Loneliness linked to a number of diseases and conditions

Q: I live alone, and stay-at-home orders have been hard. I've heard people say that being lonely is really bad for your health, and now I believe them. What problems can it cause? Also, I'm going to start seeing friends and family again. What can we do to stay safe?

A: While it's easy to understand the link between loneliness and depression, anxiety and other psychological ills, the connection to physical effects on the human body can seem like a bit of a stretch. However, ongoing research has shown that loneliness, as well as the social isolation we have all been asked to practice for several months now, do, indeed, take a physical toll.

Individuals who experience chronic loneliness have been found to be more vulnerable to a number of diseases and conditions than are people who enjoy strong emotional connections. These include an increased risk of developing heart disease, metastatic cancers and having a stroke. Older adults who are socially isolated are also more likely to become cognitively impaired or to develop dementia, including Alzheimer's disease. Researchers have even tied loneliness to an increased risk of premature death. Adults in midlife who are chronically lonely are 25% more likely to die prematurely. Older adults, whose social connections have shrunk due to factors such as retirement, have double the risk of premature death as those who are socially connected.

You're not alone in being determined to rekindle your social contacts. We've all seen an increase in the number of people returning to a semblance of normal life. The challenge is that each and every contact with someone outside of your quarantine circle becomes a calculated risk. This is because of the highly transmissible nature of the novel coronavirus and the existence of asymptomatic carriers, who can unknowingly pass along the virus. Still, several months into the pandemic, the medical community has gained a clearer understanding of mitigation measures. As a result, the focus has begun to shift from strict quarantine behavior to risk management and mitigation.

Before we go any further, we have to repeat that any contact with people outside your quarantine circle puts you at risk of infection. The best way to lessen that risk is to stick to small gatherings that are held only outside - never indoors. And it's crucial to maintain the social distancing guidelines we are all now familiar with. That means tables or chairs or picnic blankets spaced at least 6 feet apart. No handshakes or hugging, no matter how tempting it may be. Everything about the gathering should be BYO - bring your own. That includes food, drink, condiments, disposable plates, cups and utensils, and a large garbage bin for safe disposal. Wear masks except while eating or drinking. No sharing of food or drink or condiments. If things get lax and you become uncomfortable, make a polite excuse and leave. This is all a far cry from the way we visited with each other in the pre-COVID-19 world, but the potential consequences of skipping or relaxing even one of these steps are too grave.

More advice: Hello, dear readers, and welcome to our first letters column of the summer. We've had a lot of mail - thank you! So we're diving right in.

 Let's start with a question regarding two essential tools of outdoor summer living - sunscreen and insect repellent. A number of you have written to ask how long these products remain effective. It's true that most don't include an expiration date on the packaging.

However, the Food and Drug Administration requires sunscreen to maintain its original efficacy for at least three years. (Of course, that means you'll have to remember when you made your purchase.) Most manufacturers say their insect repellents remain effective for two to three years. If you need a more precise answer, you can call or email the manufacturer's customer service department and provide them with the lot number of the product you're asking about.

 A column about the unhealthful nature of processed foods puzzled a reader from Iowa. “Can breakfast cereal, which is extruded, molded and milled, be considered a healthy processed food?” she asked. The answer is that it depends on the specific cereal. Those that are made from whole grains, have little-to-no added sugar and salt, and are high in fiber can be considered healthy-ish. (Emphasis on the “ish.”) Eat them with a serving of fresh fruit, watch portion size and don't dip into the sugar bowl. Cereals fortified with vitamins, minerals and iron can contribute to daily nutritional goals.

 A reader in Virginia thought we left out an important detail in our discussion of preventing deep vein thrombosis, which is the formation of blood clots, on long plane flights. “Never once did you mention wearing compression socks on the flight,” he wrote. “Doesn't that help prevent DVT?” You're correct that wearing compression socks or stockings can help reduce the risk of developing deep vein thrombosis. According to the National Institutes of Health, about two out of every 10,000 passengers develops DVT on a long flight. For those at high risk, knee-high compression stockings with compression strength between 15 and 30 mmHg are a good idea.

 We received a lot of mail in response to a column about the importance of vitamin B12, an essential vitamin the body needs but doesn't produce. The answers to your varied questions are: B12 is manufactured by bacteria living in the guts of a variety of mammals, fish and poultry. It's available in animal products, including fish, meat, poultry, eggs, milk and milk products. It's also available as a supplement, both over-the-counter and through prescription. OTC products, although not regulated by the FDA, are considered to be a reliable source of the vitamin. Studies have found no advantage of sublingual (under the tongue) B12 over tablet form. Most B12 supplements exceed the recommended dietary allowances (RDA) for adults of about 2 to 3 micrograms per day. However, the body absorbs only as much as it needs, and any excess of the water-soluble vitamin is excreted in the urine.

Thank you to everyone who wrote with kind words. We're thrilled you continue to find this column both interesting and useful.

Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.