Why Loneliness Is A Public Health Issue with Dr. Vivek Murthy

Coming up on this week's episode of the Doctor's Pharmacy.

Our connection to other people is ultimately built on having a strong connection to ourself.

Hey everyone, it's Dr. Mark. A few years ago, I got really sick. I almost died, actually. It was a perfect storm of a few different things that got me to that point. And one of the most dangerous was mold toxicity. I found out that my house, an old converted barn, had a major mold problem. It was really scary to think about my own safe haven home slowly poisoning me. I started to think about what other toxins might be hiding in my home and what could I do to be proactive about it without ever having to get sick again. I realized that even though I thought I was pretty conscious about the cleaning products I was using, they weren't all necessarily safe. And since indoor air quality can be 500 times worse than outdoor air, I really wanted to get anything toxic out of my house. And that's how I discovered Branch Basics and started using it in my own home. 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That one bottle of concentrate can refill spray and soap bottles up to 12 times, plus do 64 loads of laundry. I know you'll love their cleaning concentrate as much as I do. One of the best parts of being at home more often is making really good food. And recently my wife and I made a special treat, almond flour bread, to have with some fresh raspberries and coconut butter for breakfast, or maybe to dip into olive oil alongside a big salad for dinner. Now I know you might be thinking that making almond flour bread at home takes a lot of ingredients and time, but it does not. We used the Simple Mills artisan bread mix to start and finish, and it's done, boom, 25 minutes. There are definitely not too many baking mixes out there, I trust, and Simple Mills is an exception because they use real food ingredients. Their bread has only six grain-free ingredients in it, all of which you'd be able to find on your own, like almond flour, black seeds, sea salt, which means no weird stuff. And if you don't do eggs, they provide options for ways to replace them. in all of their mixes. Simple Mills also makes healthier mixes for homemade pizza dough, brownies, pancakes, and muffins, and their baking mixes contain 50% less sugar than others, plus those that are sweetened only use coconut sugar, which has a lower glycemic index. Having a few boxes of Simple Mills mixes on hand is an easy kitchen hack for healthier baking on those days you just need a little extra help. Now until May 29, 2020 you can get 20% off at Simple Mills.com using the code DRHYMAN20. That's D-R-H-Y-M-A-N 20, the number 20. Just go to SimpleMills.com and enter DRHYMAN20 to get 20% off and stock up on a bunch of these tasty mixes. You won't believe how good this almond flour bread is and the brownies are another favorite of ours for an occasional decadent treat with a cold glass of macadamia milk. Now I know you'll enjoy them as much as I do so let's get Get back to this week's episode. Today's episode was recorded before the World Health Organization declared the coronavirus outbreak a pandemic and before stay at home orders were issued across the United States. As many of us are social distancing and separate from one another, I think you'll find this conversation more important than ever. And remember that just because we're separated doesn't mean we can't stay connected. Connecting with family and friends over video or phone calls has been really meaningful to me during this time and can make a huge difference for our mental health even with just five or 10 minutes a day. Now on to my conversation with former Surgeon General, Dr. Vivek Murthy. Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Pharmacy with an F, F-A-R, M-A-C-Y, a place for conversations that matter. And if you've ever suffered loneliness or felt isolated or disconnected in your life, this conversation is going to matter to you because we have an extraordinary guest today. a former Surgeon General of the United States, Dr. Vivek Murthy, who I've known for a number of years, who actually invited me to come to meet with him when he was Surgeon General and talk about the issues of food and obesity and nutrition disease. And he's just always so attentive and connected. He came to Cleveland Clinic to talk about the opioid epidemic. And I tried to get the leadership there to do what he did in the Surgeon General's office, which is to get the entire clinic meditating every day at three o'clock in the afternoon. The chief of staff was a little confused when I said that. I think it's really what we all I usually sneak off in my little room in my office and just try to do meditation in the afternoon when I'm there. But he's an extraordinary leader in medicine, in public health, and his new book, Together, the Healing Power of Human Connection in a Sometimes Lonely World, or I would probably have titled it An Often Lonely World, is really an extraordinary contribution to our understanding of what creates so much suffering and disease. if you're looking at the causes, the root causes of chronic illness, it's often related not just to food, which is my lane, but to loneliness. And people don't understand that that's actually a big driver of so much. And we're going to talk about that. He, Dr. Murthy is a, is a former guy. He was the Vice Admiral of the US Public Health Service Commission Corps, where he commanded a uniformed service of 6600 public health officers globally. He launched the Turn the Tide campaign, which was to help Our nation's healthcare providers focus on our opioid epidemic. He was a key leader in addressing that crisis while he was Surgeon General. He issued the first Surgeon General's report on alcohol, drugs, and health, calling for expanded access to prevention and treatment and recognizing addiction as a chronic disease, not a character flaw, which many people still think it is and stigmatize it. He's then focused from 2017 his attention on chronic stress and loneliness, as huge problems that affect our health, our productivity, and our happiness. He co-founded a number of organizations, Visions, which is an HIV/AIDS education program in India. I'm not sure I'm saying this right, Swasthya, which is a community health partnership in rural India that trains women as health providers and educators. They're like barefoot doctors in China, but for women, I guess. And he helped build the grassroots organization Doctors for America that was very involved in the election of President Obama. And since he's left the Surgeon General's office, he's focused on loneliness and social connection. His book, Together, the Healing Power of Human Connection in a Sometimes Lonely World, is out April 28th, HarperCollins. He's just an extraordinary guy. He has his degree from Harvard, his MD and MBA from Yale. He went to residency in Boston and was on the Harvard Medical School faculty. He's a very serious dude and a good friend, and I really am so.

Happy to have him here on the podcast. Welcome.

Be back.

Thank you so much, Mark. I feel somewhat embarrassed after that introduction, but thank you.

And he's only 25, which is what's amazing. No, no.

Are you 40 yet? I got a lot of, I'm 42.

Okay, 42. So the best is yet to come, I have a feeling. He's just getting started. I think were you the youngest surgeon general ever?

In about a century or so, the very first surgeon general in the 1800s was younger than I was.

That's because nobody lived very long back then, right?

Yeah, I think he died in his 40s.

That's unbelievable in 100 years. and that just speaks to your character, your intelligence, your insightfulness about some of the biggest things that are affecting our public health today. And I'm just so glad you laser focused on this issue of loneliness because, you know, in the early part of my career, I focused on food as a big driver of chronic disease and still it's what I'm focusing on and functional medicine to take care of the individual. But I realized that I could not really get my patients better unless I deal with the social issues that they're facing. And I began to realize that there's another medicine that's just as powerful as food, and that's love and social connection. So I would say love is medicine, food is medicine, that's how we're gonna help the world. And you really lasered in on the love is medicine through looking through the lens of loneliness. And how did that all come about? I mean, you basically our traditionally trained internal medicine doctor. It's not something we are really taught about in medical school as loneliness. How did you come to that?

Well, it's a good question. I think I had experienced loneliness a fair amount in my own life. When I was a kid in school, I was very shy and I had a hard time making friends in elementary school. Each day going to school and being dropped off by my parents, I had that pit in my stomach. of nervousness. And it wasn't because I was scared about exams or teachers. I was actually just worried I was going to be alone again. And I just couldn't wait for the bell to ring at 2:30 or 3:00 or whenever it was so that I could go back home and be where I felt really good, because I had loving parents and an amazing sister, and I felt very cared for and taken care of at home. So it was certainly a presence in my life. And it cropped up many other times, you know, during adulthood as well. at transition points in my life and even during my time as Surgeon General and in the years afterward. I also then started to see it in my patients. And this is not something I expected at all because when I was in medical school and I suspect that you and many of us had the same experience, loneliness was not part of the curriculum.

Nope.

Emotional well-being was not a class.

Loneliness 101. No.

Yeah. This is not part of, for that matter, neither was nutrition. You know, like I still remember our nutrition education in medical school was one class once a week in the evenings that was optional for like six weeks.

Yeah, and it was probably on like vitamin deficiency diseases like rickets and scurvy.

Yeah, there wasn't a whole lot of training, but certainly on this subject of our emotional health and the power and importance of social connection, there was very little. But when I started seeing patients, There are a couple things that struck me. One is that people would come in with real serious illnesses and they would have, you know, and illnesses are critical times in people's lives where they've got to make big decisions and they have to, they find themselves reflecting on the rest of their life to see, you know, gosh, you know, have I lived the life I want to live? And at those critical moments, you need people around you to help you figure out what path to take, just to support you and be there with you. But so many of the patients were alone. And I remember I used to sometimes-.

They just were in the hospital by themselves.

They were there by themselves. And I would ask sometimes, I would say, Hey, you know, we've got to make a pretty difficult decision now, you know, on whether to go to surgery or not, or whether to start chemotherapy or not. Is there somebody you want us to call to come in so that you can talk it through with them as well? And so often the answer was no. There's nobody to call. Even at the time of death, Mark, I noticed that on so many occasions that the only ones to witness people's last moments were myself and the other doctors and nurses that was the medical staff. And so I remember that quite vividly. But even despite all of that, I was not planning to talk about loneliness or work on it when I was surgeon general because I didn't know if that was just my own experience and maybe my own peculiarities of the of my medical experience as well. But what happened that really changed things for me is when I began my time in office, I began with a listening tour.

Yeah.

I traveled to all of these cities and towns all across America with a simple question, how can we help? And I tried to just sit back and listen to what people said. And what they said was fascinating because I did hear stories I expected about addiction, about obesity, about depression and anxiety. What I didn't expect to hear that within those stories were these threads of loneliness. And people wouldn't say, you know, hi, I'm Mark, I'm lonely, but they would say things like this. They would say, I feel invisible. I feel like we're struggling all alone here. I feel like people have forgotten about us. I feel like people just don't even see us. And if we died, no one would even know it. People would say things like that quite often. And it led me to realize over time, as I heard more and more of those stories from Everyone from farmers in rural areas to moms and dads in big cities to members of Congress. I started to realize that not only is loneliness far more common than we.

Thought, but you were hearing this from members of Congress.

Oh yeah, and they wouldn't say it publicly, but interestingly behind closed doors they would say, yeah, you know, this has been a struggle for us. I had one member of Congress in fact tell me, he said, if you're going to build a campaign to address loneliness, could you start with Congress first? Because we're all struggling. Start with you. But the truth is that I realized nobody was spared. People were either affected directly or through the people they loved, and that all of us at some level in modern society are vulnerable to losing our connections.

It's so intense, and I think that we're really wired as social beings, because a human being by him or herself in the world is usually dead. Historically, if you didn't have a tribe or a group that helped you navigate and survive the world, you would just die. And yet something's changed in the last 100 plus years. And you sort of say it's really different. This modern day loneliness is different than anything that has happened in other generations. And how does it actually affect us? I mean, what is the science behind loneliness and its effect on our health and our 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 for many days at a time. You could also do other things like help in child rearing so 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 because 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 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, but it's only in the case of it being there for A long period of time or an excessive amount.

It's adaptive and 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 got to stop there for a minute because 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 even greater than the impact of obesity.

Which is pretty deadly. I mean, smoking is pretty deadly. So, this is something that's not talked about. It's something that we don't, I mean, I'm in a big healthcare system. We talk about the office of experience and improved patients and doctor's experience, but this issue of loneliness being a risk factor, 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 why people eat. It's not only about what people eat, it's why people eat. I often say, you don't have to focus on what you're eating, but what's eating you. And I think people don't understand that connection. And I think the question is, 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. 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 that we don't see loneliness around us very much. And there are two reasons.

It's a blood test 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 A huge stigma around loneliness. -Shame. -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. 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 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.

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

I wasn't at the party.

I was at home. It's 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 that's not good for us? Right. 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 or disconnection are hard. Yeah, it hurts 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. And alcohol, I think, and work are two examples of those. But for those reasons, when you look around you, you might think, well, 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. But there are plenty of other studies, including one recently by Cigna, the health insurer, which pegged those numbers as significantly higher. And it's not just the US.

And 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. 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. So 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 know, you could see a sort of a cloud of votes for Republicans, Democrats. It was all mixed. It was a big Venn diagram where 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 opiate epidemic to violence to e-cigarettes, you name it, Ebola, Zika.

I bet you're glad you're not having to deal with coronavirus right now.

That's how frightening it is. 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 their 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 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 or an organization's 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 gonna have in school. and I asked 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. They're 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 we don't have in 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 in 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 a 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. That's right. 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 edifice of loneliness that surrounds so many people. So can you tell us a little bit about some of the hopeful stories and some of the things that...

Absolutely.

You know, because it's kind of depressing because 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 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 if 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 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 our 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 with 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 prescribe and you prescribe 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.

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 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 it at 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 had talked about, which were posters about kindness. It said be kind and 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, et cetera, 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, 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 for being soft.

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 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 is 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.

That's incredible. And something you can't legislate, right? You have to create the structures to do that. I think I had a very similar insight to you, is that the cause of so much of our disease and dis-ease is disconnection. And through my work in Haiti with Paul Farmer, looking at what he did to treat infectious disease using community health workers, essentially neighbors and peers and friends to help each other through making sure they took their medications and they knew what to do and were helping each other be accountable. He produced a program that was more effective than anything else the public health community in the world had ever seen and was spread across the world. And I kind of realized that it's not just infectious disease that's contagious, it's chronic, illness, which affects six out of 10 of us, and as you know, is sort of driving our economy into the ground and is burning so many people and creates so much suffering. And a lot of the reason for it, like you said, is the disconnection that drives people to behaviors and into things that actually aren't good for them, like food or whatever. And then I worked with Rick Warren to create the Daniel Plan with Dr. Amen, which was a faith-based wellness program, but it was founded on the idea of small groups or the infrastructure of the church that we just put the information in and they were able to help each other get better. Getting healthy is basically a team sport. And we've taken that now to Cleveland Clinic in a secular way. It's not a faith-based wellness program. We now are the top in our small Center for Functional Medicine, which has 10 doctors. is the number one in group visits in the entire organization. And the next biggest group down from us has about 400 doctors and we have like 10. And the reason is I was very vocal about making sure that we actually did this because this is how people change. And we see that people have a longing to belong and a longing to connect. And that's how they make meaning out of their lives. That's how they get motivated to do anything. or really missing from our culture and society. How do you see that we can spread this further? How do you take the ideas in your book and make them something we spread nationally and even globally?

Well, I think there are a couple of things we can do. I think first by recognizing how common loneliness is, but also by recognizing the power of human connection to elevate our health, our performance, and our well-being. I think that first step can help us to rethink our priorities, both our individual priorities where we're putting our time, but also organizationally, like where as workplaces and schools and governments, we're allocating resources. The second thing is I think we can think about what steps we can take in our individual life to actually create more connection. The truth is whether you're feeling lonely right now, or whether you're not, you undoubtedly know people who are lonely, and all of us are at risk of loneliness at various points in our lives. Loneliness isn't something that you're born with and affects you for your entire life. We go through natural periods of connection and disconnection in our life. And the question is, how do we prepare for that? How do we deal with it? How do we build a strong foundation of connection to begin with? So there are a couple of things in the book that I go through that are, I believe, helpful in building that connected life. One of them unexpectedly is service. It turns out that when we serve others, we actually break some of these very negative patterns of loneliness that get in basically launched within us as a part of our evolutionary history. Those patterns being the focus on self and also the elevated threat level. that we experience when we're lonely. Because when you help somebody else, first of all, that takes you away from a focus on yourself and you're focusing on another person. But the second thing is it's also disarming. Like when you're helping other people, you're also reminded of what value you have to offer to the world. And that's actually reassuring. That lowers your sense of threat. So service is a powerful way to connect with others and also to reconnect, in a sense, with our self, our own sense of self-worth and value. the second thing, though, that can help us on an individual level is to think about where we're spending our time when it comes to social relationships. So, number one, are we making sure that we have at least five to ten minutes a day that we're spending with people we love? That could be spending in person. It could be speaking to them on the phone or through video conferencing. But are we spending five to ten minutes with someone that we love every day? And this might seem very simple, but you'd be surprised how many people can go for days without having a meaningful conversation with somebody. The third thing with the... Can I interpret for a second?

Yeah, yeah, for sure. So I just reminded you, my wife, we have a... Because life's busy, crazy, running around, we have a little ritual we do called what's Up Below, which is not just chatting about the logistics of our life or what we're doing that day, but to sit down with each other, whether it's having coffee in the morning or at the end of the day, and it can be five minutes or it can be, we can sometimes go for half an hour, an hour, but it's what's up below, like, not just the surface. And we go in and we just listen to each other and we get each other. Like, what's happening in your world? What do you care about? What's upsetting you? What's thrilling you? What's whatever going on? And it just creates such a deep, powerful moment of, like, being seen and seeing somebody else. It's like, it just, it just, it's so powerful. And we don't do that. And you can do that with a friend. You can do that with. Yes. you know, I do that with my children. It's a very powerful, simple thing of just, say, dropping in to a place below the just surface level of life that we all live in all the time.

Yeah, that's such a beautiful example. And what I love about that is, Mark, I imagine with you and your wife, you could easily get caught up in the logistics of life and spend that 10 minutes just talking about your calendars and your schedules and who's gonna get groceries and who's gonna get the car fixed. and I fall into that with my wife as well, because there are a lot of logistics in life that we got to work through. But even just that five minutes can make an extraordinary impact. And that comes down to also another point about the quality of time that we spend. So, technology is really interesting, and we can have a conversation about technology and how it's impacted our connection with one another. But one of the things that I think that many of us do now, and I certainly have been guilty of this, is we have allowed technology, particularly our phones, to dilute the quality of our interactions with other people because we bring our phones often to the dinner table or and we might convince ourselves, Hey, I'm not really paying attention to it. I've got it on silent. I've put it face down. I'm not really paying attention to it. But we actually know from studies that when there is a phone even within sight, even if it's on vibrate and face down, it actually changes how people feel about the conversation in a negative way. And so, think about it.

There's a restaurant called Hearth, which is in New York City and they have a little box on every table says, Please open me. And you open it up and it has an invitation to put your phones in the box for dinner. And there's a game I sometimes play with my friends. Everybody has to put their phone in the box. The first person to take it out pays the bill. So there's several fun things you can do that actually help you stay more connected. I love that.

Absolutely. That's a great idea. So just like that, I think there are, in the book, what I will try to do is I try to share some stories. that lay out some individual steps we can take in our lives, but also stories that talk about what schools and workplaces can do and are doing already in some cases to create a culture of connection. Because at the end of the day, Mark, if we want to create real connection, if we want to build a people-centered life and a people-centered society, it's going to involve more than programs. It's going to require us to shift culture. and to ask ourselves what's really important. Now, if we got a group of 100 people together on any street corner in America, my guess is if you ask them to name their top three priorities, that people would be at the top of that list. People might say it's my daughter or my son or my spouse or my mom or my dad. But if you look at how- They behave. Yeah, how where we put our time and energy and where frankly society nudges us to spend our time and energy, it's not usually with the people we love most. It's in investing it in places where we can acquire greater power, reputation, and wealth. The traditional marks of achievement in modern society. I'm not saying that those aren't important or those shouldn't be pursued. It's a question of where are they on the priority list? And I work your Facebook feed or.

Instagram feed or your email or-- Right.

With those feeds in particular, like I think about our childhood and about the childhood that my kids will be experiencing. And in modern childhood, I think the messages, the cultural messages about what matters, are just coming at you a thousand times faster. And I meet so many young people who are feeling, because of this culture of comparison on social media, that they are not thin enough, that they're not good looking enough, that they're not popular enough or funny enough, that they're not enough. You know that ultimately that they're not enough. And that has actually a very powerful and insidious effect on our connection with other people. And this is one of the things I think that is not often well appreciated, which is that our connection to other people is ultimately built on having a strong connection to ourself. Now, what does it mean to have a strong connection to ourself? It means to know that we have a sense of worth and value. It means to recognize that we are human beings who have something meaningful to add to the world. And that requires a combination of self-knowledge and self-compassion. Now, how do we develop self-knowledge? Well, we develop it partly by living life, but not only by living life, by having time to reflect and time to think. And much of that white space in our life that many people used to ponder and reflect on things on, that has disappeared. It's evaporated as now in the five minutes you have between events or when you're waiting at the bus stop, we just pull out our devices and look at the news or check our inbox. But ultimately, if we are not able to support, particularly among our kids, a healthy sense of self, if we're not able to convey to them and help them understand what it is that makes them worthy and valuable, and that it's not what they're wearing or how much money their parents have in their pockets or how popular they are and what parties they're getting invited to, then we are going to run into a situation where people feel less and less adequate, and then they will seek to be the people that they think other people want them to be. And when we do that, that's a recipe for loneliness. When we try to be something we're not, when we can't inhabit our own skin, people feel lonely. That's why workplaces often struggle with loneliness, because for years we have told people that, you know, don't bring feelings to the workplace and check all of that at the door. And, you know, you're not here to make friends. You're here to get work done and keep your friendships and your personal life outside. And the truth is that's just not a natural way of living. We don't operate like that as human beings. And if we have to be somebody that we're not in the workplace, that increases our likelihood of being lonely there too.

That's true. We certainly are trained as doctors to not emotionally connect with our patients. And I fought that from day one. And when you sit and really get someone and you listen to them and what matters and what they care about and really are present with them. It's just so powerfully healing. Forget any other medicine, right? I think that's one of the real gifts. And I think I just want to come back to the whole service concept because I don't know if people understand what that means. When we look at how we're designed, there is a sort of altruism gene that we have. E.O. Wilson talks about the social conquest of the earth, this book, that we cannot survive in isolation and that we're hardwired to support each other, help each other, connect with each other and aid each other. And the biology of it's very fascinating. When you look at the areas of the brain that get stimulated by altruism or service or helping others, it actually is the same area of the brain that gets activated with heroin or cocaine or sugar. And I remember going to Haiti and, you know, it was just an awful, horrible scene with 300,000 people dead, 300,000 wounded. I mean, the military who was there, the 82nd Airborne, they'd never seen anything like this in their entire careers, in the wars in Iraq and Afghanistan. And we were in the middle of it, and I was working 20 hours a day, and it was horrible conditions, no food, no water. I mean, it was just really tough. And yet I was really happy in this weird way because I was just serving. I was helping, I was serving. It wasn't for me, it wasn't for my ego, it wasn't for anything. My bank account, I was volunteering. And it was a time that I felt most connected and most fulfilled to what really mattered. And I really think we need to have a society where we are helping each other and are connected with each other and it doesn't require anything other than to look around you and see who's in need or what needs to get done in your community and trying to be that person who can be of service because it'll not only help you with your own emotional, physical, mental health, but it's going to create a culture, like you said, of kindness and love. And that's such what we need in America today, around the world globally because we're sort of veering the opposite away. And I think that's why your book is so critical. And I encourage everybody to get a copy of Together, the Healing Power of Human Connection in a Sometimes Only World. Because if all of us took up this book and implemented in our own lives and implemented in our workplace, in our schools, in our families, in our communities, I think this country would turn around pretty fast.

I certainly hope so. That's my dream that we will together be able to build a more connected and more fulfilled society.

And what are the challenges some people have to actually doing this in their life? Because it sounds like everybody would want to do this, but how do people get over those obstacles?

It's a great question. I think there are a few key obstacles that come up. Number one, sometimes people feel that focusing on connections in their own life is somehow self-indulgent, that they should be focusing on doing more at work, on getting that promotion, on building up their bank account, on taking their kids to activities. Busy parents, I think, are very interesting because I think a lot of them struggle with loneliness, especially in the early years, when their kids are 1, 2, 3, 4 years old before they're in school. It can be very all-consuming as a parent to really take care of your children and that can isolate you from others. But I think this feeling that somehow investing in our connections is a luxury that it's self-indulgent, I think, is one of the reasons why people don't do it more. I think the second reason is that again, there's a sense of shame that people have and even admitting to others that they need some more human contact, that they need some time with their friends. They don't want to seem desperate or needy or somehow, again, not likable or an outcast in some way. So people have a hard time not just acknowledging to other people, even acknowledging it to themselves. And I think the last thing is there's a structural issue as well, which is that if you look at how our lives are designed with spending so many hours at work and many people have to commute many of those hours, there's a question of time that comes up, which is where am I going to find the time to go and interact with other people and to take a vacation with my best friends, which I haven't done in a long time, or to finally make time to go away with my spouse for a weekend. and those questions feel really burdensome. I mean, they can feel really tiring when you think about it, oh my God, that's so hard. Let me just keep going with life. But this is where I think it's so powerful and important to recognize that the dividends that come from just a small amount of time spent in connection can last for hours, days, weeks, or even longer. And that's why the five or 10 minutes that you spend with someone that you love can be really powerful. I'll tell you about something I did in my own life that helped me. which is that, you know, I made a decision after residency training when I had just gone through several years of caring for incredibly sick people, including people who were very young. I remember being on the oncology service and half the patients I was taking care of were all young people in their 20s who had gastric cancer or other malignancies that were in their end stage. And I remember at the end of that thinking, God, I just I need to think about my life and I don't know, like, that could be me.

Yeah.

And am I spending my time the way I want to be spending it? So I made a decision that I would make it a point to go home and visit my parents and my sister more often. And that's when the frequency of my visits actually changed a year or two ago. I was actually out in Colorado for a fellowship Retreat at a point where I was struggling to figure out what I wanted to do with my life and was I was also feeling kind of isolated. I was in the throes of early parenthood also and it was all consumed with the care of our kids, which was wonderful and such a blessing, but really not having much in terms of relationships outside. And I ran into these two friends there who I love, but who I rarely ever see. And we talked about how we wish we got together more often, but we just don't. And then in that moment I said, why don't we do this? I said, why don't we build a moai together? And MOI is a Japanese term. I actually have a whole story about MOI in the book. But it's an intentional community. So I said, why don't we just say, because we know we're not going to see each other, you know, probably for another six, nine months. Why don't we say that every month that we are going to get on video conference together and that we're going to have a two hour conversation? And let's also say that we're going to be real with each other, that we're going to talk about the issues that we are struggling with, the stuff that really matters to us. Things like health and finances and our relationships with family, which people don't get into often because they're sticky. It's the stuff that we all are struggling with. And so we've been doing that for the last year. And it's been so incredibly gratifying. So, anyway, the point is that there are reasons to not connect, but once we realize the power of even a small amount of time spent connecting with others, once we realize that we don't need anything else to do that, we just need our intention and a willingness to show up, to listen, to be vulnerable and open with other people in our life, then we can start building that road toward living a truly connected life. And I think that is what holds the key to greater health and also greater fulfillment.

So true. Thank you for doing this, writing this book. I think it's those micro steps, whether it's five minutes a day, whether it's finding some old friends and reconnecting like you did, whether it's finding a place to be of service in your community. You don't have to have some big giant community that you're building overnight, but those micro steps make a huge difference and will help heal so much of the suffering in the world. So thank you Vivek for writing this book. I want everybody to get a copy. It's Together, the Healing Power of Human Connection in a Sometimes Only World. You can learn more about it. His website, which is VivekMurthy.com, V-I-V-E-K-M-U-R-T-H-Y.com/Together-Book. Please get it anywhere you get your books. If you love this conversation, please share it with your friends and family on social media. Leave a comment, we'd love to hear from you. Subscribe wherever you get your podcasts, and.

We'Ll see you next week on the Doctor's Pharmacy. Thanks so much, Mark.

So much fun to do this together. hi, everyone. It's Dr. Mark Hyman. So, two quick things. Number one, thanks so much for listening to this week's podcast. It really means a lot to me. If you love the podcast, I'd really appreciate you sharing with your friends and family. Second, I want to tell you about a brand new newsletter I started called Mark's Picks. Every week, I'm going to send out a list of a few things that I've been using to take my own health to the next level. This could be books, podcasts, research that I found, supplement recommendations, recipes, or even gadgets. I use a few of those. And if you'd like to get access to this free weekly list, all you have to do is visit DrHyman.com/picks. That's DrHyman.com/picks. I'll only email you once a week, I promise, and I'll never send you anything else besides my own recommendations. So just go to drhyman.com/picks that's P-I-C-K-S to sign up free today.

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