As I mentioned in a recent post, I recently finished reading Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life by Ezekiel Emanuel. Dr. Emanuel is a well-known medical oncologist, bioethicist, health policy researcher, and author of several books, though he is perhaps best known for being the chief architect of the 2010 Affordable Care Act. I heard him talk about his latest book about how to live a full and healthy life during a radio interview during my morning commute, and I was intrigued enough to order the book from my local public library.
I enjoyed reading Dr. Emanuel's book. His central argument is that at some point around the age of 75 years, most people experience meaningful declines in creativity, productivity, and overall vitality. Extending life far beyond that point can diminish the quality of life and seems counter to the purpose of living. His approach to wellness emphasizes quality over quantity (living a healthy and meaningful life as opposed to simply focusing on extending the number of years lived). Living a healthy and meaningful life is like ice cream. It's meant to be enjoyed before it all melts away!
Dr. Emanuel argues against what he calls the "Wellness Industrial Complex", which prescribes complicated regimens that often conflict, while at the same time promising us a longer and more productive life. He argues that we spend too much time following "wellness" recommendations that may only add a few extra days or months to our life, and that we could better spend that time enjoying our life in the here and now. Dr. Emanuel writes that "with so much health and wellness advice out there, it can be nearly impossible to differentiate the valid, reliable, and effective from the speculative, deceptive, and just plain stupid. Even when the advice is scientifically sound, it's often extraneous, misrepresented, or misused."
His approach is much simpler and can be summarized with six simple rules:
1. "Don't be a schmuck"
Dr. Emanuel defines "being a schmuck" as anyone who takes unnecessary risks. He says, "One of the best and easiest things you can do for your wellness is not take stupid risks." "Stupid things" include smoking, drinking alcohol, doing drugs, or not taking your vaccines. He also adds to this list engaging in activities such as extreme mountaineering (e.g., climbing Mount Everest). The risk of dying while climbing Mount Everest is on the order of 1 in 100. The risk of death increases to 1 in 25 for climbers over the age of 59 years - "almost nothing can be schmuckier than that."
2. "Talk to people"
Dr. Emanuel writes, "It's important to cultivate family, friends, and other social relationships for a long, healthy, and happy life." I've posted a lot about the so-called "Loneliness Epidemic" several times in the last year (see, in particular, my posts, "The Loneliness Epidemic", "To be of importance to others is to be alive...", and "We all need the human touch..."). There are now a countless number of studies that provide convincing evidence that fostering and maintaining close personal relationships through marriage, family, and friendships is one of the most important drivers of happiness and vitality. The Harvard Study of Adult Development provides important evidence on this point. Robert Waldinger, who has led the study for over two decades, states, "The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health. Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation."
Relationships matter even more than one's heredity (see the article "Good genes are nice, but joy is better" in the Harvard Gazette or Waldinger's TED talk "What makes a good life" for more). The psychiatrist George Vaillant led the Harvard Study from 1972 until 2004. He said, "When the study began, nobody cared about empathy or attachment. But the key to healthy aging is relationships, relationships, relationships."
Dr. Emanuel says that there are two great things about social relationships. "First, unlike exercise, there's no strenuous exertion today for payback decades into the future. Good social relations are good for you now. [Second], initiating conversations is also generous. It's good for you, and it's good for the people you talk to, so you can be virtuous just by starting a conversation."
3. "Expand your mind"
Dr. Emanuel recommends that we should stay mentally sharp through continuous learning, curiosity, and mental engagement. He writes, "Be a mensch" and offers the American patriot Benjamin Franklin as an example. "When I say, 'Be a mensch,' what I want to communicate is that the purpose of your life should not just be to live longer. It should be greater than that; it should be trying to make the world a better place. Benjamin Franklin said it best when he said, 'The noblest question in the world is, What good may I do in it?' That’s part of what being a mensch is." At the age of 70 years, Benjamin Franklin crossed the Atlantic for the seventh time to serve as America's first ambassador to France. During his Atlantic crossing, he mapped the Gulf Stream in order to improve the speed by which ships could travel across the oceans. Once he arrived in France, he invented bifocals and developed the prototype for a new type of ship's anchor.
There's an important caveat here though. We shouldn't spend our time working through the daily crossword or Wordle. Having a variety of intellectual pursuits is far more important. We should try new hobbies, learn to play an instrument, or join a book club. Dr. Emanuel suggests learning how to cook a new recipe - "This is a wellness trifecta. It requires complex mental tasks as you plan the recipe, physical tasks as you go about the kitchen to organize the food, and then, if you invite friends over and have a meal together, it promotes social relationships."
4. "Move it"
We've all heard recommendation #4 before - regular exercise is critical to our overall physical and mental health. Dr. Emanuel suggests that we focus on three types of exercise - aerobic exercise (like running or walking) for our heart and lungs, strength training for our muscles and flexibility, and balance training to maintain a healthy core. Importantly, he suggests that "more is not always better" - there's no added benefit to vigorously exercising for more than 150 minutes a week. He says, "The time you spend overexercising is time you could devote to more meaningful activities, like volunteering in your community or talking with your best friend as you walk through a forest."
5. "Eat your ice cream"
Recommendation #5 was the longest chapter in the book, and the one that I thought was the most interesting. Dr. Emanuel says, "We have to do wellness behaviors for years and decades if they are going to do any good. Constant deprivation requiring great expenditures of willpower are not the way to wellness. Indeed, people who constantly diet with willpower fail at it and never lose weight." Or worse (and the studies suggest that dramatic swings between weight gain and weight loss are really bad for your health), they gain all the lost weight back. He suggest beginning by stopping the bad stuff - stop drinking sodas and other sugary drinks. Similarly, cut down (or eliminate) salty snacks, packaged cakes, and cookies. An occasional indulgence is acceptable, but we should try to limit our consumption of these items as much as possible.
We should avoid processed foods. Dr. Emanuel favors consumption of fermented foods such as yogurt (plain yogurt, not the kind with all the added sugar), kimchi, cottage cheese, miso, and sourdough bread. These are all healthy foods which can maintain a healthy microbiome (all the beneficial bacteria that normally live in your gastrointestinal tract).
Dr. Emanuel also suggests limiting our alcohol consumption to one to two drinks per week and always with someone else. He suggests that most Americans don't get nearly enough fiber, and he generally recommends against most, if not all, of the dietary supplements that have become far too popular in the last several years. Finally, he reviews a few studies that suggest that eating ice cream can actually be healthy, but as in all things, with moderation (this was my favorite recommendation!).
6. "Sleep like a baby"
Sleep is not optional! Most of us need around seven to eight hours of uninterrupted sleep per day. Dr. Emanuel recommends against sleeping aids such as melatonin. "There are other things you can do to sleep better: Sleep in a cool, dark room. Don't look at your phone for the hour before. The dinner glass of wine can disrupt your sleep. Don't take a nap or consume caffeine after 2 pm."
"Don't be a schmuck. Be a mensch. And really, eat your ice cream!"
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