'Love More': Why Doctors Should Promote Social Connection

Those who embrace lifestyle medicine are familiar with the slogan Dean Ornish, MD, likes to use: eat well, move more, stress less, love more.

That last one, love, was the renowned physician and author's focus at the recent American College of Lifestyle Medicine Conference in Denver. That's because love — essentially the support, connectedness, and caring that patients feel when they join a lifestyle-change program — is "where healing occurs at the deepest level."

Indeed, social connectedness is emerging as a vital pillar in the burgeoning field of lifestyle medicine, a specialty that uses lifestyle interventions to treat chronic conditions. About 300 lifestyle medicine programs are now integrated into residencies in medical schools across the country, up from a handful just 5 years ago, said Meagan Grega, MD, the conference chair.

"The energy and growth in American lifestyle medicine is unparalleled by anything else I see in the healthcare world right now," said Grega, a family doctor for 25 years in eastern Pennsylvania.

The field applies volumes of research, from the 1990s to today, demonstrating the healing effects of lifestyle changes. Ornish's Preventive Medicine Research Institute has published research on small changes (like pomegranate juice helping blood flow in the heart) and huge ones: Coronary heart patients reversed the narrowing of arteries without lipid-lowering drugs after 1 year of lifestyle changes, including a vegetarian diet, aerobic exercise, stress management, and group support.

Ranking alongside bedrocks like healthy diet, sleep, exercise, and stress management is positive social connection. That part, the "love more" part, often draws skepticism but is vital, said Ornish, who is sometimes referred to as the father of lifestyle medicine.

It's "invariably the part that's the most meaningful — that sense of connection to community that can come when you bring total strangers together," Ornish said. "The 'love more' part, in many ways, is not only as important, but in some ways even more because everything really flows from that."

Patients in a support group, who can "let down their emotional defenses and talk openly and authentically," are much more likely to make and maintain healthy changes, Ornish said.

Love as Medicine

The healing power of love may sound like pseudoscience, but more and more research backs the health benefits of connection and the hazards of isolation.  

Mounting evidence links loneliness and isolation with a range of health issues, from mood disorders like depression to chronic conditions like cardiovascular disease. What's more, data suggest that loneliness and social isolation in the United States are on the rise, and the COVID pandemic only made that more clear. In May 2023, Surgeon General Vivek Murthy called loneliness, isolation, and lack of connection in the United States a "public health crisis."

"Good relationships keep us happier and healthier," said Robert Waldinger, MD, a psychiatrist at Massachusetts General Hospital.

Waldinger, who was not affiliated with the conference, is head of the Harvard Study of Adult Development, one of the longest studies of adult life. Beginning in 1938, the study has tracked 724 people plus more than 1300 of their descendants and found that embracing community and close relationships helps us live longer and be happier.

In the study, the people who were most satisfied with their relationships at age 50 years were the healthiest at age 80 years. Knowing you have someone to rely on protects the brain: "Those people's memories stay sharper longer," Waldinger said.

Waldinger draws a distinction between connection and love. "Love is, I think, more of a feeling," Waldinger noted. "Connection is a feeling, but it's also an activity."

One in five Americans say they're lonely, he said, "and loneliness is a stressor." People who are isolated don't sleep as well, he added. Their health declines earlier in midlife, brain function slips sooner, and their lives are shorter.

"You don't have anyone to complain to," he said. If you do, "you can feel your body start to calm down." Those without social connections may stay in a low-level "fight-or-flight mode."

"What we think happens is that you have low levels of inflammation chronically, and those can gradually break down body systems." Moreover, higher rates of cardiac reactivity, for instance, a racing heartbeat when upset, can lead to high blood pressure and lower immune function.

In his talk, Ornish said that, "Anger is that one emotion that has consistently been shown to make heart disease worse."

Helping people in those straits is gratifying, Ornish said. "If we can work with people as lifestyle medicine practitioners when they're suffering, there's an opportunity for transformation."

Future

Of course, that can be easier said than done. Ornish relayed a patient's typical reaction to a lifestyle program: "This is kind of weird stuff. Like, I get diet. But a plant-based diet, really? Meditation? Loving more? Really?"

He told the conference that, "Part of our job as lifestyle medicine practitioners is to spend a little extra time with them. It doesn't even take that much time. And to really help them understand what brings them a sense of hope and meaning and purpose."

The results can be motivating. "Most people feel so much better so quickly," Ornish said. "It reframes the reason for change from fear of dying to joy of living."

Grega, for one, is optimistic for the future, citing survey results showing that 95% of medical students think that they'd be better counselors with lifestyle training. "They passionately want this type of thing," she said.

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Cite this: 'Love More': Why Doctors Should Promote Social Connection - Medscape - Nov 15, 2023.