Why Social Connection Belongs in Your Treatment Plan
Pillar six of six in the lifestyle medicine series. Social connection has some of the strongest evidence of any pillar in this series, and it's the one most often left out of a medical visit entirely. Here's why it matters, how it ties into autoimmune disease specifically, and what helps.
Importance of social connection
The American College of Lifestyle Medicine recently renamed this pillar "positive social connection," widening it to include not just relationships with people, but also connection to nature and a sense of purpose.
The evidence behind it is quite strong. A study following over 300,000 people found that strong social relationships were linked to a 50% greater chance of survival over the study period. Lacking social connection, by comparison, carries a mortality risk similar to smoking up to 15 cigarettes a day, though researchers have since cautioned it's a general benchmark rather than a precise one-to-one statistic. About half of U.S. adults report feeling lonely, and the U.S. Surgeon General has named loneliness an independent risk factor for heart disease, dementia, depression, and early death.
Where this connects to autoimmune disease
This shows up clearly in rheumatic disease too. About a third of people with inflammatory arthritis report feeling lonely, and the lonelier someone feels, the more active their disease tends to be. In lupus, loneliness is linked to more pain, more depression, and more disability.
There may be an inflammation piece here too, similar to sleep and stress, though the evidence is weaker. Some studies link loneliness and isolation to higher levels of inflammatory markers like IL-6 and CRP, the same markers involved in autoimmune disease. But results are inconsistent across studies, some find a link with one marker but not another, some find nothing at all depending on the population studied. This is a plausible, actively studied mechanism, not a settled one.
And it runs the other way too: autoimmune disease itself drives isolation. Fatigue makes it harder to keep plans. Flares are unpredictable, which makes committing to things feel risky. Chronic illness is often invisible to other people, so friends and family don't always understand why someone cancels or pulls back. It's not just that isolation affects the disease, the disease creates real barriers to staying connected in the first place.
Isolation raises pain, specifically. A survey of over 25,000 people found that the lonelier or more isolated someone felt, the more pain they reported, both how often and how intense. Part of the mechanism is one covered earlier in this series: loneliness activates the body's stress response, raising cortisol and other stress hormones that heighten pain sensitivity, the same pathway that connects poor sleep and chronic stress to pain. Isolation feeds into that same loop from a different direction.
What helps
Prioritize quality over quantity. A few close, reliable relationships protect health more than a large network of casual contacts.
Build regular contact into your routine, not just occasional big events. Consistency matters more than intensity, a weekly call with a friend does more for you than one long conversation every few months. Call instead of texting when you can. Most people expect calls to feel awkward, so they avoid them, but that awkwardness rarely happens. People consistently feel more connected after a call than after a text.
Start with something you already enjoy, then find the group built around it. This is what I tell patients who struggle with isolation or social anxiety specifically. Having something in common makes connecting a lot easier than trying to make small talk from scratch. Like working out or running? Join a gym or a running group. Like to read? Join a book club. A lot of communities also offer free or low-cost classes, cooking, art, whatever's local.
Consider a support group, in person or online. Connecting with others managing the same disease helps a lot of patients. One caveat: online groups in particular can skew toward the most severe cases, since people posting most often tend to be the ones struggling most, which can increase anxiety instead of easing it. If a group leaves you more anxious than supported, step back or find a different one instead of pushing through it.
Watch passive social media use. People who spend more than 2 hours a day on social media are roughly twice as likely to feel socially isolated as those who spend under 30 minutes. Scrolling isn't the same as connecting.
Volunteer if you're able. It reduces loneliness and builds a sense of purpose, and the updated ACLM pillar treats purpose as its own protective factor, separate from relationships with other people.
Don't discount your care team. Feeling heard and known by the people managing your health is its own form of connection, and it counts.
Bottom line
If you're living with an autoimmune disease and feeling isolated, that isn't a side issue to your care, it's connected to how the disease itself behaves. Building even a small amount of regular, reliable connection into your life matters for your health, right alongside the other five pillars in this series.
This wraps up the six-part lifestyle medicine series. If you want to go deeper on any of these pillars, I've got more resources on the Resources tab of the website.
Sources
American College of Lifestyle Medicine. "Pillar updates: Stress management and social connection." Explanation of the pillar's expansion and rename to "positive social connection."
Holt-Lunstad J, Smith TB, Layton JB. "Social Relationships and Mortality Risk: A Meta-analytic Review." PLOS Medicine, 2010. Meta-analysis of 148 studies and over 308,000 participants.
Smith RW, Holt-Lunstad J, Kawachi I. "Benchmarking Social Isolation, Loneliness, and Smoking: Challenges and Opportunities for Public Health." American Journal of Epidemiology, 2023. Commentary clarifying the scope and limits of the smoking comparison.
Kumar A, Epley N. "It's Surprisingly Nice to Hear You: Misunderstanding the Impact of Communication Media Can Lead to Suboptimal Choices in Distant Interactions." Journal of Experimental Psychology: General, 2020. Found phone calls created significantly stronger feelings of connection than text-based communication, despite people predicting calls would feel more awkward.
U.S. Surgeon General's Advisory, "Our Epidemic of Loneliness and Isolation," 2023. National advisory on the health impacts of loneliness and isolation.
"Associations between loneliness, disease activity and disease impact in inflammatory arthritis: a nationwide cross-sectional study among more than 12,000 patients." Rheumatology, 2025. Found roughly a third of patients with inflammatory arthritis experience loneliness, correlated with disease activity and impact.
"The association between loneliness, social isolation and inflammation: A systematic review and meta-analysis." Neuroscience & Biobehavioral Reviews, 2020. Found some association between loneliness and IL-6, and between isolation and CRP/fibrinogen, but flagged notable heterogeneity across studies and results sensitive to statistical adjustment.
"Social isolation, loneliness, and inflammation: A multi-cohort investigation in early and mid-adulthood." Brain, Behavior, and Immunity, 2024. A multi-cohort study finding inconsistent results across three different cohorts, association with a newer marker (suPAR) in some but not CRP or IL-6, and no association at all in the youngest cohort studied.
Rheumatology Advisor, "Combating Loneliness and Social Isolation in Rheumatology," summarizing Ma et al.'s prospective cohort study finding 31-53% increased mortality risk from social isolation in RA and osteoarthritis, and research linking loneliness to pain, depression, disability, and frailty in lupus.
"Loneliness, social isolation, and pain following the COVID-19 outbreak: data from a nationwide internet survey in Japan." Scientific Reports, 2021. Survey of 25,482 people finding loneliness and social isolation positively associated with pain prevalence, intensity, and chronic pain.
"A mixed studies systematic review on the health and wellbeing effects, and underlying mechanisms, of online support groups for chronic conditions." Communications Psychology, 2025. Review of 100 studies finding online support groups can help social wellbeing but may increase anxiety and distress, especially when members are exposed to other participants' most difficult experiences.
Primack BA, et al. "Social Media Use and Perceived Social Isolation Among Young Adults in the U.S." American Journal of Preventive Medicine, 2017. Found young adults using social media more than 2 hours a day had roughly double the odds of perceived social isolation compared to those using it under 30 minutes a day.
"Time and Frequency of Social Media Use and Loneliness Among U.S. Adults." International Journal of Environmental Research and Public Health, 2025. Found the same pattern in a national sample of adults ages 30-70.
HEAL-HOA Dual Randomised Controlled Trial. The Lancet Healthy Longevity, 2025. Randomized controlled trial finding volunteering reduced loneliness in older adults, with benefit maintained through continued participation.
