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

26:50We have a dear friend who every year goes on a hiking trip with one of her high school buddies still, or however you do those social engagements. I talk to my friends that tends to be while I'm driving because I can't stand driving. So it's a way of connecting. Or, you know, we host once or twice a week, you know, dinner, whether it's a Friday night dinner or some other dinner just to get together with people. Now, you may or may not have that. And we know that the eating alone phenomenon, unfortunately, is going in the wrong direction. We're having too much of it and not enough social life. The other thing you can do are what cause what are called weak relationships, which are sort of casual interactions where there might be some overlap, either by chance, you happen to be sitting next to someone on an airplane or train or what have you, or, you know, you keep going to the, to the same coffee shop, you can talk to the barista and engaging them, Not artificially, you know, just talking to them.

28:02One 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 a kiddie corner from her had a cup, a box of cupcakes from one of the popular stores. She asked her about the cupcakes. She got talking about the cupcakes. And she felt, you know, by the end of it, she was like, well, I feel like really good. And she went in and began doing a lot of systematic research. She switched her whole research focus to these relationships and their importance.

28:45And I think we underestimate. We often, you know, trying to buzz through life and be efficient and not talk to people. and it turns out that if you just talk while you're doing these things you know it's not like you're a barista can't both talk to you and make your latte or whatever you're having and those relationships actually give you a little boost they also teach you how to interact with someone and that the thing my father taught me the most he is probably the most social guy ever new is you know just ask an open-ended question to someone you know we used to go draw 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 barking a conversation and learning about people you're happier they're happy you maybe gotten some information.

29:48And we, I think in our society, tend to poo-poo those kind of weak interactions way too much. And we don't think about how to use them. They matter. I mean, I've lived in the Berkshires for 30 years. I just moved to Texas. But you go to the same restaurants, you go to the same dry cleaners, you go to the same grocery store. I mean, I've known the guys who own the grocery store for 30 years and they helped 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.

30:20It's like, it's 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 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 used to, I still take the train from Washington to Philly and Philly to Washington. And the seven o 'clock to sell up from Washington to Philly, there was this guy who was a conductor. And I had a book out. It's actually on my bookshelf, King, A Life by Jonathan Ige.

30:57And 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. Is that about Martin Luther King? yeah about yeah every week every week we would have a conversation about all sorts of things he would tell me about the civil rights activists in his family he would ask me how things were going at pen what about the demonstrations and all sorts of things and you know unfortunately just uh he just retired 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 liked the book, what I learned about the book.

31:40I eventually, 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 know, 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, Like, you know, this, you know, we do obsess about what we eat and what substance we take and how much we exercise and what biohacking things we do.

32:12But this social fabric issue is so important. And particularly, I've noticed it in myself. Like, I've really developed over the last, 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 world and stay with a friend. and I almost have too many friends because it's like, I want to keep up with them all and it's hard. But when we see each other, it's like you're just part of this extended tribe. And that's, you know, I think E.O. Wilson talked about this in one of his books, I think, Social Conquest of the Earth where, you know, from ants to humans, we're all these social beings.

32:51And 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 really simple. So find friends who have healthy habits and do it because that matters, right? Yes. It's 100%. Look, I mean, we have what's called the neocortex. Neo, which is new cortex. That's the part in the front of the head. It's executive function, but it's also, So it's there mainly for complex social relationships. That's what distinguishes humans.

33:31You know, we talk about language and this and that, but it's really our ability to have complex social relationships. And that's part of our brain structure. And it's critical. And like other things, you got to use it to keep it in shape and keep it working. Use it or lose it, as they say. And that really applies to the brain as much as the muscle. I would say the other thing that is very important, and you've hinted at it with E.L. Wilson and your own challenges of so many people, is there is something called the Dunbar number, which is the number of people you can have as acquaintances that you can break bread with, you would have over.

34:12And he points out, he's an anthropologist, I guess, emeritus now at Oxford. And there's a Dunnmire number, which is roughly 150. Exactly. That's the number of people you can have as acquaintances. Close friends, five to 15. 150 is really the number of people you can keep track of. That's the capacity of our brain, basically. There are some people, and I'm a sort of quasi-expert. on Ben Franklin because I'm obsessed by him. You know, he corresponded with well over a thousand people across his lifetime, writing letters before email made it easy, handwriting letters to people, some about science, some about printing, some about politics and negotiations and diplomacy.

34:59But he created all sorts of societies to bring people together. The American Philosophical Society, all the, you know, the firemen, insurance companies, Subscription lending libraries And he was a guy who believed in Sociability And creating social relationships And mutual support Lots of things we can do In that regard And you point out Changing physician 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 do the right thing All of these are critical. And the best proof, and with that I'm going to shut up, there is one of the most important— I doubt that.

35:48I doubt that. But keep going. One of the most important studies— I've never known an Emanuel to shut up before.

35:58I know both your brothers, and I'm like, no. Harvard Adult Development Study. Now, there's no more boring title than that for a research study. But it started in the late 30s, early 40s, following Harvard sophomores and to see how they developed and what made them develop for success. It included John Kennedy, the editor of the Washington Wargate, Brent Bradley. And then they merged with a one that wasn't just Harvard students, but also a local kids, immigrant kids in Boston. And so they're following them. 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.

36:52And I think it just is the fact 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 things. I don't know if you know about the Rosetta study. Do you know about this Rosetta, Pennsylvania study? No, go ahead. It was an amazing study. I read it in a Deepak book like 20, 30 years ago. and basically there was a community from Italy, from a village in Italy that moved en masse and immigrated to the United States and they set up residence in this little town called Rosetta, Pennsylvania.

37:29And there was a wide disparity in income and education 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 celebrations and birthdays and funerals and weddings. And it was like this really rich, dynamic, engaged community. And despite the fact that they ate the same shit as the rest of Americans, they didn't die. They had a much longer health span and more longer lifespan. And I'm like, it was amazing. So think about that. Like the power of the social connections outweighs the other shit that you might think is more important like your diet or even exercise.

38:15Let me give you another piece of data on that, that I've sort of stumbled on. And so if you look around the world, Latin American countries have, are the second, broadly speaking, the second most happy countries in the world. And they're happy beyond what their socioeconomic indicators, whether it's income per person and other variables would suggest. And what most people who look at this think is critical is they are much more likely to eat meals together. They have more meals with other people than any other region of the world in Latin America. And if you look at Hispanics in the United States, as you point out, eating the same crap we do, turns out their life expectancy is higher than whites.

39:14Most, they have fewer problems in most categories of chronic illness than whites in the United States. And it goes exactly to what you're saying, which is, look, sociability can compensate and overcomes lots of these other factors that might be, you know, anti-wellness. And I think that's, again, that's something we tend to ignore, especially in the wellness community that's focused on the three physical things we can do. The individual narcissistic pursuits. Yeah. Yeah. Amazing. This is really good. That's like rule four of your six rules. I want to jump back to the first one because I think, you know, we covered this social thing really well.

40:03And I think it's important. And I think if you're lonely or isolated or disconnected, it's hard to think about where to get started. But there's always something like, you know, join a club, join a church, join a synagogue, join a mosque, you know, get a walking group, a jogging group, a biking group, whatever, whatever turns you on 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 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.

40:31You 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 think, title, which is, I think, you know, eat your ice cream, which I love. But I want to know what before we go on. What's your favorite ice cream? At the moment, there's a place in Washington, D.C. that makes a Leibniz Yuzu ice cream. and that's my favorite. Wow. It's like yogurt with yuzu. Yes. Wow, wow, wow. So you can't have a lot of it.

41:10You 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 on a special trip to Paris, and there's a place called Plaq, P-L-A-Q, that has, she says, the best chocolate ice cream she's ever had. I haven't been there, so I can't. Well, my favorites are pistachio and his in the gelato. Yeah. And then, of course, in Italy, and then Chunky Monkey, if I'm really bad. I'm Ben and Jerry. 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.

41:54It's good for sociabilities, as we've mentioned many, many times. And it's obviously also critical for nutrition and part of the problem, I would say a large part of the problem of American decreasing 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.

42:35The two stops are stopped on the sodas and sugary drinks. Those, excuse me, are 140 calories per shot, per 12 ounce can with no nutritional value. you, it's like 10 teaspoons of sugar. It's ridiculous. 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 who lost 75 pounds just by stopping soda. And I would say one of the pieces of good news over the last, you know, of 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's got to go down for me, but we're not in progress, and we should celebrate progress.

43:22The second is snacks, the pretzels, the Twinkies, the 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. Yes, snacks are just an invention of the food industry. Humans never had snacks. If you still think you need snacks, switch to healthy snacks. And there are healthy snacks. They're called nuts or dried fruit or, you know, real apples and other things. But the starchy snacks are, they have zoomed up, you know, 500 added calories. It's like, you know, one of those big items a day.

44:13We often eat them instead of breakfast. Those are the two big things to stop. That'll bring down your ultra-processed food amounts and things like that. On the pro side, the big number one pro in my mind, I'd actually, you're the real expert. I'm just the pretender here, is fermented foods. and things like kimchi, yogurt, raw alpine cheeses. Those are the, those are your microbiome. They're good for your health in all sorts of ways. And if you added them once or twice a day to your diet, you would go a long way on the positive side. The other thing, I 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.

45:14And, you know, the fat globules and the saturated fat in dairy, we know that it is anti type 2 diabetes. People who eat a lot of dairy don't develop type 2 diabetes as much. They lose weight. The number one weight loss diet item is yogurt. Again, another dairy product. Although that could be correlation, not causation, right, in the epidemiology. We could spend the whole hour talking about how it's just doing food studies. I totally agree with you. I think if you do those two things, you go along this. Now, are there many others? Yes, my book goes on and on about all sorts of obviously fruits and vegetables.

45:58We now know it's not just the All the good nutrients in them But it's also the fiber And the variety of fibers that are in them That help our body and help our microbiome We're going to learn a lot more But part of it is, you know, again It's a lot of common sense If it's not processed If you just buy it and cook it You know, whether it's by roasting it Or sautéing it or what have you it's going to be a lot better for you than whatever package. And that's not a complicated, you know, we've got a lot of complicated rules. I think the brain can only handle so much. And the other thing I would say, Mark, that I've sort of come to, and I'll tell this little story, you've got to learn how to cook.

46:46One of the worst things you've ever had to cook, the American diet was getting rid of home ec out of school. I probably was the last generation who had home ec in their school. And I had every year I'd hire two or three research assistants. I had a research assistant who literally had no idea how to cook. 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, and a recipe with detailed how to do everything. And, you know, it turned out the first thing he did is he didn't know the difference between a cut up chicken and a whole chicken.

47:36Okay. He didn't have a roasting pan, right? 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'd like to say - And a couple of pans, a couple of knives, and a cutting board, you're doing it okay. That's what I see. What I like to say to people is, every week, try one new recipe, right? You've got 21 meals in a week. One, one, you know, on a Sunday night or a Saturday night, and then have some friends over and share the meal.

48:12By 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's one of these triple winners.

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49:38My mother used to say, if you can read, you can cook. And I think that's, you know, actually how I learned to cook. And aside from my mother teaching me when I was young, I did recipes. I don't follow the recipes. And you do that enough. And then you 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 I think it's not that hard. I mean, you need to learn two or three breakfasts, two or three lunches, two or three dinners. And then you can experiment after that. And it doesn't have to take a long time.

50:07It doesn't have to be difficult. It doesn't have to 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 on the outside throw it in the oven 450 20 minutes a pound boom you're done and it's like a perfect chicken it's not dry it's moist because it steams from the inside and like it takes it literally takes like five minutes to make and other than the cooking time in the oven it's really easy and And I think, you know, this is not an accident, Zeke, that we can't cook.

50:41This is a deliberate, intentional decision made by the food industry to disenfranchise people and disintermediate people from their kitchen. You know, you deserve a break today. Betty Crocker, like starting to put in processed food into the recipes. I mean, I thought Betty Crocker was real, but she was an invention of the food industry because there was a home ec teacher named Betty who was trying to get all these federal extension workers to teach young mothers and families how to cook and grow a garden and make food. And they were freaking out because they couldn't get their processed food into the kitchen.

51:11And 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 fundamental life skill. I mean, I wanted to make duck breasts and I had no idea. So 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.

51:38Especially today where you can go on YouTube and get the step-by-step. It's not that complicated. But I do think that getting rid of home economics, you know, there's two failures in the system. One failure is home, parents not teaching their kids and not encouraging their kids to learn how to cook for themselves. And the other is we have a school system to make up for deficiencies in that regard and for teaching kids. And we got rid of home economics somewhere in the, you know, 60s and 70s that 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.

52:18You have bad nutrition, you have obesity, you have a whole range of chronic illnesses, osteoarthritis, renal failure, hypertension. If we don't fix this food system problem, right, we are going to be settled with high costs from chronic illness and less longevity, and we're going to have more disabilities. It is, they're all tied together. And so food, and as you point out, Mark, food and learning how to do it yourself. The other thing that sort of gets me is I was raised in a house that didn't have a salt shaker. My father was a pediatrician with an expertise in kidney disease. And salt was forbidden.

53:06My mom had no salt in the house. So I grew up with no salt. My pastes, buds are just whatever is natural. That's what we got. And so I've always found restaurants too salty, a little too. Very, very, very. 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 complicated Everyone can do it And this isn't classist or sexist You know, given the cost of eating at McDonald's these days Buying food at a supermarket it and spending a half hour or whatever to cook it is going to be cheaper.

54:12It is going to be cheaper. People think, you know, Mark Bittman wrote a piece in the New York Times about this. You'd go to McDonald's for a family of four, you make a roast chicken, a salad, and a baked potato, and it's way cheaper to feed your family of four real food. Yeah. And it doesn't, and the food industry has been so deliberate about trying to convince us that eating well is elitist, that it's difficult, that it's expensive, that it takes too much time, that, you know, you can't do it. And it's all propaganda. You know, once you learn the basics, you're busy. I have, what, 45 jobs? I probably have 10, 15 jobs.

54:43Like, we do it. I cooked dinner last night. I threw a sweet potato, wrote a Japanese sweet potato in the oven. I made lamb chops in the pan, took like 10 minutes. I stir-fried some bok choy with ginger, which took five minutes. And I had an amazing dinner, and it was delicious. And I had a piece of your chocolate that you sent me afterwards. I saw a little bit left. I mean, it doesn't have to be complicated. And I think your other point I just want to double down on is eat stuff that is not different than the ingredients you have in your kitchen. If it's not in your kitchen, you probably don't want to be eating it.

55:18If you're not going to cook with it, don't eat it. Like butylated hydroxy toluene, you probably don't have in your herb cabinet, right? It's a preservative, but like that is not something or you want, you know, be eating carrageenan, which is 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. 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.

55:51It's not that harsh. No, I totally, totally agree with that. And And again, at this moment where processed foods and going out to fast food restaurants is getting so expensive, doing it at home is going to be both healthier, both immediately and in the long term and cheaper. And the other thing, Mark, is, you know, the evidence growing by just staying off ultra processed foods for a month and the change breeds people. And compelling, compelling. You're feeling better. You're less depressed. You're able to sleep. All of those things. Now, we need to study them better and we need to understand them.

56:31But, you know, people report this a lot. There was a recent article in the Wall Street Journal about a woman and her daughter who did this, you know, were off ultra processed foods. First of all, she then realized how much ultra processed foods there is everywhere and everyone's trying to offer her daughter something. But her daughter began to like vegetables, which she never liked. She stopped being a picky eater, which drives every parent crazy. And I think this is so, it's so fundamental. And, you know, it is, we have a whole system that is pushing us in the wrong direction. If there is one good thing about the current moment, I think the message of get off ultra-processed foods, stop drinking soda.

57:19Those messages are beginning to see through. And I think we are saying, again, it's early days. We still have a very big obesity epidemic, but we're 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 Zik is so powerful around food. What you're saying, your message is very simple. Don't eat the crap and eat real food and enjoy what you're doing and learn some simple skills like cooking and also eat with your family and community. These are really simple messages. When I did that shared medical appointment, one of those groups was for diabetes and obesity.

57:58And 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 stents and hypertension she had an injection 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 ultra-processed food.

58:41She didn't know better. Her family didn't know better. That's just what they grew up with. They didn't know. And she got to this group and she changed her diet. And she went from eating that to eating whole foods that were anti-inflammatory, all 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 three months. Now, that seems like a crazy-ass story, but that just shows the power of the food that you're eating, both the bad and the good.

59:17And 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 so powerful. So don't underestimate that for everybody listening. And just, Zeke, I love your simple, no-nonsense, direct, no-bullshit kind of advice. Can I add one other 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'm drinking diet soda. Is that okay? And they would whisper it because they were kind of embarrassed. They knew it was the wrong thing, and then they were embarrassed.

59:56And I said, 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. The 80-20, 80-20. 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 cup of sugar.

1:00:39And 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 lot. But occasionally you can indulge when it's, you know, and you're celebrating something and you're making a big deal out of it. The problem, we've made that routine and that's where we have to break ourselves. I mean, that's the key, what you said is resilience. So if you're doing most of the things most of the time in a way that's supporting your health, you're resilient. But if you're a diabetic and you have that cheesecake, you're screwed. But if you're you or me who rides your bike a hundred miles a day, so what?

1:01:20Like, that's the key message here is your health is about resilience. Before we kind of wrap up, I want to cover a couple of your key rules, which is exercise, 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 capacity up. I do it by biking. and I like to go fast and the added value of biking is you can go in nature and go on bike paths and you get that added benefit of being out in nature and you can also ride with people and talk and it's a social activity.

1:02:04You got to do 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 in a variety of ways. Lifting weights is one way. You know, strengthening your core is also very important. And the third thing, which is often left out, is balance and flexibility. Now, you know, some people have heard, well, I don't have to stretch before I exercise. That is true. You know, heating up your muscles 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.

1:02:45But the flexibility reduces problems. And especially as you're getting older and you might be losing your balance, having the balance and flexibility created mainly by yoga. So every morning I wake up and do 20 minutes of yoga, five minutes of core and strength training. My brother gave me these new bands that really seem to work and great. Let me guess which brother, Ari. So that's the package. And the other thing is you should, everyone needs to be aware, being obsessive about it, doing it, you know, five hours, six hours a week is not going to make you live long. There is a plateau. It is not the more I do, the better it is, you know, unlimited.

1:03:33There is a plateau. And actually, the more you do, you risk injury, whether it's repetitive motion injuries or, like me, you can have accidents. You can twist your ankle. So that's the three, aerobic, strength training, and flexibility and balance by yoga. It is. And exercise, you know, if you actually look at the science of exercise and all the different systems in your body that it affects, 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. And the important thing is to move from horizontal to vertical, right?

1:04:17That's the biggest game is just build it in. After dinner, go out for a walk with your loved ones or build in some sociability. 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 more about the job, you know, what was going well, what, what, where 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. It's fun.

1:04:54It's fun. I always say, I, I always say I like to play. I don't like to exercise. So yeah, absolutely. Absolutely. And you know, we, at the church, the Saddleback Church, they had jogging for Jesus. So they did it like in community. So I think it's actually a double benefit. How about sleep? 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 like to say, is make the bed. But, you know, in the end, it's got to come to you.

1:05:29You'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 have this routine where I get in bed and I read a regular book 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. But the other thing is, all those sleep medications, not good for you. Almost all the societies, professional medical societies related to sleep say, you know, it's cognitive behavior therapy for insomnia that you need. And so you got to forget the Ambien or Halcyon or whatever you're using.

1:06:19And I also, you know, I've been perplexed by the popularity of 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. 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 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 gonna nap you don't nap after two alcohol allows you to fall asleep faster but it gives you disrupted sleep often you wake up after it and it doesn't make it restful.

1:07:24What you report is very common, Mark. And so I have a bunch of rules in the book of how to maximize your chance that you'll get to sleep. The problem is, I often have bad nights. My brain just keeps going. You can prep all you want. In the end, you can't will it the way you can will. I'm going out for a 20-mile bike ride. But you can set up the conditions, and there's ways to do that. And what you mentioned, just because you jumped over it 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.

1:08:03You 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 schmucky yeah definitely don't be schmucky 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 climb mount everest climbing kilimanjaro as you walk up it's no no no not kilimanjaro i mean base jumping yes climbing mount everest is the everest yeah yeah i've done kilimanjaro too i wouldn't recommend it for a whole variety of reasons, but it's not a schmucky move.

1:08:42It's not that challenging. Although people do die doing it. And they're, you know, not taking your vaccine, schmucky move. You know, we have long history of how good and beneficial they are. I have a long section there talking about cancer screening tests. It's important to start on time. It's also important to end so that you don't do over-testing. I do a detailed analysis for the men about prostate cancer PSA screening. I'm not for it. The bottom line is, in all the studies, the cancer screening test PSA may save one out of a thousand lives, but it also means you're a patient, you're constantly looking at the number and testing.

1:09:38You may get procedures done, which all have relatively high root effects and complications as, you know, impotence, incontinence. So overall, yes, you might not die of prostate cancer, but your longevity is about the same, and it may or may not save one person out of a thousand. That just doesn't seem like a really, it's up to you to decide, but it doesn't seem. Yeah, it's complicated because on a population level, you're right. It doesn't make sense. On an individual level, if you're that 43 year old with prostate cancer, it makes a lot of sense. And it's interesting, and the company I co-founded, Function Health, has blown up and we have like 300 ,000 members now.

1:10:22And we have a whole range of demographics And literally, I got two emails recently 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 of it's abnormal and they need to go get unnecessary procedures. But like, it's a tough calculus. You're a bioethicist, so you're better at this than I am. But it's like, it's 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, the United States Preventative Services Task Force, the American Society of Clinical Oncology, et cetera, they do recommend it.

1:11:10And they certainly recommend talking about it with your doctor so you have the bottom line. But what you say, Mark, is 100 % true. We're seeing this, you might even say, 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, wonderful, skilled servant, real dedicated to America. And every single one of those is tragedy. People in the prime of life, And we don't fully understand how much of this is related to our bad diets and our bad obesity epidemic.

1:11:59How much of it 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 start and have that conversation, frankly, with your 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. 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.

1:12:37And, you know, there's mortality exactly how much is very hard to determine. Yeah, well, I don't know. I think with all the advent of technology, I assume the phones will not be separate from us. And then we'll just be able to say, hey, TechSeek, I love you. I'm going to come over for dinner. Please make the cheesecake. The last point I think is really important. And the data on this is really striking. If you have meaning and purpose, you live an average of seven years longer, which is incredible because if you eradicated cancer and heart disease from the face of the planet, life extension would only be five to seven years.

1:13:11You know, you are a doctor, you're a bioethicist, you're a health policy geek, and you're also a philosopher and did your, you know, you did your PhD in political philosophy at Harvard. Talk to us about this idea of purpose and how people can get their purpose, find their purpose and get connected to purpose. Because, you know, when you look at the data, when people stop working at 65, and that's just an arbitrary number, I'm 65, you're 67 or whatever we are 69. I think there's a drop-off in people's lives. There's an increase in mortality and death, literally starting when people are 65 and they quit their job because they're losing meaning and purpose.

1:13:56So 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 a very interesting phenomenon. But I would say one of the important element 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.

1:14:39It could be by focus on, you know, creating beautiful spaces for other people to enjoy or creating beautiful art or, you know, just being nice to people. And I was seeing someone pointed me to a video of a guy who was a school bus driver, but all the kids felt that he saw them, he interacted, he asked about, you know, that gives him purpose to bring joy to these kids every day to make going to school a wonderful activity instead of something that they might dread or were fearful of. And I think the doing of something outside of yourself is really, really important. And so you're 100 % right. One of the things I write about extensively in the book is retirement and the dangers around retirement.

1:15:25We don't do retirement well in this country. When you're planning for retirement, first of all, you have to plan for it. You don't just say, oh, 65, and that's good. And we're doing some research around the activities people engage in around retirement that are important for longevity and wellness. And it's really important to plan for it and to make sure you just don't stop things cold turkey because work has a schedule, it has social interaction, it has 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.

1:16:15It 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 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 docent museum, you know, or grow vegetables and enter, you know, contests. It's really important to do that stuff and to not just lose that purpose. Now, how we find it, what we find our purpose to be, it's a big challenge. I mean, when I went to college with your sister, my first year, I was really sort of felt at sea.

1:17:04And I was like, well, what am I going to do? 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 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 it was a, 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. It 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 there's no real doing something for other people outside of yourself does tend to be very debilitating to people.

1:17:53This is so important, Zeke, and I think it's really underappreciated. We're wired this way. You know, whether it's C.O. Wilson's book about the social conquest of the earth, 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. 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 get the juice of it. And Yiddish is called naches. It's like the good stuff of life.

1:18:34And it's like you basically feel different 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 a crazy, horrible situation. I was a weird thing to say, but 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.

1:19:19it'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 really love this message last last kind of thing i want to ask you about is this is idea and it's kind of the name of your next book which is this idea of creative rejuvenation can you just speak to what that is it's i love the sound of it i'm not sure i understand. Well, it's really about social systems. It's really about the healthcare system. One of our, you know, we have a broken healthcare system, broken in every way you can imagine.

1:19:58We don't cover all Americans, bad thing. We have way too high cost, bad thing. Our quality is uneven and we can't guarantee everyone good quality. We have disparities, whether it's urban, rural or racial or based on sex. And we're all dissatisfied with the system. I don't know anyone these days who isn't bitching and moaning about the American healthcare system. So the question is, you know, in business, if you have something that's failing so bad, right, you have creative destruction, they say, you know, Kodak doesn't exist anymore. You know, eventually the internal Russian engine will not exist.

1:20:41It's harder in hospitals. You can't just get rid of hospitals. You can't just not have, you know, and not having a particular school or a particular facility isn't going to solve the bigger structural problem. So part of what I've been trying to do in this book is how can we creatively rejuvenate not just people, but the social institutions like the healthcare system that we have and redesign them so that the sort of the creakiness that has encumbered them over the last 75 years, we can overcome the problems that that creates. And that's really what the book is thinking about. I have some ideas and I have some ideas of, you know, if we had a better, if we could design a better system, how could we get it implemented in the current political environment where there seems to be a lot of polarization?

1:21:39I do think healthcare - I can't wait for that book. I 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 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 undeductible. So we have a lot of the elements and then we have to make it work. And so that's where I'm going with the book. That's beautiful. You know, I wrote a book called Food Fix about how to fix the food system. This is like health care fix. This is what you're writing. It's health policy fix.

1:22:11And I love it. And I'm excited because my wife is actually going to Columbia to get her MPH and 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 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, Zeke, has been putting a whole beach of sand. And I really appreciate you. And I'm so glad you're in my life. And I'll see you in a couple of weeks. And thank you for writing the book. Everybody, go get a copy right now. Eat your ice cream.

1:22:44Six 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-won advice from someone who's in a family. And he's written another book about, you know, about the Emmanuel brothers, which you should read, from a family whose whole purpose in life has been to contribute to the world and make it a better place. And thank you for doing that. Thank you, Mark. Great. I really appreciate that. And this has been a wonderful interview. Really wonderful. Oh, thanks, Zeke.

1:23:16And enjoy. I'll see you soon. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health, where I am Chief Medical Officer.

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