The Importance of Relationships
Disclaimer: Not Medical Advice. Opinions are my own.
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Today's Newsletter at a Glance:
- Keep Your Close Friends Close
- Loneliness & Mortality
- Why is Social Isolation so Dangerous?
- Relationships Are Worth the Effort
My father recently turned 90.
He told me a few years back,
"If I can give you one piece of advice, keep your close friends close. Not because you want to go out on the town until 3 in the morning (though he probably could), but because it's so important to have a friend you can call, check in on, and ask, 'What are you doing and how are you doing?"
Real friendships matter, especially as you get older.
We are social creatures. Strong social relationships are cardioprotective.
I do want to note that being naturally introverted and enjoying alone time is not what today's newsletter addresses. Alone time is important.
The data is clear: true isolation and loneliness are strongly correlated with worse health and longevity outcomes.
In today's newsletter, we will explore the harmful effects of loneliness and isolation on your health, why they are so dangerous, and the key takeaways you can apply in your life.
Loneliness & Mortality
In 2023, the U.S. Surgeon General’s advisory stated that lacking social connection carries a mortality risk comparable to smoking up to 15 cigarettes a day.
About half of American adults report measurable loneliness.
We're spending less time together. More time in front of screens.
Americans went from about 60 minutes a day in person with friends to about 20 minutes over roughly two decades.
The data is catching up.
The study that put this on the map was a 2010 meta-analysis led by Julianne Holt-Lunstad, a psychologist at Brigham Young University.
Her team pooled 148 studies covering more than 300,000 people. People with stronger social relationships had about 50% greater odds of survival than people with weaker ones. The finding held across age, sex, starting health status, and cause of death.
Newer evidence points in the same direction:
- More than 2 million adults: A 2023 meta-analysis of 90 cohort studies found that social isolation was linked to a 32% higher risk of death from any cause, and loneliness to a 14% higher risk. Isolation was also tied to a higher risk of death from cardiovascular disease and cancer.
- The heart in particular: In the UK Biobank, which followed about 443,000 people for nearly 15 years, isolation and loneliness were linked to about a 15% higher risk of coronary heart disease.
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Younger people are also affected: The link between isolation and premature death is actually stronger in people younger than 65 than in older adults.
Why is Social Isolation so Dangerous?
The leading explanation comes from the late John Cacioppo at the University of Chicago:
For most of human history, being cut off from the group meant you were more likely to be hurt or killed, so the brain evolved to read isolation as danger.
Chronic stress. Loneliness is linked to higher cortisol and heightened sympathetic “fight or flight” activation. Over time, that elevates blood pressure. In a study of middle-aged and older adults, loneliness predicted rising systolic pressure over four years.
Inflammation. Isolation and loneliness are linked to increased inflammation. Steve Cole at UCLA has shown that lonely people’s immune cells switch on inflammation genes and turn down antiviral ones, as if bracing for a wound instead of an infection.
Worse sleep. Lonely people wake more often during the night. It’s the same threat logic: you sleep lighter when nobody is watching your back.
Accountability. Nobody nudges you to walk, eat better, take your pills, or get the chest pain checked. The depression data show this clearly: depressed heart patients are less likely to take their medicines as directed, improve their diets, exercise, and attend cardiac rehabilitation sessions. Isolated people show the same pattern.
Depression. Loneliness and depression often go hand in hand, and depression brings its own biology. The AHA points to reduced heart rate variability and increases in blood factors that encourage clot formation as possible contributors.
The damage is multifactorial.
Relationships Are Worth the Effort
Relationships require effort.
They are worth the effort for health reasons and make life even more enjoyable.
- Reach out to someone you haven’t talked to in a while. Today.
- Have the hard conversation. Is there a relationship that's gone cold because of something left unsaid? A sibling, a parent, an old friend? You don't have to fix everything in one talk. It may be uncomfortable for an hour. Carrying it for another ten years is even more detrimental.
- Put people on the calendar like you would a workout. We schedule what we value. Set a standing weekly walk with a friend, and you get your cardio and your connection in the same 30 minutes.
- Trade scroll time for face time. "I don’t have time,: you might say. But most of us (myself included) spend a lot of time on screens. Trade 10, 30, or even 60 minutes of that screen time for face time.
- Join something that meets regularly. A church, a run club, a volunteer shift, a pickup game. Most friendships form through recurring, low-pressure contact. Serving others is one of the best ways to feel connected.
- If you need help, you are not alone. Depression is a medical condition and can be treated. Talk to your doctor the same way you'd bring up a physical symptom. If you're in crisis, call or text 988 to reach the Suicide & Crisis Lifeline.
We focus on our biomarkers, daily steps, and grocery cart, but we shouldn’t overlook a key part of our physical and mental health: social relationships.
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I want to hear from you!
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Only the best,
Jeremy London, MD
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* Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay seeking medical advice for any medical condition they may have and should consult their healthcare professionals for any such conditions.
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