STORY AND PHOTOS BY KAREN BOSSICK

Dr. Ezekiel Emanuel wasted no time in telling a packed auditorium at the Church of the Big Wood that they already knew most of the secrets for a long, healthy life.

"Before I wrote the book, you knew almost all of it,” said Emanuel, a University of Pennsylvania physician and bioethicist and author of "Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life."

The most important ingredient has nothing to do with what you eat or how many miles you log on a bicycle, he told those attending St. Luke's Wood River Foundation’s annual Health & Well-Being Speaker Series. It's the people sitting next to you.

Dr. Ezekiel Emanuel, right, said the secret to a long, healthy life is not the complicated thing many make it out to be.

Emanuel, who advises the director general of the World Health Organization, said he wrote the book out of fury. He had just finished reading Peter Attia's "Outlive" — all 413 pages of it — and it made his blood boil.

He ticked off the things that bothered him with the rapid-fire delivery of a man who has spent decades telling powerful people what they don't want to hear.

First, he said, "Wellness should not be an expression. You should get a wellness lifestyle and put it in the rear-view mirror and just go about your life."

Second, the notion that getting healthy requires deprivation is nonsense. He cited a study of doctors and nurses whose hand-washing compliance dropped steadily over a 12-hour hospital shift — not because they were careless but because willpower simply runs out.

"You can't do wellness by self-denial," he said. "You have to enjoy what you're doing so you'll continue to do it for years and years."

Third, he said, too many wellness gurus think they can outsmart Mother Nature: "We've been evolving for millions of years, and you think you're going to come along and outsmart her? It's just not going to happen."

Fourth, he said, the body operates on homeostasis — a careful balance. More is not always better. Too many supplements can cause toxicity. The immune system can attack the body if it's overactive.

And fifth — the one that really got under his skin — the entire wellness industry ignores the single most important factor for a long and healthy life: social relationships.

"It turns out when you study people, it's social relationships that are the most determinative thing for your wellness and your longevity. Diet, very important. Exercise, very important. But social connections are more important. And you don't hear a word about them."

Emanuel laid out his six rules with the blunt charm of a man whose father used to smack him on the back of the head for doing something stupid. Rule No. 1: "Don't Be a Schmuck."

"We all take risks," he said. "The riskiest thing we all do is drive a car."

The lifetime chance of dying in a car if you drive 10,000 miles a year? One in 93. But people who worry about car accidents will happily climb Mount Everest, where the chance of dying is one in 100 — one in 25 if you’re over 59. Base jumping? One in 127 per jump. Even being President of the United States carries a one-in-11 historical chance of being assassinated in office, he noted, ticking off Lincoln, Garfield, McKinley and Kennedy.

On alcohol, he was pragmatic. The World Health Organization says the right level of consumption is zero.

"That's just not going to happen," he said, noting that 55 percent of Americans drink. Yes, alcohol is corrosive to the liver and associated with seven types of cancer. But there's evidence of cardiovascular benefit for men over 55.

His advice: Don't drink alone, no binge drinking, and keep it sociable: "Why do people like alcohol? It's a social lubricant. And by the way, we're not the only animals that like it. Birds eat fermented food. Chimpanzees seek it out."

On vaccines, he was emphatic. The shingles vaccine, he said, is not just good for preventing a painful disease. It prevents dementia by 20 percent," he said.

The pneumococcal, flu and DPT vaccines likewise have been shown to decrease the risk of cognitive impairment and Alzheimer's disease.

Social interaction triggers the release of oxytocin and dopamine while downregulating stress hormones through the hypothalamus. A major U.K. Biobank study found that socially isolated people had activated genes related to inflammation, decreased immune response and cardiovascular risk.

"They interview lots of 90-year-old, 100-year-old people, and they tell you all sorts of stuff about how they got there," he said. "But the consistency is family and close friends."

Even introverts benefit. He described a University of Chicago study involving commuters on trains and buses. Those forced into conversation — introverts and extroverts alike — reported the ride went faster and they were happier at the end.

He illustrated the point with his own family. His brother Rahm — former Chicago mayor and White House Chief of Staff — was in the audience. His other brother Ari, the Hollywood agent, had called before the talk.

"He said, 'I know you won't believe me, but you have to pop down to the Wall Street Journal and write down that I totally disagree with you. Call me up and try to argue with me.' That's a good social relationship,” Ezekiel said, grinning.

He complimented the audience for its likely food choices: "You live in Sun Valley. You are all physically engaged, you're eating healthy, and I saw the Farmer's Market. But America as a whole is the No. 1 worst eating country in the world, with 65 to 70 percent of calories coming from ultra-processed foods.”

Go for fermented foods and fiber, he told the audience. Kimchi, sauerkraut, yogurt, cottage cheese and hard alpine cheeses feed the gut microbiome. And 93 percent of Americans don't get enough fiber.

"Everyone's talking about protein maxing, but no one's talking about fiber," he said. "Fiber is way more important."

His prescription for breakfast: A bowl of fruit with berries or kiwis, yogurt, whole grain granola, chia seeds and hemp hearts.

"You've got fiber, you've got protein, you've got good fats. Go do it."

As for exercise, aerobic exercise should get the heart rate to about 70 percent of maximum — calculated by subtracting your age from 220 — for about 150 minutes a week. Strength training is essential because starting around age 55, people lose about 10 percent of muscle mass per decade. And some form of yoga or stretching is needed for balance and flexibility.

But recommendations of 10 hours a week of physical activity is nuts.

"Five hours is probably the max you should be doing. The longevity curve plateaus at about 150 minutes of intense exercise or five hours of moderate exercise per week. Beyond that, you're not getting any longevity bonus. And you're putting yourself at risk for repetitive motion injuries."

His final rule was sleep, which he called unique among wellness activities because willpower is counterproductive: "If you use your willpower to sleep, it'll keep you awake all night.”

His sleep hygiene rules: No caffeine eight to nine hours before bed, no alcohol within eight hours, no naps after 2 p.m., a cool dark room, and a consistent bedtime. Melatonin and prescription pills are not effective, he said. Cognitive behavioral therapy for insomnia is the only approach that works.

Emanuel concluded with Benjamin Franklin, whom he believes is "the most brilliant person who's ever lived in North America."

Everything Franklin is known for — his inventions, scientific discoveries, diplomacy and writing -- happened after he retired at 42. At 80, he came home from nine years as a diplomat in Paris and began expanding his house, with a big dining room on the bottom floor for hosting conversations and a library on the top floor for his 4,000 books.

Franklin was endlessly curious, deeply social, and physically active as a young man, carrying double loads of printing type up and down stairs and swimming three miles in the Thames.

He also kept a diary tracking 13 virtues — things like humility, orderliness and generosity — and worked on improving one at a time over several weeks before moving to the next.

"He said it was foolish to do all the things at once because that was just frustrating," Emanuel said. "You have to focus on one thing and then move on to others."

"I think that's the essence of a good, well-lived, fulfilling life,"