Loneliness – as lethal for body as it is for mind


Loneliness – the word reeks of sadness and longing. Language created it to express the pain of being alone. So said German-American existentialist philosopher and theologian Paul Tillich.

Dr Axel Sigurdsson

Tillich distinguished loneliness from “solitude”, which he said expresses “the glory of being alone”. And research shows that loneliness is not only a psychological issue but a medical one.

Below, Icelandic cardiologist Dr Axel Sigurdsson explains why loneliness can affect the main organs associated with feelings: hearts and minds. He shows why it is possible to die from a broken heart. Sigurdsson delves into how and why loneliness really can be lethal. Along the way, he shows why social contact can effectively be ‘food’ for body and mind. – MARIKA SBOROS

By Axel Sigurdsson

Loneliness and social isolation are becoming problems of epidemic proportions. The global statistics are chilling. Today, at least 25% of Americans say that have no one with whom to discuss important matters important.

What is even scarier is that loneliness is killing people.

Research associates loneliness and social isolation with an increased risk of early mortality. Being socially connected is shown to increase psychological and emotional well-being. It also has a positive influence on physical health.

Although psychologists usually associate loneliness with social isolation, it is important to discriminate between the two. Social isolation refers to a lack of contact with other people. Loneliness indicates a state of mind.

Despite these definitions, there is significant overlap between social isolation and loneliness. Hence, many often use the terms interchangeably.

Analysts project that changes in marital and childbearing patterns and the age structure of the US society will produce a steady increase in the number of older people who lack spouses or children.

Living alone

Since 1970, the composition of households and families and the marital status and living arrangements of adults in the US have experienced marked changes. For example, the proportion of the population of married couples with children decreased and that of single mothers increased. As well, over time, the median age at first marriage has grown.

In 1940, 7.7% of households consisted of one person living alone. In 2000, this number was up to 25%.

By 2010, US Census Bureau predicts that the number of people living alone will reach almost 31,000,000. Thus that represents a 40% increase since 1980.

The negative health consequences of social isolation are particularly strong among some of the fastest growing segments of the population. These are the elderly, the poor, and minorities such as African Americans.

Psychologists say that loneliness is a subjective feeling of isolation, not belonging, or lacking companionship. It reflects a discrepancy between desired and actual social relationships. A person can feel lonely despite living with a spouse or other family members. Some can experience loneliness in a room full of people.

Click here to read: Real cause of heart disease? It’s not diet, says Kendrick

Definition of being lonely

A recent US survey suggests that 35% of adult Americans meet the definition of being lonely. Older adults were more likely to be lonely than younger individuals. Married respondents were least likely to be lonely. People with higher incomes were less likely to be lonely than those with lower incomes.

Older adults were more likely to be lonely than younger individuals. Married respondents were least likely to be lonely. People with higher incomes were less likely to be lonely than those with lower incomes.

Lonely respondents were less likely to be involved in activities that build social networks, such as attending religious services, volunteering, participating in a community organization or spending time on a hobby.

Loneliness was a significant predictor of poor health. Those who rated their health as “excellent” were over half as likely to be lonely than those who rated their health as “poor” (25% vs. 55%).

Researchers define social isolation as a state of complete or near complete lack of contact between an individual and society. It includes living alone, staying home for lengthy periods, having no communication with family, acquaintances or friends, and willfully avoiding contact with other humans.

Effects of social isolation

Social isolation may have significant effects on health and well-being.

Almost 30 years ago, House, Landis, and Umberson published a landmark review of prospective epidemiological studies of social isolation in humans. They reported that social isolation was a significant risk factor for morbidity and mortality. They even suggested that social isolation was as strong a risk factor as smoking, obesity, sedentary lifestyle, and high blood pressure.

Click here to read: Perfect storm of heart disease: how to protect yourself 

But why is social isolation associated with poor health? The “social control hypothesis” may provide some answers. The theory holds that good health behaviours may be promoted by direct social control.

For example, one study showed that among women, direct social control (ie how often someone tells you or reminds you to do something to protect your health) predicted increased physical activity three years later.

Being married is associated with an increased likelihood of engaging in health-promoting behaviours such as exercise. Presumably, that’s because marital partners exert some influence over these behaviours.

However, scientific studies have indicated an association between social isolation, loneliness and heart disease. Studies also associate loneliness with impaired cognitive function and increased risk of dementia. Loneliness may even alter our immune response, increasing the risk of illness

The tale of Roseto

The story of the Rosetans may help to understand the importance of family relations and social surroundings for the risk of heart disease.

Roseto is an Italian-American town in eastern Pennsylvania. In the early 1960s, a local physician, Dr. Benjamin Falcone pointed out that he rarely saw a case of a heart attack in any of the 1600 inhabitants of Roseto under age of 65. Subsequently, data confirmed that from 1955 to 1965 the death rate from heart attack was markedly lower than in nearby communities and the rest of the country.

However, the usual risk factors were not less common in Roseto than elsewhere. The men spent their days doing hazardous labour in underground slate mines. Smoking was common.

The traditional Italian food had been Americanized, and could not be considered heart healthy. So why weren’t the Rosetans dropping dead from heart attacks?

Dr Stewart Wolf and coworkers described the social and family structure of the inhabitants of Roseto:

The Roseto that we saw in the early 1960s was sustained by the traditional value of southern Italian villagers. The family, not the individual, was the unit of their society. The community was their base of operations and each inhabitant felt a responsibility for its welfare and quality. Most households contained three generations.

Rosetans were proud and happy, generous, hospitable and ready to celebrate any small triumph of their citizens. The elderly were not only cherished but, instead of being retired from family and community responsibilities, they were promoted to the ‘supreme court’.

No shortage of stress

“There was no shortage of stress among Rosetans. They experienced many of the same social problems and personal conflicts as their neighbors, but they had a philosophy of cohesion with powerful support from family and neighbor and deep religious convictions to shield them against and counteract the stresses.”

(Editor’s note: Wolf is known as ‘the father of psychosomatic medicine’. He is also author of The Roseto Story, An Anatomy of Health.)

Researchers now use the Roseto effect to describe the phenomenon by which a close-knit community experiences a reduced rate of heart disease.

Psychologists have developed interventions to tackle social isolation and loneliness. However, there is little evidence to show that they work.

Part of the problem is that many people don’t understand the mechanisms by which loneliness and social isolation impact on health. However, national and international public health authorities increasingly recognize the importance of tackling social isolation and loneliness among older people.

In the UK, five partner organisations established the Campaign to End Loneliness in 2011. It is a network of national, regional and local organizations and people working together through community action, good practice, research, and policy. The aim is to ensure that authorities act on loneliness as a public health priority at national and local levels.

In 2016, the National Association of Area Agencies and the AARP Foundation launched a campaign to raise awareness of social isolation and loneliness in older Americans. They created a brochure to outline risk factors and steps seniors can take.

The bottom line is the need for recognition of the links between poor health and loneliness.



  1. Oh-oh, another Paradox! aka data . . .

    I’ve lost a lot of friends, relatives and especially neighbours, and now I’m tending to cut myself off from people I know for the simple reason I expect also to be dead soon and don’t want other people to be worried by my absence. OTOH I spend a lot of time talking to strangers, on the various local nature reserves, places where people walk with or without their dogs, and on the farmland where I regularly meet various farmers and gamekeepers etc. Also I know most of the staff in most of the local shops, farm shops etc. and of course on the internet, so I’m far from lonely.

    It’s actually surprising, in a good way, just how many other folks, especially the other oldies, eat Real Food. The younger ones, not so much 🙁

  2. While the importance of family relations and social surroundings is clear (and I certainly agree with Dr Sigurdsson’s point of view), the use of the Roseto effect to demonstrate such benefits is questionable.
    What Dr Stewart Wolf dismissed as a bad diet in the 1960’s was very much tainted by the beginnings of the era of Ancel Keys’ influence. In 1957, Dr Keys wrote that the plaque riddled state of American arteries was “…dominated by the long-time effects of a rich, fatty diet and innumerable fat-loading meals.” Dr Keys even wrote specifically on why he considered Roseto to be an ‘aberration’ or an ‘outlier’, using Macolm Gladwell’s popular term.
    In “The Mystery of the Rosetan People”, a descendant of those Italian founding fathers Rock Positano wrote: “Rosetans fried their sausages and meatballs in lard, ate salami, hard and soft cheeses all brimming with cholesterol” (mostly sourced locally incidentally). For Dr Stewart Wolf, the lead investigator, it was simply too obvious that the Rosetan diet was unhealthy and that they did not enjoy the benefits of a more modern American diet. He even criticised them for using lard because they could not afford olive oil – but having been to the original Roseto in Southern Italy, I can confirm that many recipes still use lard today – it’s their tradition. Even in the original Roseto in Puglia, olive oil was expensive and perhaps surprisingly – used more for other purposes than cooking. Dr Wolf noted: “I’ve had many dinners with Rosetan families. They usually have more than one type of meat. When I eat ham, I cut the rim of the fat off and don’t eat it, same way with roast beef, but they cut right through and eat it all. We were very elaborate in our study of their diet because we had Ancel Keys breathing down our necks”. “One of their favorite dishes was fried peppers in lard and they are very good. Then you’d take a piece of Italian bread and rub it around in the gravy that is left and eat that, and that’s delicious.”

    With hindsight, although those Roseto researchers loved the local food, they were convinced it was bad for them because of America’s growing obsession with cholesterol and low-fat foods.
    As Dr Sigurdsson mentions, the Rosetan diet and lifestyle did finally get westernised but it really kicked in during the late 60’s and 70’s and so was not related to those healthy hearts of older Rosetans in the 1950’s and 60’s who had been eating ‘healthy, locally-sourced produce’ for their entire lives.
    Not to forget: In the 60’s they were still walking a lot – life in many ways was still organised around a central high street which virtually does not exist today.
    In summary, I am not trying to contest the main tenet of this article, just suggesting that the Roseto effect is really about many aspects of community and social involvement but centered around a rich Italian style diet. That’s probably why to this day, inhabitants of Southern Italy live several years longer than those living in and around Roseto Pennsylvania. I write extensively on this in my book, Fat is our Friend, if anyone wants to read more on this.

  3. Earlier this year, I saw a doctor because I had anxiety and depression. I was prescribed anti-depressant medication and referred to a psychologist. So far so good. Then he gave me a spiel about my cholesterol (no blood test results on hand) and started writing a script for a statin drug. I mentioned that lowering my cholesterol might exacerbate my depression and it would be wrong to put me on statins. He asked how I knew all this and I said I read the information sheet that comes with the medicine … Another case of income before outcome?

    • Doriand, another small victory for an informed patient. The low-fat diet is certainly linked to anxiety, so it makes sense that statins would make the situation worse. My brother was losing his memory on statins.

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