696: Dr. Zeke Emanuel - The Six Rules for Health & Longevity, The Harvard Study on Happiness, The Truth About Biohacking, Social Connection, and How to Avoid Being a Schmuck

The Learning Leader Show with Ryan Hawk

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My guest: Ezekiel J. "Zeke" Emanuel, MD, PhD, is a prominent oncologist, bioethicist, and health policy expert. Currently Vice Provost for Global Initiatives at the University of Pennsylvania, he was instrumental in shaping the Affordable Care Act and served as the founding chair of the Department of Bioethics at the National Institutes of Health.

Key Learnings

Zeke's dad was called "Speedy." He was a Chicago pediatrician who worked 24-hour call, walked so fast the nurses had to run to keep up, and had a rule: the fourth child in any family was free. He recognized the financial strain on families and just wouldn't charge.

Zeke's mom was the definition of the anti-helicopter parent. At the playground, she sat on the bench. At the beach, she dropped the boys off with a blanket and a snack. "You go play. Something goes wrong? Okay, that's how it goes." That's how three future powerhouse leaders learned to negotiate, create, and figure it out.

The Emanuel brothers' group text is full of bragging. Zeke posted his 51.9 VO2 max score at 68 years old, asking, "Do I win in the family?" His kids replied that they don't even read the articles Zeke and Rahm forward anymore. Close doesn't mean uncompetitive.

A dozen years ago, Zeke wrote his most famous article, "Why I Hope to Die at 75." He still stands by it. The point wasn't that he wants to die. The point is that after 75, he won't take medical treatments meant to prolong life. 

By age 75, 30% of adults have Alzheimer's or cognitive impairment. By 80, it's 40%. Zeke doesn't want to be remembered as a doddering old man who can't recognize his own family.

Living a long time is a means, not an end. It's not the goal of life. It's what allows you to be present, engaged, and useful for the years you have.

Biohacking is a lie: It suggests you know better than millions of years of evolution and the entire medical profession. The body isn't about maxing. It's about balance. Too much immune response gives you autoimmunity. Too little makes you sick. The body finds health in the median.

You're not going to be perfect over decades. Wellness isn't a four-minute figure skating routine graded on execution. It's a lifetime practice. So build habits you enjoy and can sustain without thinking about them.

Zeke's six simple rules for a long and healthy life:

• Don't be a schmuck. Avoid activities riskier than driving. Smoking, vaping, base jumping, climbing Everest.
• Talk to people. The number one predictor of a long, happy life.
• Expand your mind. Travel. Talk to the chef. Learn something new.
• Eat your ice cream. Moderation over perfection. Fermented foods and fiber.
• Move. Aerobic, strength, and flexibility. All three.
• Sleep like a baby. You can't will it. But you can create the conditions.

The Harvard Adult Development Study followed people for 85 years. John F. Kennedy was in it. Ben Bradlee was in it. The finding: close friends and being married correlated with the healthiest, longest, happiest lives. Not exercise. Not diet. Relationships.

Having no close friends is equivalent to smoking 15 cigarettes a day. That's how bad loneliness is for you. It's not just psychological. It's physical.

Introverts get the same happiness boost from social interaction as extroverts. A University of Chicago study by Nicholas Epley found that introverts assume they won't enjoy talking to strangers on their commute. They were wrong. When they did it, they were just as happy as extroverts.

Take the headphones off. Zeke has been telling people this since the iPod era. Random encounters increase your surface area for luck, learning, and connection. You never know who you're going to meet or what they might tell you.

To be interesting, you have to be interested. Zeke asks to meet the chef at every great restaurant. He asks his Ethiopian Uber driver which tribe he's from. He talks to the person on the plane. It's virtuous. Good for you AND good for them.

Zeke's hero is Ben Franklin. Franklin came back to America at 80 after negotiating the end of the Revolutionary War. The first thing he did was build a library for his curiosity and a dining room for his social dinners. That's the way to live.

The wellness trifecta: hosting a dinner party with curious people. You're eating good food. You're getting together with people. Your mind is being stretched by great conversation. Three benefits from one activity.

Zeke is anti-wellness-industrial-complex. Peptides from your corner store: disaster, unregulated, no idea what's in them. Testosterone replacement therapy without a real deficiency: bad idea, accelerates prostate cancer. Growth hormone for aging: promotes cancers. That's being a schmuck.

Sleep is the one wellness practice you can't will yourself into. You can only build the conditions for it. Dark room. Cool temperature. No caffeine or alcohol eight hours before bed. Phone in another room. Read a book. Everything else is up to your body.

Ice cream actually decreases your risk of type 2 diabetes. The fat content softens the glycemic response. Plus, you usually eat it with other people. Social eating matters.

Zeke's champagne moment a year from now: finishing his next book on how to fix the American healthcare system, and turning 70.

Reflection Questions

• Are you optimizing for length of life, or for the quality of years you actually get? 
• When was the last time you turned your headphones off, introduced yourself to a stranger, or asked to meet the chef? 
• Who are the friends you rely on for social interaction? Not casual acquaintances, but the ones who lift your health, longevity, and happiness. When did you last make plans with them?

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