6 Simple Rules for a Long, Healthy Life with Dr. Ezekiel Emanuel

Mark Hyman, MD

Full Transcript

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Dr. Mark Hyman
Loneliness is an epidemic. Our former surgeon general wrote a whole treatise on it. It's like smoking two packs of cigarettes a day.

Dr. Ezekiel Emanuel
I read one of the books on wellness and it made me pissed off beyond belief. Part of what bothered me about a lot of these wellness books is the sort of narcissism of them. You know, it's about me living a long time. If you wanna both be healthy and live a long and happy life, it's about purpose engaging with other people and engaging your mind. The people who are talking about wellness today and longevity and pursuing it obsessively, it consumes their life.

It's the total focus, and that's not good for the body.

Dr. Mark Hyman
Ezekiel Emanuel, MD PhD, is the vice provost for global incentives and the Diane S Levy and Robert M Levy University professor at the University of Pennsylvania, as well as a leading oncologist, bioethicist, health policy expert. He's a key architect of the Affordable Care Act and he authored over 350 publications and 15 books, and he advises the World Health Organization. And he frequently contributes to major media outlets on health and policy issues.

Dr. Ezekiel Emanuel
The first thing is social life is critically important. One of the reasons we have a loneliness epidemic is because we're not interacting. Social media is not helping, and we have a lot of forces pushing us to be isolated. The number one thing for a long and happy life is social relations and robust social relations. And the last thing is you gotta stay mentally engaged.

You gotta be mentally on it. Be curious about the world. You gotta have purpose.

Dr. Mark Hyman
If you have meaning and purpose, you live an average of seven years longer. Well, Zeke, it's so good to see you again and I'm so happy to have you on the podcast. I've wanted this moment for a long time and and here we are.

Dr. Ezekiel Emanuel
That's my great honor. I don't know how long we've known each other, Mark, on and off for pushing forty years.

Dr. Mark Hyman
A long time. Yeah. You were my sister's close friend at Amherst. And and then we hung out when you were working in the Obama administration, and we went down to Washington, had dinner. I was like, wow.

We're like, you're actually changing the face of health care. This is the coolest thing ever. And I could literally read your bio, which would probably take the full hour, and it'll probably take another hour to read all the awards you've ever received. But leave it to say you are a supreme underachiever who's accomplished nothing in your life and and are an example really for someone who's actually living with purpose. I'm joking, but who's living with purpose, who's dedicated their life to making the world a better place, and is involved in health policy and and thinking about how we change our health care system.

And your next book is all about this. But today, we're gonna talk about your book, which I love the title of, Eat Your Ice Cream. Six Simple Rules for a Long and Healthy Life. Because if someone were to say to me, Mark, if you were only need one food for the rest of your life, what would it be? It would be ice cream.

I love ice cream that much. So I'm really happy about your title, and and the message is in there. And and I wanna sort of first ask you, well, like, what inspired you to write this book? Because, you know, you're a health policy guy. This is a nutrition book.

Not exactly or you're a medical oncologist, you know, you're a bioethicist. I mean, know, it's sort of tangential, but, like, something inspired you to do this.

Dr. Ezekiel Emanuel
Well, I would say that there are three confluence streams. So it is true that primarily in the Obama administration, I worked on health care reform and the Affordable Care Act, but it wasn't the only thing I did. I also worked on global health and trying to improve the health of women and children. And one of the other things I did is I collaborated with Sam Cass and others to try to do better on our nutrition policy. So one of the things Sam and I did was to open the White House Farmers Market about a block and a half from the White House, and we worked to get fresh fruits and vegetables right in the center and heart of Washington DC.

And the first lady opened it, and it was very successful. I also worked on revising the food pyramid, which had become, I think, fair to say incoherent and substituting the food plate that I think is much clearer advice. We worked and tried to get food companies to put labels on the front about how much sugar, how much salt, and other things. We didn't succeed in that. But I was very interested in food policy, and I have I have a long interest in cooking and food.

I was a pop up kitchen a breakfast chef for a few times. So that's one strand, sort of the And

Dr. Mark Hyman
you also and you also raise bees, and you make chocolate. So

Dr. Ezekiel Emanuel
Long trend of interest in food policy. Yeah. The second thing is I was at a meeting, I wanna say four years ago, three years ago, something like that, and Ariana Huffington asked me a question. Why don't we have more focus on wellness? And I said, well, you know, first of all, wellness is pretty simple.

Sixth rule. And second of all, no one's making a ton of money from wellness. There's no big corporation like Pfizer gonna make a lot of money from wellness. Med schools aren't gonna make a lot of money from wellness. Hospitals are gonna lose money from wellness.

So you don't have the, you know, push on the wellness thing. And, honestly, the answer that there are six simple things stuck with me, but I wasn't satisfied that we couldn't have a movement in that direction, and it sort of gnawed at the back of my brain, you might put it. And then, honestly, I read one of the books on wellness that are in the back behind me on my bookshelf, and it made me pissed off beyond belief.

Dr. Mark Hyman
You don't wanna say what that book is?

Dr. Ezekiel Emanuel
I'm happy to say the book. But basically, heavy focus on exercise, less on food, less on sleep, and that was it. And I'm like, this is just wrong. This is just the of course, exercise is important. Food's really important.

Sleep's important, but it's not the whole universe, and it's missing key elements. And the consequence of being angry and pissed off, if you're an Emmanuel, and the time it was the end of the semester. And so I literally, in the next two and a half, three weeks, sat down and scribbled out the sort of first draft of this book. And I was, like, so mad, and everything that I had understood just came down. You know?

For one thing, yes, as I said. Yep. As you know, exercise and food and sleep, who could object to that? But it leaves out the most, in my view, the most important thing. The first most important thing is social relationships.

You know, you look around the world and almost all the long lived places. And, by the way, places that are happy, social relationships and sociability around meals turn out to be absolutely integral to their culture and their way of life, and that is often left out of these books. And in fact, they suggest you should be, you know, individually work hard and, you know, pump weights and whatever else. The second thing is, you know, as my father so kindly says in one of the chapters is entitled

Dr. Mark Hyman
Who was a pediatrician. He was a doctor A

Dr. Ezekiel Emanuel
pediatrician and probably his biggest public health effort. He was a practicing pediatrician taking care of but he had a big public health effort around banning lead paint and getting rid of lead paints from apartments in the early nineteen sixties. He led that campaign in Chicago. And so, you know, there are plenty of things we do that are schmucky, as it were. You know, the number one, I had I had a a student that's like, I'm gonna climb Mount Everest.

Well, that's a schmuck move. Okay? Lots of your audience may or may not know this, but, you know, your chance of dying going up Mount Everest are one in a hundred for all age, all comers, including the experts. Yeah. The chance of dying if you're 59, and I'll confess I'm 59, is one in twenty five.

What an idiot. Who would do that? What take a chance of dying one in twenty five for a few weeks or months of bragging rights that you climbed Everest just doesn't like a smart woman. I mean, climbing Everest is more dangerous than base jumping, and I thought base jumping was the schmucky move of all time.

Dr. Mark Hyman
So maybe maybe free soloing is probably the dumbest move.

Dr. Ezekiel Emanuel
But there are lots of other things we do that are schmucky. You know, smoking, obviously, and vaping, alcohol. Certainly over one drink a day is is a schmuck move. And there are other things, you know, and I could be very

Dr. Mark Hyman
So basically, the the title of your book could be don't do schmucky things.

Dr. Ezekiel Emanuel
Yeah. That's great. And the last thing is, and and is you gotta stay mentally engaged. You gotta be mentally on it. Be curious about the world.

And as I think you pointed out, and it is you know, you gotta have purpose. It's not just I mean, part of what bothered me about a lot of these wellness books is the sort of narcissism of them. You know? It's about me living a long time. Yeah.

If you wanna both be healthy and live a long and happy life, you know, it's about purpose and engaging with other people and engaging your mind. And so you gotta balance the physical stuff with these more social mental things. So that that's what drove me to write the book. It's a long answer.

Dr. Mark Hyman
It's great. I think I think and you come out of a mission perspective because you have a, you know, a deep understanding of the health of America and population and even the global population. You work to sort of try to improve that health through doing policies that, you know, help people get access to care. And and and what really struck me about this book was that it's it's it's simple. Like, this the the you talk about the sort of the wellness industrial complex, and it's people who are, you know, engaged in all kinds of extreme behaviors that, you know, may or may not turn out to be good, whether it's, you know, stem cells or peptides.

And I'm I'm not saying they're they're necessarily bad. I'm just saying there are lot of things on the edges or margins, and people forget about the core fundamentals. And, you know, when I went to Ikaria, I went to Sardinia, they didn't have hyberic chambers, they didn't do plasmapheresis, they weren't doing peptides, they, you know, weren't doing, you know, like, tons of vitamins. They were just living in a default environment that required them to do automatically the things that are good for them. Like this one guy, Pietro, was 95 years old.

He was a shepherd his whole life, would hike, you know, probably five, ten miles a day with his sheep up and down rocky terrain, eat only the local food. You know, he had a little wine. I mean, don't think he was, you know, drinking a ton of wine. And I met this guy, he was like clear eyed. His back was straight as an arrow.

He was had a booming voice. He sat and, you know, serenaded me with his Italian songs. And I was like, holy crowd, this is what '95 looks like. And he wasn't doing any of those things, but had deep social connections, deep relationships, deep sense of meaning, deep sense of belonging, deep sense of purpose. He used his body naturally.

He ate naturally good foods. I'm sure that he had very little stress. In fact, this one guy, Zeke, who I went to who had this, like, beautiful mountaintop where he lived with his family. It was like a sort of ranch or farm, had all these sheep, like 200 sheep. I said, so, Silvio, tell me, do you have any stress in your life?

And he looked at me like I was a Martian. And I'm like, you know, stress when things don't go well or things are hard or difficult. He's like, thought for me. He's like, well, you know, occasionally, a goat gets out at night, and I have to go get it. You know?

And I'm like, okay. So what you're talking about, I wanna sort of break this down for people. And

Dr. Ezekiel Emanuel
and and you're pointing to, as usual, Mark, you summarized it well. They have all these activities that are good for wellness built into the fabric of their daily life. They don't think about, I gotta do wellness. I gotta do exercise. It's built into the lifestyle that they have, and that I think is the key.

And and I think it's the key for two reasons. The first is, you know, if you are forcing yourself all the time, you have to use willpower. Right? You know, I gotta do cold plunges, and I hate the cold plunges. You'll burn out because our willpower, you can easily exhaust it.

It's it's not something that goes on and on and on. And on the other hand, if it's built into your life and you're kinda doing these things unconsciously, you know, you take joy in them. They're actually, you know, not only good for your body, good for your mind. They're, you know, fun and happy making in the process. And, you know, so for me, it's one of the key elements is, look.

Why is social relations so important? Well, they're just they're good in the moment, and they're good long term. And those are the kinds of things you want. That's the first thing. The second thing you point out, and, again, so, so important.

What's hap the the the people who are talking about wellness today and longevity and pursuing it obsessively, it consumes their life. It's the total focus, and that's not the body is carefully balanced. And when we sort of go extreme one way, like, we're gonna, you know, I don't know, hundreds of push ups or weight rooms for hours a day, that is not good for the body. The body is a very carefully calibrated push pull, and we know this from immunology, something I've actually done a, you know, study and research on and was in a lab for. Right?

You don't have enough of it. You got immune deficiency. You're subject to infection. You got too much of it. You've got autoimmune disease, and it's a careful balance.

You can't overhype it, and you can't underplay it or, you know, neuter it. And I think part of what gets me about all this, you know, obsessive focus is, you know, no. You don't overdo it. You have to balance things, and the body nature is built like that. Not too much at one side and not too much at the other.

And part of the problem of the well, it's a part of the problem of the food system and ultra processed foods and all the people pushing you to consume consume more of that, but it's also part and parcel of the problem of the wellness longevity influencers who are telling you, you know, more meat, more a a limited amount. No. That you you don't keep eating this stuff. You you know? A well balanced diet is the key.

And by the way, as you know better than I, why is why is it people able to do it in Sardinia and all all sorts of other places?

Dr. Mark Hyman
They don't have a choice. There's no there's no McDonald's anywhere.

Dr. Ezekiel Emanuel
It's not new one or the charm. You know? You go back. I'm a philosopher, so I spend a lot of time reading, you know, Aristotle, but also, Hippocrates. It's not like they didn't know about these things.

They know about sociability. They know about food. They know about exercise. They know about sleep. They write about this.

It's not, woo. We've known about this for two thousand five hundred years. What they didn't recommend is doing it obsessively as if there's nothing else beyond wellness in your life.

Dr. Mark Hyman
And all those traditions, whether it's Avicenna or Maimonides or Hippocrates, all these ancient physicians all basically said the same thing, or the yellow emperor of China. You know? And it's it's really it's really so essential to kind of dive into, you know, those elements that we can make defaults. And I think what I love about your book is that you're not asking people to be heroic. You're asking them to just use common sense and basically not be schmucky.

And also giving them really simple practical things that they can kind of tune in on to start to build these these basic six pillars of longevity and health and health span, particularly into their lives. And, you know, you mentioned the social thing. I want to come back to the nutrition, but you mentioned the social thing. And I think it's something that's so underestimated. And, you know, I I worked with Paul Farmer after the earthquake in Haiti, and I really started to get to know him and see his work.

And what he did was to work on curing TB and AIDS in one of the worst places on the planet where everybody public health official had given up on because it was just too difficult to give him a schedule of drugs and multi drug resistant TB and AIDS. And he's like, no, no, no. This is not a medical problem. This is a social problem. So we're going to put community health workers in.

We're going to help neighbors help neighbors. And basically, community is medicine. And I came out of that and I was like, wait a minute. We had this whole thing called non communicable diseases, but that's wrong. They're very communicable.

They're not infectious, but they're contagious. Whether it's heart disease, chronic disease, diabetes, Alzheimer's, And many of these things that we're suffering from in America now are all basically communicable through our social influences. And and then I work with Rick Warren and his church in in Saddleback Church, we got people to do this together. They had 5,000 small groups that worked together. We put a healthy curriculum in there for a healthy lifestyle, very simple stuff, and they did it.

They lost a quarter million pounds in the year, doing it together. And his his saying was, everybody needs a buddy. You know? And I came up with this concept of sociogenomics. You know, what are the social influences on our gene expression even?

And that's a whole now field of academic research. And I just had kind of conceived of it because of this whole thing. So what you're saying about this is important, and it's hard to do. And I wonder if you could start by talking about how you would think about guiding people to build and support and encourage these social relationships and networks. Because loneliness is an epidemic.

Our former surgeon general wrote a whole treatise on it. It's, you know, like smoking two packs of cigarettes a day is one of the deadliest things out there. And yet, you know, we talk about exercise nutrition, but we don't talk about this that much. So can you talk about what what the data is on this, and also what what people can do to start to build this? Because maybe people are sitting home lonely and isolated and, you know, just disconnected.

And how do they start?

Dr. Ezekiel Emanuel
I think you raise an incredibly big set of issues. The first thing is social life is critically important. Again, know, Aristotle said, man's a social animal, and one of the reasons we have a loneliness epidemic is because we're not interacting. COVID made it a lot worse. Social media is not helping, and we have a lot of forces pushing us to be more isolated.

I was noticing that on reports about schools that are no longer allowing cell phones in school from bell to bell, they report that school is noisier. Why is it noisier? Kids are talking

Dr. Mark Hyman
Kids are talking.

Dr. Ezekiel Emanuel
Yeah. It's like, oh, this is a good noise. We want this noise.

Dr. Mark Hyman
You did that in your in your in your college classes.

Dr. Ezekiel Emanuel
But I think I think it's emblematic. So there are things we can do at the social level that aren't the individual, and I wanna talk about that because I think institutions, organizations, corporations have a role here, and they need to take responsibility. Just like I keep pounding away at my university, let's just have a default that no phones in the classroom, no computers in the classroom, and if a professor wants them, they can have them, but the default is no because we know it's better for learning. We know it's better for sociability. What's the reason to permit it?

So that's the thing a school could do. Here's another thing that corporations can do. A lot of corporations have tried to boost wellness, boost the mental health of their workers, decrease the anxiety, And it turns out they did a big study in England that's in the book. And, you know, all of that stuff, mindfulness training, yoga training, breathing, blah, zero impact because it was individual focus. The thing which had the big and enduring impact was group activities, volunteer group activities to go do something for the community.

Why? See? Because it wasn't psychological. It wasn't focused on the individual, their anxiety, whatever was going on. Was focused on bringing them together with other people and doing something that was outside of themselves in their own world.

And, again, corporations can do this voluntary I mean, we do it we tend to do it once a year around Thanksgiving or Christmas time, going down to a food Mhmm. Whatever, but we could do more of it and organize these activities more. And I think, again, these are things that organizations and institutions can do to help people. By the way, I think the government also could have a big role if we we emphasize national service. That's a whole different conversation, but I think it's all the same piece.

Bring people together and create an environment where you have to be social. So let's talk about the individual. There are two kinds Before you

Dr. Mark Hyman
before you do before you do, as you guys wanna jump in quick, there was a study we did at Cleveland Clinic when I was there because I I took the faith based wellness insights, and I said, let's do this in a secular environment in a health care system. So we created shared medical appointments, and we got groups of people together around different conditions. And we basically had, you know, a coach, a nutritionist, a doctor come for ten minutes. It wasn't very intensive, but it was two hours a week for ten weeks. We saw three times better outcomes in those patients compared to the one on one visits for the same disease with the same doctor in the same clinic when they did it in a group at far less cost.

So I I think really, you know, the community is the medicine. Yeah. And you wrote about the social cure. Right? It's actually that.

Dr. Ezekiel Emanuel
And I think you you point out. You know, churches do it, you know, bodies for bodies. I think that I think that's a beautiful encapsulation of the issue. The other thing we so we know probably the most important thing are your strong social relations, the five to 15 people who you really are close to, family, close friends who you can confide in. You go maybe on trips.

You know, we have a dear friend who every year goes on a hiking trip with one of her high school buddies still or, you know, whatever your your however you do that those social engagements. You know? I talk to my friends. It tends to be while I'm driving because I can't stand driving, so it's a it's a way of connecting. Or, you know, we we host once or twice a week, you know, dinner, whether it's a Friday night dinner or some other dinner just to get together with people.

Now you may or may not have that, and we know that the eating alone phenomenon, unfortunately, is going in the wrong direction. We're having too much of it and not enough social life. The other thing you can do are what cause what are called weak relationships, which are sort of casual interactions where there might be some overlap, either by chance, you happen to be sitting next to someone on an airplane or train or what have you, or, you know, you keep going to the to the same coffee shop. You can talk to the barista. Right.

And you can Yeah. Engaging them. Not artificially. You know, just talking to them. One of the great researchers of these things called weak social interactions is a woman, and she describes how she got into the field.

And she got into the field one day. She's sitting on a train. There was this you know, the early cupcake craze. Lady sitting kiddie corner from her had a cup a box of cupcakes from one of the popular stores. She asked her about the cupcakes.

We got talking about the cupcakes, and she felt you know, by the end of it, she was like, wow. I feel, like, really good. I just thought, fuck. Cupcakes. And so she went in and began doing a lot of systematic research.

She switched her whole research focus to these deep relationships and their importance. And I think we underestimate. We often, you know, try to buzz through life and be efficient and not talk to people. And it turns out that if you just talk while you're doing these things, you know, it's not like you're a barista can't both talk to you and make your latte or whatever you're having, and those relationships actually give you a little boost. They also teach you how to interact with someone.

And the the thing my father taught me the most, he is probably the most social guy I ever knew, is, you know, just ask an open ended question to someone. You know? We used to go we'd take car trips and drive into town and go to a diner, and and he would ask, you know, the waitress. And invariably, in those days, was a waitress. It's like, you know, what's interesting to do around here?

Are you from here? You know? Did your family move here? And just simple open ended questions, and you end up marking a conversation and learning about people. You're happier.

They're happy. You've maybe gotten some information. And we, I think, our society, tend to poo poo those kind of weak interactions way too much. And we don't we don't think about how to use them.

Dr. Mark Hyman
They matter. I mean, I I lived in the Berkshire for thirty years. I just moved to Texas. But, you know, you go to the same restaurants. You go to the same dry cleaners.

You go to the same grocery store. I mean, I've known the the guys who own the grocery store for thirty years, and they help me out with my groceries. And it's like, I don't have, like, deep relationship with them, but but they know me. I know them. I know their names.

I know a little bit about them and their families. It's like, it's actually cut it is. I never really thought about this concept of weak relationships, but it's like cultivating like some kind of intimacy or connection with people who you who are in your orbit on a regular basis that you can actually start to feel that sense of belonging or connection or being in a in a larger extended community?

Dr. Ezekiel Emanuel
So I used to I still take the train from Washington to Philly and Philly to Washington, and the 07:00 gasella up from Washington to Philly, there was this guy who was a conductor, and I had a book out. It's actually on my bookshelf, King, a Life by Jonathan Ike, and I was in the midst of reading it. I just happened to put it out on the table. I got my computer out. I'm just organizing everything you need.

Comes by to take the tickets, and he says, is that a good book? And we start a conversation, and, you know, every week

Dr. Mark Hyman
Is that about Martin Luther King?

Dr. Ezekiel Emanuel
Yeah. About Martin yeah. Yeah. Every week every week, we would have a conversation about all sorts of things. He would tell me about the civil rights activists and his family.

He would ask me how things were going at Penn, what about the demonstrations, and all sorts of things. And, you know, unfortunately, just he just retired. I say, unfortunately for me, because we had a great relationship over a couple of years just which just sparked because he asked about the book, and I told him why I liked the book, what I learned about the book. I event I eventually. The next week I saw him, I brought him a signed copy of the book, and he was thrilled.

Dr. Mark Hyman
And you actually you actually marched with Martin Luther King with your mother who was an activist in Chicago back in the day. Right?

Dr. Ezekiel Emanuel
That is correct. Absolutely. We got eggs and tomatoes thrown at us. Absolutely. You know, very good memory there, Mark.

Dr. Mark Hyman
I pay attention. You know, you you're you know, you've obviously been trying to make the world a better place for a long time. And I think, you know, this you know, we we do obsess about what we eat and what subs we take and how much we exercise and what biohacking things we do. But this this social fabric issue is so important. And particularly, I've noticed it in myself.

Like, I I've really developed over the last, let's say, fifteen years, very intentionally, a really deep global community of friends where I literally can go to almost any city in the in the world and stay with a friend. And I almost have too many friends because I it's like I want to keep up with them all, and it's hard. But when we see each other, it's it's like there's you're just part of this extended tribe. That's you know, I I think E. O.

Wilson talked about this in one of his books. I think Social Conquest of the Earth where, you know, from ants to humans, we're all these social beings. And Tina Rosenberg wrote about this in Join the Club where, you know, people change by being in community. And whether it's AA or Weight Watchers or whether the shared medical appointments I did or the faith based wellness thing or all the things you're talking about, it's it's it's really simple. So find friends who have healthy habits and do it because that's that matters.

Right?

Dr. Ezekiel Emanuel
Yes. It's a 100%. Look. I mean, you know, we have what's called the neocortex. Neo, which is new cortex.

That's the part in the front of the head. It's executive function, but it's also it's there mainly for complex social relationships. That's what distinguishes humans. You know, we talk about language and this and that, but it's really our ability to have complex social relationships, and that's part of our brain structure, and it's critical. And like other things, you gotta use it to keep it in shape and keep it working.

Use it or lose it, as they say, and that really applies to the brain as much as to muscle. I would say the other thing that is very important, and you you've hinted at it with E. L. Wilson and and your own challenges of so many people, is there is something called the Dunbar number, which is a number of people you can have as acquaintances that you can break bread with, you wouldn't you would have over, and he points out he's a he's a anthropologist, I guess, emeritus now at Oxford, and there's a Dunbar number, which is roughly 50. 50.

Exactly. Yeah. That's the number of people you can have as acquaintances. Close friends, five to 15. 150 is really the number of people you can keep track of.

That's the the capacity of our brain, basically. Yeah. There are some people, and I I will I'm a sort of quasi expert on Ben Franklin because I'm obsessed by him. You know? He corresponded with well over a thousand people across his lifetime.

Writing letters before email made it easy. Write handwriting letters to people, some about science, some about printing, some about politics and negotiations and diplomacy. But he created all sorts of societies to bring people together, the American Philosophical Society, all the, you know, the the firemen, insurance companies, subscription lending libraries. And he was a guy who believed in in sociability and creating social relationships and mutual support. Lots of things we can do in that regard.

And, you know, you point out, you know, changing changing physician visits so that they're more communal often works. Community health care workers, creating a community of people who push each other to be healthy and to do the right thing. All of these are critical. And the best proof, and with that, I'm gonna shut up, there is one of the most important

Dr. Mark Hyman
I doubt that. I doubt that, but keep going.

Dr. Ezekiel Emanuel
One of the most important studies

Dr. Mark Hyman
I've never known an Emmanuel to shut up before. That's how

Dr. Ezekiel Emanuel
I know. I

Dr. Mark Hyman
know both your brothers, and I'm like, no.

Dr. Ezekiel Emanuel
Harvard Adult Development Study. Now there's no more boring title than that for a research study, but it started in the late thirties, early forties, following Harvard sophomores and to see how they developed and what made them develop for success. It included John Kennedy, the editor of the Washington Wargate, Brent Bradley. And then they merged with a a one that wasn't just Harvard students, but also a local kids immigrant kids in Boston. And so they following them, it's it's the longest study I know of eighty five years.

And the number one issue, the number one thing for a long both long and happy life is social relations and robust social relations. And I think it just it just is the fact that that if you had to point to the number one thing, it's probably that. And, yeah, and of course, eating and exercise and sleep, all important.

Dr. Mark Hyman
Yeah. I wanna I wanna get to those things. I I don't know if you know about the Rosetta study. Do you know about this Rosetta Pennsylvania study?

Dr. Ezekiel Emanuel
No. Go ahead.

Dr. Mark Hyman
It it was amazing study. It it was I read in a Deepak book like twenty, thirty years ago. And basically, was a community from Italy, from a village in Italy that moved en masse and immigrated to The United States. And they set up residence in this little town called Rosetta, Pennsylvania. And there was a wide disparity in income and, you know, education.

And and they adopted the American way of life in terms of food. But they had these deep social connections, so they all went to each other's, you know, celebrations and birthdays and funerals and weddings, and it was like this really rich, dynamic, engaged community. And despite the fact that they ate the same shit as the rest of Americans, they didn't die. They had much longer health span and more longer lifespan. And I'm like, it was amazing.

So think about that. Like the power of of the social connections outweighs the other shit that you might think is more important, like your diet or even exercise.

Dr. Ezekiel Emanuel
Let me give you another piece of data on that that I've sort of stumbled on. And and so if you look around the world, Latin American countries have are the second, broadly speaking, the second most happy countries in the world, and they're happy beyond what their socioeconomic indicators, whether it's income per person and other variables, would suggest. And what most people who look at this think is critical is they are much more likely to eat meals together. They have more meals with other people than any other region of the world in Latin America. And if you look at Hispanics in The United States, as you point out, eating the same crap we do, turns out their life expectancy is higher than whites.

Most they have fewer problems in most categories of chronic illness than whites in The United States. And it goes exactly to what you're you're saying, which is, look. Sociability can compensate and overcomes lots of these other factors that might be, anti wellness. And I think that's, again, that's something we tend to ignore, especially in the wellness community that's focused on the three physical things we can do in

Dr. Mark Hyman
seven Individual narcissistic pursuits. Yeah. Yeah. Amazing. This is really good.

That's like rule four of your six rules. I want to jump back to the first one because I think we covered this social thing really well, and I think it's important. And I think if you're lonely or isolated or disconnected, it it's hard to think about where to get started, but there's always something like, you know, join a club, join a church, join a synagogue, join a mosque, you know, get a walking group, a jogging group, a biking group, whatever whatever turns you on, bowling group. I mean, if you're in a knitting group, you're going to live longer than someone who's not in a knitting group. I mean, it's it's actually there's data out there about this.

Talk about your perspective on food because, you know, you you actually have these hobbies that are interesting. You make chocolate and you make honey, which are sweet and delicious and a little bit on the, you know, kind of psychological forbidden fruit side, but actually are both quite healthy for you in the right amount. So can you talk about your, and this is kind of your eat ice cream, I I think, title, which is I think, you know, eat your ice cream, which I love. But I wanna know what before we go on, what's your favorite ice cream?

Dr. Ezekiel Emanuel
At the moment, there's a place in Washington DC that makes a Lebna yuzu ice cream, and that's my favorite. Wow.

Dr. Mark Hyman
It's like yogurt with yuzu.

Dr. Ezekiel Emanuel
Yes. It costs us

Dr. Mark Hyman
Wow. Wow. Wow.

Dr. Ezekiel Emanuel
So I I you can't have a lot of it. You just can't afford it. And my wife says, which I haven't tasted, that there's a place in Paris. She took her mother for her mother's 70 birthday and a special special trip to Paris, and there's a place called Plaque, p l a q, that has, she says, the best chocolate ice cream she's ever had. I haven't been there, so I can't.

Dr. Mark Hyman
My my my favorites are pistachio and hazelnut gelato. Yeah. And then, of course, in Italy, and then chunky monkey if I'm really bad. Ben and Jerry's.

Dr. Ezekiel Emanuel
So let me talk about food for a second. Yeah. Food is incredibly important for all sorts of reasons. Cooking keeps your mind sharp, you know, following recipes, making up recipes. It's good for sociabilities, as we've mentioned many, many times.

It's obviously also critical for nutrition and part of the problem I I would say a large part of the problem of American decrease in problems in life expectancy not reaching those of other countries like Japan or France or Switzerland, the obesity epidemic, which is worse in The United States than anywhere else, all of that is traceable to the food and our food system. What I try to say in this book is the most important things you can do are no. Stop doing a few things and start doing a few things. Don't try to change everything all at once. The two stops are stop on the sodas and sugary drinks.

Those, excuse me, are a 140 calories per shot per 12 ounce can with no nutritional value. It's like 10 teaspoons of sugar. It's ridiculous. Okay? You gotta, you know, wind it down.

However you can do, if you can stop cold turkey, it's I

Dr. Mark Hyman
had a patient who lost 75 pounds just by stopping soda.

Dr. Ezekiel Emanuel
And and I would say one of the pieces of good news over the long, you know, five or six years is soda consumption has gone down in America. We're now at, I think, one, on average, one can per person per day. It should it's gotta go down further, not progress, and we should celebrate progress. The second is snacks, the pretzels, the Twinkies, the, you know, cakes and cookies and crackers, those are not good for you. And those we've actually had a dramatic increase, 500 calories per day increase in the consumption of those starchy snacks.

Dr. Mark Hyman
Yes. Snacks are just an invention of the food industry. Like, humans never had snacks. We just ate meals.

Dr. Ezekiel Emanuel
If you still need think you need snacks, switch to healthy snacks, and there are healthy snacks. They're called nuts or dried fruit or, you know, real apples and other things. But the the starchy snacks are they have zoomed up, you know, 500 added calories. It's like, you know, one of those big items a day. We often eat them instead of breakfast.

Those are the two big things to stop. That'll bring down your ultra processed food amounts and things like that. On the pro side, the big number one pro in my mind, I'd actually you're you're the real expert. I'm just the pretender here, is fermented foods and things like kimchi, yogurt, raw alpine cheeses. Those are the those are good for your your microbiome.

They're good for your health in all sorts of ways. And if you added them once or twice a day to your diet, you would go a long way on the positive side. The other thing, I think I'm sort of a big I am probably out of step with a lot of people, but I'm actually a big believer in dairy. And, you know, the fat globules and the saturated fat in dairy, we know that it is anti type two diabetes. People who eat a lot of dairy don't develop type two diabetes as much.

They lose weight. The number one weight loss diet item is yogurt. Again, another dairy product. It's it's

Dr. Mark Hyman
Although that that could be correlation, not causation, right, in epidemiology.

Dr. Ezekiel Emanuel
We we could spend the whole hour talking about allergists who are doing food studies. I totally agree with you. I think if you do those two things, you go along this. Now are there many others? Yes.

My book goes on and on about all sorts of fruits and vegetables. We now know it's not just the all the good nutrients in them, but it's also the fiber and the variety of fibers that are in them that help our body and help our microbiome. We're gonna learn a lot more, but part of it is, you know, again, it's it's a lot of common sense. If it's not processed, if you just buy it and cook it, you know, whether it's by roasting it or sauteing it or what have you, it's gonna be a lot better for you than whatever package. And and that's not a complicated you know, we got a lot of complicated rules.

I think the brain can only handle so much. And the other thing I would say, Mark, that I've sort of come to, and I'll I'll tell this little story, you gotta learn how to cook. One of the worst things you ever

Dr. Mark Hyman
had to Amen.

Dr. Ezekiel Emanuel
The American diet was getting rid of home ec out of school. I probably was the last generation who had home ec in their school, and I have every year, I hire two or three research assistants. I had a research assistant who literally had no idea how to cook. So I Yeah. Create I had a you know, my roast chicken, my favorite you know, it's so simple.

You know? It's just a little mustard, olive oil, and lemon. Not complicated with some vegetables around it. I gave him detailed recipe with detailed how to do everything, and, you know, it turned out the first thing he did is he didn't know the difference between a cut up chicken and a whole chicken. Okay?

So it's like he didn't have a roasting pan. Right? He didn't he didn't have any of the basics. I said, listen. You're gonna have to accumulate this this stuff.

Dr. Mark Hyman
And You need the tools to cook. Right?

Dr. Ezekiel Emanuel
Yes. Exactly. And you you can't you're not gonna go out and spend thousands of dollars getting the tools. You do it over time. What I like to

Dr. Mark Hyman
pans, a couple of knives, a cutting board. You're doing it okay.

Dr. Ezekiel Emanuel
Actually, what I like to say to people is every week, try one new recipe. Right? You've got 21 meals in a week. One. One.

You know, on the Sunday night or a Saturday night, and then have some friends over and share the meal. By the end of the year, you have 50 recipes. You've got a lot of variety in your day. And, you know, you're gonna it's good for your nutrition. It's good for your social ability.

It's also good for your brain because you're being challenged. You're being challenged not just in terms of reading, problem solving, but you're moving your arms around. You're connecting what you're reading with your physical motions. It's one of these triple winners.

Dr. Mark Hyman
My mother used to say, if you can read, you can cook. And I think that's, you know, actually how I learned to cook, aside from my mother teaching when I was young, I did recipes, I would follow recipes, you do that enough, and then you'd be understanding the fundamental principles, and the layering effect, and what to do when, what I mean, what to put in first, second, third, and how long things take to cook. And and I think it's not that hard. I mean, you you need to learn two or three breakfasts, two or three lunches, two or three dinners, and then you can experiment after that. And it doesn't have to take a long time, it doesn't have to be difficult, it doesn't be complicated.

Like, you know, Carrie, my sister, who is your friend, she taught me how to make the best roast chicken in the world. Essentially, you take a chicken, you wash it, you throw you take a lemons and you stick it with a fork, you throw it inside, you throw some rosemary garlic inside, salt, pepper, olive on the outside, throw in the oven, four fifty, twenty minutes a pound, boom, you're done. And it's like a perfect chicken, it's not dry, it's moist because it seems from the inside. And like it takes it literally takes like five minutes to make and other than the cooking time in the oven. It's really easy.

And I think, you know, we this is not an accident, Zeke, that we can't cook. This is a deliberate, intentional decision made by the food industry to disenfranchise people and disintermediate people from their kitchen. You know, you deserve a break today. Betty Crocker, like, starting to put in processed food into the recipes. I mean, I thought Betty Crocker was real, but she was a invention of the food industry because there was a home ec teacher named Betty who was trying to get all these federal extension workers to teach young mothers and families how to cook and grow a garden and make food.

And they were freaking out because they couldn't get their processed food into the kitchen. And so they started to do that, and that's really led to generations who don't know how to cook, which is really critical. It's like it's like imagine if you don't know how to type now in America or in the world because you have to use your computer or you don't know how to drive or you don't know how to make your bed. I mean, are basic fundamental life skills. Brush your teeth.

It's a it's a fundamental life skill. I mean, I wanted to make duck breasts, and I had no idea. So I I go I went on YouTube, and I'm like, Gordon Ramsey, how do you make a duck breast? Oh, that's so easy. Okay.

Fine. I'll make a duck breast. Especially

Dr. Ezekiel Emanuel
today where you can go on YouTube and get the step by step. It's not that complicated. But I do think that getting rid of home economics you know, there's two failures in the system. One failure is home, parents not teaching their kids and not encouraging their kids to learn how to cook for themselves. And the other is we have a school system to make up for deficiencies in that regard and for teaching kids.

And we got rid of home economics somewhere in the, you know, sixties and seventies Yeah. Yeah. Weren't appropriate to school. But it's part of health. As we've learned over the last fifty years, nutrition is a key element.

You have bad nutrition. You have obesity. You have type two dib. You have a whole range of chronic illnesses, osteoarthritis, renal failure, hypertension. If we if if we don't fix this food system problem, right, we are going to be settled with high cost from chronic illness and less longevity, and we're gonna have more disabilities.

It is it it's all tied together. And so food and as you point out, Mark, food and do it learning how to do it yourself. The other thing that, you know, sorta gets me is I was raised in a house that didn't have a salt shaker. My my father was a pediatrician with an expertise in kidney disease, and, well, salt was forbidden. My mom had no salt in the house, so I grew up with no salt.

My taste is buds are just whatever is natural, that's what we got. And so I've always found restaurants a too salty, a little

Dr. Mark Hyman
too Very. Very. Very.

Dr. Ezekiel Emanuel
And and, you know, if you don't cook yourself, you don't know what oils they're using. You don't know how much salt they're adding. There are all sorts of things you can't you know? Yes. You like McDonald's, but they're controlling what you're eating, and they're controlling, you know, how much of the bad stuff you're getting.

That's not a place you wanna be to let some corporation decide what you're gonna ingest. So learning how to cook. And, again, as you point out, a couple of recipes at breakfast, lunch, and dinner, and then, you know, develop one a week. It's not a big challenge. It's not that okay.

That everyone can do it. And this isn't classist or sexist. You know, given the cost of eating at McDonald's these days, buying food at a supermarket and spending a half hour or whatever to cook it is gonna be cheaper.

Dr. Mark Hyman
It is gonna be cheaper. People think, know, for you Mark Bittman wrote a piece in New York Times about this. You'd go to McDonald's for a family of four. You make a roast chicken, a salad, and a baked potato, and it's way cheaper to feed your family of four real food. Yeah.

And it doesn't and and and the and the food industry has been so deliberate about trying to convince us that, eating well is elitist, that it's difficult, that it's expensive, that it takes too much time, that, you know, you can't do it. And it's all propaganda. You know, once you learn the basics, I you're busy. You'd I I have, what, 45 jobs. I probably have ten, fifteen jobs.

Like, we do it. I cooked dinner last night. I I threw a sweet potato, wrote a Japanese sweet potato in the oven. I made lamb chops in the pan, took like ten minutes. I I stir fried some bok choy with ginger, which took five minutes, and I had an amazing dinner, and it was delicious.

And I had a piece of your chocolate that you sent me afterwards. I saw a little bit left. I mean, it it does it doesn't have to be complicated. And I I think your other point I just wanna double down on is eat stuff that is not different than the ingredients you have in your kitchen. If it's not in your kitchen, you probably don't wanna be eating it.

If you're not gonna cook with it, don't eat it. Like butylated hydroxytoluene, you probably don't have in your in your herb cabinet. Right? It's it's a preservative, but, like, that is not something or you want, you know, be eating carrageenan, which is a, you know, from a plant, but it still causes damage to your gut lining and leaky gut. So you don't add those things to your food.

It's and it's really not what you're adding to your food. It's what the corporations are adding. So if you want french fries, make it at home. If you want a cookie, make it at home. Like, from real ingredients, butter and saw and sugar and flour and whatever eggs.

It's not that harsh.

Dr. Ezekiel Emanuel
No. I totally totally agree with that. And again, at this moment, where processed foods and going out to fast food restaurants is getting so expensive, doing it at home is going to be both healthier, both immediately and in the long term and cheaper. And the other thing, Mark, is, you know, the evidence growing by just staying off ultra processed foods for a month and the change breeds

Dr. Mark Hyman
Yeah.

Dr. Ezekiel Emanuel
In people. And the

Dr. Mark Hyman
It's compelling.

Dr. Ezekiel Emanuel
You're feeling better. You're less depressed. You're able to sleep. All of those things. Now we need to study them better, and we need to understand them.

But but, you know, people report this a lot. There was a recent article in the Wall Street Journal about a woman and her daughter who did this, you know, were off ultra processed foods. First of all, she then realized how much ultra processed foods there is everywhere, and everyone's trying to offer her daughter something. But her daughter began to like vegetables, which she never liked. She stopped being a picky eater, which drives every parent crazy.

And I think this is so it it's so fundamental, and, you know, it it is. We we have a whole system that is pushing us in the wrong direction. If there is one good thing about the current moment, I think the message of get off ultra processed foods, stop drinking soda, those messages are beginning to to

Dr. Mark Hyman
seep through.

Dr. Ezekiel Emanuel
And I think we are seeing again, it's early days. We still have a very big obesity epidemic, but we're seeing seeing some positive changes. And I think we need to celebrate what is happening that's good and not just be, you know, doom and gloom about things.

Dr. Mark Hyman
You're right. I mean, the power of Zeke is so powerful around food. What you're saying your message is very simple. Don't eat the crap and eat real food, and and enjoy enjoy what you're doing, and learn some simple skills like cooking, and also eat with your family and community. These are really simple messages.

Dr. Ezekiel Emanuel
Yeah.

Dr. Mark Hyman
When I did that shared medical appointment, one of those groups was for diabetes and obesity. And there was a woman in that group who was 65 or 66. She was type two diabetic on insulin. She had heart failure. Her a one c was 11 and a half, which for those listening is extremely high.

Like, you're almost in the hospital at that level. Her heart she had a heart failure with after multiple stents and hypertension. She had an ejection fraction of 35%, which her heart means her heart was pumping probably like 40% less than it should. She had fatty liver. Her kidneys were starting to go with protein in urine.

And she was a body mass index of forty six. So she was huge. Like normal is twenty five or less, thirty is obese. She had lived her whole life eating ultra processed food. She didn't know better.

Her family didn't know better. That's just what they grew up with. They didn't know. And she got to this group, and she changed her diet. And she went from eating that to eating whole foods or anti inflammatory, all the things we talked about.

In three days, she got off her insulin. In three months, her a one c went from 11 to five. Her ejection fraction went from 35% to 50%, which is normal. Her fatty liver resolved. Her liver function normalized.

Her kidney normalized. Her blood pressure normalized. And she got off all her medications in three months. Now that seems like a crazy ass story, but that just shows the power of the food that you're eating, both the bad and the good. And I think, you know, as a doctor practicing this for thirty years, I can tell you over and over again, food is if I had one drug to use to help people, would be food.

I mean, it's it's so powerful. So don't underestimate that for everybody listening. And and and and and just Zeke, I love I love your simple, no nonsense, direct, no bullshit kind of advice because it's it's just like get back to the

Dr. Ezekiel Emanuel
once people knew I was doing the book, they would often come to me with, you know, I'm doing the following. I'm drinking diet soda. Is that okay? And and they would whisper it because they didn't they were kind of embarrassed. They knew it was the wrong thing, and then they were embarrassed.

And I said to them, you know, the great thing about the body is you don't have to be perfect around all of it. You have to just your general tendency, the central part

Dr. Mark Hyman
Eighty twenty. Of course. Eighty twenty.

Dr. Ezekiel Emanuel
Yeah. Has to be good. And every so often, you're gonna indulge something. You're gonna indulge ice cream. For me, the indulgence and I said this to the lady.

For me, the indulgence is cheesecake. My mom made the best cheesecake in the world. Right? Oh. I like making the cheesecake.

And as I told her, not on any wellness diet that I've ever seen, cheesecake, three full fat packages of cream cheese, you know, a cup of sugar, and all. I said, not there. Do I have it every day? Absolutely not. Do I have it maybe once every two months?

That would be probably, you one. But occasionally, you can indulge when it's

Dr. Mark Hyman
Of course.

Dr. Ezekiel Emanuel
Occasional, and you're celebrating something, and you're making a big deal out of it. The problem, we've made that routine, and that's where we have to break ourselves.

Dr. Mark Hyman
I mean, that's the key, what you said, is resilience. So if you're doing most of the things most of the time in a way that's supporting your health, you're resilient. But if you're a diabetic and you have that cheesecake, you're screwed. But if you're you or me who rides your bike a 100 miles a day, so what? Like, you know, like, that's that's that's the key message here is your your health is about resilience.

Before we kind of wrap up, I want to cover a couple of other key roles, which is exercise, sleep, avoid stupid stuff, and pursue purpose. So let's just kinda quickly go through those. Tell us about your view on exercise.

Dr. Ezekiel Emanuel
You've gotta do all three parts of exercise, which is the aerobic, getting your heart rate up, your lung capacity up. I do it by biking, and, you know, I like to go fast, and I like the added value of biking is you can go in nature and go on bike paths, and, you know, you get the added benefit of being out in nature. And you can also ride with people and talk, and it it's a social activity. You gotta do strength training, and that is especially true for people over 50 and 60 where the muscle mass goes down. You've gotta preserve that muscle mass in a variety of ways.

Lifting weights is one way. You know? Strengthening your core is also very important. And the third thing, which is often left out, is balance and flexibility. Now, you know, some people have heard, well, I don't have to stretch before I exercise.

That is true. You know, heating up your muscles are probably more important than stretching. Stretching is not bad for you. That's what we know, but it may or may not be protective. But the flexibility reduces problems, and especially as you're getting older and you might be losing your balance, having the balance and flexibility created mainly by yoga.

So every morning, I wake up and do twenty minutes of yoga, five minutes of core and strength training. My brother gave me these new bands that really seem to work and

Dr. Mark Hyman
Let and me guess which brother, Ari.

Dr. Ezekiel Emanuel
So that's that's the package. And the other thing is you should everyone needs to be aware. Being obsessive about it, doing it, you know, five hours, six hours a week is not gonna make you live longer. There is a plateau. It is not the more I do, the better it is, you know, unlimited.

There is a plateau. And, actually, the more you do, you risk injury and whether it's repetitive motion injuries or, like me, I you know, you can have accidents. You can twist your ankle. So that's that's the three. Aerobic, strength training, and flexibility and balance by yoga.

Dr. Mark Hyman
It is. And and and exercise, you know, if you actually look at the science of exercise and all the different systems in your body that it affects, it's it's if it were a prescription pill, it would be the most powerful drug on the planet selling trillions of dollars a year. It's that powerful. So what you're saying is really important.

Dr. Ezekiel Emanuel
And the important thing is to move from horizontal to vertical. Right? That's the biggest gain is just build it in. You know? After dinner, go out for a walk with your loved ones, you know, or build in some sociability.

Take a walk. Go running with a colleague. I used to, for more than ten years when I was at the NIH, twice a week, three times a week, I would go out with one of my dear friends. We would go for five or six miles running, and we'd have a conversation and, you know, bit and moan about the job, you know, what was going well, what what. Well, you can make each of these activities more than just the exercise and a sort of single-minded.

It's all about me. You can make it

Dr. Mark Hyman
It's fun.

Dr. Ezekiel Emanuel
It's complimented.

Dr. Mark Hyman
I always say I I always say I like to play. I don't like to exercise. So yeah. Absolutely. Absolutely.

And, you know, we at the church, the Saddleback church, they had they had jogging for Jesus. So they did it, like, in community. So I think it's actually a double a double benefit. How about sleep?

Dr. Ezekiel Emanuel
The the important thing about sleep to recognize is this is the one of the six wellness activities you cannot will yourself to do. You can't lie in bed and say, I am gonna fall asleep. It has to come. And so what you can do, I I like to say, is make the bed, but, you know, in the end, it's gotta come to you. You've gotta get the room right.

You've gotta make it dark. Make it cool. Don't look at your screen before bed. I I have this routine where I get in bed, and I read a regular book with that real pages, so I'm not looking at a screen. And then I know my eyes are beginning to beget heavy.

I can't remember the last sentence I read, then it That's right. But the other thing is all those sleep medications, not good for you. Almost all the societies, professional medical societies related to sleep say, you know, it's it's cognitive behavior therapy for insomnia that you need, and so you gotta forget the Ambien or Halcyon or whatever you're using. And I also, you know, I've been perplexed by the the the popularity of aura rings and how much sleep you're getting, etcetera. You know, sleep is one of those things you know immediately in the morning whether you had a good night's sleep or not.

It's like

Dr. Mark Hyman
That's right.

Dr. Ezekiel Emanuel
I don't care how many hours I was in bed, if I feel refreshed when I get up, you know, I'm refreshed when I get up. And, you know, so I never understand what information they give you that is very useful.

Dr. Mark Hyman
Well, actually, the the most useful thing I ever learned was when I drink anything, which I don't often, that my sleep is so impacted by my my alcohol. Even a couple of glasses or one glass, it's like striking. It was striking. I was like, wow.

Dr. Ezekiel Emanuel
Well, that's a there's a whole series of things like you should not probably take caffeine after a noon or two. If you're gonna nap, you don't nap after two. Alcohol allows you to fall asleep faster, but it gives you disrupted sleep. Often, you wake up after it, and it doesn't make you restful. This is you're you what you report is very common, Mark.

And Yeah. So I have a bunch of rules in the book of how to maximize your chance that you get to sleep. The problem is, you know, I'm like I often have bad nights. My brain is just keeps going is you can prep all you want. In the end, you can't will it the way you can will.

I'm I'm going out for a 20 mile bike ride. Yeah.

Dr. Mark Hyman
But you can you can set up the conditions, and there's ways to do that. And and and what you mentioned just because you jumped over quickly was something called CBT or cognitive behavioral therapy. It's actually a specific type of therapy that you know, there are online programs and online courses. You can find a therapist, but it's specific, really, really effective and well studied for sleep. So something to think about if you're having sleep issues.

Okay. Avoid stupid stuff. This is obvious, but, you know, this is like don't be schmucky.

Dr. Ezekiel Emanuel
Yeah. Exactly. Don't be schmucky. You know, we mentioned some at the top of the hour, which is, you know, climbing Kilimanjaro, base jumping. Those are high risk activities.

Dr. Mark Hyman
No. Climbing Kilimanjaro is you could walk up. It's No.

Dr. Ezekiel Emanuel
No. No. Not Kilimanjaro. I mean, jumping. Yes.

Climbing Mount Everest is

Dr. Mark Hyman
the Kilimanjaro. Yeah. Yeah.

Dr. Ezekiel Emanuel
I've done Kilimanjaro too. I wouldn't recommend it for a whole variety of reasons, but it's it's not a schmucking move. It's not that not that challenging. Although people do do die doing it. And they're, you know, not taking your vaccines, schmucky move.

You know? We have long history of how good and beneficial they are. I have a long section there talking about cancer screening tests. It's important to start on time. It's also important to end so that you don't do over testing.

I do a detailed analysis for the men about prostate cancer PSA screening. I'm at for it. The bottom line is in all the studies, the cancer screening test PSA may save one out of a thousand lives, but it also means you're a patient. You're constantly looking at the number and get and testing. You may get procedures done, which have all have relatively high side side effects and complications as, you know, impotence, incontinence.

So overall, yes, you might not die of prostate cancer, but your longevity is about the same, and it may or may not save one person out of a thousand. That just doesn't seem like a really it's it's up to you to decide, but it doesn't

Dr. Mark Hyman
seem Yeah. It's it's complicated. Because on a population level, you're right. It doesn't make sense. On an individual level, if you're that 43 year old with prostate cancer, it makes a lot of sense.

And and it's interesting is and the company I co founded Functional Health has blown up, and we have, 300,000 members now. And, you know, we have a whole range of demographics. And literally, I got two emails recently of of men in their forties who had young families who found prostate cancer and were able to get it addressed and save their lives. And I'm like, wow. Yeah.

I mean, maybe a lot of people it's normal, and or maybe some of it's abnormal, and they need to go get on the same procedures. But, like, it's it's a tough calculus. You're a bioethicist, so you're better at this than I am, but it's like it's it's complicated.

Dr. Ezekiel Emanuel
As I say in the book, this is my view. Here's what the recommendations are from the various professional societies, and you're right. Most professional societies, United States Preventive Services Task Force, the American Society of Clinical Oncology, etcetera, they they do recommend it, and they certainly recommend talking about it with your doctor so you have the the bottom line. But what you say, Mark, is a 100% true. We're seeing this, you might even say, mini mini explosion of cancer among younger people, which

Dr. Mark Hyman
Yeah.

Dr. Ezekiel Emanuel
No one has the definitive answer as to why it's happening, but you're seeing colon cancer in people in their thirties and forties. And I had a very dear friend who died of colon cancer in her early forties. Just tragic. Wonderful civil servant, real dedicated to America. And, you know, these these every single one of those is tragedy.

People in the prime of life, and we don't fully understand how much of this is related to our bad diets and our bad obesity epidemic? How much of this is related to carcinogens that are all around us?

Dr. Mark Hyman
Juxtaposed. Yeah. No. Yeah. It's the combo.

It's a combo package.

Dr. Ezekiel Emanuel
Being clear about when to start your cancer screening, very important. Don't be a schmuck and avoid them, or be fearful. You have to have to start and have that conversation frankly with your doctor.

Dr. Mark Hyman
Yeah. So you also have don't smoke, don't drink too much, don't drive recklessly, and make sure you do preventive care and screening, which

Dr. Ezekiel Emanuel
Driving is like the thing that just it's like we're all addicted to that little phone, and we have to stop because there are increasing number of accidents from that. And, you know, there's mortality. Exactly how much is very hard to determine.

Dr. Mark Hyman
Yeah. Well, I don't know. I think with all the advent of technology and AI, soon the phones will not be separate from us, and then we'll just be able to say, hey. TechSeek, I love you. I'm gonna come in over for dinner.

Please make the cheesecake. The last point I think is really important, and the data on this is really striking. If you have meaning and purpose, you live an average of seven years longer, which is incredible. Because if you eradicated cancer and heart disease from the face of the planet, life extension would only be five to seven years. You know, you you are a doctor.

You're a bioethicist. You're a health policy geek. And you're also a philosopher and and did your you know, you did your PhD in political philosophy at Harvard. Talk to us about this idea of purpose and and how people can get their purpose, find their purpose, and and get connected to purpose. Because, you know, when you look at the data, when people stop working at 65, and that's just an arbitrary number, I'm 65, you're 67, or whatever you are, 69, I I I think there's a drop off in in in people's lives.

There's an increase in mortality and death literally starting when people are 65 and they quit their job because they're losing meaning and purpose. So take us through why it's important, how it works, what you think the biology of it is, and how do people start to find it? Like, I don't know my purpose. You know?

Dr. Ezekiel Emanuel
Exactly how you find it is is a very interesting phenomenon. But I would say one of the important elements of purpose is it tends to be not tends to be. It is something outside yourself. It's not about yourself. It's about doing something in the world with and for other people.

And I think that's a a very critical to having meaning and a fulfilling life. Knowing that you're leaving the planet better off could be by focusing on raising your children, could be by focusing on educating people, could be by focus on, you know, creating beautiful spaces for other people to enjoy or creating beautiful art or, you know, just being nice to people. And I was seeing someone pointed me to a a video of a guy who was a school bus driver, but all the kids felt that he saw them. He interacted. He asked about you know, that gives him purpose to bring joy to these kids every day to make going to school a wonderful activity instead of something that they might dread or were fearful of.

And I think the doing of something outside of yourself is really, really important. And so you're a 100% right. One of the things I write about extensively in the book is retirement and the dangers around retirement. We don't do retirement well in this country. We it when you're planning for retirement, first of all, you have to plan for it.

You don't just say, oh, 65, and that's good. And we're doing some research around the activities people engage in around retirement that are important for longevity and wellness, and it's really important to plan for it and to make sure you just don't stop things cold turkey because work has a schedule. It has social interaction. It has meant things that are mentally challenging for you no matter what you're doing. And once you lose all those things and you sort of relax and, you know, as I sort of tongue in cheek joke, you know, drinking pina coladas on the beach, Doing that long term is not good for you.

It might be restful for, you know, a few weeks of recuperation, but as a long term plan, and if you got to 65, you're gonna live a a good seventeen, eighteen more years, you really have to think about, well, what else am I gonna do? Volunteer at the library, volunteer at the zoo, or an animal shelter, or what have you, being the ghost of the museum, you know, or grow vegetables and enter, you know, contests. It's really important to do that stuff and to not just lose that purpose. Now how we find it, what we find our purpose to be, it's a big challenge. I mean, when I went to college with your sister, my first year, I was really sort of felt at sea, and I was like, well, what am I gonna do?

What what is the point of this whole exercise? And I took a walk out into the forest around my college, and, you know, it was snowy, and and it began to come to me to think through. Alright. What talents do I have? How can I contribute to the world the best?

And and it was a know, did it answer all my questions? Of course not. But did it put me on a course about thinking, how can I contribute? I think that's the key question we have to ask. Comes in a lot of different shapes and sizes, and it may not be one thing that's the same your whole life.

I do think having a sort of empty life where you're there's no real doing something for other people outside of yourself does tend to be very debilitating to people.

Dr. Mark Hyman
This is so important, Zika, and I I think it's it's really underappreciated. We're wired this way. You know, whether it's E. O. Wilson's book about the social conquest of the Earth.

Yeah. The areas in your brain that are activated by altruism, by service, by giving to others is the same part of your brain that's activated in the pleasure centers by cocaine or heroin or nicotine. It literally sugar. You can literally get the same hit. And, you know, as we're both doctors.

You know, as doctors, that's part of the kind of like stuff we get. We we get the the juice of it. And the Hittite Yiddish is called nachos. It's like the good stuff of life. And it's like you basically feel different in in in the moments that I've been most alive and most happy, were the moments that I was completely outside myself, not thinking about myself, and actually in service of others.

And when I went to Haiti after the earthquake, that's what I did. Working twenty hours a day, barely eating, barely drinking, you know, doing amputations, in a crazy horrible situation. I it was a weird thing to say, but I felt I felt good. I felt happy. I was you know, it was a tragedy that I was in, but it was still like this moment where I wasn't in myself.

And this whole narcissistic individualist pursuit of longevity is kind of what you're railing against and saying, hey guys, it's more complicated than that. It's about it's about, yeah, what you eat and exercise and sleep for sure, but it's also about your relationships and your connections and and your purpose. And those are things that come from being in service. So I I I really love this message. Last last kind of thing I wanna ask you about is this this idea.

It's kind of the name of your next book, which is this idea of creative rejuvenation. Can you just speak to what that is? It's I I love the sound of it. I'm not sure I understand it.

Dr. Ezekiel Emanuel
Well, it's really about it's about social system. It's really about the health care system. One of our you know, we we have a broken health care system, broken in every way you can imagine. We don't cover all Americans. Bad thing.

We have way too high cost. Bad thing. Our quality is uneven, and we don't can't guarantee everyone good quality. We have disparities, whether it's urban rural or racial or based on sex, and we're all dissatisfied with the system. I don't know anyone these days who isn't bitching and moaning about the American health care system.

So the question is, you know, in business, if you have something that's failing so bad, right, you have you have creative destruction, they say. You know? You just Kodak doesn't exist anymore. You know? Eventually, the internal combustion engine will not exist.

It's harder in hospitals. You can't just get rid of hospitals. You can't just not have a you know? And not having a particular school or a particular facility isn't gonna solve the bigger structural problem. So part of I've been trying to do in this book is how can we creatively rejuvenate not just people, but the social institutions like the health care system that we have and redesign them so that the sort of the creakiness that has encumbered them over the last seventy five years, we can overcome the problems that that creates.

And that's really what the book is thinking about. I have some ideas, and I have some ideas of, you know, if we had a better if we could design a better system, how could we get it implemented in the current political environment where there seems to be a lot of polarization? I do think health care may

Dr. Mark Hyman
be I I can't wait for that book.

Dr. Ezekiel Emanuel
I could think health care may be one of those places where it's bipartisan. Everyone thinks the system's broken. Everyone says, well, I would like to to have guaranteed health care. I'd like to have it affordable so I don't risk being bankrupt. I don't wanna pay those super high deductible.

So we have a lot of the elements, and then we have to make it worth. And so that that that's where I'm going with the book.

Dr. Mark Hyman
That's beautiful. You know, I I I wrote a book called Food Fix about how to fix the food system. This is like health care fix. This is what you're writing. It's health policy fix, and I love it.

And I'm excited because my wife is actually going to Columbia to get her MPhD in health policy, so she's all about this stuff. It's great.

Dr. Ezekiel Emanuel
Yeah.

Dr. Mark Hyman
So, you know, I'm gonna just end with a quote from Common that you remind me of was, where are you gonna put your one grain of spiritual sand on the universal scales of humanity? And I think your life seek has been putting a whole beach of sand. And I really appreciate you, and I'm so glad you're in my life. And I'll see you in a couple of weeks. And thank you for writing the book.

Everybody go get a copy right now. Eat Your Ice Cream, Six Simple Rules for a Long and Healthy Life is out, and you're going to love it. And it's going to take all the nonsense out of all the wellness stuff and give you just simple, practical, hard won advice from someone who's in a family, and he's written another book about, you know, about the Emmanuel brothers, which you should read, from a family whose whole purpose in life has been to contribute to the world and make it a better place. And thank you for doing that.

Dr. Ezekiel Emanuel
Thank you, Mark. Great. I really appreciate that and this has been a wonderful interview. Really wonderful.

Dr. Mark Hyman
Oh, thanks, Ike. And enjoy. I'll see you soon. If you love this podcast, please share

Dr. Mark Hyman
it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Doctor Hyman show wherever you get your podcasts.

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