What the Hoka? with Dr. Jordan Metzl | Crooked Media
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August 01, 2023
America Dissected
What the Hoka? with Dr. Jordan Metzl

In This Episode

You can’t miss them, Hoka’s–those clunky athletic shoes with the thick foamy sole–are everywhere. But why? Abdul reflects on the broader juxtaposition between fitness and health. Then he sits down with Dr. Jordan Mezl, a sports medicine physician and founder of “Iron Strength” a New York City-based fitness community to talk about fitness, why we carry so much baggage about it, and…those Hoka shoes.






Dr. Abdul El-Sayed, narrating: The CDC sounds the alarm about serious meat allergies that can result from tick bites. A tornado hit a Pfizer warehouse last week, possibly leading to a serious shortage in medications. For the first time since the COVID pandemic started, average daily deaths in the United States are no longer above the pre-pandemic normal. This is America Dissected. I’m your host, Doctor Abdul El-Sayed. [music break] You really can’t miss ’em. 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 seem 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 school board, 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 ten or 11, I could still enjoy sports at 37 or 38. A pure, 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 HOKAs. 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. 


Dr. Abdul El-Sayed: All right. Can you introduce yourself for the tape? 


Dr. Jordan Metzl: Yeah. My name is uh Dr. Jordan. J-O-R-D-A-N Metzl. M-E-T-Z-L. I’m a sports medicine physician at the Hospital for Special Surgery in New York City. 


Dr. Abdul El-Sayed: So uh before we jump in, I I um I got to ask you’ve you’ve run 35 marathons and finished 14 Iron Mans. Do you like do one of these every month? [laughter] Is that is that sort of the pace we’re at right now? 


Dr. Jordan Metzl: Well, I kind of got started uh I think from the day I was born. I kind of jumped out of the womb as it goes in family lore. And I just started moving. And I’ve been moving ever since. And uh and I really, truly enjoy just being out and moving and moving around and and setting goals. And so uh I’m lucky enough to have three wonderful brothers and in some different iteration, we do a lot of these things together, which makes a big difference in terms of having a community. And uh and I love doing it. Now up to 36 marathons 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 which are really beneficial for both mental and physical wellness. 


Dr. Abdul El-Sayed: I’m sorry. So we had June’s numbers. Forgive me about that. [laughter] Um. So you’ve been working at the intersection between movement and medicine your entire career. What drew you to the medical side of physical fitness? 


Dr. Jordan Metzl: So it’s interesting. So I come from a family of doctors. My dad’s a pediatrician, my mom, a psychologist. I have three brothers, all of whom are doctors. Um. And so kind of the the family uh craft was helping others and is helping others and and to be involved in medicine. Um. And for myself, I always had a deep love of movement and exercise. Uh. 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 absorbed knowledge a lot better. So there was a whole kind of process of recognizing the kind of mental benefits of exercise for me, was able to concentrate better, etc. Um. But then when I got into residency, um I noticed that, you know, it’s 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 the day off if you ran the Boston Marathon and nobody really had ever taken them up on that, like, well, hell, that sounds better than sitting 36 hours or 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, 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 uh 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 exercise, starting quite small, and then about ten years ago started the 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 cour–, 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. 


Dr. Abdul El-Sayed: I really love that. I want to um ask you, because exercise is one of those things that is, you know, canonical to what a doctor will tell you to do. The unfortunate thing about it is that sometimes it can be kind of shamey, right? There’s this way in which a doctor will look at you when you walk in the the office and just say, you know, you need to exercise. And, you know, the first idea you probably have in your mind is like, well, so do you. Um. But but it can get it can get kind of shamey. And there’s this sort of weird cultural uh 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. Um. And when we talk about exercise so much of that can almost come off as self punitive rather than an investment in ones self. Um. I want to ask you just generally, what do we get wrong about this nexus between physical activity, fitness, exercise and health? 


Dr. Jordan Metzl: That was a great question. And I think that uh, you know, one of the things to think about is we can learn from kids. So, you know, five, six, seven year olds when they go out and they do think things, you know, what are the reasons they do it? 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 you know, you have to be shamed into 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-à-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 you have to do this. I think that is a focus is generally for most people guaranteed to lose. Um. 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 encourage them do that thing. Um. 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, um just because it’s so interesting to me, especially around the pandemic, where 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 um you know, and so why do some people do it one way? And why do some people do it the other way? What are some of the factors that in in their personalities, in 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. 


Dr. Abdul El-Sayed: One of things I really appreciated about your answer is at no point did you mention body weight uh and body image. Um. You talked a little bit about Instagram, but that, you know, so much of the way that we think about exercise is tied to weight loss and um you’re talking about fun and community, which to me tend to speak a lot more to the mental health benefits of exercise, not simply the calorie burn. And I think that sometimes is is so de-emphasized in the way that we think about it. I happen to be one who does not enjoy running long distances. I like running very short distances many times. Um. And the you know I used to I played football in 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. [laughter] Um uh. But, you know, it just goes to show that people, 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 um activity is this the implicit scoreboard. So I played um sports through high school and college, and when I finished college, in fact, when I 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 um 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 a it took me 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. Um. And I just think that so often we have um taken away all of the meaning of this thing that is just so inherently human uh and built so much else around it in ways that that fundamentally de-emphasize the things that we naturally enjoy about doing it. So I got to ask you. Right. And I just [laugh] not to uh not to to get back to scoreboards here, but, you know, what is the 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, or I’m not going to run 36 marathons. What would be that that that um sort of central exercise that would maximize the overall benefit that somebody had? 


Dr. Jordan Metzl: Well, I think the first thing in the base of the pyramid is is just locomotion, movement and walking. Um. You know, people don’t think about walking. And so there’s this concept we talk about called the NEAT Profile, an acronym for Non Exercise Activity Thermogenesis, or just burning calories from walking throughout, moving throughout the day. And one of the real tough parts about the pandemic was that many people kept doing their exercise during their, you know, virtual exercise, peloton or whatever. Um. But then they would sit at their desk, at their home, and their NEAT profiles were way down and have been way down. 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. Um. 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 this 10,000 and magic number. The answer is the more you move, the better. You know, 6000, 5000. Um. But whatever it is, it’ll motivate you to kind of figure out, you know, well, how much do I need to move every day? That’s that’s the baseline. It’s just moving every day. Then the next level up is some combination of strength and intensity. Um. 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 mus– muscle strength. I have patients in their eighties doing strength training 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, um which, you know, really affects all issues related to morb– morbidity, mortality, you know, the things that make us sick and the things that, you know, ultimately kill us. So many of these diseases are are preventable. Um. And I guess my last comment is actually one of the one of the books I did called The Exercise Cure was all about the the argument for the medicine of exercise as a drug and looking at the evidence of, you know, exercise for the treatment of prevention of diabetes and hypertension and hyperlipidemia and depression and anxiety. And the more we know uh 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 and the other. But I definitely think that, you know, thinking about exercise in 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 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 to think about. 


Dr. Abdul El-Sayed: I really appreciate that that point about locomotion. And um, you know, I went to medical school in New York and then uh moved out to Metro Detroit, where, of course, our um our community put the put the nation in cars, which unfortunately took us took us off our feet. And so you can imagine it’s built entirely around the car. And um I saw that the amount that I was walking went way down, plummeted, you know, in the course of of my move. And um, 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 just because I needed to get to and from uh work or or class. And um that has a real impact also on your mental health. You know one of the things that you talked about in that contrast between rural Nebraska and New York uh 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, you hold in a given walk um 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 that 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 you’re passing different streetscapes, you know, as you walk and um frankly, completely different neighborhoods, social milieus in the context of the walk. And it just makes the walk that much more entertaining, um which 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 um 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 whoever 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 let me play a game of pick up of 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. Um. You know, the one being very motivating and the other one being completely demotivating. I want to–


Dr. Jordan Metzl: Yeah, if you look at what’s the fast– I’m sorry what the fastest growing sport in America right now, last three years running, which I saw this morning out out out at the park out here, which is driving some people crazy and and and it caused many Achilles tendon ruptures in my office is pickleball. Right? It’s the fast, by far the fastest growing sport in the United States um and uh I just have an article that I wrote on you know looking at pickleball, some of the injuries. But my overall argument is, despite the fact that we do see a large number of injuries in kind of some of the 50 to 67 year old people who are going, you know, ball’s out on the pickleball court, um that, you know, I think the benefit of that sport, the what the reason it’s so popular is 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, have layers of everything built around to keep us, you know, 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, um the healthier it is for us and we want to do it. 


Dr. Abdul El-Sayed: A friend of mine uh who’s in the same field that you are, uh joked to me, said, you know, had they had headphones and podcasts or music back in the hunter gatherer days, we would have died out simply because so much of the physical activity that had happened was necessitated in the hunting and gathering by which you actually were able to feed yourself. And it was always a communal activity, right? Nobody was out there hunting by themselves. Nobody was out there gathering by themselves. We are by nature um pack animals and we enjoy one another’s company. And it 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 in 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. Um. One of the things that I think holds a lot of folks back, and particularly among you know the demographic of our listeners, who tend to be, um you know, millennials now, where we’re starting to have that experience of waking up in the morning and not not quite figuring out why some random part of your body hurts. Um. [laugh] And, you know, one of the important aspects of of of what changed my thinking about physical activity as I’m nearing 40 is that um I got some advice that injuries are not uh are not 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 is 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, you know, 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, like, maybe you just don’t go as hard, right? Maybe you just sort of leave a little bit in the tank uh as as you’re playing. I’d love to to hear a bit about how you think um about injuries and the advice that you give your uh patients who um we’ll just say are are uh still, still, still capable, but not not quite as much as they they had been. 


Dr. Jordan Metzl: Yeah. So if you came into my waiting room any day, you would see, you know, people between kind of eight and 85. And the only commonalities in all those people is they all want to move, right? They all want to move. They all want to, whether they’re like a kid just starting at gymnastics or they’re like doing a, a 5k at 84. I got a lady this year, 84 years old, doing the marathon. 


Dr. Abdul El-Sayed: Wow. 


Dr. Jordan Metzl: Um. 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 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 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 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 my for no matter who you are, how old you are, if pain is changing your mechanic of movement, you got to get it checked out. So if you’re hitting a golf ball differently because your elbow hurts, or you’re swimming differently cause your shoulder hurts or your, you know, your overhead uh [?] 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 over striding? Is their foot rolling and do they need an orthotic, do 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 Athlete’s Book on Home Remedies was all about how to teach people how to do that on their own, because 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 and if you can 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 should you be asking yourself? You know, if you see a doctor, what you should be asking of them, um I think it’s all important as part of this, you know, maintaining your athletic body because 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. [music break]


Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Dr. Jordan Metzl. 


Dr. Abdul El-Sayed: So how should folks think about fitness goals as we age. I’ll be honest with you, you know having played a very competitive or a sport at a very competitive level into my early adulthood, I know I’m never going to be as strong or as fast or have the endurance I had when I was in college. And I have a lot of friends who weren’t as athletic when they were young. And so they’re hitting, you know, personal records on a number of things. I’m like, I’m never going to touch my personal records. They were they were set when I was 22 and felt nearly invincible. And they shall remain my personal records for the rest of my life. Um. How do you think about, you know, fitness goals 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 in the in 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 used to be able to do X, Y and Z, and now maybe the best I could do is just X and Y. How should we think about about fitness goals as we age? 


Dr. Jordan Metzl: All right. I’m going to tell you the answer that uh I found to this question for myself. And then I’m going to tell you some secrets around this. So the answer I’m going to tell you that I found for myself comes out of so if you do like endurance races, like marathons, like New York [?] club has a list of every race you’ve run in you know, in since like I got to New York in 1999 and in 1999, I ran the New York City Marathon. I ran 305 then. Right. And I’m thinking, God damn it, how did I do that? Like, I was running like six and a half, six 45 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 is 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 of 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 here’s the twist you have to do wherever you are, and that is that I want you to imagine yourself ten 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, ten years from now. The problem is you’re all you’re looking is backwards where you were and not looking at yourself ten 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 ten years from now and appreciating where you are now is actually really 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 your life and not let go of those things. 


Dr. Abdul El-Sayed: I really appreciate that advice. The other um almost by accident for me, the other piece that’s at least helped me is that I have taken up different sports as I’ve gotten older. One of the things about, like I said, I played football and lacrosse. Um. These aren’t sports that you can continue to play. You know, when your football career is over. It’s over. You can touch football and flag football and they’re great, um but they’re just not the same thing. And with lacrosse, I, you know, my my, my life got too hectic to be able to consistently make a spring league, etc.. That and the other players just got too good [laugh] 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 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 mountain biking. 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. A very, very different skill set than um the one that that that that I 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 of 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 stuff I do at work that beginner’s mind, I think, opens you up to um different learnings in your own work. And I found that the value of it and the benefit of it tremendous. And you know, frankly, I wouldn’t have taken it up 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, 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 something new with someone else. 


Dr. Jordan Metzl: Yeah, absolutely. And uh you know, it’s interesting. My my youngest brother’s a serious mountain biker and he keeps trying to get me out there. And so I do a lot of road biking. And so I’ve got good cardiopulmonary fitness and good endurance. But at that mountain biking, you always feel like you’re like one step away from death. You know, [laugh] it’s a lot, but he loves it now. You know, 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. 


Dr. Abdul El-Sayed: It is a lot of fun. I will say that the hazard of of that wipeout is is serious and gets more serious, I think, as you get older. Um. But I will say, you know, it’s a if road biking is the sort of low impact steady state version mountain bike always feels like the high intensity intervals of biking. 


Dr. Jordan Metzl: Yeah. 


Dr. Abdul El-Sayed: Right. It’s like you–


Dr. Jordan Metzl: That’s fair to say, yeah. 


Dr. Abdul El-Sayed: –[?] up a hill and then you’re downhill and then your uphill– 


Dr. Jordan Metzl: Yup. 


Dr. Abdul El-Sayed: –downhill. And so. 


Dr. Jordan Metzl: Yup. 


Dr. Abdul El-Sayed: Um yeah it’s a lot of fun. Um. I want to I want to go back to to walking, though. And this was the sort of the premise of of the episode that we wanted to talk a bit about. Yeah. If you’re walking or running, 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, of, of the the walking/running uh footwear choices by these, you know, very, very um thick, foamy, pillowy shoes, HOKAs come to mind I don’t know if I’m saying that right, is it Hoh-kas or Ha-kas? 


Dr. Jordan Metzl: HOKAs. That’s ok, good enough.


Dr. Abdul El-Sayed: Ok, so HOKAs come to mind.


Dr. Jordan Metzl: Hakas a dance, hakas a dance those people do in uh in New Zealand. 


Dr. Abdul El-Sayed: Yes it’s the it’s the classic um. 


Dr. Jordan Metzl: The Maori. Yep. 


Dr. Abdul El-Sayed: Yep uh it’s the Maori dance. So HOKAs uh you know you see them everywhere now. Can you can you talk to us about um, about uh the sort of the footwear fad. Are those shoes really um you know better better for you if 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 our own lives? 


Dr. Jordan Metzl: Yeah. So, you know, it’s an important choice making to figure out what kind of shoe you’re going to pick, um running or walking. And there’s such a big variance of, you know, choices people have. And if it just sounds like you say all right, well, inherently, I would think more cushion is better. 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 ways, you know, three ways a Sunday 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 could 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 some arthritis in their hips or their knees. For those guys, having a little 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 go into a running store or a store and have them look at you. They have treadmills in 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. What we call motion control to not as much motion control, neutral. Um. And and you really can find the thing that’s right for you. So the mistake people make is, 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’s 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 in to go to a place where they know what they’re doing. Let you walk and see how that looks and try to pick the best shoes from that. 


Dr. Abdul El-Sayed: One of the things that you hear a lot about is open toe boxes. So, you know, anybody um who watches anything on on squatting, for example, there’s a big focus on how open your toe boxes, um I you know, I was saying the same thing about walking and running and, you know, toe boxes, that space, you know, between your your the the edge of the um and I’m trying not to use medical language here. You know, you probably say better than me. Um. So what can you explain to us what a toe box is um and the idea of an open versus closed toe box? 


Dr. Jordan Metzl: Guys so the toe box is basically the front of the shoe. And if you think about the balls of your feet um from the inside to the outside, that’s essentially what we call in in uh in medical terms, the metatarsals alright and there’s a there’s a bottom part and a top part. The top part is up near your toes and the area where your toes and your metatarsals basically intersect is called your toe box and and different shoes have different amounts of width there. Um. And for example, if you’re somebody that has a bunion, you have a very wi– you need a wider toebox. If you’re somebody that has a very narrow foot, you want a narrow toe box. And again, depending on what kind of sport you’re doing, for example, if you’re doing trail running, you want a wider toe box 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 toe box. And so people’s feet are built differently. And so their requirements for the width of their toe box 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 toe box that you can stabilize your forefoot when you’re doing a lot of your power lifting, etc., versus uh, you know, somebody else 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. 


Dr. Abdul El-Sayed: One of the things you hear a lot about is collapsed arches and that, you know, more and more of us are um flat footed nowadays. Is that is that true? And if so, why? 


Dr. Jordan Metzl: So, you know, flat footed. So there’s there’s a couple of terms. There’s flat footedness called pes planus. Uh. There’s a very high arch called a pes cavus or a high arched foot. And then there’s something called pronation when your arch falls into the middle. Now, all of these can be normal variance, so there’s nothing wrong with being flat footed or even having a high arch or even pronatig, rolling into the middle. But 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 it 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 providers. So if you’re a happy pronator, then don’t worry about it at all. 


Dr. Abdul El-Sayed: All right. Um. And as we we part here um and folks have listened to the episode and they’re thinking a little bit about their own fitness goals and their fitness journeys, We talked about the benefit of of a fitness community and a group of people that you come together around your movement with. One of the things that I’ve tended to find is that these communities sometimes um become an easy target for a certain non evidence driven attempt to improve outcomes, and you end up getting a whole lot of quackery that happens pretty quickly. How 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 um questionable uh attempts to improve this or that outcome. What are your recommendations to someone who’s who’s built a fitness community, who treats uh athletes of all shapes, sizes um and ages about making sure that you know someone is safe in the community that they join, uh and that this is a productive place where the suggestions are driven by some basis and evidence uh and um, you know, not driven by shame, obsession with outcomes, etc.. 


Dr. Jordan Metzl: Yeah, that’s a great question. And the answer is I think that a, you know, you can never be totally sure, especially if you don’t come from a, you know, medical background. Um. But that I kind of always think about, you know, some things are data driven, definitely make a difference. And the good side, some things can be known to be problematic on the bad side. Like anabolic steroids, for example, um and some things may be helpful. They may not be helpful, but they certainly don’t hurt so if something like cupping, which we’re not positive that makes a difference, but it’s certainly except for having some rings on your back or whatever doesn’t seem to hurt. And some people really get a lot of benefit from that. And so, you know, those those kind 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? Uh. 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 um and that can become problematic. You know, as is a lot of nutrition stuff, which is pretty wacky in many of the fitness communities to get to look a certain way to do some certain kind of nutritional diets or supplements. And, you know, those kind of things can be quite problematic. Uh and can pose a whole set of risks. 


Dr. Abdul El-Sayed: Well, uh Dr. Metzl, we really appreciate you uh joining us today to share um how we ought to be thinking about physical activity and fitness. Uh. We appreciate your insights. Our guest today was Dr. 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. Uh. You guys can go ahead and check them out. We’ll post in the show notes. Jordan, thank you so much for the time.


Dr. Jordan Metzl: [?] It was awesome. I had a great time. [music break]


Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. So it turns out you can get a serious meat allergy from a bug bite. That’s right. According to the CDC, upwards of 450,000 people across the U.S. have what’s called alpha gal syndrome, named after an abbreviation of a specific sugar found in most edible red meats. 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 a 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 eminently 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. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illick-Frank. Vasilis Fotopoulos mixes and masters our show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Michael Martinez, and me, Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care 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 Veterans Services.