Social Engagement Blog | Stanford Lifestyle Medicine

Battling Adverse Childhood Experiences with Lifestyle Medicine

September 27, 2023/in Social Engagement /by Maya Shetty

Just under half (45 percent) of children in the US have experienced at least one adverse childhood experience (ACE), which is a traumatic event that occurs before the age of 18, such as neglect, physical, emotional, or sexual abuse, according to the National Child Health Organization.

ACEs and their impact on individual lives are a difficult and heavy reality that needs to be addressed. Oftentimes, ACEs accompany other adverse environmental and societal exposures, such as air pollution, poverty, community violence, bullying, and discrimination. ACEs are linked to various detrimental health outcomes, including chronic diseases, mental health disorders, and substance abuse.

“Trauma is widespread with the potential to be exceptionally debilitating and devastating; thus, it is vital that medical professionals start implementing positive lifestyle interventions to minimize the effect of ACEs and trauma with our patients,” says Rusly Harsono, MD, Stanford Medicine pediatrician.

ACEs are associated with increases in systemic inflammatory markers, such as C-reactive protein, fibrinogen, and pro-inflammatory cytokines, which promote adverse health outcomes. Through addressing systemic inflammation, the health consequences associated with ACEs can be combated.

In the research paper, “The Call for Lifestyle Medicine Interventions to Address the Impact of Adverse Childhood Experiences,” Rhonda Spencer, DrPH, MPH and her research team at Loma Linda University have explored whether lifestyle medicine can be leveraged to address systemic inflammation to combat health consequences associated with ACEs through studying centenarians.

Despite tremendous ACEs and additional environmental stressors, the centenarians in the study have lived long and healthy lives. The research team hypothesized that the lifestyle choices the centenarians had made in their childhood and across their lifespan, such as engaging in physical activity, time in nature, routine rest, plant-based diet, connection with family and friends, faith foundation, helping others, and a positive outlook on life, may have protected them against the long-term effects of ACEs.

Dr. Harsono expresses that this research is a call to action for medical professionals.

Here are evidence-based lifestyle interventions that Dr. Harsono and Dr. Spencer recommend for medical professionals to prevent and treat early chronic disease among their patients:

Provide a standard whole health lifestyle questionnaire that assesses physical activity, time in nature, routine rest, plant-based diet, developing and strengthening family and friend relationships, faith foundation, ability to help others, and a positive outlook on life.
Create education opportunities on evidence-based lifestyle interventions for patients and medical staff.
Promote key partnerships between healthcare institutions and local community-based organizations to develop whole health programs for battling the effects of ACEs.
Encourage and conduct research to assess the impact of protective lifestyle factors on mitigating the adverse effects of ACEs, especially the inflammatory response.

“It is important to see the impact of lifestyle interventions for ACEs, in combination with other treatment modalities,” says Dr. Harsono. “These interventions are powerful, and we should promote and practice them in the medical community as much as possible.”

By Helena Zhang, BS

Lifestyle Medicine Lessons from Makoyoh’sokoi (the Wolf Trail) Program

September 25, 2023/in Movement & Exercise, Social Engagement /by Maya Shetty

Community health that embraces culture is an important aspect of lifestyle medicine, but not all health recommendations are equally accessible or realistic for all peoples within a given region, particularly among Indigenous cultures. This has prompted Stanford researchers to investigate the influence of existing culture-specific programs that promote health and wellness at the individual and community levels.

“Indigenous populations didn’t practice the pillars of lifestyle medicine, they just lived their lives,” says Levi Frehlich, PhD (c), Stanford Lifestyle Medicine lead statistician and current University of Calgary PhD candidate. “They integrate physical activity and nutrition by foraging and hunting, and they integrate stress management, social engagement, reflection and gratitude within their ceremonies and daily rituals.”

Frehlich recently published a research paper, “Spread of Makoyoh’sokoi (Wolf Trail): a Community-led Physical Activity-based, Holistic Wellness Program for Indigenous Women in Canada.” As one of the principal investigators for the paper, Frehlich discusses the program’s development, implementation, and evaluation as a health initiative that has been ongoing for more than five years.

“The primary purpose of the Makoyoh’sokoi program is to support Indigenous communities and provide the best holistic program possible,” says Frehlich. “Yes, the research outputs are interesting, but really it comes down to helping improve the health of women in these communities.”

Makoyoh’sokoi – The Wolf Trail Program

The Makoyoh’sokoi (ma-koy-yoh-so-koy), or Wolf Trail, program is a free, 15-week holistic wellness program that offers various physical activities and guided health lessons by and for Indigenous women. Each week, women are guided through a lesson on different aspects of physical activity and wellbeing and are given the opportunity to explore the health resources in their surrounding community.

Initial data from previous offerings of the program reported increased activity levels, more positive relationships with food, enhanced social engagement, and improved health outcomes like weight and blood pressure management. Feedback during the pilot phase of the program was overwhelmingly positive, particularly about the opportunity to engage with Indigenous cultures in environments where it was explicitly safe and encouraged to do so. Over the last five years, the program has expanded to other regions of Canada, with oversight from the program’s advisory board, which includes community members, Elders, and allies.

Lifestyle Medicine and Community Health

The Makoyoh’sokoi program’s mission statement emphasizes three key elements of community health: “support”, “making a difference”, and “in our world”.

To support Indigenous women, the program has tailored educational and interactive materials with the help of physicians, dieticians, community leaders, and Elders to provide resources for every aspect of health. While some lessons lead participants through different physical exercises, others teach them how to design their own nutritious meals and how to tell the story of their health journey.

To make a difference in the lives of the participants, the program recognizes that everyone’s goal is different but united by similar themes that are personal, yet measurable.

Finally, the program is designed “in our world,” or in a manner that reflects beliefs central to Indigenous foundations of spiritual harmony. In practice, this becomes part of an intricate system of care that recognizes each person’s role in their community.

Historically, the colonization of Indigenous communities has heightened their risk of facing intergenerational traumas and chronic diseases like obesity and diabetes. Rather than dismissing the influence history and culture can have on one’s health, the program recognizes how these can impact people at individual and community levels. By recognizing these truths and giving women the space to process them together, the mission of the program remains steadfast as a beacon for the well-being of future Indigenous generations

“The pillars of lifestyle medicine have historically been a natural part of the lives of Indigenous populations, but with colonization, many of these healthy practices have been lost.” says Frehlich. “The Makoyoh’sokoi program reconnects women to their community and culture, supporting their health and well-being.”

To read more about the design of the program and its impact throughout Canada, “Spread of the Makoyoh’sokoi (Wolf Trail)...” was published in the Journal of Health, Population, and Nutrition in August 2023. To become more familiar with the program, read about the specific communities it serves, or become involved, go to the program’s website: https://wolftrail.ca.

By Carly Smith, BS, MPH (c)

Phone Down, Eyes Up

July 13, 2023/in Social Engagement /by Maya Shetty

Phone, wallet, keys – the trio of don’t-forget items when you leave your house. However, can the presence of a phone influence the degree of connection and empathy in our lives?

Through a study, researchers found that the mere presence of a mobile phone during face-to-face conversations can weaken interpersonal bonds, especially during meaningful conversations.

While mobile devices have revolutionized the way we communicate over long distances, the two experiments in the study have shown that:

The mere presence of a phone during conversations can result in diminished feelings of closeness, connection, and perceived empathy, between conversing partners.
These effects were most pronounced when participants were engaged in discussions on personally meaningful topics, demonstrating that mobile phones could potentially disrupt the formation of deeper connections.

As we continue to grapple with the omnipresence of mobile technology, this research serves as a wake-up call, reminding us to be more mindful of our device use during face-to-face interactions. It is time we remedy the loneliness in our world with more genuine, unmediated human connection. Perhaps, then, we need to occasionally disconnect from our devices to truly connect with those around us.

By: Helena Zhang, BS & Bruce Feldstein, MD, BCC

Sources:

Przybylski, A. K., & Weinstein, N. (2013). Can you connect with me now? How the presence of mobile communication technology influences face-to-face conversation quality. Journal of Social and Personal Relationships. July 19

Gardening as a Lifestyle Medicine Practice

June 12, 2023/in Healthful Nutrition, Social Engagement, Student Blogs /by Maya Shetty

By Donovan Giang, Maya Shetty, and Rusly Harsono, MD

Life hastens while we focus on our goals, and this can be overwhelming and stressful. Let’s find balance and evaluate our lifestyle! Do you feel like you are eating healthy or connecting well with people around you on a consistent basis? Home and Community Gardening may help you and your family to get there. Home gardening is the practice of growing plants in a traditional outdoor garden or a kitchen garden using pots or trays inside our home. Community gardening, on the other hand, involves gardening in a space shared by the community. Studies showed that both forms of gardening have several health benefits, from improving nutrition to social connection.

Home Gardening Impact on Nutritional Health

Carney et al in 2013 reported that adults and children’s vegetable intake “several times a day” increased significantly from 18.2% to 84% (p<0.001) and from 24% to 64% (p = 0.003) respectively following a community-based participatory research project that enrolled 163 household members in a community-based gardening project to assess food security, safety and family relationships.

Researchers from the University of California, San Francisco in 2020 provided insight into how home gardening may improve nutritional health and facilitate better health behaviors. This qualitative study explored changes in health behavior following the implementation of a home gardening and nutritional education program in an urban community at high risk for cardiometabolic disease. Participants from low-income, Latino / Latina population in Santa Clara County were provided with home gardening supplies and attended 10 educational workshops to learn about nutrition, as well as gardening skills and healthy recipes. After a year of gardening, participants reported increased consumption of fresh produce, shifted toward home cooking, and decreased fast food consumption. Participants attributed these changes to the affordability, convenience, flavor, and freshness of their grown produce, as well pride in their garden.

Gardening and Social Connection

One of the most significant benefits associated with gardening is the circle of sharing that promotes connection within a local community. As individuals start their own gardens in their home or as part of a community garden, the act of sharing with those around them can build friendships, leading to continued social interaction, trust, and reciprocity. A qualitative research study in 2004 titled “Growing urban health: Community gardening in South-east Toronto” demonstrated these benefits among community gardeners. The researchers collected data from active community gardener participants on their experiences through direct observation, focus groups discussions, and in-depth interviews. Participants reported greater attachment to their community, more positive social interactions, and stronger relationships due to their community gardening experience. A participant of the study even described the joy from being able to share home-grown produce with friends, suggesting community gardens may also help strengthen social connections beyond the boundaries of one’s neighborhood.

Through stronger social relationships and a growing sense of joy in gardening, gardeners have more opportunities to inspire those around them to start their own gardens. Carney et al (2013) reported this effect with home gardeners. In this study, the researchers provided support and resources for participant families, who were mostly of a Hispanic and farm working background, to start their own home gardens. Through pre- and post-gardening questionnaires and interviews, the researchers found that not only did a significant proportion (94.9%) of participants report an improvement to their family’s health but also many of these participants (92.3%) encouraged other families to start gardens as well. As a result, one individual’s gardening can blossom into a rewarding community effort.

Nutrition and social engagement are key to support a healthy lifestyle. Researchers reported that through gardening we can improve our lifestyle medicine practices in at least these two pillars: healthful nutrition and social engagement. Boles et al in 2021 reported that targeting mindsets about the process of health behaviors have meaningful implications for individuals’ engagement in healthy behaviors. Gardening can transform the process of eating healthy into fun through opportunity to relax, expressing creativity and connecting with others.

Let’s try gardening for yourself, try collaborating with your neighbors or larger community to create a shared garden! Home gardening in your backyard or kitchen countertop is a great way to start living healthy. Hydroponic gardens recently have become popular to allow indoor gardening without dirt all year round. No matter which form of gardening you do, take the opportunity to try something new and maintain a healthy lifestyle!

References:

Boles, Danielle Z., et al. “Can Exercising and Eating Healthy Be Fun and Indulgent Instead of Boring and Depriving? Targeting Mindsets About the Process of Engaging in Healthy Behaviors.” Frontiers in Psychology, vol. 12, Oct. 21, pp. 1-14., https://doi.org/10.3389/fpsyg.2021.745950
Carney, Patricia A., et al. “Impact of a Community Gardening Project on Vegetable Intake, Food Security and Family Relationships: A Community-Based Participatory Research Study.” Journal of Community Health: The Publication for Health Promotion and Disease Prevention, vol. 37, no. 4, Aug. 2012, pp. 874–81., https://doi.org/10.1007/s10900-011-9522-z.

Eng, S., et al. “Healthy Lifestyle Through Home Gardening: The Art of Sharing.” American Journal of Lifestyle Medicine, vol. 13, no. 4, July 2019, pp. 347-350–350., https://doi.org/10.1177/1559827619842068.
Palar, Kartika, et al. “Nutrition and Health Improvements After Participation in an Urban Home Garden Program.” Journal of Nutrition Education and Behavior, vol. 51, no. 9, Oct. 2019, pp. 1037–46., https://doi.org/10.1016/j.jneb.2019.06.028.
Sarah Wakefield, Fiona Yeudall, Carolin Taron, Jennifer Reynolds, Ana Skinner, Growing urban health: Community gardening in South-East Toronto, Health Promotion International, Volume 22, Issue 2, June 2007, Pages 92–101, https://doi.org/10.1093/heapro/dam001

Racism and Heart Disease Risk

May 24, 2023/in Social Engagement, Stress Management /by Maya Shetty

Our experiences, emotions, and behaviors are interconnected and can profoundly influence one another. While there are times one part of your life can seep into and impact another positively, problems in one area can also have a negative impact if not addressed. One area we aim to highlight is the connection between social relationships and physical health, particularly heart health.

The impact of racism on physical health is a critical area in the healthcare space, and it warrants our attention. In an article published by Boston University, Andrew Thurston sheds light on a groundbreaking study that establishes a strong correlation between experiencing racism and an increased risk of heart disease among Black women.

The study, spearheaded by Dr. Yvette Cozier, an epidemiologist, and professor at the Boston University School of Public Health, analyzed data from the Black Women’s Health Study (BWHS) – an ongoing, long-term research project initiated in 1995. With a cohort of over 59,000 Black women from across the United States, the BWHS has made significant strides in understanding the health disparities faced by this demographic.

To determine the association between racial discrimination and heart disease, the research team employed a detailed questionnaire that assessed participants’ experiences of racism in various contexts, such as work, housing, and public spaces. The questionnaire also considered the frequency and severity of these encounters.

After examining the self-reported data alongside medical records, the researchers found that perceived racism in employment, housing, and interactions with the police was associated with a 26 percent higher risk of coronary heart disease for Black women.

Sheehy, who’s also affiliated with the BU Slone Epidemiology Center, explains, “When we think about how racism impacts our health, it’s a psychosocial stressor… it increases your blood pressure, your level of inflammation—[and] all of these biological mechanisms increase your risk of coronary heart disease”.

The study forces us to examine how the interconnectedness of our lives allows racial discrimination to have far-reaching consequences on one’s health, wellness and lived experience. While the study underscores the importance of providing holistic and culturally aware patient care, further research is needed to elucidate how coping mechanisms can counteract the effects of racism. We must recognize how structural racism within the healthcare system can impact lives, advocate for, and work toward change.

By: Helena Zhang, BS & Michael Fredericson, MD

Sources:

Study Abstract: https://newsroom.heart.org/policy?id=63ed57d8b3aed303f1737879
Black Women’s Health Study: https://www.bu.edu/bwhs/

Can Lifestyle Reverse Your Biological Age?

April 26, 2023/in Cognitive Enhancement, Healthful Nutrition, Movement & Exercise, Restorative Sleep, Social Engagement, Stress Management /by Maya Shetty

By: Ben Maines, MD candidate

We all know that eating right, sleeping well, and minimizing stress are good for our health, but what if they could turn back the clock on biological aging? A small but groundbreaking 2020 study found that an 8-week prescription of a healthful diet, stress reduction breathing practices, and exercise decreased participants’ epigenetic age by a little over three years relative to a control group. Sounds too good to be true, doesn’t it? And what do we mean by epigenetic age? We’ll answer those questions and more, but first, a primer in epigenetics. Epigenetics describes reversible molecular modifications made to DNA. At the cutting edge of our modern understanding of medicine and cellular biology, epigenetics facilitates variation between genetically identical cells like your neurons and muscle cells. In the case of twins, for example, you can think of the DNA as the blueprint shared by twins, while epigenetics is the footnotes — instructions that dictate how the blueprint is interpreted and applied. Think of it as the mechanism that bridges nurture and nature, fine-tuning your genetics in response to your environment and lifestyle. At the molecular level, that tuning involves the addition or removal of small molecules like methyl groups to DNA and its packaging. Some molecules make the genes to which they are attached more accessible to the machinery that will translate them, essentially turning those genes on, while others do just the opposite. Evolutionarily, these changes facilitate rapid adaptation to an ever-changing environment. An individual’s experience of famine, for example, can epigenetically tune their metabolism and growth for energy conservation. These epigenetic changes may also be seen in their descendants for several generations to come. The exciting news is that tuning isn’t permanent, which is where lifestyle medicine comes in. Many of the epigenetic phenomena that we understand are related to metabolism and stress responses. Though evolutionarily conserved, these epigenetic changes can be maladaptive in the modern context. A traumatic childhood experience, for example, can trigger epigenetic modifications that not only alter an individual’s stress response to cause chronic stress, but are also heritable to their offspring. This enhanced stress response may have protected an early human in the savannah from repeating risky behaviors, but in our more predictable modern world, chronic stress more often contributes to poor mental health and diseases like cardiovascular disease and high blood pressure. Thinking back to epigenetic age, it seems rational then that if we know the patterns of epigenetic modifications associated with failing health and the diseases of aging, we can use them as a surrogate measure of healthfulness. Though we don’t yet fully understand its nuances, molecularly determined epigenetic age is a better predictor of an individual’s health and longevity than chronological age, presenting an exciting frontier for understanding and modifying health and longevity through lifestyle medicine and targeted therapeutics. For example, a team led by scientists here at Stanford and at the Buck Institute for Research on Aging used deep learning to identify key molecules of systemic inflammation such as CXCL9 that correlate closely with morbidity, cardiovascular degradation, frailty, and other signs of biological aging. As we age, this increasing chronic, systemic inflammation is likely driven by epigenetic changes, raising the tantalizing possibility that it could also be reversed.

How can we use lifestyle medicine to modify our epigenetic fate?

So far, the main clinical epigenetic therapies that have seen success are small molecules that reduce DNA methylation to treat cancer. These molecules function by pushing the reset button on many of the accumulated epigenetic changes that allow the cancer cells’ runaway growth. What if we could do the same to the changes that predict ageing, chronic inflammation, and disease? For now, it seems that our therapeutic tools are too blunt, lacking the precision to target the maladaptive and disease-associated epigenetic changes. So, for now, our best tool for harnessing our epigenetic destiny is our lifestyle. Let’s take a deeper dive into what that looks like at the cutting edge of each of our Stanford Lifestyle Medicine Pillars.

Epigenetics & Physical Activity

Daily exercise has long been associated with health benefits from reduced incidence of cardiovascular disease and improved cancer prognosis to slower cognitive decline. The CDC recommends getting at least 150 minutes of moderate-intensity aerobic activity and 2 strengthening workouts a week for optimal health benefits. There is now evidence that exercise also broadly improves the capacity of your cells to alter their methylation patterns. Exercise leads to higher levels of the protein superoxide dismutase, which works through a series of receptors and pathways in the liver to alter the methylation of key metabolism genes and enhance metabolic function. These pathways affect health in a myriad of ways including improving glucose tolerance to reduce the risk of diabetes. Though some of those epigenetic changes are maintained from parents to children, many are re-programmed during critical developmental periods in-utero, allowing maternal exercise during pregnancy to have profound impacts on offspring health later in life. Lifestyle, it seems, is preventive care that begins even before we’re born. The systemic epigenetic changes induced by physical activity were seen in a recent study by Washington State University that analyzed differences between physical activity and epigenetics in identical twins. Researchers found that twins who exercised for 150 minutes a week or more had more epigenetic markers related to lower risk of metabolic syndrome than twins who exercised less.

Epigenetics & Nutrition

According to recent research, what you eat, and perhaps more unexpectedly, what your parents ate, seems to affect our health through epigenetics in two interesting ways. First, by the availability of small molecules that participate in and modulate the biochemical reactions that add and remove epigenetic tags. For example, plant-forward diets tend to be high in epigenetic substrates like folate, a precursor of the methyl groups added to DNA; cofactors that facilitate that reaction like vitamins A and C; and polyphenolic compounds like curcumin (found in turmeric) that modulate DNA Methyltransferase, the protein that initiates the reaction. Leading theories suggest that by maintaining abundant nutrients involved in epigenetic processes, the body’s response to stress and ever-changing metabolic supply and demand can be efficiently fine-tuned. Diseases like diabetes arise in part because of maladaptive or improper metabolic tuning. A second way that nutrition impacts epigenetics seems to be mediated by metabolic stressors and nutrient sensing. Our cells work along the spectrum between two main modes; when nutrients are limited, pathways turn on that favor maintenance, and clearing and recycling debris, to enhance cellular function and efficiency. Abundant nutrients, on the other hand, downregulate the efficiency pathways and promote storage and more reckless use of resources. With time, famine or feast can become encoded as heritable epigenetic changes, contributing to the increased risk of obesity, diabetes, and several other health conditions in the offspring of parents with poor diet and nutritional profile.

Epigenetics & Sleep

Sleep, namely the lack thereof, has been associated with everything from heart disease and stroke to metabolic disruption. Its greatest impact, though, is on the brain. Interestingly, susceptibility to sleep deprivation is a highly genetic phenomenon. Some people can barely function without 8 hours of sleep, while for others, 6 is more than enough. This suggests a significant role for epigenetics. Cognitive functions like learning and memory rely on neural plasticity, which requires fine-tuned epigenetic adjustments to the gene expression patterns of individual neurons. This process requires sleep, and even single sleep disruption events can impair them, especially in the hippocampus, one of our primary memory and learning centers. More chronic sleep deprivation can alter mood, exacerbate psychiatric disorders, and increase the risk of neurodegeneration as in Alzheimer’s. Most of the epigenetic changes seen with sleep deprivation modify genes involved in metabolism, circadian rhythm, and synaptic plasticity and signaling. For example, night shift workers have altered expression of the genes CLOCK and Dlg4, a master regulator of our body’s internal clock, and a protein implicated in autism that scaffolds synaptic signaling respectively.

Epigenetics & Stress

Technically, stress is any stimulus that disrupts our body’s homeostasis, whether running from a predator in our evolutionary past, experiencing a traumatic life event, or persistent psychological distress. The hypothalamus-pituitary-adrenal (HPA) axis, then, is the stress response control center, a system that connects our brain to our hormone-secreting glands that release systemic stress signals like cortisol, adrenaline, and pro-inflammatory molecules. These signals go on to modulate all our body’s systems, from metabolism and neuronal activity to immune function, and are themselves epigenetically tuned. Typically, our bodies overcome the stressor and return to homeostasis, but traumatic and chronic stress can lead to compounding epigenetic changes that dysregulate our immune, metabolic, neuronal, cardiovascular, and other systems. For example, traumatic childhood experiences trigger epigenetic changes in immune cells like macrophage, increasing pro-inflammatory reactivity and hormonal dysregulation, which may underlie the plethora of adverse health outcomes associated with childhood trauma. Much like the epigenetics of nutrition and exercise, parental stress can be passed on to children both through inherited epigenetic patterns, and through stress hormones circulated from the mother to the developing fetus. On the bright side, positive life experiences, social relationships, and mindfulness practices like meditation and breathing exercises all work to short-circuit these maladaptive stress responses and associated epigenetic changes. For example, one mindfulness-based intervention in breast cancer patients resulted in a reduction of greater than 50% in the epigenetically controlled levels of 91 pro-inflammatory hormones and molecules compared to control patients, an effect that persisted 12 months later.

Epigenetics & Social Engagement

Our capacity to form complex social bonds is evolutionarily foundational to survival, so it’s no wonder that relationships, too, are intimately tied to epigenetics. On one hand, the epigenetic changes associated with chronic and traumatic stress are implicated in impaired capacity for developing and maintaining social bonds. On the other hand, Strong social relationships are important for mitigating stress and its deleterious epigenetic effects, and are one of the strongest predictors of health, happiness, and longevity. Though this is one of the more complex and least understood areas of epigenetics, it’s hard to overstate its role. For instance, mutations in MeCP2, a gene that helps interpret epigenetic methylation patterns, results in the profound cognitive and social dysfunction known as Rhett syndrome.

Epigenetics & Cognitive Enhancement

As it turns out, synaptic plasticity, the phenomenon underlying higher cognitive functions like memory and learning, is largely governed by epigenetic mechanisms. In a highly simplified sense, the strength of patterns and combinations of synaptic firing are enhanced by repeated stimulation, and conversely tuned down in the absence of activity. This is accomplished by epigenetic changes that modulate the sensitivity of neurons to subsequent stimulation. Carrying that principle one step farther, research indicates that enhanced synaptic activity is also essential in synaptic and axonal regeneration after damage such as in the brain of a stroke patient. In animal models, for example, exposure to stimulatory physical and social environments after a brain injury or in disease states such as Parkinson’s leads to increased synaptic activity, which triggers epigenetic changes that promote regenerative healing. Given this observation, it is speculated that similar mechanisms underlie the positive effects of exposure to nature and socially stimulating environments on cognitive and neurological recovery after a brain injury or in diseases like Alzheimer’s. Further, it is plausible that the epigenetic benefits of physical fitness, a varied, plant-based diet, sleep, and relationships translate to beneficial effects on cognitive performance in both health and recovery. For example, the Mediterranean Diet is associated with slowed brain aging and improved cognitive functioning, whereas the Western Diet has been implicated in accelerating natural brain aging processes.

Social Isolation and Loneliness Affect Cardiovascular Health

February 22, 2023/in Social Engagement /by Maya Shetty

“Human beings are wired to connect.” Neuroscience suggests that minor neurons in our brains are stimulated when we interact with others. Social isolation during COVID-19 pandemic has emphasized the importance of psychosocial determinants of cardiovascular diseases. Is social isolation and loneliness a health pandemic?

A wave of new research on the health impact of social connection has tried to address this question. In 2023, researchers from UK published a study showing the association of social isolation and loneliness with incident heart failure on over 400,000 adults between 40 and 69 years. Social isolation was defined as “being objectively alone or having infrequent social connections, and loneliness was defined as “a painful feeling caused by a discrepancy between one’s desire for connections and the actual degree of connections”. They found that even when other known risk factors are controlled for (such as age, sex, and other socioeconomic factors), social isolation and loneliness increased the risk of developing heart failure by 15-20% in a dose-dependent manner. Living alone contributed to the greatest risk of heart failure. The associations between social isolation and loneliness and incident of heart failure were independent of individual’s genetic risk of heart failure.

Social isolation and loneliness may precipitate unhealthy lifestyles (physical inactivity, alcohol addiction) and hinder older adults from getting social support or seeking health care resources. Social isolation and loneliness are associated with increased activity of hypothalamic-pituitary-adrenal axis and sympathetic nervous system, enhanced inflammatory and oxidative stress which all in turn may accelerate atherosclerosis leading to cardiac remodeling preceding heart failure.

The study is a call to action. To address heart failure and the health pandemic that social disconnectedness has created, there is an urgent need for community-level strategies aimed at reducing social isolation and loneliness.

The power of social connection pillar of lifestyle medicine, your HEART depends on it! It is easier than you think. Let’s start from ourselves, find what works for you: increase contact with family and friends, join groups or clubs (sports club, gym, group activity) and use social media in a positive way to connect with others (join local support group, learn what’s happening in your community).

By: Rusly Harsono, MD

No Content Available

Journal References:

Reference: Liang YY, Chen Y, Feng H, Liu X, Ai QH, Xue H, Shu X, Weng F, He Z, Ma J, Ma H, Ai S, Geng Q, Zhang J. Association of Social Isolation and Loneliness With Incident Heart Failure in a Population-Based Cohort Study. JACC Heart Fail. 2023 Jan 20:S2213-1779(23)00026-4. doi: 10.1016/j.jchf.2022.11.028. Epub ahead of print. PMID: 36737310; PMCID: PMC9891238.

Money Is Important But It Is Not Everything It When Comes to Well-Being

November 10, 2022/in Social Engagement /by Maya Shetty

Money is important but is it everything? Does money buy happiness? These questions come up frequently but what are the answers? A daily survey in 2010 of 1,000 US residents conducted by the Gallup Organization showed that emotional well-being improved with raising income but this relationship diminished and plateau with further increasing of income beyond a ‘satiation point.’ At the time of the study was reported, the satiation point where no further improvement of emotional well-being with increasing income was around $75,000. Participants’ daily emotional well-being (hedonic well-being or experienced happiness) was measured by answered to questions about emotional experiences the previous day (frequency and intensity of experiences of joy, fascination, anxiety, sadness, anger, stress, worry, affection that make one’s life pleasant or unpleasant) . The study also measured participants’ life satisfaction by having participants answer questions on their thoughts or evaluation about their daily life in a scale from 0 to 10. Interestingly at the same time period, participants’ income ‘satiation point’ where raising income further no longer changed participants’ life satisfaction was higher at around $120,000. This study pointed out that money is important but it is not everything when comes to well-being.

Every individual and family are not created equal. This study indirectly indicates the importance of lifestyle medicine. Happiness is not only limited to hedonia but also eudaimonia. Adhering to lifestyle medicine pillars guides us towards our overall well-being!

By: Rusly Harsono, MD & Maya Shetty, BS

Journal Reference:

Kahneman, Daniel, and Angus Deaton. “High Income Improves Evaluation of Life but Not Emotional Well-being.” Proceedings of the National Academy of Sciences of the United States of America, v. 107 ,.38 pp. 16489-16493. doi: 10.1073/pnas.1011492107