The Ultimate Human with Gary Brecka - 274. Dr. Courtney Conley: Dementia, 4,000 Steps, Big Toe & The 6th Vital Sign

Episode Date: June 2, 2026

I sat down with Dr. Courtney Conley and what she told me stopped me cold…your walking speed can predict dementia up to seven years before the first cognitive symptom appears, which is why scientists are arguing it should be added to blood pressure and temperature as the sixth vital sign. We got into the mechanism behind it: BDNF, hippocampal neurogenesis, and why 4,000 steps a day can cut dementia risk by roughly 50% and I walked away convinced this is the most under-prescribed medicine of the 21st century. CLICK HERE TO BECOME GARY’S VIP!: ⁠https://bit.ly/4ai0Xwg⁠ Get Courtney Conley’s book, “Walk”: ⁠https://amzn.to/4dLseJK⁠  Connect with Courtney Conley Website: ⁠https://bit.ly/434xEux⁠  YouTube: ⁠https://bit.ly/4o5GFNx⁠  Instagram: ⁠https://bit.ly/4wXIrEn⁠  Facebook: ⁠https://bit.ly/3RAfaj4⁠   TikTok: ⁠https://bit.ly/4x2eHGK⁠  X: ⁠https://bit.ly/4fMRNwv⁠  LinkedIn: ⁠https://bit.ly/3RR5LUe⁠  Thank you to our partners A-GAME: “ULTIMATE15” FOR 15% OFF: http://bit.ly/4kek1ij AION: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4h6KHAD AIRES: "ULTIMATE20 " FOR 20% OFF: https://bit.ly/4a3Duze BAJA GOLD: "ULTIMATE10" FOR 10% OFF: https://bit.ly/3WSBqUa BODYHEALTH: “ULTIMATE20” FOR 20% OFF: http://bit.ly/4e5IjsV COLD LIFE: THE ULTIMATE HUMAN PLUNGE: https://bit.ly/4eULUKp CYMBIOTIKA: "ULTIMATE10" FOR 10% OFF: https://bit.ly/4tjyluP GENETIC METHYLATION TEST (UK ONLY): https://bit.ly/48QJJrk GENETIC TEST (USA ONLY): ⁠https://bit.ly/3Yg1Uk9 GOPUFF: GET YOUR FAVORITE SNACK!: https://bit.ly/4obIFDC H2TAB: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4hMNdgg HEALF: 10% OFF YOUR ORDER: https://bit.ly/41HJg6S PEPTUAL: “TUH10” FOR 10% OFF: https://bit.ly/4mKxgcn SNOOZE: LET’S GET TO SLEEP!: https://bit.ly/4pt1T6V WHOOP: JOIN & GET 1 FREE MONTH!: https://bit.ly/3VQ0nzW Watch  the “Ultimate Human Podcast” every Tuesday & Thursday at 9AM EST: YouTube: ⁠https://bit.ly/3RPQYX8⁠ Podcasts: ⁠https://bit.ly/3RQftU0⁠ Connect with Gary Brecka Instagram: ⁠https://bit.ly/3RPpnFs⁠ TikTok: ⁠https://bit.ly/4coJ8fo⁠ X: ⁠https://bit.ly/3Opc8tf⁠ Facebook: ⁠https://bit.ly/464VA1H⁠ LinkedIn: ⁠https://bit.ly/4hH7Ri2⁠ Website: ⁠https://bit.ly/4eLDbdU⁠ Merch: ⁠https://bit.ly/4aBpOM1⁠ Newsletter: ⁠https://bit.ly/47ejrws⁠ Ask Gary: ⁠https://bit.ly/3PEAJuG⁠ Timestamps 00:00 - Intro of Show 01:25 - Same school, same degree: the human biology connection 04:29 - Pain to purpose: why modern shoes are built on a flawed premise 07:25 - Walking as the most under-prescribed medicine & the 7,000-step sweet spot 08:16 - Why your foot doesn't need arch support & can adult mechanics change? 13:10 - Micro walks: the 5-minute prescription for chronic pain & depression 18:21 - What gait analysis looks at & exchanging function for fashion 20:27 - The big toe chain reaction: how shoe width controls your knees, hips, and ankles 25:44 - Toe strength, foot awareness drills & preventing non-contact athletic injuries 31:54 - Where to start: building your walking baseline & post-meal blood sugar 37:00 - The 24-hour shoe clock: a realistic footwear rule 40:45 - Walking speed as the 6th vital sign, dementia risk & the soleus "second heart" 49:14 - Walking as a physiological necessity, ankle mobility & aging in place 58:55 - ​What does it mean to you to be an Ultimate Human? Disclaimer: This podcast is for informational purposes only and does not provide medical advice. It is not intended for diagnosing or treating any health condition. Always consult a licensed healthcare professional before making health or wellness decisions. Gary Brecka is the owner of Ultimate Human, LLC which operates The Ultimate Human podcast and promotes certain third-party products used by Gary Brecka in his personal health and wellness protocols and daily life and for which Ultimate Human LLC and / or Gary Brecka directly or indirectly holds an economic interest or receives compensation.  Accordingly, statements made by Gary Brecka and others (including on The Ultimate Human podcast) may be considered.  Learn more about your ad choices. Visit megaphone.fm/adchoices

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.

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 going to have problems. If we just back up for a section, somebody is 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. Hey guys, welcome back to the Ultimate Human Podcast. I'm your host, human biologist Gary Brecker, 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. Because we went to the same undergraduate school, we went to the same grad school, and we got the same degrees. That's wild. I was like, wait a second,

the University of Maryland National College of Chiropractic, 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. Yes. But I was actually born in college park,

Maryland. Oh, really? Did you go to college park? Yeah. Oh, gosh. I mean, that's such crazy. I was like, and then I immediately called Malia. I'm like, how old is she?

I wonder if I tutored her in my, in anatomy. Because I, I, I, uh, I tutored anatomy for the three years that I was at national. And I was like, and he was like, no, but she's too young. I was like, a little spring chicken of her. So, I mean, such a, 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 a school, a chiropractic college at the time that taught that spinal manipulation was the be-all and all of everything. 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.

So my degree says conferred the degree of... So I think you're the first human biologist other than myself that we've had on the podcast. So it's vindication for me. So... But anyway, welcome to the podcast. Thank you so much for having me. And it's funny how similar our tracks were, you know, starting.

You graduated in 2003, I think. Yeah, so was it National University of Health Sciences by that? Yes. Okay. Lombard, Illinois, man. Yeah. I loved 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, 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 six 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. Not like Colorado. No, no, it's not. And the Board of Trade was like three blocks from my house. And it was such a brutal walk to go three blocks in the wintertime in Chicago. I was like, I don't know where I want to live. I just don't want to be here. Sorry, sorry, Chicago.

Great city. Don't get me wrong. But terrible weather. So, you know, your background and your journey started, like a lot of my podcast guests, with sort of this pain-to-purpose journey. Yeah. You know, you were kinesiologist. 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, we learned about the foot and ankle, I think we had maybe a half a semester. Yeah, we spent a lot of time on the spine, your 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 in a place. 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, and 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 plus 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-antanomical positions and causing upchain issues, knee hips, shoulders, rotator cuff, spine, spine. because of how we've gotten accustomed to, we need cushioning, we need support,

we need high archers, 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 under-prescribed medicine

of the 21st century. Yes. And what do you think is 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 because 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. That is ill-fell. fitting or doesn't fit or respect the anatomy of the foot, you're going to have problems. We actually have a foot with us here today.

This is Eddie. This is Eddie. Tell me that's not an actual real person. 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 Eddie Vedder's foot. That is not Eddie Vedder's foot. 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. 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, because it was so ridiculed for these things. And they were really a pain to put on because 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. 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're 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 a disservice. So I guess the big question is, is it fixable? Right? I mean, because 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. So by the time you get a hold of an athlete, Yeah. Or someone with Borgate, I mean, those mechanics have been, 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. You know, I looked into some of the research that you've done or cited. You know, you blew through the 10,000 steps myth, you know, saying that just getting 10,000 steps. 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. Yeah. 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 four 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. Yeah. It's brisk. Yeah, yeah. Well, Colorado is actually one of the fittest states in the nation.

Believe it or not, I 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. For six months out of the year, you're indoors. Yeah. For, you know, not bad mouth in Chicago. Yeah.

Well, we've really hammered Chicago. I lost every Chicago follow. right now is like to Delado, so they're out. But in Colorado, you can, I mean, you play in the winter. Yeah. You know, 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 a, you know, there's a sense of accomplishment, if you will, with just daily tasks walking around and, you know, walking your dog. Yeah. I appreciate that. Well, I want to get back to the 10,000 versus 7,000 steps and the brisk pace because I feel like, you know, 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.

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 five minutes a day. You're decreasing your risk of all-cause mortality by 7%.

I saw that. It seems like a no-brainer. Yeah. But 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. Right.

There's an emotional side to it. There's a mental side to it. But that's the beautiful thing with walking. Yeah. 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. Yeah.

And they're more accessible than people think, right? And you can access them through things like mobility. Yes. Right? 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. Right. 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. Yeah, walk. The number one thing on a prescription path. 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.

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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 the UltimateHuman.com forward slash VIP and step into your ultimate potential. Now let's get back to the Ultimate Human podcast. So starting with gate analysis, when someone comes into your clinic for an evaluation, what are you specifically looking at?

I love watching people walk. Dude, New York must be high stress for you. She's jacked up, he's jacked up, This guy's got overpronated, underpronated, ankle roll. Like, my fiance is 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, we will either get them on the treadmill if they're not used to,

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 gate 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. There's a judgment-free zone. 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 seven-inch stilettos. Oh, yeah. And, you know, I have these farragamo, beautiful loafers. They bring a tear to my eye every time I take them out of the closet. so beautiful. They hurt my feet. 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. And I think we have definitely exchanged fashion for function. Oh, 100%. 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 to front of every pair of shoes? If you look at the majority of shoes, they are tapered at the toebox. Yeah. And it's this fashion over function that we've really grown accustomed to from a societal, you know, 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 hammer toes and pain in the forefoot, those go away. Really? 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 dorsesiflection, like when you push off. As you push off. 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 gate, 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 footbinding. Yeah, footbinding in like the Asian culture. It was like very 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 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 attractive too. And but they, I see people's feet like that. Did you do? Yes. Yeah. I mean, just destroy their foot mechanics. 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 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. And I'm not just talking about a walking gate. 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. Yeah. 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 to anatomically correct itself? Depending upon when you intervene. That's why I think this conversation needs to be.

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 hammer toes and a disruption of the integrity of the forefoot increases our risks of falling as we age. Yeah.

So it's a very... Falling is the greatest risk, too. It's a much bigger conversation than I think we're paying attention to it. Yeah, and I think we can make up for that in younger years, right? Because we're a little more nimble, we have more pro preception. Maybe we can, if we're off-balance, we can just double step.

Yeah. You know, if we catch the back of our heel with our toe, we can catch a step, but in older populations, you know, 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. 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 widespread position. Right.

Right. But if you lose that strength, which we know Sarkropini is a thing, that also happens in your foot. Age-related muscle racing, 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, right? It comes into your clinic. They have disruptive foot mechanics or gate anomalies, and then you fix those mechanics. What are you seeing in those patient journeys?

When we do the gate 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 four toes. I'm pulling 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. 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. 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 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, 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.

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 athletes

and they're blowing the keyle seals 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 got to 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, 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 a assisted walking. It's great. And I'm like,

nobody gets free lunch. You're going to get weaker. There's a tradeoff 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, etc.

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. Yeah. If you want protein to build lean muscle, but without the caloric impact or need to cut,

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build lean muscle without having to cut, you need perfect amino. Now let's get back to the Ultimate Human podcast. 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 going to 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. 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 eight to nine hours, you're not, you don't have that stimulus

to every system in your body. 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, 2,500 steps, we figure out why. If it's pain, then we have to do something like a microwalk, which is five 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. Mm-hmm. And we have to start with building their self-efficacy, in their confidence, in their movement. And sometimes that's a very big conversation at five minutes. Mm-hmm. And then we'll say, okay, things are good. They start to feel confident. Mm-hmm.

Things didn't explode like they have been told. Words are important. Right. 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, you know? 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 ones and metformin and a 15-minute walk immediately after a meal, post-praniel. It's so exciting. It's so unbelievable. Like that should be the first prescription where you forked 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 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. 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 is, 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 thing. 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. You know, I feel it too when we're in Coconut Grove and like 15 minutes from us as the little restaurant district. When we go out to eat and walk back, just that 15 minute walk? Yeah. It's like, I do feel better. You're going to sleep better. I know you're big on sleep.

I'm 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 going to sleep better. But we know this. It's if you increase activity, you're sleeping better. Yeah.

And we're not asking you to run a marathon here. Right. Yeah. That's why it's this conversation of being easily accessible. Mm-hmm. You have something called the 24-hour shoe clock. Yes. What is that?

My wife likes this. She's like, yeah, I need a shoe for every 24 hours. You know? 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- 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 Farragamos. Beautiful. 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 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.

See, I started with the Vivo toes shoes and gave them up, but I think I could be reconvinced for these. Well, people, this is... Those are a lot more fashionable. Yes, they're getting there. I don't know if you can 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 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, smart as sexy. When people see your foot, they know that you're paying attention to your foot health. I don't think the 15-year-old's kidding. No, I don't think she's not buying. 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.

But when I first started doing this, there was one shoe-burant 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, you know, they're, observing your recommendation in some form of fashion. We have a high heel shoe rehab section in the book where if you are, 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, when 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. It should be, strengthen your foot. We're 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. 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? 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 going to be in the category with blood pressure and temperature. I mean, that's pretty significant, that something is simple as an essential. 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 private, 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 five trillion dollars a year

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 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 signs behind post-brandial 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. Yeah. 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. 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. So 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 going to make time to strength train. So I think finding your baseline and figuring out where you want to live is important. And because I have heard you say,

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

Yeah. We've got almost like a track in here, you know. But I know I see what you mean. And not breaking it up, like get hobble, hobble, hobble sit. Yes. Get hobo, hobble sit. It's like. You need that continuous.

Yeah. 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 to 9,000. Yeah. And it's interesting because I'm active. You know, 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 day. the morning. Right. But that, I know that when I get home, I have 20 minutes in me. Because I, that's my windows, that's 79,000. And what do you do? Just get outside and walk? Get outside and walk. Okay. Rain, snow, wind. Yeah. I always saw people like, dog with my daughter. Yeah. A non-willing participant, I'm sure, a lot of those times. Here's something I found really fascinating. Four thousand 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's 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, 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. limp. 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 great 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 science is that a lot of it is just a back-to-the-basics approach. That's right. It's keep it simple. Yeah. That's, I love that conversation. because, you know, the soleus has been touted,

the soleus your calf muscle is the second heart. Second heart, yeah. I will have patience where they will come in and their legs from the knees down are very swollen, so of 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. It's a 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.

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 if 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. 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 and walking. If, you know, if I said to you, you can't sleep, what if we turned to 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.

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. 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 hit 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. Yeah. So true. So all the stuff we're doing is to make sure we can walk. Yeah.

With our families, with our grandkids. 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. 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 score through a protocol I have her on. I'm going to put it out on Instagram. But I do notice that, you know, because they are so mobility impaired, 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 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 Ortea, but he talked about the centenarian decathlon in the book Outlive. And I thought it was really appropriate to start thinking today about what you want to 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 by 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 want to ride my ears out on a regenerative farm. So that's on my horizon.

It's like, yeah. We can't have goals. I wanna have my cows and chickens and greenhouse and like that's freedom to me. If you know me, you know I'm a huge believer in the benefits of hydrogen water. H2 tab delivers cost effective portable tablets that generate ultra clean molecular hydrogen

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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. If I put on a weighted ruck vest, you know, 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 three and a half mile loop

to my wife and I go on in the woods. When I come back, I feel like I took a limous pool. Isn't it awesome? It's almost like spiritual, and it has to do with forest bathing, you know, they've dimmed, 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, the birds, you know. I get giddy. I get giddy too. I do. Like, 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. But where can they find you if they want to know more about you, clinic? I started an online education company that is specifically for foot health called

gate 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. Things you... 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 five things. Pay attention to your footwear. I'm going to have to give up my Travis Scott's, but I'll do it. Not all the time. 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 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 know, you wouldn't squat 100 pounds today and 200 pounds tomorrow. Right. 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? 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. 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 it, breathing becomes difficult. And so patients with neck pain, yes. It doesn't correct your posture in the right way. You know, so I would, you know,

I used to wear them years ago in Colorado and I'd come back on my backward 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. Yeah. 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. And I just threw it in my backpack. And I'm walking around.

I'm walking around Colorado. And I get home and I'm like, man, my back. And I was like, oh. because that kettle bell 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 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 to 9,000, you can challenge yourself. Yeah. Throw on a vest. do some, you know, 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? 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. Dr. Conley, this has been amazing. My VIPs are so excited to talk to you. We're going to go into my VIP room here in a moment. But thank you so much for coming on the Ultimate Human Podcasts and you are my academic sister. So that was really cool. You're 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. Thank you so much. And until next time, that's just science.