The Loneliness Epidemic: Why Community Is Key To Better Health and Longevity

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Biological aging is a result of all of our stressors and our psychological stressors and relational stressors or lack of connection is really important.

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In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in. One of the biggest factors in terms of your risk for premature death is loneliness. Being lonely and socially isolated is equivalent to smoking two packs of cigarettes a day. That's really serious. So biological aging as a result of all of our stressors and our psychological stressors and relational stressors or lack of connection is really important. Lack of physical touch, lack of intimacy, plays a huge role, not lack of being understood and seen and witnessed, plays a huge role in so much of the ailments that we're suffering, not just mental illness, but also physical illness and our longevity. So this whole idea of sociogenomics, I actually came up with this term years ago when I was in Haiti and then it became part of medical literature, not because of me, but because other people also started glomming onto it. And it was this idea that our social relationships and our social networks may be more important than our genetic connections in determining our health and our health outcomes. And that our lifestyle certainly influences our genes, but so does our social connections, our relationships influence our gene expression. And it's really not an abstract theory or notion. It literally is biology. Our thoughts, our beliefs, our relationships all drive real changes that we can measure in our gene expression that control inflammation, stress hormones. So for example, you're having a conversation with somebody. If it's a loving, connected, intimate conversation, your anti-inflammatory genes will turn on, your healing and repair genes will turn on. whereas if you're in a conflictual relationship or a conversation with somebody, you're gonna have your stress hormones increase, you're gonna have inflammation increase, you're gonna increase all sorts of bad things in your body that are produced by your body that cause harm. So we have huge, huge, huge motivation, I think, to focus as a, as a key part of our health strategy and just life happiness strategy, a, a, a, a, a, a deep sense of community and making sure we build that. So our social connections, our community and relationships all are associated with long lifespan, with better mental health, with improved physical health, even things like blood pressure, waist circumference, body mass, inflammation. Now, I was in icaria and Sardinia, which are two of the blue zones in the quit peninsula. And one of the things these communities have in common where people live to be longer than anywhere else. And I wrote a lot about this in young forever, my new book, was the power of community. They all were part of this fabric and they all had their place. They all had their role. They all had a meaning and purpose. Even if you're a hundred years old, I remember Julia was 103 months, she said, and she basically was still working at a hundred years old, making all sorts of wedding accoutrements like doilies and little lace things. I don't know what they do or in Italy, but it was kind of cool. She was constantly working and making stuff for all these weddings and was still involved in the community life. So I want to share a little bit about a study that it kind of reflects the power of this and it was, an 80 year study called the Harvard Study of Adult Development. And it had been producing data on so many different things on who lives longer, happier, healthier lives. And they wanted to understand not what makes people sick, but what makes people thrive, what makes them well. So what were the lessons from this study was 84 year study, right? Long study. They were tracking the same people and over generations asking thousands of questions, hundreds of measurements to find out what really makes people healthy and happy. And they were these people are giving regular updates on their life, their health, their income, their employment, their marital status. They filled out questionnaires and were part of interviews where they revealed their fears and their hopes, their disappointments, their accomplishments, their regrets, life satisfaction, and lots more. And this had a really incredible impact by providing lots of data. Then researchers use this data to assess how people's lives, their experiences, their attitudes affect their well-being. And one of the things that's was so powerful from this study was sort of surprising. It wasn't career achievement, it wasn't exercise, it wasn't a healthy diet that determined the quality and happiness of your life. It was good relationships. Good relationships keeps us healthier and happier. That was powerful. And the study's leaders that are, I mean, obviously the people started the study are dead. The current leader of the study, Robert Waldinger from Harvard and Mark Schultz, have a new book. It's called the Good Life: Lessons from the World's Longest Scientific Study of Happiness. And it's a great book. I actually had Robert Waldinger on the podcast, the Doctor's Pharmacy, and you can learn more about the book and things there. But what are the things that we can do? What are the lessons learned from the study about how do we improve the quality of our relationships? First, we have to look at ourselves, right? Who are we? What is our life like? What are the choices we're making? How are we not prioritizing relationships? So we can get really busy. We can do all sorts stuff that we think is helping us get ahead. We can spend too much time on social media, but we often don't really think about building and investing in the quality and the number of our relationships. And for me, I know as personally that my relationships, my friendships, my community is the most important thing for me. It really is what keeps me grounded, keeps me healthy, keeps me happy. And then more and more as I get older, focus more on this as opposed to like when you have kids in a career and you try to just kind of get by and it's like sometimes friends can fall by the wayside, but it's really important to find and it even can be just one or two good friends. It makes a huge difference. Now, when these people in the study actually were interviewed, they really actually benefited from this interview because it helped them realize where they neglected their relationships and then they considered sort of looking and finding, well, how can we improve that? So maybe look at your own life. What's your social life like? Who are the people in your life that you care most about, that you want to have a relationship with? Think about how they support you and how often you spend time together and maybe do a little bit of effort to actually focus on what matters to you most and help you make decisions that actually can enhance the quality and number of your relationships. So maybe spend more time with people who make you laugh and who elevate you and less time with people who drain you and are or, you know, energy steps. So I, you know, I think it's important to find friends and community members that help bring you up and not take you down. You know, sometimes you meet with people and all they want to do is complain and go on and on about everything. And I think there, you know, there are other people who, when you're around them, you laugh, you have fun, you play, and it's just, that's what you want. You know, prioritize your relationships. We schedule and exercise. We make ourselves maybe time to make a healthy diet. We focus on our career and work, but we don't, focus on prioritizing those relationships that matter and being showing up and being present for us rather than zoning out on social media, you know, rather than like, you know, doing a million things at once, focus on, on your relationships, you know, when during COVID I, I think we all felt a little isolated. And so I reached out to about six of my close male friends, and we all have known each other for 40, often plus years, maybe 35, the small, the fewest, I think was 25 years. And so we've known each other and we formed group. And every, every Tuesday at six o'clock, we meet for an hour and a half and spend time together and share about our lives. And it's been one of the most impactful things I've done. And it's something you can do. It doesn't take any organization. You just need a zoom link or, you know, it's really pretty easy. And you can have these deep connections and relationships that allow you to be seen and known and, and can really help activate so many healing pathways in your body. Um, big time to talk to people, right? And it came in sometimes as small relationships that matter. But a study in the University of Kansas found that the simple act of just reaching out to somebody, a friend for conversation once a day, dramatically increases happiness and lowers their stress hormones. So hanging out with friends lowers your stress hormones.

Pretty good.

And also, it's not all about you, right? So take time to ask questions, find out what's exciting for them. find out what they're struggling with, find out what makes them happy, have them share their life with you and value their opinions. Be present, focus and don't just be superficial with them, but go deep. So maybe try to have one conversation a day and put that in your calendar and see what the effects will be over time. Super important. Next thing is be kind. My grandmother used to ask my mother when she came home and said, I met this new friend. She says, are they kind? and I think kindness was such an important value in my family. And how do we be kind to each other? And, you know, you know, the, you.

Know, the, the, the relationship happiness is.

Determined by how you are in that relationship. Uh, there was a research study in, Michigan State that looked, on data, for, for 2500 married couples, and they found they were, you know, how good they were in five different dimensions. Uh, were they extroverts? Were they agreeable? were they conscientious, were they stable emotionally, were they open to doing new things and experiences? And the ones who had higher levels of agreeableness and emotional stability also had higher happiness. So the more kind and positive you were, the more likely you were to be happy. So people invest a lot of time in finding someone who's perfectly compatible, but that might not be the whole story. It's more about being kind to the people you care about and fostering those deep connections. Also, A friend of mine had a word that I really loved, which is called coptuiveness, which is where you cop to it. If you screw up, if you make a mistake, you cop to it. And it's really about learning to apologize, learning to repair relationships, learning how to have nonviolent communication, and owning your stuff. Like I said, also a great way to build relationship is to ask questions instead of talking about yourself. Ask questions about somebody. Show that you care, show that you're interested, and what they care about or thinking about. If someone wants advice, don't just give them your opinion. Ask them questions to guide them to the right answer that they know themselves. Also, don't be shy about expressing your love. There are lots of ways to love and lots of ways to express it. Maybe it's simple things. I had a flight that came in the other night late and I usually take the Uber home. My partner, she showed up unexpected and picked me up at the airport. just brought me such joy and delight. It was such a simple thing, you know, 10, 15 minutes from the airport here. And it wasn't a big deal for her, but it made a huge difference in terms of my own happiness. And it was really powerful. So help your friends with a project, you know, ask them what they need to do, whether it's clean up the garage or work on a project together, you know, call an old friend. Maybe they haven't heard from you a while. Maybe you just want to check in on them. ask them how they're doing. Maybe you want to focus on helping somebody who's trying to do something that may be difficult for them, try to support them and give them some love. Also, when you have a partner or a close friend, do little acts of kindness. Give them a little gift, buy them something they like, get them something that makes them smile. It can be super simple. When you often don't do these acts. Life just, it's a little bit flatter and when you do them, it's super fun. Like I said, when my partner picked me up at the airport, it was like, wow, I got that she really cared. Also, tell people how you feel about them. Don't wait till their eulogy to tell them all the things you like about them. Be specific. Give people feedback about what you love about them, what you like about them, what makes you happy, how you feel in their presence. Who would you be without them? who would you be now that you're with them? What do they inspire you to do? And thank them for what they do and how they show up for you. Don't be shy. Like I said, don't wait till someone's dead to write a eulogy about them. It's better to have eulogies when you're alive. And I actually had a friend group where we would get together and on people's birthdays we would basically go around and for everybody's birthday we would share a little bit about what they're like and what we like about them, what we love about them, something that inspires us about them. And it's like getting a living eulogy. It's pretty awesome. So I really, really, really invested in my own friendships in my own community, and I think it's a critical aspect of our health. And as I get older, it becomes more and more important. If you're a longtime listener, you might.

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HYMAN for 20% off plus free shipping. What is the science behind loneliness and its effect on our health and our longevity. And what do we know about that?

Well, it starts with what you just touched on. Understanding how loneliness impacts our body starts with how we were thousands of years ago. And we, over time, evolved to really need each other. So thousands of years ago when we were hunter-gatherers, there was safety in numbers. So if you had a trusted group of people that you were with, you could take turns keeping watch at night to make sure that there weren't predators that attacked. you could also pool your food so that you had a stable food supply over time instead of starving, you know, for many days at a time. You could also do other things like help in child rearing. So you could have people could take care of each other's kids and share the responsibilities, which can be quite taxing if it's just you alone managing a growing family. And so we over time came to depend on other people for our safety, so much so that when we were separated from the tribe, when we were effectively more at risk then of starvation or being pursued by a predator, it put us in a stress state. And now in some ways that's actually a very healthy response. Cause that stress state would raise our threat level and focus us inward and push us to quickly get back to the tribe as quickly as possible. And that's in a sense what loneliness is like. Like loneliness, like hunger or thirst is a signal that our body is sending us that we're lacking something that we need for survival. And if we react quickly to that and fill the gap, you know, with social connection, healthy social connection in our life, then that feeling of loneliness goes away and we're, and we're okay. The problem though, is when that state of threat, which is effectively a physiological stress state persists for a long period of time. Like we know that stress is not good for us, you know, when it, when, but it's only in, in the case of it being there for a long period of time or an excessive amount.

It's adaptive in a small- yeah, small.

Amounts can actually be quite good. Like before we give a big speech or take an exam or take on any big task or go out on a date that we're really excited about, we might feel some stress, right? And that might push us to perform better and to actually bring out the best in ourselves. But when we're chronically stressed, that actually is when our body starts to break down. That's when we have elevated levels of cortisol and other stress hormones flowing in our body. We have increased levels of inflammation and that over time damages tissues, blood vessels, and leads to higher rates of heart disease and other illnesses. And so loneliness, when it's chronic, when it's long standing, puts us in a chronic stress state. And it's from that that we see so many of the negative consequences. Now, there are other practical, you know, implications to our health of not having connections. Some of the day to day help we might need going to the doctor, taking our medicines, having someone to remind us and inspire us to eat healthily or to go and work out.

To have a reason for living.

Right.

To have a reason for living. We may miss out on these things too. So the healthiness of our lifestyle may deteriorate as well. But what we see overall is when you look at the data at the impact of loneliness on our health, what you find is that loneliness is associated with a reduction in our lifespan. And that mortality impact is similar to the mortality impact of smoking 15 cigarettes a day.

Wow.

It's greater than the mortality impact of sedentary living and obesity. I think as surgeon general, how much time I spent on those three issues on smoking, obesity, and physical activity compared to how much I spent on loneliness. There was no comparison.

Wait, we gotta stop there for a minute. 'Cause what you just said was remarkable that loneliness is a bigger risk factor for a shortened lifespan than smoking. obesity or lack of exercise.

Well, it seems to be just, that's like headline news. It seems to be just as powerful as smoking 15 cigarettes a day and, and even greater than the impact of.

Obesity, which is pretty deadly.

I mean, smoking is pretty deadly. So, yeah, this is something that's not talked about. It's something that we don't, I mean, I'm, I'm in a big health care system. We talk about the office of experience and improved patients and doctor's experience, but this issue of loneliness being a risk factor, I just, it's just not in our training and it's not. in our even approach as a culture to figure out how to solve some of our big issues like depression and the opioid epidemic and, you know, why people eat.

You know, it's not only about what.

People eat, it's why people eat. You know, I often say, you know, you don't have to focus on what you're eating, but what's eating you.

Yeah.

And I think people don't, don't understand that connection. And I, I think the question is, you know, what's happened to our society that's led to this?

And how do we get it back.

To a place where we do have connection and not social media, which actually leads to more isolation, more disconnection, more separation, feelings of isolation. You see the Instagram models and this and that. It just sort of makes you feel bad about yourself. It's not really true social connection.

Yeah.

So let me pick up on one thing you said even earlier also, and then I'll get to what's driving this. But something you said, I think is really important, which is that we weren't really trained to think about this or to recognize how important it was. And I think part of the challenge is We don't see loneliness around us very much.

And there are two blood tests for loneliness.

There is, and you're right. But also, even if we just think about the people in our lives, we may not recognize that loneliness is that common, but there are two big reasons for that. One is because there's a huge stigma around loneliness.

Yeah.

There's a sense of shame that people have because they feel like if they say that I'm lonely, that's like saying I'm not likable or I'm not lovable or I'm not desirable in some way. Yeah. It's like saying I'm a loser and nobody wants to feel that way. I certainly didn't when I was younger and felt lonely. I didn't never told anyone about that. But there's another reason though that loneliness is hard to see. And that's because we stereotypically might think of loneliness as the person who's sitting in the corner at a party and not interacting with anyone.

But that would have been me as a kid. Yeah, actually I never got invited to the party.

So I wasn't at the party.

I was alone. It is true.

But the other reason we don't see it is because it looks like other things. So loneliness can look like depression, it can look like anxiety, it can often lead to addiction or increase our risk for addiction. In fact, the founder of AA, one of the most interesting things I found that he said is that loneliness he felt was at the root cause of so many people's struggles with alcoholism. and needed to be addressed in order for them to get into and stay in recovery. And that is something I found also when looking at the opioid epidemic. There's a reason that the opioid epidemic has been labeled part of the larger group of illnesses called deaths of despair. Because it is often a sense of hopelessness and isolation that can lead people to experience emotional pain. And then as human beings, once we experience emotional pain, we will seek to relieve that pain. And the question in those moments is what are we reaching for? So are we reaching for alcohol? Are we reaching for drugs? Are we reaching for food? Are we reaching for exercise? Some people work out when they feel stressed or in pain and that helps them. Are we reaching for work? Some people drown themselves in work when the stresses of their personal life are connected to their connection.

Yeah, that would have been me.

That would be me.

Right. And this is the thing is that there are socially acceptable ways to sometimes deal with your pain even though it hurts you in the long run.

Yeah.

And alcohol, I think, and work are two examples of those. But for those reasons, when you look around you, you might think, oh, maybe I don't know that many people are lonely. But I will tell you that the statistics back up the fact that a very large number of people that we know are likely struggling with loneliness. If you look at the conservative numbers, what you'll find is that probably somewhere around 20 to 22% of adults in the United States are struggling with loneliness. Those are the lower numbers.

Wow.

But there are plenty of other studies, including one recently by Cigna, the health insurer, which have pegged those numbers as significantly higher. And it's not just the US. What percent? Well, in the Cigna study, most recently, they found that it's in the 60s. It's more than 60% of adults who actually say they're struggling with loneliness. Now, this is either because loneliness, maybe loneliness is increasing, maybe people are just more comfortable now starting to admit that they're struggling with loneliness. Maybe the studies are getting better. Who knows what the reasons are. and it could be potentially all of those. But the point is that we are talking about more people who struggle with loneliness and have diabetes in the United States, more people struggling with loneliness than adults who smoke in the United States. So this is both common and it's also consequential for our health. And it's invisible. And it's invisible. Yeah. It's invisible. It's incredibly striking.

And you talk about how in your book Together, the Healing Power of Human Connection in a Sometimes Lonely World, which I encourage everyone to get a copy of, whether you're lonely or not, because likely you know someone is and likely the things in this book are going to help you get more connected to things that matter in your life and also help you engage with your community in different ways to build love and connection, which is what this is all about. You talk about in the book how loneliness also has not just impact on the individual, but in a broader context, it affects our kids' ability to function and learn in school. It affects productivity in the workplace and effectiveness on a sort of commercial level of competitiveness. It affects this incredible polarization and division in our society.

I mean.

I remember hearing this guy, Peter Orzag, who was a budget director under Obama, talk at Cleveland Clinic about the voting in Congress and in the '60s, you could see a sort of a cloud of votes for Republicans, Democrats. It was all mixed. It was a big Venn diagram there was tons of overlap and voting across party lines. And then he showed a graph now, and it was just a complete separation. And we're seeing that mirrored, like I've never seen before in history, in terms of lack of ability for our government to function, but then it's spreading out in terms of divisiveness and conflict among all kinds of groups, racial groups.

And.

All these different divisions in society that are really, I think, crippling our ability to actually have a great society. And so can you talk more about how loneliness is driving some of these trends and what we can do about it?

Yeah. This is one of the reasons that I wanted to focus on this issue because when I came out of government, when I finished my time as Surgeon General, I found myself thinking about all the different issues we had touched on from the opioid epidemic to violence to e-cigarettes, you name it, Ebola, Zika, Bet.

You'Re glad you're not having to deal with coronavirus right now. That's so frightening.

It's a difficult, yeah, a very difficult and disturbing situation right now. And I think it's sadly only going to get worse before it gets better. But one of the things I wanted to do is I wanted to ask myself the question, what's at the root cause of many of these deeper issues? And can I do something to make a small contribution to addressing that deeper root cause? And what I kept coming back to again and again, guided both by the conversations I had with people around the country and the science that I was reading, was that our connection with each other is actually one of the most powerful and important resources that we have, not just for our health, but that affects our performance in the world, in school, in the workplace, that impacts whether we talk to each other or not in communities and even has an impact on our politics. And that's why I wanted to work on this. And here's why, how it affects us. You know, if we can't, when we are connected to each other, Our threat levels are lower, our levels of stress are lower. When we are lonely, it increases our threat level and actually shifts our focus internally towards ourselves. Because if you're in a threat state, you want to focus on yourself for your own, your safety and survival. But it's hard to optimize our output. It's hard to be the best person we can be and bring our full self to the task, if you will, if we're in a constant state of stress. and if we're so focused on ourselves that we're missing what's happening in the outside world, you can see that playing out in the workplaces, in schools, and in Congress as well, absolutely. And you can see what a price we pay as a society, because the political dysfunction impacts us all. But also when people aren't happy in the workplace, that impacts productivity and retention. It impacts creativity in the workplace, that impacts businesses and organizations bottom line. But in schools, what concerns me most, especially as a dad who has two young kids who are three and two, is I think about what experience they're going to have in school. And I ask myself, well, is it job of school to teach people how to read, write, you know, and do arithmetic? Or is it also to teach kids how to build a foundation for a healthy life in other ways, including in terms of their social and emotional well-being?

You know, obviously there's three things you.

Never learn in school that are the.

Most important things in life. how to have healthy relationships, how to take care of your health, and how to manage your money.

Yeah, that's right. So these things, these are the foundations that matter. And when we don't have, and one of these key important foundations, what we realize is that everything else we build on it is built on a shaky foundation. And I realize that when we have strong relationships in our lives, we are better. We are better at work. We're better at play. We're better in terms of our health. We're better in terms of our relationships and what we bring to our family and to our friends. When we don't, when we feel lonely, all of those things are more fragile and they're more likely to collapse on us. And so that's why when I thought about this issue, I felt like if we can try, if we can make a shift as a society from being one that is focused on wealth, reputation, and power, to one that is focused on people. If we can truly create a people-centered life and a people-centered society, then I think we can capture the great power of social connection and experience the joys and the benefits that it has to bring to our health and ultimately to all of our lives.

And there's good data on this.

It's not just like a warm and fuzzy, touchy-feely thing to sort of help end loneliness and get people connected to each other. There's actually great data on how much a difference it makes in overall society and the success of our country, the success of our citizens, the health of them, all the things that really we care about are centered around this issue. And your book isn't called Alone, it's called Together. And the reason is because in it, you tell some amazing stories about people who solved this in their communities and are trying to break through this incredible sort of edifice of loneliness that surrounds so many so many people.

So can you tell us a little.

Bit about some of the hopeful stories and some of the things that- Absolutely. -because it's kind of depressing as we're all lonely and everybody's lonely and it's ruining everything, which is true. How do we get out of it?

And what are the sort of stories that you can share about how that's happening? Yeah, so to me, this is actually a deeply inspiring topic for exactly that reason, because there are so many stories that we don't read about or hear about in the papers every day, but of people who in their own lives are building connection and building community and helping to create, I think, what all of us want. But the other thing that's fascinating about it to me is that in building a connected life does not require us to purchase expensive medicines. It does not require us to have special medical equipment. It doesn't require fancy and expensive programs. It only requires what we already have inside of us, which is desire and our ability to give and receive love with each other. I remember being at the White House for an event when we were working on the opioid epidemic, and I was facilitating a conversation with a group of people about the epidemic and what was driving it. And it was in that moment, I remember sitting on that stage where it struck me that we were talking about medication-assisted therapy and counseling and all of the other things that we need to put in place. to help people struggling with opioid use disorder. And it struck me in that moment that what so many people that I met on the road felt like they were lacking were relationships. And at the heart of those relationships and communities were love. And I really do believe that love is the oldest medicine that we have.

There you go.

Love is medicine.

It is. It is. And of all the medicines I've prescribed and you've prescribed and so many doctors prescribe in the hospitals to treat our patients, those are important. Those are good. But there are a few things that come close to the power of what genuine human relationships can do, and those are powered by love. Some of the stories that I came across were really fascinating in this regard. I came across a mayor, Tom Tate, from Anaheim, California, who is the last person you would think of as leading a social movement in his community because he's a self-described introvert. really didn't like to hang out with other people very much, and also was definitely afraid of public speaking.

And he was a mayor.

Right.

So what ended up happening is just by, you know, accident of, you know, of life, he was appointed to serve an M Cannon on the city council because there was a vacancy and the mayor knew him and appointed him. So he took that on, found he enjoyed it, actually joined a Toastmasters club to get more comfortable with public speaking. Really had to work through a lot of issues and then ran for city council again. And then the mayor seat opened up. And he thought, you know, maybe I should run for mayor because what was really interesting is he had been seeing these signs around town, these posters, which were posters about kindness. It said, Be kind. And we talked about the importance of kindness. But there was no name stamp below it. There was no sponsoring organization. There's no URL to go to. to learn more. It was literally just a poster with the message of kindness. And he kept thinking to himself, this feels right. This feels like what our community needs. We need more kindness. That's the glue that holds us together. And without that, all these programs that we're funding and structuring, Etc. Well intended as they are, are not going to work as well if people aren't connected to each other and invested in each other. So he decided to run for mayor on a platform of making Anaheim a city of kindness. Wow. And he was scared about this. He thought, oh, I'm going to get laughed out of town. People are going to think I'm not a serious candidate.

I'm going to be made fun of or being bombed.

Yeah.

My political platform is kindness. How about that? Exactly. But you know what he found? When he got up to announce his candidacy and to say that his goal was to make Anaheim a kinder city, he saw heads nodding in the audience. He saw people murmuring approval. And he realized that so many of us, even though we may not lead with it, We want more kindness, we want more love, we want more connection in our lives and in our communities. So he eventually won that race. He became the mayor of Anaheim. He created all of these programs from neighborhood programs to get neighbors to connect more deeply with each other to a 1 million acts of kindness program in the school system to get the schools students throughout Anaheim to basically engage in random acts of kindness and then to come together and share those experiences. And talking to him was such a beautiful experience because I came to see that through this focus on kindness, that what he did, which was incredibly powerful, is he didn't just set up a new program. He changed culture in the city. And when you change culture, which are the values and the ideas that people hold to be important, then you have a huge ripple effect on not just the programs they support, but on how they live their lives. And that's what he saw throughout Anaheim.

If you're saying that the key to a good life is connections and relationships and happiness, the converse is that loneliness is actually a huge risk factor, right?

Absolutely. And loneliness, as you know, is a subjective experience. So, you know, you can be lonely in a crowd. You can be lonely in an intimate relationship. You can be perfectly happy on a mountaintop as a hermit. It all depends on that subjective sense of whether I'm connected enough to the people I want to be connected to. And if I am connected enough, then I won't say that I'm lonely. But I think that, you know, what we've learned, and we're doing more research on this, is that loneliness is a stressor. That loneliness actually keeps us in chronic fight or flight mode, keeps our bodies revved up slightly because we're more vigilant to threats. when we are lonely. And that seems to contribute a lot to breaking down health as well as happiness.

So literally it's a physiological stress to be lonely and isolated.

Exactly.

Wow, amazing.

The.

Sort of brings me to the question of what is the biology of all of this? You're a psychiatrist and we were chatting before we started the podcast that typically psychiatrists pay no attention to the brain, and focus on the mind, whereas neurologists focus on the brain and not the mind.

But it's all connected.

So how does connections and relationships foster health and how does loneliness biologically create disease and shorter lifespans? Because that's fascinating to me as a functional medicine doctor. I kind of want to know the why and the cause.

Absolutely. Well, let me give an example. So let's say you have something really upsetting happen during your day.

Right?

And you find that you're thinking about it, you're kind of ruminating about it, and then at the end of the day, there's somebody you can talk to. Maybe somebody at home, or maybe you call somebody up, somebody who's a good listener, a sympathetic listener. You can literally feel your body calm down as you get to talk about it, right? And you can literally feel your body return to equilibrium from that fight or flight mode, that agitation, because what we know is that when you're upset, that your body secretes stress hormones, circulating levels of cortisol go up, inflammation goes up, and then the body's meant to return to equilibrium. But what if you don't have anybody to talk to about what's upsetting you? And so what we find is that good relationships seem to be stress regulators.

It's quite amazing. I think I noticed when I was researching in my book on longevity that I came upon a study that cuddling actually changes your epigenome. That just physical affection and connection. And it's true when you're with people who you have a deep connection with, who love you, who their nervous system is also sort of grounded, I would say. I just feel my nervous system start to kind of calm down at the same time. And I think that the data on all this, really around sociogenomics, which is what is the biology and the effects of our social relationships and connections on our gene expression and everything downstream from that that you talked about, like inflammation, it's really, it's quite amazing. And so this is, this is really an important study because it, you know, wasn't focused so much on what makes people sick, but what makes people thrive, right? What makes people live a long time?

And have a happy life.

So what was sort of the surprising and interesting findings? What were the surprisingly interesting findings that you had from the study? What are the important lessons that you learned about relationships in particular, but also in general, when you had this sort of, you know, 80 years of data on all these men who you studied?

Yeah.

Well, the finding that relationships keep us happier and healthier was a surprise at first. It began to emerge in the 1980s and at first people running our study didn't believe the data because yeah, we know the mind and the body are connected. How could your relationships at age 50 predict whether you're going to get type 2 diabetes in older age or whether you're going to get arthritis? How could that possibly happen? And then other studies began to find the same thing. And that's where we begin to believe it. So no one study, even my famous longitudinal study, 85 years, no one study of this kind can prove anything. But if you have many studies pointing in the same direction, then we begin to have much more confidence and we begin to say, my gosh, this is real. This is powerful. And so I think one of the things that surprised us is the finding that loneliness and poor quality relationships are as damaging to your health as cigarette smoking, as obesity. So that these things that we consider so dangerous for us are no more dangerous than isolation and loneliness.

Yeah.

Yeah.

And it's so interesting. We have such a, quote, connected society, but we're still often so isolated and disconnected from each other. You know, we have social media, but it doesn't feel very social. It often drives more stress in our nervous systems than, than actually healing from the nature of the way we kind of interact. And it's just, it's kind of a, it's kind of a weird moment, I think, in history where we've lost our tribal communities, we've lost our connections, we live in these nuclear families. or these single parent families, I was a single parent. And, you know, we kind of navigate life in these little bubbles of isolation. And, you know, it's unusual to see today, you know, big extended families and communities and, and, you know, you have to really work at it. So I wonder, you know, how did how did these people actually cultivate it? What were the life skills and hacks that allowed them to keep, maintain, build and nurture these relationships that actually determine their health span and their lifespan.

Well, one thing to point out is that not everybody was successful at cultivating this. So some of the stories in our book, we have stories of our real participants and their names are disguised to protect their privacy, but we have stories about their lives and not all the stories are happy. Not all the stories have happy endings because some of these people weren't successful. but the ones who were seemed to get it that making relationships a priority, no matter where you were, at home, at work, out in the community, that focusing on people really made a difference, really helped you cultivate this kind of well-being. And so some of our folks got it right away. Some of our folks learned that lesson as they got older, as they had more life experience.

You know, yeah, you know, sort of thinking about my father, you know, and, and I, and I, you know, how isolated he was. And, I mean, he was married, but he really kind of focused on his career and focused on being successful and kind of lost a lot of his friends and ended up, you know, really, really without a lot of friends as he got older. And then I invited him to this men's work. I've done men's work for 30 years. And we had this thing called Spirit Camp, and we would go up to this sort of camp, like a YMCA camp on top of this mountain in the Berkshires. And I invited him to come, and my friend invited his father to come. And they were both like the same age, 79 years old. And they were both kind of New York Jews from Brooklyn. They both were kind of atheists. they both were, you know, joined the Navy at 17. They were very similar. They were both tall, interesting characters, and they kind of bonded and developed this incredible friendship. And I saw how much it enriched my father's life. And even on his deathbed, like this guy Jerry, his friend, was calling him on the phone. And, you know, I just realized how important those things are. And we often don't prioritize them in our lives. And I think it sounds like the people in the study who prioritize them actually did much better.

We asked our original people this question. We said, who could you call in the middle of the night if you were sick or scared? And some people couldn't list anybody.

Oh my goodness.

Some people who were married couldn't list anybody. And then some people could list several people, you know? And I think what your dad found was a friend. He found a real friend who would call him when he was sick, right? And who would be there, who would have his back. And I think what one of the things we've learned is so powerful from our study is, you know, what we call in my jargon, secure attachment, that when you feel like there's somebody in the world who's got your back, who you could go to if you were really in trouble. That's what each of us needs in order to thrive, in order to feel okay about our lives.

Yeah, it's true. I mean, I don't want to make this about me, but just reflecting on how true this is. I remember when I was a little boy, I was very isolated. I was kind of a weird, nerdy kid and hid in my room with a lot of books. It's paid off in the end. Yeah, me too. Paid off in the end. But I really didn't have anybody who who saw me as a kid. And then I went out west and I went backpacking.

I was 18.

I met this guy on the top of this mountain and we were both going to be in Ithaca in the fall. And we kind of bonded and we really had this incredible friendship for like 45 years. And he just, I'm in Baja and he just left and we had this mountain biking trip here and we talked and we just like, he's been such an integral part of my life throughout everything. and has helped me feel like I have that secure attachment, like I have somebody to call. And now I've obviously developed many, many more people I could call, but it's having that gave me a sense of being okay. Like somehow life was quite different before and after that experience. So I don't know how to tell people to form those attachments or how you find those people, how do you build that. Like I just wonder if there are any insights from the study about how to actually create it because you say, oh, I want you to eat more vegetables. Okay, I got that. I want you to exercise more. Okay, I got that. But, like, I want you to have a deeper connections and relationships. Like, how do you get here to there? If you're in that isolation stage.

Well, one thing is to be active. So you and your friend had to arrange that he would come be with you in Baja.

Right? Yeah.

You both had to go out of your way. You had to carve out the time. You had to make the arrangements. you had to be active. And I think one of the things many of us, myself included, can fall into is the sense of, oh, my good friends are my good friends. The friendships will take care of themselves. I don't really have to do anything. And what we came to understand from our research is something that we're thinking about as a kind of social fitness analogous to physical fitness where you work out one day and then You don't say to yourself, well, I've done that. I don't have to do that ever again, right?

You don't do that, right?

Really?

And the same...

I ate one vegetable. I don't know, I'm good enough.

Exactly, exactly. So you don't do that. You say, okay, I need to have a routine. I need to... This is a practice, both of self-care, you know, of diet, of exercise, but also a self-caring practice of tending to important relationships. So part of it is actively maintaining the relationships that you've built to make sure they stay close, get closer. Another then is if you're isolated to find ways to have contact with people. And often one of the best ways is to have contact around a shared interest. So you happened to meet your friend on a mountaintop, which meant that you were both interested at least that day in taking a hike, right?

Yeah.

So, and you could connect around the trail, around nature, you could share things, right? So what if you volunteer for a cause you're passionate about? And so you might be shy, but if you're right next to people who also care about climate change or about saving the world in some other way or about gardening or about golf, fishing or whatever, right? Fishing, anything, that what you find is that the shared interest provides a place to start conversations and that by starting those conversations, you can begin to get to know someone. I'll say one more thing which we find constantly is that bringing curiosity is a huge benefit to making a relationship. So we all love it. when somebody is curious about us. Like, you know, Mark, if I ask you more about yourself, you'll want to talk about it, right? You know, you asked me about my Zen life and I told you about it a little bit before we started this podcast. And so what we find is that when you ask people about themselves, they feel your interest, they feel seen, and when they get to tell you about themselves, they feel known. And so if you can just bring curiosity, you don't have to bring anything else. Notice something, you know, I notice something in your Zoom background in your, notice something that's on a co-worker's desk, you know, a photo or a little object. Just be curious and you will strike up conversations that turn out to be meaningful.

You know, Robert, I think you just hit on something so fundamental. which is that all of us want really one thing, which is to be seen and known and heard and gotten.

And how rare that is and how simple it is to actually create that.

Experience for someone by just being curious about them. Tell me more about yourself or ask, like, I went to dinner with some friends here in Mexico. I said, so how did you guys meet? What's your love story? And then the whole, it was like an hour and a half conversation. And it was great. It was so entertaining and fun. And, you know, they felt like we cared about them and it deepened our connection. And so I think, I think it's not that hard to do, but so many of us are just tired and burnt out and focused on what we have to do and getting through the next thing and, you know, on our own lives. And, but, but stopping that and taking a breath and, and actually figuring out how to get curious about people in your life will 100% create real connection. So that's such a beautiful, beautiful nugget. And I think we don't, we kind of lost the art of questions. I have a friend Andrew who's like, he's like the master. Like, he'll just go in and ask you these piercing questions that literally, you know, probably may or may not want to share with anybody, but, like, they get, they get to the real essence of what matters and what you care about and who you are. And, and those are now they're just talking about the weather or whatever.

It's like having more in my deeper.

Sense of inquiry about another person's heart and soul and mind. It's beautiful. Thanks for listening today.

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