Why Your Friends Are Better Medicine Than Anything You're Taking | Dr. Ezekiel Emanuel

Key Takeaway

Social interaction is the single most powerful intervention for longevity—not exercise or diet. Friendship literally changes your biology: it releases dopamine and oxytocin, reduces cortisol, and turns off pro-inflammatory genes. Studies of 3 million people show that those with more high-quality friendships live significantly longer. The problem? We're going in the wrong direction—19% of people have one or zero friends, and over half of meals are eaten alone.

Episode Overview

Dr. Zeke Emanuel, oncologist and bioethicist, challenges the wellness industrial complex with his book 'Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life.' He argues that longevity shouldn't be the goal—quality of life and purpose matter more. Emanuel critiques influencers like Peter Attia and Bryan Johnson for their obsessive, self-focused approaches while offering evidence-based, sustainable wellness advice centered on social connection, avoiding unnecessary risks, and living with joy rather than deprivation.

Full Transcript

Transcript of Why Your Friends Are Better Medicine Than Anything You're Taking | Dr. Ezekiel Emanuel from 10% Happier. Auto-generated from episode audio; may contain minor errors.

Hey everybody, welcome to the 10% Happier podcast. I'm your host Dan Harris. We are doing something a little different and very special this week. A whole week is dedicated to an occasional series we do on the show called Get Fit Sane-ly, where we cover physical health and wellness through the lens of psychology, mindfulness, and self-compassion. Our tagline for this is how to take care of your body without losing your mind. And this week's Get Fit Sane-ly series has a sponsor. It's supported by Magnesium Breakthrough by a company called BioOptimizers.

They argue that Magnesium Breakthrough is a is a supplement that delivers better sleep, calmer days, and more energy. So big thanks to the folks over at BioOptimizers. You'll hear more about Magnesium Breakthrough a little bit later in today's episode. Today we're going to be talking about longevity, but without any of the pseudoscience or [ __ ] or time-consuming expensive protocols that so many longevity experts or so-called longevity experts attempt to foist upon us. My guest today is the legendary Dr. Zeke Emanuel, who's an oncologist, a bioethicist, and a healthcare policy expert.

He's got a new book with an awesome title. It's called Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life. This is a great conversation. I think you're going to love it. We'll be right back with Dr. Zeke Emanuel. Zeke Emanuel. Zeke Emanuel. A few things before we hear from our sponsors today. Mark your calendars. Our summer Sunday Live series premieres in just a few weeks. Every Sunday for eight weeks starting on July 12th at 4:00 p.m. Eastern, you can join us for a live meditation and Q&A hosted by the legendary meditation teacher Sharon Salzberg.

This is happening only over on my newish meditation app, which is called 10% with Dan Harris. Every Sunday Sharon's going to break down one part of a foundational Buddhist list called the Noble Eightfold Path. You can think of the Eightfold Path as the Buddha's cookbook for human happiness. We will drop replays in the app if you miss the live sessions, but it should be pretty fun to go to the live sessions themselves. Sharon will guide a meditation, talk a little bit about one aspect of the Eightfold Path, and then take your questions.

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We love what we're doing over in the app, and we'd love to have you as part of it. We'll be right back after this quick break. break. break. If you've been noticing mental fog, mood dips, or just a harder time feeling sharp, our sponsor today by Optimizers says those are among the things people commonly report when they're not hitting consistently their daily magnesium intake. Biooptimizers say that magnesium supports normal nerve function and the systems that help the body and mind regulate. They've got a daily formula called magnesium breakthrough, which features seven forms of magnesium and comes with a 365 day money back guarantee.

As always, you should talk to your doctor before starting any new supplement. More on this later. To learn more, you can go to biooptimizers.com/happier biooptimizers.com/happier biooptimizers.com/happier and use the code happier for 15% off. Today's episode is with Dr. Zeke Emanuel, who has spent his career thinking about what it means to actually live well instead of just living for a longer period of time, which is the right frame for something I want to tell you about, Eight Sleep. They make a product called the Pod, which is a smart mattress cover that heats and cools each side of your bed automatically and tracks your sleep without making you wear anything.

It's not about hacking your way to 120, it's about waking up and feeling like a functional human tomorrow. Use the code Dan Harris at eightsleep.com/danharis eightsleep.com/danharis eightsleep.com/danharis for up to $350 off of the Pod 5. Dr. Zeke Emanuel, welcome to the show. Oh, it's my pleasure. This is great. I've been looking forward to this one. I've been looking forward to talking to you. I I have followed your career and the career of your also famous brothers for decades. for decades. for decades. Also the successful ones.

I'm the schlepper. Uh it feels like you've you've used that line before. Is that Is that Is that the story you're telling yourself? I want to come back to your brothers when we talk about uh personal relationships, but um but in the meantime, let me get to your your new book. This is not the only longevity book on the market, and I believe you were you were deliberately trying to counter program against uh many of the people who hold themselves out as longevity experts. What's your beef with them?

This book has three sources. One are, you know, people that know me or people I meet at a cocktail party or some other event who ask me for health advice, and I get a lot of it. Um you know, recently it's been almost every day something about, you know, how to handle cancer or some other disease or, you know, should I be drinking alcohol or not? Um and I wanted to give them something coherent instead of uh just one-offs. The second is about the 3 or 4 years ago Ariana Huffington asked me a question at a conference that she said, "Why don't they teach more wellness in medical school so that they can talk to patients?" And I said, "Well, you know, there are six simple things.

They're pretty simple. Um no one in, you know, none of the hospitals, none of the drug companies, the insurance companies going to make a lot of money from it, so no one's pushing it. And then, um, in, uh, December 2023, I had finished all my lecturing in my classes, and for some reason I had Peter Attia's Outlive came to the house. I don't know how I thought my brother sent it to me, but he swears on a stack of Bibles, no. Um, anyway, I read it.

And it made me so pissed off because here is a guy who embodies the, uh, wellness industrial complex complex complex going on and on about exercise, a little bit on food, and a little bit on sleep. And most of what he says is is true, but it's like 400 pages, and he says absolutely nothing about the most important wellness activity you can engage in, which is social interaction. And it's like, how can you talk about wellness without talking about how we need to interact with other people?

So, being, you know, sometimes being just mad, uh, is very productive. And so, I sat down and I wrote 35,000 words, the basically the first draft of this book. book. book. And my beef is part of what you said. First, um, they want you to be obsessed by, by, by, uh, wellness, and really make it the focus of your life. As a matter of fact, you know, I think Peter Attia has a line in something like, "Outliving is the only thing we should care about." It's like, "No, that's wrong." That's the first thing.

The second thing is they, uh, a lot of their recommendations are about self-denial, deprivation, you know, forcing yourself to do things that you don't want to do. And you know, if you're going to do wellness for a decade or for two decades or for the rest of your life, which is what you're going to have to do, you know, you it can't be unpleasant. It can't be something that you have to will yourself to do because it really, uh, tastes like cod liver oil. So, that's just not going to work.

And the third thing, uh, is they always want to optimize, biohack, and all this other stuff, which I have no idea what it means, and they have no idea what it means. Just catchy phrases. The last thing is, you know, when you look under the hood, every single one of them has a huge conflict of interest. Uh, huge. I mean, they are selling a test, or they're selling some special lab exam, or they're selling uh, some protein supplement, or some dietary advice, or something. You know, I guess one's even selling, you know, his own uh, olive oil.

It's like, I got nothing to sell. I just want the facts to speak to you, and I want to make it simple, so you can do it, and you can live a nice, joyous, wonderful life, but make it healthy, uh, long, as long as you want it to be, and make it happy. And so, that was the motivation here. So, you're right. I I didn't I didn't say I got to be counter programming to them. I said, "They're just wrong, and I'm going to give people what's right." Bob, I love everything you've said.

Um, I believe you've made the case, and you you you hinted at this in what you just said there, but I believe you've made the case that longevity should not be the goal. What do you mean by that? by that? by that? The meaning of life is not in just living a long time. You know, if you go to a an audience, and I've done this many, many times, you have to, you know, "Which is more important to you, quality of life or quantity of life?" They always say quality of life.

That's what really counts, and I think they really mean it. But then when you begin, "Oh, yeah, I want to live a long time." And and I think people don't have a good sense of what quality of life means. And part of the most important element of quality of life is having a purpose. And having a purpose means you get outside yourself. You're not narcissistic, it's only about me. You ask, "What can I do for others? You know, I one of the things I things I things I I'm a professor, so I spend time thinking about uh one of my heroes is Ben Franklin.

I teach at the University of Pennsylvania, he founded the University of Pennsylvania. And if you read his biography or any one of them out there, you know, the guy is brilliant. He he did everything and he was world-class in almost everything but one thing. And you know, here's a guy who understood what the purpose of life is. is. is. I am going to make the world better. And he did it in so many, you know, we all think of bifocals. Okay, yes, Ben Franklin invented bifocals.

By the way, he invented them at 79. Okay, this is a guy who was active all the way to the end. Um but he did so many things because he was interested is how can I make the world better? How can I improve Philadelphia? How can I improve Pennsylvania? How can I improve the United States? How can I improve the world? So, you know, not only through his inventions, through his scientific discoveries, but through his politics, through founding a myriad of organizations, organizations, organizations, the University of Pennsylvania, an insurance company, a hospital, scholarly organization, the American Philosophical Society, lending libraries, fire brigades.

brigades. brigades. So, that's usually if you unpack what people mean by having a purpose, it's really how can I make the world better? How can I make my fellow human being better? How can I make the community I live in better? And that's getting outside the narcissistic self of living a long time. Why are you living a long time is the key question. Let let me tell you a story about six or eight months ago, I was at a conference and um my brother, the successful one, um sponsored the conference conference conference two successful brothers.

Ari Ari sponsors a conference every year and he sat me at the table over the opening night dinner next to Bryan Johnson, one of the uh longevity gurus, who turns out to be a lovely, lovely person and I actually liked him a lot. But, I said, you know, Bryan, I don't I don't agree with you and and here's what I don't agree with. I said, what's the point of living a long time to him? All I got was silence. He had no answer for that. And then he turned to someone after a painful 15 or 30 seconds and he said, you know, I'm the most monitored person in human history.

Living a long time without getting outside yourself, without trying to do something for other people, there's no content to it. And it just, you know, just living a long time, twiddling your thumbs, is not it's not purposeful. And you will not have a happy life. And Ben Franklin taught that to everyone, you know. He taught that the important thing is to do for others. And I think that's really, you know, if you unpack, well, what's a good purposeful life? What will I What will make me fulfilled on my deathbed?

It's Here's what I did for other people. Well, a bunch of things to say based on what you just said. First, Bryan Johnson, is that his last name? He is, just for people who don't know who he is, he's got a Netflix show called Don't Die. He's this tech tech tech bro who is investing, you know, untold millions in in his own personal longevity product project. I have not met the man. I don't have a ton to say about him specifically except that I completely agree with you about the the self focus and often self aggression that is the the byproduct of the wellness industrial complex that as you've called it.

And I think that's a huge problem, which is why I mean, I am four square in your camp on the importance of things like purpose and social interaction, both of which we will get to in a in a quite fullsome way as this uh continues. But, I do want to ask you one question about something you said about Ben Franklin, which is he was good at everything except for one thing. What was the one thing? His personal family life. He was not good at that. You know, and I I'll give you uh two or three points.

First, he had an illegitimate son just before he got married to Deborah Read. And now, he was responsible. He adopt He brought the son in we and we don't still to this day, 250 275 years later, no one knows who the mother was. Brought her in and Deborah Read raised uh William Franklin uh as her own child. I think it caused some tensions if I read between the lines. lines. lines. Um Um Um Uh you know, it's uh you're getting married to someone you don't screw around like that.

Second, he spent a lot of time away from his wife. Early on, they were a very close partnership building the printing press and the printing media empire that he created. Um but then he, you know, he became he retired and he became famous. Everything we know about him, except the uh Poor Richard's Almanac, he did after he retired. He went to England as a representative. He represented the United States and the various colonies in England. in England. in England. And she got very sick in the 1770s, wanted him to come home, and he stayed in England.

in England. in England. Um and he could have come home and probably should have come home and no harm to the country would have been done. She ended up dying in 1774, and he didn't return till the end of I think the end of 1775 or just uh first month of or two of 1776. Many things, family life was not He was not an exemplar. Almost I don't that Not almost. Everything else, he really was an exemplar. A world He was world-class in everything he touched, whether it was inventions or science or, you know, doing good or he he was a politician.

He ran for office several times. Uh Uh Uh you know, he was a world-class printer, uh author. His autobiography is still one of the 50 great books in American history. That's the one thing he was not world-class at. world-class at. world-class at. I I think about this a lot. People even people we admire are complicated and not just one thing. Like John Lennon, for example, he on the same record where he recorded Imagine, you know, he's talking about world peace, there's a diss track against Paul McCartney called How Do You Sleep?

And so like, you know, people are complex and so I take your point about um about Ben Franklin. A- Anyway, but there's a lot to be learned from that man about doing good in the world. Indeed. Go through your six rules. Um the first, and I love the way you've titled these rules especially as a a Jew, the first is don't be a schmuck, which is the type of thing my father or my Jewish uncles might have said to me when I was being a schmuck.

So, hold forth on that. What do you mean specifically by don't be a schmuck? Yeah, that's what my father said to me when we did stupid stuff and he used to bang the back of our head with his hand uh going, "What is being a schmuck?" Well, it's taking unreasonable risks. It's doing something stupid and taking too many risks in life is certainly doing something stupid. Um and, you know, there are a lot of things that we know, you know, we know smoking, vaping, taking hard drugs.

Those are pretty stupid things. They shorten your life. They are not for your benefit. And, you know, not taking vaccines. RFK Jr. is asking you to be a schmuck when he suggests not taking a vaccine. You know, increases the safety of your life, prevents you from dying or suffering many diseases. Let Let me just, you know, one of the vaccines I'm really hot on is the shingles vaccine. Prevents painful illness. Um, you know, some people even end up in the hospital in the bed because of shingles.

But also, recent research suggests that it decreases your risk of getting dementia by 20%. Well, if I can get two shots and decrease my risk of having dementia by 20%, I'm a schmuck if I don't take it. And so, that That's being a schmuck. So, when I was researching the book, I was like, "What's the schmuckiest move people do in life?" And so, I thought it was base jumping. Maybe you have You know, base jumping is where you put a squirrel suit on. You've got an arm and it it's got some wings on it and you jump, no propulsion, no parachute, and you're at the whim of the wind.

And wind. And wind. And you know, the injury rate is every one in 250 uh jumps ends up in a serious injury. And it turns out one in every 2,500 jumps is death. And a lot of the people who do base jumping expect to die base jumping. That seems to me to be a pretty schmucky move. But then I found something even schmuckier. schmuckier. schmuckier. Climbing Mount Everest. People pay a hundred, hundred fifty thousand dollars to climb Mount Everest. They practice. Turns out the risk of dying, Sherpas, expert mountaineers, certainly the tourists who pay to go up there, one in a hundred, all comers.

And then, if you're over 59, it's one in 25. Now, what could be schmuckier than you know, one in 25 chance of dying to climb Mount Everest? That just seems to me insanely risky. Um, for most of us the the the probably the riskiest thing we do um every day is turn on the ignition of our car and drive. Yes. Yes. Yes. Um, that's a pretty schmucky thing, but we all do it. We've built it into our risk profile. Um, I hate driving. So, that's what don't be a schmuck is.

Don't take unreasonable risks and do things that prevent you. Now, I talk about in that chapter, I talk about taking your cancer screening test, whether it's for colon cancer, if you've smoked, for lung cancer, breast cancer for women, cervical cancer for women. And I have a many pages on the prostate specific antigen for men, PSA test. I'm against it. I explain why I'm against it. I also give the other side and I say, you know, the guideline recommendations are for men to take it, stop taking it at 75.

I don't agree, but you know, and I give you my reasons. But, I leave it to people to decide. Well, okay, so you're saying I'm I'm a man of a certain age. By the way, because I want you to like me, I'll tell you that I I did get my shingles shots a couple of years ago. Excellent. But, I but the PSA test, my doctor runs it every year. Are you saying that I should say to her, don't do this? I've got mine tested four times, uh and I explain in the book how I got it tested four times against my will, even though as you probably can tell, I'm a pretty strong-willed person.

And I'm a knowledgeable on college, yes, who knows something about Look, here's the here's the the line with the PSA test. Um it is true that the PSA test will reduce your risk of getting prostate cancer and dying of prostate cancer. That is true. One in a thousand. Uh that's how what the reduction is. One person in a thousand will be saved. But, it won't reduce your all-cause mortality, which means it won't save an extra day in your life. And why is that, you might say?

If if if I less risk of dying of prostate cancer, why won't it actually lengthen my life? Because the men who get prostate cancer tend to be older. They tend to have other diseases. And if they don't die from prostate cancer, they'll die from one of those other diseases. In the oncology world, it's tip Some men do die of prostate cancer, but typically men die with prostate cancer, not from prostate cancer. And that means that they're dying of other things. So, it's true. You won't die of prostate cancer.

You will die of something else at about the same time. And so, my point is I don't care what's written on my death certificate as the cause of death. I just care just care just care how did I live up until that moment? And prostate prostate prostate treating prostate cancer is not benign. You know, they take the prostate out. There's a risk of impotence. There's a risk of incontinence. If you get radiation, there's also a risk of damage to your colorectal system. And so, you can have bad diarrhea.

It diarrhea. It diarrhea. It just not worth it in my opinion. And if you get a positive, you know, over four, over four, over four, then you're going to spend a lot of time worrying and anxiety. And that's not a pleasant place to be either. I'm a little bit haunted by the fact that I was hospice volunteer for a while and there was a youngish man in his 40s who was in there dying of prostate cancer. And and yeah, so that story hangs over me a bit.

Yeah, no, I understand. Anecdotes are very powerful, especially if you experience them first hand. And then you have to say, well, how many people get prostate cancer at 40? And how do I compare that risk to everything else I'm going to have in my life, you know? Just the other day, I was riding one of those city bikes in New York City to get from Grand Central to Penn Station. And you know, there are cars that you believe are aiming to kill you. They may be.

You know, I do that all the time when I'm in New York. And so, you have to take your risks and decide which ones you're going to accept. I have a pretty good idea about what the risks there are. And I don't think taking a prostate test is going to save me from the 40. If I If I'm destined to die of prostate cancer at 40, PSA isn't going to help because I won't even be starting it then. Right. Right. Right. Okay, so Okay, so Okay, so let's get to some other quick recommendations from you that fall into the category of non-schmuckiness.

Um in other words, you should do these things in order to not be a schmuck. One is wear your sunscreen, and the other is don't have a gun in the house. We have a lot of I mean the the wear your sunscreen is mostly directed at younger people who think somehow, you know, this is bad for you. Uh getting a sunburn is a good thing, you know, going to tanning salons is a good thing. Wrong. Wrong. Wrong. Now, you do need sun, and it does have positive benefits to the skin.

So, I do think that there's some time every day, and for example, I do not wear sunscreen on my face when I go bike riding cuz I do want to get some sun. It produces vitamin D, and there are some other benefits. But, But, But, especially if you're younger, getting burned is a prelude to very bad melanoma skin cancer, and that's not a good thing. thing. thing. And, like you, I've been scarred by treating a very young man who happened to have red hair and lots of freckles, who was a police officer in Massachusetts, and at 28 got a melanoma, and it was metastatic to his brain, and it was one of the most awful deaths of all the cancer patients I treated.

He had to be in a dark room, and he was in excruciating pain the whole time. It's not a good way to to to live. Ignoring your sunscreen and and doing tanning beds bad bad idea. Guns are, you know, owning a gun, you know, look, people worry about violence, worry about people, you know, getting shot in their neighborhood or what have you. First of all, we should all recognize the gun violence rate is actually lower than it's been. it's been. it's been. We're actually safer. So, your worry about that is a hangover of a little bit of the past and not current.

And having a gun actually increases your risk of dying by a gun. And that's counterproductive to a lot of people. I got a gun, it's going to protect me. No. First of all, the most likely assailant likely assailant likely assailant if you die by a gun, turns out to be a friend or relative who comes into the house and you get in a argument or something. It's not some random stranger in the neighborhood. That's just very rare. Second, unfortunately, a lot of people store their gun loaded and unlocked.

They want to use it quick. Kids then have a tendency to go into the dresser drawers or the nightstand drawers, find this loaded gun, and then tragedy strikes. You know, gun violence is the number one cause of death of young kids. young kids. young kids. Go figure. And it's not because they're caught in a robbery or something. It's because they got a gun at home and by mistake pulled it and it was pointed in the wrong direction. So, if you want to be safe, be safe, be safe, don't own a gun.

That's what the data show. And I'm a guy who says, here's what the data show. And I would live by the the data. And this is a study of 18 million people in California that suggests that owning a gun is bad. It also dramatically increases the risk of suicide by people just cuz, you know, people might get depressed and then they, you know, reach they have a gun that's handy. that's handy. that's handy. If you have to figure out, well, I got to go to the pharmacy, I got to buy this, and this, and this, and you know, that the sort of blues that might induce you to suicide pass and you can't effectuate it and that that's kind of important.

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To learn more, head to bioptimizers.com/happier. bioptimizers.com/happier. bioptimizers.com/happier. That's bioptimizers.com/happier That's bioptimizers.com/happier That's bioptimizers.com/happier and use the code happier to get 15% off your order. You'll also receive free gifts and extra savings automatically applied at checkout. Okay, let's move on to your second of of the six rules. Don't be a misanthrope. You also referenced this earlier as the probably the number one most potent intervention for longevity. Please say more. more. more. Yes, I mean, you know, uh turns out that as Aristotle said 2,500 years ago, man is a social animal.

Interacting with other people is what makes us unique. It's also what makes us, um you know, powerful in this world. We're not the fastest animal in the world. We're not the strongest animal in the world, but we can collaborate and together we could do amazing things. So, you know, we got a spaceship up there at the moon, right? And that's a result of collaborations of tens of thousands of people and it's an amazing thing to do. That is that social interaction is important. Now, a lot of people say, "Yeah, it's important psychologically." No, it's important biologically.

Having friends, talking to people, being able to reveal yourself to someone changes your biology. It changes your brain. So, you release dopamine, you release oxytocin, the so-called love hormone. It makes your hypothalamic uh pituitary uh adrenal axis that releases cortisol, a stress hormone, down-regulated. And we also know that if you're isolated or lonely, you have more genes that turn on that are pro-inflammatory and just uh bad for your body. So, the fact is that biologically friendship changes the brain and changes your body for the better.

If you have friends, you are actually going to live longer. And that And the other part of it is we've studied 3 million people worldwide about this and found out that in fact people who have more friends, higher quality friendships, they see people more, they interact more, actually live longer, have reduced risk of mortality over the next uh 8 10 years depending on how long you live. And there are a lot of studies to that effect. So, good strong friendships really important. One of our problems in the world, um and it's not just the United States, but it's worldwide, is worldwide, is worldwide, is we're actually going in the wrong direction.

We're eating more meals alone. We uh many more people have uh one or zero friends. 19% of the population have one or zero friends. I mean, what's that about? Um and over half the meals are now eaten alone. That is terrible. You have to be with other people. And it's not just these strong, you know, intense relationships with your closest friends or your closest siblings, it's also casual conversations with people you just just just happen to meet cuz they're sitting next to you. I'm going to take an Amtrak train this afternoon.

There's going to be someone sitting next to me probably. I'll talk to them. Or, you know, my Uber drivers. You know, in Washington D.C., there are lots of um Ethiopian Uber drivers. And every time I see one, I I say, "You're from Ethiopia?" They say, "Yes, how do you know?" And you know, it's a I I've been to Ethiopia five times. And then we have a whole conversation. They light up because someone has recognized them and seen them and engaged them about their home country. I feel better.

I've learned something about them. They feel better because they been seen and engaged and been able to talk about themselves. You know, it's it's a it's a good thing all around. It's virtuous. Um And it's a casual conversation, you know? 15 minutes later, the Uber drop ride is over. And you know, he feel the driver feels better. And I feel better. Yes. Yes. Yes. And there's a lot of research around these so-called micro interactions that Barbara Fredrickson has done. And it's it's just we're leaving money on the table table table when it comes to happiness by ignoring the this opportunity that that just surrounds us all all day every day.

This might be a good time to say a little bit more about your relationship with your brothers, which again I've just followed from a distance for decades. Ari Emanuel is who you referenced is a big-time Hollywood agent. And Rahm Emanuel was chief of staff in the White House, also mayor in Chicago. The sense I get from the outside is that you guys are in contact all the time. Am I right about that? How is that structured? Tell me more. So, to tell you the truth, as we've been talking across the top is is comes in my text messages.

He texted twice and two of his kids also texted. We have a family chat of of 15 of us and yeah, so I don't know. He just texted me about space. He's like he seems to be pretty preoccupied by the Artemis project. Turns out my wife is expert on space travel and the history of space travel. So he's texting everyone about this great part and you know, Sunday I think it was Ari and I talked five times day. So and we're all going to see each other this coming weekend to celebrate Ari's birthday.

So we are very close. I can say this pretty definitively. There isn't a week that goes by that we're not in contact and typically contact multiple times in the week. Also it extends down. It's not just them, you know. Rahm's son just until a week ago lived in the city, would come over for dinner pretty regularly. When his daughter also lived in Washington DC, she would come over pretty regularly. pretty regularly. pretty regularly. Ari's eldest for a while he moved out of the city about two years ago.

Also lived in DC, would come over for dinner. So we're pretty close with them and that my daughters and all the other cousins are pretty close. So we try to breed a kind of family closeness. I describe this in the book one time. We're sitting at the table and the phone rings and my wife says, says, says, "It's Ari." "It's Ari." "It's Ari." And I was like, "Yeah, we were at dinner." And and she said, "Oh, take it. It'll It'll be less than 90 seconds. You never talk more than 90 seconds." seconds." seconds." So you know, we talk a lot and one of the great things about you know, now more than 60 years of being siblings is you know, we can talk in a way that no one understands cuz there's so much background to every word.

I know exactly what my brother is saying, even when he talks in Morse code. And I think this is uh it's one of the great things about friendship is you don't have to get someone up to speed. But, it does take a long time to get to be that close with someone. It doesn't happen overnight. It's not oh, it's quality over quantity. No, you need quantity to get quality of friendships. You need to have a lot of time together. And I think that's as I point out in the book, it's one of the reasons some of our deepest friends are people who became friends in college, where you got midnight bull session, you're hanging out together for, you know, all the time.

And in my brother's cases, you know, we lived in the same room for years together. And, you know, we we hung out. We spent lots and lots of time together doing all sorts of interesting things and getting into trouble together. So, you know, it's like really really fun. It's beautiful. Um my friend Glenn one of my closest friends often says, "It's hard to make old friends." Which is true. is true. is true. Yes, that's a great line. Yeah, it is a great line. One quick supplemental question I want to ask you before I move on to rule number three.

You you referenced texting and the phone a couple times in the course of this, but I I believe in the book you argue that when we're in a social situation, we should put the phone away. Don't have it on the table. Correct. So, the data are um pretty convincing that if even on silent, if the phone is within your visual field, your mind is at the phone. I wonder what's happening. You know, we check the phone 144 times a day. So, say you're up 16 hours, you know, that's checking the phone almost every 5 minutes throughout the day.

Even if it's not ringing, and that's a lot of mental focus over there. And if when people that I mean they've done the study uh go out with a family member or a friend and you can have the phone silenced on the table. It turns out that the people who have it on the table compared to people who don't have it and it's away, it's away, it's away, they actually have less enjoyable dinner, they're think the conversation is less interesting, that they learn less just by having the phone there.

There's a kind of mental distraction just by having it in your visual field. I know this personally because two years ago ago ago I I had always told students you have to turn the phone off. But then I said, "I'm banning the phone. You've got to turn it off and put it in the backpack away from the desk, so it's not even visible." Now some students try to cheat on it, but we catch them. Turns out that my teaching evaluations shot up. And it's like I did nothing different.

Same lectures, same, you know, Socratic method asking questions of students. Why did it go up? Students were engaged. They were paying attention. They weren't on the phone and they weren't their mind wasn't sort of being distracted. And I think that's a very important element which we don't pay attention to. Um and similarly when you're going to bed, you should put the phone in another room and you should not look at the blue light. You shouldn't have it anywhere around, so it's not distracting your mind. mind.

mind. One more question actually on on this social connection piece. You have argued and I I I make the same argument in my public pronouncements a lot that that this is the lever to pull if you care about longevity and by the way it's also the lever to pull if you care about being happy. You also however mentioned purpose and I've heard it argued um in fact my friend Richie Davidson was on this show recently made the case that purpose is one of the most powerful predictors of a long and healthy life.

I don't have access to the data at hand, but it's something to that effect. And so, I'm just wondering, are these related? Are they different? Like, how do you Which one's more important? How do you think about all this? Look, are there people who can lead a purposeful life and be somewhat socially isolated? And I think the answer is yes, there are those people, you know, solitary brilliant scientists or solitary brilliant writers. Um although often they have other quirks and elements that might not make them happy.

But in general, I think it's uh our purpose involves doing things with other people and for other people. Um again, Ben Franklin knew this. He created lots of social organizations. His Junto, he did a lot of research, a lot of scientific research on electricity was done in collaboration with other people. And I do think they're related. We are social animals. We do undertake projects with other people. And it's very productive because, you know, our ideas bounce off their ideas. You look at startups, and I work with a lot of startups in the healthcare field.

And one of the things that's um uh very common is co-founders. And why is it co-founders? Cuz you're bouncing ideas back and forth and you're generative with up someone else in a way that is very hard. There are some people who are really talented and can do it all alone. I've known uh three or four of them. But in general, it's that collaboration, that working together that uh generates a purpose, um a shared purpose. We want to start a company to do this. And gives you satisfaction of, you know, uh work solving a problem.

So, I think there's a big element of the collaborative uh in purpose. And I think they feed as you put it so eloquently, they feed off each other. each other. each other. Thanks for clearing that up. Rule number three, don't be a dimwit. Uh what does that mean? that mean? that mean? So, um I like to say I know what a horrible uh old age would be for me. me. me. And that's my body is great, you know, uh the heart's working, the lungs are working, working, working, uh all the circulatory system's working, liver's great, liver's great, liver's great, but my mind is gone.

Uh that would be hell. That would be the worst situation to be in. Being dead would even be better than that. And so, you know, our brain does deteriorate as we grow old, and so we need to actually intentionally intentionally intentionally maintain maintain maintain uh cognitive intactness and cognitive engagement. Um and there are multiple things we can do. Now, some of it's genetic and you're not going to alter that, right? That you know, we've learned uh that if you have APOE4 and you have two genes of that, you're much higher risk for early for Alzheimer's and early Alzheimer's.

So, there's a big genetic component. But, there are things we can do. And, you know, we talked about the shingles vaccine as one. Exercise, another. Not eating ultra-processed food. Here's another one. Get more education. So, get that master's or PhD degree. What does it do? It makes more neural connections, and when the neurons die and neural connections get paired back, right? You start from a higher level. And so, the cognitive impairment will happen many years further than someone who hasn't gotten as much education and doesn't have as many neural connections.

Um so, those are things that we can do that does help us forestall. Another important one, and you know, this is one of those areas where the the data are, you know, mind-blowing in my opinion. You know, if you look at what happens when people retire. Um it turns out retirement is really potentially very dangerous to mental functioning. functioning. functioning. Why is that? Well, we're not 100% sure, but we do know that in countries where the retirement age is early and people tend to retire younger, uh the cognitive decline happens sooner.

And we know that there's a sort of cognitive decline when people retire. Partially, that's because work has a lot of functions to it. It forces us to keep Uh Uh Uh we have a social network at work, so we're engaging with other people. We have mental challenges at work, problems that we need to solve. And when we take all that away, right? We end up in bed, we don't get up at a certain time, our social network shrinks, uh we don't have as many challenges, uh we substitute for the hard work we were doing, we substitute passive watching of TV or some other passive function, and the brain goes to mush.

This again is something Ben Franklin knew, and I have a lovely quote in the book. Ben Franklin said, "Well, the man who thinks uh the life of pleasure is going to be good for him." It turns out, no, it's not a good thing, and it's it's bad for the brain. And that that generally is true. So, in addition to doing all the wellness other wellness activities we mentioned, keeping mentally engaged is important. So, what can you do? Well, we know taking up a musical instrument really, really important.

It has a visual, auditory role. It also requires muscle coordination. Um so, there are lots of things in that. Similarly, for taking up a language, visual, auditory, and muscle connections in the mouth. So, there are lots of things you can do. You know, you know lots of people they take up gardening, or they take up art, that you know, pottery or painting or something. Um Um, all of those are good, but you have to do them, you know, intentionally. You can't just let them go. Uh, you know, occasionally I'll take a guitar lesson or whatever.

Similarly, I think it's important to keep up those social interactions. So, learn how to cook, cook better, finer, become a, you know, a a a master chef and have people over for dinner and dinner parties. And that that's another great way to keep mentally sharp. mentally sharp. mentally sharp. What you didn't mention and what I would argue should be on the list, but I'm curious to hear your POV on this on this on this is meditation. is meditation. is meditation. Look, I I have a point of view of I can't meditate, so I can't tell you what the value is.

Wait, wait, wait, wait. Hold on. Hold on. You can't meditate. Let's unpack that. Say, why do you think you can't meditate? I've probably tried uh meditation and mindfulness, I don't know, five, seven, eight times and, you know, I get in that every time. You know, it's like, I got to get up. I got I I can't My brain doesn't go to where it's supposed to be. So, look, I did I did Taekwondo with my kids for years and years and, you know, they would like to uh end every class with uh a meditation and I was like, I just got to get out of here, man.

This is like I this doesn't work for me. Um, so, I have never been able to meditate and, you know, people say, well, if you have sleeping problems, you know, try meditation. Yeah, you know, doesn't work. I can't meditate. So, um I don't know, maybe I'm just a failure at meditation. The other thing I would also say is, you know, think about experiences experiences experiences that are going to open you up. So, one of the things um I don't really talk about this in the book, but one of the things about a decade ago I committed to is each year trying to do something serious that's out of my usual career comfort zone.

Uh, decade ago I made my first chocolate. Um, I learned went out and harvested the cacao beans, learned how they fermented and dried and then roasted and we made and I packed, you know, I did everything. Conched it and the sugar, played it, uh package it. Took a whole week to make about 2,800 bars. That was a very good bar. It won some awards. Most recently I've made my fourth chocolate bar. Also won a lot of awards. Good chocolate with dried cherries. And I have a collaborator who I who's uh chocolate I mean he's a real chocolatier.

I'm just a uh actor. But I've I've tried to do that separate things. Last year I did honey. I just put a couple of beehives in the back in my garden help me learn how to do raise bees and harvest the honey off the frames. Um so, you know, uh challenge yourself. Do something that you don't normally do. Have an experience you don't normally have. Um have. Um have. Um that's also very good for staying cognitively engaged and intact. I love that. It's really cool. Um I I do want to say a word about meditation, but I want to preface what I'm going to say by saying I'm not trying to convince you to do it.

I never try to convince anybody to meditate. So, this is not me bullying you in any way. But just to say uh I think it's hilarious that you say I got an F because you were the one giving yourself an F. And often what people who believe what you believe uh i.e. I cannot meditate. Often people in that position are laboring under the misconception misconception misconception that they need to clear their minds and that if they're having thoughts like I want to get the [ __ ] out of here or whatever, that that equals an F.

But the truth is we all have these crazy thoughts. The point is not to stop thinking. It's to notice when you're thinking and start again and again and again. And the the doing of that, the noticing, oh yeah, I just got carried away by this restless thought and then and back to your breath or whatever you're trying to focus on is the bicep curl for the brain. It's the mechanism by which the brain changes. So, again, I'm not trying to talk you into anything, just giving you some facts.

All right, maybe I'll try it again. You know, if ever we're in the same city, I would give you a one-on-one lesson and I would make it super short. Okay. Okay. Okay. Um you got a deal. Okay, great. And again, you feel free to never take me up on that. Quick word about Eight Sleep, which my family and I are genuinely enjoying and using every day now. The frame that fits today's conversation with Dr. Immanuel is that longevity is not about adding decades on the back end.

It's about how well you function in the decades that you actually have, and the lever that gets pulled every single night, whether you pay attention to it or not, is sleep. Eight Sleep makes a product called the Pod, which is a cover that goes on top of your existing mattress. It heats and cools each side of the bed independently and automatically anywhere from 55 to 110°. It tracks your heart rate, HRV, respiratory rate, sleep stages, all without having to wear something like a ring or a watch.

Eight Sleep says the Pod is built on over a billion hours of sleep data. Their own clinical studies suggest users can get up to 34% more deep sleep and fall asleep up to 44% faster. Individual results vary, and the usual caveats apply here. The Pod is not a medical device. Here's why I keep coming back to it, though. Most of what's gets sold to us as longevity tech is asking you to do something. You got to take something, track something, optimize something. The Pod is the rare thing that just does the work while you're asleep, and the way it tracks how you're sleeping is so elegant and so informative.

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Lesson number four or rule number four, don't be a glutton. Please say more. Well, that chapter on eating and eating well is well is well is uh uh uh uh the longest chapter in the book because there is so much to say about food and the food system. I'd like to boil it down to here are four things that are the sort of core and then there's a lot of other stuff you can do. And uh you know, if food is a sort of central focus, central focus, central focus, okay, then you'll read the whole chapter.

If food isn't a central focus, here are the four things you really need to do. The first is stop with the sodas and sugary beverages, okay? Soda, you know, 12-oz can of pop uh has 140 calories. 140 calories. 140 calories. That's 10 teaspoons of sugar, 10. You wouldn't drink water like that, but you drink the soda like that. And there's zero zero nutritional value. No proteins in it, no fiber, nothing of use. Stop with the sodas, okay? That's 140 calories if you just drink one and if you drink two, it's 280 and you're already over 10% of your daily caloric intake.

Uh so, don't do that. And you know, for some people it's hard. Look, I grew up drinking soda. Uh I stopped drinking soda in high school when my running coach said, you know, stop with the carbonated beverages, not good for you. Um I occasionally had I like the burn of of ginger beer, especially a good homemade ginger beer. Um you know, once every 2 months or something I'll have uh one of those. Second is ultra-processed food. Now, we in America are the kings of ultra-processed food.

Uh we almost 60% of our caloric intake is ultra-processed foods. Way, way too much. Compare this to the Italians where it's 20% of their diet. Huge gap. And you know, if you like Italian food and you like if you ever go into Italy and eat eaten there, you'll know that they don't they don't have ultra-processed foods uh commonly. Um it's all that packaged stuff. And top of the list is over the last 30 years the amount of packaged sweets, you know, muffins, cake, cookies, pretzels that we consume has gone up to 500 calories a day.

We often think that, you know, that muffin in the morning with a cup of coffee, that's breakfast. That isn't breakfast. That's just dreadful for you. Uh the coffee's good for you, but the the other stuff is dreadful. Just eat cut back on that. You know, now occasionally you'll have a hankering for something, you know, I mentioned in the book I used to feed my kid Milano kids Milano cookies, you know, all right. Now occasionally they you know, uh uh uh they might serve it on the airplane.

I understand you want to eat it, but cut way back on it. Those are the two stops. And if you just do nothing else, do the stops. stops. stops. Then here's the two positives I say. And and this is probably not what people are expecting. In this moment everyone's obsessed by protein. They're probably expecting more protein. No. Americans almost uniformly get enough protein. You have to be a vegan and not really s- thinking about how am I getting my protein to not get enough protein. But uh almost everyone else gets enough protein, more than enough protein.

protein. protein. The first one is fermented foods. Yogurt, cottage cheese, alpine cheeses, kimchi if you like kimchi, sauerkraut, uh pickles. Fermented foods. Fermented foods. Fermented foods. Why are they good? They're good because they have those bacteria that are good for the microbiome. We're just beginning to learn enough about the microbiome, but there's a lot of things we do know about the microbiome that it's really important important important for keeping the colon healthy and uh making sure that we absorb the right nutrients. So, that's the first.

The second is, you know, almost every American does not get enough fiber. Uh and so, forget the protein, focus on the fiber. 93% of Americans do not consume enough fiber. And all you need is like 30 35 g a day. And I often say to people, you know, look, start out with a bowl of fruit and yogurt and uh some granola, you know, oat-based granola, and granola, and granola, and hemp hearts, and you've got a great breakfast, okay? You've got fiber in the fruit, you've got that yogurt with the lactobacilli and all the other bac- uh the bacteria added to it.

You've got protein and omega-3s and sixes in the hemp hearts and in the yogurt. Um it's a great meal. great meal. great meal. And then end the day and have a salad uh at night, and you're almost all the way there to uh enough fiber. But people don't eat enough fruits and vegetables in the United States, partially cuz we subsidize all this ultra-processed foods, whether it's the corn, the soybeans, the wheat, the rice, and we don't do a good job of subsidizing fruits and vegetables, very very little.

You want a snack? Don't eat the, you know, muffin, eat some nuts. Nuts are very good in protein, very good in fats, uh very good in fiber, uh much better snack for you. So, those are the four rules. Now, there are, as I say, many, many other rules, things like, you know, what about organic? No nutritional difference, but you know, you know, you know, organic doesn't have the pesticides. Now, do you think pesticides are good or bad for you? Let me just make a suggestion. Almost all of us, if we could afford it, would not would eat organic and not have the pesticides.

And by the way, the pesticides don't stop being pesticides when you consume them. They go down into your gut and they're still pesticides. That's not pro- probably not good and it may in fact be, you know, this is hypothesis, not fact, um tied to, you know, the increase in the colorectal cancer and cancers of young people. young people. young people. Okay, just on nutrition, the obvious question is the book is called Eat Your Ice Cream and you were running down those poor Milano cookies uh uh not 5 minutes ago.

Uh so, one might be tempted to conclude that you're anti-dessert notwithstanding your chocolatier side hustle. So, uh explain that. Absolutely not. I'm a big baker. I love to bake. Let's talk about two things. One is desserts in general. Look, um I like desserts uh and uh I cook, you know, make it special. Don't eat a big dessert uh you know, a quarter of the pie every night. Uh but, you can have, you know, once or twice a week, two or three times a week, you know, a piece, a small piece.

And it depends on what you're eating, whether it's got nutritional value. You know, you have a fruit compote or you have uh fruit uh tart. Um that can have a lot of fiber and a lot of other advantages. I love to make my mother's cheesecake. I don't do it often, you know, once every 3 months maybe. My wife was just reminding me, you haven't made it in a long time. Maybe we should um Anyway, my point is point is point is it it's an occasional thing, not a everyday thing.

Ice cream and I just reached over because near my right hand is this article from 19 2014, dairy consumption and the risk of type two diabetes looking at over 150,000 Americans and hidden in a chart and you can't read it in the abstract but hidden in a chart is the most important thing for decreasing your risk of type two diabetes turned out to be ice cream. And then yogurt and it turns out ice cream is dairy. is dairy. is dairy. Dairy is good. That's one of the principles in this book.

Not everyone agrees with every word I've just said about dairy being good. There are some people who say well it's also got some bad aspects. That's probably true but in general it's good for you and ice cream turns out to be good and it also I again this goes back to the start of the conversation in your first or second question which is look part of wellness is having joy and who doesn't have joy when they eat good ice cream really. cream really. cream really. Now you have to avoid the crappy ice cream.

cream. cream. That's stuff with the emulsifiers the polysorbate 80. Those things are dreadful for you. Don't eat that. If you're going to eat ice cream you have to get ice cream with as few ingredients as possible so that they're you know they got milk sugar and you know the flavoring that you're going to enjoy. to enjoy. to enjoy. So that's that's the way I view it. This is radical. behind me. behind me. behind me. You know I I love it. This is radical and energizing news.

I'm going to mouth some ice cream tonight. I believe you and I think you coined this phrase and I love it and I really agree with it. Moderation is the new discipline. Absolutely. My philosophical colleagues I have a very dear friend and he he's a philosophical sort. He said I read the book and you're like Aristotle for the modern age. It's all about moderation not too many extremes. Look the body we know is well balanced and actually opposes the extremes. You know, too much inflammation, bad.

You get autoimmune disease, a lot of inflammatory diseases like arthritis or ulcerative colitis. Too little, Too little, Too little, liable to infections, right? So, we know the body has a lot of these control mechanisms. Turn something on, but then turn it off, uh or turn it down and then be able to turn it on when, say, a new foreign body comes in. So, we use that and it's really important. What the body doesn't like is going to one extreme or another. another. another. Um and that I think is very important.

And I think the same thing for thing for thing for uh the rest of life. Virtue is sort of in the middle and that's a very both Aristotelian notion, a Ben Franklin notion, and you know, it's age-old wisdom. wisdom. wisdom. Uh just adhere to it. And I do think it it's very, very important. You know, one of the things again which sort of pissed me off about the uh influencers in the wellness industrial complexes this lurching to extremes. If something must be good, more of it must be better.

No, it doesn't follow doesn't follow doesn't follow at all, you know? There are tox- there's lots of toxic things if you have too much of something. Do you believe that we can moderately consume alcohol? consume alcohol? consume alcohol? So, this is a very important question um which I've been asked myriad of times and it opens the book. So, there probably is uh uh based upon the science, science, science, no level of alcohol or a very low level of alcohol uh that's healthy for us. We know, you know, alcohol's tied to seven different cancers, bad for the liver, bad for the brain cells.

Um nonetheless, human beings have been drinking alcohol forever and literally because animals are also interested in the little buzz they get from alcohol. Oh, a lot of primates will go after fermented uh fruits that have a little alcohol in them. Birds do the same thing. thing. thing. So, there's something biological in the attraction to alcohol. 65% of Americans are drinkers. 30 30 35% are teetotalers. I I'm a teetotaler. I don't actually I will taste a very little bit of my wife's wine just to uh know if it's a wine I like, but I in general I don't like the flavor of it.

But, I don't tell people no alcohol because you're not going to get 65% of people to stop drinking alcohol. And what you can get is to tell people, "Look, here's about what's safe, and it's about it's about it's about uh uh uh three to four drinks a week, half a drink a day, and you really shouldn't be going up. And binge drinking, drinking five or six drinks at a sitting, really bad for you. Don't do it. Drinking alone. Drinking alone. Drinking alone. You know, if one of the advantages of alcohol is to be in community with other people, to grease the social interaction, interaction, interaction, then drinking alone is antithesis of that and doesn't it's hard to justify that.

And don't drink to relieve your sorrows cuz that is not a good way, you know, be with other people. So, if you're going to drink, drink with other people to relieve your sorrows. So, I think I think thinking of those rules and putting it in context. So, if you're going to have a dinner party and you're going to break out some wine, sure. It's a way of, you know, having a nutritious meal, having good conversation with other people, and if wine is the grease of that, all them that's fine.

It seems to me the right thing as long as you again do it in moderation. moderation. moderation. Um so, that's my view about drinking. You know, I'm not a a nag about this. It's not like, "Oh, you drink and you're a bad person." That's That's not I'm going to get you anywhere. anywhere. anywhere. Related to uh food and body weight, where are you on GLP-1s? GLP-1s? GLP-1s? Great, miracle drug. They were invented for diabetes, then they we realized, "Oh, they can cut down overweight by 20%," which is huge.

They reduce the risk of heart disease, they reduce renal failure, um failure, um failure, um and lots of They have lots of other benefits. And then, who knew that they cross the blood-brain barrier and affect your reward system and addictions? Amazing. And there are plenty of people who It's not a matter of willpower, it's a matter of how they are that they have trouble with their weight. I luckily am not one of them, but those people need help. You know, if you're obese at 20, you know, you you're losing 10, 13 years of your life.

If you could take a drug and reduce that risk substantially, risk substantially, risk substantially, it it's therapeutic and it's a a benefit. But, the idea that, you know, we're going to feed kids ultra-processed foods, get them addicted to that, and then treat them with GLP-1s, that is not a formula for success. That is idiocy. Okay? We have to change our food system, and that I think is uh one of the unsung issues. You know, we didn't get fat as a society over the last five or six decades decades decades willy-nilly.

It is a direct result of a food industry that made ultra-processed foods, you know, high in fats, high in salt, high in sugar, and made us addicted to them, uh and made it easy to buy, made it cheap, subsidized the ingredients that go into that. We have to reverse all that. It's one of the things that I agree with Maha about. So, that I guess my first political statement. political statement. political statement. Well, no, you know, we've run down RFK, uh so it's your second political statement.

Uh statement. Uh statement. Uh This was in relationship to vaccines uh a while back, but I'm cool with them running down my and I think they may be right about a few things, but stopped clocks are right about a few things as well. Two more rules to get to. Rule number five is don't be a couch potato. Yeah, what say you on the exercise front? Look, one of the biggest problems in our society, and we have a lot of problems, is is is too many people are too sedentary.

Um and if I can just get most people to just go from horizontal to vertical and walking a little bit, that's actually the biggest gain in life expectancy you can generate from exercise. Exercise really, really important. Uh the body expects exercise. You know, there are three kinds of exercise. Each one is important. The first is, you know, what you usually associate with exercise, getting your heart rate up and your lungs up and you're breathing hard. Um that's anaerobic exercise. It's good for producing new blood vessels.

It's good for keeping the heart functioning and it's really important. And you know, the the lore out there is 75 minutes a week of vigorous exercise and 150 minutes per week of moderate exercise like walking. Um very, very important. And you know, you there are many things you can do and it doesn't require going to a gym. You know, as I said, you can walk. walk. walk. You could run. You could ride a bicycle. You could go swimming. If you live in a place that's where it snows, you can go cross-country skiing or downhill or downhill or downhill skiing.

skiing. skiing. There are lots of things you can do. One of the things you cannot do is play golf and go in a golf cart. You play golf, go in a golf cart, which 70% of Americans who golf do, that's not exercise. Zero exercise. You walk around with your clubs, that's about three or four hours of walking around. it's good, but it ain't vigorous. So, that's physical aerobic exercise. aerobic exercise. aerobic exercise. The second kind is strength training, getting your muscles up. This is especially important for people over the age of 55-60 because you lose muscle mass pretty rapidly after that.

So, you're losing about 8 to 10% of your muscle mass every decade. So, keeping up with strength training really, really important, especially as you age past 55. Uh lifting weights is one way to do it. Look, if you're riding a bike or running, you're getting a lot of strength training in your lower body. What you're missing is your upper body. If you're swimming, you're getting a lot of strength training in your upper body and you're missing a lot of in your lower body. So, those are, you know, you got to balance it out.

And then there's uh flexibility and balance, and that's yoga. Um and that I do do, and I'm, you know, uh I I've probably been doing it now for about maybe even as long as two decades, and it's very good to keep the muscles limber, especially if you're going out and riding on a bicycle. And, you know, I'm never going to return to, you know, be as limber as my 5-year-old granddaughter, who, you know, can do all these contortions. Um but I'm pretty limber for a uh 60-plus-year-old guy guy guy because I do 20 minutes of yoga every morning.

morning. morning. Rule number six, don't be a sheep counter. In other words, sleep. This is probably the the most difficult of the rules for two reasons. First of all, you know, Americans, we just don't get enough sleep. We're, you know, we work hard, we're driven, uh and uh we don't really end up with enough sleep in the day, and we want a quick fix to it. Want to take a pill, melatonin or some sleep prescription sleeping pill. Turns out those don't work. Don't take the pills, they don't work, they don't help.

That's not Seema Manuel, that's the American Academy of Sleep Medicine or the American College of Physicians or any number of medical groups telling you that really those things don't work. We have not found the GLP-1 of sleep. The other problem with sleep that makes it difficult and frustrating for people is look, you can will yourself to get on the exercise bike as it were, the treadmill. You can will yourself to eat uh all the right foods. You can't will yourself to sleep. You know, as you just said, you know, uh with meditation, the mind goes here, there, and everywhere and if you try to will yourself to sleep, you can almost guarantee you will not get any shut-eye of any value.

And so, uh you have to uh set the bed as it were, you know, cool room, dark, cover all those lights on the electronics that are hanging around, make make it quiet, but then you know, it's it's up to nature and that's that's our challenge. our challenge. our challenge. I many of my listeners know this, but I'm curious to hear your thoughts on this. I I've had a whole sleep odyssey, was diagnosed after 10-15 years of dealing with it. I was finally diagnosed with restless legs syndrome and there were two medications that have really helped me and I'm I don't take a proper sleep medications, but one is gabapentin, gabapentin, gabapentin, which is a nerve agent or something.

Agent's probably the wrong word, but nerve pain, I don't know, something. the It relieves nerve pain. Yes, it's a very important drug for us oncologists for patients who have nerve pain because of their cancer. Yes, very good drug. good drug. good drug. The second is trazodone, which it's antidepressant, but it can make you drowsy and doesn't, unlike Ambien, um screw up your sleep architecture. In in fact, for some people can actually improve the sleep architecture. At least that's That's I've been told. But I'm curious because I do find myself feeling this evangelical urge around trazodone because it has been so helpful.

What should I You know, where where am I wrong here? How should Where should I be cautious? If you're getting it through a physician who has is monitoring you and making sure that it's not having any serious bad side effects, that's the right way to take these kind of drugs. And it is you know, I think it's a It's wonderful that you were actually diagnosed with restless leg syndrome. It's not actually that commonly diagnosed for people. And so, I think a sharp doctor, whoever you were working with.

Um and I think again, it if you have it under supervision, that's super important in my opinion. So, I'm not I would not say uh that you're getting it wrong. I would just say you should not be self-medicating in this context. I guess that's probably what I'm really saying. Yes. Yes. Yes. Um and you know, a lot of people who go through this odyssey of having problems sleeping and not being able to find a diagnosis. Look, I I'm I'm one of those people, you know. I I get into bed, I get in and it's chilly, and then, you know, I sweat all over the place the place the place cuz I think my mitochondria are still working uh overtime.

And then, uh you know, I uh uh have a hard time falling asleep because and this happens to me very frequently when I'm writing my books is whatever is stuck in my mind, the last thing I was writing that was giving me trouble. It's like, "Oh, well, the mind is going trying to solve the problem." problem." problem." And it and it tends to impede my falling asleep. The other thing is, you know, it's very important there are a couple of other things you should not do.

So, alcohol and caffeine, you know, coffee, tea, and other caffeinated items like chocolate, you know, you can't have them 7 or 8 hours before you go to bed because of the half-life of them hanging around and disrupting your sleep cycle. And, you know, caffeine blocks the adenosine uptake breakdown. And so, that's a problem. It adenosine is a key sleep medication. It blocks the receptor there. receptor there. receptor there. And that's how it keeps you awake. So, no alcohol, no alcohol, no alcohol, no caffeine. Alcohol also, it might get make you sleepy, but the problem is that that disrupts your sleep.

It it interrupts with good high-quality sleep. And also, no nap after 2:00 in the afternoon because you won't leave your body enough time to develop and build up the adenosine that puts you to bed. A lot of people think it's melatonin that is the sleep chemical, but that's not true. It does go up before you go to sleep, but it's not what's activating the brain. That's adenosine. adenosine. adenosine. Let me loop back to something you said before about I'm glad you were saying that you were glad that I got a diagnosis.

diagnosis. diagnosis. You presumed I had a sharp doctor. I want to answer that. I want to say more about what happened there because it does lead to another question I have for you about being and staying healthy. So, the answer is my doctors did not figure this out. ChatGPT figured it out. So, I'm just curious not only for your perspective as an oncologist, but also as a health policy expert, you know, to what extent should those of us who are concerned with being and staying healthy interact with chatbots?

I've just gotten very interested in AI in medicine. I will say there's a great book out there. It's called The Giant Leap by my good friend and colleague Bob Wachter from the University of California, San Francisco. If you're interested in AI's role in medicine and and future, I would recommend that book. but here's my take and it's very it's somewhat complicated. Chatbots are getting better and better. Health chatbots are getting better and better. More doctors are relying on chatbots like Open Evidence to help them with complicated cases.

So, I am actually quite bullish about the use of AI in medicine to improve things like diagnosis diagnosis diagnosis and other items and I have seen a lot of people actually get benefit in getting either a diagnosis or a hint. I actually just used one for the guy who runs Zingerman's, which is a famous deli in Ann Arbor. He has a very complicated history and I helped him using a chatbot cuz he has he has a lot of different symptoms and it's hard to put them all together with it with Open Evidence.

Good. And those things are going to get better and better and better. Not all of them are the same and [clears throat] some of them them them Chat GPT is not actually great. There are others which are better. We're in a sort of interim stage where they're getting better, but they're still faulty in in many ways. So, I think it's it's important not to rely too much on them and there's still some safety concerns because they haven't been regulated in the right way and and actually we've got a article about how we think chatbots and AI should be regulated for health care and I don't think you can just pull them off the shelf.

Nonetheless, we know that people are using them. You know, most of the inquiries the the the biggest portion of the inquiries on AI is related to health. They're going to be used willy-nilly. We need a way of regulating them. We need a way of making sure that they all come up to a good standard, but I think they're going to be integral. They're going to be integral to for people to get primary care cuz we don't have enough primary care doctors. They're going to be integral to people in rural areas where you don't necess- it's harder to get specialists.

So, I think actually there's a very going to be a very important role for AI. I will I should also say I should mention my conflicts here. I actually work with a number of companies that are doing using AI to try to improve some parts of the healthcare system. So, I I'm actually heavily heavily heavily involved in that already personally as well as trying to write scholarly on it. So, that's my app I mean I'm glad ChatGPT helped you actually because I think it is it it is a recognition that, you know, you got a complicated situation.

Sometimes the AI can work better than people can. But I'm all I also presume ChatGPT did not prescribe for you the trazodone or gabapentin. Unfortunately, I think you have a doctor who can make sure that you're staying safe and you don't have any serious adverse effects. adverse effects. adverse effects. Yes, but I will say that ChatGPT recommended the recommend- Yes, well it's if I diagnose the restless leg syndrome, I'm sure it recommended these drugs. I've held you for a long time. This has been phenomenal. I've I've loved this conversation.

I do want to give you an opportunity if if there's anything we missed or anything you wanted to get to that we didn't get to. Is there anything You know, if I had to put parting words is look, several things. First, wellness is a long-term endeavor. It's not like I can do 2 weeks of it and I'm good for life. It it's got to be part of your life and you have to make it part of your life and you have to make it feel good.

You know, I when I go out bicycle riding in nature, it's great. My mind wanders so I can think of all the different things. I love looking at the trees or the fox or the deer that run across the road or parallel to it. I love being with my wife and being able to talk to her as we're riding uh, or when she gets annoyed with me going ahead. ahead. ahead. Make it something you enjoy doing. And find those activities. There are lots to choose from.

Find those activities that you also enjoy doing, that you look forward to do doing, that if you don't do, you feel a little deficient because of that. That's going to be the important thing. And don't make it all about yourself. Uh, part of the beauty of a lot of this wellness, social interactions, staying mentally sharp, eating and especially eating with other people or exercising exercising with other people, is that, you know, they're not just about you. You know, if you say to your friend, "Let's go out for a walk after dinner." You're doing your friend a favor, too.

Let's be virtuous. Recognize that. They might not have had the oomph to get off the couch had you not said, "You know, I'm going for a walk. Why don't you come?" I think we often look again at wellness as something obsessive about us, but it it can be it's a communal activity that can be really good. Every so often when I run, I will see a big running group or a big bicycling group, and it's like, yeah, this is social activity, and people are gaining a lot by going with others.

That's the bottom line about wellness in my view for the future. future. future. Amen. Dr. Zeke Emanuel, everybody check out his book. It's called Eat Your Ice Cream, Six Simple Rules for a Long and Healthy Life. I'll put links to that in the show notes. In the meantime, meantime, meantime, so great to meet you. Thank you for coming on. coming on. coming on. It's been fabulous. Thank you for such a wonderful interview. wonderful interview. wonderful interview. Thank you so much for listening to or watching the show, and thank you so much to everybody who worked so hard to make this show a reality.

10% Happier is produced by Tara Anderson and Eleanor Vassili. Our recording and engineering is handled by the great folks over at Pod People. Lauren Smith is our managing producer. Marissa Schneiderman is our senior producer. DJ Cashmere is our executive producer. And Nick Thorburn of the band Islands wrote our theme. Also, one last thing before you go, remember to sign up for my app, which is called 10% with Dan Harris. You can sign up for the app over on danharris.com. On the app, you'll find a growing library of meditations from many of the world's greatest meditation teachers, ad-free access to this podcast and our voluminous back catalog, exclusive live stream events, and robust discussion threads connect with me and with our teachers and our team and one another.

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