It’s not easy to convince patients there’s more to health than diet, exercise and supplementation. Too often, they’re certain that if they can just get their “macros” right—eat exactly the right amounts of protein, fat, and carbohydrate—and do precisely the right intensity of exercise and nail the optimal supplement regimen, then perfect health will be a given. They have a laser-like focus on the physical—diet, activity, sleep, sunlight—which leads to a gaping hole in something they often completely ignore: emotional health. They do this at their peril. A new study out of Denmark adds weight to the already large body of evidence indicating that loneliness increases the chances of poor health outcomes.

All other things being equal, or, at least, when researchers control for variables such as age, smoking, BMI, alcohol consumption and level of education, feeling lonely and socially isolated or disconnected is a risk factor for several adverse health developments. In the case of the Danish study, they looked at over 13,000 individuals who’d been seen in heart centers for ischemic heart disease, arrhythmia, heart failure, or heart valve disease between April 2013 and April 2014.

After asking participants if they had someone to talk to when they needed it, or if they sometimes felt alone even when they wanted to be with someone, the researchers determined that “feeling lonely was associated with poor outcomes in all patients regardless of their type of heart disease,” even after adjusting for the factors listed above. According to a press release from the European Society of Cardiology, “Loneliness was associated with a doubled mortality risk in women and nearly doubled risk in men. Both men and women who felt lonely were three times more likely to report symptoms of anxiety and depression, and had a significantly lower quality of life than those who did not feel lonely.”

It's important to note that being alone isn’t the same as feeling lonely. As any introvert can confirm, it’s possible to be in one’s own company and feel perfectly fine, but it’s equally possible to be in a room full of people and feel terribly lonely. So, it’s not necessarily about being surrounded by people, but rather, having confidants to confide in, or relatives and good friends someone trusts and feels free to “be themselves” around. As study author Vinggaard Christensen noted, “people may live alone but not feel lonely while others cohabit but do feel lonely.”

She went on to say:

“Loneliness is a strong predictor of premature death, worse mental health, and lower quality of life in patients with cardiovascular disease, and a much stronger predictor than living alone, in both men and women.”

It’s worth noting that the famed “blue zones”—various enclaves around the world celebrated for the health and longevity of their populations—differ in several ways, but have some similarities. Among their differences are climates (some warm, some colder) and diets (some higher in fat and animal products, others leaning more low-fat vegetarian), but one similarity that stands out is a strong sense of community. Can we attribute the purported health effects of the Mediterranean diet to olive oil, fresh vegetables, and red wine, or is it that those things are typically enjoyed in a communal setting, surrounded by friends and family, discussing the events of the day or reminiscing about happy times from the past? Olive oil and red wine certainly aren’t part of the traditional diet in Okinawa, yet Okinawans were another example of a population that lived long, healthy lives, as were the Seventh Day Adventists in Loma Linda, California, who eschew alcohol and mostly follow a vegetarian diet. (The Okinawans traditionally cooked in lard, and pork and pork fat are still widely used there today.)

In an ironic twist, thanks to social media, we’re more “connected” now than ever before, and yet, we seem far more disconnected, too. According to Christensen, “We live in a time when loneliness is more present and health providers should take this into account when assessing risk. Our study shows that asking two questions about social support provides a lot of information about the likelihood of having poor health outcomes.” We already know having support and encouragement from family and friends can make it easier for patients to implement and maintain diet and lifestyle changes. Now, we’re seeing that the importance of human relationships and connection go far beyond this.

By Amy Berger, MS, CNS