Announcer:
0:00
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Michael Koren:
0:11
Hello, I'm Dr. Michael Koren, Executive Editor of MedEvidence, and it gives me great pleasure to invite back Dr. Ezekiel Emanuel, who is a former classmate of mine and a well-known expert in oncology, in public health, and has just written an incredible book. Zeke, I loved your book. It was a fabulous book. It was a wonderful combination of clinical, scientific, and philosophical insights that I think people just will love reading, will enjoy it, and hopefully we'll get some tidbits that help them live longer, happier lives. So why don't you show us this book and let us know how this all came about? How did this project come to the fore?
Dr. Ezekiel Emanuel:
0:54
Well, it's it's entitled Eat Your Ice Cream. It is a wellness book, and I like to say it's simultaneously an anti-wellness industrial complex book. The book came about almost exactly two years ago when I finished teaching my semester and I got Outlive by Peter Atia. And I read it and it made me irate and mad.
Dr. Michael Koren:
1:23
Okay.
Dr. Ezekiel Emanuel:
1:24
Mad because it was a book about obsessing about wellness and and you know making it the focus of your life. Mad because it emphasized exercise, but didn't emphasize the most important thing for wellness, which is social relationships and also keeping your mind sharp. And so I sat down because I wasn't teaching and wrote out the first draft of this book in about two and a half or three weeks.
Dr. Michael Koren:
1:56
Wow. That's crazy.
Dr. Ezekiel Emanuel:
1:57
And uh, you know, fury will make you go fast. Um so that that was the origin. And you know, part of it is look, I wanted to, you know, convince people you don't have to obsess about wellness. The little tweaks and little adjustments you might make not proven to give you minutes, much less days, much less months of extra life, and that you shouldn't make you know the pursuit of wellness the goal of your life. You should make, you know, sure, making the world better and making your devoting yourself to your family, your friends, that's that's really the goal of of life. And and you know, wellness is just a means to that realizing that goal.
Dr. Michael Koren:
2:45
Well, you make a great case in the beginning of the book against the medical industrial complex, which is trying to sell us lots of stuff, which by and large doesn't help us and in many cases hurts us. So I thought that was really, really well done. And I guess that's what drove your rage. And probably that part of the book you wrote in an hour, but uh, you could you could feel the passion.
Dr. Ezekiel Emanuel:
3:07
Yes. Well, you know, part of the thing is that almost all the influencers in wellness out there are making money one way or another by selling you, you know, either special tests, genetic tests, or full body MRIs, or selling you a supplement or selling you something else, you know, special appointment at their spas or offices. I'm selling nothing. I'm not gonna sell you a damn thing. And I'm gonna give you the basics of what we actually know, not sort of project from you know, C. elegans, that little worm that uh lots of uh people study to find to find out about physiology that may have no relationship to human beings. As you mentioned, Michael, I'm a I'm an oncologist, and you know, we've been testing all sorts of things on mice. And one thing we know is it's really relatively easy to cure a mice, a mice, a mouse, um, but it doesn't necessarily translate into human beings. And so the physiology of what works you know is very different. And so, you know, yeah, wrap a mice in might extend the life of a mouse, but right you don't have a tail.
Dr. Michael Koren:
4:22
Yeah, that that's such that's such an important point that what works in one species may not work in another, but it gets to a broader concept, which you address in different ways. Don't use these words exactly, but the difference between inductive reasoning and deductive reasoning. And while an observation in a mouse may create a hypothesis, it's certainly not something that you should spend $100 a month on.
Dr. Ezekiel Emanuel:
4:48
Totally agree. And and I think again, you know, extrapolation is at best a hypothesis until you actually demonstrate it's true or demonstrate that it's false. And I think this idea that we're gonna biohack, which I have no idea what it really means, but you know, we who you know don't know very much are going to outsmart evolution is a little strange.
Dr. Michael Koren:
5:15
Sure. Um Yeah, and just uh just as a slight defense of Peter Atia, I would say that I like the fact that he's passionate about diet and exercise. And certainly we all agree that's important.
Dr. Ezekiel Emanuel:
5:28
Oh, absolutely a hundred percent it's important, and a lot of the stuff he has in there is quite reasonable. What I don't like is this sort of obsession of, you know, living a long time as a competition, as if the last man standing wins something, or the idea that where he goes off and and does, you know, gives advice on the basis of no evidence, you know, and that that is that is really not on, in my opinion. And I I don't think it's it's the way we should uh understand how to go forward. The other thing I think that is really important is a lot of these wellness gurus and influencers, you know, are pushing extremes. As you know and and I know, the body is a very tightly balanced machine and pushing one extreme, you know, like gotta rev up the immune system. Well, that's not a good thing. That causes autoimmunity, you know, gotta tone down the immune system. That's not a good thing, might expose you to attack. You know, you know what we go too far. Yeah, careful balance is the way biology created us, and the idea that we're gonna push to an extreme. If one milligram is good, a hundred milligrams have to be better. No, it could be a lot worse.
Dr. Michael Koren:
6:50
You you got that. So your your book is broken down into six basic chapters. And do you want to walk us through those chapters?
Dr. Ezekiel Emanuel:
6:59
Yes. The first one, so that that six outline came to me because Ariana Huffington at a conference I was at and and on the state said, you know, why don't they teach more wellness in medical school? And I said, you know, partly it's really simple. It's six things, and partly no one in in the medical industrial complex is going to make that much money on it, so you don't have drug companies chasing you. But it really is six simple things. The first one is as I title the chapter, don't be a schmuck, don't take unreasonable risks.
Dr. Michael Koren:
7:35
And it it's funny, in researching the So not everybody probably knows what the word schmuck means. So you might want to break that down just a little bit for our listeners and viewers.
Dr. Ezekiel Emanuel:
7:46
It's a Yiddish word derived from the German of Don't be a moron.
Dr. Michael Koren:
7:51
Don't do stupid things and don't be a person that does stupid things and recognize when you're doing stupid things.
Dr. Ezekiel Emanuel:
7:57
My father used to call say all the time to me, don't be a schmuck.
Dr. Michael Koren:
8:00
Okay.
Dr. Ezekiel Emanuel:
8:01
Um so in any case, you know, one of the things I learned by looking at the risks of all sorts of things is, you know, probably the worst risk you can take is to climb Mount Everest. Um and I was really surprised among everyone who climbs, including the expert mountain climbers, the mortality rate is one in a hundred. And if you're over 59, the mortality rate is one in 25. Now, what could be more schmucky than to make that risk for what? To say you've been to the top, bragging rights? That seems crazy to me. And actually, I stumbled upon this because I was looking at the the um risks of base jumping, which I thought was had to be the craziest thing anyone's ever done. That's you know, putting on one of those Michelin squirrel suits and jumping off a mountain. And I'm like, wait a second, you've got no propulsion, you you don't have a parachute, you've just got this squirrel suit, basically. And I found out that actually the death rate in that is much lower than climbing Mount Everest, it's one in 2500. The injury rate is pretty high, getting smashed into the mountain and things like that by winds.
Dr. Michael Koren:
9:15
But you don't recommend climbing Mount Everest.
Dr. Ezekiel Emanuel:
9:19
Yeah, well, lots of people, you know, lots of tourists go up there, which is why it's it's crammed and people die. And by the way, if if you die up on Mount Everest, they're not getting your body back. You're frozen up there. Very few people's bodies have been returned.
Dr. Michael Koren:
9:35
Wow, okay. So that's don't be a schmuck. So uh moving on to the other categories. By the way, uh stopping smoking was a big focus of that chapter as well, which we'd all agree with.
Dr. Ezekiel Emanuel:
9:45
Yeah, and and also vaping, vaping, you know, as I like to as you know, but vaping is better than smoking, but not much. And it it's not like vaping is going to be without its health risks. And by the way, smoking, we have, you know, over a century of really good data on the risks of smoking, but vaping, it's so new, we don't know what chronic long-term decades of vaping will do to the lungs, the heart, and other organs.
Dr. Michael Koren:
10:16
Right. Um, they're probably safer ways to get your nicotine. And I'm looking at somebody in the room right now.
Dr. Ezekiel Emanuel:
10:21
Yes, but all of them cause trouble. The second chapter is really about this point, which I think is super important, which the the most important thing for wellness really is social relationships. You know, man is a social animal. Our brains are wired to interact because we know that, you know, what man is not the strongest animal out there, he's not the fastest animal out there. There, man is not the king of the hill because he's got any physical attributes that are better than others. King of the hill and dominate all other animals because human beings know how to collaborate, know how to socialize, can do things together. We are, by definition, a social animal. That's why we have survived and thrived. That's our fitness advantage. And, you know, part of the problem today is we are not very social. More people are eating alone. More people have zero or one friends, close friends. It's really, you know, and the phone has the the mobile.
Dr. Michael Koren:
11:30
The great irony of social media is is created isolation, not socialization necessarily.
Dr. Ezekiel Emanuel:
11:36
Right, exactly. It's it's a it's a it's an oxymoron, the notion that it's social media. And similarly, COVID obviously did a number on our skills, but interacting with other people is also something that is learned. The idea of looking someone in the eye, the idea of paying attention to what they're saying, the idea of asking questions so you understand and you communicate to the person that you're actually interested in what they have to say. Those are actually social skills that we learn. And they've gotten rusty because we've been isolated. And, you know, kids in school, I see this all the time. They don't talk to each other, they're looking at their phones. So I have a rule in my class: no cell phones.
Dr. Michael Koren:
12:20
And there are data that you present that shows that those social interactions actually extend life.
Dr. Ezekiel Emanuel:
12:25
Yes, absolutely. So the more social friends you have, the more frequently you interact with people, the longer your life. And it's more effective, more substantial than exercise and the other things, which I think surprises a lot of people. Well, how can it be? Believe me, your body, your brain knows when you're interacting and you're happier for it. The rest of the body stress goes down. There's lots of effects, and now they're looking at the kinds of genes that are being turned on by social interaction. There's a fantastic study, I think it was in Nature Medicine, looking at particular genes that get turned down, the the um uh moderating of the immune response so you don't have as much inflammation, the the enhancement of response to vaccines. So it's uh it's uh pretty, it's it's not just psychologically better, it's biologically better. And I think a lot of people don't appreciate that.
Dr. Michael Koren:
13:25
Yeah. And you mentioned exercise, that's another chapter in the book.
Dr. Ezekiel Emanuel:
13:29
Yes. You know, again, I think when you talk to people about exercise, they tend to focus on one thing, either, you know, going in the gym and lifting weights or aerobic exercise running. But it's really three different kinds of exercise, and you need them all. You know, you need aerobic exercise to get your heart rate up for lung and cardiovascular health and reduce your stroke risk. You need weightlifting because after about 40 and certainly after 60, your muscle mass declines and you've got to exercise to keep it up. And then you need balance and flexibility. Yoga is is essential for that. So each you need to do each one of them and not only one kind of exercise. I think the important thing, especially as people are growing older, is if you don't do that exercise, it's not like 20 years later you are going to be able to, you know, run an eight-minute mile or whatever it is, or ride your bike at 15 miles an hour. If you're not doing it today, you're certainly not going to be doing it 20 years from now. And so to keep up a good physical response and have good cardiovascular and muscle response, you really need to be doing it. And I also point out in the book, you stop for an injury, or just because you've, you know, you're you're taking a pause, the advantages disappear pretty fast, much faster than you might think.
Dr. Michael Koren:
14:55
Yeah, interesting. And then um you have a chapter which is also the title of the book, Eat Your Ice Cream. That seems uh not something that you would necessarily expect from this type of book. So explain that to everybody.
Dr. Ezekiel Emanuel:
15:08
Well, you food is obviously very important to health and longevity. And eating the right diet, again, is something we've been moving away from. Processed foods that sort of entered the diet about 130, 140 years ago have not been our friend. And most recently, with the real industrialization of food, about 60% of all calories for an American adult come from ultra-processed foods. You know, the pretzels, the frozen pizzas, the frozen tacos, all that preparation. And that's not good for you. But as I make a point in the book, there are probably three rules. There's a lot more detail that you can get into. But rule number one: stop drinking sugary sodas. That's about 140 calories, totally empty calories, no nutrition in them. It's 10 teaspoons of sugar in that can of uh soda. Not a good idea. Second is in the last 30 years, our consumption of snacks, you know, baked goods, cookies, packaged cookies, pretzels, all of those things has shot up about 500 calories. It's about a quarter of the daily recommended calories. Well, and again, it's not nutritious.
Dr. Michael Koren:
16:33
Yeah, I didn't realize it was 500 calories a day in junk food.
Dr. Ezekiel Emanuel:
16:36
Yeah, most people don't realize it. But a lot of people skip breakfast and eat a muffin, or you know, get uh a cookies at tea time, 3 30 in the afternoon. Those that is not good, and cutting back on that is really important. And then there are the positive things you can do. I at the top of my list is eat fermented food, kimchi, sauerkraut, yogurt, milk cheeses, all of those fermented, they're good for the microbiome. Certainly the yogurt and and cheeses have a fair amount of protein. They've got the the kimchi and sauerkraut and other fermented uh vegetables have good fiber in them. So the probiotics or prebiotics as they refer to them. So they're really, really, very beneficial. And then there's a bunch of other stuff you that are in the book, how much protein you need, how much fiber. I do think, you know, we're on we've really explored the microbiome, but I think in the next decade we're gonna learn a whole lot more about how the microbiome intersects. One of the things people don't appreciate-
Dr. Michael Koren:
17:42
-just for everybody's knowledge, the microbiome is all the bacteria in your gut. And we think these organisms are really essential for human health. And so we think about bacteria in a negative way sometimes, but in fact, there are positive bacteria. So you're making the point that we're just understanding this interface between all this bacteria. I've actually heard that the microbiome is the biggest organ in the body when you think about it. So these are really important insights.
Dr. Ezekiel Emanuel:
18:09
A hundred trillion bacteria live inside you. A hundred trillion. I mean, that's huge, way more than all the brain cells you have, and just all the cells you have, and about three times more than all the other cells you have in your body. And they're not there. I mean, again, evolution tells you they're not there by mistake. They're doing a lot of good there. And having a diversity of bacteria, uh, very important. They need the fibers and fibrous tissue that are contained in vegetables and fruits to grow, to have the good bacteria grow. And when you minimize the microbiome that happens with ultra-processed foods, diet, sodas, and other things, you actually affect what gets absorbed, and you affect your mental health. We know that there's a deep connection with the mental health, and you undermine your nutrition. So I'm convinced that we're gonna learn so much more about which bacteria help us in what ways. But again, the key there is to eat lots of that that's probably the biggest effect of fruits and vegetables, not the antioxidants they have, et cetera, is to cultivate a wide diversity of good bacteria.
Dr. Michael Koren:
19:22
Yeah, no, no doubt. So I want to transition a little bit. In your book, you richly quote your dad, who is a physician, and I love those anecdotes. And you also quote Benjamin Franklin, who is a personal hero of mine. We were just talking beforehand how important he was for the United States of America. I would argue that he was the intellectual architect of the United States of America. I don't know if you agree with that or not, but in my opinion, I would say that. And also his insights in his career mirror what you're trying to do in this book, which is to go from the scientific to the philosophical to the social to the clinical. And throughout his career, he's he he did absolutely wonderful things. Just a little detail that I always found fascinating is that he was the oldest signer of the Declaration of Independence, age 70, if I remember correctly. And most of the signers were actually young men, less than 40 years old, including Thomas Jefferson, who wrote it, who was, I think, in his early 30s at the time. And revolution is a is a task for young men, but thinking through it carefully is a task for older guys like us. So it's so interesting. So is uh tell me about your connection with Benjamin Franklin.
Dr. Ezekiel Emanuel:
20:36
Well, I teach at the University of Pennsylvania, the college that he founded in 1749, and he wrote the founding document about it. Very worldly guy, by the way. He wanted a uh globe in each classroom, he made it secular so it wasn't tied to any religion the way Harvard and Yale were founded before. But I'm here, and when I arrived, you know, every administrator has a clip about Ben Franklin in their speeches, their public speeches, and I'm like, who is this guy? So I read a biography. And then the moment you read one of the great biographies of him, like Tthe First American, you realize this guy is in another plane from everybody you've ever read about. I do believe there are only a few people who are really his equal, people like Da Vinci, because I like to say that Benjamin Franklin was world-class in everything he did, and he did everything. He was a printer who created the first, you know, media empire stretching from New England down to the Caribbean. He was an inventor. We all know he's one of the still to this day, one of the top five inventors of all time. You know, we talk about his bifocals and lightning rod, but he has a musical instrument he invented. He has a ladder chair that he invented, he invented the swim fins that you put on your hands and propel yourself faster. He actually, for us doctors, the urethral catheter he invented for his brother, flexible urethral catheter, he invented. He invented paper currency with a watermark on it, so you couldn't counterfeit it. Anyway, you go on and on. He was a scientist, he was best known in his lifetime as a scientist for understanding. He he named negative and positive charge, he discovered conservation of electricity before anyone else. Brilliant scientist, and he won the night seven uh 18th century equivalent of the Nobel Prize, the Copley Medal from the Royal Society for it, got honorary degrees from Harvard and Oxford and St. Andrews. He was a diplomat, he was, as you mentioned, a politician and revolutionary. He was his autobiography, he is one of the top 50 books in American history. And I could go on and on. Everything he touched, he was world class. As a matter of fact, John Adams said of him in Europe, when they were both in Europe trying to get support for the American Revolution, you know, Benjamin Franklin's face is as famous as the moon's. Because everyone, and when Wedgewood made a statue of George Washington after the Americans won the revolution, they used the face of Benjamin Franklin. They didn't know what George Washington looked like, but they knew what Benjamin Franklin looked like. And so he's actually, you could get these little ceramic stat porcelain statues with George Washington's name on it, but Ben Franklin's face. That's really quite humorous.
Dr. Michael Koren:
23:41
I love that. Well, one of my favorite quotes, and I'm paraphrasing a little bit, he spent a good portion of his life in England, in London, particularly, in 17 or 18 years, as I recall. And over that period of time, it became clear to him that the United States had to become a separate country. And he said it best when he said, in England, it matters who you are. In America, it matters what you can do. And I think that is so incredibly insightful, and I think it's actually learning for us nowadays, including uh students from the University of Pennsylvania. So and I say that my my wonderful daughter, who's brilliant and was a class president at the University of Pennsylvania, and I should have a talk about Benjamin Franklin. We never actually did that. I I thought about that, and I'd love to have that conversation to see how his legacy has impacted her.
Dr. Ezekiel Emanuel:
24:34
Well, one of the there are two reasons Ben Ben Franklin's in this book. One is early in his life, he actually set himself to become better. He consciously outlined 13 different virtues he wanted to develop. And he had a very brilliant insight about how you grow and change. And he said that you can't change all 13 things at once. So he would take one of them, like frugality, and focus on it for several weeks until he had mastered it. And then he'd move on to another one. And I think this is actually one of the points I want to make in the book is you know, there are six different things you need to do for wellness. And within each one, there's multiple different activities, like exercise. You know, you got to do aerobic exercise and muscle strengthening and flexibility and balance. But you don't try everything at once. So these, you know, wellness offerings of, you know, four days to perfect health, unbelievable garbage. It's the equivalent of snake oil. And Benjamin Franklin understood this. You have to focus because you'll be overwhelmed and you'll use up your willpower. Willpower, as we've learned from very detailed studies, is easily fatigued. If you ask yourself to, you know, over and over use your willpower to not eat this or to force yourself to exercise for that, you you will not be able to maintain those changes. You can only maintain those changes when they become a habit and you make them enjoyable. I think that's one of the reasons that social interactions can are critical because they actually make you happy. They're good for you right now. You don't have to wait for the benefits to you know to arise in 20 years. And it turns out you're being generous because they're also good for the person you're interacting with. So, you know, you go into a coffee shop and order coffee, right? Talk to the barista. It's good for you, good for them. Talk to your close friends. You know, one of the things people are always shocked with, I say, Yeah, I talk to my brothers four or five times a week. It's like, are you kidding? How do you because it's good for me and good for them, and we always have something to talk about. And that's really, really important for people to do. And Ben Franklin understood this intimately. The other thing he really understood was staying mentally sharp and curious and always trying to improve yourself. And again, that's one of the messages of the book that you know this is a lifetime process. It's not a sprint, it's you know, decades and decades of your life. You just make that make uh being better part of your daily routine and your habit to try just try to be better every day.
Dr. Michael Koren:
27:27
I love that. I absolutely love that. Zeke, this has been an incredible conversation. Thank you so much for talking to our MedEvidence listeners and viewers. So show us your book one more time and tell everybody how to get a copy of it.
Dr. Ezekiel Emanuel:
27:41
Eat your ice cream. Pre-orders are available now at Amazon, Barnes Noble, local bookstores, and it gets released on January 6th.
Dr. Michael Koren:
27:54
Well, best of luck with the book. Again, I've I've enjoyed reading it, and I think I can't see how anybody won't get some insight or get something positive from the from this wonderful look at the clinical, scientific, and philosophical elements of our current healthcare system and our approach to wellness. So again-
Dr. Ezekiel Emanuel:
28:12
-yeah, I tried to make it so that you would not only enjoy the book, learn something, but also laugh. So I hope the stories are fun and engaging, and you know, you can you can see. I laugh at myself, uh, but I think the circumstances are really I'm trying to make it enjoyable.
Dr. Michael Koren:
28:30
So it's beautifully written. So I'll say to the people that are listening to us, don't be a schmuck and get this book.
Dr. Ezekiel Emanuel:
28:38
Thank you for the endorsement, Michael.
Dr. Michael Koren:
28:41
Again, Zeke Emanuel, Dr. Michael Koren, thank you for listening and viewing MedEvidence.
Announcer:
28:46
Thanks for joining the MedEvidence Podcast. To learn more, head over to Medevidence.com or subscribe to our podcast on your favorite podcast platform.
