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Betting the Farm

Reading Time: 8 Minutes

Published August 22, 2026

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Good morning! Before baseball, before football, America was captivated by watching men walk in circles. Pedestrianism reached its peak in the 1870s, when tens of thousands packed arenas for six-day races in which competitors marched around indoor dirt tracks, surviving on catnaps on trackside cots. The spectacle had everything a proper sport required: rivalries, gambling, celebrities, brass bands, carnival food, and a schedule that ended only because Sunday laws prohibited “public amusements.” The sport's biggest star, Edward Payson Weston, covered more than 500 miles in a single race, survived a coca-leaf doping scandal, and lived to 90. The craze eventually gave way to bicycle racing, which offered the same entertainment—just faster and with more spectacular crashes. The next study makes the case for a pedestrianism revival.

The Need for Walking Speed

NEURO NEWS

The walking fad of the 1800s appears to have aged better than mutton chops. What was once a spectator sport has become one of geriatrics' simplest—and most revealing—functional measures.

Walk this way

Researchers pooled data from nearly 4,000 adults with an average age of 84 and identified the "super-movers," those who walked faster than about 93% of their peers. Compared with slower walkers, these brisk walkers were about 50% less likely to develop cognitive impairment and 60% less likely to receive a diagnosis of Alzheimer disease or another dementia over 3.4 to 5.4 years of follow-up. Brain scans also revealed that the super-movers tended to have larger hippocampi. But the postmortem findings told the most interesting story: Despite similar burdens of amyloid plaques and tau tangles, super-movers maintained better cognitive function than non–super-movers during life.

Walk, don't run, to conclusions

Like all observational studies, this one can’t prove that brisk walking protects the brain. It’s entirely plausible that some of the relationship runs in the opposite direction: Healthier brains (and healthier bodies) may produce faster walkers in the first place. Gait speed reflects much more than walking ability, from cardiovascular fitness to musculoskeletal health, making it difficult to disentangle cause from consequence.

Key takeaways

The study doesn’t suggest prescribing speed-walking. Instead, it helps support the idea of gait speed as the “sixth vital sign.” The logic is simple: A brisk gait depends on the seamless coordination of the brain, cardiovascular system, muscles, vision, and balance. For clinicians, it’s a reminder not to skip the 4-meter walk test—already part of the Short Physical Performance Battery and many comprehensive geriatric assessments. The pedestrianists had the right idea, if somewhat prone to excessive dosing.

For more education on this topic, check out this CME activity: Walk It Off: Preventing Recurrences of Low Back Pain

Unearthing the Farm Effect

IMMUNO INSIGHTS

There’s something very George Costanza about the hygiene hypothesis: If our instincts about dirt and germs are wrong, perhaps the opposite is right. Some microbial exposures we try to avoid may actually work in our favor. New research from German farms traces an unglamorous potential pathway: cow gut → barn air → immune signaling → fewer childhood allergies.

Old MacDonald had a farm—E-I-E-I-AhR

For decades, children raised on farms have shown lower rates of asthma, hay fever, and eczema—a phenomenon known as the farm effect. In a new study of mattress dust from more than 1,000 rural German children and cow-shed air from nearly 50 farms, researchers linked just nine bacterial species to much of that advantage. Exposure to these bacteria could explain about two-thirds of the lower asthma rates and half of the lower hay fever and eczema rates among farm-exposed children. The bacteria originate in the cow gut and turn up in barn air via inelegant means. Their metabolites can be inhaled and activate immune-related receptors, including the aryl hydrocarbon receptor (AhR), potentially dampening excessive inflammation.

Don't bet the farm

This is observational, not a trial. Nobody randomized toddlers to cattle sheds. Researchers replicated the findings in other European populations, but whether they extend more broadly remains unclear. The exact biological mechanism also needs more study. For now, cattle exposure remains decidedly off-label.

Key takeaways

We spent the 2000s attaching hand sanitizers to backpacks; meanwhile, farm kids were making the case that not all microbial exposure is bad. The findings don’t change allergy-prevention advice, but they strengthen the idea that early environmental exposures help program the developing immune system. Pinpointing the microbes behind the farm effect could eventually lead to new ways to prevent allergic disease—no livestock required. The broader lesson: Not every encounter with dirt requires intervention. Toddlers everywhere are standing a little taller over their mud pies.

For more education on asthma, check out this CME activity: Breathing Better for Sleep Apnea, COPD, Asthma, and More!

Protein Power or Poison?

Special Contributor—Frank Domino, MD

Confused about how to counsel patients (and ourselves) on how to eat? Good! It means you have been paying attention.

In early 2026, HHS and the USDA released new dietary guidelines telling us we needed “more protein,” based upon ... very little. The recommendation of up to 1.6 g/kg of body weight/day (up to double the previous 0.8 g/kg/day) came despite their own advisory committee’s report, which recommended changing protein sources, not amounts. The louder charge came from internet “influencers.” Because nothing says “peer review” like a shirtless guy selling whey powder from his garage.

But misinformation about food is not new. Starting in the 1960s, the sugar industry quietly paid Harvard researchers to point the finger at fat, especially saturated fat, and by the 1990s we had followed along with fat-free cookies, cakes, potato chips, and fake “butter.” As a result, the obesity crisis grew, and life expectancy gains started to slow down.

So let’s take a look at how we should be counseling folks, especially around protein.

#1. Protein is good

0.8 to 1.0 g/kg/day of protein is safe and effective for most populations. More is unlikely to hurt your kidneys (as was once thought), but high animal protein intake is tied to overconsumption of calories and, ultimately, obesity, CVD, and MASH outcomes.

#2. Plant protein is good

For example, substituting just 3% of your total calories per day with plant protein lowers CVD and all-cause mortality risk—at least in the Japanese population of this study, where high plant protein intake is already the norm. For someone in the US eating 2,000 calories a day, this is equivalent to adding three tablespoons of cooked lentils to your day. Or about two ounces of tofu. The key here is substituting. Adding them but still taking on that 16-ounce steak misses the mark.

#3. Egg protein is ... well, GOOD

We have long had data showing that eating cholesterol-containing foods does NOT appreciably increase CVD risk. Unless, of course, you are overconsuming (see #1 above). In a large Chinese cohort, eggs LOWERED CVD risk.

#4. Dairy ... it’s confusing

The data on dairy products is confounded by fat percentage and added sugar. Regarding full-fat dairy, the authors of two large studies found a correlation between whole-fat milk and an increase in total and CVD mortality (my Cap’n Crunch indulgence is saddened by this ...) but not with 2% milk or 1% milk (FYI: nonfat milk is not a thing in many other countries). To be clear, nonfat (skim) milk has never been found to be “better.”

Yet, in the PURE study from 21 countries, researchers found a higher total dairy intake was associated with lower risk of the combined outcome of mortality or major CVD events and with total mortality.

And maybe the best data on dairy is a 2025 meta-analysis on dairy consumption, in which lower-fat (2%) dairy products resulted in a lower risk of CVD and stroke. What about fermented foods, like yogurt? Yogurt is even more confusing to study because it is highly sugar-sweetened in some countries and not in others.

Key Takeaways

With regard to protein, more is not better. Substituting plant protein is a good thing. Eggs are good, and 2% dairy is good. Add this to a high-fiber diet and you have done far more than what someone on the internet is selling you. Best of all, this advice is free—no discount code required.

For more education on hypertension management, check out this CME activity: Dialing in Hypertension Treatment: Managing Adverse Effects in Older Adults

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

Alissa Scott, Author
Aylin Madore, MD, MEd, Editor
Margaret Oliverio, MD, Editor
Ariel Reinish, MD, MEd, Editor
Emily Ruge, Editor

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