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

22:33Gary Brecka:And I guess that was considered attractive too. I see people's feet like that. Did you do? Yes. Yeah. I mean, just destroy their foot mechanics. Destroy it. 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 going to 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. Yeah. And there's a lot of strength and power that comes from that big toe.

23:15And 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

23:53Gary Brecka:and 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 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.

24:36Gary Brecka: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 hammer toes 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?

25:18Gary Brecka:Because we're a little more nimble. We have more proprioception. Maybe if we're off balance, we can just double step. 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 got to be so inherently connected to longevity because of the fall risk, basically. 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.

26:01And 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? But if you lose that strength, which we know sarcopenia is a thing, that also happens in your foot.

26:33Gary Brecka: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 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. It comes into your clinic, they have disrupted 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.

27:23So 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 four toes. I'm doing this right now, by the way. Okay, got it. If you couldn't lift just your thumb, you'd probably panic.

27:41Gary Brecka: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. Ooh, 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.

28:22Gary Brecka:Yeah. You'd be surprised with the professional athletes that I have worked with. 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 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 a certain range of motion at your big toe and your ankle.

28:59And if these basic markers are not met, I'm always scratching my head going, this is like elite, 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.

29:14Gary Brecka: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 and you're talking about the youngest most athletically competent well trained strong capable athlete 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 yes 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 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 want to wear that it's like assisted walking it's great and i'm like ah nobody gets free lunch You're gonna get weaker.

30:46There'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 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 their later years.

31:20Gary Brecka:Yeah. If you want protein to build lean muscle, but without the caloric impact or need to cut, you need Perfect Amino. It's pure essential amino acids, the building blocks of proteins, in a precise form and ratio that allows for near 100 % utilization in building lean muscle and no caloric impact. So we build protein six times as much as whey, but without the excess body fat we normally get during bulking. This is the new era of protein supplementation, and it's real. If you want to build lean muscle without having to cut, you need Perfect Amino. Now let's get back to the Ultimate Human podcast.

31:56Gary Brecka:So if we just back up for a section, somebody is watching this podcast and is like, okay, I'm starting to be convinced that I need to walk more. Yeah. What would you recommend as a starting point? I mean, not somebody that has massive pain or any noticeable anatomical issues that they're aware of, right? But just an average person, it's like, I'm gonna throw some things into my calendar to extend my lifespan, health span, reduce these all-cause mortality risks. Where do they start? It's such a great conversation because we actually have to try to convince people to walk more when it's our biological necessity.

32:40it'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,

32:49Gary Brecka: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 eight to nine 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, Because 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 five minutes per day. That's where we start. Wow. And would you do these more than one time a day?

33:31Depending upon what they're capable of.

33:34Gary Brecka: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 five 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 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.

34:11And you know what else?

34:13Gary Brecka:You just feel good doing that. It's really interesting. I've been down the rabbit hole lately of, 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, post-prandial. It's so exciting. It's so unbelievable. Like that should be the first prescription where you 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.

35:05So 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.

35:21Gary Brecka: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 three 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, 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 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 insulin sense probably that correlation, yeah, no question And we're so much more in control of this than ever.

36:22Gary Brecka:You know, I feel it too when we were in Coconut Grove and like 15 minutes from us is the little restaurant district. When we go out to eat and walk back, just that 15 minute walk. It's like, I do feel better. You're going to sleep better. I know you're big on sleeping. I am huge on sleep. 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 going to sleep better. But we know this. If you increase activity, you're sleeping better. Yeah. And we're not asking you to run a marathon here. Right. Yeah, just walk.

36:57That's why it's this conversation of being easily accessible.

37:00Gary Brecka: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. Yeah, right. I'm like, I don't think that's what she means. 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 going to win. Fashion over function right there. So I'm not going to 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 want to wear your fancy shoes, your Ferragamos.

37:43Beautiful.

37:44Gary Brecka:These things are works of art. If you were in those shoes for three hours during the day, 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.

38:20Because if you restrict the foot all day long, that's when you're going to see problems.

38:25Gary Brecka: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. See, I started with the Vivo toes shoes and gave them up. But I think I could be reconvinced for these. Those are a lot more fashionable ones. Yes, they're getting there. I don't know if you can see these on the camera, but way more fashionable than the 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 is sexy, Addy.

39:00Smart is sexy. When people see your foot, they know that you're paying attention to your foot health.

39:05Gary Brecka:I don't think the 15-year-old is kidding. No, I don't think she cares. I'm really trying every angle. Yeah, she's not buying it. I got a 17-year-old. I can tell you she's not. 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.

39:43They're sticking out of her purse and she's got tennis shoes on.

39:47Gary Brecka:And when they get to the office, they're observing your recommendation in some form or fashion. We have a high heel shoe rehab section in the book. You do? Yes. It's very important. If you wear high heels, just do these things. Right. It's just being proactive. Yeah. You know, I really hope that, you know, 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.

40:27It should be 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 and longevity.

40:44Gary Brecka: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 of scientists that looked at walking speed, making this the sixth 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 seven years in advance. 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?

41:29Is 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 going to 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.

41:58Gary Brecka: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 a year, is entirely preventable through things exactly like what you're talking about. Like we have so much more control of our destiny than we think. And if we just draw our attention back to the basics very often. So let's maybe top five tips for someone who is not walking regularly, doesn't know about the proper footwear, maybe isn't aware of the science behind postprandial walking right after a meal.

42:48Gary Brecka: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 decide where you need to be. 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, 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.

43:34So my next 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.

43:59Gary Brecka:And because I have heard you say, 7 ,000 is more important than 10 ,000 because 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. It's that in - Malia, 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.

44:43Well, you could go very fast. You just picked up your speed. We could call that an intentional walk.

44:48Gary Brecka:Yeah. We've got like almost like a track in here, you know. But no, I see what you mean. And not breaking it up, like get hobble, hobble, hobble, sit. Yes. Get hobble, hobble, hobble, sit. It's like - You need that continuous. When you look at the research, 30 minutes fast pace. You know, my marker for myself personally is every day, you want the consistency between 7 ,000 to 9 ,000. Yeah. 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 seven, eight 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.

45:32I was still moving all day long. I still got my strength training workout done in the morning. But I know that when I get home, I have 20 minutes in me because that's my window. That's 79 ,000.

45:45Gary Brecka:And what do you do? Just get outside and walk? Get outside and walk. Okay. Rain, snow, wind. Yeah. Dog with my daughter. Yeah. A non-willing participant, I'm sure, a lot of those times. 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.

46:35So they basically help these neurons fire. 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's stored. That's where the memory's stored. 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.

47:17Gary Brecka:And it's also magically designed to circulate lymphatic fluid, which is our waste elimination pathway. So we don't think about, it's a passive system, there's no pressure behind it. So these muscular contractions help circulate lymph. And 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. 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. You know? And, you know, that's what's inspiring to me about a lot of the longevity sciences is that a lot of it is just a back to the basics approach.

48:00It's keep it simple. Yeah. That's, I love that conversation because, you know, the soleus has been touted, the soleus or 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 it's 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.

48:34Gary Brecka:Just a little minor. Yes. Sort of almost looks like I used to do that all the time. Like a nervous twitch. That's what I do on an airplane. I hate, 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. So 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 - We need to. Into our lifestyle. It's not a conversation of if.

49:11If 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. What if we turned the situation or the conversation around to what if you couldn't walk? That gets people, you say that and you're like, okay, I think my heart rate just skipped a beat. That's scary. If I said to you, what if you couldn't walk? What if you couldn't sleep? What if you couldn't breathe?

49:55You're not living. 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 want to be doing in the last decade of their life, every single person would say walking.

50:36Gary Brecka: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, both of my parents are 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 uh improving all my mother's cognitive score and do a protocol i have her on i'm going to 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 um and i really hate to quote peter tia but he talked about the centenarian decathlon yeah and in in the book outlive and i thought it was really appropriate to start thinking today about yes what you want to be doing if 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.

51:56And it's little things. It's getting up and out of a chair. It's walking down stairs. 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.

52:23Gary Brecka:That sounds great to me, by the So eventually I want to ride my years out on a regenerative farm. So that's on my horizon. It's like - We can't have goals. I want to have my cows and chickens and greenhouse. And 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.

53:09Gary Brecka: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 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. All this - Very cool stuff. Super cool stuff. And, you know, all the hyperbarics and the red light.

53:50Gary Brecka:if I put on a weighted ruck vest the vest I'm wearing right now is weighted this one's about 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 limbo isn't it awesome it's almost like spiritual it has to do with forest bathing they've been doing in Japanese medicine for centuries. And 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 three and a half mile walk in the woods, squirrels, birds, you know.

54:34Gary Brecka: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 want to tell my audience where they can find you. Walk is coming out on May 5th? May 5th. Okay, so it's right around the corner. Yes, it is. And I thought that it was already out, so I'm definitely going to link that in the show notes for my audience.

55:07Gary Brecka:But where can they find you if they want to know more about you? 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.

55:47there's footwear recommendations on that website. I think that's also very important. You had asked about the five things. Pay attention to your footwear.

55:57Gary Brecka:I'm going to have to give up my Travis Scott. I'll do it. Not all the time. I'll do it to cut my dementia risk by 50%. I could also just wear them when I go out and get myself a pair of these. I might revisit these guys again because - I think 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?

56:33This does feel better, but there's a transition. You wouldn't squat 100 pounds today and 200 pounds tomorrow.

56:40Gary Brecka:Right. So same with the foot. It needs progressive load. 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? Because I walk with a ruck all the time. I don't like the rucksacks that have the straps because I feel like they kind of bounce on your shoulders. They actually hurt my back. But I wear a vest called an ion vest. And when it zips up, 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.

57:18I think that's important. When you see a lot of these vests that are very heavy on the clavicle and heavy on it, breathing becomes difficult. And so patients with neck pain, yes.

57:26Gary Brecka:It doesn't correct your posture in the right way. So I used to wear them years ago in Colorado and a comeback of my backward hurt. But when I wear this high-on 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 mat. Do you want to hear a funny story? When I first started weighted walking or rocking, 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 backpacking, backpack in my garage. And so I threw a, I'm almost embarrassed to say this, a 25 pound kettlebell.

58:03And I just threw it in my backpack. And I'm walking around. It's already gone the wrong way. I'm hiking around Colorado and I get home and I'm like, man, my back. And I was like, oh, because that kettlebell was smacking against my spine for an hour. So I've learned, but I don't do that anymore. Equipment matters. But yes, it can be very beneficial for people, especially if they want to 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.

58:40Gary Brecka:Yeah. throw on a vest do some you know walking lunges with it on then you're turning this into a game changer for 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 to be an ultimate human is to be able to 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.

59:24Walking on our two feet, being a biped is what differentiates us from every other species. And 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.

59:46Gary Brecka:I love it. Dr. Conley, this has been amazing. My VIPs are so excited to talk to you. We're gonna go into my VIP room here in a moment. But thank you so much for coming on the Ultimate Human Podcast. And you are my academic sister. So that was really cool. You are the first guest that had team undergrad and grad school as I have. And one of our degrees is exactly the same. So thank you for coming on the Ultimate Dermot Podcast. Thank you so much. And until next time, that's just science.