Chapter 74
Social Bonds
When they are stressed, most people not only eat more, but they are also more likely to reach for foods high in calories, fat, and sugar. When participants in one study, for example, were given solvable and unsolvable crossword puzzles in randomized groups, those who were more stressed chose unhealthier snacks; they were more likely to eat M&Ms than grapes. It’s not called comfort food for nothing, soul food. Overeating could be a sign that something is eating away at us inside.
Similar experimental studies showed that acute stress can trigger an uncontrollable craving for cigarettes and alcohol and can lead to relapse in the abuse of illegal drugs. Studies also show how severe life events such as the death of a child or a partner can mean a shorter lifespan. What is really the cause there? Is it perhaps only the unhealthy behavior that comes with it?
Once the study results are adjusted for these secondary influences, this significant association between stress and mortality disappears.
Stay active
That stress has less influence than lifestyle is best illustrated by the natural experiments that resulted from the deprivations of wartime. After all, what could be more stressful than living under Nazi occupation? The number of heart attacks must have skyrocketed, right? No: studies in Nazi-occupied Norway and Finland, as well as in Sweden under the trade blockade, showed sharply falling numbers—down to about a quarter of the prewar period. See in see.nf/worldwars what happens when meat, eggs, and butter are rationed and food scarcity leads people to eat mostly fruits and vegetables from the garden. In connection with the Nazi occupation of Norway, the Journal of the American Medical Association says: “Stress means very little or nothing at all when the diet contains hardly any animal fats.”
Social Bonds
The ability to form social bonds is characteristic of the Blue Zones and is being studied in depth for its possible effect on a long life. For example, mortality rates are lower among married people than among singles. The loss of a (spouse) increases the risk of death equally in widowers and widows. However, “death from a broken heart” is probably partly attributable to the association between grief and increased consumption of cigarettes and alcohol. Higher mortality rates occur not only among the widowed but also among the divorced. Those who have never been married also seem to be at higher risk. Most studies found no difference between the sexes, but when they did, single men had a higher risk of dying prematurely than single women.
The advantage of being married could be a consequence of selection bias or confounding factors. For example, healthier people are more likely to marry or remain married, and married people also have a higher socioeconomic status and live more healthfully. Nevertheless, studies that take such factors into account also show that it is better to have a partner.
Single or not, objectively measurable social isolation and subjective loneliness are associated with an increased risk of early death. But this effect is reduced when confounders are factored out, such as smoking or alcohol problems that have to do with feeling lonely. And then there is the perennial chicken-or-egg possibility of reverse causality, in which it is not social isolation that leads to impaired health, but impaired health that leads to isolation.
Who is saving whom?
Does being licked count as social contact? In more than two thirds of US households, including mine, there is a pet. An article in the prestigious journal Science on the bond between dog and human, the kind that makes you want to keep exclaiming “How cuuuute!”, explains that oxytocin is released in the brain when you pet a dog or look it in the eyes—both in humans and in the dog. Oxytocin is the “love hormone” that enables nursing mothers to have an intimate bond with their children.
I was reading about the potential mechanisms by which our animal friends might possibly make it easier for us to survive after a heart attack when I came across a passage about a “profound” cardiovascular response while petting dogs or horses: “This response is normally manifested in a significant drop in heart rate and blood pressure.” That made complete sense to me. But when I read the next sentence, I stopped short: “Unfortunately, we have no information on the physiological responses of the person doing the petting.” The researchers were talking about the animals’ heartbeat and blood pressure!
To my surprise, studies on the influence of pets on human health have, in the words of one review, yielded “a hodgepodge of conflicting results.” You can find all the details in the video see.nf/pets. As you can imagine, these observational studies are full of potential confounders and possible reverse causality; the only intervention study on the relationship between humans and pets examined “insects as pets.” Still, it can’t hurt to follow this advice from a medical journal article from 1925: “The best prescription for a walk is a dog, a walking stick, and a friend.”
3. Maintaining the body’s functions
Maintaining the bones
Osteoporosis literally means “porous bone,” and its characteristics are reduced bone formation, extreme bone loss, or both, which makes the bones fragile and contributes to millions of bone fractures every year. Estimates suggest that 200 million people worldwide suffer from it.
Bone density is a powerful and reliable predictor of osteoporotic fractures. Although the cutoff for an osteoporosis diagnosis is arbitrarily set, by the current definition about one tenth of women age 60 and older may be affected, two tenths at 70, four tenths at 80, and six or seven tenths at 90. Most people think osteoporosis mainly affects women, but one third of hip fractures occur in men. For 50-year-old white women and men, for example, the risk of suffering an osteoporotic fracture at some point in life is 40 and 13 percent, respectively.
The good news is that we can prevent osteoporosis. According to a study from the world’s largest twin registry, the osteoporosis fracture risk is less than 30 percent hereditary. The researchers concluded: “Measures to prevent bone fractures in older age should target lifestyle.” That is consistent with the widely varying rates of hip fractures around the world, which differ by country by a factor of 10 to 100, suggesting that bone loss in old age is not inevitable.
The U. S. Preventive Services Task Force (USPSTF), an independent scientific panel that formulates evidence-based clinical guidelines for prevention, recommends that all women age 65 and older have their bone density measured (for example with a DEXA scan), and postmenopausal women at increased risk perhaps even earlier—if there have been hip fractures in the family, if they smoke, drink a lot of alcohol, or are underweight. What do you do if you get the diagnosis? Or more important: What should you do so you never get such a diagnosis? Before we get to osteoporosis medications, let’s look at the medications that may be causing the disease.
Acid blockers can harm the bones
Gastric acid-suppressing proton pump inhibitors (PPIs), with brand names such as Prilosec/Omeprazol, Prevacid/Lansoprazol, Nexium/Pantoprazol, and AcipHex/Rabeprazol, are among the most commonly used drugs in the world and generate billions in revenue, but they exact a price. As I show in see.nf/ppi, there are dozens of studies with a combined total of more than two million participants that count more hip fractures among people who take these drugs for longer or shorter periods at various doses. This drug class also increases the risk of other possible side effects such as pneumonia, intestinal infections, kidney failure, stomach cancer, cardiovascular disease, and premature death. In addition, because of withdrawal symptoms it can be difficult to stop taking them once you have started. And as I explain in the video: Most patients never should have had to take these medications in the first place.