Doc’s Corner

Our State of Mind and Social Connections Influence Our Health and Longevity

Study after study has shown that people who are lonely and depressed are three to 10 times more likely to get sick and die prematurely compared with people who are not depressed and who have a stronger sense of love, connection, and community. For example, a study in JAMA, by Nancy Frasure-Smith, found that 6 months after a heart attack, people who were depressed were four times more likely to be dead than those who weren’t depressed. This was independent of the usual risk factors like cholesterol, blood pressure, weight, and even smoking and left ventricular function. Dean Ornish, MD, clinical professor of medicine at University of California, San Francisco wrote a book about this in 1998 called Love & Survival, which reviewed what were then hundreds (now thousands) of studies showing that people who are lonely and depressed are many times more likely to get sick and die prematurely—not only from heart disease but from all causes—when compared with those who have a strong sense of love, connection, and community.

The ongoing COVID 19 pandemic has taken an emotional toll on Americans, particularly those living with cognitive decline and disease.

More than half of all adults report changes in sleep (58 percent), moodiness (57 percent) and withdrawal from loved ones (51 percent) – but only 8 percent have sought professional help.
Among those with a relative/friend suffering from cognitive impairment, three out of five say that their loved one has experienced difficulty coping with less in-person contact (67 percent), cognitive decline (63 percent) and increased depression/anxiety (62 percent).

It is reasonable to expect that the lockdownexerts unfavorable psychological effects on the short and possibly longer term. Because of the well-documented acute impact of physical activity on symptoms of psychological distress and potential to improve mood,physical activity should be recommended as a nonpharmacological countermeasure. In addition, physical activity can also promote feelings of vitality. Importantly, even low to moderate volume and low to moderate intensity exercise seems to be beneficial. Indeed as little as 10min moderate intensity walking can improve mood. On the otherhand, even short term reduced physical activity may exert harmful effects on physical and mental health that may persist.

In conducting the Lifestyle Heart Trial, Dr Ornish’s team met with people twice a week for 5 years. They got to know these patients very well. The patients were asked, “Why do you overeat/drink too much/work too hard/smoke cigarettes? These behaviors seemed so maladaptive to the researchers.” They would look at them and say, “You don’t get it. These behaviors are very adaptive. They help us deal with our loneliness. They help us get through the day.” They would say things like, “I have 20 friends in this pack of cigarettes and they are always there for me when nobody else is”; “Food fills the void”; or “Alcohol numbs the pain.”

Working all the time is a more socially acceptable way that many use to distract from the pain. Video games, surfing the Internet, watching too much TV—there are so many ways we have of literally or figuratively bypassing pain. But pain is the messenger; it’s there to get our attention, to say, “Hey, listen up: You are doing something that is not in your best interest.” If you don’t listen to the pain and just numb it without changing these underlying causes, it is a little like clipping the wires of a fire alarm when your house is burning and then going back to sleep thinking that you solved the problem.

Part of the reason why people who are lonely and depressed are more likely to get sick is that they are more likely to make lifestyle choices that are self-destructive than life enhancing. Because of this, information is important but that information is not usually sufficient to motivate people to make sustainable changes in their lifestyle. If it were, then nobody would smoke. When you tell a patient that smoking is bad for them, it’s not as if they say, “Oh, I didn’t know it was bad for me. I will quit today.” Everybody knows smoking is bad. It is written on every pack of cigarettes.

Telling someone who is depressed and lonely that they are going to live longer if they just quit smoking or change their lifestyle isn’t that motivating because they are just trying to get through the day. They are not always sure that they want to live longer. Life is not fun when you are really depressed. Depression has a major impact on our health, so it should be part of any medical evaluation, but part of the problem is that so many physicians themselves are depressed. If the patient starts to talk about their depression and the doctor hasn’t really dealt with his or her own issues, it makes them uncomfortable, and they will often change the subject and start talking about statins and LDL instead. Awareness is always the first step in healing. Depression is treatable. The facts reveal that love is more powerful than fear.

In medicine, we focus on what we can see and measure easily. We can measure cholesterol and blood pressure easily so we tend to focus on those things. The American Heart Association still doesn’t list emotional stress in their “Seven Key Modifiable Risk Factors”. There is a saying that not everything that counts can be counted. In other words, not everything that is meaningful is measurable. We tend to focus on what is easily measurable, even though these psychosocial factors are at least as important—and in some ways, even more so.

Scientists are getting more innovative at measuring these factors. In a recent study, researchers analyzed 148 million Twitter messages (tweets) across the United States and found that language patterns reflecting negative social relationships, disengagement, and negative emotions—especially anger and fear—were risk factors for heart disease and were even more predictive than smoking, diabetes, hypertension, and obesity. In contrast, positive emotions and psychological engagement were protective. The conventional wisdom is that small changes are easy and big changes are hard. We are actually finding that the opposite is often true. One reason is that the underlying biological mechanisms are so dynamic. When you make big changes in your lifestyle, you experience big improvements very quickly. This reframes the reason for changing lifestyle from fear of dying to joy of living.

In addition to the restrictions from COVID 19, the need for connection and community often goes unfulfilled in our culture because of the breakdown of the social networks that used to give people a sense of these. Many people don’t have an extended family that they see regularly, or even a nuclear family. They don’t have a church or synagogue that they go to regularly. They haven’t been in the same job for 10 or 20 years. We all know that these things affect the quality of our lives, but they also affect our survival to a much larger degree than most people realize. The many restrictions imposed on us, “to improve our safety”, has massive unintended consequences on our health. The need for intimacy is such a primal human need. Our challenge living in the culture we find ourselves in, is to create situations that make us feel a sense of caring and connection.

The lockdown (COVID 19 restrictions) implemented in an attempt to contain the SARS-CoV-2 virus and now continuing with less certain benefit is unprecedented, and represents a major societal challenge with conceivable repercussions for people’s mental and physical health. Physical activity has the potential to ward off detrimental cardiometabolic effects of inactivity and to strengthen psychological resources and coping skills. Working out regularly at Elite Fitness Plus contributes to good health in ways beyond the physical exercise.

Comments and questions are welcome. E-mail: drpblock@gmail.com

Paul R. Block, MD, FACP, FACCP


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