Written by Christopher Kelly
March 4, 2019
Christopher: Well, Stephanie, thank you so much for joining me this afternoon.
Stephanie: Thanks for inviting me.
Christopher: We are recording in person at the Saguaro Hotel in Scottsdale, Arizona. Stephanie and I are here for the Physicians for Ancestral Health winter retreat. Stephanie, I have found some of your ideas of the past five years some of the most interesting that I've encountered and I'm very excited to have you on the podcast to discuss some of them. Let me start by asking you the question: What is it that draws you towards things that people find somewhat awkward to talk about? Because that does seem to be a recurring theme in some of the things you speak about.
Stephanie: There definitely is a theme toward that. Yeah, my topics tend to be ones that involve pushing some boundaries or a little bit of a stigma. I think I'm just not willing to settle for everyone's sort of default explanations for things. When I find an issue that I feel like hasn't been delved into enough or people's default explanations are just the same thing over and over and don't satisfy me, I'm not willing to stop asking questions where other people, maybe when it's an uncomfortable topic, will move on or ignore it or drop it or just go with--
Christopher: An unsatisfactory answer?
Stephanie: Yeah. So, when I get really curious about something, I want to dive into it and I won't be deterred by the fact that it makes other people uncomfortable. In fact, I think that maybe some of the reasons that we suffer issues now is because people are afraid to dive into certain things. It's not good enough for me.
Christopher: I love that. It's something I've learned as a parent, that when you have kids they ask you for an explanation for why we do things in a certain way. Why do we wear shoes even though it's hot outside? And you give them the answer and they find it unsatisfactory and so they ask why, why, why? You keep asking why and yet somehow, as adults, we tend to lose that curiosity. I love that as a reason why you go down these roots. I can tell you why I thought your Shoes Are Not Paleo talk -- You first started doing that talk in 2014?
Stephanie: I did the Some Shoes Are Not Paleo, yeah, in 2014 in Berkeley and then 2016 a little more advanced in Boulder.
Christopher: Okay. And the reason that talk resonated with me the first time I heard it was because, as a cyclist, I'd really stopped walking at all. I stopped using my feet apart from to pedal a bicycle and I developed some problems that were probably secondary to that. I went to see a podiatrist and the podiatrist said, "Well, your feet are really weak. What you need are these carbon fiber orthotics that you put in your shoes and they will support your feet so that your ankles don't hurt."
Okay. I mean, I didn't know. I mean, I don't think I know anything health now but I know even less then if that's possible and so I accepted that on face, bought the carbon fiber orthotic and I wore them. Sure enough, they did sort of make me feel better in the short term but I think over the long run they probably just made my feet even worse.
Eventually, I figured out that what I really needed to do was to take the shoes off completely and just build back some strength into my feet which I've tried to do over the last five years. I've had some success with that but I still do a lot of cycling so my feet probably aren't as strong as they should be. So, tell us about how you got interested in the idea of not wearing shoes.
Stephanie: So, this began back when I was practicing massage therapy which I did full time from about 2010 to 2016 and I just kept noticing the patterns that were showing up in people's bodies. Everybody has too much forward flexion and bad posture. Of course, there's individual idiosyncrasies but overall there were some really consistent patterns. Nobody is stuck in too much extension. It doesn't go that way.
And just consistent things people say like glute amnesia or just core strength issues. The thing that's interesting, when you just were mentioning thinking about your feet being weak or being told that your feet were weak, first off, is that we, just for some reason, assume that feet just aren't very good at their jobs even though we've been bipedal creatures for millions for years and living and getting all over the planet without shoes. We somehow just feel like feet just didn't evolve very well.
I think, first, it just doesn't make sense to think of things in the beginning from the idea that they're not actually good at what they do. The other thing is that we put too much emphasis on the feet as what needs to be strong. The biggest reason that I ended up focusing on going barefoot and why, say, the minimalist shoes didn't cut it is because I think a lot of the importance of understanding feet is not just in what they themselves do biomechanically which is, obviously, important but the information that they provide the rest of the body. This goes even back to Berkley 2014 when Ivy was crawling up the steps and able to navigate that hard environment and get the feedback from the environment to say, "Oh, this is--," not consciously but unconsciously for the body to assess, "Oh, I'm exerting and I'm getting resistance."
The whole process of learning how to move is part of our development when we're young. In fact, I think when adults sometimes ask about what should I wear for shoes or not or how much benefit can I get, it's not as much benefit as anyone could get if they didn't wear shoes in the first place or grew up using their feet and walking, running and moving on challenging surfaces.
We just avoided this assumption that kids are endangered by running around barefoot and kind of let them decide if their feet needed any protection or not. We could have a lot to gain from that, from bringing up a generation that wasn't subject to learning to move without all the information that the body and the brain is expecting to rely on, to figure out how to move efficiently.
It's all that feedback from the environment is telling you if you are wasting energy by moving sloppily and clumsily and creating a lot of impact between you and ground. And if you're feeling that kind of feedback, it's a stimulus to your core muscles to say, "Oh, we need to engage more. We need to create a better posture. We need to stop flopping around and wasting energy. We're going to put all our energy into forward momentum, not left, right, up and down and all over the place."
And even that glute amnesia that would come up when I worked for a physical therapy company all the time, the glutes have the ability to balance the pelvis relative to the femur and keep it perpendicular even when you're on one foot at a time. That's the only muscle that has that ability and if you're never getting the information from your feet that says, "Oh, I'm hitting the ground really hard," there's nothing to stimulate that muscle to engage.
Christopher: I've seen it with my kids. It's super interesting to observe them. That's happened to me twice now, having the privilege of watching another human learn how to walk. And you can see how much awkward it makes it when the child is wearing shoes. It's painful to watch especially when they start running. If you've ever seen a small child running in shoes, you know that's going to trip them up. They always catch the front of their foot and then they trip and it's agonizing to see a kid fall on tarmac for that reason.
So, why should we care about this as adults? It's my perhaps most important question. So what? What kind of deleterious effects could happen from wearing shoes? Should we care?
Stephanie: I think that it's a contributor to a lot of the musculoskeletal issues that we end up with that we associate with old age which really is just a manifestation of repetition of doing poor movements thousands or millions of times over the course of your life. If we allow the body to take shortcuts and not engage those muscles, that would be stimulated by enough information from the feet telling us, "Oh, yeah, we need those." It takes shortcuts that will allow you to slouch and use your, sort of hang off your fascia rather than engage the muscles.
The space that we have between bones in our joints exist because muscles and fascia are engaging around it to hold that space apart. If your muscles relax completely, you just sort of collapse into a heap, into a pile. It's the actual engagement of muscles at some base tension level that creates posture and that creates space and holds joints in good alignment where there's not going to be excessive grinding.
A lot of people don't realize that cartilage actually does regenerate. It's just that most often most people, because of their repeated movement patterns and the things that they've done for so many years and the gradual changes that have happened because of it, most people's cartilages never get an opportunity to regenerate because it's always being ground down in the same way through inefficient movements over time.
I think it has a huge effect. The failure to learn to move in biomechanically efficient ways and to keep that up throughout a lifetime, I think, is a major contributor to everything like spinal deterioration and joint problems, why we have so many hip and knee replacements and rotator cuff issues. A lot of it comes down to we don't do the things that would teach our body how to move in a way that's healthful in the long term.
Christopher: And so is there something special -- Well, it's a leading question because I know the answer and I'm trying to make you say what I know. So, you're saying there's something special about the sense of touch that comes through the sole of the foot, right? You can't cover that with anything and have the same effects. So, you're just not getting that input from -- Is proprioception the appropriate term?
Stephanie: Yeah, there are receptors in the -- I think, mechanoreceptors might be the correct term for the ones that respond specifically not only to impact but also to variations in the height or the depth of the tissue on the bottom of the foot. So, for example, if you have sand or pebbles or something under your foot, it deforms the tissue on the bottom of the foot when you step on it and that adds to the sensation. That adds to the information that you're able to use to assess the level of impact that's being created and then to modify movements in response to that.
If you have either a smooth surface or something that deforms in response to your foot, so if the ground or the sock or the inside of the shoe or whatever, deforms rather than deforming your foot, it changes the amount of information that's available and it doesn't give you the same accurate assessment of impact.
Christopher: And so this is really easy to explain when you think about wearing gloves, right?
Christopher: It's just not the same. That's actually -- That's the thing I always remember about your teaching is you wear shoes like you wear gloves. Sometimes you go outside and you need to cover your hands because it's cold or maybe you're doing some work and you need to protect your hands. But for the most part, we don't do that. We're in a hotel right now and nobody's wearing gloves. It's quite a comfortable temperature. But I don't think -- I'm going to look around. I think we might be the only people not wearing shoes.
Stephanie: I think so.
Christopher: Practically, have you experienced even yourself like any noticeable changes in your health from -- Because you practice what you preach. When I came here for this interview, I knew you wouldn't be wearing shoes. This is something you've been doing for a while now yourself. Have you noticed any benefits in your own personal health? Perhaps you didn't have any problems to fix in the beginning?
Stephanie: I had problems. Well, the first most obvious thing that improved for me was issues of flat feet. I mean, I was thoroughly diagnosed by an orthopedic surgeon as being very flat footed.
Christopher: I was as well, actually.
Stephanie: Yeah, back in about 2012, and that was around the idea that I was starting to toy with the concept of bare-footedness and he thoroughly discouraged me from that. But once I started doing it -- and this was both at home and outside. I mean, I now understand what it is that my feet were doing. And being flat footed, which is often given as an excuse that people say, "Oh, well, I have flat feet. I can't do such and such. I need support." But you may have seen again raising a couple of small humans that everybody starts out with flat feet.
Christopher: Right, right, yeah. They all are, pudgy little flat feet.
Stephanie: In the same way that everybody starts out with a spine that curves only in one forward direction, the kyphotic curvature in the spine, and you don't get those adjustments that create the lordotic curves in the spine or that create arches in the feet until you actually start using them and engaging those muscles that hold, again, the muscles that hold the bones and the joints in the properly relationship.
But then when it comes to the feet, the other thing that is misunderstood about arches is that they're not really a permanent feature of the foot so much as the position that it can be in. Which, I mean, of course, if you can shove it up there with an orthotic then that's understandable too. But it's a lot like just thinking about your lap. The moment it happens that I'm seated and I have a lap and you happen to be standing and don't have a lap, right. We could change it up in a moment if we wanted to.
But when it turns out that -- our listeners can't necessarily see this -- but I could show you right now, here's my foot with an arch and then if I adjust my knee a little bit there's my foot with no arch. It's not even in the foot so much what's happening as the alignment in the knee and the hip that's actually -- think of it like a marionette. The strings are coming from the hip down to the knee and then the knee down to the foot and ankle. And you can move it into any sort of position that you want with those strings. It's not really being generated in the foot. It's a space that's there because you're pulling up on it with all these strings from above.
Christopher: Yeah, I'm totally with you here. I love this. I mean, can I get back to this idea that every time you intervene with the human body you better have a really good reason to do that. You must have assumed like -- We're here for the Physicians for Ancestral Health winter retreat. Ancestral health is the theme. I think it stems from that, is the idea that if you're going to do something, if you're going to intervene, you have to have a good reason. You must assume that this organism have evolved to be optimal. Any change you can make to it is going to make it less so.
Christopher: I think a lot of people listening to this podcast will already be into minimalist footwear. As I am too, actually. The shoes that I do wear, they tend to have very thin soles. Do you think that's not good enough? You think that people should like go the full Monty and not wear any shoes at all when possible?
Stephanie: The biggest issue with going to minimal shoes, and this is especially if people are doing it for sports or running or things like that, there was some backlash towards the minimalist shoes because were seem to be getting more stress fractures.
Christopher: So, I got this at podiatrist. I said, "No, do you not think--" Because the first thing I said to them was like, "Do you not think I need to take my shoes off completely and let my feet get stronger?" And they said, "Oh, no. You shouldn't do that because we see people all the time with stress fractures in their metatarsals and so you shouldn't do that."
Stephanie: Did they say that about people who are really going barefoot or who were wearing the minimalist shoes? Because the thing is, the minimalist shoes were getting the backlash about it.
Christopher: Yeah, no, they were talking -- I'm pretty sure they were talking about minimalist shoe runners. I wasn't a runner, anyway. I was a cyclist.
Stephanie: This is the problem and this is why what we were just saying earlier that if you have even a minimal shoe and very thin soles, something in between you and the variations in the ground beneath you reduces your ability to accurately sense impact forces. So, people who just put on--
Christopher: Right. So, there's mechanoreceptors.
Stephanie: And so people who put on minimalist shoes are liable to go and just keep up the same impactful running form that they had before but now they actually have no protection. I mean, virtually, no protection. The stress fractures went up in people wearing minimalist shoes but I've never heard of any such thing happening in people who actually ran barefoot because once you're completely exposed to the ground, you really -- It's quite difficult to land hard enough to cause yourself damage like that.
If anything, the idea is you would be better off going completely barefoot to try and improve your movement pattern such that it would be safe for you to put on minimalist shoes. It goes the other way from what people think. It's another transition from fully protective shoe to minimalist shoe to nothing. It's the necessity of learning how to run gently and once your body has a sense of what that's like then putting on a minimalist shoe won't be as dangerous for you.
Christopher: Okay. That does make sense. And how do you deal with practical concerns like sharp objects? I'm sure you get this question all the time. It's really--
Christopher: Yeah, tweezers.
Stephanie: It's called first aid. I mean, how often do you get paper cuts or you do some construction and you hit your thumb with a hammer or something like that? They're small, dangerous. In the kitchen and you nick yourself with a knife and little things happen. You deal with them as needed and you generally don't die.
Christopher: Right. And I accept that. I think that's a really good answer and important information. So where I live in Santa Cruz, everything has fucking thorns, literally everything. The moment -- I really don't want to wear shoes. I've been subscribed to this idea for a long time now. Every time I take a foot off of the deck onto the ground, I look at my foot and it's literally got 20,000 thorns sticking in it.
I'd been watching very much enjoying -- Bruce Parry has a TV series where he hangs out with hunter-gatherers and he had exactly the same problems. These people would go off into the jungle and they'd be running after a pig or something and shoes really don't work in the jungle apparently. He knows as a former royal Marines commander, I think. They knew you can't wear shoes in the jungle because it keeps the moisture next to your feet, and then you get trench foot is what they call it.
Wearing those shoes is optimal for that reason but then there's like pokies in the jungle as well. If you're trying to follow these hunter gatherers chasing the pig and he would have tons of thorns sticking in his feet. Like, "Oh god, can you stop for a second? I'll take the thorn out." I mean, obviously, the hunter-gatherer foot is harder. Do have any practical advice for toughening up the foot so this doesn't happen?
Stephanie: Well, yes. I mean, I'm a wimpy modern American also and I can't handle all those situations. In fact, plant life and thorns, yeah, they're too much for me a lot of the time. I don't go barefoot all the time. I acknowledge the benefits that it has. I do it where I'm sufficiently comfortable. I also realize that my body is probably never going to be optimal, anyway. I know that there are some shortcomings.
The biggest advantage would be the earlier we can get people to be able to develop that way, because they'd be closer to those folks who are running through the jungle who grew up in those environments. They stand a better chance to be able to learn to use their feet optimally. When I'm not comfortable I will give up. Of course, there's quite a committed barefoot community and you can connect with those people.
I mean, there's online that you might not run into a lot of them in one place very often but if you're good with online communities there are quite a lot of people. And they would find a lot of encouragement, just practice and keeping at it and you'll get tougher and tougher as you go. Then that's kind of an each person deciding how far you want to go with.
I try to think about it as part of sort of whole body caring way. I try to spend some time barefoot. I try to do activities like running to some extent or even more so strength training where I know I'm specifically trying to target those muscle areas and the postural compensations that I'm not getting enough of from, say, barefoot running or having grown up that way.
I'm not fanatic or zealot about it although the times that we run into each other tend to be ones where it's quite easy to go barefoot. I sort of feel no reason at all not to. Even though I don't, and I get criticized sometimes if some people in the barefoot community would not appreciate the fact of me wearing shoes on quite a fair amount of occasions now. But it's an individual choice to decide.
I recognize the importance it has. I'd like to increase the chance that future generations get to be brought up in healthier ways. I'll incorporate it to certain extent and then I try to compensate positively for how I don't incorporate it now. I just try to fit it into a whole system of trying to live a healthier modern life and not all of that looks like pretending to go back to paleo times.
Christopher: Right. It's not reenactment. To be fair, I've seen my daughter do very well in that same environment. I'm kind of jealous of her in that regard that she has not really worn shoes outside from the beginning and she can run around across the pokies just fine. That's annoying.
Stephanie: That's a great example. Yes, taking someone who grew up in that environment and who can handle it, those of us who didn't sort of can come to terms in different degrees with how compromised our lives are going to be. But if we can improve the chance that the next generation has full access to everything that their feet can do for them then so much the better.
Christopher: This has not really been a problem for me because I don't normally take cues from the outside very well. I'm just not noticing what people would say or care apart from potentially in the gym where people tell me that I should be wearing shoes and then I'm like, "Are you fucking kidding? If I drop this plate on my foot it's going to crush it whether I'm wearing shoes or there's a one millimeter of nylon on top of my foot." It's not going to make any difference. But I realized for some people that there are some social norms, some conventions that need to be conformed to. Have you managed to navigate that?
Stephanie: If you were sitting here in person you can see that I have some decorative items on my feet. Honestly, I just try to get by with camouflage for the most part. The trouble is, the reasons that people are stuck on the idea of wearing shoes are not very accurate. They'll often cite things like non-existent health codes or really incorrect liability concerns. But by the time somebody who's usually an employee of some business or whatever accosts you and feels that their job is on the line for enforcing some kind of policy about what you should or shouldn't be doing with your feet, it's a losing situation.
You're in a confrontational moment and it's not a point in time where you can educate people. I, for the most part, just decided that I'll try to fly under the radar as much as I can in that particular regard and spread my information other ways. There's not much use trying to educate people in that moment of confrontation. I try to avoid it.
Christopher: Maybe I can get a picture or something so you can see this in the show notes, but Stephanie is wearing what looks like a pair of flip flops and there's no sole in them which is kind of funny.
Stephanie: If you go on -- The best place that I know of is Etsy. If you go on there and search for barefoot sandals you'll get a huge array of things that look like these little beaded or crochet or different types of foot decorations. The one I have on now just has beads that go around the ankle and the second toe and they're pretty. I feel like adorned but, well, there's just some dirt on the bottom of the foot.
Christopher: Yeah. If you wear it too for long enough you'll feet will be black enough to where people don't ever notice there's not a sole on that. So, what do guys do? Have you seen men wearing those?
Stephanie: I've seen -- it's a little bit tough for guys sometimes. I have actually seen a few guys who have made something like sandal tops for camouflage purposes. They do something quite similar that look like the top of a sandal or flip flop or something like that.
Christopher: It's not going to stop my wife from rolling her eyes at me, is it?
Christopher: Is there something to stop that? I don't think anything could really stop that. Actually, before we leave that topic I think what we should do is a challenge on the forum. Stephanie doesn't know anything about this so you're going to have to just bear with me for a second. We run a forum and we do this accountability challenges and I would propose that a barefoot challenge would be a really good thing for us to do on the forum.
If you don't currently have access to the forum then you can get access via Patreon. So, search for nourish balance thrive on Patreon and become our patron and then you'll get access to our forum. And then I'm going to run -- One of the things I realize about these accountability challenges is they can be quite a lot of work to organize but this one I'm going to organize and I'm going to see if we can do.
How would we measure progress? That's a good point, isn't it? How would you -- I mean, you've already said that you don't want to let perfect be the enemy of pretty good. So, the goal is not to be -- I'm not going to put on shoes for a week would probably not be a really good goal. What would you say? Just like an increase in or a decrease in shoe wearing over a one-week period? What would you think is reasonable?
Stephanie: Well, for some people, I don't necessarily know what your listeners' tendencies are going to be. For some people, just the idea of going out in their backyard and not feeling like they have to put on shoes. For some people, it's just going around in their house and not feeling like they have to put on shoes. A lot of it is really a mental thing so it's just getting over the fear about walking some place without shoes.
You might want to cover a few different environments that people could go into whether it's, again, just like even in their house, going down to get the mail, walking down the end of the block, to jogging around the track in the park. Maybe it's which different steps or something, level, that you could get to or maybe amounts of timing. I mean, when you're first starting to go out barefoot you have never before, sometimes it's a very short time that you want to spend doing that. And it's really an individual thing.
Christopher: It is. It can be very personal, isn't it? I'm sure people listening to this will have some ideas how we can best organize this challenge. In which case, yeah, tell me about it on the forum. I really want to engage more with the people listening to this podcast. Yeah, join us on the forum and we'll do an accountability challenge.
Onto the next thing that people tend to find upsetting. In fact, this is probably a really good place for me to warn people that this might not be the conversation that you want to have with whoever you're traveling in the car with right now at this exact moment. I hate to use the word adult theme or something like that or explicit or something because it's not really not. And we're not going to talk about anything that I wouldn't talk about with my daughter.
In fact, I was watching one of Stephanie's talks last night and my five-year old daughter Ivy saw some of your PowerPoints and it was -- Okay, so now I have to stop. If you're in the car with your kid and you don't want to talk about this right now then you have to stop the podcast. There were pictures of the male reproductive organ and she wanted to know what it was. For me, it's like, well, we're going to have to have this conversation at some point and I know she's smart enough and ready enough to understand anatomical parts so we just talked about it and she was perfectly satisfied with the explanation and we just moved on. I realize that not everybody would want to have these types of discussions.
Okay. So, we're going to talk about why circumcision is not paleo. How the heck did you get into this? This is kind of an interesting story. How did you come to care about male circumcision?
Stephanie: Well, it's funny, I thought you might transition earlier because you made a couple of comments that I thought just would be perfect segues to go from how people should have access to the full capability of their body or anything like that.
Christopher: Assume it's perfect.
Christopher: Don't touch it unless--
Stephanie: Assume it's perfect, yeah. Yeah. What you should, if you're going to go and change things, you should have a really good reason for doing so. Having had that mindset, I already sort of generally felt that way about the topic. I think I had a course in college where we watched the video of circumcision and I logged in my brain somewhere that I thought that sounded like a terrible idea but I never spent a lot of time thinking about it.
And then, I believe this was late 2014, there was a news story about a young boy whose parents hadn't been married, they had separated when he was very young, they had signed some sort of parenting agreement that said that the father would handle the boy's circumcision. That had never been followed through on and several years down the line when the kid was about three or four, the dad decided it was time and the mother, at that point, had decided that she did not approve of that happening to her son. There was this news story going on about it.
They got into legal battle and it turned into a big mess. I made a semi casual remark on Facebook, of course, where things always get stirred up these days, about how I thought that the whole practice was rather barbaric. And because of the terminology I used, I was accused of being anti-Semitic and I thought that has absolutely nothing to do. I'm not anti-Semitic and it has nothing whatsoever to do with my reasons for having--
Christopher: They just love Facebook.
Stephanie: An opposition to that practice. So, the person who was making those comments, one of their other comments was that foreskin has no function, that it doesn't do anything at all and, therefore, has no value. Again, from an ancestral perspective, could not imagine the idea that this part of the body so closely tied to reproduction, which of all aspects of the body have extremely high evolutionary pressure to be honed to the finest detail, I just could not fathom the idea that it didn't have any function.
So, I decided that if I was going to have this argument I should be able to back up my reasons. I began studying what the arguments for and against circumcision were and I realized one of the biggest gaps is actually people talking about the functions that it has and I've learned quite a lot about the various functions and a lot of things that are not part of the current debate.
I mean, specifically, when it comes to most of the debate, it's usually about supposed medical benefits versus -- well, medically speaking, for example, the American Academy of Pediatrics pits the three medical benefits that they cite versus what they refer to as risks. The benefits being reduced rate of urinary tract infections, penile cancer and STDs and the risks being complications which they indicate as being rare but the rarity doesn't necessarily mitigate how severe they might be.
I mean, death is one of them. Hemorrhage, amputation. Death is usually listed as hemorrhage. So you bled out. But they didn't say why. But it only even talks about these. And they say, "Well, these risks are so rare so don't worry about it." It's never part of the discussion to talk about the costs, the actual things that happen by default and what is lost in the process, to say nothing of just the trauma of it that people want to dismiss particularly when it comes to just routine infant circumcision that this tiny young being is being subjected to just ridiculously excruciating torment with hardly any anesthesia to speak of and weeks of healing. It's hard not to just get angry talking about this.
Christopher: So, is there any truth to those claims that's made by the pediatricians that it does reduce UTIs?
Stephanie: The trouble is if you start getting bogged down and talking about that, you end up missing the point. You could say, okay, so when it comes to the UTIs, they only find reductions within the first year of life. So, there's an improvement in UTI rate for circumcised boys in the first year of life. I don't think anyone has bothered asking if maybe we just don't know how to handle infant penises because they're not doing so themselves at that point in time and there's been so much of this idea that you're supposed to retract it and clean under it, which you're not. It's attached very firmly with the membrane that early forced retraction will cause damage and possibly subsequently make it difficult to retract. That membrane normally dissolves over adolescence, puberty and sometime by adulthood so that it can retract naturally.
If you damage it early on, you're going to end up with scar tissue and it may not work later on. As well as just the fact that we have soap and we dunk them in a soapy water and there's the microbiome in there that's normally supposed to be taking care of and protecting that area and we're sticking soapy water in it. Maybe we're just not properly caring for intact baby boys.
I'm not aware that anyone has tried to study that question. This idea that having them circumcised reduces UTI risk, maybe we're not looking at why they're getting UTIs. And then there's the penile cancer. It's an extremely rare form of cancer. I believe the one statistic on it is the number needed to treat one instance is you need 900 circumcisions to eliminate one potential case of penile cancer.
And then the STD risk is tied to these studies that were done to try and find a way to reduce AIDS in Africa and so circumcision was proposed as a way of doing that. There's a lot of refutation of those studies online. And also if you consider just condom usage, nobody in their right mind thinks that being circumcised is a preventative in a way that would discourage you from using condoms for safer sex. It just doesn't even make sense.
Christopher: No. I think that argument could almost be discarded out of hand.
Stephanie: Yeah. And not to mention that you're making decisions on behalf of someone's future sex life that has--
Christopher: Right. Yeah. Infants don't need to worry about STDs, right?
Stephanie: No. It's not the time to deal with that. But then it's not regarded that that individual should just have the right to their full body the way that -- This is not cutting hair or fingernails. It doesn't grow back. And to decide that this person can just do without that particularly without having ay recognition of, again, what it does, I think, is just very irresponsible and is kind of a human rights issue.
I mean, everybody these days can get behind the concept of being against female genital mutilation because somehow we regard it as being more severe or more objectionable for some reason. I think that's just because of familiarity. We're familiar with one and we're not familiar with the other. And so what we think of as one is customary and one is not customary, at least for the discussion that we generally have in the US.
Christopher: Okay. So, not much of an upside to discuss the downside. Perhaps it might be good to talk about some of the functions of the foreskin. Is it just vestigial?
Stephanie: This is a big misconception. Of course, you can get by without it. You could get by without a lot of things. That doesn't make it a good idea or preferable to not have them. The foreskin actually does a lot of things. In my previous presentations I've kind of broken it down to seven main categories of function that I think pretty much encompass what it does.
Those are protection, lubrication, sensation, mechanical action, partner stimulation, erectile stimulation and penis size. Some of the things that I think people would find most surprising is its role, for example, in what's called intromission which is the ability of the penis to enter into the vagina and come back out.
There was study that was done that showed that an intact penis with a foreskin, not retracted, took one-tenth the force to enter the vaginal opening that a circumcised penis did. So, it was a dramatic reduction in force needed. And just to think the effect that that alone has on people's sexual experience. It's one small detail but if we really wanted to evaluate how good is the sex that people are having, so a considerable question to ask is how is this affecting the physical action of intercourse?
In addition to that, when it comes to sensation, there's a lot of argument about sensation. Does it reduce sensation? Could I stand to have any more sensation than I have as it is? All these things. But when you look at the two most innervated parts of the penis, you have the glans which has predominantly free nerve endings, and the type of sensation that those register is actually more of an irritation, if anything. It contributes to a sense of intensity.
And then you look at the ridged band which is the farthest out tip of the foreskin when it's flaccid and it rolls back to somewhere mid shaft when it's erect, that band which is eliminated in all circumcision whether it's what they call looser or tighter one, that's automatically gone, that is innervated with Meissner's corpuscles. Those are the same types of nerve endings found in the fingertips and the lips. They register fine touch sensation.
So, during sex, that part of sensitivity is somewhere mid shaft to the penis. Meaning, what that male partner is going to feel at that time on that part of the penis is going to be different. If you're assuming that that individual is moving in a way to stimulate himself to a large degree, whether he's getting more sensation mid shaft or only on the glans on the tip of the penis, it's going to change the way that he's moving. So, how is that affecting his partner's experience?
In my personal life, I've experienced quite a number of both and I personally feel that they tend to move in different ways in my experience. And so I often find myself coaching male partners who've been circumcised to adjust their movement in a way that feels better to me because I sense that they're moving in a way that they're trying to stimulate themselves in the only part where they have a high level of sensation. It doesn't match up as well with what my body is expecting.
Christopher: Talk about the lubrication aspect. I find that fascinating as well. If vaginal dryness is a problem and you think it's just the woman that's got the problem but that may not be the case.
Stephanie: Yeah. The inside of the foreskin and the head of the penis is mucosal tissue. It produces lubrication. I mean, that's the -- I mean, the term smegma is there which is of Greek origin for soap. A substantial portion of that lubrication is produced by the penis to help facilitate. And we have a bunch of different things going on. Again, that issue of the amount of force that's necessary to enter. So, if you have less force you're going to need less lubrication to facilitate it.
You have, as the foreskin rolls back onto the shaft with each thrust you're keeping the epithelial tissue on the outside for the most part and bringing the mucosal tissues together on the inside.
So, you are sort of creating a little bit of a barrier and helping to keep the lubrication inside. There's more of it in the first place because the penis is contributing its portion whereas only relying on one partner if you have a circumcised penis. You're keeping it inside so there's more lubrication because the penis produces its own with the mucosal tissue in the foreskin and the glans. It stays there and isn't eliminated because you have it being protected while the foreskin, before there's an erection, it's still being contained in there and then once you do get to the point of intercourse it's being maintained inside because, as the foreskin is rolling back and allowing the mucosal tissues to come together, you're keeping the epithelial tissue on the outside and keeping it all inside and together.
There are several things going on that are missing when you don't have a foreskin in terms of lubrication. As you say, we tend to put the responsibility for this on the female partner as if she is supposed to be the one supplying all the lubrication instead of realizing that that's actually a mutual contribution and both producing it on both sides and then keeping it all where it needs to be, and the foreskin is part of helping to do that.
Christopher: I mean, you solve that problem with K-Y jelly, right?
Stephanie: Well, that's the thing. We have medical interventions, or not necessarily medical, but commercial interventions for pretty much all of these issues. Oh, well, vaginal dryness, okay, here's some lube. Not enough stimulation, here's some ribbed condoms. Can't keep an erection? Okay, here's your Viagra. We can--
Christopher: Right. There's no attempt to understand the underlying process that led to the problem in the first place.
Stephanie: Even if there is, it's like, well, as long as you got the solution for it then you don't have a problem, do you?
Christopher: Right, right. Talk about the stimulation thing. That's interesting as well, that the foreskin may play a role in male stimulation. Not may. It does, sorry. That's like I've been hanging out with Tommy and scientists for too long.
Stephanie: It certainly plays a role in the male stimulation but also of the female stimulation because part of it is you don't want to take away tissue that you have available to stimulate your partner with in the first place. I mean, the ridged band, it's got a little bit of a texture to it and that is moving in and out of the vaginal opening can be the more sensitive area on the female, that's just like a ribbed condom or something. It's kind of there to try and basically reproduce that sort of little additional texture that's available there.
But in addition too, because of the way that you're moving, if there's a long thrust in and out, you're breaking body contact and versus if you're doing movements where there's a lot of close contact that's going to be generally more stimulating for the female partner because so much of the sensation is on the outside, the labia and clitoris, around the vaginal opening. That ability for both partners to get a lot of sensation in close contact and kind of grinding is going to increase the chance of both partners having a really pleasurable experience.
Christopher: So, the big question is then, why the actual fuck is happening? Why would anyone do this? I realize at this point I may have offended probably what percentage of men in the US? I'm British and, as far as I know, this doesn't really happen in the UK unless there's a very particular medical reason or perhaps a strong and strange religious or cultural reason. It just doesn't happen in the UK. It's very confusing for me to come to the US and hear stories from other parents in Santa Cruz when you had a child and then -- It's not even like a pediatrician is getting involved. The nurses will say to the parents or did say to the parents -- I'm talking about some specific examples here.
Is the father cut? Is this something you want us to do right now? It's kind of like framed just like a half question. This is what we do. This is how it's done. Maybe some medical reasons would be given like some of the ones you mentioned earlier but not really. It's just kind of, well, this is what we do type thing. And if you're not going to do it then you're kind of breaking the convention.
Yeah. Parents I've known in Santa Cruz, the baby has just been taken away a very, very early stage and been circumcised and then later on we already know of some people where it's led to problems like painful erections before the kid is even old enough to know what an erection is which is horrifying.
Stephanie: These don't necessarily get candid in those complications that people--
Stephanie: The risks are rare. I really don't believe that this stuff is being fully accounted for.
Christopher: Right. And so what I worry about, men listening to this, that you're going to take this as a literal and metaphorically affront on your manhood. I think this is probably a really good time to adopt a growth mindset because what's happening here is the default is whatever--
Say, you're a man and you haven't had all your kids yet and some of those future children could be boys. Then it would seem in the US that the default position is to do whatever has been done to you. Even this is the time to, okay, maybe I should at least look into this and understand that this is not the right thing to do for my child in the future and not take it as a personal affront to your manhood. That is the last thing I'd want to happen. But why is it happening in the US? I honestly don't know the answer to this question. Why are people doing it in the US?
Stephanie: As you say, it's not because of any therapeutic intervention. It's just something that's held as a custom and it's held as something that's parents' choice because that's what we're used to. The origins of it being such a predominant practice go back to the late 1800s, like 19th century. It started out as the medical profession was evolving and especially as surgery started to become something that was safer and as we had things like anesthesia and antiseptic capabilities. The amount of surgery was going up.
People were looking for ways to solve all sorts of problems. The concept of things like irritation which is this nebulous microscopic sort of irritation in the nervous system, things that we can't even assess, but like this idea that medical issues and problems were coming from this unknowable irritation in the genitals or a source of this potential irritation or just the general idea, like the sort of Victorian concept of too much sexual excitement is bad for your health.
Somehow, it ended up getting blamed for a lot of things and either in effort to prevent everything from paralysis to kidney dysfunction to tuberculosis to epilepsy were blamed on either excess irritation from the foreskin or on too much masturbation and too much sexual excitement. It became a common scapegoat, I suppose, for a lot of things and then at some point it just became common enough that we accepted it as default norm.
So many different medical reasons have been given for it over the last 150 years or so and we've pretty much disproven all of them along the way. I mean, nobody blames excessive spinal curvature and paralysis on foreskins anymore. But now we still, every time one thing has been disproven another thing has been come up with to replace it. That's where now we are at the urinary tract infections, penile cancer and STDs.
It's persisted but I think part of the reason may be that what you are just saying about the fact that it is such a personal thing that I think and I feel badly for all the guys who have to at some point, if they decide to, grapple with the question if they were subjected to it, how do they feel about that, what does that mean and do they want to make, say, a different choice if they're involved in one in the future.
Well, I mean, this is to say nothing if we should, not just consider the human rights issue rather than a parental choice thing in the first place. But I think it really is a difficult topic for a lot of people to think about because I think nobody wants to think, I mean especially something so personal as having been compromised and so a lot of -- There's the tendency to say, "Well, if it was good enough for me it must be good enough for someone else because I can't imagine myself as less than my full potential."
It's just a very difficult question for a lot of people to ask and I certainly, even though I speak strongly about it, I certainly don't want people to feel less than -- It could come from saying less than full potential. I don't want people to take it as a personal attack in any way or to somehow feel that they are invalidated or broken. I mean, we've all had compromises in whatever ways bodily or otherwise over life to deal with. I think trying to pretend that it's all just the same doesn't make a lot of sense either, that one is equal to the other. It doesn't make sense.
Christopher: I mean, you framed it perfectly the beginning of this podcast. You just ask questions about why do we do this? I don't know. Why do we do it? Let's investigate. Why do we do it?
Stephanie: Well, again, if we're going to go and make interventions like this, we should have a really good reason. We shouldn't just have a, "Oh, somebody did it before--"
Christopher: That's what we do.
Stephanie: So, that's just what we do. Like I said, coming from an ancestral perspective, my basic assumption is that we should figure that these things probably came about for pretty good reason. That should be the default view. We should have to have a pretty strong reason otherwise to--
Christopher: To intervene?
Stephanie: To intervene, yeah.
Christopher: And so what could be done? Do you think there's any reason for men who have been cut to try and do anything about it? Is this going to be one of those things where you have to have the serenity to accept the things that you can't change?
Stephanie: It's very much like the barefoot topic to me and this is why they go hand in hand to me, is we can do some things, actually. I mean, there are processes that you try to restore foreskin which is never going to recreate the type of nerves and specialized aspects that were there before but can potentially change the keratinized skin at the glans to more, let it go back to more mucus capability, or to change the mechanical action by increasing the skin by just stretching--
I mean, specifically done to help more skin grow. There are people who are working on that. In the same way that you can, as an adult, go barefoot and kind of incorporate that into your overall health regimen. It's not going to be some instant fix. But the best thing that we could possibly do is just stop perpetuating it on the next generation.
We could make a huge shift in a few decades by just not perpetuating these things. I feel like we're in a certain position now because this is what history has brought us to and the best possible thing is if we just stop doing it to the future.
Christopher: I sometimes think about what it would be like if some life form arrive from another planet and I was to explaining to him all the things that we do and then kind of like, "You did what because why?" It's just bonkers, isn't it? I mean, surely, in 500 years it would be just one of the things we look back on and think, what the actual fuck were we thinking with that one?
Stephanie: Yeah. I'm imagining that too. I don't know exactly how long things will take but I hope this one doesn't last much longer.
Christopher: Me too. Me too. And I'm very grateful for where I came from. Just sheer luck. I think that--
Stephanie: I mean, you don't feel like you'd be just as well off without it apparently. You said sheer luck. You said grateful and you said sheer luck. You clearly don't feel like you'd be just as happy.
Christopher: Oh, yeah. No. I must admit I can't imagine it. Knowing how sensitive that part of my body is to touch, the idea of it being exposed all the time, I don't know. Probably someone listening to this has done this later on in life and has had to experience the transition from something that's incredibly sensitive to something that's keratinized like my fucking dog's foot. It can run on tarmac because it's keratinized. That must not be a fun transition.
Stephanie: I mean, there certainly are people who have gone through it later in life for any number of reasons, personal choice or actual medical necessity. From what I've seen the reaction differs. Some will say that it's really, really taken away from their sex lives and other say that things have gotten better. I don't know how much those reactions differ based on if the person felt strongly enough to pursue the procedure in adult life they may be sort of committed to that idea of having felt like it was an improvement. Because it could potentially be quite a mental disaster to think of it not being better.
Christopher: Yeah. Humans are very strong reasons to -- We want to explain our behavior. Everything has to make a coherent story in our minds at least and hopefully in other people's minds too. It doesn't surprise me that once people have gone down that road they try and rationalize that with stories of, "Oh, yeah, it's even better now."
Stephanie: I don't know. You've decided that you didn't need your left hand, you'd be so much better off without your left and so you cut it off and then later could you possibly think, gosh, maybe I really would have liked to have my left hand? No, this hook I'm attaching and I'm a much better pirate now and this is just so much better than it was before because I would hate to think that I really cut off my left hand and did something so wrong.
Christopher: Yeah. It's absolutely wrong.
Stephanie: When I see people, statistics about some of this stuff, I just don't know if they've fully explored possibilities like that when people -- I'm sure there are stories in which people really have seen some improvement or advantage for one reason or another. I'm not saying that that doesn't happen. But I think it's also worth considering if some people, just personal commitment to that belief that led them to that choice maybe a factor.
Christopher: So, shoes off, foreskin on.
Christopher: What comes next? I feel like there's this emerging story that's still evolving here. Where are you going next with your not paleo theme?
Stephanie: Well, I did also give a poster in 2018 that was on evolutionary feminism. That, my next exploration after those two, really has started to move into more -- It started with questions about male and female relationship dynamics and has since expanded to really start questioning how we organize all of society ever since agriculture which is our paleo transition.
We started building little houses and separating ourselves in them and organizing that around nuclear family and relationship structures. That's the biggest thing that I've started to try and untangle the last couple of years.
Christopher: Explain that nuclear family. I think I have a problem with the word nuclear. I think I tend to insert an extra syllable into. But nuclear, I've never heard that term before. Can you explain it?
Stephanie: Well, just mother, father and their children as a basis for domestic unit of society, which is nothing at all like how society used to be organized before agriculture, mainly in a tribal group. You don't really have discrete parent units like that. You have a bunch of people who basically all live together. You have support structures for both parenting and for just among all the members of the tribe but that don't exist in how we've now divided it up into these little tiny boxed units as our basic way of organizing society.
I mean, there's so much that's tied up into that in terms of romantic relationships, how we raise children, how we care for elderly, just how we create social support and relationships. You just had another podcast guest, Julian Abel, who was talking about cooperative communities.
Christopher: Caring communities.
Stephanie: Caring communities. And just how drastically having those improved health outcomes. I think that this is possibly one of the most important things that we need to explore, is just how do we organize society? That's the big next question that I have and that I'm working on now.
Christopher: That's awesome. And how are you going to communicate these ideas? I grow increasingly skeptical of the book format because, I mean, personally, and I think other people are guilty of this too, is that we motor through these books. I get some great ideas, and maybe one or two from each book, but the chances of me doing something about what I've just read are close to zero. I'm probably onto the next book before I even thought about why I might do about what I've just read. I wonder what is the best way to make an impact on people's lives through teaching? Is it the book? I don't know. Maybe I'm wrong about that. Maybe it is the book.
Stephanie: Well, I do intend to write some things sort of incorporating all these ideas but I also, as with the ways that I've approached everything in the past, I tend to dive in and try to do or create the thing that I'm advocating. Maybe that's why I actually have gone so much without shoes--
Christopher: Literal skin in the game. I love it.
Stephanie: Yeah. Sort of like I'm interested in creating an intentional community that is based around these ideas and just trying to use more of a tribal format not like, not the way of isolated commune concept but trying to see if there's a way to organize a different, both physically different and intentionally different, kind of living system.
Christopher: I'd be all about that if it could happen. I always think about that. I mean, even like really day to day stuff in my life. Mountain biking, for example. I enjoy riding my bike but it doesn't take all day. It takes 90 minutes or maybe two or three hours at the very most. And so it would be really easy. If I was living with other families that also rode bikes for us to just trade off, right?
Okay, you want to go ride with your husband, fine. We'll look after your kid. It's not going to make any more difference to us to have an extra head or even an extra two or three heads while you go ride. And then you can do the same for me. But as is for most families, it's a complete bowleg to go and do something like that because somebody is left holding the babies literally.
Stephanie: Yeah. It's very inefficient the way that we have things now, that every family group has completely separate structure and a copy of everything, that there's a full kitchen and there's a washer and dryer in practically every unit or something. Obviously, not all. Things are built that way. We have way more things than we need. So much of our stuff is going unused all the time because we think everybody needs to have a copy of it.
We're not sharing things with one another and we're not seeing one another because just by being organized this way. I mean, one of the most significant things that I was looking at with the idea of evolutionary feminism is especially female support networks. Because when you live in a tribal group, as you were mentioning things like caring the baby or, say, even co-nursing was something that was super common when you have tribal groups of women.
You're dealing with all those child care responsibilities but you can pass them off to the next person or you're all helping one another with those kinds of things. Now, we're trying to -- Two, if we're lucky parents, trying to handle all of that stuff. And in particular, at least having been looking at it from the female side, although I'm starting to see more and more that this is going on in the male side of things too, feeling really disconnected because of not having a network of other women.
This goes back to what agriculture allowed us to do when we were no longer nomadic tribal people, when you can actually stay in one place long enough to accumulate things and to build a permanent structure and then to want to then pass that down to who, specifically your children rather than just the community's children.
Because there's such a high reproductive burden on females the attractiveness of a male provider who can build a house and a farm and provide all that she and all of her children might need to survive is super attractive. We sort of voluntarily allowed our support networks to dissolve as we moved in with the guys. I don't believe that the whole concept patriarchy came from any deliberate oppression on the side of men trying to keep women down. I think we just didn't realize how important our peer support networks were and we just allowed ourselves to fall into the attractiveness of what was available in these as houses and agriculture developed.
We let that become more important than our tribe. I mean, the first houses may not have had doors and you could just walk next door to your neighbor and still be, you know. But over time we got more and more isolated in it. We just built ourselves into these little human zoo jails rather than being connected. Again, we're not going to try to go back and live without any of the modern things that we have now. I'm not trying to advocate for that.
I'm trying to look at what can we do to reintroduce some of the elements of community and some of it involves the idea of women living more with women and then maybe the men are going to live next door. When the presents pile up on the front porch of the women's house enough, maybe we'll open the door and the guys can come in and then have a nice little visit and then, you know.
Just thinking about that there are other ways to fulfill all the needs that we currently are trying to fill with this nuclear family unit. How to get support for the domestic space, how to care for the kids, how to have our romantic relationships, how to do all these things. The current system with the nuclear family model isn't doing a great job of filling all those needs that we have as a society, as individuals and as a society. I think it's time to look at some other possible models.
Christopher: I love it. I absolutely love it. Do you think you can do it? Do you think you could start a community like that?
Stephanie: I have my eye set on Austin. It seems to be aware of so much is happening right now. That's my thought as a first place. But because it's about local domestic environment, if it works in one place, hopefully it will pop up in many, many other places.
Christopher: Yeah, of course. Of course.
Stephanie: That's the idea, to try something that's at least somewhat replicable.
Christopher: That's awesome. Well, I think of you as one of the unsung heroes of the ancestral health movement and the reason I say that is because you've come up with some really great ideas and you talk about them very well. But you don't really have that much of an online presence. There is a paper I can cite in the show notes for this episode. But you are a regular at these conferences. You're at the Ancestral health Symposium. We're here at the Physicians for Ancestral Health winter retreat. You'll be at Paleo f(x), is that right?
Stephanie: Yes. Every year, I've made another website or two and another idea and every time just the next thing happens and so they've kind of all fallen away. But I feel at this point I'm sort of building up to something and I do show up at the conferences, the Ancestral Health Symposium, the Physicians for Ancestral Health and Paleo f(x) and I'm also now planning for the second time to Future Frontiers which is also in Austin.
Christopher: I'll have to remember that one.
Stephanie: It was called Voice and Exit for the past few years and they've now just changed the name to Future Frontiers. That one is also just kind of all about looking at the future of humanity and what we need to create human flourishing. It was at that one last year that I sort of announced the concept of this community, which is, again, still evolving but use the name -- Well, the name Amazonia was dubbed on it by one of my fellow group participants in the activity where it originated. That's the working title for the community.
Christopher: I don't get it. What's the reference? You just conjure up references to where I get everything now from cat food to you name it. It comes from amazon.com. I don't get the reference.
Stephanie: Oh, it wasn't about -- No, just the idea of the amazons, the mythical females who didn't need men for anything, which wasn't exactly the intent of what I was going for but it was sort of a tongue in cheek offered by one of the male participants in the group and I decided to just run with it, anyway.
Christopher: He was clearly better read than I am.
Stephanie: It's just what is it? Wonder Woman? Do they call them Amazons? That she was part of that or something? I should be better up on my ancient mythology. I think they were -- They were sort of like they would cut off their right breast so that they would be better archers, it wouldn't be in the way, that sort of thing.
Christopher: Yeah, I've heard that before.
Stephanie: Yeah. So, the concept was just, the reason it was offered was, because I was talking about a female centric community and so he sort of called it Amazonia and I said, "You know what, I'm just going to run with that."
Stephanie: I don't know. That's just the working title for now. Anyway, because I spent so much time in Austin for the Paleo f(x) and just so much energy is going on down there, that's what I've been thinking.
Christopher: Okay. It's about time I get myself down there. I've never been to Paleo f(x) and I've never been to Austin, Texas.
Stephanie: Yeah. I'm hoping that I'll see you there in April.
Christopher: Cool. Okay. Can people connect with you online? On Facebook or anywhere else? Would you rather just -- Now, she's cringing. Okay. Yes, so just come and see you in person at Paleo f(x) or any of the conferences that we talked about.
Stephanie: Yeah. Right now. I'm hopefully going to have something that's a little better to offer than this in the not too distant future. But maybe we'll have another podcast episode and then we can tell them exactly where to find this.
Christopher: That sounds great. Thank you so much, Stephanie. I very much enjoy you. I think you're doing some fantastic work. Yeah, thank you for taking the time. I really appreciate it.
Stephanie: Thank you very much.
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