. There was a great study in Japan and they looked at 1,400 workers at a Toyota facility. And they looked at their toe strength versus their grip strength.

Yeah, you talk about toe strength, I love that.

And toe strength actually declines faster than grip strength. And it was also associated with other metabolic markers. And when you lose the capacity and strength of your toes, it increases your risks of falling. Because if you think about it, if I was standing and I went to lean forward, the first thing you should feel are your toes pressing into the floor, hopefully in a wide splayed position, right? Right. But if you lose that strength, which we know sarcopenia is a thing that also happens in your foot— age-related muscle wasting, yep. So if I lose strength in my foot and I can't feel things, and we know we lose power faster than we lose strength, so there's our reactivity. Right. This is not a good recipe for being balanced and upright as we age.

Right. Now, what are some of the— what is a typical patient journey for someone that comes into your clinic with— and let's maybe talk about professional athlete and let's just talk about soccer mom. Yeah. Right. That comes into your clinic. They have disruptive foot mechanics or gait anomalies. And then you fix those mechanics. What are you seeing in those patient journeys?

When we do the gait assessment, I will pick out, I'll prioritize what's necessary to make them efficient. So that depends. When I look at someone's foot, we'll start with, can you do basic things like lift just your big toe, lift your foretoes?

I'm doing this right now, by the way.

Okay. If you couldn't lift just your thumb, you'd probably panic.

Exactly right.

We should be able to do those things with our feet. The feet, the hands, and the lips have the most real estate in the homunculus. That means they have a lot of sensory input, and then our brains increase motor output. So we should be able to do these things with our feet. We also should be able to lift up all of our toes and spread them. So you should see daylight between each toe.

Oh, I think I'm feeling that one. Yeah, I think I'm— yeah, I see some grimaces on my staff's face off camera too. They're like, yeah, no daylight between those sausages.

So if they can't do these foot awareness drills, as I call them, then that's where we have to start. Yeah, you'd be surprised with the professional athletes that I have worked with. Um, they will tell you too, in all of our— through college, through all of our training, they're building jet engines of bodies on paper airplanes of feet. Wow. So we know that there's a lot of body weight going through our feet when we run, for example. So with these athletes, I'm saying, you should be able to produce power. You should be able to do X amount of single leg calf raises. You should be able to produce a certain amount of strength out of your big toe and your lesser toes. You should have certain range of motion at your big toe and your ankle. And if these basic markers are not met, I'm always scratching my head going, these are elite athletes and they're not using what I believe to be the most powerful part of your body to propel you forward.

You know what I find fascinating too? I've been called in to address this in certain professional sports teams is the level of non-contact injuries. It seems to be on the rise. It doesn't seem to be, statistically it is. You're talking about the youngest, most athletically competent, well-trained, strong, capable athletes, and they're blowing Achilles heels being whistled into a game, or they're blowing an ACL, MCL running a normal pattern down the field without trauma, non-traumatic, so non-contact. And, you know, I always have looked at recovery as an issue, but the mechanics of the foot is, I gotta say, I don't, that's not going on in the locker rooms of any of these.

It's the foundation. It's the foundation for what happens at the foot, at the Achilles tendon. It's like, what is the injury?

I'm looking at my face like, that makes so much sense.

And what we've done is if I have pain there, for example, We go into a shoe store and they say, "Well, here's this very cushioned shoe that basically, that has a big, it looks like there's a big tilt on the front of it. It's a rocker." So then people put the shoe on and it basically rockers them forward. And we say, "Wow, that feels great.

Why would I not wanna wear that?" It's like assisted walking. It's great.

And I'm like, "Ah, nobody gets a free lunch." You're gonna get weaker. There's a trade-off here. So we have to have our foot on the ground. And I think when we talk about these injuries, you can't say that, you know, this one factor is contributing to these increase in ruptures, et cetera. But I do think that tendons need load and muscles need to be strong. And we need to start incorporating those things from the ground up when these kids are in high school sports and all of these other activities that lead them into, you know, their later years. Yeah.

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It's, it's such a great conversation because we actually have to try to convince people to walk more when it's the— our biological necessity. It's a core biological input. So when you think about your day, for example, if I was strength training in the beginning of the day— Which I do every day, yeah. I have my hour in the morning. That's when I get my work done. If I go and sit at my desk and take meetings for the next 8 to 9 hours, you don't have that stimulus to every system in your body that basically gets it to function. So what I will tell my patients, listen, depending upon where they sit, if I need to, if someone has a very low baseline, 2,000, 2,500 steps, we figure out why. If it's pain, then we have to do something like a micro walk, which is 5 minutes per day. That's where we start.

Wow. And would you do these more than one time a day?

Depending upon what they're capable of. Yeah. You know, it's interesting. Some of the patients that I see, we will start with once a day. And we have to start with building their self-efficacy and their confidence in their movement. And sometimes that's a very big conversation at 5 minutes. And then we'll say, okay, things are good. They start to feel confident. Things didn't explode like they have been told. Words are important. And so then we'll add in a second one and then we'll add in a third one. And before you know it, they're at 1,500 more steps a day, which starts to get them into that territory of decreasing the risks of depressive symptoms. And you know what else?

You just feel good doing that. It's really interesting. I've been down the rabbit hole lately of, you know, I see a lot of metabolic syndrome and obviously one of the leading causes is insulin resistance and high blood sugar. And looking at some comparative studies between like GLP-1s and metformin and a 15-minute walk immediately after a meal, postprandial.

It's so exciting. It's unbelievable.

Like, that should be the first prescription.

Put your fork down, move. Literally within 30 minutes after you eat, if you look at all this research, it's really cool. I mean, if you have insulin resistance or diabetes, eating directly after, or excuse me, walking after you eat, within 30 minutes, you basically reduce the amount of glucose in your bloodstream and it helps your pancreas. So, you have two systems that grab glucose out of your bloodstream and get it into your cells, your pancreas and muscle contraction. So, when you're sedentary after you eat, your pancreas has to work really hard because his friend, the muscle contraction, isn't helping.

Right, he's not sponging up any of the glucose, right?

So I think that there's really cool research looking at if you were to take a 15-minute walk after you ate 3 times a day, yeah, it's equivalent to taking one 45-minute walk.

I read that same study. What I also found really fascinating was— it makes sense to me, you move after eating, you reduce your blood sugar— what I found really fascinating was their insulin sensitivity improved. Yeah. Meaning they became less insulin resistant. So their fasting insulin went way down, like from high double digits into single digits. And I think that's the panacea, right? Because the amount of things that insulin resistance and hyperglycemia are related to is mind-numbing. It's like the first domino to fall in a whole cascade of things.

I think that's why you also see that correlation with a decrease in cancer risk. Because of the changes with that.

Probably that correlation. Yeah, no question. And we're so much more in control of this than ever. You know, I feel it too when we, we're in Coconut Grove and like 15 minutes from us is the little restaurant district. When we go out to eat and walk back, it's that 15-minute walk. Yeah. It's like, I do feel better.

You're gonna sleep better. Yeah. I know you're big on sleep. I am huge on sleep.

Yeah, I got a sleep challenge coming up.

I was like, If people just walked more, the research is, if you just did a little more walking than your baseline, you're gonna sleep better. But we know this, it's if you increase activity, you're sleeping better. And we're not asking you to run a marathon here. Right, yeah, just walk. That's why it's this conversation of being easily accessible.

You have something called the 24-hour shoe clock. Yes. What is that? So my wife likes this. She's like, "Yeah, I need a shoe for every 24 hours." Daddy. I'm like, "I don't think that's what she meant." What do you mean?

You know, I'm not going to win this conversation if I tell people that they need to wear minimal footwear all the time. It's not realistic, and I'm aware of that. I also have a 15-year-old, and I certainly know that she's not gonna— Fashion over function right there. So I'm not gonna win those conversations. I want people to pay attention. Yeah. So for example, if you're going out to dinner or you're going on a date and you wanna wear your, Fancy shoes, your Ferragamos. Beautiful.

These things are works of art.

If you were in those shoes for 3 hours during the day, yeah, you want to wear something that is going to be more functional for the rest of the day that you're on your feet. So it's basically splitting up your time. If I'm going to have non-functional footwear or traditional footwear, you cannot wear those shoes all day long. It's okay Go wear them for a couple hours, but for the rest of the day, you're going to either put your foot on the ground, walk around barefoot in your house, wear a shoe that allows your foot to start moving and splaying and improving its function. Because if you restrict the foot all day long, that's when you're going to see problems.

Can we put some footwear recommendations into the show notes? You obviously probably have some brands that you— What are you wearing right now?

These are Vivo Barefoots.

Vivo. See, I started with the Vivo toe shoes and gave them up, but I think I could— I think I could be reconvincing for these. Well, people, this is— those are a lot more fashionable. Yes, they're getting there. See these on the camera, but way more fashionable than the toe ones I had at the beginning. I still remember when Ben Greenfield showed up at my house and I was like, brother, what is on your feet?

I keep telling my daughter, I'm like, smart, smart is sexy, Addie. Smart is sexy. When people see your foot, you're— they know that you're paying attention to your Good health.

I don't think the 15-year-old's getting it. No, I don't think she's buying it.

I'm really trying every angle.

Yeah, she's not buying it. I got a 17-year-old and I can tell you she's not buying it.

But when I first started doing this, there was one shoe brand that was making shoes that respected the anatomy of the foot. Now there's hundreds. I mean, they have everything from athletic shoes, sneakers, dress shoes, casual shoes, sandals. So there's the opportunity to really respect your foot's anatomy is out there. And it's getting better.

Yeah, I love that 24-hour clock concept because you're right. You know, I mean, first of all, if you ever walk down the street in New York City, every woman that's passing you has her heels in her purse. They're sticking out of her purse and she's got, you know, tennis shoes on. And when they get to the office, you know, they're observing your recommendation in some form or fashion.

We have a high heel shoe rehab section in the book where if you wear— You do? Yes, it's very important. If you wear high heels, just do these things. It's just being proactive. I really hope that when you go into, say, a grocery store, for example, and you go to the foot section, all you see are these products that alleviate symptoms. Use this if you have heel pain. Here's something if you have a bunion. Here's something— And I really want to change that script. Let's look at this proactively. Strengthen your foot, wear the right footwear so that you don't have to depend upon things to try to help you feel better once you've disrupted foot function.

You said that walking speed can predict mortality. Yes. And longevity. What do you mean by that?

When you go to the doctor, they take your vital signs, blood pressure, temperature, oxygen saturation. And the reason they do that is if something's wrong there, It's a red flag. Pay attention to me. And there was a couple scientists that looked at walking speed, making this the 6th vital sign, because when you can detect a slower cadence, so if someone is walking slower, this can be a predictor of dementia up to 7 years in advance. Mm. So we should be saying, okay, why are you walking slower? Is this some type of cognitive issue that you're having? Is it a problem with balance? Is it a fear of walking? Is it strength that you don't have the capacity for at your foot? So again, the fact that they touted this and said, "You're gonna be in the category with blood pressure and temperature," I mean, that's pretty significant. That something as simple as an assessment of seeing how fast you can walk can be a predictor of diseases that we can do something about now, it seems again like a very simple conversation that we need to be having.

Yeah, you know, it's interesting as I chair Bobby Kennedy's Maha Action, it's this public-private partnership between Health and Human Services and the public sector, or the private sector. And they estimate that 85% of all chronic disease, which costs us $5 trillion trillion dollars a year, um, is entirely preventable through things exactly like what you're talking about. Like, we have so much more control over our destiny than we think. And if we just draw our attention back to the basics very often, um, so let's maybe— top 5 tips for someone who is not walking regularly, um, doesn't know about the proper footwear, um, maybe isn't aware of the science behind postprandial walking right after a meal. Let's give the listeners some practical things that they could start doing to dramatically improve either their gait or their foot health.

I think you have to, number one, find your baseline. Figure out where you are. What are your goals? That's what I love about looking at the different step counts. You can just decide where you need to be. You know, if you're someone that suffers from depression or anxiety and you have a low step count, this is where we need to start.

Low-hanging fruit right there.

Low-hanging fruit, you know, depending upon what your baseline is. I think the other interesting conversation with baseline is if you are someone that's also taking 15,000 steps a day, there is a law of diminishing return when we look at the longevity benefits with step counts. Hmm. My question to them is, "Well, are you strength training?" And if they say to me, "Well, no, I don't have any time because I'm walking 15,000 steps a day." Right. We'll dial it down. So then we'll have the conversation, "Hey, give me about 8,000 to 9,000 steps a day, and then we're gonna make time to strength train." So I think finding your baseline and figuring out where you wanna live is important.

And 'cause I have heard you say, 7,000 is more important than 10,000, 'cause 10,000 is like this just sort of magic number that really wasn't evidence-based. Yes, no. And it's sort of a great number for people to target, but you're saying 7,000, depending on your pace, you can get a lot more out of that.

Yeah, there's a difference between ambient walking and intentional walking. So ambient would be someone saying, well, I got 7,000 steps and it was because I was just around my house and I was busy all day.

Um, it's that in— it's funny, Malia got— what was the record? She got 18,000 in my condo, mainly because she's running around trying to find me.

You could go very fast too. You just picked up your speed. We could call that an intentional walk.

Yeah, we've got like a little, almost like a track in here, you know. It's, uh, but, um, I know, I see what you mean. And, and not breaking it up, like get, hobble, hobble, hobble, sit. Yes. Get hobble, hobble, hobble, sit. It's like— You need that continuous.

Interval. Yeah, when you look at the research, 30 minutes fast-paced. My marker for myself personally is every day you want the consistency between 7,000 to 9,000. And it's interesting because I'm active. I do my workouts in the morning, and then if I'm in the clinic, I won't be sitting. I'll be with patients for 7, 8 hours. It's always surprising to me sometimes when I get home, and I'll look at my step count and I'll be like, wow, I thought I was really active today, but I only have 5,000 steps. I was still moving all day long. I still got my strength training workout done in the morning. But that, I know that when I get home, I have 20 minutes in me, 'cause that's my window, is that 7,000 to 9,000.

And what do you do? Just get outside and walk?

Get outside and walk. Rain, snow, wind, talk with my daughter. Yeah, I always self-control.

A non-willing participant, I'm sure, a lot of those times. Times. Um, here's, here's something I found really fascinating: 4,000 steps a day can cut dementia risk by 50%. What is the connection between 4,000 steps and early onset dementia?

When you're walking, you have increased cerebral blood flow to your brain, and really in that prefrontal cortex. There's also something called BDNF, which is brain-derived neurotrophic factor. And if you think of that as like a fertilizer to the neurons in your brain, so they basically help these neurons fire. Right. Walking does that. It basically increases this fertilizer to your brain. Neurogenesis occurs. So the formation of new cells, in fact, in the hippocampus, which is where you will see the first changes with Alzheimer's patients.

So that's where the memory is stored.

That's where the memory is stored. Yeah. So we have something literally that is so easily accessible that has a direct impact on our cognitive function, on our brain function, and it's simply increased blood flow and all of these things that happen when we get walking.

And you know, it's also, magically designed to circulate lymphatic fluid. Yes. You know, which is our waste elimination pathway. So we don't think about, you know, it's a passive system, there's no pressure behind it. So these muscular contractions help circulate lymph. And, you know, all the blue zone and meta-analyses and big data studies prove this too. In fact, in some of the blue zones, you would have these pockets of hypercentenarianism. Yeah. And they were like, well, what's causing hypercentenarianism in the same sort of town? Oh, it's the grade of the slope they're walking up. And that's what's inspiring to me about a lot of the longevity science is that a lot of it is just a back to the basics approach.

That's right, it's keep it simple. I love that conversation because the soleus has been touted, the soleus, your calf muscle, is the second heart. Second heart, yeah. I will have patients where they will come in and their legs from the knees down are very swollen, so like pitting edema. Their step count is always very low, and they're maybe not comfortable going for a 20-minute walk. I will literally have them start just at home, just start pumping their calf. They'll start tapping their heel just to get pumping going, pump the circulation.

Just that little minor sort of, almost looks like, I used to do that all the time.

Get fidgety, I call it.

A nervous twitch.

That's what I do on an airplane. Nobody likes sitting next to me on an airplane. Yeah, sitting next to you like, "This lady's about to have a panic attack over here." I'm either doing that or I stand up and start doing calf raises in the middle of the airplane.

Yeah, that's real popular. Um, so I, I just, you know, I love how it's so, you know, fundamentally simple. And if we're intentional about it, you know, we could easily fit this back into our— and we need to— into our lifestyle.

It's, um, it's not a conversation of if. If you think of I really want to stress that walking should be a physiological necessity on the same importance as breathing and sleeping. Those three things, when optimally done, this is what it's about. This is longevity. Breathing, sleeping, walking. Sleeping and walking. If I said to you, you can't sleep, but what if we turned the situation or the conversation around to what if you couldn't walk? Mm. That gets people— you say that and you're like, okay, I think my heart rate just skipped a beat. That's scary. Right. If I said to you, what if you couldn't walk? What if you couldn't sleep? What if you couldn't breathe? You're not living. Mm-hmm. And that's— walking needs to be in that category. It is not an option. It is a physiological necessity to get our bodies to perform well, to literally survive. And I think when we take it for granted, because it does sound too simple, we get into problems. And if you, like I said, change that conversation to what if you couldn't walk, I truly think that everything we do, strength training and HIIT training and diet and exercise, if you were to ask someone what they wanna be doing in the last decade of their life, every single person would say walking. Yeah, so true. So all the stuff we're doing is to make sure we can walk. Yeah, yeah. With our families, with our grandkids.

And the loss of independence, the loss of walking is a very scary conversation.

Yeah. And we don't think about it.

You know, um, both of my parents are, uh, at the age— they're in their 80s, um, and they're both deconditioned. In fact, I'm doing a whole thing on Instagram now where I'm improving all my mother's cognitive scoring through a protocol I have her on. I'm gonna put it out, you know, on Instagram. But I do notice that, you know, because they are so mobility impaired, yes, um, the amount of restrictions that it takes— restaurant choices have to be close, you know, they're going to my son's wedding, and like the planning around getting them to the wedding, you know, just the, the, the loss of independence and You know, as we start to remove these factors of independence later in life, and I really hate to quote Peter Attia, but he talks about the centenarian decathlon in the book "Outlive," and I thought it was really appropriate to start thinking today about what you wanna be doing when you're in your 80s. I know my parents never thought about that in their 40s and 50s. They just took it for granted. And it's little things.

It's getting up and out of a chair. It's walking downstairs. Those things, you know, in my world, I'm always looking at the foot and ankle too. You can't sit into a chair or walk down a stair if you don't have good ankle mobility or good foot strength. Those are the conversations that we need to be having. It's not, you know, sell your house and go buy a ranch so you don't have to walk up and down the stairs.

That sounds great to me, by the way. I like, eventually I wanna ride my years out on a regenerative ranch. Farm. So that's on my horizon.

It's like, we can all have goals.

I want to have my— I want to have my cows and chickens and greenhouse. And like, that's, that's freedom to me. If you know me, you know I'm a huge believer in the benefits of hydrogen water. H2Tab delivers cost-effective portable tablets that generate ultra-clean molecular hydrogen at 12 parts per million, one of the highest concentrations on the market, with over 1,300 published studies showing benefits of oxidative stress, energy, recovery, brain function, and so much more. Taking charge of your health has never been easier or more cost effective. Just drop a tablet in water, let it dissolve, and drink it back. It's less than a dollar a day. Science-backed and part of my daily routine. I never travel without this, and it is my favorite biohack. Visit DrinkH2Tab.com. That's DrinkH2Tab.com and upgrade your hydration today. Now let's get back to the Ultimate Human Podcast. You know, I, I talk about this on the podcast all the time. We have a little place in Colorado too, in the mountains, 10,000 feet, and I've got all this fancy stuff, you know, I showed you today, uh, all this very cool stuff, super cool stuff, and you know, all the, you know, the hyperbarics and the red light. If I put on a weighted ruck vest— yes, um, you know, the vest I'm wearing right now is weighted, this one's about, uh, 12 pounds, I think. And after I put it on, I don't even notice I have it on. But I put on this ION weighted vest and I have this 3.5-mile loop that my wife and I go on in the woods. When I come back, I feel like I took a limo. Isn't it awesome? It's almost like spiritual and it has to do with forest bathing, like they've been doing in Japanese medicine for centuries. Sometimes I come back here and I go, man, this is so nonsensical. It just seems so extreme. But then, you know, when I'm out there, just a 3.5-mile walk in the woods, squirrels, the birds, you know, I get giddy. I get giddy too.

I do.

I come back and I'm like, I wish everybody could feel that.

Yes. It's like I get giddy.

Like I'm ready to take on the day. And then I'm just in a better mood the rest of the day. Yeah. It's just a morning walk. Yep. All right. Well, you know, this is coming. So, I wind down all my podcasts by asking my guests the same question. Before we get to that question, I, I want to tell my audience where they can find you. This is— Walk is coming out on May 5th. May 5th. Okay, so it's right around, right around the corner. Um, and I thought that it was already out, so I'm definitely gonna link that in the show notes for my audience. But where can they find you if they want to know more about you?

Uh, I started an online education company that is specifically for foot health. Called Gait Happens. And so on that platform, we have education on how to improve your foot strength, how to improve your foot power and mobility.

So I've really— These things people can do at home?

Yes. Okay, great. All these things you can do at home. Our Instagram account, our YouTube channel, there's all exercises everywhere. I want people to start training their feet like they train the rest of their bodies. And so, yes, we have a lot of resources out there. There's footwear recommendations on that website. I think that's also very important. You had asked about the 5 things. Pay attention to your footwear.

I'm gonna have to give up my Travis Scotts, but I'll do it. Not all of them. I'll do it. I'll do it to cut my dementia risk by 50%. You know, I could also just wear them when I go out and get myself a pair of these. So I might revisit these guys again because, I think that there's something magical.

You know how we get giddy when you start walking in the woods? When your foot can start to feel the ground and you feel the strength and power from the ground up and your knee pain goes away and your back pain goes away, which I hear all the time in my clinic, then the conversation becomes much easier. The patients will come to me saying, "You know what? This does feel better, but there's a transition." You wouldn't squat 100 pounds today and 200 pounds tomorrow. So same with the foot, it needs progressive loads. So on that site, we have footwear that you can transition to, like maybe you start here and then you can work your way down into something more minimal. Okay, I love that.

And where do you fall on weighted walking? 'Cause I walk with a ruck all the time. I don't like the rucksacks that have the straps 'cause I feel like they kind of bounce on your shoulders and they actually hurt my back.— but I wear a vest called an ION Vest, and when it zips up, it's very— it hugs your body. Yes. And about 10 minutes after you have it on, you don't even know that you have it on anymore.

I think that's important. When you see a lot of these vests that are very heavy on the clavicle and heavy on the— breathing becomes difficult, right?

So pain— also neck pain. Yes. Correct. It doesn't correct your posture in the right way. Yeah. You know, so I would, uh, you know, I, I used to wear them years ago in Colorado, and I come back and my back would hurt. But when I wear this Ion vest, it actually helps hold me upright. It's tight to my body. A few minutes later, I don't even notice I have it on.

Yeah, the equipment, Matt, do you wanna hear a funny story? When I first started weighted walking or rucking, I was like, this makes sense to me, right? More load through my foot, burn a little more calories, get my heart rate up. So I had my backpack in my garage. And so I threw a, I'm almost embarrassed to say this, a 25-pound kettlebell and I just threw it in my backpack and I'm walking around.

Already going the wrong way.

I'm hiking around Colorado and I get home and I'm like, "Man, my back." And I was like, "Oh," 'cause that kettlebell was smacking against my spine for an hour. So I've learned, but I don't do that anymore. Right. Equipment matters. Yes. But yes, it can be very beneficial for people, especially if they wanna amp up their walking. If you're someone who's getting 2,500 steps, The bigger conversation is I need more steps. If you're someone hitting those 7,000 to 9,000, you can challenge yourself. Throw on a vest, do some walking lunges with it on, then you're turning this into a—

It's been a game changer for me. Yes, it's wonderful. My wife and I use it all the time. Okay, so here comes the question. You sort of answered it in the beginning of the podcast, but I'll give you another shot at it. But what does it mean to you to be an ultimate Human? human?

To be an ultimate human is to be able to walk freely, to be independent, and to be able to enjoy really life and getting outside and walking with our families and walking with our children. And that to me is the ultimate human. It defines us as a species. Walking on our two feet, being a biped, is what differentiates us from every other species. And we are very— we're supposed to be very good at it. And we've wildly ignored what literally has defined us as human beings. It is a physiological necessity. And when we take care of the small things, we can become the ultimate human.

I love it. Um, Dr. Conley, this been amazing. My VIPs are so excited to talk to you. We're going to go into my VIP room here in a moment. Great. But thank you so much for coming on The Ultimate Human Podcast. And you are my academic sister. So that was really cool. That was— you are the first guest that had same undergrad and grad school as, as I have, and one of our degrees is exactly the same. Um, so thank you for coming on The Ultimate Human Podcast. And until next time, that's just science.