“Remember the first rule of life: We’re all going to die.” A grim thought in isolation, but in the context of Ezekiel Emanuel’s new book, Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life, the statement offers a sense of liberation.
Emanuel has been working to improve Americans’ health for decades. A bioethicist, health policy expert, oncologist, and chocolatier — yes, really — he helped to write the Affordable Care Act (ACA) and to create USDA’s MyPlate, which replaced the Food Pyramid.
He reproduced this fatalistic first rule in his book to remind readers that we’re all fated to oblivion. So let’s not single-mindedly strive to avoid death, but rather simply try our best to live life as well as we can.
“Wellness ought to be in the background: an unconscious part of your lifestyle, not an obsession,” he writes.
In Eat Your Ice Cream, Emanuel lays out six fundamental wellness behaviors that can be woven into one’s life with relatively little effort: Avoid self-destructive risks, be social, stay mentally sharp, eat healthy, exercise regularly, and get rest. If you do those simple things, the research suggests, you have a good chance of living a long and healthy life. And together, they’re more effective than any pricey supplement, restrictive diet, or glamorous wellness treatment.
Big Think spoke with Emanuel in advance of his book’s release. During our conversation, he revealed why social connection is the most important aspect of health and why Benjamin Franklin is a wellness icon. True to his book’s title, he also made the case for eating your ice cream. (The following interview has been edited for length and clarity.)
Big Think: You write that most wellness advice manages to be both too complicated and too simplistic. What do you mean by that?
Emanuel: If you pick up any of the wellness books and some of the books on food, they’ve got tons of detail in them, most of which is totally irrelevant to staying healthy. The latest one that gets me is ultra-processed foods. People say, “Well, there are some good ultra-processed foods.” Yes, I could spend time sifting through all the ultra-processed foods, asking whether each is in the “good” or “bad” category, but that’s already way too complicated.
The simplistic part of most wellness advice is that it focuses mainly on the physical elements of wellness: eating well, exercising, and sleeping. All important, don’t get me wrong, but they’re not the most important. They leave out the cognitive social parts — such as interacting with other people and having good, deep relationships.
Big Think: One of my pet theories is that many wellness books get complicated because they’re trying to sound science-y to convince readers that their ideas are important and valid.
Emanuel: I would say that another aspect of it is that a lot of these influencers have to do something every day or week. They have to bring in something new to make it complicated so that someone will come and listen to you.
The fact is that when it comes to wellness, everything is 2,500 years old or more. Aristotle knew about friendship and social relations. Hippocrates knew about diet and exercise. They both knew about sleep. There’s not that much new here.
What differentiates my book is that I’m not trying to sell you anything. There’s no clinic where you can pay an exorbitant amount of money, no supplement, no special exercise class. I want to demystify wellness and also remind people that you don’t have to be obsessed to live a healthy life. You don’t have to deprive yourself. Wellness should be something fun.
Big Think: Why is it that family, friends, and social interaction together constitute the most important element of wellness, longevity, and happiness?
Emanuel: Why is it that human beings have survived and come to dominate the Earth? We’re not the strongest. We’re not the fastest. We are, however, a species that can bring its members together to accomplish what each of us as individuals cannot. Communication and collaboration are big parts of the brain. We get big boosts of key hormones and neurotransmitters from connecting with people. [It’s] critical for the brain and thus critical for wellness.
The longest study of human happiness and health is the Harvard Adult Development Study. It started in the 1930s and 40s, [and] the researchers followed subjects for 85 years. It turns out the most important predictor of living a long time with few health problems was good social relationships.
Aristotle knew about friendship and social relations. Hippocrates knew about diet and exercise. They both knew about sleep. There’s not that much new here.
Big Think: As much as you extol social connection as a pillar of wellness, you come down hard on social media, calling it “anti-wellness” in your book. Why?
Emanuel: Social media today is heavily associated with anxiety, depression, and a whole series of problems.
I wrote last summer about banning phones and computers from my classroom. I’ve now done it two semesters in a row, and students are way more focused. More students have come up to me and said this was the best [class] they’ve taken. I think it has little to do with me since I haven’t really changed the class in 15 years. It has more to do with the fact that they’re present in the class.
They’re not on their devices shopping, emailing, or looking at the news and Facebook. Data show that when kids take a holiday from electronics, they feel much better. They’re less anxious.
Big Think: Let’s shift to one of the main thrusts of your book: What are the eight major “schmuck moves” we should avoid?
Emanuel: The first is smoking and vaping. Smoking is associated with myriad health problems. You see all sorts of cancers linked to smoking. Vaping is, as far as we can tell, less toxic than smoking, but it’s no free lunch. We’ve also been doing it for less than two decades, so we don’t know the long-term effects.
Alcohol is another big issue. We know that alcohol is bad in many ways. It causes liver disease [and is] associated with at least seven cancers. We also know that you can lose coordination and reaction time. The recommendations generally are either zero or half a glass a day.
Now, I’m a realist here; 60 to 65% of American adults drink. We’re not getting to zero. A drink every other day or a drink for celebrations, that’s what you should do.
Third, many people skip sunscreen, and there are two really terrible things about sunlight. The least bad is all those wrinkles and the early problems of aging in the skin. The other is melanoma, which is a deadly skin cancer.
Related to that are tanning beds. One of the things I worked hard on when helping to write the ACA was getting a tax on tanning beds. There are no positives to them. They age your skin. They raise your chances of cancer. We shouldn’t be doing it.
The fifth is skipping vaccines. Vaccines are victims of their own success. [Today], people are wondering, “Why are we worried about measles? Why are we worried about mumps? Why are we worried about chickenpox?” We’re worried because those were serious problems when we didn’t have vaccines. People were hospitalized and died. Don’t skip your vaccines; overwhelming evidence says they’re safer than getting the diseases, including the COVID vaccines.
Skipping recommended cancer screening is the sixth. Whether it’s for cervical cancer, breast cancer, colon cancer, or lung cancer, it’s a problem.
Owning a gun is another schmuck move. We all have a natural instinct to protect ourselves and the ones we love. Part of the problem is that a lot of guns in America are stored loaded and unlocked, which is a bad combination. Guns are the number one cause of mortality among children and adolescents. Just having a gun around means that you are twice as likely as your neighbor who doesn’t have a gun to die by one. Now, if you’re a hunter and you’re very careful, great. But for self-protection, it’s not a good idea.
The last one is climbing Mount Everest. The mortality rate for all climbers, including the experts, is around 1 in 100. If you’re over 59, it’s 1 in 25. Who’s taking those chances in exchange for pounding your chest? It makes no sense. If you want to do something thrilling, go skydiving.
[Editor’s Note: According to the United States Parachute Association, the fatality index rate was 0.27 fatalities per 100,000 skydives in 2023, several orders of magnitude safer than an Everest ascent.]
Big Think: You write that upswings in wellness obsessions seem to emerge when there is a collective sense that the world has spun out of control. In this light, do you think that, for most people, pursuing wellness is more about their mental health rather than their physical health?
Emanuel: It’s an assertion of autonomy and self-determination of the things we can control. Historically, 150 years ago, there was a big wellness upswing that coincided with the second industrial revolution. People were flooding the cities. Lots of people were emigrating to the United States and other countries. It corresponded to moments of nationalism, with lots of xenophobia. There was also a huge amount of income inequality.
Today, we have almost an identical situation. We have the AI revolution. We have large-scale immigration issues along with xenophobia. We have income inequality. A lot of people worry that their lives are spinning out of control, so they focus on things that they can control. Wellness seems to be one of them.
Big Think: Benjamin Franklin is a recurring character in your book. Why?
Emanuel: Fifteen years ago, I started at Penn. Every administrator, when giving a speech, inevitably throws in one of Franklin’s aphorisms. And I thought, “This is a little corny.” So I read a biography about Franklin, and he’s the most brilliant person ever born in North or South America — maybe in the world. His only rivals are people like Leonardo da Vinci and Albert Einstein. I ended up teaching a course about him because he was so amazing.
I believe he thought through how to live a good life. He invented retirement for working-class people. He made enough as a printer that he could retire at 42, and he said, “I’m going to live a life of leisure.”
By that, he didn’t mean going to the Jersey Shore. It meant that he didn’t have to worry about business and making money. He could focus on doing good, and for him, doing good was science and social improvement activities. He founded the University of Pennsylvania. He founded the Pennsylvania Hospital. He created an insurance company. Almost all of his inventions occurred after he retired.
He realized that not contributing to society is not good for the soul. You have to be useful. You have to try to make the world a better place. That’s key to wellness, too, and [Franklin] lived a long life. At a time when the average age at death was under forty, he lived to 84, fully mentally competent all the way to the end.
Big Think: In your book, you mention that one of the worst things someone can do for their health is retire. Can you explain what you mean by that?
Emanuel: There are many studies, and they almost uniformly show that retirement is not good for cognitive function. There are many hypotheses. One of them is that you lose a schedule. [Another is that] you lose social relationships because a lot of those are formed at work.
One of the most interesting studies came from RAND. It looked at different countries’ retirement ages and the cognitive functioning of people who retired. It turns out that retiring in your 50s is very bad for cognitive functioning. In the United States and Switzerland, we tend to retire later and are actually better off.
We too often don’t plan for retirement and assume that lying around is the key. We end up doing passive things, like watching TV, rather than active ones, like volunteering at libraries, schools, or food banks. If you’re going to retire, you have to plan for it and make sure you’re staying active and contributing.
You have to be useful. You have to try to make the world a better place. That’s key to wellness, too.
Big Think: What are the three biggest “bang for your buck” dietary moves someone can make?
Emanuel: One of them is avoiding sugary drinks. A 12-ounce can of soda has 140 calories, zero nutrition, and 10 teaspoons of sugar. The good news is that soda consumption has gone down in the United States. We’re now down to about one a day per person, on average, and that continues to go down.
The second is avoiding packaged salty and sweet snacks. Snacking has gone way up in terms of calorie consumption over the past 30 years, [to around] 500 calories per day. That’s about a quarter of the recommended calorie consumption for women and a fifth for men. That’s way too much.
The third is adding fermented foods to your diet. For one thing, it’s good probiotics. Whether it’s yogurt, kimchi, miso, or cheeses, fermented foods are good for your gut. Some of them, like kimchi, also have high fiber.
Big Think: Consuming dairy has gone out of style with wellness influencers and even many nutrition scientists, but you’re still a fan. Make the case.
Emanuel: The main objection to dairy is saturated fat, but the saturated fat in dairy is not the same as in red or processed meats. We know that dairy is associated with a lower risk of diabetes. Dairy has a lot of protein and good bacteria. If you look at studies of the foods associated with weight loss, yogurt is at the top of those lists. Dairy is also protective against some cancers and promotes others. It is protective against colorectal cancers; the ones it promotes tend to be rarer.
On balance, I think dairy is good, especially if it’s in the form of yogurt, kefir, or cheese. Or even ice cream!
Big Think: Which brings me to my next question and the title of your book! I’ve been covering nutrition science for a long time, but I don’t think I’ve ever come across a convincing argument that ice cream is healthy. Tell me: Why is ice cream good for us?
Emanuel: There’s some good data that it’s at least neutral or positive for you. Should you have two scoops of ice cream every night? No. But could you have it once or twice a week? Yes. Use it for a reward or a celebration!
Wellness isn’t about perfection. This isn’t the Olympics. Choose a lifestyle that is good overall. Might all of our lifestyles have something that isn’t aligned with wellness? Yeah. But if you’re 90% there — and I’m a professor — that’s an A.
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