Mark Sisson (5:47)

Let's take a step back from there and just look at regular fashion shoes, right? And look at what has been sort of the standard configuration of footwear for the last 150 years, which for most people is a raised heel, is a stiletto front, right, A narrow pointy front in the name of fashion. For some reason, that became a thing, a fashionable thing about 100 years ago, 150 years ago, where the peasantry wore wide boots that allowed their feet to move around as they're supposed to while they were doing manual labor. Meanwhile the gentry were and the upper classes were constricting their feet into these fashionable shoes that had higher heels, elevated heels, you know, narrow, narrow toe box coming to a point at the end which scrunched the big toe against the other toes, confined the, what we call the metatarsal head, that mid range part of the forefoot. Okay, so then we, let's cut to now to running shoes, which when I first started running in the late 60s and early 70s, there weren't really any running shoes because not many people were runners. It was not a, it was not a big fad. It wasn't, certainly wasn't a running boom until years later in the early days of running as basically also mostly in the US I ran in Chuck Taylor's, I went ran in, you know, basketball sneakers and then eventually got some running shoes which were onitsuga tigers. And these were what we would call minimalist shoes today. The sole was very thin, like a quarter inch thick. And those were kind of the, the original running shoes that anybody who self selected as a runner, in my case, I was too small to play basketball, football, baseball, hockey, any of the sort of traditional US sports. I became a runner just because that was all that was left to me as a, as an ectomorphic youngster who had pretty good lung capacity and a high tolerance for pain. So the origin of running shoes goes back to, or at least these thickness padded cushion running shoes that we know today goes back to coach Bill Bowerman of the Oregon Track Club and, and Phil Knight who was Starting up Blue Ribbon Sports, which became Nike. And they were interested in developing a shoe that they're very good, elite, skinny, ectomorphic runners could wear and run with good form, more miles. The early shoes were so thin that it was literally the bottoms of your feet that dictated. It was your shoes that said, 40 miles a week, that's enough running for you, pal, or 50 miles or whatever it was. And it wasn't until these guys developed this, this cushioning and this waffle sole that allowed elite runners to now run 90 miles a week, 100 miles a week, and be better competitive on the world scene. So the origin of the thick cushion running shoe goes back to those days, to Nike. And then that just became this kind of bizarre evolution of thicker and thicker and thicker and thicker shoes. With the assumption being that the more people took on this new fad of running, the more they would benefit from cushioning. So the shoes became thicker, they, the heel became raised. This was all in the interest of making it easier in some sense to put in 20 or 30 or 40 miles a week. If you were a start, a beginner runner, you'd never self selected to be a runner. Now you read about running in Jim Fix's book on the book of running, or you, you, you heard about a friend who was entering a marathon and you said, I got to do that. And over the years, more and more people who should not be running started running. They started running thinking that it was the best thing they could do in terms of overall fitness. They started running thinking it was a good way to lose weight. It wasn't. They started running thinking it was going to be better for their cardiovascular health. Maybe, maybe not. We can get into that later. But with all of these new people coming into the running scene, the running shoe, big shoe, as we call them, big, you know, started creating these, these, you know, outrageously thick shoes that gave some amount of cushioning. And eventually so many people were running with bad form like they were, they were landing on their heels and rotating off the front of their feet. And the shoes, for some reason, allowed people to do this activity and not get injured in real time. Now what happened was over, over time, they got injured, they got injuries further up the kinetic chain. So a thick shoe may feel good when you're putting it on in the running shoe store and you, and you take your 15 jog steps down the aisle and you go, oh, my God, these feel like clouds. I'll take them. But then you get out on the roads and you start running and you realize this is forgiving bad, bad form. And Christopher McDougall wrote about this 15 years ago in the book Born to Run and he, he acknowledged that running shoes were a source of a lot of problems for a lot of runners. Now 15 years later, I'm looking at this looking backwards and going, Christopher and Dougl had the right idea, but he didn't take it far enough. And taking it far enough is to suggest that most runners to this day, even with high tech running shoes get injured. 50% of all runners get injured every year at any point in time. Like right now, 25% of all people who identify as runners are injured. I mean, that's a higher rate than the NFL. This is not what you want to see in some ideal form of exercise. So the running shoe industry has promoted bad form by creating thicker and thicker and more and more cushioning in these shoes and doing so because a lot of people go to their podiatrist and they go, doc, my feet hurt. I've got these running injuries, I've got Achilles tendon problems, I've got plantar fasciitis. What do I do? And the podiatrist or the orthopedist will say, well, you need thicker shoes. If you want to keep doing this, you're going to need more and more cushioning.

Dr. Stephanie Estima (11:52)

And that's not.

Mark Sisson (11:53)

And orthotic. Which is.

Dr. Stephanie Estima (11:54)

Yeah, yeah.

Mark Sisson (11:55)

Which is, you know, how so many people have, you know, a real short term fix would be the orthotic. But many of these shoes now because of the, that industry have literally built in orthotics. So you go buy a pair of these shoes and the arch is already very supported and it's already kind of throwing your feet in a, in a pronated positioning even before you take your first step.

Dr. Stephanie Estima (12:17)

Yeah. And even if you sort, if you just look at the architecture, if you just go to your local, you know, whatever, your local Nike, whatever, whatever store where they have traditional running shoes, that heel is elevated. Right. So if you think about what is gonna happen when you're running, it's gonna sort of artificially tilt you forward. So it's gonna give you the sensation that you have that forward propulsion. Right. But what in effect, and maybe you can speak to this a little bit more, but some of the downstream effects of that, of course, that the Achilles is gonna get eternally short. I mean, I can't tell you how many women in practice who would come home from like a day of, you know, being in their heels and then go get in their runners and then snap their Achilles, the Achilles becomes shortened, short limits the. You've already said this a little bit, but limits that pronation limits toe flexion. Like, you can't actually use the toes to propel you forward. Like, talk a little bit about some of the biomechanical maladaptations that happen in the, like in the foot when we're squeezing the toe box, when we're artificially lifting the heel, when we're sort of over supinating or over, you know, protecting against the dreaded pronation. And that's sort of my, like, little nod to, like, orthotics or silly. But yeah, tell. Tell me a little bit about that. What happens there?

Mark Sisson (13:28)

So, yeah, so the first thing with these elevated heels, as you acknowledged, it tilts the. The entire center of gravity is tilted forward, which isn't necessarily a good thing. You think, like, maybe you're running with better form, but you're actually not. It's the calf muscle that gets shortened. And by shortening the calf muscle that puts the strain on the Achilles, which is a. The strongest tendon in the body. And we absolutely depend on it for walking, for running, for jumping, for sprinting, for dancing, for everything we do. So when you shorten the calf muscle over time, it puts that tension on the Achilles that can manifest itself, by the way, as plantar fasciitis, too. It can reach down to the plantar fascia. Now we've got. So we've got the elevated heel. Now we've also got this restricted toe box. And I don't care how wide you claim your shoes are, your big toe is still being scrunched against the other toes unnaturally in a position that limits the range of that great, what we call the great toe, the big toe. Now, in bodybuilding circles and in weightlifting circles, they will. They will acknowledge that in order to engage the gluteus maximus, the butt muscle, you need to. You need to engage, you need to involve fully the great toe. In fact, the term is great toe, great ass, which is why a lot of these guys in the gym and girls will take off their shoes on leg days. They'll do squats and deadlifts and lunges, either barefoot, if the gym will allow it, or in socks, which isn't as good as being barefoot. But at any rate, it's to free up that big toe to abduct, to pull away from and splay outwardly from the rest of the foot. The foot wants to splay outward on every footfall. The natural tendency, if you were to sprint down the beach at low tide and go back and check your footprints, you would see that your foot is at its greatest display on push off while you're sprinting down the beach barefoot. The foot wants to do that when you run. Now you've put it into a shoe that's restrictive, that's encasing your toes, that's restricting this, this great toe and just restricting all of the toes from being able to do what they're supposed to do, which is articulate and accommodate the change in texture and surface and so on of the, of the round that you're running on or walking on. So you combine all of these factors, not the least of which, by the way, one of our advisory board members, Ray McClanahan, I don't know if you know Ray, but he's one of the top running podiatrists in the world, has done a great review of plantar fasciitis and describes a different diagnosis. So many docs who will, who will diagnose plantar fasciitis because people come in, they've been running, they're there for some reason, that arch area is just so tender, and they can't, you know, they try to roll it out with a lacrosse ball. They try to do all of the, you know, the stem, the electrical stuff, they try to stretch, and none of that works. It's because plantar fasciitis isn't really an itis. It's not as much an inflammation as it is an osis, almost a death of tissue. So plantar fasciosis, if you think about the foot and the fact that this whole area needs. Needs circulation, you need to get blood supply to this area, and tendons and ligaments are not really well supplied with blood to begin with. Now, if you cut it off by scrunching the big toe against the rest of the toes and the foot, you've cut off the circulation to that area, to that plantar fascia area, and so that that tissue starts to literally die. So one of the, one of the cures for plantar fasciosis misdiagnosed as plantar fasciitis is a lot of barefoot walking, a lot of time allowing that big toe to abduct, or wearing minimalist footwear with very wide toe box that allow. Or wearing toe spacers, toe spreaders, to allow that circulation to, to get back in there at the end of the day. When we look at running shoes, one of the great assumptions is while these shoes are supposedly increasing your leverage and decreasing the amount of strain on your body, they're increasing the amount of strain on your body up, up the kinetic chain. And we can talk a little bit more about what that looks like. Yeah, they're, you know, they're also, they're incurring an atrophy within the foot. So your foot muscles, the intrinsic muscles of your feet, all those small muscles of your feet want to work, they want to be moving. The arch needs to be moving. The, you know, all of the abductors, adductors, all of those things want to be moving. And now you encase them and you clomp along with your heel striking and, you know, going down the road and your feet, the muscles of your feet literally atrophy to the point that now you're putting all of that burden of your running from the ankles up to the knees, up through the hips and the lower back. And those are the areas that tend to wind up getting injured as a result of this, this over overlooking the most important and critical part of your gait, which is your foot strength and your foot health.

Dr. Stephanie Estima (18:15)

I just love that we're talking about this because I have so many women that are new to weight training or they're interested in upping their weight training game, growing their glutes, growing their hamstrings, growing, growing their quads, like developing that sort of quad sweep, if you will. And so many women complain about this. I can't feel my glutes. Like, it doesn't. I can squat, I can lunge. I can definitely feel my quads working, but can't feel the glutes working. And I think that the missing, one of the missing components, of course, is exactly what you're talking about is this freedom, if you will, for that great toe to, to be able to abduct and adduct and to be able to plantar and dorsiflex. So like point down and point up during that natural gait cycle. And then of course, when you are training, when you're actually doing the resistance training at the gym, that is exactly, you know, I do exactly that. I wear my shoes to the gym because, you know, outside's kind of dirty and gross. But then I get in the gym and my shoes are off. I haven't done barefoot. I think I've. I've tried it once and I got a couple of like hairy eyeballs from people. So I do do it in my socks, but yeah, I'm essentially barefoot with, you know, like a sock covering or whatever. And I can very, very easily see a huge difference in my ability to activate glute Max. As you were saying, when the toe is free to point, like, when it's free to point downwards.

Mark Sisson (19:35)

Yeah. You literally think about pressing down through the. Through the great toe. When you're doing, like, hip flexors, right? Those. You know, the new piece of gym equipment that. That has come on the scene recently. You know that you're just doing hip thrusters thrusts.

Dr. Stephanie Estima (19:49)

Yeah, yeah, yeah. Great.

Mark Sisson (19:51)

And I've seen people now, and I'm coaching people in. In the gym to do exactly that. Splay the toes outwardly as much as possible, and then on the thrust upward, just press into that great toe. And people are going, oh, my God. I feel it for the first time. It's like, yeah, it's there, you know? And, you know, I. You're aware of my new shoe company, right, Paluva?

Dr. Stephanie Estima (20:11)

I. I have a pair. Yes.

Mark Sisson (20:13)

Okay, good. Yeah. So I'm getting a lot of bodybuilders who. Who will. It. They'll. They'll report back, oh, my God. Like, on leg days, I feel like I literally, like, intuitively feel like I'm engaging 20% of my entire posterior chain just due to the fact that I'm able to abduct. Abduct that. That gray toe and splay those toes outwardly and screw the foot into the ground that way.

Dr. Stephanie Estima (20:36)

Yes. Yeah. And even just to pronate a little bit, I know we've been taught. Even I. I was taught in chiropractic school, like, pronation is absolutely like, pes planis. Like, if you have someone who has, like, you know, like, a diagnosis of, like, totally flat feet, no arch, like, that's the pos. Like, the worst possible thing that you could ever see. And I totally disagree. I actually think that pronating a little bit, especially when we're talking about the squats, the lunges, or the lower leg activation, is actually very important. Like, that rolling into the great toe is. Is really important. I'd love for you to talk, if you can. You were talking about moving up the kinetic chain. So let's say that we are wearing these casts, Right. Essentially, is what you're doing when we're wearing these sort of traditional shoes. Talk to us about what happens at the level of the. You talked a little bit about plantar fasciitis, which is. And. Or maybe more accurately fasciosis, which is more in the foot. But talk to us about what can happen maybe at the next couple of joint levels. Right. So knee, hip, back, cervical spine, fine at large. Really? Yeah.

Mark Sisson (21:36)

So the, you know, the. The best way to go about life is barefoot. That's how we're born. That's, that is what prompted the current genetic configuration that we all share today. Our genes want us to be barefoot, and they work best if we're barefoot. Now, we've obviously created this, this civilization that's surrounding with pavement and concrete and hardwood floors and tile floors and all manner of nasty stuff that we might step on. So we can't be barefoot all the time. But, but the, the. The idea here is that the feet are our main point of contact with the universe, with Earth. They are. Our feet have tens of thousands of sensory nerve endings in the bottoms of the feet that are supposed to be informing the brain at every footfall and every time we weight the forward foot. By the time we put the weight on the forward foot, the brain should have all the information it needs on exactly how to accommodate the surface, the texture, the temperature, the tilt of the. Of the surface that we're walking on. And maybe if it's a rock, a curved rock, we scrunch the arch a little bit differently. Or if it's a divot or a pothole, we. We articulate the toes slightly differently. If it's an uneven surface, if it's canted to the outside, we roll the ankle. The ankle is supposed to roll a little bit. If it's strong and mobile and resilient, we roll the ankle so that the knee doesn't get tweaked from, from bending to the outside. Because the knee is really only supposed to move in one plane, in one direction, forward or back. But if you, if you. And then, and then further on up, up the kinetic chain to, to tell. Inform the. The hips, maybe how to rotate to accommodate the forces that are generated from the walk or the jump or the run or the sprint or the dance or planting your feet to swing a baseball bat or a hockey stick or a golf club. All of this starts with the feet, and all of it theoretically requires the input from the bottoms of the feet to inform the brain of how to organize the kinetic chain. Now, many people, I love to hear this. Like people say, geez, but Mark, I just have flat feet. I have no arches. I'm like, you were born with a perfect kinetic chain. Everything about your ability to move was perfect. The only thing you did to screw it up was you started wearing shoes. Because if your brain, if you're, if your feet are feeling the ground underneath and informing your brain of exactly how you move your particular kinetic chain, whether your arches are flat, they can still be wickedly strong. Like a lot of people with flat feet have strong arches. It's, you know, that's not a zero sum game. That's not an either or, that's not black and white. Flat feet doesn't mean weak arches. It just means that's the shape of your feet. Just like, you know, people have wide hips or narrow hips or they're knock kneed or duck footed or whatever, People have this perfect kinetic chain that's perfect for them, provided the brain has the information it needs on how to orchestrate all of those connections, all of the connectivity, every joint from the bottom of the feet up through the neck will work perfectly if you give it that appropriate sensory input. Once you put shoes on it, all bets are off. And so that's really the issue is that over time, people who get injured running, for instance, it's an overuse injury. It's just some part of that kinetic chain is being repetitively used in the wrong way. An injury is your body's way of telling you you're doing it wrong, full stop. Right. Like our ancestors over millions of years, they didn't get injured training, you know, doing 30 miles a week or 50 miles a week of running. They didn't get injured walking. They, if they did, it was a traumatic injury. Right. But they didn't get overuse injuries from this because, because they were barefoot, they had, the brain had all the information on exactly, you know, how, how to orchestrate this chain. Now a good example would be if you were to run barefoot across a football field that had gopher holes in it. Right. If you're barefoot, you could pretty much sprint across that field. And even though you might step in a gopher hole, by the time you put your weight on that foot, your ankle's not going to twist because it's going to, there'll be enough accommodation through the kinetic chain and maybe, maybe your knee will dip a little bit more to offset that. Maybe you'll even stumble a couple of steps. But you won't. You almost, almost without exception, you won't, you know, twist your ankle or sprain your ankle running barefoot across something like that. Now if you put on cleats that are stiff and they're an inch off the ground, and now you're running sprints on that same football field. Yeah. Maybe you will sprain your ankle because you've negated all of that important input into the brain to be able to accommodate a shift, a change in terrain that you're running on.

Dr. Stephanie Estima (26:24)

Fantastic. You mentioned before, just in passing, I'd like to actually double click on it a little bit that not everybody should be running. So we were talking about Phil McKnight and how he developed, you know, this cushioning under the shoe to help some of his elite athletes. And it sort of trickled down to everybody being able to run and everybody should be able to run. And you sort of made a comment that not everybody shouldn't be like, not everybody should be running. So what are some of the things that we might see in, let's say a novice or a poorly trained runner? What are some of the things that we are going to see, let's say, from a biomechanical perspective, like what's going to happen with them?

Mark Sisson (26:57)

Well, so from, well, biomechanically, people who are overweight, for instance, and start running have a tough time running with, with good form, which in my book literally and figuratively means with a, with a soft midfoot landing, right? You want to spend more time in the air and less time on the ground. You want to live. You want to use the middle part of your foot as the primary landing point. But unless you're trained to do that, unless you've done it barefoot, you typically tend to put on these shoes and then be. And then land with your heel. So the foot, the, your, your gait is kind of heel centric. And so you put that forward foot out, land on the heel, roll off the big toe. Now these shoes, we didn't talk about this. A lot of these modern running shoes have what they call a rocker in the front end of the shoe. So the big, the toes are already rocked upwardly. To sort of assume that that's how you're going to roll off your stride, by landing on the heel and rolling off the big toe. That way, rather than forcing your big toe to be the gen, the propulsion generator, and push off the big toe, the great toe. So bad form, heel striking, you know, too much time spent on the ground and too little in the air. And that's larger result sometimes of being overweight. But, you know, up to seven times the forces of walking when you're running. Now, those are some of the biomechanical issues. But what I take the greatest exception to are the amount of runners who go out the door and think, this is going to be a great workout, it's going to be valuable. I'm going to struggle, I'm going to suffer, I'm going to put myself through a lot of discomfort, I'm going to sweat, I'm going to burn the calories because my Watch is going to show what calories I'm burning. And most citizen runners, most runners who are not training to be the best in the world run at a heart rate that is too high to be burning fat, but too low to be generating any sort of positive shift in performance. Too, too high to be optimizing fat burning and capillary perfusion and excessing fat out of stored body fat, but too low a heart rate to be improving VO2 max to be improving anaerobic threshold. So it's what we call the no man's land or the, the black hole of training. Now you'd say, well, so what? I mean, they're doing the work. They're, they're burning off the calories. Why, why isn't that valuable somehow? Well, the calories, because they're not burning fat, they're burning glucose, they're burning glycogen that's stored in the muscles. And until you've learned how to burn body fat and that's all you have is a sugar burning tank. You get back from that workout and now you're exhausted because you've been training hard and your heart rate has been too high. You've, you've secreted the fight or flight hormone cortisol. So now you're, you're, you're hungry and your body, your brain says we have to eat, we have to eat more carbohydrates and replace the glycogen that we lost in this, in this run, in this hard run, in this fight or flight, life or death event that we just encountered willingly and over time.

Dr. Stephanie Estima (29:56)

Voluntarily.

Mark Sisson (29:57)

Voluntarily. No, it's so, you know, it's, obviously you have to have, have lived through it and understand it to see how ironic it is that people who want to do the right thing and go out there and buy the shoes and get out their door and start huffing and puffing and struggling and sweating and groaning and then get home and they, and they, you know, sit on the couch and they can't move for the rest of the day. But you know what? Doesn't matter because I did my 45 minutes, so my work is done. When in fact it's, it's counterproductive. It's counterproductive to, we, to losing weight. So most people who engage in a running program to lose weight over time don't lose weight. You know, you might lose £10 the first week or the first, first month because you are engaging in a new activity that is not inflammatory to a certain extent. You're, you're, you're you know, you're sweating out some of the toxins. Your, your, your, your body, you know, retains water if you have a systemic inflammation. So some of that subsides, you know, if you are burning 400 grams of glycogen in a workout, each gram of glycogen holds 4 grams of water. So there's water weight loss. So some people say, well you know, I, every time I run I lose four pounds and then I gain it back. Well that's, you know, that's, that's not how it's supposed to work. That's not you burning off stored body fat. That's you burning off glycogen and some water and sweating and then, and then just, you know, replenishing the glycogen with more food. And the problem is because the brain, because you haven't learned how to burn fat and you're not taking fat out of storage and you're consuming more carbohydrate to be able to carbo load, to be able to do this again the next day and the next day and the next day. Over time, people's body weight doesn't change that much, but their body composition does. And they get, they get what we call skinny fat. They get a little bit fatter, there's a little bit more fat and then they're losing muscle. Because make no mistake, running is catabolic. Running tears muscle tissue down. Running at, certainly at a, at a heart rate that is that in that no man's land in that black hole of training. And, and that would be above zone 2. Running in zone 3, 4 and 5 is catabolic. Now that's, that's not a bad thing if you're an elite runner and you're trying to break a world record. When I was a decent Marathoner I weighed 140 pounds and I, today I'm at 71. I'm 172 pounds. So I weigh 32 pounds more now than when I was an elite marathon runner. I had the same body fat now as I did then. So I'm carrying 20 pounds more muscle, a little bit more, a little bit more fat, a little bit more water weight and a little bit more bone density because I also didn't have the bone density because one of the issues with running a lot and running at that high a heart rate for too long is because it's catabolic, because it's a cortisol inducing activity. You don't get the bone density that you would get just by going to the gym and doing, you know, a good heavy leg day or a good strength training routine. And a lot of runners, because they're running and they're so invested in their running, whether they're good or not, they don't have now they don't have the energy or the time to go to the gym and do those two important weight training sessions each week that will improve their muscle mass and their strength and their power and most likely increase their prospects for a longer, healthier life.

Dr. Stephanie Estima (33:15)

I say sarcastically that marathons are really great for body workers. They're really great for chiropractors and physical therapists and any type of body worker, because I can tell you that when I was in physical practice, I would have marathoners show up after they'd run the Toronto marathon, whatever marathon they had run, and they literally looked like they were, were closer to death's door than they had any other time that I had seen them. And sometimes, you know, to your point, I think that longevity and performance often are inversely proportional to each other. Like, you know, if you're an elite athlete and you want to really perform, like, you're also sacrificing a little bit of your longevity and your health in.

Mark Sisson (33:53)

Order, and you're doing it knowingly, you're doing it willingly. I think most elite athletes will acknowledge I'm okay giving up five years in the back end of my life if I can be one of the best in the world at this point.

Dr. Stephanie Estima (34:02)

Yes, yes. But for the most, like for the 95, the genetically non gifted, let's say, or people who are not taking advantage of the, of the capacity, you know, maybe the genetic gifts or whatever that they have, who maybe shouldn't be running as much as they should. You are, you know, you're scarring. I mean, from a joint perspective. Got like, you're ripping apart the joints. I've seen too many X rays with like, literally the bones are sitting on top of each other, there's no cartilage, they're getting injured over and over again. Certainly from a heart perspective, like all of that running, I mean, and maybe you can even speak to this about like the arrhythmias and the scar, like, just like the endurance athlete like that. Pounding the pavement all the time also has injurious, you know, outcomes for the heart as well. Sodium is an essential nutrient involved in the maintenance of normal cellular balance, the regulation of fluid and electrolytes, and your blood pressure. Start your morning right with a refreshing, salty tonic of element tea. It's spring season now, which Means I will be enjoying watermelon or grapefruit salt on ice. And it is a fabulous way to balance stress hormones and make sure that I am maximizing my muscle gains. Element also has a no questions asked refund policy. Try watermelon or any flavor that you want and if you don't like it, they will refund your money, no questions asked and you don't even need to return the box. Head over to drinklement.com Dr. Estima that'S-R-I-N-K l m n t.com d r e s t I m a and you will get a free LMNT sample pack with any purchase.

Mark Sisson (35:41)

So, you know, it's interesting. The heart has no real innervation. There's. The heart can't sense pain in the same way that muscles can. So if you go to the gym and you go, you know, Stephanie, we're going to work biceps today and we're going to do 45 sets of 12 each of 75 pounds. Your biceps at some point are going to go, no, we're not, I'm out of here. The heart, you could say, hey, we're going out the door, we're going to go run eight miles, we're going to do it at eight and a half minute mile pace. And the heart goes, all right, I guess, I guess I got to keep up with it. The heart is a demand based organ and it supplies oxygen and blood supply to the working muscles on demand. As you consciously decide to move your legs and make that first move, the heart just goes along for the ride and has to keep up with it. Now. Okay, you do that once in a while. Great. You did that every single day for decades. The heart, it gets stretched out, it gets scarred. And my generation, which was the running boom generation starting in the late 60s, early 70s, through the 80s, there are lots of people my age who ran for 20 years or 25 years who have all manner of cardiac problems. AFIB is the, is an epidemic in my age group of runners. Like probably 2 million cases of afib. Atrial fibrillation.

Dr. Stephanie Estima (37:04)

Wow.

Mark Sisson (37:05)

VTAC. I kept and I talk about it in the book. I used to keep a registry of all the world class elite athletes I knew who had had a heart attack and died, had had a heart attack and survived, had a heart attack and had a pacemaker installed, had multiple open heart surgeries, had pacemakers installed. I mean it's, it's. I stopped keeping track at about 60, 60 world class athletes that I knew. So people who say, oh, My God, running. So good for you. It's so good for your heart. And the more you do, the better it is. No, it's a. It's a. It's a J curve. It's right. It's a. It is a point at which some of it is good and then at which. Beyond which there's not only a decreasing return, there's a negative return to doing too much. I, in my own case, have PVCs. I have premature ventricular contractions, so I have some scar tissue that affects how often my heart beats. So if without, I take medication for it and I didn't need an ablation, I had a choice. I could do the ablation or the meds. I take a meds. It limits my heart rate to a certain max heart rate. So it's like there's a governor on my heart. But that's for me, assuming in my teens and 20s and 30s that the more I trained, the harder I trained, the fitter I'd become, the better performing athlete I would be. And so I ran my heart rate up to max. I'm talking zones four and five for anywhere from 20 minutes to an hour and a half, four or five times a week for decades. And, you know, what do I have to show for it now? Well, luckily, I stopped competing a long time ago, and I stopped doing that. So, you know, I was a runner who did a hundred miles a week for seven years in my. In my peak training. Wow. And I had a high week of 127 miles, and I haven't run a mile in 30 years. Now, again, I'm very fit. I'm probably fitter now overall than I was when I was an elite marathoner. You know, I can. I can deadlift almost twice my body weight. I can dead hang a minute and a half. I can, you know, hold a plank for three minutes, like, a lot longer if you want me to. I mean, I can. There's a lot of these different metrics. Peter Attia would call it, whatever the Centenarian Olympics or whatever that, you know, the decathlon, I think that he taught, that he talks about. But I'm. I'm competent across a wide range of. Of physical attributes. Not just a good runner, able to run metronomically at a fast pace for a prescribed distance. And that's really what I'm. The overall intent, by the way, the book was originally going to be a longevity book. And as I got more and more into this, I said no, I got to really hammer home this concept that walking is the single greatest thing you can do for today, for tomorrow and for the rest of your life. Walking is a quintessential human movement. Walking is something that all runners should be doing more of as part of their training. Even if you're a decent runner, you should be walking more. And one of the problems with walking over the past few decades and because of the running boom, so many people who would have benefited from walking but said, oh, you know what, I'm walking, if running is so good, why would I even bother walking? It's not, it's not going to benefit me.

Dr. Stephanie Estima (40:15)

It's not real exercise.

Mark Sisson (40:16)

It's not real exercise. If I can't, if I can't run and I can't because of my knees or my, I'm overweight or whatever, then I guess I'm just going to give up and just, you know, play my video games or watch my soap operas. So the, the intent of the book is to, is to drive home this fact that we are, we are creatures that are, that are designed to move around a lot throughout the day, whether it's walking or just changing positions. You know, if you've, you know, Katie Bowman would say the same thing. You know, she's like looking for all of these different, even if she's resting, she's resting in a different position every time she's, she's shifting. So, you know, the, for a while, a couple of, like when I first started writing about health and fitness, the stand up desk was the big thing. But it turns out standing for any length of great length of time is just as bad as sitting for any great length of time. So you want to move around as much as you possibly can. And, and walking is the best way to do this. And you don't, you don't have to go, well, Mark, I can't find an hour a day to walk. I'm like, okay, then find, you know, five 12 minute sessions where you can walk. Because the fact, in fact, I would argue that five 12 minute sessions spread throughout the day is better than one compact hour of walking where then you don't do anything else except sit around and go back to your normal strategy. So walking, walking, walking as much as possible. And for most people, walking is enough to create that aerobic base walking for most people, the people that we were just talking about who are struggling and suffering and running at too high a heart rate. You know, we prescribe this, this, this zone we call the fat burning zone or fat max zone. You've had Phil Maffetone on And he's the one who really pioneered this work where you're, you're, you're running at or below the highest heart rate where you're still burning mostly fat. And that's what's going to prompt capillary perfusion, more capillaries, more mitochondrial proliferation. So you're gonna build more mitochondria where the fat burns. And the result of that is that when you're sitting around doing nothing, you're gonna burn more fat, just going about your day. And as you get more and more competent in your ability to train harder and harder, you, you can up that performance output and still derive most of your energy from fat versus tapping into those glycogen stores. Now, once in a while you're going to want to do some glycolytic work, but not every single day. You know, that's the difference here in doing glycolytic work. Every day you are tearing yourself down. You're, you're, you're not only tearing yourself down, you're increasing the likelihood that you're going to get sick because it's compromising your immune system. You're probably compromising your digestion because cortisol has an effect on that too. And you know, it doesn't have to be the running thing. I see it a lot in particularly, you know, the particularly women. I, I'm, I'm not gonna, you know, I'm not gonna mince words here who do like Orange Theory five times a week or Barry's boot camp or do two a days at Soul Cycle or spinning classes, you know, because they think that the more they do and the more they sweat, the, you know, the, the leaner they'll get or the skinnier they're going to get. But over time they don't. Unless you, unless you do the work in the gym and build the muscle and unless you do the low level work, the base work zone 2 or lower, all you're doing is practicing hurting and ultimately beating yourself up. So it's a little sad to think that people are in this mindset that it's gotta be, it's, you know, no pain, no gain. It's gotta hurt. It's gotta, I gotta, you know, it's gotta feel like I really beat myself up today in order for that workout to be valuable. When in fact, if you do most of your low level stuff, zone one or two, for most people, that's a lot, a lot, a lot, a lot of walking and then two workouts a week in the gym, not three, not four. I mean, you could do three, but whatever, spread apart because. And you know this from, from all your training, that if you, if you're in the gym doing the right amount of training and the right amount of intensity, you can't repeat it the next day or even two days later. It takes you that long to, for your muscles to improve and to recover and to build back stronger from the work you did. And where people go wrong very often is they lift weights too much, right? And then they don't get stronger, they just get beat up until they get injured in the gym. So there's a beautiful sweet spot, minimum effective dose, if you will, of exercise that'll get you to 80 or 85% of your performance goals with the least amount of struggle and suffer and pain and sacrifice. Lots of walking, two workouts a week in the gym, and then one day a week of sprinting. And we can talk a little bit about what that means. Sprinting isn't necessarily running on the track, but sprinting. The concept of sprinting is doing an activity where your heart rate, you're all out and your heart rate is as high as you can get it within 20 seconds or 40 seconds or whatever short window of time you've allocated to that. Could be on the assault bike, could be on the elliptical trainer, could be on the treadmill on a 15% vertical, could be on the track if you want, could be in the pool, could be on. You know, there's all manner of places and ways in which you can do this sort of sprint training, but sprinting all out, getting your heart rate way up there, that's what's going to improve your VO2 max. That's what's going to, you know, give you that increased anaerobic threshold. Not just going out and practicing herding every day. In this no man's land of heart rate training.

Dr. Stephanie Estima (45:53)

You've touched on some absolutely excellent points. I just wanted to. You mentioned women, the orange theory, the F45s, the berries boot camps, all, all the things. It doesn't have to be those companies, but just if you're, you know, doing the doubles, you're going to car, you know, doing two cardio, and they're all.

Mark Sisson (46:08)

Great, don't get me wrong, they're all great, but just.

Dr. Stephanie Estima (46:10)

Yeah, yeah, yeah, but I mean, everything exists on a continuum. And I wanted to maybe just stay here for a moment because I think most women at least has been my experience from my community, reaching out, people reaching out who listen to the podcast, they feel like exercise has to be hard Right. So, you know, I sort of have a joke and I, and I, in the spirit of, you know, honesty and transparency, I often make the joke. Like, my toxic trait is I always make a zone two workout, a zone four workout, right? So I start and I'm like, this isn't hard enough. I gotta make it count, you know. So what do you say to the overachieving type A or even just a woman who feels like she has to suffer in order for something to work? Like, it has to be running. Like, walking is too easy. I enjoy walking too much. Therefore it's not doing what it should. Like, how do we, you know, when you and I can tell you, when I run, I want to stop. Like, I, you know, there's been many. I don't run really anymore, but when I would, when I would run, I would literally be trying to override. Like, my body's like, just, just take it. Like do like a two minute walk. Just like catch your breath.

Mark Sisson (47:14)

Yes.

Dr. Stephanie Estima (47:14)

And I would literally, I'm like, shut up. You know, like, to that voice, like, shut up. I gotta get through this. I gotta get through this. In the time that I've set for myself, I'm running this many minutes per mile. La la la. So what do you, what do you say to that woman who feels like it has to be punitive in order for it to be effective?

Mark Sisson (47:31)

Well, you know, it gets into the psyche. There's a whole section of the book called the obligate runner. Right? People who feel like the day is not complete if they didn't do their run, and if they didn't do their run, they beat themselves up, they feel guilty, the rest of the day is ruined. No matter how good the rest of the day is with the rest, with their family or their job or whatever. So there's the obligate runner and that, you know, that, that extends out to other arenas, whether it's in the gym again, doing multiple days of, of these different boot camps or whatever. You know, there's a thing called exercise anorexia where it is an endemic kind of problem in some people where they are, that's the control they have over their body that they're, that they're. One thing that they can control is they can override the brains, the, the limbic systems, innate desire to stop, and they can override it and control themselves and push through and do it again and again and again. Now, you know, as a, as a once in a while exercise in, you know, mental fortitude. Great, I think that's fine. But you know, the cold plunge does the same thing. You know, you might hate the cold plunge, but the reason it's good for you is because you hate it. And you're willing to get in there and override that survival mechanism for the two minutes that you're in there. But when it comes to exercise and working out, doing this day in and day out, it does not generate the kind of benefits I will assume that people go to the gym and do what they're doing in order to think that they're going to improve their lot in life, whether they're going to improve their performance, whether they're going to improve their body composition, whether they're going to improve their, their chances of living a longer life. All of these things like, why would you go to the gym if I, if none of these were going to happen, and all that was going to happen was you were going to get sick and beat yourself up. And yet that's what happens to a lot of people, especially to a lot of runners. They just, they're, they're doing it until they get injured, and then the injury is their forced time off and time of reflection. So it's so much of this is kind of taking an opportunity to be self, to be introspective and go, why am I engaging in this activity if not to improve myself, if I'm just going to beat myself up? That makes no sense. That's the definition of insanity. To keep running at this pace every day. For instance, to be running 30 or 40 or 50 miles a week to compete in marathons and then never get faster in these marathons. I know so many people who are like a 3:45 or a 4:10 marathoner and do three or four or five of them a year and don't get any faster. I'm like, dude, I like or lady, I, you know, I, I, I, I ran for seven years. I ran 100 miles a week for seven years. I've never spent that much time running in my life. You willingly do that several times a year in marathons. And you touched on it earlier. If those people were to show up at a practitioner's office or a hospital the day after a marathon, the triage group would go, I think this person's having a heart attack because of all of the damage that's being done in that overcoming, overriding the tendency to stop, pull over the side of the road and walk. So doing a marathon once in a while, once in a lifetime, bucket list item, you know, absolutely. I don't want to talk, you out of that, but taking it on as some avocation that you're, that you're thinking is going to improve your, you know, your, your longevity prospects or decrease your risk for certain diseases, it's not doing it. It's in fact it's quite the opposite. It's having a, a negative effect at the end of the day. And there are 50 different ways, 50 different exercise choices that you could be engaging in that would be far more efficient and far less painful or at least much more comfortable and fun. By the way, so many people say I love running. I'm like, I'm not sure you love running. I think you love having run. I think you love calling yourself a runner, but I don't think you love running. You know, that's why you're out there with those headphones on, listening to Metallica and trying to get past the thoughts to pull over the side of the road and stop.

Dr. Stephanie Estima (51:28)

Yeah. So if we embrace this idea that walking is, you know, we're born to walk and that we should be walking more, I would assume that when we do get started with walking and maybe we're using a paluva shoe or maybe a minimal shoe, would you recommend that is where we start, or would we, would you recommend moving from like just going from the running in the bad cast of a shoe to walking in the bad, or do you just. How do we start?

Mark Sisson (51:54)

How do we get on the track? So that's a great point because I think first of all, you know, trying to convince runners that it's okay to walk has been a big challenge for this book. But I'm giving runners permission to walk a lot. And you know, we go back to that, that math heart rate, that, that fat max heart rate which is 180 minus your age. So if you're a 40 year old woman and you're out there either running or walking, you should, your heart rate for 80% of the time you're spending training, your heart rate should be at 140 or lower. Now if you can run at a heart rate of 140 with good form, then fine, great, but most people can't run at that heart rate. But by the time they're breaking into a run, their heart's now 150, 155, 160, 165. So. But walking, you can keep that. You could walk briskly, you could walk with a weight vest on, you could walk ruck with a rucksack, but you could walk at a heart rate of, you know, 135 130, 125. And be very comfortable and conversational and walk with friends or have a phone call while you're walking and still be getting the work done, the, the aerobic base building work done. So still you, once you walk, once you're, once you decide you're going to walk, that's the opportunity also to realign that, that kinetic chain, that posterior chain. And that means walking in minimalist footwear. Walking in, I have the paluba shoes or a five toed shoe. There's another company makes a five toed shoe. There are some great minimalist shoes but you want to do that, you want to, you want a wide, thin, flat, flexible sole. So it's, you don't want any sort of heel raising. You don't want, you want it to be thin enough to be able to feel the ground you're walking on. So if you're stepping on cobblestones, you want to feel every cobblestone. We call that foot candy. Like when you're walking in a cobblestone, it feels, oh my God, it feels so cool. I can feel everything. And I now I feel that every time I step, I step in a slightly different position. But it's good because I'm, and since I'm not running and I'm not putting seven times my body weight forces on that, I'm just doing a nice easy roll off, push off the big toe, the great toe, plant the heel, roll off the, off the toe. Now I'm reinforcing my entire kinetic chain in a way that's going to make my feet stronger, more resilient, more mobile, decrease my risk for injury. I mean nobody gets injured walking for the most part. Right. And if 50% of people get injured running, that should be your first indicator that one is slightly better than the other slightly. In fact, if you're injured, if you're injured as a runner, how do you come back from your running injuries? You walk.

Dr. Stephanie Estima (54:29)

You walk.

Mark Sisson (54:30)

Yeah, right.

Dr. Stephanie Estima (54:31)

And for the type A personalities as well, you know, the people that need the, I need to know feel like I'm achieving something with the walking. If I remember correctly from Phil's, our conversation with Phil and maybe you can add on to this is the way that you know that you're getting better is that you can still maintain that same heart rate. So 180 minus your age, but the distance that you travel improves or the pace at which you do it is.

Mark Sisson (54:54)

That, is that, that's 100% true. So that's the measure of efficiency. So that's when you realize, oh, my God, this is working. Because now, and so you may be with a, with, as a runner with a fair amount of walking, you may get to the point where all of a sudden one day you go, oh, now I can run at 145 or 135 beats a minute or 137 beats a minute. And I'm actually running. I'm not running fast, but I'm running. The great example is, is Mark Allen, who's the greatest triathlete, really greatest Ironman triathlete ever. And he did years of this training to get to the point where he was so good at burning fat, he eventually won six Ironmans in a row. And it took him a long time to get there. And he had to develop this efficiency, this ability to become more and more efficient at a faster and faster speed, still maintaining the lowest possible heart rate. What we called the math heart rate at the in, in those days. But we call it fat max in the book here. So. And we talk a lot about, in the book about how to get there and how to measure that and how to, you know, how to, how to work within that. But the point being, over time, you want to improve, you want to get better at burning fat, you want to get better at mechanical efficiency and all of the other metrics that we use to make you perform better, look better, feel better, live longer, decrease your risk for getting sick and decrease your risk for injury.

Dr. Stephanie Estima (56:12)

And this requires a little bit of precision. Right. Like you need to understand. So the 180 minus your heart rate is sort of analog, if you will. Like, it gives you sort of a rough estimate. But is it better to have a heart rate monitor? Is that something you would recommend?

Mark Sisson (56:24)

I mean, I do recommend it now. I've been doing this long enough, and I know a lot of people doing it long enough that we just know what the, what the breath rate is and what the feeling is. You don't need the heart rate monitor to, you know, to keep you honest in that regard. But there is a tendency to exceed, like you said, to maybe push it a little bit and going, I'm starting out zone two. But you know what? Yeah, I feel like I could go into zone three pretty easily, but I, I wear a heart monitor. So this is not to say you shouldn't go out and do something, you know, reasonably Zone three, four, once in a while. So my, my workout week is typically a lot of zone one and two. A lot, lot, lots of walking. I lift twice a week and Then once a week I get on a fat tire bike on the sand and I'll do an hour and, an hour and 10 hour and 20 minutes of zones 3, 4 and 5. I'm trained, I've got a, I've built a base. I do the sprint workout once a week. But that one workout is where I put it all together. I put my aerobic time that I put together, I put the speed work that I've done, I put the strength stuff that I've done in the gym and now I apply it to one workout a week where I'm like, if I were racing, that would be my race. But I'm not racing. So. And I don't intend to race, you know, ever again. So that's the time, the one time where I put all these component parts together into an event that would be considered like the persistence hunt or the once in a while all, all out effort, spread out over time. So I'm. A lot of runners would say, well, how does that look to me, Mark? Because I run six days a week. I run anywhere from five to seven miles, so that's 35 or 40 miles a week. I'm not getting any faster. I'm running 10 minute miles. And I would say, all right, if you did all of the aerobic work at the fat max or lower heart rate, which for most people is walking, not running, if you did one sprint workout a week, and for runners that would be a running sprint workout on the track, but they're very short, they're very brief. And then twice a week in the gym, then once a week, go run your six miles. I guarantee you you'll run faster per mile than slogging it out and hurting every day. So if I can give you this program and say you're going to be a better runner only running running your distance once a week, would that be okay with you? You can still call yourself a runner. You know, it's not like you lose your running card because you're not running every day and you're getting better and better and better over time. Those are the kind of people that I would say then when you hop in the, you know, the, the local 5k or Turkey Trot or 10k or whatever it is that you do once in a while. Now you're showing up at the, at the starting line with your peers who have been slogging out 35, 40 miles a week and now you're beating them in the race with, with little run training but, but really mindful training in terms of building an aerobic base, doing some high end VO2 work, building some strength in the gym and then applying it to this one event that you're doing. Does that make sense?

Dr. Stephanie Estima (59:30)

That makes perfect sense. And I think if I can add on to that, and I'm sure you'll have comments here too. I think having the grace and again, kind of back to that psyche, like if you're, if you, you're going, you know that you're, let's say you reduce your running to once a week and you're putting everything in. But you wake up that day and maybe you've been sick that week, it's been just like a hell week. For whatever reason, you haven't slept well, lots of stress. Also giving yourself a little bit of wiggle room to not, you know, you don't have to leave it all on the floor that particular day. Like it's okay if you are stressed and you don't perform at what you were maybe expect. Like if the output and the behavior don't exactly match up that day, that's also okay.

Mark Sisson (60:09)

When in doubt, walk. Literally if you woke up that day and you said today was the day that I was going to go run my, you know, my time trial around the neighborhood, but I'm not feeling right. Go for a walk. I mean walking is, it's restorative. It'll, there's very few opportunities that you have to do something that's beneficial, that isn't stressful and that you can do whenever you want. I mean, this happens to me a lot where I'll get to the gym and you know, I, I again I'm somebody who says when you go to the gym and you do the strength training twice a week, give yourself at least three days between body part workouts because that's how long it really takes to recover and get better from the routine that you did. And some days, three days isn't enough for me. So I get to the gym, I plan to do, you know, an upper body routine. I usually do a full body kind of thing. And I'll go, you know what to two sets in. I'm like, it's not happening today. I don't feel recovered. Go for a walk. I mean it's such a great, it's such a great plan B for any day that you don't feel like it as opposed to making it sort of binary. Like either I have it and then I quit and I just go back to work and don't do anything. Now you have like, okay, it's not, I don't have it today. It's just I'm not feeling it. Or maybe I'm stress from some other stuff that pile up over the week. But I can go for a walk and that'll be a de stressor and it'll get my mind right and improve my mood. I mean, there's so many things that happen as a result of just getting out in nature or outside doesn't even have to be in nature. And walking in fresh air, mood, elevation, you know, improving digestion, lymphatic flow, certainly creativity. I mean, a lot of people say, but Mark, you know, running is my meditation and it's my, you know, it's how I clear my head. I'm like, okay, but that happens with walking too. It's just that you're not, you're not spewing and struggling and sweating and pounding and hurting yourself so much. But that's one of the things that I recognized early on when I really started walking a lot in earnest was, oh my God, my creativity jumps up as a result of just being outside and walking.

Dr. Stephanie Estima (62:15)

Yeah. I was saying to you actually before we got going today that I did a leg workout two days ago and I'm still very, very sore from it. And today was supposed to be my bike ride. I was like, actually just doing a recovery walk. Like it was a 50 minute nice and slow. Did my duolingo or whatever I was doing on it, but it was. And I already feel better. Like, I already feel like there's been a lot of healing that's happened, but there's been several instances. You know, you were talking about when you went to the gym and you were supposed to do upper body or whatever. That happened to me earlier this week as well. Like, I went, I was like four or five sets in. I was supposed to do shoulders that day. And I was like, it's just, I can't. No, it's not. Not today. Not today, Satan. So just went back home and like.

Mark Sisson (62:52)

But you know, you've been doing this long enough to know that you're not going to backslide. You're not going to detrain from skipping a day. In fact, if anything, you'll be better off not doing the work. Even though it said you were going to do it in your, you know, in your calendar. You're better off taking the day off because you've become attuned to the signals that your body is giving you based on the work that you're doing. So, you know, when you're working hard you're working hard. And then when you know, you also know that you need the time, the rest of the, the nutrition, the time, the recovery to build back stronger. And if you haven't given it enough time, and sometimes, you know, in my case, if I'm traveling or if I have other stuff going on, I don't even agonize about missing a workout again. I can walk. Whatever city I go to, I can walk. That's another great thing. I don't have to find a gym, you know, or find a bike that's set up with my configuration to go do a, you know, hour and a half ride or whatever. I can just go walk. It's a, it's amazing, this freedom that it gives you when you understand that if, if all you ever do is 85% of your work is, is walking. And then you, you find those times when you can do the high intensity stuff in brief bouts and sprint once in a while. You're 85% of where you need to be in your performance goals. And by the way, the other 15% takes 10 times as much time and effort to improve. So what we're talking about was what I would call a minimum effective dose of overall training to be a better performer, to feel better about yourself, to, you know, to optimize body composition. By the way, you know, we know 80% of body composition is a result of your diet, right? So you can't exercise away a bad diet. You need to have your diet, right? But what that also means is, is that again, exercise is not a great way to lose weight. You have to do the work, but you can't like walking. People say, well, but I don't burn that many calories. I'm like, this is not about calories. This is about moving. This is not about calories. Calorie. That whole thing happens as a result of how you eat. So don't count calories. Don't think, okay, I walked, you know, I walked 22 miles this week. That's 200 and that's 2,000. No, don't even think about calories that way. Your body will, will, will figure that out. You burn, if you did it right, you'd burn mostly fat. So that's your body taking your fat out of your fat stores and combusting it as fuel. That's a great thing. It probably decreased your appetite. It didn't. One of the things we noticed about runners versus walkers is that runners come back from workouts and their appetite is boosted over time. And walker's appetite is either the same or a little bit lower. In fact, people are. If people are engaged in a walking program and they've started a new, a new way of eating, let's say they're keto or they're carnivore or whatever, they're low carb and they get hungry in the middle of the day, I say, okay, instead of reaching for the refrigerator door, reach for the front door, go out for a 15 minute walk. I guarantee you that hunger will dissipate, those cravings will go away. Because it is, it's accessing energy from your stored body fat, which is not just going to your muscles, but, you know, going throughout your body. And now you're getting a, a brief, you know, boost in mental clarity and mood. And those hungers and that hunger and that appetite kind of dissipates for now.

Dr. Stephanie Estima (66:14)

Yeah, that's such a great little tool is like, if you're hungry, go for a walk. Because it is, as you said, it's anabolic. And now you're feeding your body, right. Like you're feeding your body with that stored energy. I wanted to ask you a personal question. I know that you recently went through a hip replacement and it seems like the word on the street is that you bounce back faster than anybody has ever seen. So maybe you can tell us a little bit about. Was walking part of your recovery protocol? Is that how you walking was the.

Mark Sisson (66:41)

Walking was the recovery protocol? It was. That's, again, it's unbelievable to me. So I'm, now I'm coming up on eight weeks and I feel like I'm 100% back. The only thing I'm not doing is sprinting. And I'm only doing that because I don't want my doctor to know. But, you know, I can, I can do bounding on the, on the treadmill. I mean, I'm doing three and four mile walks at a high heart rate. I'm riding a bike for an hour, doing. I'm, I'm doing heavy leg days, which I've been doing since week three. The, it, it's, it's just really unbelievable to me how, and I'm going to write a paper about this because my doctor, who is a pioneer of this procedure that I had, it's the ant. One of the anterior approaches said, don't do physical therapy, just walk. And I'm like, okay, that's. That aligns with my thought process.

Dr. Stephanie Estima (67:27)

That's convenient. I have a book on that.

Mark Sisson (67:29)

Day of the day of the operation, I walked about 200 paces, like the afternoon it was done. I did 200 paces the next day. I did it in Vail the next day. And it was middle winter. I was walking through Vail Town Center Square. I did probably close to a half mile the next day, and then I did a mile the next day. And by day five, I was doing three miles and, and I did it with my, with the paluva shoes. Now here's what I'm going to talk about. What happens when you have any sort of a lower extremity issue. You tend to favor the one side. And so I didn't want a limp, so I wanted every footfall to be balanced and, and symmetrical. Right? Bilaterally symmetrical is what they say. So with the Palovas, plant the heel, roll off the big toe. Plant the heel, roll off the big toe consciously. And, and because they, they, you know, they have to, they have to separate your, the muscles of your leg, pull the femur out, saw it off, put a thing in, put it back in. It's a real insult to the muscles. They're not, the muscles aren't cut, but it's like they were pulled badly. So I had hip flexor tension for a long time. So what that looked like for me was I would walk, but I, I would walk if, if the hip flexor tension started to compromise my, my balanced gait, my reacquiring, my full balance gait, I just shortened the steps up, right. But I would still walk with a balanced stride. And, and then I started doing hip flexor exercises. That was the only physical therapy I did. I did it myself. Just, I, I know enough about these things. I mean, I don't even, you know, it's, it was seven weeks, a couple days ago, and I don't even think that I have a, you know, an injury or a new hip now. It's just, it's. I feel like I'm fully recovered. It's, it's been incredible. And walking, you know, here I am doing this book and it's so not coincidental. But, but to, to use walking as the means of recovering from this trauma. Trauma. Right. This surgical procedure and have it be that effective just continuously drives it home to me that this is what everybody should be doing.

Dr. Stephanie Estima (69:31)

Yeah. I mean, I've used walking as a therapy for concussed patients. It's like, I know you used to be, you know, high performing, doing all the things, but all you gotta do now, like, you just gotta join a walking group or just walk around the block. Like that's what you gotta do right now to heal your brain. So there's. So I love that we're talking about this from a mechanistic, like, we're talking about this from like the mechanic, like the biomechanics of the hip. Like you've literally pulled the femur out, you're sawing it off, all that kind of stuff. And it also has so many wide, like walking has so many wide ranging applications for therapy for mental health, which is of course, you know, a crisis now in this sort of post covidian, I guess, era. And I think that it's important for us to be considering walking as. I love that you said it was not part of my recovery, it was the recovery tool. And to hear that you're seven weeks out and not even to feel like you've had major surgery is not only impressive, but also a testament to your fitness going into the surgery. But then what you did exactly after that, I think that's just incredible.

Mark Sisson (70:29)

I was, that's a good point. I was very prepared for this. I went in and because I had been limping for six months prior to this, I didn't want to compromise that. So I, I found things that I could do. Like I could do the elliptical trainer without. I could do, I could be again bilaterally symmetrical on the trainer. I still did some leg days. So I went in prehabbed as, as they say, ready to, to hit, to hit the ground, running, walking. And so many people who get either knee replacements or hip replacements or artificial joint, they go into it having given up for a year or two years prior with the pain. And so the muscles have atrophied and now it becomes real problematic when they finally have the procedure done and now they have to start rehab literally from zero. So I went into it with this mindset that I'm going to, this is going to be an easy recovery for me. I'm going to, you know, aggressively pursue it, but, but mindful that I want to maintain balance, I want to reacquire a perfect stride, a perfect gait as soon as possible. I don't need to be, you know, superman yet, but I just want to, I just want it to be balanced because one of the things that happens is some people take like I had a knee problem, a knee surgery, I don't know, 15 years ago, and I had to learn how to walk again because of the nature. I was in the cast for three months and then it was about another, you know, six months of rehab and I had, literally, I would, I would walk on balls of my feet. I couldn't Plant my heel. For some reason the brain hadn't figured it out yet. But to your point about mental health, if you're any kind of fan of Chinese medicine, the big, the big toe on foot reflexology is connected to the brain. Right. And so one of the things that I, one of the experiments I want to do is with early onset dementia and it put people in paluvas and have them walk a lot because it's again, it's rolling off that big toe. It's plant the heel, roll off the big toe. And you can't do that in traditional hokas and Skechers and all these thick shoes that scrunch the big toe over and then have that rockered front that just when they say roll off the big toe, you're not pushing off the big toe there, you're just rolling it forward. It's already, there's no work involved. But the, the big toe is also directly rely wired to, to the brain. And that's a acknowledged part of Chinese medicine.

Dr. Stephanie Estima (72:58)

That's really exciting. I would love to see that, I would love to see that studied and I think you could probably get some, I mean that's not very difficult to do. People are already walking so that, that's really interesting. I'd love to see, I'd love to see that come to, to fruition for sure. All right, so tell us a little bit just in, in wrapping up here. We've mentioned Puluva a few times. This is a pair of shoes that I have and I, and I wear, I wear for my, my walks. I usually like to do the, my husband's Italian to do the passeggiata after dinner. We like to go for our evening stroll after dinner to help, to help digest. But what are some ways that people, if they want to start incorporating walking into their life, do we, we wanna pick up some minimalist shoes like a paluva? Tell us where we can find information on that. Sure, of course. Tell us about your book as well.

Mark Sisson (73:39)

Sure. So the shoe company is Paluva. P E L u v a palud.com is where you can shop for the different styles. We have, you know, seven different men's styles and six different women's styles, including some amazing house shoes, these quilted they call the Zen, that this particular model is called the Zen. So a lot of people are wearing these in their homes as slippers just to start to accommodate a five toed separation, you know, displaying things. So many people, you know, are buying toe spreaders and toe separators now like Tens of millions of people because they recognize that their feet are all scrunched together and toe separators are fine, you know, but they don't, they're not, you're not actively articulating the toes when you're wearing them. Typically you're just, you know, Netflix and chill or wear them for, you know, while you're getting your nails done or something. But now we've got a, we've got a shoe that you put on and if you want to start by walking in your house, do that. Although a lot of people like travel with the Zen, it's their favorite travel shoe for airports and all the other stuff too. No, then we have the Sport Mesh, which is a trainer, athletic trainer. A lot of people are using that in the gym. But the way to, to start with the paluvas is just get your toes into them the first time and wear them for an hour or two around the house. Maybe walk the dog with them or go outside for a quick walk to see how they feel and build up. Within three or four days, you'll, you'll, your feet will get stronger and they'll start to acknowledge the ground feel that these provide, at which point you can, you can walk to your heart's content. I would say, you know, don't run in them. They're the best running shoe ever made. But you have to know how to run and, but, you know, do everything else. Walk in them, do the errands in them, drop the kids off at school, go to old school. Whole Foods. We make a leather, leather lace up for the workplace for men. I wear them to weddings and funerals. I mean, it's, I've got a desert boot right here. This is, this is, this is men's and women's desert boot. But it's a suede, a suede shoe that looks great, quite dressy. Anyway, that's paluva. The book is called Born to Walk and we have a website dedicated to it, born to walkbook.com with lots of free downloads in addition to links to your favorite bookseller, of course, Amazon, Barnes and Noble, you know, and, and all the other typical booksellers would love to have people pick it up and understand that walking is the quintessential human movement. And you know, everything will, everything good will come to you if you start walking more and more.

Dr. Stephanie Estima (76:08)

Awesome. Awesome. Walking is the new running mark. You have such a giant in the health space. Obviously I have looked up to you and followed your work for, for many years. It's been such a pleasure to have you back on the show. Thank you so much for your time today.

Mark Sisson (76:19)

Thanks for having me. It's great to be here.

Dr. Stephanie Estima (76:21)

All right, all right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor, and these conversations are meant for educational purposes only.