Why The Wellness Industry Is Wrong | 6 Simple Rules for a Long, Healthy Life

Key Takeaway

Loneliness is as dangerous as smoking two packs of cigarettes daily. Combat it by building both strong relationships (5-15 close people) and weak relationships (casual interactions with baristas, neighbors). Ask open-ended questions to spark conversations. The number one predictor of a long, happy life isn't exercise or diet—it's robust social relationships.

Episode Overview

Dr. Ezekiel Emanuel discusses six simple rules for longevity, emphasizing that wellness culture's obsession with individual optimization misses the most critical factor: social relationships. He argues against extreme wellness practices, advocating instead for balanced approaches that include purpose, mental engagement, and community connection.

Full Transcript

Transcript of Why The Wellness Industry Is Wrong | 6 Simple Rules for a Long, Healthy Life from The Dr. Hyman Show. Auto-generated from episode audio; may contain minor errors.

Loneliness is an epidemic. Our former surgeon journal wrote whole treaties on it. It's like smoking two packs of cigarettes a day. 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 want to 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. Ezekiel Emanuel, MD PhD is the vice provos 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, and 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.

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 got to stay mentally engaged. You got to be mentally on it. Be curious about the world. You got to have purpose. have purpose. have purpose. If you have meaning and purpose, you live an average of 7 years longer.

Hey, it's Dr. Heyman. I'm so excited to share this episode with you today. But before we dive in, I want to get your help. Please take a minute to hit that subscribe button. Whether you're watching here on YouTube or listening on your favorite podcast platform. It truly means the world to me and it helps my team and I bring you this podcast every single week. Plus, I don't want you to miss a thing. So, thanks so much for being part of this community and I'm glad you're here.

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 uh and here we are. Yeah, it's my great honor. I don't know how long we've known each other, Mark. on and off for uh pushing 40 years. A long time. Yeah. You were my sister's close friend at Ammerst and uh and then uh we hung out when you were working in the Obama administration and uh we went down to Washington, had dinner.

I was like, wow. We're like, you're actually changing the face of healthcare. This is the coolest thing ever. And I could literally read your bio, which would probably take the full hour, and it would probably take another hour to read all the awards you've ever received. Uh but but believe it to say you are a supreme underachiever who's accomplished nothing in your life 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 going to talk about uh 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 eat 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 messages in there. And and I want to sort of first ask you like what inspired you to write this book because you know you're a health policy guy.

This is a nutrition book. It's not exactly area. You're a medical oncologist, you know, you're a bioethicist. I mean, you know, it's sort of tangential, but like something inspired you to do this. Well, I would say that there are three uh confluence streams. So, it is true that primarily in the Obama administration, I worked on healthc 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.

Um, and one of the other things I did is I collaborated with Sam Cass and others to try to do uh better on our nutrition policy. So, one of the things Sam and I did was to open the White House uh farmers market uh about a block and a half from the White House. Um, and we worked uh to get fresh fruits and vegetables right in the center and heart of Washington DC. um and the first lady opened it and it was very successful. I also worked on revising the uh food pyramid which had become I think fair to say incoherent and substituting uh the food plate that I think is much clearer advice.

We worked and tried to get food companies to put uh uh uh 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 um I have I have a long interest in cooking and food. I was a a pop-up kitchen, a breakfast chef um for a few times. Um so that's one strand sort of this this this and you also raised bees and you also raised bees and you make chocolate.

So long strand of interest in food policy. Yeah. Yeah. Yeah. The shocking thing is I was at a meeting I want to say four years ago, three years ago, something like that. Um, uh, 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 six rule. And second of all, no one's making a ton of money from wellness. There's no big corporation like Fizer going to make a lot of money from wellness.

Med schools aren't going to make a lot of money from wellness. hospitals are going to 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 the I wasn't satisfied that we couldn't have a movement in that direction. And it sort of noted at the back of my brain, you might put it. And then honestly, I read um one of the uh uh books on wellness um that are in the back behind me on on on my bookshelf and it made me pissed off beyond belief.

beyond belief. beyond belief. You don't want to say what that book is. I 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 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 Emanuel and the time 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.

Um, and I was like so mad and everything that I had understood just came down. You know, for one thing, yes, as I said, 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 uh 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 who was a pediatrician. He was a doctor too too too a 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 1960s.

He led that campaign in Chicago. Chicago. Chicago. Um and um so you know there are plenty of things we do that are schmuckucky as it were. You know the number one I had I had a a a student that's like I'm going to climb Mount Everest. Well that's a schmuck move. Okay. Lots of your audience may or may not know this, but um you know your chance of dying going up Mount Everest are one in a 100 for all age all comers, including the experts. Your chance of dying if you're over 59, and I'll confess I'm over 59, is one in 25.

What an idiot. Who would do that? Make a chance of dying one in 25 for a few weeks or months of bragging rights that you climbed Everest just doesn't doesn't doesn't like a smart woman. I mean, climbing Everest is more dangerous than bass jumping. And I thought bass jumping was the schmuckucky move of all time. Well, maybe maybe free soloing is probably the dumbest move. But there are lots of other things we do that are schmuckucky. You know, smoking obviously and vaping, uh, alcohol. Certainly over one drink a day is is a schmuck move.

Um, and there are other things, you know, and I could be very So basically the title of your book could be don't do schmuckucky things. Yeah, that's great. And the last thing is and is you got to stay mentally engaged. You got to be mentally on it. Uh be curious about the world. And as I think you pointed out and is, you know, you got to 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 alone. Yeah, if you want to both be healthy and live a long and happy life, you know, it's about purpose and ina engaging with other people and engaging your mind. And so you got to 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. It's great. And I think I think you you come at it from an issue perspective because you have a you know a deep understanding of the health of America and population and even the global population.

and 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 not saying that they're necessarily bad.

I'm just saying there are a lot of things on the edges or margins and people forget about the core fundamentals and you know when I went to Icaria went to Sardinia they didn't have hyperic chambers they didn't do plasmis 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 Petro was 95 years old he was a shepherd his whole life would hike you know probably 5 10 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, I don't think he was, you know, drinking a ton of wine. And I met this guy and he was like cleareyed. His back was straight as an arrow. He was had a booming voice. He sat in, you know, serenated 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 they had very little stress. In fact, this one guy uh who I went 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, um, Silio, 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 a minute. He's like, well, you know, occasionally a goat gets out at night and I have to go get it. And I'm like, okay. So, [clears throat] what you're talking about, I want to sort of break this down for people. I think you're pointing to as usual, Mark, you summarize 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 got to do wellness, I got to do exercise.

It's built into the lifestyle that they have. And that I think is the key be 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 got to do cold plunges and I hate the cold plunges and 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 kind of doing these things unconsciously, um, you know, you take joy in them, they're actually, you know, not only good for your body, good for your mind, um, they're, you know, fun and happymaking 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 happen the the people who are talking about wellness today and longevity and pursuing it and obsessively um it consumes their life. um 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 going to you know uh I don't know hundreds of push-ups or weight rooms uh 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 chemical balance. You can't overhype it, and you can't under uh uh um play it or, you know, uh um neuter it. And I think part of what gets me about all of 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 um well it's a part of the problem of the food system um and ultrarocessed 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 uh uh influencers who are telling you more meat more unlimited amount. No, that you you don't keep eating the uh the 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?

places? places? They don't have a choice. There's no there's no McDonald's anywhere. It's not new. want to sh you know you go back I'm a philosopher so I spend a lot of time reading you know Aristotle but also uh um you know hypocrates and you know it's not like they didn't know about these things you know they know about socialility 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 2500 years what they didn't recommend is doing it obsessively as if there's nothing else beyond wellness in your life and all those traditions whether it's Aviscina or Mymonities or Hypocrates all these ancient physicians all basically said the same thing or the yellow emperor of China uh you know um and it's it's really uh 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 schmuckucky and also So 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 the 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 they're not infectious, but they're contagious. Whether it's heart disease, chronic dis diabetes, Alzheimer's, and many of these things that that we're suffering from in America now are all basically communicable through our social influences. And and then I worked with Rick Warren and his church in in Saddleback Church and we got people to do this together.

They had 5,000 small groups that worked together. We put a healthy curriculum in there for healthy lifestyle. Very simple stuff. And they did it. They lost a quarter million pounds in the year doing together. And his his saying was everybody needs a buddy, you know, and I came up with this concept of social genomics. You know, what are the social uh 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 and it's hard to do and I wonder if you could start by talking about how you would think uh about guiding people to build and and support and encourage these social relationships and networks cuz loneliness is an epidemic. Our former surgeon general wrote whole treaties on it. It's you know like smoking two packs of cigarettes a day. It's 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 cuz maybe people are sitting home lonely and isolated and you know just disconnected and how do they start? I think you raised an incredibly big set of issues. The first thing is um social life is critically important. Um again you know Arisa 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. Um, and we have a lot of forces pushing us to be more isolated. Um, uh, 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 to kids are talking. Yeah. It's like, oh, this is a good noise. We want this noise. Well, you did that in your in your in your college classes. classes. classes. 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 want to talk about that because I think institutions, organizations, institutions, organizations, institutions, organizations, corporations have a role here and they need to take responsibility just like I've 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 social ability.

Um what's the reason to permit it? And so that the thing a school could do. Here's another thing that corporations can do. A lot of corporations have tried to boost wellness, uh 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. Um and uh you know all of that stuff mindfulness training, yoga training, breathing but zero impact uh because it was individual focus. The thing which had the big and enduring impact was impact was impact was uh uh 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. It 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 foodever, but we could do more of it um and organize these activities more. And I think again these are things that uh 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 of the same piece. Bring people together and encourage create an an environment where you have to be social. So let's talk about the individual. Um there are two kind before before you do as before before you do as you guys want to 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 healthcare 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 10 minutes. It wasn't very intensive but it was two hours a week for 10 weeks. We saw three times better outcomes better outcomes 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 think really, you know, the community is the medicine.

medicine. medicine. Yeah. Yeah. Yeah. And you wrote about the social cure, right? It's actually that I think you you point out, you know, the churches do it, you know, buddies for bodies. I think that I think that's a beautiful encapsulation beautiful encapsulation 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. Um family uh 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. um or you know whatever your your however you do that those social engagements you know I talk to my friends that tends to be while I'm driving because I can't stand driving so it's it's a way of connecting um or you know we we host uh uh once or twice a week you know dinner whether it's a Friday night dinner or some other dinner just to get together with uh people now you may or may not have that and we know that uh eating alone phenomena 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 uh what have you or you know you keep going to the uh to the same coffee shop you can talk to the barista and begin engaging them not artificially you know just talking to them.

Um, 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 was sitting on a train. There was this, you know, the early cupcake craze. Lady sitting uh a kitty corner from her had a cup a box of cupcakes um from one of the popular stores. She asked her about the cupcakes. got talking about the cupcakes and she felt you know by the end of it she was like wow I feel like really good just cupcakes and so went in and began doing a lot of systematic research she switched her whole research focus to these relationships and their importance and I think we underestimate we often you know trying to buzz through life and be efficient and not talk to people um 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 drive 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 it 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 sparking a conversation and learning about people. You're happier, they're happy you maybe gotten some information. Um, and we I think in our society tend to poo poo those kind of weak interactions way too much. Um, and we don't we don't think about how to use them. them. them. They matter. I mean, I I've lived in the birkers for 30 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, you I mean, I've known the the guys who own the grocery store for 30 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 actually actually 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 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.

So I I used to uh I still take the train from Washington to Philly and Philly to Washington and the uh 7:00 asella up from Washington to Philly. There was this guy who was a conductor and I had a book out um it's actually on my bookshelf, King A Life by Jonathan Ike. Um and I was in the midst of reading it. I just happened to put it out on the table, got my computer out. I'm just organizing everything and he comes by to take the tickets and he says, "Is that a good book?" And we start a conversation and you know every week week week is that about Martin Luther King?

Yeah. About 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 uh he just retired. I I say unfortunately for me because we had a great relationship over a couple of years. Um just so which just sparked because he asked about the book and I told him why I like 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. And you actually you actually marched with Martin Luther King with your mother who was an activist in Chicago back in the day. Right. That is correct. Absolutely. We got eggs and tomatoes thrown at us. Absolutely. You're a very good memory there, Mark. 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 uh let's say 15 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. Uh and I almost have too many friends because I it's like I want to keep up with them all and it's hard.

Uh but when we see each other it's it's like there's you're just part of this extended tribe and that's you know I think Eio Wilson um 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 you know 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 because that's that matters, right? Yes. Uh it's 100%. Look, I mean, you know, we have what's called the neoortex. Neo, which is new cortex. That's the part in the front of the head. Um 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. Um, and that's part of our brain structure and it's critical and like other things, you got to use it uh to keep it in shape and keep it working.

Uh, 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 and you you've hinted at it with Eio 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 anthrop anthropologist I guess ameritus now at Oxford and there's a Denmark number which is roughly 1550 Exactly.

That's the number of people you can have as acquaintances. Close friends 5 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 well I'm a sort of quasi expert on Ben Franklin because I'm obsessed by him. Um you know 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.

Um, but he created all sorts of societies to bring people together. The American Philosophical Society, all the, you know, the the firemen, insurance companies, uh, subscription lending libraries. And he was a guy who believed in in, uh, socialability 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 uh visits so that they're more communal often works. Community healthcare workers, creating a community of people who push each other to be healthy and to uh to do the right thing.

All of these are critical and the best proof and and with that I'm going to shut up. There is, you know, one of the the most important I doubt that. I doubt that, but keep going. going. going. One of the most important studies. I've never known an Emanuel to shut up before. before. before. Um, Um, Um, I know I know both your brothers and I'm like, no. like, no. like, no. Harvard adult development study. Now, there's no more boring title than that um for a research study, but it started in uh the late 30s, early 40s following Harvard uh sophomores um and to see how they developed and what made them develop for success.

It included John Kennedy, the editor of the Washington, Bren Bradley. Um and then they merged with a a one that wasn't just Harvard students but also local kids uh immigrant kids in Boston. Um and so they following them it's it's the longest study I know of 85 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.

Yeah. I want to get to those Yeah. I want to get to those things. I I don't know if you know about the Rosetta study. Do you know about this Rosetta Pennsylvania study? No. Go ahead. It amazing study. It it was I read in a Deepo book like 20 30 years ago and basically there was a community from Italy from a village in Italy that moved on mass and immigrated to 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 as the rest of Americans, they didn't die. They had a much longer uh 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 uh other that you might think is more important like your diet or even exercise.

Let me give you another piece of data on that that I've sort of stumbled on and and so if you look um around the world uh uh 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 uh and other variables would suggest. And what most people who look at this think is critical is they are much more likely to eat um meals together. They have more meals with other people than any other region of the world in Latin America.

Um, 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 uh problems in most categories of chronic illness uh than whites in the United States. And it goes exactly to what you're you're saying which is look sociability can compensate and um overcomes lots of these other factors that might be you know anti-wwellness 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 instead individual narcissistic pursuits.

Yeah. Yeah. Amazing. This is that was this is really good. That was that's like rule four of your of your six rules. Uh I want to jump back to the first one cuz I think you know we covered this social thing really well. And I 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 a walking group, a jogging group, a biking group, what whatever whatever turns you on.

A 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 uh title which is I think you know eat your ice cream which I love. Um, but I want to what before we go on, what's your favorite ice cream at the moment? Um, there's a place in Washington DC that makes a Lebna yuzu ice cream and that's my favorite. Wow. Wow. Wow. Yogurt with yuzu. Yes. It cost 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 75th birthday and a special special trip to Paris. And there's a place called Plaque, PL 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 I can't I can't Well, my my my favorites are pistachio uh and his gelato, and then of course in Italy, and then chunky monkey if I'm really bad. really bad.

really bad. Ben and Jerry. So, so let me talk about food for a second. 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 social abilities as we've mentioned many many times. It's obviously also critical for nutrition. And part of the problem, I would say a large part of the problem of American decrease in uh uh uh 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. Um, 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 140 calories per shot per 12 ounce can with no nutritional value.

It's like 10 teaspoons of sugar. It's ridicul. Okay, you got to, you know, wind it down. However you can do, if you can stop cold turkey, it's I had a patient lost 75 pounds just by stopping soda. And and I would say one of the pieces of good news over the last, 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 got to go down and we should celebrate progress.

The second is um 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. starchy snacks. starchy snacks. Yeah, snacks are just an invention of the food industry. Like humans never had snacks. We just ate meals. 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 uh apples and other things.

But the the starchy stacks are the they have zoomed up five, you know, 500 added calories. It's like a uh um you know, one of those big uh uh items a day, we often eat them instead of breakfast. of breakfast. of breakfast. Those are the two big things to stop. That'll bring down your ultrarocessed food amounts and things like that. On the pro side, um the big number one pro in my mind, I'd actually you're the real expert. I'm just the pretender here, is fermented foods.

Um and things like kimchi, yogurt, uh raw uh uh alpine cheeses. cheeses. cheeses. Those are the those are good for your your uh microbiome. They're good for your health in all sorts of ways. Um, and uh, if you added them once or twice a day to your diet, you would go a long way on the positive uh, side. The other thing I am sort of a big I am I'm probably out of step with a lot of people, but I'm actually a big believer in dairy.

Um and uh you know uh the fat globules and the saturated fat in dairy. We know that it is anti- uh uh type 2 diabetes. People who eat a lot of dairy don't develop type two diabetes as much. They lose weight. The number one weight loss um uh diet item is yogurt. Um again another dairy product. It's it's although that could that could be correlation not causation, right? in epidemiology. epidemiology. epidemiology. We could we could spend the whole hour talking about talking about talking about doing food studies.

I totally agree with you. I think if you do those two things, you go a long distance. Now, are there many others? Yes. My book goes on and on about all sorts of other obviously fruits and vegetables. um we now know it's not just the uh 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. Um we're going to 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 problemless, if you just buy it and cook it, you know, whether it's by roasting it or uh uh sautéing it or what have you, it's going to 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 I'll tell this little story. Um you got to learn how to cook.

One of the worst things that ever happened. Amen. Amen. Amen. The American diet was getting rid of uh home ech out of school. I probably was the last generation who had home in their school. And I had every year I'd hire uh two or three research assistants. I had a research assistant who literally had no idea how to cook. So I So I So I 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 uh in uh 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 cutup chicken and a whole chicken okay like he didn't have a roasting pan had, right?

He didn't he didn't have any of the basics. I said, "Listen, you have to accumulate this this stuff." And you need the tools to cook, right? Yes. Exactly. And you can't You're not going to go out and spend thousands of dollars getting the tools. You do it over time. What I like a couple of pans, a couple of knives, and a cutting board. You're doing okay. What I like to say to people is every week try one new recipe, right? Not you 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 going to 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 it's it's a it's one of these triple winners. 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 me when I was young. I did recipes and follow the recipes and you do that enough and then you be understand the fundamental principles and the layering effect and what to do when 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 need to learn two or three breakfastes, 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 was 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 oil on the outside, throw in the oven, 450, 20 minutes a pound, boom, you're done.

And it's like a perfect chicken. It's not dry. has some moist cuz it steams from the inside and like it takes it literally takes like 5 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 uh uh 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 immension of the food industry cuz there was a home 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, these 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 Ramsay, how do you make a duck breast? Oh, that's so easy. Okay, fine. I'll make a duck breast. Especially 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 in that regard and for teaching kids and we got rid of home economics somewhere in the you know 60s and 70s um as weren't appropriate to school. But it's part of health as we've learned over the last 50 years. Nutrition is a key element. You have bad nutrition, you have obesity, you have type 2 diab you have a whole range of chronic illnesses, osteoarthritis, renal failure, hypertension.

If we if we don't fix this food system problem, right, we are going to be saddled with high cost from chronic illness and less uh longevity and we're going to have more disabilities. It is it's they're all tied together. And so food and as you point out uh uh Mark food and doing learning how to do it yourself. The other thing that you know sort of gets me is um I was raised in a house that didn't have a salt shaker. My mother my father was a pediatrician with an expertise in kidney disease.

And now salt was forbidden. My mom had no salt in the house. So I grew up with no salt. My past buds are just whatever is natural. That's what we got. And so I've always found restaurants a too salty, a little too little too little too very very very 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 want to be to let some corporation decide what you're going to 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. Everyone can do it. And this isn't classes or sexist. Um, 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 going to be cheaper.

It is going to be cheaper. People think, you know, Mark Bitman wrote a piece New York Times about this. You 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. And it doesn't. and and and the and the food industry been so deliberate about trying to convince us that uh 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 I what 45 jobs I probably have 10 15 jobs like we do it I cooked dinner last night I I threw a sweet potato roast a Japanese sweet potato in the oven I made lamb chops in the pan took like 10 minutes I I stirfried tried some bok choy with ginger, which took 5 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 still 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 want to double down on is eat stuff that is not different than the ingredients you'd have in your kitchen. If it's not in your kitchen, you probably don't want to be eating it. If you're not going to cook with it, don't eat it. like butilate hydroxy taluine 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 don't want you know be eating kagenine 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 salt and sugar and flour and whatever eggs.

It's not that hard. 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 uh and cheaper. And the other thing Mark is, you know, the evidence growing by just staying off ultrarocessed foods for a month and the change breathes in people and the compelling 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 um but you know, people report this uh 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 ultrarocessed foods. First of all, she then realized how much ultrarocessed foods there is everywhere. And everyone's trying to offer her daughter something. Um, 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 uh uh the current moment I think the message of get off ultrarocessed foods, stop drinking soda. Those messages are beginning to to see through. 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.

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 is these are really simple messages. messages. messages. Yeah. Yeah. Yeah. 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 2 diabetic on insulin. She had heart failure. Her A1C 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 stances and hypertension. She had an ejection fraction of 35% which her heart means her heart was pumping probably like you know 40% less than it should. She had fatty liver her kidneys were starting to go with protein and urine and she was a body mass index of 46.

So she was huge like normal is 25 or less 30 is obese. She had lived her whole life eating ultrarocessed 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 in and she went from eating that to eating whole foods that were anti-inflammatory. All the things we talked about. In three days, she got off her insulin. In three months, her A1C went from 11 to 5.

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 3 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 30 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 just Zeke, I love I love your simple, nononsense, direct uh no kind of advice because it's it's just like thing, Mark, once people knew I was doing the book, they would often come to me with, you know, I'm doing the following. I I 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 this. You have to just your general tendency, the central part of 8020. 8020. 8020. Yeah. Has to be good. And every so often you're going to indulge something. You're going to 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? 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 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 a while. But occasionally you can indulge when it's occional and you're celebrating something and you're making a big deal out of it. The problem The problem The problem we've made that routine and that's where we have to break ourselves.

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 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 your key rules, which is uh exercise, uh sleep, avoid stupid stuff, and pursue purpose.

So let's just kind of quickly go through those. Tell us about your view on exercise. You've got to do all three parts of exercise, which is the aerobic, getting your heart rate up, your lung uh capacity up. I do it by biking. Um and uh 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 that added benefit of being out in nature. Um and you can also ride with people and talk and it it's a social activity.

you got to do uh strength training and that is especially true for people over 50 and 60 where the muscle mass goes down. You've got to preserve that muscle mass uh in uh a variety of ways. Lifting weights is one way. Um you know strengthening your core is also very important. And the third thing which is often left out is balance and flexibility. Um, 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 is probably more important than stretching.

Stretching is not bad for you. That's what we know. But it may or may not be protective. protective. protective. Uh, but the flexibility reduces uh uh 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 20 minutes of yoga, 5 minutes of core uh and strength training. Uh my brother gave me these new bands that really seem to work. And and let me guess which brother Ari.

Um 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 5 hours 6 hours a week is not going to 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 uh you can twist your ankle.

Um so that's that's the three aerobic strength training and flexibility and balance by yoga. yoga. yoga. It is and and in 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. Yeah. 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. Uh, you know, or build in some socialability. Take a walk, go running with a colleague. I used to, for more than 10 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 moment about the job you know what was going well what what 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 fun other other other I always say I like to 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 we they had jogging for Jesus so they did it like in communities so I I think is actually a double a double benefit.

How about sleep? about sleep? about sleep? The 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 going to 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 got to come to you. You've got to get the room right. You've got to 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 with with real pages. So, I'm not looking at a screen and then I know my eyes are beginning to get heavy. I can't remember the last sentence I read and it um but the other thing is all those sleep medications not good for you. Um almost all the societies uh professional medical societies uh related to sleep uh say you know it's it's cognitive behavior uh therapy for insomnia that you need and so uh you got to forget the ambient or hion or whatever you're using and um I also you know I've been perplexed by the the the uh popularity of uh aura rings and how much sleep you're getting, etc.

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 that's right. that's right. that's right. 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. 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." 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 going to 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 um so I have a bunch of rules in the book of h how to maximize your chance that you'll get to sleep.

The problem is, you know, I'm like I often have bad nights. I'm 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. But you can make you can set up the conditions and there's ways to do that. And and and what you mentioned just cuz 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 uh you know, this is like don't be schmuckucky. Yeah, exactly. Don't be schmuckucky. Um you know, we mentioned some at the top of the hour, which is you know, climbing Kilimanjaro, base jumping. Those are high-risk activities. No, climb Mount Everest. Climbing Kilimanjaro is you walk up. It's No, no, no, not Kilamanjaro. I mean base jumping.

Yes. Climbing Mount Everest is the Kil Everest. Yeah. I've done Kilamanjaro, too. I wouldn't recommend it for a whole variety of reasons, but it's it's not a schmuckucky move. It's not that not that challenging. Uh, uh, although people do do die doing it. Um, uh, and there, you know, not taking your vaccines, schmuckucky 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 uh so that you don't do over testing.

I do a detailed analysis for the men about prostate cancer PSA screening. I'm not for it. Um the bottom line is uh in all the studies uh the cancer screening test PSA may save one out of a thousand lives. Uh but it also means you're a patient. you're constantly looking uh at the number and get and uh testing. You may get procedures done which have all have relatively high effects and complications as you know impetence, incontinence. Um so overall um 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 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 43y old with prostate cancer, it makes a lot of sense. And and it's interesting as and the company I co-ounded, Function Health, has blown up and we have like 300,000 members now. you know, we have a whole range of demographics and literally I got two emails uh recently of of men in their 40s 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 it's abnormal and they need to go get unnecessary 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. complicated. complicated. 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 uh uh Society of Clinical Oncology, etc., they they do recommend it.

Um uh and they certainly recommend talking about it with your doctor so you have the the bottom line. But what you say uh uh Mark is 100% true. We're seeing this uh you might even say mini mini explosion of cancer among younger people which no one has the definitive answer as to why it's happening but you're seeing colon cancer in people in their 30s and 40s. And I had a very dear friend who died of colon cancer in her early 40s. Just tragic. Um wonderful civil servant real dedicated to America.

Um, and it, 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 it is related to our bad diets and our bad uh obesity epidemic, how much of is related to carcinogens that are all around us. We just don't know. It's the combo. It's a combo package. Being clear about when to start your cancer screenings 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.

doctor. doctor. 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 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 turn. 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 uh text seek I love you I'm going to coming 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 7 years longer longer longer which is incredible because if you eradicated cancer and heart disease from the face of the planet life extension would only be 5 to seven years. you know, you you are a doctor, you're a bioethicist, you're a health policy geek and uh you're also a philosopher and and did your 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 data 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 a increase in mortality in 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, exactly how you find it is is a very interesting phenomena. 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 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 if I 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 uh 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 and 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 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 um we're doing some research around the activities people engage in around retirement that are important for longevity and wellness.

Um, and it's really important to plan for it and to make sure you just don't stop things cold turkey. Um, because work has a schedule. It has social interaction. It has me 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. Um, 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 going to live a a good 17, 18 more years, you really have to think about, well, what else am I going to do?

Volunteer at the library, volunteer at the zoo, or an animal shelter, or what have you, being the dose at the museum, uh, you know, or grow vegetables and enter, you know, contests. Um it's really important to do that stuff and to um not just lose uh that purpose. Now how we find it, what we find our purpose to be, it's a big challenge. I mean when I went went to college um uh with your sister um my first year I was really sort of felt at sea and um I was like well what am I going to 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 all right what talents do I have? How can I contribute to the world the best? And and it was a that you 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 and 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. This is so important, Zeke, and I I think it's it's really underappreciated. We're wired this way. You know, whether it's Theo Wilson's book about the social conquest of the earth, 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 Yiddish is called nas. It's like the good stuff of life. And it's like you basically feel different. And it 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 20 hours a day, barely eating, barely drinking, you know, doing amputations, like in 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 want to ask you about is this this idea and it's kind of the name of your next book which is this idea of creative uh 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. it. it. Well, it's really about um 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 bet that our quality is uneven and uh we don't can't guarantee everyone good quality. We have disparities whether it's urban, rural or racial um 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 um you know in business if you have something that's failing so bad, right? you have create you have uh creative destruction they say you know you just Kodak doesn't exist anymore you know eventually the internal combustion engine will not exist um it's harder in hospitals you can't just get rid of hospitals you can't just u not have a uh you know and not having a particular school or a particular facility isn't going to solve the bigger structural problem so part of I been trying to do in this book is how can we creative ly rejuvenate not just people but the social institutions like the health care system that we have and redesign them uh so that the sort of the creakiness that has encumbered them over the last 75 years um we can overcome the problems that that creates and that's really what the book is thinking about um I have some ideas um 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 healthare healthare healthare I can't I can't wait for that book. I do think healthcare 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 healthcare. I would like to have it affordable so I don't risk being bankrupt. I don't want to pay those super high deductible." So, we have a lot of the elements and then we have to make it work. And so, that that that's where I'm going with the book.

That's beautiful. You know, I I I wrote a book called Food Fix about how to fix the food system. This is like healthcare fix. This is what you're writing. It's health policy fix. And I love it. And uh I'm excited because my wife is actually going to Colombia to get her M. PH PhD in health policy. So, she's all about this stuff. It's great. Yeah. So you know I'm going to just end with a a quote from common that you remind me of was where are you going to 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 so glad you're in my life and I'll see you in a couple of weeks.

Uh 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. It's 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 one advice from someone who's in a family. And he's written another book about, you know, um about the Emanuel 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. Thank you, Mark. Great. I really appreciate that. And this been a wonderful interview. Really wonderful. A thanks, Zeke. And uh enjoy. I'll see you soon. If you love that last video, you're going to love the next one. Check it out here.