Stress, Loneliness and a Question Too Rarely Asked

We should no longer be surprised when we hear that prolonged stress can increase the risk of health conditions such as asthma, ulcers, heart attack and stroke. Various studies over the years have suggested as much. But the idea that certain types of stress cannot only weaken your immune system but prematurely age it — making you even more susceptible to infections — takes the conversation to another level.

As reported by the New York Times, no one had conducted a deep investigation into the relationship between social stress and immunological function until gerontology specialists at the University of Southern California took on the task. Using survey responses from a nationally representative sample of over 5,700 adults in the United States 50 and over as a baseline, they determined higher levels of reported stress were associated with older immune system profiles, regardless of the subject’s true age.

“Any information on how immune aging works, or how it might differ for certain people, is valuable for public health,” writes the Times’ Hannah Seo. Adds Dr. Matthew Yousefzadeh, who researches aging at the University of Minnesota and was not involved with the new research, this new data touches on a timely concern. “I think a lot of people right now are looking at ways to rejuvenate or stimulate or boost the immune systems, particularly with aging.”

“While there is much research interest in rejuvenating our immune system, science has yet to find a way to reverse aging,” Seo wrote of her interview with Yousefzadeh. “So, it’s important to do everything you can to keep your immune system robust, he said, because once things decline, you cannot really go back to how things were.”

The advice for preventing untimely immune cell aging is also not surprising. The strategies for warding off immune aging are not all that different than ones that will ward off the effects of aging in general. Shedding unhealthy habits regarding the things you eat and drink is a good example.

“Focusing on what brings you joy, and where you can find social support, can help,” advises Seo. “That may mean pursuing hobbies, spending time with loved ones, or unplugging from work or social media when you can.”

Then, there is the question of getting proper exercise.

When it comes to exercise, according to Time magazine’s Jamie Ducharme, there are signs that the pandemic has ushered in a culture shift in the fitness world. People are now “chasing the mental-health benefits of exercise even more than the physical ones,” she reports. A recent “trends” story from online fitness-class scheduling platform Mindbody found that the two main reasons Americans now work out are to reduce stress and feel better mentally. “That’s a striking change from even the recent pre-pandemic past; in 2019, controlling weight and looking better were top motivators for many exercisers, according to Mindbody’s report from that year,” says Ducharme.

Says Idan Shalev, a bio-behavioral health scientist at Pennsylvania State University who studies the effects of stress across life spans, to the NYT, “Having social supports is also very important, like family, friends, since loneliness (also affects) the immune system.”

I was recently reminded of the toll loneliness is taking on public health by a post on HealthExec, an interactive community for news for healthcare executives and clinical decision-makers. A recent survey from Cigna and Morning Consult found that 58% of U.S. adults today are considered lonely.

Says NYT reporter John Leland, even before the pandemic, there was an “epidemic of loneliness,” affecting physical health and life expectancy in this country. In a meta-analysis by Brigham Young University, the risk effects of loneliness, isolation and weak social networks is assessed as being equivalent to smoking 15 cigarettes a day.

The essence of this “loneliness epidemic within an epidemic” struck me most clearly in a recent opinion piece by Dr. T. Salewa Oseni, a surgical oncologist at Massachusetts General Hospital and an assistant professor of surgery at Harvard Medical School. His thoughts were posted on STAT, an online news source covering health, medicine and the life sciences.

As a surgeon specializing in cancer, he often has the task of delivering the news to people once they have been diagnosed. He recalls one woman who shocked him by being not the least bit relieved when he gave her the news that her cancer was curable and her prognosis was excellent.

“I’m ready to die,” she told him. “I don’t see the point of fighting this thing.”

Exploring this response further, he learned that she was a widow and living alone. Her part-time job as a cashier was her main source of human interactions, which were not satisfying. Going back to that life was something she dreaded.

“‘Toward the end of our conversation, I asked gently, ‘What about religious affiliation? Do you have community there?'” he writes.

“Protestant,” she responded. “And no, I don’t go to services anymore.”

“It’s a delicate thing, as a doctor, to prescribe a bit of church. But that is what I suggested,” he says. He told the patient: “Perhaps you can re-engage with your church or reach out to your pastor.”

“For many, their belief system is central to their coping strategy. So I believe it is an appropriate time to talk about faith and religion, though many of my colleagues may disagree,” he points out.

“I meet people like (her) almost every day,” Oseni continues, “people for whom meaningful social connections don’t exist. But given the importance of these connections in mental and physical health, I believe that physicians cannot ignore the role faith and religion can play in fostering them.”

“Americans increasingly identify as non-religious,” Oseni admits. “Many of my colleagues may believe that religion or faith or spirituality is a private matter outside the purview of medicine. Yet this is not entirely true: Physicians are comfortable relegating faith and religion to palliative or hospice care. This reinforces the notion that faith, religion, and spirituality are only end-of-life issues and not also ways to foster human connections.”

Oseni had the opportunity to see this patient for a follow-up visit. “Over time, and after multiple phone calls, she had opted for treatment and was doing well,” he recalls. “Walking into the room, I was struck by her smile. Somewhere along the way, someone from her church had reached out, and a coffee date had resurrected a lapsed friendship. By the end of the visit, I had a huge smile as well, not only because she had successfully completed treatment but because she had once again found human connection.”