What the HOKA? with Dr. Jordan Metzl

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You really can't miss them. They're those grandpa-ish sneakers with the super thick soles that everyone seems to be wearing these days. Hokas have taken feet by storm, but why? I wanted to understand the answer to that question, which led me down a rather familiar rabbit hole around fitness.

Let me start here, I hate running. Sprinting is fine, but that activity that people everywhere seem to enjoy, where you propel yourself forward at some sub-maximal pace for longer than a minute. Nah, I have to admit there have been a few seasons of my life when I was convinced it was a physical activity I needed and I'd force myself to take a run a few times a week.

But I never enjoyed it. Something between boredom and anger consumes me, and I ask myself, Why are you doing this? I'm told that if you lean in, you really get into it. There's this quote runner's high, but I've never been able to sustain my runs long enough to feel it, besides, I'm not built for distance.

Never have been, but that gets me to a broader goal of today's conversation. I usually hate those aphorisms. We make up to take the edge off things. But one that I have a newfound respect for is the idea of a quote. Fitness journey, and that's because for most of my life, fitness wasn't a journey.

It was a destination. I grew up in those quaint old times when sports were something you did in your backyard with your friends. I loved them. A regular summer day meant playing baseball or roller hockey, or soccer, or football. Sure, I played in the odd league here or there, but it was never the hyper-competitive travel sports that kids seemed to start in elementary school.

These days, I only began playing competitively in middle school, and it broke my understanding of what sports were even for see. As a kid, I played for the joy of the sport, because sports were fun, because I loved playing with my friends. Doing something I saw a pro do on TV, or just giggling through it all. As soon as we got uniforms and there was a scoreboard, all of a sudden, the only joy was winning.

It subjugated everything else to that singular goal. I ran, lifted weights, practiced because it translated into winning. Sure, there was still joy in it if you were winning. And that really sucks. Because when my competitive athletic career ended after college, it's like I'd been training for so long that I forgot just how to have fun. That, from as early as I could remember, movement was just something that just made me happy.

I could never really shake the fact that I was just never going to be as good at it as I was in college. So what was even the point that psychological doom loop was robbing me of so much joy? Those things that I loved about sports as a kid, they're still true, even if I was never going to be as good at them. And it was this recognition that, just like I did when I was 10 or 11, I could still enjoy sports at 37 or 38. A purer, more uncomplicated form, that's gotten me back into it in a sustained kind of way.

I've begun to explore sports I would never have tried when I was younger. During the pandemic, like a lot of folks, I took up biking both gravel and mountain biking. To be clear, I am not playing towards my strengths here, but I'm enjoying the process of learning these sports. And ironically, the fact that I'm never going to be competitive at these sports has freed me. I can just enjoy the way.

Bombing down a hill with the wind flowing through my hair under a helmet, of course, makes me feel. It. Turns out. It's really not a fitness destination, it really is a journey which brings us back to those Hoka shoes. While I'm not a particular fan of running as a sport or a form of exercise, even I can't doubt the convenience. Unlike biking, which requires, well, a bike, you can run almost anywhere.

All you need is a pair of shoes in Come Those. Hoka's. Dr. Jordan Metzl is in many ways the perfect guest for today's episode. He's a sports medicine doctor and founder of Iron Strength, a fitness community built around the joy of physical activity based in New York.

He's also a 36 time marathoner and a 14 time triathlete who had to negotiate his own fitness journey. While inspiring people and healing patients on their own, he joined me to talk about the joys and health benefits of fitness. Why there's so much baggage around it and those darn Hoka shoes. Here's my conversation with Dr. Jordan Metzl. All right.

Can you introduce yourself for the?

Um, and I try, and my goal is to keep doing this stuff for as long as I possibly can. Um, for a whole host of reasons are really beneficial for both mental and physical wellness. I'm sorry, so we had June's numbers.

Um, and for myself, I always had a deep love of movement and exercise. Um, and I actually ultimately found out during med school that when I would exercise or run, and then I would take a test or study, I absorb knowledge a lot better. So there was a whole kind of process of recognizing the kind of mental benefits of exercise for me is able to concentrate better. Uh, et cetera, um. But then when I got into residency, um, I noticed that, you know, with this kind of sleepless uh weeks on end, that that exercise was tremendously important. And when I was in, I did my internship in Boston. And they gave you a the day off if you ran the Boston Marathon. And nobody really had ever taken them up.

On that, I'm like, Well, hell, that sounds better than sitting 36 hours in a call room. So I did the Boston Marathon and that was my first, and, uh, and just loved doing it. But over time, I had this very strong kind of sports world, which was doing, you know, all kinds of sports, but particularly marathons and triathlons and all kinds of activities. And then I had my sports medicine world went, went through sports medicine fellowship and started a sports medicine practice here in New York City.

And I had these two very separate silos the silo of medicine and the silo of fitness and activity. And then, over the course of years, what's happened is those two worlds have kind of come closer together. And so, not only am I still a very much of a practicing sports medicine doctor all day long, taking care of people's achy body parts tip to toe. But then I also have started employing medicine, starting the exercise, starting quite small. And then about 10 years ago, started the uh, I think. One of the first physician led fitness initiatives called Iron Strength to get people out and moving around. And then about eight years ago, we started a core A course at Cornell called Prescribing the Medicine of Exercise. A course for second year med students to learn how to talk to their patients about exercise. Really, with a focus on evidence-based kind of education and knowledge for them.

And this kind of fitness community has grown. Just last Monday, we ran one of our big fitness events for the city. We had over a thousand people on the flight deck of an aircraft carrier here in New York. All doing exercise, and the whole idea is the things that make people healthy, exercise and community, and kind of laughing and smiling. You know, people do so well when they see other people, when they move, when they're part of a community, and so these are some of the things that make people healthy.

And so the idea of prescribing wellness through exercise is something that has kind of grown and developed over time. And I've been lucky enough to develop it here. I really love that I want to.

And there's this sort of weird cultural thing that tends to take hold in sometimes. Exercise communities, in which, you know, we don't tend to have great relationships with our body in this culture. And when we talk about exercise. So much of that can almost come off as self-punitive, rather than an investment in oneself. I want to ask you just generally, what do we get wrong about this nexus between physical activity?

They do it because it's fun, because they're having a good time, because they're part of a group. You know, maybe they want to get a gold star on the fridge for their report. But they do things because, you know, they like doing them. And along the way, kind of losing that fun part of exercise. You know, through all the, you know, shaming. And you have to look like this on Instagram, you have to do this class, and you know, you can be shamed in doing this or that. I think we. What I found is that, you know, the most important factors are fun and community, those are by far the most important things.

And so it could be a zumba community, a crossfit community, a yoga community, a running community. There's not a best kind of exercise. The holy grail of exercise is compliance. And so when we start thinking about prescribing exercise for our patients. I think the first question is, what do you like to do? And vis-a-vis that, what will you keep doing?

And that's always the first question I ask. Because trying to say, you need to do this amount of this per week, this amount of that per week, you have to get this amount of steps in. And I think that, as a focus, is generally, for most people, guaranteed to lose. The key thing is, what do you like doing? I'm personally very lucky that I love running for long periods of time, but not everybody likes that, and that's totally fine. I think the key is finding what people like to do and that then kind of encourages them to do that thing, so I think that's really important.

And, you know, we have great data on fitness compliance. Actually, I'm just working on a book right now on kind of the motivational aspects of fitness, just because it's so interesting to me, especially during the pandemic. Why? Some people, you know, went far to the left, some people went far to the right in terms of did a lot more or did a lot less. And you know. And so why do some people do one way? and why do some people do the other way? What are some of the factors that you know, their personalities and their environments that really change that paradigm for them? And what can we learn from that? And that's kind of what I'm thinking about now.

But I think it's a fascinating topic, but I think it really starts with fun and community. Very basic, but I think very true.

And you know, I played football in high school. And I used to just really admire the cross-country runners because I would look over at them and be like, man, their entire sport is our punishment.

But, you know, it just goes to show that people enjoy different kinds of physical activity. I think sometimes the other part of it that tends to ruin the way that we think about activity is the implicit scoreboard. So I played sports through high school and college, and when I finished college. In fact, when I went to med school, I gained a tremendous amount of weight. Simply because I just stopped exercising and I ate like I did when I was a college lacrosse player, and part of the problem was that I could not get myself...

I had lost the motivation that comes with this is just a fun thing to do and I feel good when I do it. And I had tied everything about physical activity to winning something, and it was just. It took me years to deprogram myself from that approach to saying, you know, I don't really need to focus on a certain gain or a certain metric, or a certain outcome.

I just really enjoy doing this and it makes me feel better. Both about myself, but also just the natural endorphins that I get every day carry me through my day in a different kind of way. And I just think that so often. We have taken away all of the meaning of this thing that is just so inherently human and built so much else around it. In ways that fundamentally de-emphasize the things that we naturally enjoy about doing it. So I got to ask you, right? And I just....

Not to get back to scoreboards here. But you know what is the best exercise like? If there was one exercise that everybody right could sort of think through and say, you know, I can do this? Even if I'm not going to be a rock climber or a weightlifter, I'm not going to run 36 marathons. What would be that sort of central exercise that would maximize the overall benefit?

And so at the base of the whole thing is just daily locomotion. And if you're in an urban center like New York City, it's actually way easier. You may think, Well, I'm in Nebraska, I got tons of space, tons of roads, I can move wherever I want, whenever I want. But people's neat profiles in urban centers are actually better than they are in places like rural Nebraska. Because we have to walk to get around. I finished work today, I walked home from work today.

You know, you may drive your truck home somewhere else, or you may have to figure out how you're going to move around. So at the base of it, I would say, is your neat steps, your neat profile. And 10,000 steps is not a magic number. There's been a lot of studies looking at it as 10,000, a magic number. The answer is the more you move, the better.

You know, 6,000, 5,000. But whatever it is, it'll motivate you to kind of figure out. You know, how much do I need to move every day? That's the baseline, it's just moving every day. Then the next level up is some combination of strength and intensity, and so, you know, keeping your muscles strong. The unfortunate truth is, the further we are from 25, the faster we lose muscle strength.

And if you're not actively strengthening your muscles over 40 45 years old, you're getting weaker every single day. And that muscle strength around your skeleton affects the way your body moves and the way your body feels. If you have an arthritic knee and you lose strength around that knee, that knee hurts more. You have a bulging disc in your back and you lose strength around that back, that back hurts more. So, you know, maintaining and building muscle strength.

I have patients in their 80s doing strength training and so I'm a big believer in getting people to work on their strength at any age of life. And that's hugely important. And then intensity, and intensity may sound like a, you know, if you're a 20-year-old lacrosse player, it doesn't bother you, but if you're a, you know, a 60-year-old person. Going to the gym. Intensity may sound worrisome to you, but in fact, intensity is tremendously valuable. Much like challenging your muscles, challenging your cardiorespiratory fitness to kind of maintain and build fitness throughout your life.

Because if you're not actively challenging it, you're losing it, which, you know, really affects all issues related to morbidity, mortality. You know, things that make us sick, and the things that you know, ultimately kill us. So many of these diseases are preventable. And I guess my last comment is actually one of the books I did called The Exercise Cure was all about the argument for the medicine of exercise as a drug. And looking at the evidence of, you know, exercise for the treatment and prevention of diabetes and hypertension, and hyperlipidemia, and depression and anxiety. And the more we know in really well-done studies looking at exercise versus many of the drugs that are given. You know, I'm definitely a Western-trained doctor. I'm not like exercise, and, you know, don't take your medicine for this, that or the other.

But I definitely think that, you know, thinking about exercise, in addition to many of the things we give our patients, is really important. And so that's the whole concept of this Prescribing the Medicine of Exercise seminar and a lot about why I think exercise is so important. So the baseline is walking every day, then comes strengthening and intensity in whichever way you want to do it. And I think those are some of the important pillars.

And you know, the impact for me every day. I hadn't really appreciated what it meant to be able to, just in the course of my day, walk three or four miles. Just because I needed to get to and from work or class. And that has a real impact also on your mental health, you know, one of the things that talked about in that contrast between rural Nebraska and New York is the necessity of walking. But it's also the social distance that you travel, which means the number of people that you see. The number of different views that you hold in a given walk is just way bigger in a place like New York than it is, you know, walking in a suburban community, it's like, you know, you start looking at one house and you walk a bit, and you're like, you're still looking at that same house and then you keep walking.

And now that house behind you is another house, it looks just like that house. You may or may not see two or three people. Maybe maybe if you're lucky in your entire walk versus in New York, you're completely surrounded by people, you're passing different streetscapes, you know, as you walk, and, frankly, completely different neighborhoods, social milieus in the context of the walk.

And it just makes the walk that much more entertaining, which kind of gets back to the main point that you made. Which is that so much of the physical activity that we do is decoupled from the social experience of exercise. You know, it's so much easier to get out there and work out with a friend. You talked about your brothers, because that's a social experience beyond, you know, what we often do, which is, let me go to the gym, let me get on the treadmill, stand in one place, or run in one place. With headphones on my ears, listening to the thing I would have listened to had I been in the car or wherever else I was. And then, as soon as the number hits 30 on the treadmill, I get off. I don't talk to anybody.

And then I go home, which is not that fun. Versus, you know, let me play a game of pickup or whatever sport I want to play. Or, you know, let me work out with a friend where it is a social experience. And that act of getting our heart rates up together is itself, you know, fundamentally or foundationally different than just trying to do it alone. You know, the one being very motivating.

But my overall argument is despite the fact that we do see a large number of injuries. And kind of some of the 50, 60, 70 year old people who are going, you know, balls out on the pickleball court, that, you know, I think the benefit of that sport. The reason it's so popular is that because it's all those things you talk about. It's like a communal experience, people can interact, there's all these different people playing, all these different groups and it's a lot of fun to see. So, I think it's for those reasons that we are inherently social animals. And we can have all these different constructs of layers of everything built around to keep us in our own little silos.

But it doesn't change our biology at all. We're inherently social animals and we need to interact with each other. And the better we are able to do that, the healthier it is for us and we want to do it. A friend of mine who's in the same field.

And it allows us to get the best of one another. And the other part of it is also is. Even if you are competitive and interested in growing, and whatever activity it is that you're engaged. It's so much easier to do when you have somebody else you're doing it with, right. Just learning from them, watching how they do it and trying to pick up some of those skills and put them into your own game. One of the things that I think holds a lot of folks back, particularly among the demographic of our listeners, who tend to be millennials. Now, where we're starting to have that experience of waking up in the morning and not quite figuring out why some random part of your body hurts.

And one of the important aspects of of what changed my thinking about physical activity as I'm nearing 40 is that I got some advice. That injuries are not.

They should not hold you back from what you can do, it's just that they are a constant that ought to be managed. Which not to say that go ahead and injure yourself all the time. But that is to say that if you constantly are nursing an injury in the way that you might when you were a younger, competitive athlete. I mean, I just don't play, I just rehab. You will constantly be rehabbing, and it also is a reminder that maybe you just don't go as hard, right?

Maybe you just sort of leave a little bit in the tank as you're playing. I'd love to hear a bit about how you think about injuries and the advice that you give your patients. Who will just say, are still capable, but not quite as much as they had been.

I got a lady this year, 84 years old, doing the marathon.

So there's a broad spectrum and everybody wants to move, and so my job is to try and figure out how I keep them moving. And, you know, that includes kind of figuring out what their problems are and then trying to give them the best solution to manage, uh, and prevent the problem they're having. So the classic thing is like, let's say, somebody wants to be a runner. And they have pain on the inside part of their shin, classic shin splints. And so they go see their doctor and the doctor says, Well, that's easy.

Just stop running well, yes, it makes the shin feel better, but it's a terrible medical advice, right? It's the wrong advice. Because for all the reasons why we want to keep them moving, um, you know, that's it's. It's unhealthy for them to just stop running. And so the question is, as a sports medicine doctor, you know, what I think about is, first of all, what's the injury, right? Is this a stress reaction?

Is it a stress fracture? how serious is it? And so, in that, I would first tell you that, yes, aches and pains can be part of activity, but my food. No matter who you are, how old you are, if pain is changing your mechanic of movement, you got to check, get it checked out. So if you're hitting a golf ball differently cause your elbow hurts, so you're swimming differently, because your shoulder hurts. So you're, you know, your overhead, uh, military press hurts, you know, is off because your shoulder hurts.

If it's changing how you do things, you got to get it checked out, that's number one and then number two. For example, the runner with shin splints, yes, they may be getting shin pain from running. How they are now, but what are the factors that are causing that? are they overstriding? Is there a foot rolling?

Do they need an orthotic? They need stronger muscles? is their bone density low? You know, there's a whole host of things that I think about when I think about the injury and why that injury happened in the first place. And so it's not enough to say, all right, this is an ache and pain.

It's part of the thing, but I really want people to think about, you know, what's this problem? How did it happen? what is it? how did it happen? and how can I prevent it going forward?

Um, and so that's very much what I do all day long. Um, and the the first book I did, called the Athletes Book a Home Remedies, was all about how to teach people how to do that on their own cause. I'm strongly of the belief that people need to be their own best advocates, patients, athletes need to really advocate for themselves. And if you look for any crap, if you find it on Google, you can, like, you know, Drink, Eye of Lizard, or, you know, all kinds of wacky stuff. You'll find it on the internet.

So just knowing how to think about what the questions you should be asking, what you asking yourself, you know, if you see a doctor, what you should be asking them. Um, I think it's all important as part of this, you know, maintaining your athletic body, cause this is the one body you got for your whole life. So you want to make sure you do right by it and it works for you. You know, not now when you're a millennial, but you know when you're 60, when you're 70, when you're 80. You want to make sure you're moving all the time, and so I think making sure you do the right stuff now is really important for that.

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And we're back with more of my conversation with Dr. Jordan Metzl. So how should folks think about?

Um, how do you think about, you know, fitness schools? As we age? Given the fact that, as you talked about this is, you know, aging is basically managed decline. And if you're really good at it, right, you can reduce the rate of change in the in. In the the way your body, um, will lose some of its power, uh, but you're still kind of losing capacity. And I, you know, I'd love to. As someone who, clearly, you know, sets goals and accomplishes them and works with others to do the same, how do you think about that?

And you know, I know that most most folks aren't going to have that experience of saying, you know, I trained to my absolute peak when I was really young. And I'm just trying to, you know, stay healthy now. Um, but for a lot of folks, there is that experience of saying, well, you know, I. I used to be able to do X, Y and Z, and now maybe the best I could do is just X and Y. Um, how should we think about about fitness schools as we age?

Then, right, and I'm thinking, God damn it, how did I do like?

I was running like six and a half 645 miles easily, no problem at all the whole time, and it was like it wasn't even that hard. I was like, no problem at all.

Now, you know, maybe 345 350. Pushing as hard as I try to get every drop out of the whole lemon, Squeeze it as hard as I can. You know, a couple minutes per mile slower on a good day. Um, and I'm going as hard as I can. And I look back. I'm like, Oh, that was like, you know, 25 years, 20 years ago, 25 years ago, 24 years ago. I'm like, Well, damn, you know, I'm still doing okay. Um, so the the here's the twist. You have to do wherever you are.

And that is that I want you to imagine yourself 10 years from now looking at where you are right now. And you say, well, God, I would give my left arm to be able to do everything I'm doing right now. 10 years from now. The problem is you're all you're looking is backwards where you were, and not looking at yourself 10 years from now. Saying, God, I wish I was where I am right now. And so I think, I think, mentally, thinking about where you're going to be 10 years from now and appreciating where you are now is actually real. I found it to be very helpful for my patients and for myself. Just because if you look backwards, you'll never get to what you did before. For exactly the reasons you're talking about, which is that you were physiologically a different guy back then, as was I now. That being said, the changes with aging, um, are not fixable, but they're definitely, uh, you can reduce the effects by training smarter.

And that includes, you know, strength training and intensity training, two things that are really important to put into.

Um, these aren't sports that you can continue to play. You know, winter football career is over, it's over, and you can play touch football and flag football. And they're great, um, but they're just not the same thing. And, uh, with lacrosse, I, you know, I just I, my, my my, uh. Life got too hectic to be able to consistently make a Spring League, et cetera.

Uh, that and the other players just got too good, um, and uh. And. And so I started to take up different things, like sports that I wouldn't have ever considered when I was, uh, a bit younger. And that has, I think, introduced sort of an opportunity not to compare myself on the same playing field. But to say, Oh, here's a new thing, let me let me learn this thing and let me learn the skill of it. Which, um, you know, brings what they call that beginner's mind approach to something. And I think it helps you get in touch with.

What are the what are the athletic needs of this new sport? Um, so, one sport that I took up, frankly, last year and got super excited about is not something I ever would have done. When I was younger, just not in the milieu of things I would have been excited about. And um, I've just found it completely, uh, captivating in a different way. Very, very different skillset than, um, the one that that, that, uh, that I'd used when I was playing team sports. Um, and so, you know, I'm a better mountain biker this year than I was last year. I put a lot of time and effort into it.

Um, and I think I can be a better mountain biker next year than I was this year. And, you know, I don't know. Obviously, that's not going to continue forever. Um, but it still allows me that sort of upward trajectory, where it keeps me, um, you know, athletically oriented. Now, of course, I could probably do this counter counterfactual, being like, man, had I taken up mountain biking back when I was 22? But you know, that's just not, that's just not the pathway.

And I can look back and say, back when I was 22, I was playing lacrosse at a pretty high level and it was really a lot of fun. Um, and I think that that ability to sort of take up new hobbies, um, is something that that sometimes we miss out on. Right to say, Oh, there's this new thing I'd like to try. And even if I'm not going to be the best at it, right? Maybe I can continue to get better and that'll stretch me in different ways. And I think it's that ability to, you know, rather than thinking about the objective outcome, but just that, that pathway of growth.

And, to be honest, that ability to sort of apply a beginner's mind to this new sport that I took up when I was 37. Um, it has, I think it's. It's forced me to remember what it looks like, to keep learning new things. And even in the the other practices of my daily life, the the stuff I do at work, that beginner's mind, I think, opens you up to, um, different learnings in your own work. And I, I found the value of it and the benefit of it tremendous. And, you know, frankly, I wouldn't have taken it up to your to your earliest point. I would not have taken this up if there wasn't a community of folks built around it.

Right, so there's a group of folks that I go, I go biking with regularly on weekends and and, you know, have built relationships, um, and experience from them. And so, you know, to your point, I think there's just something really profound about taking up.

And I, you know, I, I've wiped out almost every single time I've gone with him, but I still go back sometimes. But it's a great sport, it is a lot of fun, I will.

And this was the sort of the premise of of the episode that we wanted to talk a bit about. If you're walking or running, uh, your one most important piece of equipment is that point at which you touch the ground, which is which is your shoes. And um, there's been this almost takeover of, uh, of, of the the the the walking, slash, running, um uh. Footwear choices by these, you know, very, very, um, thick, foamy pillowy shoes. Uh, haka has come to mind. I don't know if I'm saying that, right.

Is it Hoka's or haka's? Hoka's okay, Hoka's comes to mind.

If you're you're walking or running, why have they picked up so quickly? How should we be thinking about the right footwear for walking, running? Uh in.

It just seems like a bed the more cushy the bed, the better. But we know we tried different mattresses in our lives. You get on a really soft mattress, you wake up the next morning, your back is twisted. Next week, you know, three ways a Sunday, you're like, Man, I need a firmer mattress.

Um, and it's interesting because shoes are a lot of the same that it looks like. It should be fabulous to have the most cushy shoe you get. And for some people, it helps, For other people, that cushy shoe is the equivalent of walking on the sand. They're biomechanically.

Somebody who rolls their feet into the middle pronates a lot, and when they walk on a very soft surface, they just roll a lot more. And it makes all their problems, their knees, their shins hurt just a lot more. So the answer is there's not a one size fits all, and some people do very well. Those people are people who have a neutral anatomy, maybe people with arthritis in their hips or their knees.

For those guys, having one more cushion probably helps a lot, but for other people, particularly people who have biomechanical challenges, which is many of us, um, that extra cushion may be too much. And so how do you know what's right for you? And the answer is, first of all, trial and error is fine. And if you get a pair of cushy shoes and you start noticing your knees and hips hurt a lot. When you're trying to run, you can use use those as walking shoes, or if they're walking shoes and you're hurting a lot, maybe you can use them like as a planter or something. Um, that's fine.

Um, but then you want to figure out, you know, you can go into a running store store and have them look at you. They have treadmills on the store that you can walk on there, see what works. Um, and you know, so many different companies have different variations of high cushion to low cushion, we call motion control to not as much motion control and neutral. Um, and and you really can find the thing that's right for you.

So the mistake people make is, uh, as I see that awesome Nike sneaker over your right shoulder, is they go for fashion instead of function. Um, now that is, you know that certainly there's a role for great sneakers, god knows, but the question is using them for lots of moving around and activity. How do you pick those?

And how do you figure out those? And I think that is going into. Go to a place where they know what they're doing, let you walk and see how that looks, and try and pick the best shoes from.

Um, so can you explain to us what a toolbox is? um, and the idea of an open versus closed toolbox?

Um, and for example, if you're somebody that has a bunion, you have a very wide. You need a wider toolbox. If you're somebody has a very narrow foot, you want a narrower toolbox. And again, depending on what kind of sport you're doing, for example, if you're doing trail running, you want a wider toolbox. Because you want to be able to use all those metatarsals to kind of grip into the surface of the of the of the dirt uneven terrain versus. If you're somebody who's doing kind of road hard, road running, you may not want as wide of a toolbox. And so people's feet are built differently, and so their requirements for the width of their toolbox is different.

And also the kind of activity they're doing. So, for example, if you're somebody doing mostly crossfit and you're in, you know, that kind of setting. You're going to want a bit of a wider toolbox. Uh, that you can stabilize your forefoot when you're doing a lot of your powerlifting, et cetera. Versus, uh, you know somebody else that that may want something different. So again, I kind of get back to the point that it's important to kind of go into a place where you can try on some different options. Um, and see what feels best for you, depending on what sport you're you're doing. One of the things that you hear a lot about is.

Uh, there's a very high arch called the Pes cavus, or a high arch foot, and then there's something called pronation, when your arch falls into the middle. Now, all of these can be normal variants, so there's nothing wrong with being flat footed, or even having a high arch, or even pronating rolling into the middle. But it it becomes a problem when, for example, if you're somebody with a significant pronation and you're getting a lot of shin pain, then we will correct your arches because you're getting a lot of shin pain because you're mechanically rolling your arches in too much for the activity that you're doing, even though you've had the same foot for your whole life. But maybe you started running more and that put more load on the inside part of your leg.

So it's always a combination of the kind of foot you have and what activity you're doing, but flat footedness, particularly, is a normal variant. And we used to have people made a lot of money off of correcting people's flat footedness by getting them all. Arch supports or orthotics. You know, thankfully, we don't do that, or many of us don't do that anymore, because there's just no evidence that makes any difference at all. But if you're symptomatic, and particularly if you're a symptomatic pronator, I would call you an unhappy pronator.

You pronate and you're unhappy about it with your legs, then I may correct you with an arch support, but there are many more happy pronators than unhappy pronators. So if?

That happens pretty quickly. How should people think about a healthy fitness community, a place where they feel welcomed and engaged with? But that's not necessarily going to feed them all kinds of questionable attempts to improve this or that outcome. What are your recommendations as someone who's built a fitness community who treats athletes of all shapes, sizes and ages? About making sure that someone is safe in the community, that they join and that this is a productive place. Where the suggestions are driven by some basis and evidence, and not driven by shame or obsession with outcomes, et cetera. Yeah, that's a great question, and the answer is.

And some people really get a lot of benefit from that. And so those kinds of things where I would call that can't hurt medicine and likely can help if it's placebo. If it's true, if it's some combination of both those things, who cares? Some people really are helped by that. So I think about the stuff that can really hurt you, stuff that can really help you, and then kind of can't hurt medicine. And if you're in the it can really help you or can't hurt medicine.

I think it's a lot of trial and error to see what works for you. I think some of the problems we get into is there's a lot of peer pressure around some of these different things people are doing. And that can become problematic. As is a lot of the nutrition stuff, which is pretty wacky in many of the fitness communities. To get to look a certain way, to do some certain nutritional diets or supplements, and those kinds of things can be quite problematic.

Jordan Metzl. He is a sports medicine physician at the Hospital for Special Surgery in New York. He's also the founder of Iron Strength community fitness program. You guys can go ahead and check them out, we'll post them as show notes.

JORDAN, Thank you so much for the time dude. it was awesome. I had a great time.

That sugar is important because it can also be transmitted via the bite of the lone star tick, common in the eastern half of the United States. That bite can then lead to an allergic reaction. When people come in contact with the sugar through meat, the reaction can range from hives to diarrhea to full-blown anaphylaxis, which is deadly. Critically, the reaction may not occur every time someone with alpha-gal has meat. Get this. The warming climate is leading to worse tick seasons.

In fact, the 2023 season has been the worst on record, so let's play this out. More climate heating means more ticks, means more alpha-gal, which means more allergies to red meat. And that fact that climate change may be leading to more meat allergies may just be the talking point that gets Republicans interested in stopping climate change. Here's to hoping.

In other climate-related news, a Pfizer warehouse in North Carolina was hit by tornado last week, destroying supplies of critical medications used in surgery and critical care, such as IVS and anesthetics. And that really sucks because there already had been critical shortages of many of these medications. All of this points to a problem that has become imminently clear since the pandemic Our medical supply chain is extremely brittle and that.

That's a pharma consolidation problem, when pharmaceutical companies buy each other or play games with prices to drive competitors out of the market. They end up becoming one of very few producers in that market. When that happens, anytime there's trouble in the supply chain of one of these producers, consumers all over the world feel it. Remember that baby formula shortage last year? Yeah, same thing.

And when you're talking about critical medications, that means millions are at risk of not having the meds they need in emergency situations. Oh, and terrible tornadoes like the one that hit that storage facility. They're also getting more common because of climate change. Just saying, let's end on a positive note.

For the first time since Covid, average daily deaths in the United States are no longer above the pre-pandemic normal. Remember, during the pandemic, mortality skyrocketed, not just because of Covid, but because of all of the other diseases that went untreated. Because of what Covid did to hospitals around our country. And for the first time, more than three years later, we're not experiencing that mortality bump. And that's the most reassuring news that the pandemic really is ebbing, but we've got to wait to see what the fall brings.

That's all I got. On your way out, don't forget to rate and review the show. It really does go a long way. Also, if you love the show and want to rep us, please drop by the Crooked store. For some America, dissected Merch.

America dissected is a product of crooked media. Our producer is Austin Fisher, our associate producers are Terry Terpstra and Emma Lickfrank. Vasilis Fotopoulos mixes and masters our show production support from Ari Schwartz.

Our theme song is by Takashi Azawa and Alex Uguiera. our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-Sayed, your host. thanks for listening.

This show is for general information and entertainment purposes only. It's not intended to provide specific healthcare or medical advice and should not be construed as providing healthcare or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.